Quality Of Life Enjoyment And Satisfaction Questionnaire Research Articles

EPA-1118 - Knowledge of the illness and its relations with quality of life, social functioning, cognitive performances, and adherence in psychotic patients: Toward effectiveness-focused interventions

Introduction Psychosocial factors are often underestimated in psychotic patients, although they may profoundly influence (and be influenced by) clinical presentation and effectiveness of therapeutic interventions in these people. Objectives To investigate relevance, relationship with clinical presentation and overall quality of life of multiple psychosocial factors in psychotic patients. Aims To evaluate whether knowledge about the illness and utilization of health services are defective in psychotic vs. non-psychotic patients and whether these correlates with the type of psychotic symptoms, cognitive performances, global social functioning, quality of life, and acceptance of pharmacotherapy. Methods Approximately 110 patients were enrolled after written informed consent. Patients were administered the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance scale (PSP), the Drug Attitude Inventory (DAI), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). All patients were also screened for cognitive performances. Patients and relatives completed a questionnaire on knowledge about the illness and on the level of utilization of mental health services. Patients were subdivided in psychotic (cases) and non-psychotic (controls) based on their score on the PANSS. Results Psychotic patients and their relatives showed lower levels of knowledge about the illness. These features were associated with the other variables assessed in a very complex and multidimensional model of reciprocal influences. Conclusions Lack of response to pharmacological treatments and to overall therapeutic interventions in psychotic patients may also depend on multiple psychosocial factors, which may be carefully investigated and become the target of adjunctive, effectiveness-focused interventions.

Is the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) a unidimensional or bidimensional instrument?

The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) is among the most frequently used outcome measures in psychiatry research [1]. It is a generic, self-reported QOL measure assessing the physical health, subjective feelings, leisure activities, social relationships, general activities, satisfaction with medications and life-satisfaction domains. The Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LESQ-SF) was developed as an index from the original, long form, fully representing its concept [1, 2]. In the most recent psychometric study, the Chinese version of the Q-LES-Q-SF was evaluated [3]. The authors approached its validity in one new way—studying factorial structure using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). This approach resulted in one interesting finding that the measure has psychosocial and physical dimensions. However, this finding could be biased. First, it is not clear why the authors decided to study the factorial structure of this index measure. Although not clearly stated, they were looking for possible underlying dimensions. However, the authors used principal component analysis (PCA) with varimax rotation for EFA, which is wrong, because PCA is not the method of choice if one wants to discover underlying factors or dimensions [4]. The right method is principal axis factoring, for example, which is essentially factor analysis (FA) [4]. If the goal is data reduction, PCA is more appropriate. In PCA, all variance of observed variables (shared; unique; and error) is analyzed, while in FA only shared variance is analyzed. Thus, PCA yields components and FA gives factors. Nevertheless, it is generally accepted that the difference between FA and PCA decreases when the number of variables and the magnitude of the factor loadings increase [5]. To consider this notion in this particular situation, the authors need to show all item loadings and not only those above 0.4 for the two factors, because some items might cross-load on two factors. Finally, two components were extracted together accounting for 46.47 % of the variance, with the ‘‘psychosocial dimension’’ explaining 37.41 % and the ‘‘physical dimension’’ explaining 9.07 %. The literature varies on how much variance should be explained before the number of components is sufficient, but the majority suggest that the proportion of variance for each extracted component should be 5–10 % as long as the cumulative proportion of variance explained is 70–90 %, although some indicate as little as 50 % of the variance explained is acceptable [6, 7]. Second, the authors used CFA to confirm the bidirectional model they found in the PCA step. It is not clear why the original unidimensional model of 14 items was not tested. The original model might be similar to the bidimensional in terms of data fit, and a statistical approach needs to be taken to decide which one is better. Additionally, these fit indexes were included: included goodness-of-fit index (GFI), adjusted GFI, and the root of the mean square residual. The Tucker Lewis index, Comparative Fit index and root mean square error of approximation were not given, but they are standard nowadays [8]. I advise authors to share with us additional data in order to justify that the Q-LES-Q-SF is a bidimensional instrument. D. Stevanovic (&) Clinic for Neurology and Psychiatry for Children and Youth, Dr. Subotic 6a, 11000 Belgrade, Serbia e-mail: stevanovic.dejan79@gmail.com

