title: Quality of life during treatment with haloperidol or olanzapine in the year following a first psychotic episode Application of a disease-specific mapping function to estimate utility gains with effective treatment of schizophrenia Health-related quality of life in patients with schizophrenia during treatment with long-acting, injectable risperidone. Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic disorders: Quality of life and clinical outcomes of a randomized clinical trial Changes in quality of life in chronic psychiatric patients: A comparison between EuroQol (EQ-5D) and WHOQoL The relationship between quality of life and clinical efficacy from a randomized trial comparing olanzapine and ziprasidone. Development and validation of a patient-based health-related quality of life questionnaire in schizophrenia: the S-QoL Estimating a preference-based index from the Japanese SF-36. The MOS 36-Item Short Form Health Survey: reliability, validity, and preliminary findings in schizophrenic outpatients. Short-term symptomatic and functional outcomes of schizophrenia in Butajira, Ethiopia Longer time to antipsychotic treatment discontinuation for any cause is associated with better functional outcomes for patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder. Reliability, validity, and application of the medical outcomes study 36-item short-form health survey (SF-36) in schizophrenic patients treated with olanzapine versus haloperidol.
abstract: OBJECTIVES Schizophrenia causes significant impairments of quality of life . As treatment approaches have advanced , more attention has been given to re-integrating patients into their psychosocial environments , rather than simply monitoring psychotic symptoms . The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics . This improvement is particularly relevant early in the course of schizophrenia . METHODS To address these considerations , improvements in measures of general health and social function ( determined using the SF-36 ) were assessed in 195 patients with first-episode schizophrenia for up to one year following r and omization to either olanzapine or haloperidol  in a double blind clinical trial . We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol . In order to test this hypothesis , we used a repeated measure model with SF-36 scores as the outcome , and treatment group , time , time2 , time-by-treatment group interaction , and time2-by-treatment group interaction as fixed effects . RESULTS Both treatments demonstrated similar changes on the SF-36 . Independent of treatment , patients demonstrated significant improvements in most of the SF-36 subscales , which approached normative scores by the end of one year of treatment . Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study ( p<.4 ) . CONCLUSIONS These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders , namely that they can expect to recover significant quality of life and social function at least initially in treatment Background Most tools for estimating utilities use clinical trial data from general health status models , such as the 36-Item Short-Form Health Survey ( SF-36 ) . A disease-specific model may be more appropriate . The objective of this study was to apply a disease-specific utility mapping function for schizophrenia to data from a large , 1-year , open-label study of long-acting risperidone and to compare its performance with an SF-36-based utility mapping function . Methods Patients with schizophrenia or schizoaffective disorder by DSM-IV criteria received 25 , 50 , or 75 mg long-acting risperidone every 2 weeks for 12 months . The Positive and Negative Syndrome Scale ( PANSS ) and SF-36 were used to assess efficacy and health-related quality of life . Movement disorder severity was measured using the Extrapyramidal Symptom Rating Scale ( ESRS ) ; data concerning other common adverse effects ( orthostatic hypotension , weight gain ) were collected . Transforms were applied to estimate utilities . Results A total of 474 patients completed the study . Long-acting risperidone treatment was associated with a utility gain of 0.051 using the disease-specific function . The estimated gain using an SF-36-based mapping function was smaller : 0.0285 . Estimates of gains were only weakly correlated ( r = 0.2 ) . Because of differences in scaling and variance , the requisite sample size for a r and omized trial to confirm observed effects is much smaller for the disease-specific mapping function ( 156 versus 672 total subjects ) . Conclusion Application of a disease-specific mapping function was feasible . Differences in scaling and precision suggest the clinical ly based mapping function has greater power than the SF-36-based measure to detect differences in utility BACKGROUND We investigated the impact of treatment with long-acting , injectable risperidone versus placebo on health-related quality of life ( HRQoL ) in patients with schizophrenia . Results are discussed in the context of HRQoL in the general U.S. population . METHOD Patients with DSM-IV schizophrenia entered a r and omized , double-blind , placebo-controlled trial . After screening , previous antipsychotics were discontinued , and oral risperidone was titrated up to a dose of 4 mg/day over 1 week . Patients were then r and omly assigned to receive placebo  [ N = 92 ] or long-acting risperidone ( 25 [ N = 93 ] , 50 [ N = 97 ] , or 75 mg [ N = 87 ] every 2 weeks ) for 12 weeks . HRQoL was measured using the Medical Outcomes Study Short-Form 36-item question naire ( SF-36 ) . RESULTS At week 12 , patients receiving long-acting risperidone had improved significantly ( p < .05 ) in 5 domains of the SF-36 ( bodily pain , general health , social functioning , role-emotional , and mental health ) compared with patients receiving placebo . The effect was greatest for the 25-mg group , with significant improvement versus placebo in 6 domains ( p < .05 ) . At baseline , all SF-36 domain scores except bodily pain were significantly lower ( p < .05 ) than normal values in all groups . With placebo , scores in all 8 domains