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Quality of life in schizophrenia: the role of compliance

The assessment of outcome in schizophrenia has changed significantly in the last decade. The introduction of the novel antipsychotic drugs and the movement of community psychiatry and deinstitutionalization has shifted attention to functioning of the patient in everyday situations, satisfaction from life, the fulfillment of social roles and interpersonal communication. These domains constitute the so-called "Quality of Life" (QoL). QoL is a complex phenomenon, dependent on many factors that interrelate to each other. In schizophrenia in particular, research has underlined the importance of the following factors related to the QoL of the patients.

Experiences related to the medication. These refer to the effectiveness of the medication to alleviate positive as well as negative symptoms, side effects (e.g. extrapyramidal symptoms, sedation, effect on the sexual function) and their consequences in everyday life.

Insight of the patient into his condition and the restrictions imposed by the illness.

Compliance to medication, related to the above mentioned two factors. This refers to experiences with previous medications, the characteristics of current medication, dosage and the route of administration of the medication, as well as to idiosyncratic factors and factors related to the stage of the illness and symptomatology (responiveness to antipsychotic drugs, insight). Compliance is also related to the type of care offered to the patient (continuity of care vs. fragmented care), in the sense that continuous care ensures that the patient is not lost during his "career", being followed up at regular times and having access to the services at all times.

There is very little research into the effect of compliance in the QoL in schizophrenia. The complexity of the phenomenon makes its study difficult, since the interrelations between factors are not yet clear as well the direction of effect. However, the existing research shows that improved compliance ensures a better QoL for schizophrenic patients. The introduction of the novel antipsychotics and newer formulations, with less side effects, is promising not only for their effectiveness in minimizing symptoms of the illness, but also for improving compliance and QoL.

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Mavreas, V. Quality of life in schizophrenia: the role of compliance. Ann Gen Hosp Psychiatry 2 (Suppl 1), S25 (2003).

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