Symptom improvement after antipsychotics not a predictor of life satisfaction

Symptom improvement after antipsychotics not a predictor of life satisfaction
By Sarah Pritchard, medwireNews Reporter
31 March 2014
Eur Neuropsychopharmacol 2014; Advance online publication

medwireNews: Patients treated with antipsychotics for chronic schizophrenia only report a slight improvement in their satisfaction with life (SWL), despite the significant clinical benefits of the treatment, report Canadian researchers.

Their findings reveal that the most significant predictor of improvement in SWL after a year of treatment was baseline SWL level, which accounted for more variation in score changes than other factors including a measure of the clinical severity of disease.

“It may well be that treatment and symptom management are necessary but not sufficient for gains in SWL,” suggest Gagan Fervaha (Center for Addiction and Mental Health, Toronto, Ontario) and colleagues.

“[O]r perhaps it may be the case that these two clinical domains are independent”, they add, in European Neuropsychopharmacology.

The team cautions that despite aspiring to “personalised medicine”, we may be doing so while still “steeped in more traditional definitions” of response and recovery that are driven by symptom-based efficacy measures.

Data for 753 participants of the Clinical Antipsychotic Trial of Intervention Effectiveness were included in the analysis. Participants had a mean baseline SWL score of 4.4, where a score of 1.0 indicates “terrible” and 7.0 indicates “delighted” in response to the Lehman Quality of Life Interview item: “How do you feel about your life in general?”.

After 12 months’ treatment, the most significant independent predictor of treatment-related change in SWL was baseline SWL score, which explained 41% of the variance, report Fervaha et al. Specifically, patients with lower scores at baseline had larger improvements during follow-up.

Conversely, a change in Clinical Global Impression - Severity score from baseline was only associated with a minor change in SWL, and this was not significant in multivariate analysis.

The other significant independent predictors revealed by multivariate analysis included a change in Calgary Depression Scale for Schizophrenia total scores from baseline, and a change in Quality of Life Scale total scores. However, these collectively accounted for less than 3% of the variance, say the researchers.

“As previous work has demonstrated that severity of psychotic symptoms is only minimally related to SWL, it follows that ameliorating these symptoms will not substantially alter SWL”, conclude the researchers