Influence de la psychopathologie et des attentes sur la qualité de vie subjective des patients schizophrènes : une étude comparative

Abstract

Most studies on the quality of life (Qol) of patients with schizophrenia deal with objective living conditions and how they are perceived by hospitalized patients. The few studies that compare Qol for patients treated in part time services with the Qol of ambulatory patients do not show any significant difference in terms of subjective Qol. Some stu-dies evaluate the influence of psychopathology and needs (or expectations) on the subjective Qol in these groups of patients. Available data indicate that the general well-being is influenced by psychopathology (positive, negative or depressive symptoms) and unmet needs in ambulatory patients. They also show that subjective Qol in certain life domains (social relations, family relations, leisure, health, law and security) is influenced by negative symptoms, anxiety and depression in patients treated in part-time services. The aim of this study is to compare the objective and subjective Qol of patients with schizophrenia treated in part time services (day hospital and day care center) to the Qol of out-patients treated on a purely ambulatory basis (out patient clinic). We studied the Qol of 2 groups of 30 patients with schizophrenia (ICD 10 criteria) treated in various centers. The first group was made of ambulatory patients, the second one was constituted of patients treated in a day hospital or a day care center. Patients were matched for age, duration of illness, number of hospitalizations. The instruments used for rating were the following: Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), Positive And Negative Symptoms Scale (PANSS), Drug Attitude Inventory (DAI-10). The Qol was measured with a french version of the Lancashire Quality Of Life Profile (LQOLP) (Salomé, Germain, Petitjean, Demant and Boyer, 2000). This instrument measures the objective Qol as well as the subjective Qol. It does possess satisfying psychometric properties and offers the possibility to establish Qol profiles. All Qol ratings were carried out by a clinician who was not involved in the treatment of the patients. When the 2 groups are compared our results indicate that ambulatory patients are less symptomatic, have a better level of functioning and a better objective Qol in such domains as: finances, living situation, family relations and health. There is no significant difference in terms of anxiety and depression as measured by the respective items of the PANSS. Patients treated in part-time services present higher scores of positive symptoms. Our results indicate that there is no significant difference for subjective Qol variables between the two groups, except for general well-being, that tends to be higher in ambulatory patients. When exploring the influence of clinical data on the Qol in each group, we find negative correlations in ambulatory patients between various domains of subjective Qol and illness severity (law and security, family relations, social relations, general well-being), global functioning (family relations, social relation, health) and positive symptoms (living conditions, law and security, family relations, social relations, health). In this same group, the subjective Qol for family relations is significantly correlated with several expectations in terms of Qol improvement (leisure, social relations, family relations, transport, work). In these patients, the subjective Qol for social relations is also significantly correlated with their expectations in terms of Qol improvement (work, money, lodging, affective relations, transport). There is no significant correlation between subjective Qol and expectations in patients treated in part-time services. Our results indicate that part time services treat schizophrenic patients with a lower level of global functioning and a higher level of symptom severity compared with ambulatory patients. These results confirm other studies that show no significant difference between these 2 groups in terms of subjective Qol. The subjective Qol in the field of relations (family and social) in ambulatory patients seems particularly sensitive to illness severity, positive symptoms and global functioning level. This has also been reported by other studies. In patients treated in part-time services, the subjective Qol, particularly for living conditions and security, seems sensitive to anxiety and depression. This has also been shown by other studies. Finally, our results underline the importance of patients' expectations in terms of subjective Qol, particularly in the field of relations (family and social) for ambulatory patients.