Improvement in Quality of Life With Left Prefrontal Transcranial Magnetic Stimulation in Patients With Pharmacoresistant Major Depression: Acute and Six Month Outcomes

BackgroundTranscranial magnetic stimulation (TMS) is a safe and effective treatment for major depression. We describe quality of life (QOL) outcomes from acute treatment with TMS, and describe the durability of benefit across 24-weeks. MethodsThree hundred and one medication-free patients with pharmacoresistant major depression were randomized to active or sham TMS in a 6-week controlled trial. Nonresponders to the 6-week blinded phase of the study were enrolled in a 6-week open-label study without unblinding the prior treatment assignment. Responders and partial responders to both the blinded (active or sham treatment) or open acute treatment phases were tapered off TMS over three weeks, while initiating maintenance antidepressant medication monotherapy. These subjects entered the 24-week study to examine the durability of response to TMS. The Medical Outcomes Study-36 Item Short Form (SF-36) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to measure overall function and QOL. During the 24-week durability of effect study, QOL assessments were done at study entry and at the end of 24-weeks. ResultsStatistically significant improvement in both functional status and QOL outcomes was observed in patients treated with active TMS compared with sham TMS during the acute phase of the randomized, sham-controlled trial. Similar benefits were observed in patients who entered the open-label extension study. These improvements were sustained across the 24-week follow up study. ConclusionsAcute treatment with TMS improved functional status and QOL outcomes in patients with major depression. This clinical effect was durable in long-term follow up.

Prevalence of Depression in Patients with Type II Diabetes Mellitus and its Impact on Quality of Life

Background:Diabetes mellitus (DM) is a frequently encountered chronic metabolic disease with various complications throughout its course, which causes severe restriction and disability in an individual's life. It has been well documented that the incidence of depression is higher in diabetic patients and co-morbid depression causes further deterioration in the quality of life in diabetic patients.Aims:To study the prevalence of depression and its impact on quality of life in patients with type II DM.Settings and Design:Single centre, cross-sectional, single interview.Materials and Methods:Total 195 type II DM patients are included in this study. To diagnose Depressive Episode Structured Clinical Interview for DSM IV Axis-1 Disorders, Research Version patient edition was applied. All patients were evaluated with a semi-structured socio-demographic proforma to assess socio-demographic characteristics, Hamilton Rating Scale for Depression (HAM-D) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES–Q) SF (Short Form) to measure the quality of life.Results:Among them, 46.15% (N=90; males: 41, females: 49) met the DSM-IV diagnostic criteria for major depressive episodes. Among the depressed group, majority were (36.7%) moderately depressed. QLESQ-SF total and each item scores were significantly lower in the depressed group than in the non-depressed group. Both the HAM-D scores and HbA1c level have significant negative correlations with QLESQ-SF total scores.Conclusion:Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Therefore, treating depression would have a beneficial effect on the quality of life.

Relationship between sleep disturbance and depression, anxiety, and functioning in college students.

Sleep disturbance (SD) has complex associations with depression, both preceding and following the onset and recurrence of depression. We hypothesized that students with depressive symptoms with SD would demonstrate a greater burden of comorbid psychiatric symptoms and functional impairment compared to students with depressive symptoms without SD. During a mental health screening, 287 undergraduate students endorsed symptoms of depression (Beck Depression Inventory [BDI] ≥ 13) and filled out the following self-report measures: demographic questionnaire, BDI, Anxiety Symptom Questionnaire-intensity and frequency (ASQ), Beck Hopelessness Scale (BHS), Beck Anxiety Inventory (BAI), Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ), and the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ). SD was measured using the BDI sleep item #16 dichotomized (score 0: no SD; or score > 0: some SD). Students with depressive symptoms and SD (n = 220), compared to those without SD (n = 67), endorsed significantly more intense and frequent anxiety and poorer cognitive and physical functioning. Students with depressive symptoms with and without SD did not significantly differ in depressive severity, hopelessness, or quality of life. College students with depressive symptoms with SD may experience a greater burden of comorbid anxiety symptoms and hyperarousal, and may have impairments in functioning, compared to students with depressive symptoms without SD. These findings require replication.

