Erlend Strand Gardsjord1, Kristin Lie Romm2, Jan Ivar Røssberg2, Svein Friis2, Helene Eidsmo Barder3, Julie Evensen4, Ulrik Haahr5, Wenche Ten Velden Hegelstad6, Inge Joa7, Jan Olav Johannessen7, Johannes Langeveld6, Tor Ketil Larsen8, Stein Opjordsmoen9, Bjørn Rishovd Rund10, Erik Simonsen11, Per Vaglum12, Thomas McGlashan13, Ingrid Melle14. 1. Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, NORMENT: Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway. Electronic address: e.s.gardsjord@medisin.uio.no. 2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway. 3. Women and Children's Division, Oslo University Hospital, 0407 Oslo, Norway. 4. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway. 5. Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark. 6. Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway. 7. Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway. 8. Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway. 9. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway. 10. Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway. 11. Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark. 12. Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway. 13. Department of Social and Behavioural Health, Yale School of Medicine, Yale University, New Haven, CT, USA. 14. Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, NORMENT: Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
Abstract
BACKGROUND: Quality of life is an important outcome measure for patients with psychosis. We investigated whether going into stable symptomatic remission is associated with a more positive development of subjective quality of life (S-QoL) and if different patient characteristics are associated with S-QoL depending on remission status. METHODS: Three hundred and one patients with a first-episode psychosis were included at baseline. At 10-year follow-up 186 were reassessed. QoL was assessed by Lehman's Quality of Life Interview. Remission was defined according to criteria proposed by the Remission in Schizophrenia Working Group. One-way ANOVA, mixed model analysis, bivariate correlations and multiple regression analyses were performed. RESULTS: Patients going into stable symptomatic remission showed a more positive S-QoL-development over the follow-up period and reported higher life satisfaction at 10-year follow-up compared to non-remission. At 10-year follow-up, depressive symptoms and alcohol abuse or dependence explained a significant amount of variance in S-QoL among patients in remission. Among patients in non-remission, PANSS excitative component explained a significant amount of variance in S-QoL. All significant effects were negative. CONCLUSIONS: Stable symptomatic remission is associated with a more positive development of overall life satisfaction. Furthermore, different symptoms influence life satisfaction depending on status of remission. This has important clinical implications. While patients in remission might need treatment for depressive symptoms to increase S-QoL, in non-remission measures aiming to decrease hostility and uncooperativeness should be part of the treatment approach. Alcohol problems should be treated regardless of remission status.
BACKGROUND: Quality of life is an important outcome measure for patients with psychosis. We investigated whether going into stable symptomatic remission is associated with a more positive development of subjective quality of life (S-QoL) and if different patient characteristics are associated with S-QoL depending on remission status. METHODS: Three hundred and one patients with a first-episode psychosis were included at baseline. At 10-year follow-up 186 were reassessed. QoL was assessed by Lehman's Quality of Life Interview. Remission was defined according to criteria proposed by the Remission in Schizophrenia Working Group. One-way ANOVA, mixed model analysis, bivariate correlations and multiple regression analyses were performed. RESULTS:Patients going into stable symptomatic remission showed a more positive S-QoL-development over the follow-up period and reported higher life satisfaction at 10-year follow-up compared to non-remission. At 10-year follow-up, depressive symptoms and alcohol abuse or dependence explained a significant amount of variance in S-QoL among patients in remission. Among patients in non-remission, PANSS excitative component explained a significant amount of variance in S-QoL. All significant effects were negative. CONCLUSIONS: Stable symptomatic remission is associated with a more positive development of overall life satisfaction. Furthermore, different symptoms influence life satisfaction depending on status of remission. This has important clinical implications. While patients in remission might need treatment for depressive symptoms to increase S-QoL, in non-remission measures aiming to decrease hostility and uncooperativeness should be part of the treatment approach. Alcohol problems should be treated regardless of remission status.