Subjective Well-being In Patients Research Articles

Effects of progressive muscle relaxation on state anxiety and subjective well-being in people with schizophrenia: a randomized controlled trial

Objective: To examine the efficacy of a single progressive muscle relaxation session compared with a control condition on state anxiety, psychological stress, fatigue and subjective well-being in patients with schizophrenia. Design: Randomized controlled trial. Setting: An acute inpatient care unit of an University Psychiatric Centre. Subjects: Sixty-four out of 88 eligible patients with schizophrenia. Interventions: Patients were randomly assigned to either a single progressive muscle relaxation session during 25 minutes or a resting control condition with the opportunity to read for an equal amount of time. Main outcome measures: Before and after the single interventions the State anxiety inventory and the Subjective exercise experiences scale were completed. Effect sizes were calculated. Results: Only within progressive muscle relaxation, participants (n=27) showed decreased state anxiety, psychological stress and fatigue and increased subjective well-being. Between-group differences in post scores were found for state anxiety, subjective well-being and psychological stress, but not for fatigue. The effect size favouring progressive muscle relaxation was 1.26 for subjective well-being and −1.25 and −1.02 for respectively state anxiety and psychological stress. Conclusions: Progressive muscle relaxation is highly effective in reducing acute feelings of stress and anxiety in patients with schizophrenia. A reduction in stress and state anxiety is associated with an increase in subjective well-being.

P03-311 - Evolution of subjective well-being in patients with schizophrenia or schizoaffective disorder. 4D study

IntroductionThe subjective well-being has been associated with dropouts of treatment and relapses.ObjectivesDetermine baseline variables associated with a positive evolution in subjective well-being (increase of 20% and ≥10 points in subjective SWN-K). Assess the relationship between SWN-K and compliance of treatment.MethodsNon-interventional, prospective (6 moths) study of a cohort of patients with schizophrenia of schizoaffective disorders who have had a clinical relapse that required a change in therapeutic strategy.Results305 patients were included, 288 (94.4%) was the population analyzed and 272 (89.1%) completed the follow-up. 226 (78.5%) of patients have a diagnosis of schizophrenia, the rest were diagnosed of schizoaffective disorder.Mean total scores in SWN-K were statistically significant in every visit vs. baseline (69.5, 75.5, 77.8 and 80.0). All subscales (social, physical, emotional, mental and self-control) showed a parallel evolution. This progress was associated with compliance according to the evaluations by the psychiatrist, family and patient.Baseline variables associated to positive response in SWN-K in logistic regression were: gender (female) and depressive symptoms (CDSS).ConclusionsProgress in SWN-K score was related to compliance. Depressive symptoms and gender are the only variables at baseline associated with positive response in SWN-K.

Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics

It has been suggested that atypical antipsychotics may exert beneficial effects on subjective well-being as well as depressive symptoms in schizophrenia. However, the relationship between the two remains to be clarified. The authors examined the relationship between subjective well-being and depressive symptoms across the course of acute treatment with atypical antipsychotics in patients with schizophrenia. Thirty-five inpatients with schizophrenia were examined for subjective well-being, psychopathology, and extrapyramidal side effects before and 8 weeks after the initiation of new treatment with atypical antipsychotics. Significant improvement was observed in subjective well-being, psychotic symptoms, and depressive symptoms. No change was observed in the severity of extrapyramidal side effect. The subjective well-being score had significant negative correlations with depressive symptom score both at baseline and at week 8. The mean change in subjective well-being score was significantly correlated with that in depressive symptom score. The severity of depressive symptoms at baseline was significantly correlated with the subsequent change in subjective well-being score and the change in depressive symptom score was the only predictor of change in subjective well-being score. Depressive symptoms were significantly associated with subjective well-being in patients with schizophrenia and may moderate the acute effects of atypical antipsychotic treatment on subjective well-being. Further investigations are necessary to fully define the place of depressive symptoms in the conceptualization of subjective well-being in schizophrenia and the optimal use of atypical antipsychotics.