COMPLICATED GRIEF SYMPTOMS IN ANXIETY DISORDERS: PREVALENCE AND ASSOCIATED IMPAIRMENT

Previous research has identified high rates of comorbid anxiety disorders among individuals presenting with primary CG. In the present study, we examined the prevalence of comorbid CG in bereaved primary anxiety disorder (AD) patients compared to bereaved healthy controls. We also examined the impairment associated with comorbid CG in AD. Participants were 242 bereaved adults (mean (SD) age = 41.5 (13.1), 44.2% women) with a primary AD diagnosis, including generalized anxiety disorder (GAD; n = 57), panic disorder (PD; n = 49), posttraumatic stress disorder (PTSD; n = 29), and generalized social anxiety disorder (GSAD; n = 107), as well as 155 bereaved healthy controls with no current DSM-IV Axis I diagnosis (mean (SD) age = 43.0 (13.6), 51.0% women). CG symptoms were measured using the 19-item inventory of complicated grief (ICG), with threshold CG defined as an ICG score of ≥30. Quality of life and functional impairment were assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Range of Impaired Functioning Tool (LIFE-RIFT), respectively. Participants with primary ADs had significantly higher rates of threshold CG symptoms than bereaved controls (12.0% vs. 0.65%; Fisher's Exact P < 0.001). Rates of threshold CG were significantly elevated for each AD when compared to bereaved controls. After adjustment for age, sex, education, and comorbid major depressive disorder, threshold CG was associated with lower quality of life (β = -0.140, P = 0.023) and greater impairment (β = 0.141, P = 0.035) among individuals with AD. Our findings suggest that threshold CG is of clinical relevance in bereaved individuals with a primary anxiety disorder. Screening for CG in patients with ADs may be warranted.

The relationship between clinical outcomes and quality of life in first‐episode mania: a longitudinal analysis

Despite growing attention to the relationship between bipolar disorder (BD) and quality of life (QoL), there remains a lack of information about QoL in the early stages of BD, and about the course of QoL in people with BD over time. Here, we report on QoL and symptomatic outcomes over a 1.5-year period in a Canadian sample of first-episode mania patients. Patients (n = 63) with DSM-IV-TR BD type I recovering from a recent episode of mania were recruited from a university-based hospital setting in Vancouver, BC, Canada and assessed at six monthly intervals for 18 months. In addition to symptomatic and cognitive assessments, two self-report QoL scales [the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Medical Outcomes Study Short Form 36 (SF-36)] were administered. Baseline QoL scores were high, with mean Q-LES-Q scores at 70% of the maximum possible score; QoL continued to show a trend towards improvement over time. Multiple hierarchical regressions were used to explore predictors of QoL over time, finding that: (i) length of illness and severity of depressive symptoms at baseline predicted Q-LES-Q scores at both baseline and six months; (ii) the number of previous depressive episodes and severity of depression at baseline and 12 months all predicted QoL at 12 months; and (iii) only severity of depressive symptoms at 12 months predicted QoL at 18 months. Our observation that QoL in patients who have recently experienced an episode of mania can be relatively preserved offers hope, both for healthcare providers and for those newly diagnosed. Further, that severity of depressive symptoms even in the early stages of the disease was the consistent predictor of QoL suggests that depressive symptoms need to be aggressively treated to improve QoL.

