Quality of Life in Schizophrenia

Schizophrenia exacts a significant impact on the quality of life of the affected individual in every sphere of life - family, social, academic, vocational and leisure. The impact is also felt significantly by the patient's family. In addition to the disruption of the symptoms of schizophrenia, the timing of onset often coincides with the formative years where a person may be engaged in important activities such as: studying towards employment, undergoing vocational training, beginning a career, enjoying social interaction, learning about money management and budgeting personal income, learning workplace communication skills with peers and colleagues, or living independently. Since the onset of schizophrenia disrupts all of these skills, once the patient is stabilized with medications, they frequently need counseling and training in all of these areas to resume integration into family, communal, and vocational environments.

Until recently, quality of life of schizophrenia patients was measured using generic quality of life instruments. There are now several scales specific to schizophrenia in development and some have recently been published. Quality of life scales are important markers for measuring the outcome of clinical trials and patient management. The most accurate measures are thought to result from combining scores of generic and schizophrenia-specific quality of life scales.

One of the factors that influences quality of life of patients with schizophrenia is the level of insight they have into their condition. It appears that the more insight and understanding they have, the poorer the quality of life and the greater the presence of symptoms of depression. Patients with insight are aware of their restrictions in work, school, or home, and see the conflict in their social relationships clearly. Greater insight also appears to increase the stigma felt by the patient of being mentally ill and may result in attempted suicide. Patients with greater insight into their condition rated themselves and were rated by clinicians as having significantly poorer psychosocial skills and overall quality of life levels than patients with less insight.

Ironically, it is also felt that insight into their condition is necessary in order to engage the patient in psychosocial therapy and effective treatment compliance. Therapy for schizophrenia, especially for patients with insight into their condition, must be multi-dimensional and address the problems that arise as a result of their insight. Psychosocial therapy attempts to strengthen the schizophrenic patient without the risk of increasing depression and worsening the quality of life.

An additional area that patients with schizophrenia struggle to cope with is noncompliance of treatment, even though they may have already experienced the extreme anguish of a psychotic episode. It is estimated that the noncompliance rate among schizophrenics is at least 50%. Some suggestions that that been offered that may help in efforts to promote increased compliance among patients include:

• Injectable, long-acting antipsychotic medication that is administered once every 2-4 weeks
• Simplifying the oral medication regimen (taking fewer pills and fewer times per day)
• Tailoring pills to daily activities, such as at mealtime
• Requesting an outside person, such as a friend or family member, to supervise the patient by reminding them about taking their medicine

Some very important reminders regarding medications include:

• Take medication as long as your doctor recommends
• Never discontinue a medication without consulting the prescribing physician since mediations must be tapered off under supervision
• If side effects develop that are hard to tolerate, don't stop taking the medication. Ask the doctor if you can try a different medication or if changing the dose would reduce the side effect that is disturbing. Never stop a medication without the doctor having substituted another drug in its place.

It is very important for the patient to participate to the degree he/she is able in gathering information about their condition. For the patient with positive symptoms, negative symptoms, or cognitive dysfunction, it can be difficult to understand what the doctor is saying, to remember what the physician said, or to relay the information to a member of the patient's support system (family member, friend). Some of the ways patients can help themselves gather information includes:

• Bring someone you trust to your medical appointments so that they can confirm or correct what you understood from the meeting
• Go to your appointment with a list of questions which you have thought about and written ahead of time so that you don't forget them
• Write down the answers to those questions so that you can refer back to them if a question arises. If you cannot write the answers, ask the person who is with you to take notes for you.
• Feel free to ask anything you want to know about your condition and your treatment. It's important for you to be an active participant.