Möglichkeiten und Grenzen subjektiver Lebensqualität schizophrener Patienten als Outcomekriterium psychiatrischer Therapie

 

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Zusammenfassung

Anliegen: Literaturübersicht zu den vorliegenden empirischen Ergebnissen der Erfassung subjektiver Lebensqualität schizophren erkrankter Menschen. Methode: Literaturrecherche und Darstellung eigener Forschungsergebnisse. Fokus auf Patienten unter deprivierten Lebensbedingungen. Ergebnisse: Es finden sich keine konsistenten Zusammenhänge zwischen objektiven Lebensbedingungen und deren subjektiver Bewertung. Als wichtigste Einflussfaktoren erweisen sich Depressivität, Persönlichkeitsfaktoren und Adaptationsmechanismen. Schlussfolgerungen: Subjektive und objektive Variablen hängen nicht linear zusammen. Zur Überwindung der dargestellten Interpretationsprobleme subjektiver Lebensqualitätsstudien werden Mindeststandards für die Anwendung subjektiver Lebensqualität als Outcomeindikator vorgeschlagen.

Abstract

Objective: A systematic review on empirical results of studies that assess Quality of Life (QoL) in schizophrenic patients. Method: A systematic overview of the literature is provided with focus on schizophrenic patients under deprived living conditions. Results: No consistent relationships are found between objective living conditions and their subjective evaluation by means of QoL-ratings. The latter are influenced by the level of depression, personality factors and adaptation. Conclusions: Objective and subjective variables represent distinct latent constructs. Standards for the use of subjective QoL as outcome indicator are suggested.