Effect of Aripiprazole on Verbal Memory and Fluency in Schizophrenic Patients

Second-generation antipsychotics have gradually replaced first-generation antipsychotics as first-line treatment for patients with schizophrenia. Some positive effects on verbal cognition have been shown for the second-generation antipsychotics, but most studies are based on relatively small numbers of patients. In the frame of the prospective, multi-centre, open-label study ESCAPE (A Prospective, Multicenter, Open-Label Study to Evaluate the Effectiveness and the Effect on Cognitive Function of a Treatment With Aripiprazole in a Broad Range of Schizophrenic Patients; clinicaltrials.gov identifier NCT00329810) evaluating the effectiveness and effect on cognitive functioning of aripiprazole in schizophrenic patients, we conducted a post hoc analysis to examine changes in verbal cognition and investigate the predictive value of a cognitive improvement on quality of life. This was a prospective, multi-centre, non-comparative, open-label study of aripiprazole in schizophrenic patients. At study enrolment, these patients were being treated with various first- or second-generation antipsychotics or were without previous antipsychotic treatment. On entering the study, all patients were treated with aripiprazole (Abilify(®); Otsuka, Tokyo, Japan) monotherapy; those patients who had received prior treatment with antipsychotics had their current drug(s) tapered off over a 2-week period. A post hoc analysis of the effect of aripiprazole on two verbal cognitive measures and their correlation with efficacy measures and quality of life was conducted. Patients with schizophrenia were recruited in 56 psychiatric hospitals. A total of 361 patients with schizophrenia, ranging from 18 to 65years, entered the study. Patients were treated with aripiprazole monotherapy at a dosage of 10-30mg/day. Those who were receiving first- or second-generation antipsychotics at enrolment were switched to aripiprazole monotherapy by tapering off their current drug(s) over a 2-week period. Physician- and patient-rated parameters were measured to gain a complete view of the effectiveness of aripiprazole on the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) at baseline and at weeks 4, 8 and 12 and on the Clinical Global Impression-Severity of Illness (CGI-S) scale at baseline and at weeks 1, 2, 4, 8 and 12. A secondary endpoint of verbal cognitive function was measured by the California Verbal Learning Test (CVLT) and the Verbal Fluency (VF) test at baseline and at weeks 4 and 12. The hypothesis of an improvement in verbal cognition and its predictive value on the quality of life was formulated during data collection. 238 patients completed the study. A significant improvement in verbal cognition was observed from week 4 with the long term free recall (LTFR) in the CVLT over the scheduled visits in the trial (F(2,519)=29.67, p<0.0001). For the phonemic (letter) subtest of the VF test, patients scored significantly better at week 12 in comparison with baseline (F(2,519)=3.57, p=0.0289). There was no significant effect on the semantic (categories) subtest of the VF test (F(2,518)=0.57, p=0.5614). Improvement in CGI-S scores at a particular moment in time predicted improvement in LTFR scores at that same moment (F(1,519)=38.38, p<0.0001) and in the phonemic (F(1,519)=42.77, p<0.0001) and semantic (F(1,518)=67.43, p<0.0001) subtests of the VF test. Similarly, CGI-S score improvement globally predicted quality-of-life improvement over visits. The Q-LES-Q scales leisure (F(1,144)=14.03, p<0.0001) and social relations (F(1,469)=5.28, p=0.0220) also directly correlated with verbal cognition. The findings suggest that switching to, or initiating aripiprazole in schizophrenic patients results in improvement in verbal cognitive functioning. The observed improvement on quality of life is explained by the effect of aripiprazole on the CGI-S score, though the leisure and social relations scales of the Q-LES-Q also independently correlated with verbal fluency. Randomized, controlled, clinical trials of this effect of aripiprazole for selected patients are needed.

Poster #220 INTRANASAL OXYTOCIN EFFECTS ON SOCIAL ANXIETY AND DEPRESSION IN SCHIZOPHRENIA: RESULTS FROM A DOUBLE BLIND PLACEBO CONTROLLED TRIAL

