Schizophrenia and Lifestyle: A Delicate Balance

• 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.