Literatur

• 1 Franz M, Meyer T, Ehlers F, Gallhofer B. Schizophrene Patienten, die trotz Dekaden der Enthospitalisierung in den psychiatrischen Krankenhäusern verblieben sind. Teil 1 der Hessischen Enthospitalisierungsstudie.  Psychiat Prax. 2002;  29 245-250
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Franz M, Ehlers F, Meyer T. Hessische Enthospitalisierungsstudie: Bericht für den Landeswohlfahrtsverband über den Untersuchungszeitraum 1994 - 1997. Kassel; LWV 1998
  Google Scholar
• 3 Franz M, Meyer T, Gallhofer B. Subjektive Lebensqualität schwer chronifizierter schizophrener Langzeitpatienten. Teil 3 der Hessischen Enthospitalisierungsstudie.  Psychiat Prax. 2002;  29 306-310
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Priebe S, Hoffman K, Isermann M, Kaiser W. Klinische Merkmale langzeithospitalisierter Patienten, Teil 1 der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 1996;  23 15-20
  PubMedGoogle Scholar
• 5 Kilian R. Ist Lebensqualität messbar? Probleme der quantitativen und Möglichkeiten der qualitativen Erfassung von Lebensqualität in der Psychiatrie.  Psychiat Prax. 1995;  22 97-101
  PubMedGoogle Scholar
• 6 Atkinson M, Zibin S, Chuang H. Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology.  Am J Psychiatry. 1997;  154 99-105
  PubMedGoogle Scholar
• 7 Albrecht G, Vieten B, Pörksen N, Ingenleuf H-J, Günther C, Haneberg J. Enthospitalisierung chronisch psychisch kranker Langzeitpatienten. Abschlussbericht des Projektes II-4 1999, Nordrhein-Westfälischer Forschungsverbund Public Health. 
  Google Scholar
• 8 Awad A G, Voruganti L NP, Heslegrave R J. A conceptual model of quality of life in schizophrenia: description and preliminary clinical validation.  Qual Life Res. 1997;  6 21-26
  PubMedGoogle Scholar
• 9 Baker F, Intagliata J. Quality of life in the evaluation of community support systems.  Eval Program Plann. 1982;  5 69-79
  PubMedGoogle Scholar
• 10 Barry M M, Crosby C. Quality of life as an evaluative measure in assessing the impact of community care on people with long-term psychiatric disorders.  Br J Psychiatry. 1996;  168 210-216
  CrossrefPubMedGoogle Scholar
• 11 Bengtsson-Tops A, Hansson L. Subjective quality of life in schizophrenic patients living in the community: relationship to clinical and social characteristics.  Eur Psychiatry. 1999;  14 256-263
  CrossrefPubMedGoogle Scholar
• 12 Carpiniello B, Lai G, Pariante C M, Carta M G, Rudas M. Symptoms, standards of living and subjective quality of life: A comparative study of schizophrenic and depressed outpatients.  Acta Psychiatr Scand. 1997;  96 235-241
  PubMedGoogle Scholar
• 13 Dickerson F B, Ringel N B, Parente F. Subjective quality of life in out-patients with schizophrenia: clinical and utilization correlates.  Acta Psychiatr Scand. 1998;  98 124-127
  CrossrefPubMedGoogle Scholar
• 14 Flanagan S, Doyle M, Browne S, Larkin C, O'Callaghan E. A survey of the self-rated quality of life of individuals with schizophrenia in community residential settings.  Irish J Psychol Med. 2000;  17 22-24
  PubMedGoogle Scholar
• 15 Hansson L, Middelboe T, Merinder L, Bjarnason O, Bengtsson-Tops A, Nilsson L, Sandlund M, Sourander A, Sørgaard K W, Vinding H. Predictors of subjective quality of life in schizophrenic patients living in the community: a nordic multicenter study.  Int J Soc Psychiatry. 1999;  45 247-258
  CrossrefPubMedGoogle Scholar
• 16 Hoffmann K, Priebe S, Isermann M, Kaiser W. Lebensqualität, Bedürfnisse und Behandlungsbewertung langzeithospitalisierter Patienten: Teil II der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 1997;  24 221-226
  PubMedGoogle Scholar
• 17 Huxley P, Evans S, Burns T, Fahy T, Green J. Quality of life outcome in a randomized controlled trial of case management.  Soc Psychiatry Psychiatr Epidemiol. 2001;  36 249-255
  CrossrefPubMedGoogle Scholar
• 18 Lehman A F, Ward N C, Linn L S. Chronic mental patients: the quality of life issue.  Am J Psychiatry. 1982;  139 1271-1276
  PubMedGoogle Scholar