Anxiety symptoms reported by individuals with schizophrenia have been traditionally seen as symptoms associated with the principal disorder and therefore not requiring special attention. The primary aim of this paper is to therapeutically target social anxiety symptoms in individuals with schizophrenia in order to determine the effectiveness of the cognitive behavioural group treatment model as an intervention for social anxiety in this participant group. Thirty-three individuals with schizophrenia and co-morbid social anxiety were allocated to a group-based cognitive behaviour (CBGT) intervention or waitlist control (WLC). Baseline, completion and follow-up ratings consist of measures of social anxiety: the Brief Social Phobia Scale (BSPS), Brief Fear of Negative Evaluation scale (BFNE) and the Social Interaction Anxiety Scale (SIAS); measures of general psychopathology: the Calgary Depression Scale for Schizophrenia (CDSS) and Global Severity Index (GSI) from the Brief Symptom Inventory (BSI); and the Quality of Life, Enjoyment and Satisfaction Questionnaire (QLESQ). Pre- and post-treatment measures were subjected to statistical evaluation. All outcome measures displayed statistical improvement in the intervention group compared with no change in the control group. These treatment gains were maintained at follow-up. CBGT for social anxiety in schizophrenia was demonstrated to be effective as an adjunctive treatment for this population.

Outcomes on the pharmacopsychometric triangle in bupropion‐SR vs. buspirone augmentation of citalopram in the STAR*D trial

To compare within the framework of a novel pharmacopsychometric triangle, augmentation treatment with bupropion vs. buspirone in the acute therapy of major depression in the STAR*D study. The triangle provides a composite view in three domains of antidepressive activity, side effects, and quality of life. Within the pharmacopsychometric triangle, the short six-item subscales of the Hamilton Depression Scale (HAM-D(17)) and of the Inventory of Depressive Symptomatology (IDS-C(30)), referred to as HAM-D(6) and IDS-C(6), were focussed on pure antidepressive effect. Side-effects (tolerable vs. intolerable) and quality of life were measured using patient-administered questionnaires. A modified intention to treat sample was used. Within the pharmacopsychometric triangle, bupropion-SR (sustained release) was superior to buspirone when augmented to the current citalopram treatment. Thus, in the domain of pure antidepressive effect, bupropion-SR was superior (P = 0.05) on the HAM-D(6), IDS-C(6), and IDS-C(30), but not on the HAM-D(17). In the domain of side effects, the total scores on the Patient Rated Inventory of Side Effects (PRISE) were reduced significantly more by bupropion-SR than by buspirone (P = 0.03). In the domain of quality of life, the total scores on the Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) showed a trend (P = 0.10) from baseline to endpoint of a superiority for bupropion-SR compared with buspirone. In all domains of the pharmacopsychometric triangle, bupropion-SR was superior to buspirone as augmentation therapy in depressed outpatients not responding to citalopram.

Impact of childhood trauma on functionality and quality of life in HIV-infected women

BackgroundWhile there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV.MethodsThe present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ).ResultsSubjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count.ConclusionsIn assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.

Long-term efficacy and safety outcomes with OROS-MPH in adults with ADHD

Methylphenidate (MPH) is widely prescribed for adults with attention deficit hyperactivity disorder (ADHD), but data on long-term treatment and maintenance of effect are lacking. Osmotic release oral system-methylphenidate (OROS–MPH) was evaluated in a 52-wk open-label study in subjects who had previously completed a short-term placebo-controlled trial and short-term open-label extension. Efficacy was assessed using the investigator- and subject-rated Conners’ Adult ADHD Rating Scales (CAARS:O-SV and CAARS:S-S), and the Clinical Global Impression – Severity (CGI-S), Sheehan Disability Scale (SDS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Subjects completing ≥52 wk of treatment were eligible for a 4-wk randomized, placebo-controlled withdrawal phase in which loss of treatment effect was assessed using CAARS:O-SV and CGI-S. In the open-label phase (n=156), mean CAARS:O-SV score decreased from baseline by 1.9±7.8 (p<0.01), and small, statistically significant improvements from baseline were observed for CAARS:S-S, CGI-S and SDS. In the double-blind phase (OROS-MPH, n=23; placebo, n=22), CAARS:O-SV increased from double-blind baseline in the OROS-MPH and placebo arms (4.0±7.6 vs. 6.5±7.8, not statistically significant). Long-term OROS-MPH treatment was well tolerated, and there was no evidence of withdrawal or rebound after discontinuation. In conclusion, the short-term benefits of OROS-MPH continue during long-term open-label treatment. Maintenance of efficacy in a placebo-controlled withdrawal design remains to be confirmed in larger patient populations.

