افسردگی و کیفیت زندگی در بیماران با روان پریشی اپیزود اول

Aim Quality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL. Methods We assessed 208 individuals with first-episode non-affective psychosis using measures of diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), symptoms (Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning), insight (Birchwood Scale), duration of untreated psychosis (Beiser Scale), and QOL World Health Organisation Quality of Life Instrument (WHOQOL-Bref). We used multiple regression to determine the contribution of depressive symptoms to QOL domains while controlling for socio-demographic and other clinical characteristics. Results There were complete data for 146 individuals with FEP. Quality-of-life domains were consistently predicted by depressive symptoms including depressive mood and hopelessness rather than biological symptoms of depression with those experiencing more depressive symptoms reporting worse QOL. Those who were treated as in-patients reported improved QOL, and hospitalization was an independent predictor of most QOL domains. In-patients displayed greater levels of positive symptoms with those involuntarily detained displaying greater levels of bizarre behavior, thought disorder, and delusions. Conclusions These findings suggest that QOL is heavily influenced by depressive symptoms at initial presentation; however, as QOL domains are also influenced by admission status with in-patients being more symptomatic in terms of positive symptoms, subjective QOL assessment may be compromised during the acute phase of illness by both positive and depressive symptom severity.

Quality of life (QOL) has gained recognition as a valid measure of outcome in those with first-episode psychosis (FEP) [1]. At first presentation, poorer QOL is seen in those with greater severity of both positive [2] and [3] and negative symptoms [4] and is associated with a range of variables indicating an unfavorable course such as male sex [5], being single, comorbid substance misuse [6], and poorer premorbid functioning [7] and [8]. In addition, several studies have found that the duration of untreated psychosis (DUP) is linked with QOL; those experiencing lengthier delays before accessing treatment show impaired QOL [6] and [8]. Quality of life has also been shown to be worse in those with FEP when compared with healthy controls [9] irrespective of whether the individual has remitted from their first episode of psychotic illness [8]. However, the results of studies of QOL in FEP have been inconsistent [7], [10] and [11]. This may reflect the use of different instruments and varying QOL concepts adopted in each study [1] and [9]. Furthermore, subjectivity is central to the QOL concept [9] and [12]. Quality of life can be broadly separated into 2 opposing paradigms with objective indicators of material living conditions and subjective appraisals of one's own life representing each aspect [1]. It has been consistently shown that QOL is negatively influenced by general psychopathology [6] and [13] and, in particular, depressive symptoms [6], [7] and [14]. However, it is still unclear which depressive symptoms influence QOL in FEP at first presentation. It is also unknown whether the presence of depressive symptoms affects QOL domains universally or whether their influence can distinguish one domain from another. This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL. In addition, we aimed to evaluate the contribution of possible predictors of QOL such as positive and negative symptoms, DUP, treatment factors, and socio-demographic characteristics.