Pre-incisional, Single-Injection Paravertebral Block With Ropivacaine For Postoperative Analgesia After Breast Cancer Surgery

Purpose: Breast cancer surgery – with or without axillary lymph node dissection – often results in significant early postoperative morbidity due to pain. Pre-incisional thoracic paravertebral block (TPVB) provides postoperative analgesia for up to 48 hours. We prospectively studied the quality of postoperative analgesia and the subjective well-being in patients who underwent breast cancer surgery under combined general anesthesia and TPVB. Materials and Methods: After institutional review board approval, 206 patients undergoing primary breast cancer surgery or subsequent reconstructive breast surgery under general anesthesia and TPVB (single-injection of ropivacaine 0.5 % 20 ml at the T3 level) were studied. The primary outcome variables were the pain scores at rest and with exercise, as determined by an 11-tier visual analog scale (0 = no pain, 10 = worst pain imaginable). Secondary variables included the frequency of supplemental intravenous analgesic medication, TPVB-related complications, and subjective satisfaction of the patients. Results: TPVB provided complete (VAS = 0) or effective analgesia (VAS ≤ 4) in 88.4 % of all patients during the entire observation period of 48 hours after surgery. Pain scores decreased significantly at 24 and 48 hours after surgery when compared to the first VAS value, which was determined on discharge from the post-anesthesia care unit (rest) or 6 hours after surgery (excercise), respectively (p < 0.001). Within the first 48 hours after surgery, 22 % of the patients requested metamizole or acetaminophen, while another 11 % required an additional opioid for pain relief. Patient satisfaction was high with the analgesic regimen, and was rated “excellent or good” by 181 (87.9 %) patients, “fair” (n = 14; 6.8 %) or “poor” (n = 11; 5.3 %). Two pneumothoraces occurred in our patients, which were TPVB-related complications. Conclusion: Combined general anesthesia and pre-incisional, single-injection TPVB for breast cancer surgery is an effective and technically simple analgesic regimen that produces a high level of patient satisfaction and procedural safety.

Looking beyond the importance of life goals. The personal goal model of subjective well-being in neuropsychological rehabilitation

Objective: To identify subjective importance, attainability and success of life goals and their predictive value for subjective well-being in patients with acquired brain injury. Design: Cross-sectional, descriptive. Setting: Two inpatient neurological rehabilitation centres. Participants: Patients with non-progressive neurological disorders. Interventions: Survey using questionnaires. Measures: Life goal characteristics were assessed using a life goal questionnaire (GOALS). Subjective well-being (composite score) was measured using the Center of the Epidemic Studies Depression Scale (CES-D), the Positive and Negative Affect Schedule (PANAS) and the Satisfaction With Life Scale (SWLS). Results: Fifty-nine patients participated in the study. The most important life goals are intimacy (4.59/5), achievement (3.96/5) and altruism (3.89/5). The intimacy goals are considered most attainable (4.19/5) and patients feel most successful in this domain (3.98/5). Two important predictions of the personal goal model of subjective well-being could be confirmed. First, goal attainability moderates the relation between goal importance and goal success. Second, the influence of goal importance on subjective well-being is mediated by experienced success. The most powerful predictors for subjective well-being are success in the achievement domain (β = 0.404) and discrepancy between importance and success in the intimacy domain (β = —0.276). Conclusions: The subjective well-being of neurological patients depends not only on the appraised importance of life goals but also on their attainability and success.

Response and remission of subjective well-being in patients suffering from schizophrenia spectrum disorders

Background Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being. Method The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome. Results Twenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission. Conclusions Depressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined.

Association of Adverse Drug Effects With Subjective Well-Being in Patients With Schizophrenia Receiving Stable Doses of Risperidone

The purpose of the present study was to examine the association of adverse drug effects with subjective well-being in patients with schizophrenia receiving stable doses of risperidone. Thirty outpatients with schizophrenia receiving stable doses of risperidone were comprehensively evaluated for psychopathology, subjective well-being, and adverse drug effects. Subjective well-being was assessed using the Subjective Well-being Under Neuroleptics Scale (SWN). Adverse drug effects were evaluated using the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). In correlation analysis controlling for relevant variables, the SWN score had significant negative correlations with the following subscale scores of the LUNSERS: extrapyramidal side effect (EPS) (r = -0.54, P < 0.01), akathisia (r = -0.46, P < 0.05), and autonomic adverse effect (r = -0.44, P < 0.05). The SWN score also had a significant negative correlation with the global severity of EPS as measured by the DIEPSS (r = -0.44, P < 0.05). The results of our study suggest that adverse effects, particularly EPS and akathisia, are significantly associated with subjective well-being, implying the necessity to develop rational strategies to control these variables effectively. The results also suggest that EPS and akathisia continue to be major adverse effects associated with a low level of subjective well-being in patients receiving risperidone. Further studies are required to investigate the multidimensional factors associated with subjective well-being in patients receiving atypical antipsychotics and to determine their relative contributions.

