137 / 2019-11-05 18:20:22

Quality of Life and global functioning in symptomatic remission in first episode psychosis in Northern Malawi

Psychosis,first-episode psychosis,remission,global functioning,Quality of Life

Aims: To examine whether Quality of Life; and social, occupational, and psychological functioning could also improve among the subjects in symptomatic remission after prescription of antipsychotic medications.

Methods: This study followed-up 126 subjects with first episode psychosis over 18 months between June 2009 and September 2012. Assessments at baseline included socio-demographic characteristics, the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), World Health Organization Quality of Life (WHO-QoL) scale, and social, occupational, and psychological functioning as measured by the Global Assessment of Functioning (GAF) scale. Follow-up assessments of the later 4 preceding measurements were conducted every month after initiation of antipsychotic medications, during which subjects were classified as in symptomatic remission whey they showed remission in both positive and negative symptoms according to the Remission in Schizophrenia Working Group (RSWG) criteria. Descriptive statistics were used to summarize sample characteristics and Wilcoxon Signed Ranks Test was used for the paired comparisons to generate the main results.

Results: A total of 28 subjects were lost to follow-up, thus 98 (77.8%) subjects were included in the final analysis. Nevertheless, 23 subjects were excluded when analyzing Quality of Life because they had more than 20% of missing Quality of Life follow-up data. At the end of follow-up, 70 (71.4%) of the subjects achieved symptomatic remission. Generally, there was improvement in physical health (P value = 0.003), psychological health (P value = 0.016), and GAF (P value < 0.001). Nevertheless, there was no improvement in the Quality of Life and GAF of the non-remission group, whereas the remission group had improvements in physical health (P value = 0.003), psychological health (P value = 0.015), environment (P value = 0.020), and GAF (P value < 0.001). Therefore, despite achieving symptomatic remission, the levels of overall quality of life, overall health, and social relationships did not improve.

Conclusions: Symptomatic remission following prescription of antipsychotic medication was related to improvements in GAF and some aspects of Quality of Life such as physical health, psychological health, and environment. Considering the various challenges on remission or recovery in psychosis after prescription of antipsychotic medications, epidemiological studies on therapy methods to improve Quality of Life; and social, occupational, and psychological functioning in individuals with psychosis are necessary, especially on overall quality of life and health, and social relationships. In this respect, longer period prospective studies are needed to ascertain whether antipsychotic medications would not improve overall quality of life and health, and social relationship aspects of Quality of Life.