Attitudes towards illness, antipsychotic medication and compliance in outpatients with schizophrenia

Abstract

Évaluer la QDV de malades atteints de schizophrénie, traités à titre externe, et identifier les facteurs corrélés à une QDV altérée chez eux.Étude sous forme d’enquête auprès de 100 malades traités à titre externe en psychiatrie. Leur QDV a été évaluée par la SF-36.Le taux des malades ayant une QDV altérée était de 34 %. Les dimensions les plus touchées étaient : la santé psychique, la santé perçue, la vitalité, les limitations dues à la santé physique et les limitations dues à la santé psychique. L’analyse par régression linéaire multiple a montré quatre facteurs fortement corrélés à une QDV altérée : l’inactivité professionnelle, le cours évolutif épisodique avec symptômes résiduels entre les épisodes, la présence d’effets indésirables influençant modérément la vie quotidienne et un score de la psychopathologie générale d’au moins 26.La connaissance des facteurs d’altération de la QDV permettrait d’optimiser la prise en charge. Les antipsychotiques atypiques apportent une contribution précieuse dans ce sens.The aim of the present study was to evaluate the quality of life (QOL) in outpatients with schizophrenia, and to identify factors correlated to an impaired QOL among them.A transversal study, in the form of an inquiry, was conducted in 100 outpatients, during seven months, in the psychiatric department of the Hedi Chaker teaching hospital in Sfax – Tunisia. We used the “36 item Short-Form Health Survey” (SF-36) to assess the QOL; this has been considered as impaired when the global medium score was inferior to 66.7. For the global assessment of functioning and the global assessment of the interference by existing side effects with the patient's daily performance, we have used respectively the Global Assessment of Functioning scale (GAF) and the Udvalg of Kliniske Undersogelser (UKU) side effect rating scale. The positive and negative symptoms added to the general psychopathology were assessed using the Positive and Negative syndrome scale (PANSS).The QOL was impaired in 34% of the cases. The analysis of the scores of the eight dimensions by the scale SF-36 has shown that the most affected dimensions were, in decreasing order: mental health (MH), general health perceptions (GH), vitality (VT), role limitations due to physical health problems (RP) and role limitations due to emotional problems (RE). The standardization revealed that six dimensions were impaired; these were, in decreasing order: mental health (MH), social functioning (SF), role limitations due to emotional problems (RE), role limitations due to physical health problems (RP), general health perceptions (GH) and physical functioning (PF). The standardization has also revealed an impairment of the psychological component, while the physical component has been conserved. After analysis by multiple linear regression, four factors appeared strongly correlated with the impaired QOL: the professional inactivity, the episodic course with interepisode residual symptoms, the presence of side effects moderately influencing the daily performance, and a general psychopathology score for 26 at least. These four factors affected, in decreasing order of importance, social functioning (SF) (related to two factors), general health perceptions (GH) and role limitations due to emotional problems (RE) (each related to one factor). None of the factors appeared to affect the other dimensions: physical functioning (PF), role limitations due to the physical health problems (RP), bodily pain (BP), mental health (MH) and vitality (VT). The bivariate analysis revealed three other factors correlated, to a lesser degree, to the impairment of the QOL: the disorganized sub-type, a score of (GAF) inferior or equal to 30 and the negative type of schizophrenia.Management of schizophrenic patients should go beyond the remission of the symptoms; it has also to target the improvement in QOL. This needs an action over the factors that affect the QOL, among which residual symptoms and side effects. The atypical antipsychotics would contribute preciously in this way, due to their efficacy on negative symptoms and their better tolerance than the conventional ones.