The relationship between subjective well-being and dopamine D2 receptors in patients treated with a dopamine partial agonist and full antagonist antipsychotics

Antipsychotic drugs produce unpleasant subjective experiences, which have been associated with high levels of dopamine D2 receptor occupancy. Aripiprazole is a partial agonist antipsychotic, which is hypothesized to produce a different subjective experience profile compared to standard D2 antagonist antipsychotics. The aim of this study was to compare the effect of D2 occupancy produced by a partial agonist antipsychotic (aripiprazole) to that of antagonist antipsychotics (risperidone or olanzapine) on the subjective well-being of patients. Subjective well-being was measured using the Subjective Well-being under Neuroleptics Scale (SWN) and was related to dopamine D2 receptor occupancy using [11C]raclopride PET. Patients that were switched to aripiprazole showed improvement in their subjective well-being from 79.80 (S.D.=16.08) to 89.90 (S.D.=15.33), an effect that was sustained for 6 months. This sustained improvement was observed despite very high levels of DA D2 occupancy (82-99%), in contrast to the effects of antagonist antipsychotics on subjective well-being.

Subjective wellbeing under quetiapine treatment: Effect of diagnosis, mood state, and anxiety

Objective To examine the effect of diagnosis, mood state, and anxiety on subjective wellbeing in patients with affective and non-affective psychotic disorders treated with quetiapine IR. Methods 2175 patients with schizophrenia-spectrum (SZ, n = 1681), schizoaffective (SA, n = 249), and bipolar disorder (BPD, n = 245) were treated with quetiapine over 6 months and assessed with the Clinical Global Impression-Severity of illness Scale (CGI-S) and the Subjective Wellbeing under Neuroleptic Treatment Scale (SWN-K). Diagnostic group differences and effects of mood state and anxiety on subjective wellbeing were analyzed using multi-factorial linear regression analysis and mixed models repeated measures. Results At baseline, despite similar CGI-S scores, significant SWN-K score differences between SZ (57.7 points), SA (64.1 points), and BPD (79.5 points) were detected. At baseline, depression ( p < 0.001) and anxiety ( p < 0.001) were independently associated with a worse and mania ( p < 0.001) with a better subjective wellbeing. Subjective wellbeing improved significantly in all groups ( p < 0.001; 27.6 points), and endpoint subjective wellbeing was not predicted by baseline depression or anxiety, but by endpoint depression and anxiety. Conclusion Interventions to improve subjective wellbeing should take into account the course of mood state and anxiety. Assessment of subjective wellbeing and subjective quality of life in acute mania may need adapted tools.

The Observational Evaluation of Subjective Well‐Being in Patients with Rheumatoid Arthritis

An important aspect of general health is subjective well‐being (SWB), which is defined as happiness and overall satisfaction with life. Herein we examined the reliability and validity of observation‐based ratings of SWB in patients with rheumatoid arthritis (RA). Ten RA patients experiencing a disease flare (period of increased symptoms) completed two semi‐structured interviews (baseline and 4 weeks later) that were digitally recorded. Twelve healthcare professionals watched the 20 brief videos in random order and scored them using the Well‐Being Coding System (WBCS) for observer‐reported SWB. Patient‐reported SWB scores and scores from the Medical Outcomes Study: 36‐Item Short Form Survey (SF‐36) were compared to observer‐reported scores for SWB. We found inter‐rater reliability to be extremely high and a significant relationship between observer SWB composite scores and patient SWB composite scores. Observer SWB composite scores and other scores associated with SWB from the SF‐36 were also related significantly. There was also some evidence supporting the ability of observers to detect change in SWB. Taken together, we found preliminary evidence suggesting that when using information gleaned from brief patient interviews clinicians can make reliable and valid evaluations of patients' SWB.