Satisfaction With Medication Is Correlated With Outcome but Not Persistence in Patients Treated With Placebo, Escitalopram, or Serotonin-Norepinephrine Reuptake Inhibitors

To test whether satisfaction with taking medication, assessed using item 15 of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), is associated with clinical outcome and persistence with treatment. In this post hoc analysis, data were analyzed from 4 randomized placebo-controlled studies of patients with major depressive disorder treated with escitalopram (650 patients taking escitalopram and 534 taking placebo), together with data from 2 randomized trials of escitalopram versus venlafaxine or duloxetine (235 patients taking escitalopram and 233 taking a serotonin-norepinephrine reuptake inhibitor). The studies were published between 2002 and 2007. Instruments included the Q-LES-Q, which was assessed at baseline and week 8, and the Montgomery-Asberg Depression Rating Scale (MADRS), which was assessed at baseline and weeks 1, 2, 4, 6, and 8. At baseline, the mean ± SD MADRS total score was 30.0 ± 4.6, and the mean Q-LES-Q item 15 score was 2.9 ± 0.9. At week 8, the MADRS response rates of placebo-treated patients with a low, moderate, or high satisfaction with medication at baseline were 30%, 37%, and 46%, respectively (mixed model repeated measures [MMRM]). The corresponding MADRS response rates for escitalopram-treated patients with a low, moderate, or high satisfaction at baseline were 56%, 60%, and 67%, respectively (MMRM). Baseline satisfaction with medication was not significantly correlated with time to withdrawal (all reasons). The change in satisfaction with medication from baseline to endpoint was significantly correlated with symptomatic improvement on the MADRS (P < .001). Baseline satisfaction with medication after 1 week of placebo run-in is a moderator of treatment outcome but not of persistence of treatment in the acute treatment phase of depressed outpatients. Patient attitude toward medication should be taken into account before treatment is initiated.

Assessing quality of life in patients with schizophrenia in an acute psychiatric setting: Reliability, validity and feasibility of the EQ-5D and the Q-LES-Q

Background: Quality of life (QoL) is considered an important outcome of treatment in psychiatry. Two QoL instruments, the EuroQoL-5D (EQ-5D) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), have been increasingly used among patients with schizophrenia. Aims: The aim of this study was to investigate the reliability, validity and feasibility of the EQ-5D and the Q-LES-Q among patients with schizophrenia and related disorders (n = 311) in the most acute stage of their illness. Methods: The study was carried out in nine acute psychiatric wards of two psychiatric hospitals in Finland. The instruments’ internal consistency, construct validity and missing values were evaluated. Results: Our findings show high internal consistency for the Q-LES-Q (Cronbach's alpha 0,89). For the EQ-5D, the Cronbach's alpha value was minimally acceptable (0.63) taking in to consideration the low number of items. Lower overall functioning indicated poorer QoL measured by the EQ-5D (U = 3098, P < 0.001) or the Q-LES-Q (U = 3357, P < 0.001). Missing values in the EQ-5D ranged from 6% to 7% and in the Q-LES-Q from 6% to 31%. Conclusion: Our results suggest that both QoL scales are reasonably reliable, valid and feasible in this patient group. The decision regarding which instrument to use would depend on clinical or research questions. When more detailed information for patients’ satisfaction with QoL is needed then the Q-LES-Q would be a better choice, whereas if the primary interest is to briefly assess patients’ QoL problems related to health status the EQ-5D would be a better choice.

Functional improvement and correlations with symptomatic improvement in adults with attention deficit hyperactivity disorder receiving long-acting methylphenidate

