Michael Franz

The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients

In schizophrenic patients, quality of life (QoL) studies often find high levels of general life satisfaction and satisfaction in various life domains despite deprived living conditions. Therefore, the usefulness of QoL as an outcome indicator has been questioned. Since social comparison processes have been postulated to be related to the level of satisfaction, this hypothesis was analysed empirically by the present study in schizophrenic patients. Satisfaction and social comparisons of 148 schizophrenic inpatients and 66 mentally healthy controls were examined with regard to the domains ‘health’ and ‘family’ by means of a standardised interview. The schizophrenic patients had a history of either long-term (n = 75) or short-term (n = 73) restricted and deprived living conditions. Long-term patients showed significantly higher satisfaction levels than short-term patients. They compared themselves predominantly laterally or downwards with fellow inpatients. Significant relationships between the direction of social comparisons and satisfaction ratings were found in all three samples. Social comparisons proved to be important for the level of satisfaction in schizophrenic patients. Results indicate that experiences of restricted and deprived living conditions induce accommodation processes and response-shifts that should be taken into account in the interpretation of quality-of-life data.

Treatment of alcohol withdrawal: tiapride and carbamazepine versus clomethiazole.

Abstract In Germany, clomethiazole (CLO) and benzodiazepines are predominantly used as therapeutic agents in the treatment of the alcohol withdrawal syndrome (AWS). These agents have disadvantages such as sedation, risk of respiratory insufficiency, and cardiovascular complications as well as addictive potential. Alternatively, it could be demonstrated that both tiapride (TIA) and carbamazepine (CBZ) are efficient in the treatment of AWS with less toxicity. However, they seem to be less effective in AWS than CLO as single agents. But no systematic comparison of the combination of TIA and CBZ against an established therapeutic standard can be found in the literature. Therefore, we compared the combination of TIA and CBZ with CLO in two open exploratory studies with matched samples. Outcome parameters were heart rate, blood pressure, complications, withdrawal symptoms (CIWA-Ar scale), and general clinical state (CGI scale). A retrospective evaluation of medical records (30 TIA+CBZ, 30 CLO) was followed by an open prospective study (40 TIA+CBZ, 40 CLO). Both studies revealed similar efficacy in terms of psychopathologic and vegetative symptoms. Vegetative recovery seems to be faster with TIA+CBZ. Results of this exploratory study have to be confirmed by a controlled double-blind study with severity of AWS as an experimental factor.

The "DGPPN-Cohort": A national collaboration initiative by the German Association for Psychiatry and Psychotherapy (DGPPN) for establishing a large-scale cohort of psychiatric patients.

The German Association for Psychiatry and Psychotherapy (DGPPN) has committed itself to establish a prospective national cohort of patients with major psychiatric disorders, the so-called DGPPN-Cohort. This project will enable the scientific exploitation of high-quality data and biomaterial from psychiatric patients for research. It will be set up using harmonised data sets and procedures for sample generation and guided by transparent rules for data access and data sharing regarding the central research database. While the main focus lies on biological research, it will be open to all kinds of scientific investigations, including epidemiological, clinical or health-service research.

Modifikation und Anwendung der Münchner Lebensqualitäts-Dimensionen-Liste bei schizophrenen Patienten

Fur die Evaluation einer Versorgungsstruktur schizophrener Patienten wurde ein Inventar zur Lebensqualitat gesucht, das zusammen mit weiteren Beurteilungsverfahren eingesetzt werden kann, ohne die Patienten durch die Dauer der Untersuchung zu uberfordern. Es sollte ein umfassendes Profil der subjektiven Lebensqualitat erfassen, praktikabel sein und befriedigende psychometrische Gutekriterien aufweisen (Bullinger und Poppel, 1988). Das Instrument sollte bereits durch die Art der Konstruktion einen konsequent subjektiven Ansatz verfolgen, da objektive Indikatoren der Lebensqualitat bestenfalls bescheidene Beziehungen zur Lebenszufriedenheit hervorbringen und bei Probanden mit atypischem Lebensstil — wie z.B. chronisch psychisch Kranken — noch unzulanglicher sind (Lehman, 1983).

QLiS – development of a schizophrenia-specific quality-of-life scale

BackgroundThe aim of the project was to develop an instrument for the assessment of subjective quality of life specific to schizophrenic persons on the basis of patients’ views on their own life and on sound psychometric principles.MethodsThe project applied a six-step multiphase development process with six distinct studies. (1) The elicitation of schizophrenic persons’ views on their quality of life was based on open-ended interviews with interviewees from different settings (acute ward inpatients, long-term care patients, community care patients; n = 268). (2) A cross-sectional study with schizophrenic and healthy persons was conducted to quantify the relative importance of the various aspect of quality of life that emerged from the qualitative study (n = 143). (3) We conducted an empirical comparison of response formats with schizophrenic persons (n = 32). (4) A scale construction- and reliability-testing study was performed (n = 203) as well as (5) a test-retest reliability study (n = 49). (6) The final questionnaire (QLiS, quality of life in schizophrenia) was tested in an additional study on convergent and discriminant validity (n = 135).ResultsThe QLiS comprises 52 items (plus 2 optional items related to work) in 12 subscales: social contacts, appreciation by others, relationship to family, appraisal of pharmacotherapy, appraisal of psychopathological symptoms, cognitive functioning, abilities to manage daily living, appraisal of accommodation/housing, financial situation, leading a ’normal‘ life, confidence, general life-satisfaction. An item response format with four response categories was preferred by the schizophrenic persons. The mean values of the subscales clustered around the theoretical mean of the subscales and only minimal ceiling effects were found. The reliability (test-retest-reliability and internal consistency) was with one exception > .70 for all subscales.ConclusionTaking the low numbers of items per subscale into account, the QLiS can be regarded as an accurate assessment instrument of subjective quality of life in schizophrenia with good content validity.

[Shared psychotic disorder (Folie à deux) and Huntington's disease].

INTRODUCTION Folie à deux describes a rare psychiatric disorder of mostly closely related persons. The main feature of this disease is the unconditional adoption of the delusions of the primarily diseased person by the second person. This disturbance most frequently originates from a paranoid schizophrenia. METHOD Our case is the first published description of a married couple with shared psychotic disorders which were caused by a genetically verified Chorea Huntington of the husband. RESULTS The symptoms of the wife quickly declined after spatial separation from her primarily diseased husband. Thus, in her case it was assumed that she suffered from a Folie imposée which is a sub form of the Folie à deux. DISCUSSION Our case report demonstrates that not only a paranoid schizophrenia but also an organic psychosis may cause this very interesting form of shared psychotic disorder.