Psychosocial outcomes in patients with schizophrenia: quality of life and reintegration

Abstract

The increasing interest in the quality of life and reintegration of schizophrenic patients is a major conceptual shift in therapeutic outcome criteria. At the beginning of neuroleptic or antipsychotic treatment, symptom reduction was the most relevant outcome parameter for a long time. With the development of atypical antipsychotic agents, more ambitious success criteria, including the patient's perspective, are now considered. The effects on positive psychotic symptoms do not differ markedly between typical and atypical antipsychotic agents, but the lack of motor symptoms, the improvement of negative, affective and cognitive symptoms, and particularly the greater chance of improving subjective well-being, quality of life and reintegration are the major advantages of atypical agents, obvious especially during long-term treatment. The assessment of quality of life as well as of social reintegration are new approaches to differentiate therapeutic effects and to consider more the patient's perspective. There is strong evidence in numerous trials that in comparison with typical neuroleptics, atypical agents improve quality of life significantly. With regard to reintegration, because of the more difficult methodology, there is less evidence of the advantages of atypical agents. This review describes the development of quality of life and reintegration research in schizophrenic patients, and summarizes the methodological problems and the clinical trials.