Schizophrenia and Lifestyle: A Delicate Balance
A meta-analysis exploring factors associated with quality of life in first-episode psychosis provides guidance and take-home points for clinicians.
A meta-analysis exploring factors associated with quality of life in first-episode psychosis provides guidance and take-home points for clinicians.
Dr Miller is Associate Professor, Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA. He is the Schizophrenia Section Editor for Psychiatric Times.
• Quality of life focuses on the assessment of a person’s health, comfort, and happiness
• Quality of life naturally overlaps with one’s level of functioning, but this measure goes beyond academic and vocational involvement
• Previous studies have found that patients with psychotic disorders have lower quality of life than those without psychiatric illness[1]
• Overall health, psychological well-being, and social and occupational functioning are crucial to functional recovery in early psychosis
• Lower quality of life may adversely affect adherence with medications and other treatments
• The NIMH RAISE initiative found that longer duration of untreated psychosis in first-episode psychosis was associated with lower quality of life, which was improved with comprehensive treatment[2]
• In order to better understand factors contributing to quality of life in first-episode psychosis, Watson and colleagues[3] performed a systematic, quantitative review of these associations
• Study authors searched PubMed and identified 51 publications of interest
• 21 of the 51 studies contributed correlative data to the meta-analysis
• Outcome measures included psychopathology (total and subscale scores) and duration of untreated psychosis
• Pooled correlation coefficients were calculated using a random effects model
• The authors also performed meta-regression analyses (to investigate potential moderating effects of age, sex, etc.), subgroup analyses, and sensitivity analyses
• Lower quality of life was significantly correlated with greater psychopathology (total, positive, negative, and general; r = -0.33 to -0.19). Correlations were strongest for negative symptoms
• Older age and schizophrenia (versus other psychotic disorder) diagnosis moderated associations between quality of life and psychopathology
• In subgroup analyses, studies using either the Heinrichs-Carpenter or World Health Organization quality of life scales found stronger correlations with psychopathology than studies using other scales. No differences were found based on self-report versus (semi-)structured assessments
• Lower quality of life was also significantly correlated with longer duration of untreated psychosis (r = -0.21)
• Age, sex, schizophrenia diagnosis, and the quality of life measure used did not moderate this association
• The authors concluded that (a) the severity of psychiatric symptoms was negatively correlated with quality of life, with the association being strongest for negative symptoms, and (b) longer duration of untreated psychosis was associated with reduced quality of life
• Questions remain about the directionality of these associations, the relative contribution of disease specific factors, and how objective and subjective measures contribute to overall quality of life in this patient population.
• Limitations of the study include the relatively small number of studies, and the cross-sectional (versus longitudinal) nature of the analyses
• The authors suggest future studies of the interaction between outcome variables on quality of life (eg, how the relationship between quality of life and psychotic symptoms is mediated by changes in cognition).
• Findings support the need to identify and treat symptoms soon after onset to reduce the duration of untreated psychosis, thereby reducing severity of symptoms, thereby improving quality of life.
1. Law CW, Chen EYH, Cheung EFC, et al. Impact of untreated psychosis on quality of life in patients with first-episode schizophrenia. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2005;14:1803–1811.
2. Kane JM, Robinson DG, Schooler NR, et al. Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. Am J Psychiatry. 2016;173:362–372.
3. Watson P, Zhang J-P, Rizvi A, et al. A meta-analysis of factors associated with quality of life in first episode psychosis. Schizophr Res. 2018; July [Epub ahead of print]