Should we consider mood disturbance in schizophrenia as an important determinant of quality of life?
BACKGROUND
The main objective in the treatment of schizophrenia should be to optimize individual patient functioning and quality of life. Little is known about the possible relationship of concurrent mood symptoms and quality of life. We hypothesized that the quality of life for people with schizophrenia would be inversely related to the severity of concurrent mood disruption.


METHODS
We conducted a post hoc analysis of an international, multicenter, double-blind, 28-week study of 339 patients who met DSM-IV criteria for schizophrenia, schizophreniform, or schizoaffective disorder and were randomized to treatment with either olanzapine or risperidone. Quality of life data were collected at baseline, 8, 16, 24, and 28 weeks or at early discontinuation; Positive and Negative Syndrome Scale (PANSS) data were collected at each visit (weekly to week 8 and monthly thereafter). Correlations were calculated between changes in quality of life (quality of life scale [QLS] total and subscales) and PANSS mood score. Regression models were used to determine the proportion of variability in the QLS total and subscores accounted for by changes in PANSS positive, PANSS negative, and PANSS mood scores. Finally, path analysis was performed to determine the mechanisms used by the PANSS mood scores to affect the QLS total and subscores.


RESULTS
Olanzapine demonstrated a significantly greater therapeutic effect on the PANSS mood item than risperidone did. However, mood improvements with either therapy demonstrated correlations of PANSS mood on the QLS total and subscores which were statistically significant, with the strongest correlation against the interpersonal relations (QLS-IPR) subscore. The path analysis results indicate that the PANSS mood item's most significant path in affecting the QLS total and QLS-IPR is direct.


CONCLUSIONS
Changes in the quality of life of schizophrenic patients is inversely related to changes in the concurrent mood disruption. Early therapeutic interventions directed at a broader constellation of schizophrenic symptomatology, including mood, may be helpful in improving an individual patient's quality of life. The possible relative advantages of introducing novel antipsychotic agents earlier in the course of illness for restoration of individual quality of life merit further investigation.
Tollefson
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GD
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Ind 46285, USA. tollefson_gary_d@lilly.com
Andersen
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SW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010890:Pirenzepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life; D012044:Regression Analysis; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010890:Pirenzepine; D018967:Risperidone; D000077152:Olanzapine