Clinical results versus subjective improvement with anterior transposition in cubital tunnel syndrome

This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McGowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the chi2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McGowan grade was observed in 87.63% of patients. The least responsive group was assigned a McGowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.

Effectiveness, tolerability and subjective well-being in patients receiving quetiapine: findings of a post-marketing surveillance study in schizophrenia

Objectives. Previous studies of antipsychotics have mainly focused on efficacy and tolerability. However, patient subjective well-being is increasingly being accepted as a valid and important measure of antipsychotic treatment outcomes and tolerability. Methods. In this open-label, observational trial data from 1322 outpatients with schizophrenia treated with flexibly dosed quetiapine were collected at baseline, Week 4 and Week 12. Patient well-being was assessed using Subjective Well-being under Neuroleptics (SWN-K) scale and disease severity with the Clinical Global Impressions-Severity of Illness (CGI-S) scale following quetiapine treatment. In addition, safety and tolerability were monitored throughout the study. Results. Quetiapine treatment, mean endpoint dose 337 mg/day, led to a significant reduction in disease severity, with improvements in CGI-S score of −0.7 at Week 4 and −1.3 at Week 12 (both P<0.001). In addition, patients’ subjective well-being was significantly improved at Week 12, with a mean (SD) increase from baseline in SWN-K total score of 22.9 (18.7) (P<0.001). Further, an improved tolerability profile compared with previous medication was reported. Conclusions. This study emphasises the importance of patients’ subjective well-being and the favourable acceptability of quetiapine among patients with schizophrenia.

Early Impaired Self-awareness, Depression, and Subjective Well-being Following Traumatic Brain Injury

To examine the incidence and intercorrelation of early impaired self-awareness (ISA) and depression after traumatic brain injury (TBI), as well as their contributions to prediction of patients' subjective well-being at discharge from inpatient rehabilitation. Inception cohort. Inpatient rehabilitation. Subjects were 96 patients with TBI seen for inpatient rehabilitation at the Methodist Rehabilitation Center. All subjects had emerged from posttraumatic amnesia prior to assessment for this study. None. Subjective well-being as measured by the Satisfaction With Life Scale taken at discharge from inpatient rehabilitation. Multivariable linear regression analysis revealed that ISA and functional status (Disability Rating Scale total score) at rehabilitation admission made independent contributions to prediction of subjective well-being. Bivariable correlational analyses demonstrated that frequency of depressive symptoms was inversely correlated with Satisfaction With Life Scale scores. Impaired self-awareness and depression were not correlated in this sample. Results support the idea that ISA is an important factor in determining subjective well-being in patients with TBI at acute rehabilitation discharge. Early interventions to decrease ISA may improve patients' functional status at rehabilitation discharge.

The impact of will to live and belief in curability on the subjective well-being of patients with advanced cancer

For patients with metastatic, incurable cancer the prognosis itself and its acceptance may influence their subjective well-being. This paper addresses the issue of what patients with incurable cancer should be told about their disease. It considers whether the patients' will to live and perceptions of the information their doctor provides may have consequences for well-being. The analysis is of a subset of data from a study of patients diagnosed with metastatic, incurable cancer who were recruited prospectively from one of several treatment centres in south-east Queensland, Australia. The sample is restricted to 46 patients with evaluable data at three points in time: within two weeks of diagnosis of metastatic, incurable cancer (T1); approximately three months after enrolment in the study (T2); and within eight weeks of death (T3). The results examine the impact of the patients' will to live and beliefs about curability of their disease on their quality of life. The will to live leads to an optimistic assessment of curability, which in turn enhances assessments of subjective well-being or quality of life as patients near death.

Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate ‘subjective well-being under neuroleptics’ (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being. The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology ( r=−0.20 to −0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.

Personality Correlates of Patients' Subjective Well-Being After Surgery for Colorectal Cancer

The present study examined the relationship between a general personality framework (the five-factor model) and subjective well-being in patients with colorectal cancer. Participants were 56 post-surgical patients with colorectal cancer who completed a mailed, self-administered questionnaire that assessed demographic characteristics, personality, and subjective well-being (life satisfaction, positive affect, negative affect, and affect balance). Pearson correlations indicated that neuroticism had the highest correlation with life satisfaction (r= -.61), affect balance (r= -.61), and negative affect (r= .48), whereas extroversion had the highest correlation with positive affect (r= .57). Moreover, hierarchical multiple regression analyses indicated that personality explained an additional 20% to 29% of the variance in subjective well-being after important demographic and medical variables were controlled for. The authors concluded that personality, particularly neuroticism, is strongly related to subjective well-being in patients with colorectal cancer and that clinicians should be aware of its implications for patients' functioning.