• 19 Sullivan G, Wells K B, Leake B. Quality of life of seriously mentally ill persons in Mississippi.  Hosp Community Psychiatry. 1991;  42 752-754
  PubMedGoogle Scholar
• 20 Larsen E B, Gerlach J. Subjective experience of treatment, side-effects, mental state and quality of life in chronic schizophrenic out-patients treated with depot neuroleptics.  Acta Psychiatr Scand. 1996;  93 381-388
  PubMedGoogle Scholar
• 21 Hoffmann K, Isermann M, Kaiser W, Priebe S. Lebensqualität im Verlauf der Enthospitalisierung. Teil IV der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 2000;  27 183-188
  PubMedGoogle Scholar
• 22 Okin R L, Dolnick J A, Pearsall D T. Patients' perspectives on community alternatives to hospitalization: a follow-up study.  Am J Psychiatry. 1983;  140 1460-1464
  PubMedGoogle Scholar
• 23 Stein L I, Test M A. Alternatives to mental hospital treatment.  Arch Gen Psychiatry. 1980;  37 392-397
  PubMedGoogle Scholar
• 24 Chandler D W, Meisel J, McGowen M, Mintz J, Madison K. Client outcomes in two model capitated integrated service agencies.  Psychiatr Serv. 1996;  47 (2) 175-180
  PubMedGoogle Scholar
• 25 Olfson M. Assertive Community Treatment: an evaluation of the experimental evidence.  Hosp Community Psych. 1990;  41 634-641
  PubMedGoogle Scholar
• 26 Daly I. Quality of life evaluation in health services research. In: Priebe S, Oliver JPJ, Kaiser W Quality of Life and Mental Health Care. Petersfield; Wrightson Biomedical Publishing Ltd 1999: 67-79
  Google Scholar
• 27 Bond G R, Miller L D, Krumwied R D, Ward R S. Assertive case management in three CMHCs: a controlled study.  Hosp Community Psych. 1988;  39 411-418
  PubMedGoogle Scholar
• 28 McClary S, Lubin B, Evans C. Evaluation of a community treatment program for young adult schizophrenics.  J Clin Psychol. 1989;  45 806-808
  PubMedGoogle Scholar
• 29 Taylor R E, Leese M, Clarkson P, Holloway F, Thornicroft G. Quality of life outcomes for intensive versus standard community mental health services: PRiSM Psychosis Study 9.  Br J Psychiatry. 1998;  173 416-422
  CrossrefPubMedGoogle Scholar
• 30 Hansson L, Middelboe T, Sorgaard K W, Bengtsson-Tops A, Bjarnason O, Merinder L, Nilsson L, Sandlund M, Korkeila J, Vinding H R. Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings.  Acta Psychiatr Scand. 2002;  106 343-350
  CrossrefPubMedGoogle Scholar
• 31 Lehman A F, Possidente S, Hawker F. The quality of life of chronic patients in a state hospital and in community residences.  Hosp Community Psych. 1986;  37 901-907
  PubMedGoogle Scholar
• 32 Angermeyer M C, Kilian R. Theoretical models of quality of life for mental disorders. In: Katschnig H, Freeman H, Sartorius N Quality of Life in Mental Disorders (2^nd edition). Chichester; Wiley 2006: 21-31
  Google Scholar
• 33 Becker M, Diamond R, Sainfort F. A new patient focused index for measuring quality of life in persons with severe and persistent mental illness.  Qual Life Res. 1993;  2 239-251
  CrossrefPubMedGoogle Scholar
• 34 Franz M, Meyer T, Gallhofer B. Are importance ratings useful in the assessment of subjective quality of life in schizophrenic patients?.  Int J Methods Psychiatr Res. 1999;  8 204-211
  CrossrefPubMedGoogle Scholar
• 35 Diener E, Suh E M, Lucas R E, Smith H L. Subjective well-being: three decades of progress.  Psychol Bull. 1999;  125 276-302
  CrossrefPubMedGoogle Scholar
• 36 Andrews F M, Withey S B. Social Indicators of Well-being. Americans' Perceptions of Life Quality. New York; Plenum Press 1976
  Google Scholar
• 37 Argyle M. Causes and correlates of happiness. In: Kahnemann D, Diener E, Schwarz N Well-being: The Foundations of Hedonic Psychology. New York; Sage 1999: 353-373
  Google Scholar
• 38 Meyer T. Vorstellungen schizophrener Menschen über Lebensqualität. Hamburg; Verlag Dr. Kovac 2004
  Google Scholar
• 39 Veenhoven R. Conditions of happiness. Dodrecht; Reidel 1984
  Google Scholar
• 40 Diener E. Assessing subjective well-being: progress and opportunities.  Soc Indic Res. 1994;  31 103-157
  CrossrefPubMedGoogle Scholar