BackgroundData on the relationship between core symptoms and daily functioning in adults with attention deficit hyperactivity disorder (ADHD) are limited. Daily functioning was assessed as part of an open-label extension, and associations with symptom scores were evaluated.MethodAfter a 5-week double-blind study with adults with ADHD receiving osmotic-controlled release oral delivery system (OROS) methylphenidate (MPH) 18, 36 or 72 mg/day, or placebo, participants were eligible for a 7-week open-label extension in which all patients received OROS MPH. Data for the Conners' Adult ADHD Rating Scale – Observer: Screening Version (CAARS-O:SV) (primary endpoint) have been presented previously. Secondary endpoints included the observer self-reported short version of the CAARS (CAARS-S:S) and the Clinical Global Impressions – Severity Scale (CGI-S). Daily functioning and quality of life were assessed using the Sheehan Disability Scale (SDS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) respectively. In post-hoc analyses, changes in CAARS-O:SV were evaluated in subgroups. Relationships between symptom and functional outcomes were evaluated in a multivariate regression analysis.ResultsA total of 370 patients entered the open-label extension. Significant improvements from baseline in CAARS-O:SV were similar regardless of sex, ADHD subtype, prior treatment or psychiatric co-morbidity. Significant improvements from double-blind baseline were also seen for the CAARS-S:S, CGI-S, SDS and Q-LES-Q. Improvements in the CAARS-O:SV Hyperactivity/Impulsivity subscale were associated with improvements in SDS total and subscale scores, and in the Q-LES-Q score at open-label endpoint. Improvements in CAARS-O:SV Inattention subscale and CGI-S scores were not significantly associated with functional changes.ConclusionsImprovements in ADHD symptoms relating to hyperactivity and impulsivity in adults receiving OROS MPH are associated with improvements in daily functioning and quality of life.

Quality of Life Enjoyment and Satisfaction Questionnaire - short form for quality of life assessments in clinical practice: a psychometric study

The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and its short form (Q-LES-Q-SF) are among the most frequently used outcome measures in psychiatry research. The aim of this study was to analyse the measurement properties of the Q-LES-Q-SF for quality of life assessments in the clinical settings. Fifty-seven adults with a psychiatric diagnosis participated. Psychometric evaluation included descriptive analysis, internal consistency, test-retest reliability, validity, sensitivity and responsiveness analysis. The amount of missing data was 5.3%, while no floor or ceiling effects were observed. The internal consistency and test-retest coefficients were 0.9 and 0.93, respectfully. Almost all items significantly correlated to the total score and other measures used in the study, with the correlations ranging 0.41-0.81. Finally, the responsiveness parameters indicated the Q-LES-Q-SF is 80% sensitive and 100% specific measure. This preliminary analysis of the Q-LES-Q-SF demonstrated that it could produce reliable and valid clinical assessments of quality of life.

Correlation of symptomatic improvements with functional improvements and patient-reported outcomes in adults with attention-deficit/hyperactivity disorder treated with OROS methylphenidate

Objectives. To evaluate correlations between symptom severity and daily functioning in adults with ADHD. Methods. In the 5-week, double-blind LAMDA study, 401 adults with ADHD were randomly assigned to Osmotic-Release Oral System (OROS) methylphenidate (MPH) 18, 36 or 72 mg/day, or placebo. The primary variable – investigator-rated Conners’ Adult ADHD Rating Scale (CAARS:O-SV) – has been presented previously. Secondary endpoints included the self-reported version of CAARS (CAARS-S:S) and Clinical Global Impression – Severity (CGI-S). Daily functioning and quality of life were assessed using the Sheehan Disability Scale (SDS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Relationships between symptom and functional outcomes were evaluated in post-hoc Pearson partial correlation, multivariate regression and mediator analyses. Results. Improvements in CAARS-S:S, CGI-S and SDS scores were significantly greater in each OROS MPH arm versus placebo (P < 0.01 for all comparisons). Correlations between symptom and functioning scores were significant for all comparisons (P < 0.0001). In regression analyses, CAARS Hyperactivity/Impulsivity subscale and CGI-S were correlated with SDS (P < 0.05). CAARS Inattention was correlated with the SDS Family Life domain (P < 0.05). In a mediator analysis, the impact of treatment on SDS scores was fully mediated by improvement in CAARS:O-SV score. Conclusions. OROS MPH 18–72 mg/day was associated with significant improvements in ADHD symptoms, which correlated with improved daily functioning and health-related quality of life.