Social support, coping and subjective well-being in patients with rheumatic diseases

The purpose of this cross-sectional study is to examine the relationship between social support, coping, and subjective well-being by testing three hypotheses: (1) social support influences subjective well-being via coping; (2) coping influences subjective well-being via social support; (3) there is a reciprocal relationship between social support and coping, and both concepts influence subjective well-being. Data were analyzed from 628 patients with one or more chronic rheumatic disorder(s) affecting the joints, in some patients combined with another rheumatic disease (no fibromyalgia). Although causal inferences are not possible, the results present a plausible causal sequence in supporting the second hypothesis. This is only true, however, for coping by awaiting/avoidance: coping by awaiting/avoidance led to less social support and this decrease in social support influenced subjective well-being negatively.

Drug attitude and subjective well-being in antipsychotic treatment monotherapy in real-world settings

To assess using two well-know scales (DAI-30 and SWN) the drug attitude and subjective well-being of patients treated with haloperidol or second-generation antipsychotics (SGA) in four different Italian communities. The sample included 145 patients taking five different antipsychotics (APs) in mono-therapy: haloperidol, clozapine, olanzapine, risperidone, quetiapine. A stepwise multiple regression analysis (SMRA) was used to analyse the contribution of different AP treatments and of other predictors to SWN and DAI-30 scores. Univariate analyses showed no differences in DAI-30 and SWN scores across treatments. The SMRA showed that SWN scores were negatively correlated with the severity of the psychoses (BPRS scores), while the DAI-30 scores were negatively correlated with the severity of the psychoses and positively correlated both with the length of drug treatment and with the use of olanzapine. Our study does not confirm a better drug attitude in patients treated with SGA with respect to haloperidol. The only partial exception is the better performance of olanzapine over haloperidol on DAI-30, which could be due to the lower use of anticholinergic drugs during olanzapine treatment. The differences between the SWN and DAI-30 may give good reason for the use of both instruments during AP treatments.

A longitudinal study of symptoms, anxiety and subjective well-being in patients with vertigo.

In a prospective longitudinal study of the relationship between symptoms and anxiety in people with vertigo, 101 patients were evaluated on two occasions separated by a 7 month interval. At Time 1 the age, gender, vertigo type, duration of illness, medication, and audiovestibular test results of patients were recorded, and they completed questionnaires assessing handicap, emotional distress, predisposition to anxiety, and symptoms indicative of vertigo and of somatic anxiety. These questionnaires were re-administered at Time 2, and patients also indicated whether their vertigo was more or less severe than at Time 1. Although vertiginous symptoms at Time 2 were generally mild and intermittent, they were associated with significant handicap. Reported symptoms of somatic anxiety and arousal at Time 1 proved to be the only longitudinal predictors of perceived change in vertigo severity over the 7 month period.

Erythropoietin treatment does not compromise cardiovascular function in chronic renal failure.

The anemia in patients with chronic renal failure can be corrected through treatment with recombinant human erythropoietin treatment. This correction is associated with changes in the rheologic variables, which could explain the changes in hemodynamics found by many investigators. The authors have followed up 11 patients with chronic renal failure on hemodialysis before and during six months of therapy with erythropoietin. The measurements were made before treatment, after four months of therapy, and after six months of therapy. The measurements included hematocrit, osmotic resistance of the red blood cells, red blood cell volume, plasma volume, heart rate, arterial blood pressure, and cardiac output measured by the indicator dilution method. They found a significant increase in hematocrit hemoglobin, and red blood cell volume and a decrease in osmotic resistance while the hemodynamic variables were unchanged. The conclude that, in spite of changes in rheologic variables, increasing viscosity of the blood and thus possibly increasing the peripheral resistance, these had no effect on the cardiovascular state. Erythropoietin treatment improves the subjective well-being in patients on chronic hemodialysis without compromising their cardiovascular function.