• 41 Campbell A, Converse P E, Rodgers W L. The Quality of American Life: Perceptions, Evaluations, and Satisfactions. New York; Sage 1976
  Google Scholar
• 42 McCrae R R. Well-being scales do not measure social desirability.  J Gerontol. 1986;  41 390-392
  PubMedGoogle Scholar
• 43 Franz M, Plüddemann K, Gruppe H, Gallhofer B. Modifikation und Anwendung der Münchner Lebensqualitäts-Dimensionen-Liste bei schizophrenen Patienten. In: Möller H-J, Engel R, Hoff P Befunderhebung in der Psychiatrie: Negativsymptomatik, Lebensqualität und andere neue Entwicklungen. Berlin; Springer 1996: 103-111
  Google Scholar
• 44 Karow A, Moritz S, Lambert M, Schoder S, Krausz M. PANSS syndromes and quality of life in schizophrenia.  Psychopathology. 2005;  38 320-326
  CrossrefPubMedGoogle Scholar
• 45 Tims H, Diaz P. Psychopathology and quality of life in schizophrenia and related disorders: a literature review.  Quality of Life Newsletter. 2002;  29 9-10
  PubMedGoogle Scholar
• 46 Os J van, Gilvarry C, Bale R, Horn E van, Tattan T, White I, Murray R. To what extent does symptomatic improvement result in better outcome in psychotic illness? UK700 Group.  Psychol Med. 1999;  29 1183-1195
  CrossrefPubMedGoogle Scholar
• 47 Brieger P, Röttig S, Marneros A. Lebensqualität bei unipolar depressiven und bipolar affektiven Patienten.  Psychiat Prax. 2004;  31 304-309
  Article in Thieme ConnectPubMedGoogle Scholar
• 48 Kuehner C. Subjective quality of life; validity issues with depressed patients.  Acta Psychiatr Scand. 2002;  106 62-70
  PubMedGoogle Scholar
• 49 Meyer T, Karow A, Naber D, Franz M. Anmerkungen zur kritischen Betrachtung eines modernen Konstrukts - Subjektive Lebensqualität.  Nervenarzt. 2005;  76 623-625
  CrossrefPubMedGoogle Scholar
• 50 McKenna S P, Hunt S M. A new measure of quality of life in depression: testing the reliability an construct validity of the QLDS.  Health Pol. 1992;  22 321-330
  PubMedGoogle Scholar
• 51 Katschnig H, Krautgartner M, Schrank B, Angermeyer M C. Quality of life in depression. In: Katschnig H, Freeman H, Sartorius N Quality of Life in Mental Disorders (2^nd edition). Chichester; Wiley 2006: 129-140
  Google Scholar
• 52 Norman R M, Malla A K, McLean T, Pant L, Voruganti N, Cortese L, McIntosh E, Chengand S, Rickwood A. The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale.  Acta Psychiatr Scand. 2000;  102 303-309
  CrossrefPubMedGoogle Scholar
• 53 Beck A T. Cognitive Therapy and the Emotional Disorders. New York; International Universities Press 1976
  Google Scholar
• 54 Crosby F, Muehrer P, Loewenstein G. Relative deprivation and explanation: Models and concepts. In: Olson JM, Herman CP, Zanna MP Relative Deprivation and Social Comparison: The Ontario Symposium (Vol. 4). Hillsdale NJ; Lawrence Erlbaum Associates 1986
  Google Scholar
• 55 Crosby F. Relative Deprivation and Working Women. New York; Oxford University Press 1982
  Google Scholar
• 56 Meyer T, Franz M. Vorstellungen von schizophren Erkrankten über Lebensqualität.  Gesundheitswesen. 2005;  67 120-123
  Article in Thieme ConnectPubMedGoogle Scholar
• 57 Kilian R, Lindenbach I, Löbig U, Uhle M, Angermeyer M C. Self-perceived social integration and the use of day centers of persons with severe and persistent schizophrenia living in the community: A qualitative analysis.  Soc Psychiat Soc Epidemiol. 2001;  36 545-552
  CrossrefPubMedGoogle Scholar
• 58 Festinger L. A theory of social comparison processes.  Hum Relat. 1954;  7 117-140
  PubMedGoogle Scholar
• 59 Franz M, Meyer T, Reber T, Gallhofer B. The importance of social comparison for high levels of subjective quality of life in chronic schizophrenic patients.  Qual Life Res. 2000;  9 481-489
  CrossrefPubMedGoogle Scholar
• 60 Wood J V, Taylor S E, Lichtman R R. Social comparison in adjustment to breast cancer.  J Pers Soc Psychol. 1985;  49 1169-1183
  PubMedGoogle Scholar
• 61 Wood J V, Taylor K L. Serving self-relevant goals through social comparison. In: Suls J, Wills TA Social Comparison: Contemporary Theory and Research. Hillsdale; Lawrence Erlbaum Associates 1991: 23-49
