title: Lower subjective quality of life and the development of social anxiety symptoms after the discharge of elderly patients with remitted schizophrenia: a 5-year longitudinal study.
abstract: OBJECTIVE
  Remitted schizophrenic patients living in the community often encounter difficulties in their daily lives, possibly leading to the development of social anxiety symptoms. Although several studies have reported the significance of social anxiety as a comorbidity in patients with schizophrenia, few longitudinal data are available on the development of social anxiety symptoms in patients with remitted schizophrenia, especially in association with the process of "deinstitutionalization." The aims of this study were to assess the social anxiety symptoms in remitted outpatients with schizophrenia and to examine whether the development of social anxiety symptoms was associated with psychotic symptoms, social functioning, or subjective quality of life.
  
  
  METHODS
  Fifty-six people with schizophrenia who were discharged through a deinstitutionalization project were enrolled in this longitudinal study and prospectively assessed with regard to their symptoms, social functioning, and subjective quality of life. The severity of social anxiety symptoms was measured using the Liebowitz Social Anxiety Scale (LSAS). Global/Social functioning and subjective quality of life were evaluated using the Global Assessment of Functioning Scale, the Social Functioning Scale, and the World Health Organization-Quality of Life 26 (WHO-QOL26).
  
  
  RESULTS
  Thirty-six patients completed the reassessment at the end of the 5-year follow-up period. The mean LSAS total score worsened over time, whereas other symptoms improved from the baseline. The mean WHO-QOL26 score in the worsened LSAS group was significantly lower than that in the stable LSAS group. At baseline, WHO-QOL26 scores were associated with an increase in the severity of social anxiety symptoms.
  
  
  CONCLUSIONS
  In community-dwelling patients with remitted schizophrenia, a lower subjective quality of life might lead to the development of social anxiety symptoms, both concurrently and prospectively. To achieve a complete functional recovery, additional interventions for social anxiety may be needed.
authors.affiliation: Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan. hk345@cam.ac.uk
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kumazaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Hidehito
authors.initials: H
authors.lastname: Niimura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Shinya
authors.initials: S
authors.lastname: Ito
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nemoto
authors.forename: Kei
authors.initials: K
authors.lastname: Sakuma
authors.forename: Haruo
authors.initials: H
authors.lastname: Kashima
authors.forename: Masafumi
authors.initials: M
authors.lastname: Mizuno
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010698:Phobic Disorders / Q000175:diagnosis* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012074:Remission Induction; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D012917:Social Adjustment
chemical_list: D014150:Antipsychotic Agents