Zusammenfassung
Anliegen Die Untersuchung von Positivsymptomen und Lebensqualität aus der Sicht schizophrener Patienten. Methode Bei 59 Patienten wurden selbst- und fremdbewertete Positivsymptome (semistrukturiertes Interview), Psychopathologie (PANSS), subjektive Befindlichkeit (SWN) und Lebensqualität (MSLQ) untersucht. Ergebnisse Größenideen und dialogisierende Stimmen waren subjektiv weniger beeinträchtigend als imperative, abwertende Stimmen oder Verfolgungsideen. Patienten mit hoher Beeinträchtigung durch ihre Symptome berichteten eine signifikant schlechtere subjektive Befindlichkeit (SWN: t = 2,27; p < 0,05) und Lebensqualität (MSLQ: t = 2,01; p < 0,05), unterschieden sich jedoch nicht hinsichtlich der Schwere ihrer Symptome von Patienten mit geringer Beeinträchtigung (PANSS: t = − 0,98; p = n. s.). Schlussfolgerung Die subjektive Beeinträchtigung durch Positivsymptome spiegelt die individuelle Bedeutung der Symptome wider und ist mit schlechterer Lebensqualität assoziiert.
Abstract
Objective The aim of the study was the investigation of positive symptoms and quality of life from the subjective perspective of patients with schizophrenia. Methods We assessed self- and expert-rated positive symptoms (semi-structured interview), standardized psychopathology (PANSS), subjective well-being (SWN) and QOL (MSLQ) in n = 59 patients. Results Patients reported that ideas of grandiosity and hallucinations of dialogue voices were less distressing compared with command voices, malevolent voices and delusional ideas of persecution. Patients with high levels of distress reported significant lower subjective well-being (SWN: t = 2.27; p < 0.05) and QOL (MSLQ: t = 2.01; p < 0.05), but showed no differences in symptom severity (PANSS: t = − 0,98; p = n. s.) compared with patients with low subjective distress. Conclusions Distress caused by positive symptoms reflected the individual meaning of the symptoms and was associated with lower quality of life.
Schlüsselwörter
Schizophrenie - Positivsymptome - Lebensqualität - subjektive Befindlichkeit
Key words
schizophrenia - positiv-symptoms - quality of life - subjective well-being
Literatur
1
Franz M, Meyer T, Gallhofer B.
Subjektive Lebensqualität schwer chronifizierter schizophrener Langzeitpatienten.
Psychiat Prax.
2002;
29
306-310
2
Naber D, Lambert M, Karow A.
Subjektive Befindlichkeit unter neuroleptischer Behandlung und ihre Bedeutung für Compliance und Krankheitsverlauf.
Psychiat Prax.
2004;
31, Suppl 2
S230-S232
3
Karow A, Naber D.
Subjective well-being and quality of life under atypical antipsychotic treatment.
Psychopharmacology.
2002;
162
3-10
4
Lambert M, Schimmelmann B G, Naber D. et al .
Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia.
J Clin Psychiat.
2006;
67
1690-1697
5
Meyer T, Franz M.
Vorstellungen zur Lebensqualität schizophren Erkrankter. Der Zusammenhang mit ihren quantitativen Lebensqualitätsurteilen.
Psychiat Prax.
2006;
33
344-349
6
Franz M.
Möglichkeiten und Grenzen subjektiver Lebensqualität schizophrener Patienten als Outcomekriterium psychiatrischer Therapie.
Psychiat Prax.
2006;
33
317-322
7
Schmid R, Neuner T, Cording C, Spiessl H.
Lebensqualität schizophren Erkrankter und ihr Zusammenhang mit Krankheitsbewältigungsstrategien und Behandlungsaspekten.
Psychiat Prax.
2006;
33
337-343
8
Karow A, Czekalla J, Dittmann R W. et al .
Association of subjective well-being, symptoms, and side effects with compliance after 12 months of treatment in schizophrenia.
J Clin Psychiat.
2007;
68
75-80
9
Boitz K, Angermeyer M C, Loffler W, Muller P, Priebe S.
„Lieber dick und geistig da …” Patienten beurteilen Clozapin.
Psychiat Prax.
1999;
26
188-193
10
Angermeyer M C, Holzinger A, Matschinger H.
Lebensqualität, das bedeutet für mich … Ergebnisse einer Umfrage bei schizophrenen Patienten.
Psychiat Prax.
1999;
26
56-60
11
Hofer A, Kemmler G, Eder U. et al .
Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects.
J Clini Psychia.
2004;
65
932-939
12
Holzinger A, Loffler W, Muller P, Priebe S, Angermeyer M C.
