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11. Psychosocial

P R E L I M I N A R Y V A L I D A T I O N O F A

C O N C E P T U A L M O D E L T O A S S E S S

Q U A L I T Y O F L I F E I N S C H I Z O P H R E N I A

A. George Awad, Laskhmi N.P. Voruganti*, Ronald Heslegrave

Department of Psychiatry, University of Toronto, The Wellesley Hospital 160 Wellesley Street East, Toronto, Ontario, M4 Y 1J3, Canada

A recent model has conceptualized the quality of life of medicated schizophrenics as the net outcome of a triangular interaction between the patients' clinical status, (side) effects of medication and psychosocial performance. Other factors that interact with the three major determinants and can modify outcome to neuroleptic therapy include premorbid characteris- tics, psychosocial adjustment and subjective response to neuro- leptics (Awad, 1992, 1994). The present study attempts to validate the proposed model and delineate the relative contribu- tions of clinical, drug therapy and psychosocial issues. Sixty- three stable schizophrenic outpatients (DSM-III-R) maintained on antipsychotic drug treatment were assessed and their overall response to treatment, attitudes toward treatment, side effects, clinical symptom profile and psychosocial adjustment were documented. A multiple regression analysis was used to assess the extent of which the independent predictor variables, (symp- toms, side effects, attitudes, drug response and psychosocial adjustment course) predict the dependent variable (self rated quality of life). Using the Sickness Impact Profile (SIP) overall score as the dependent variable, a significant amount of variance was accounted for by the total PANSS score (Partial r2=0.32, p=0.0001). Alternatively in predicting the Global Quality of Life Rating, significant contributions wer made by the total PANSS score (Partial r2=0.23, p=0.001), DAI score (sub- jective response--Partial r2=0.10, p=0.01) and the AIMS score (Partial r 2 =0.06, p = 0.05). Contribution of the psycho- social adjustment scores (Social Performance Schedule and Global Assessment of Functioning Scale) were negligible for both outcomes. The results confirm the multidimensional nature of quality of life and also demonstrate the relevance of illness severity and side effects toward the quality of life of medicated schizophrenics.

F A C T O R S A S S O C I A T E D W I T H

T R E A T M E N T D E L A Y A M O N G

I N D I V I D U A L S S U F F E R I N G A F I R S T

E P I S O D E O F S C H I Z O P H R E N I A

G. Bean*, J. Wong, M. Beiser

Clarke Institute of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada

Prior to entry into treatment for a first episode of schizophre- nia, the onset of prominent psychotic symptoms may occur months or years before. As delay in seeking treatment has been suggested to be associated with poor outcome, it is critical to identify factors associated with delay in seeking treatment. Individuals suffering a first episode of schizophrenia participa- ted in the study. Results revealed that delay in seeking treatment was significantly associated with negative attributions toward the ill individual by friends and family members. In turn, negative attributions were significantly associated with older age of the ill individual, poor premorbid occupational function- ing and disorganized symptoms. The relationship between these identified variables and short-term outcome will be investigated in future work.

R O L E O F C O P I N G I N C L I N I C A L S T A T U S

A N D C O U R S E O F I L L N E S S I N

S C H I Z O P H R E N I A

W. Brker*, H.D. Brenner, M. Merlo

Psychiatrische Universitgitsklinik Bern, Bolligenstrasse 111, CH-3072 Ostermundigen, Switzerland

The vulnerability-stress model of schizophrenia has stim- ulated interest in the coping efforts mobilized by afflicted patients to meet stressful demands and in the possible therapeu- tic relevance of the coping paradigm. In a prospective study funded by the Swiss National Foundation we examined the interactions by which coping and a wide range of other variables influence one another at 6- and 12-month follow-up points in a group of 28 DMS-III-R first-episode schizophrenic patients. The variables assessed included: personality factors (level of premorbid adjustment, vulnerability, psychological resources, etc.); environmental factors (acute and chronic stressors, etc.); psychopathology (positive and negative symptoms, impair- ments, psychosocial adjustment, etc.). Coping was assessed by the Osnabrt~ck Coping Questionnaire. Based on an interactive- developmental model of schizophrenia synchronic and dia- chronic analyses of the data obtained over the three cross- sections were computed. The major findings which have emerged from the analyses conducted to date show that: (1) coping is relevant to outcome of the illness at 6- and 12-months follow-up; (2) definable changes in coping, in partic- ular those occurring in the first half-year subsequent to hospital admission, are significantly related to better or worse outcome of illness; (3) coping can be understood as a transactional process between situational appraisal and coping reaction, situational appraisal seems to play a way paving role in change. The results have both theoretical and practical-therapeutic implications. Coping seems to be an additional predictive factor as well as a promising focus in psychosocial therapy.