FC22-02 - Effect of quetiapine on functioning and quality of life in bipolar depression

IntroductionDepression symptoms in bipolar disorder have debilitating effects on functioning and quality of life (QoL).ObjectivesTo assess effects of 8 weeks of quetiapine monotherapy on functioning and QoL in patients with bipolar depression (BPD).AimsTo evaluate functioning and QoL using patient-reported outcomes.MethodsData from 4 trials (BOLDER I and II; EMBOLDEN I and II) of quetiapine (300 and 600 mg/day) in BPD were combined (n = 2593). The Sheehan Disability Scale (SDS) measured functioning (BOLDER II; EMBOLDEN I and II) and the QoL Enjoyment and Satisfaction Questionnaire (Q-LES-Q)-Short Form measured QoL (BOLDER I and II; EMBOLDEN II).ResultsQuetiapine improved overall functioning (mean change [SE] in SDS total score: -7.23 [0.49], -7.49 [0.49], with quetiapine 300 mg/day and quetiapine 600 mg/day, respectively vs placebo (-5.91 [0.54]); P &lt; 0.01 for both). Both doses improved functioning in SDS domains of work/school, social life, and family life/home responsibilities vs placebo (P &lt; 0.05). Quetiapine 600 mg/day reduced days missed from work/school and productivity losses vs placebo (P &lt; 0.01). QoL was improved with both quetiapine doses vs placebo (P &lt; 0.001; least squares mean changes (SE) in Q-LES-Q total score from baseline to Day 57: 9.69 (0.51), 9.95 (0.50), and 6.81 (0.54) with quetiapine 300 mg/day, quetiapine 600 mg/day, and placebo, respectively). Tolerability was consistent with the known safety profile of quetiapine.ConclusionsQuetiapine treatment (300 and 600 mg/day) for 8 weeks significantly improved functioning and QoL vs placebo in patients with BPD.Supported by funding from AstraZeneca Pharmaceuticals LP.

Extended release quetiapine fumarate (quetiapine XR) monotherapy as maintenance treatment for generalized anxiety disorder

The objective of this study was to evaluate the efficacy and tolerability of extended release quetiapine fumarate (quetiapine XR) as maintenance monotherapy for patients with generalized anxiety disorder (GAD). Time-to-event (anxiety symptom recurrence; maximum 52 weeks) multicenter, randomized-withdrawal, parallel-group, double-blind, placebo-controlled study of quetiapine XR (50-300 mg/day) following open-label run-in (4-8 weeks) and open-label stabilization (≥ 12 weeks). Primary variable: time from randomization to anxiety event. Secondary variables included: Hamilton Anxiety Rating Scale (HAM-A) total, HAM-A psychic/somatic anxiety factors, Clinical Global Impression-Severity of Illness (CGI-S), and Quality of Life, Enjoyment and Satisfaction Questionnaire (Q-LES-Q) scores; adverse events (AE) reporting. Four hundred and thirty-two patients, stabilized on quetiapine XR, were randomized to continue quetiapine XR (N=216) or switch to placebo (N=216). Risk of anxiety symptom recurrence was significantly reduced by 81% for quetiapine XR versus placebo: hazard ratio=0.19 (95% confidence interval 0.12-0.31; P<0.001). Fewer patients receiving quetiapine XR (N=22, 10.2%) than placebo (N=84, 38.9%) experienced anxiety symptom recurrence. Significant differences were observed between quetiapine XR and placebo in: HAM-A total, psychic/somatic, CGI-S (all P<0.001) and Q-LES-Q (P<0.05) scores. AEs (>10%) during open-label treatment were dry mouth, sedation, somnolence, dizziness, fatigue, and constipation. During randomized treatment, the most common AEs for quetiapine XR were headache and nasopharyngitis. Quetiapine XR monotherapy reduced the risk of anxiety symptom recurrence in patients with GAD stabilized on quetiapine XR, with tolerability results consistent with the known profile of quetiapine.

The quality of life enjoyment and satisfaction questionnaire (Q-LES-Q), Latvian language version: Study, validation, and quality of life measurement in posttraumatic stress disorder risk patients

The quality of life enjoyment and satisfaction questionnaire (Q-LES-Q), Latvian language version: Study, validation, and quality of life measurement in posttraumatic stress disorder risk patients