Subjective illness theory and antipsychotic medication compliance by patients with schizophrenia.
J Nerv Ment Dis.
2002;
190
597-603
13
Voruganti L, Cortese L, Oyewumi L. et al .
Comparative evaluation of conventional and novel antipsychotic drugs with reference to their subjective tolerability, side-effect profile and impact on quality of life.
Schizophr Res.
2000;
43
135-145
14
Karow A, Moritz S, Lambert M, Schoder S, Krausz M.
PANSS syndromes and quality of life in schizophrenia.
Psychopathology.
2005;
38
320-326
15
Huppert J D, Weiss K A, Lim R, Pratt S, Smith T E.
Quality of life in schizophrenia: contributions of anxiety and depression.
Schizophr Res.
2001;
51 (2 – 3)
171-180
16
Hofer A, Rettenbacher M A, Widschwendter C G. et al .
Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder.
Eur Arch Psychiatry Clin Neurosci.
2006;
256 (4)
246-255
17
Pukrop R, Schlaak V, Moller-Leimkuhler A M. et al .
Reliability and validity of Quality of Life assessed by the Short-Form 36 and the Modular System for Quality of Life in patients with schizophrenia and patients with depression.
Psychiat Res.
2003;
119
63-79
18
Eack S, Newhill C.
Psychiatric Symptoms and Quality of Life in Schizophrenia: A Meta-Analysis.
Schizophr Bull.
2007;
33 (5)
1225-1237
19
Eack S M, Newhill C E, Anderson C M, Rotondi A J.
Quality of life for persons living with schizophrenia: more than just symptoms.
Psychiat Rehabil J.
2007;
30
219-222
20
Birchwood M, Meaden A, Trower P, Gilbert P, Plaistow J.
The power and omnipotence of voices: subordination and entrapment by voices and significant others.
Psychol Med.
2000;
30
337-344
21
Iqbal Z, Birchwood M, Chadwick P, Trower P.
Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model.
Brit J Psychiat.
2000;
177
522-528
22
Garety P A, Freeman D, Jolley S. et al .
Reasoning, emotions, and delusional conviction in psychosis.
J Abnorm Psychol.
2005;
114
373-384
23
Green C, Garety P A, Freeman D. et al .
Content and affect in persecutory delusions.
Brit J Clin Psychol.
2006;
45
561-577
24
Kuipers E, Garety P, Fowler D. et al .
Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms.
Schizophr Bull.
2006;
32, Suppl 1
S24-31
25
Smith B, Fowler D G, Freeman D. et al .
Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations.
Schizophr Res.
2006;
86
181-188
26
Guillem F, Pampoulova T, Stip E, Lalonde P, Todorov C.
The relationships between symptom dimensions and dysphoria in schizophrenia.
Schizophr Res.
2005;
75
83-96
27
Häfner H, Maurer K, Trendler G. et al .
Schizophrenia and depression: challenging the paradigm of two separate diseases – a controlled study of schizophrenia, depression and healthy controls.
Schizophr Res.
2005;
77
11-24
28
Birchwood M, Iqbal Z, Upthegrove R.
Psychological pathways to depression in schizophrenia: studies in acute psychosis, post psychotic depression and auditory hallucinations.
Eur Arch Psychiatry Clin Neurosci.
2005;
255
202-212
29
Bentall R P, Corcoran R, Howard R, Blackwood N, Kinderman P.
Persecutory delusions: a review and theoretical integration.
Clin psychol rev.
2001;
21
1143-1192
30
Morrison A P, Nothard S, Bowe S E, Wells A.
Interpretations of voices in patients with hallucinations and non-patient controls: a comparison and predictors of distress in patients.
Behav Res Ther.
2004;
42
1315-1323
31
Garety P A, Kuipers E, Fowler D, Freeman D, Bebbington P E.
A cognitive model of the positive symptoms of psychosis.
Psychol Med.
2001;
31
189-195
32
Hemsley D R.
Schizophrenia. A cognitive model and its implications for psychological intervention.
Behav Mod.
1996;
20
139-169
33
Freeman D, Garety P A, Kuipers E, Fowler D, Bebbington P E.
A cognitive model of persecutory delusions.
Brit J Clin Psychol.
2002;
41
331-347
34
Freeman D, Garety P A, Kuipers E. et al .
Acting on persecutory delusions: the importance of safety seeking.
Behav Res Ther.
2007;
45
89-99
35
Favrod J, Grasset F, Spreng S, Grossenbacher B, Hode Y.
Benevolent voices are not so kind: the functional significance of auditory hallucinations.
