The Comparison of Quality of Life among Patients with Schizophrenia and Major Mood Disorder in Remission in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur

By Osman, C. B.; Badli, M. M. et al. | Hong Kong Journal of Psychiatry, March 2009 | Go to article overview

The Comparison of Quality of Life among Patients with Schizophrenia and Major Mood Disorder in Remission in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur


Osman, C. B., Badli, M. M., Ainsah, O., Suthahar Suthahar, A., Salmi, R., Azlinawati, N. M., Almashoor, S. H., Hong Kong Journal of Psychiatry


Introduction

According to a study among patients with schizophrenia, the quality of life (QOL) living in the community was less satisfactory than that of healthy controls in the general population. (1) Larsen and Gerlach, (2) however, found no differences when their patients were compared to the general population. Depression is a common chronic and recurrent illness, which adversely affects longevity and QOL both during the episode and potentially for the remainder of life. (3) It has been estimated that, by 2020, major depression will be the second most frequent cause of disability in the world. (4)

Conventional versus atypical antipsychotics and antidepressants have dif different side-effects and therapeutic profiles, both of which influence QOL. (5,6) Although the effectiveness of antipsychotic drugs against positive symptoms has been demonstrated in many studies, their different effects on QOL and on long-term compliance remain unclear. (7) A study by Tempier and Pawliuk (8) on the influence of novel antipsychotics reported that recipients of these drugs scored lower in terms of QOL than those taking older drugs. Another study, however, found that taking atypical antipsychotics was associated with a better QOL than subjects receiving conventional antipsychotics. (7)

The objective of this study was therefore to examine the relationship between QOL of patients with schizophrenia and major mood disorder (both in remission), in relation to demographic profiles, illness factors, and types of drugs (typical and atypical) being used.

Study Design

Instruments

This was a cross-sectional study conducted in the outpatient psychiatric clinic at the Hospital Universiti Kebangsaan, Malaysia. Study instruments included: (1) the Brief Psychiatric Rating Scale (BPRS) (9); (2) the 17-item Hamilton Depressive Scale (HAM-D) (10); (3) the Young Manic Rating Scale (YMRS) (11); and (4) the Medical Outcomes Study (MOS) 36-item Short Form (SF-36) questionnaire. (12)

Patients with schizophrenia and major mood disorder who attended the psychiatric clinic from June 2002 to December 2002 and fulfilled the inclusion criteria of this study were recruited. After explanation, informed consent was obtained from each participant. They were clinically assessed by the authors. Subjects with schizophrenia, depression or mania were considered to be in remission if they scored 9 or below, 7 or below, and 5 or below in the BPRS, HAM-D, or YMRS, respectively. These scores have been used previously to determine the state of remission of schizophrenia, depression and mania, respectively. (13-15) The diagnosis of schizophrenia and major mood disorder (depression and manic state) was made by the treating psychiatrist as well as the authors based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). (16) Patients were subsequently subjected to the SF-36 questionnaire to assess their QOL.

Subjects

All patients attending the psychiatric clinic were registered. Simple random sampling of 1 in 10 patients with a diagnosis of schizophrenia or major mood disorder was performed. They were subsequently assessed by the investigator for the DSM-IV diagnosis and remission criteria with BPRS, HAM-D, and YMRS.

Inclusion criteria for eligibility were that the subjects had to be 18 to 65 years old, have sufficient command of the Malay or English, and did not have any underlying physical illness. Exclusion criteria were that patients were current substance / drug abusers, had a history of brain injury, and were mentally retarded. Patients were also excluded if their BPRS score exceeded 9, their HAM-D score exceeded 7, or their YMRS score exceeded 5.

The SF-36 Health Survey was developed for the MOS and had been tested and validated extensively. It is a multilingual questionnaire; the original was in English, but it had been translated and used in the Bahasa Malaysia. …

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