  Google Scholar
• 62 Meyer T, Franz M, Gallhofer B. Subgruppen und Prognose besonders schwer zu enthospitalisierender schizophrener Langzeitpatienten: Eine Differenzierung des harten Kerns. Teil 2 der Hessischen Enthospitalisierungsstudie.  Psychiat Prax. 2002;  29 301-305
  Article in Thieme ConnectPubMedGoogle Scholar
• 63 Schwarz N. Stimmung als Information: Untersuchungen zum Einfluss von Stimmungen auf die Bewertung des eigenen Lebens. Heidelberg; Springer 1987
  Google Scholar
• 64 Cheng S-T. Subjective quality of life in the planning and evaluation of programs.  Eval Program Plann. 1988;  11 123-134
  PubMedGoogle Scholar
• 65 Kilian R, Dietrich S, Toumi M, Angermeyer M C. The effects of first generation and second generation antipsychotics on the quality of life of people with schizophrenia in routine outpatient treatment.  Acta Psychiatr Scand. 2004;  110 108-118
  CrossrefPubMedGoogle Scholar
• 66 Vorunganti L, Heslegrave R, Awad A G, Seeman M V. Quality of life measurement in schizophrenia: reconciling the quest for subjectivity with the question of reliability.  Psychol Med. 1998;  28 165-172
  CrossrefPubMedGoogle Scholar
• 67 Kaiser W, Priebe S. Zur Messung von Veränderungen der subjektiven Lebensqualität bei chronisch schizophrenen Patienten.  Nervenarzt. 1998;  69 219-227
  CrossrefPubMedGoogle Scholar
• 68 Franz M, Meyer T, Spitznagel A, Schmidt H, Wening K, Gallhofer B. Responsiveness of subjective quality of life in schizophrenic patients: a quasi-experimental pilot study.  Eur Psychiatry. 2001;  16 99-103
  CrossrefPubMedGoogle Scholar
• 69 Fakhoury W KH, Kaiser W, Roeder-Wanner U U, Priebe S. Subjective evaluation: Is there more than one criterion?.  Schizophr Bull. 2002;  28 319-327
  PubMedGoogle Scholar
• 70 Priebe S, Kaiser W, Huxley P, Röder-Wanner U-U, Rudolf H. Do different subjective evaluation criteria reflect distinct constructs?.  J Nerv Ment Dis. 1998;  186 385-392
  CrossrefPubMedGoogle Scholar
• 71 Ritsner M, Modai I, Endicott J, Rivkin O, Nechamkin Y, Barak P, Goldin V, Ponizovski A. Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients.  J Clin Psychiatry. 2000;  61 880-889
  PubMedGoogle Scholar
• 72 Ruggeri M, Bisoffi G, Fontecedro L, Warner R. Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach: The South Verona outcome project 4.  Br J Psychiatry. 2001;  178 268-275
  CrossrefPubMedGoogle Scholar
• 73 Warner R, Girolamo G de, Belelli G, Bologna C, Fioritti A, Rosini G. The quality of life of people with schizophrenia in Boulder, Colorado, and Bologna, Italy.  Schizophr Bull. 1998;  24 559-568
  PubMedGoogle Scholar
• 74 Hansson L, Eklund M, Bengtsson-Tops A. The relationship of personality dimensions as measured by the temperament and character inventory and quality of life in individuals with schizophrenia or schizoaffective disorder living in the community.  Qual Life Res. 2001;  10 133-139
  CrossrefPubMedGoogle Scholar
• 75 Kentros M K, Terkelsen K, Hull J, Smith T E, Goodman M. The relationship between personality and quality of life in persons with schizoaffective disorder and schizophrenia.  Qual Life Res. 1997;  6 118-122
  PubMedGoogle Scholar
• 76 Ritsner M, Farkas H, Gibel A. Satisfaction with quality of life varies with temperament types of patients with schizophrenia.  J Nerv Ment Dis. 2003;  191 668-674
  PubMedGoogle Scholar
• 77 Sibitz I, Gössler R, Katschnig H, Amering M. „Wissen - genießen - besser leben” - Ein Seminar für Psychoseerfahrene zur Verbesserung der Lebensqualität.  Psychiat Prax. 2006;  33 170-176
  PubMedGoogle Scholar
• 78 Linehan M M. Acceptance and change. In: Hayes SC, Jacobson NS, Follette VM, Dougher MJ Acceptance and change: Content and context in psychotherapy. Reno; Context Press 1994: 73-86
  Google Scholar

PD Dr. Michael Franz

Universitätsklinikum Gießen Marburg, Standort Gießen · Arbeitsgruppe Sozialpsychiatrie

Am Steg 24

35392 Gießen

Email: michael.franz@psychiat.med.uni-giessen.de