Psychopathology.
2004;
37
304-308
36
Copolov D L, Mackinnon A, Trauer T.
Correlates of the affective impact of auditory hallucinations in psychotic disorders.
Schizophr Bull.
2004;
30
163-171
37
Romme M A, Honig A, Noorthoorn E O, Escher A D.
Coping with hearing voices: an emancipatory approach.
Brit J Psychiat.
1992;
161
99-103
38
Carter D M, Mackinnon A, Copolov D L.
Patients' strategies for coping with auditory hallucinations.
J Nerv Ment Dis.
1996;
184
159-164
39
Birchwood M, Meaden A, Trower P, Gilbert P, Plaistow J.
The power and omnipotence of voices: subordination and entrapment by voices and significant others.
Psychol Med.
2000;
30
337-344
40
Close H, Garety P.
Cognitive assessment of voices: further developments in understanding the emotional impact of voices.
Brit J Clin Psychol.
1998;
37 (Pt 2)
173-188
41
Tien A Y.
Distributions of hallucinations in the population.
Soc Psych Psych Epid.
1991;
26
287-292
42
Valmaggia L R, van der Gaag M, Tarrier N, Pijnenborg M, Slooff C J.
Cognitive-behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. Randomised controlled trial.
Br J Psychiat.
2005;
186
324-330
43
Hacker D, Birchwood M, Tudway J, Meaden A, Amphlett C.
Acting on voices: omnipotence, sources of threat, and safety-seeking behaviours.
Br J Clin Psychol.
2007 Oct 23;
44
Sanjuan J, Gonzalez J C, Aguilar E J, Leal C, van Os J.
Pleasurable auditory hallucinations.
Acta Psychiat Scand.
2004;
110
273-278
45
Miller L J, O'Connor E, DiPasquale T.
Patients' attitudes toward hallucinations.
Am J Psychiat.
1993;
150
584-588
46
Chadwick P, Birchwood M.
The omnipotence of voices. A cognitive approach to auditory hallucinations.
Brit J Psychiay.
1994;
164
190-201
47
Miller L J.
Qualitative changes in hallucinations.
Amer J Psychiat.
1996;
153
265-267
48
Kay S R, Fiszbein A, Opler L A.
The positive and negative syndrome scale (PANSS) for schizophrenia.
Schizophr Bull.
1987;
13
261-276
49
Bell M D, Lysaker P H, Beam-Goulet J L, Milstein R M, Lindenmayer J P.
Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale.
Psychiat Res.
1994;
52
295-303
50
Conley R R.
Evaluating clinical trial data: outcome measures.
J Clin Psychiat.
2001;
62, Suppl 9
23-26
51
Mass R, Schoemig T, Hitschfeld K, Wall E, Haasen C.
Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale.
Schizophr Bull.
2000;
26 (1)
167-177
52
Naber D.
A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables.
Int Clin Psychopharm.
1995;
10, Suppl 3
133-138
53
Pukrop R, Moller H J, Sass H. et al .
Das Konstrukt Lebensqualität Metaanalytische Validierung und die Entwicklung eines modularen Erhebungssystems.
Nervenarzt.
1999;
70
41-53
54
Moritz S, Werner R, Collani G V.
The inferiority complex in paranoia re-addressed. A study with the Implicit Association Test.
Cognit Neuropsych.
2006;
11
402-415
55
Rosenheck R, Stroup S, Keefe R S. et al .
Measuring outcome priorities and preferences in people with schizophrenia.
Brit J Psychiat.
2005;
187
529-536
56
Offen L, Waller G, Thomas G.
Is reported childhood sexual abuse associated with the psychopathological characteristics of patients who experience auditory hallucinations?.
Child Abuse Neglect.
2003;
27
919-927
57
Hardy A, Fowler D, Freeman D. et al .
Trauma and hallucinatory experience in psychosis.
J Nerv Ment Dis.
2005;
193
501-507
58
Gaudiano B A, Herbert J D.
Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results.
Behav Res Ther.
2006;
44
415-437
59
Bach P, Hayes S C.
The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial.
J Consult Clin Psychol.
2002;
70
1129-1139
60
Sibitz I, Gossler R, Katschnig H, Amering M.
„Wissen – genießen – besser leben” – Ein Seminar für Psychoseerfahrene zur Verbesserung der Lebensqualität und Verringerung der Verletzlichkeit.
Psychiat Prax.
2006;
33
170-176
Dr. Anne Karow
Zentrum für Psychosoziale Medizin, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
Email: karow@uke.uni-hamburg.de