remained below normal values after 12 weeks , while patients receiving long-acting risperidone showed improvement in HRQoL toward normal levels , with clinical ly meaningful improvements in all mental-health domains . In the 25-mg group , scores in 7 domains were not statistically different from normal values after 12 weeks . CONCLUSIONS Long-acting , injectable risperidone improved HRQoL toward normal levels . After 12 weeks , HRQoL of patients receiving 25 mg was not significantly different from normal Background : Little information is available on the impact of the atypical antipsychotic olanzapine on quality of life ( QOL ) . A 6-week , double-blind r and omized multicenter trial , with a long-term extension , was conducted to evaluate the clinical efficacy and QOL of olanzapine and haloperidol in treating schizophrenia and other psychotic disorders . Methods : A total of 828 out patients provided QOL data . Study patients were aged greater than 18 years with a DSM-III-R diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder and baseline BPRS ( items scored on 0–6 scale ) total scores , ≥18 were r and omized to 6 weeks of treatment with olanzapine 5 to 20 mg/day or haloperidol 5 to 20 mg/day . Patients entered a 46-week double-blind extension if they demonstrated minimal clinical response and were tolerant to study medication . The Quality of Life Scale ( QLS ) and SF-36 Health Survey were used to evaluate QOL . Results : During the 6-week acute phase , olanzapine treatment significantly improved BPRS total ( p = 0.004 ) , PANSS total scores ( p = 0.043 ) , QLS total ( p = 0.005 ) , intrapsychic foundations ( p < 0.001 ) and interpersonal relations scores ( p = 0.036 ) , and SF-36 mental component summary scores ( p < 0.001 ) compared with haloperidol . During the extension phase , olanzapine treatment significantly improved PANSS negative scores ( p = 0.035 ) and improved QLS total ( p = 0.001 ) , intrapsychic foundations ( p < 0.001 ) , and instrumental role category scores ( p = 0.015 ) versus haloperidol treatment . Significantly more  haloperidol patients discontinued treatment due to adverse events during the acute and extension phases ( p = 0.041 and p = 0.014 , respectively ) . Changes in QLS total and MCS scores were associated with changes in clinical symptoms , depression scores and extrapyramidal symptoms . Conclusions : Olanzapine was more effective than haloperidol in reducing severity of psychopathology and in improving QOL in patients with schizophrenia and other psychotic disorders . The QOL benefits of olanzapine , although modest , may be important for long-term treatment It has often been postulated that simple , short question naires are unable to reflect complex changes in well-being of individuals with chronic psychiatric disorders . To investigate these assumptions we included two recently developed instruments to measure quality of life  ( the WHOQoL-Bref and the EuroQoL EQ-5D ) in a r and omised control trial ( RCT ) in which two treatment conditions were compared . Aims of the study were to assess the sensitivity and validity of these  quality of life (QoL)-instruments  , to establish their relationship and to examine the predictors of changes in QoL. Subjective changes in QoL were measured on three assessment s waves in a period of 18 months and compared to objective changes in psychopathology and social functioning in a sample of 76 chronic schizophrenic patients who participated in the RCT . Results indicated that both WHOQoL-Bref and EuroQoL EQ-5D are capable of detecting changes in QoL over time in physical and psychological well-being . The instruments partly measure the same aspects of QoL , indicated by 50 % common variance on total scores . Reduction of positive psychotic symptoms appeared to be the most important factor in improving QoL. The weighted TTO-score of EuroQoL-5D , which is often used as an index in economic evaluations of health care , did however not correspond with these changes , which indicates that it is less sensitive to changes in social and psychological well-being . It ’s use as the core measure in ( economic ) health evaluation in the field of psychiatry therefore seems less appropriate OBJECTIVE To examine treatment-specific changes in health-related quality of life ( QOL ) among patients with schizophrenia and to assess the association between clinical and QOL improvement . METHOD This post hoc analysis used the findings of a 28-week , r and omized , multicenter trial of patients with schizophrenia ( DSM-IV ) treated with olanzapine ( 10 - 20 mg/day ) or ziprasidone ( 80 - 160 mg/day ) . Data were collected from August 2001 to December 2002 .  Efficacy was measured using the Positive and Negative Syndrome Scale ( PANSS ) . Quality of life was assessed with the generic health self-administered Medical Outcomes Study Short-Form 36-Item Health Survey ( SF-36 ) and the disease-specific expert-administered Heinrichs-Carpenter Quality of Life Scale ( QLS ) . Mixed-effects-repeated- measures and last-observation-carried-forward approaches were used to assess the effects of treatment on QOL and the association of clinical outcomes to QOL outcomes . RESULTS Olanzapine- and ziprasidone-treated patients demonstrated similar improvement from baseline to endpoint on the SF-36 and QLS . All correlations between changes in PANSS scores and the SF-36 were significant ( p < .001 ) , ranging from -0.159 to -0.400 . All correlations between changes in PANSS scores and the QLS were significant ( p < .0001 ) , ranging from -0.286 to -0.603 . The correlations between the 2 QOL measures were generally significant but small to moderate in magnitude . CONCLUSIONS The results of this study indicate that , in patients with schizophrenia , olanzapine and ziprasidone treatment are associated with significant QOL and clinical improvements . Further , the significant correlation between change scores on the PANSS and QOL measures suggests that treatment-related clinical improvements are associated with improved health-related and disease-specific QOL . CLINICAL TRIALS REGISTRATION Clinical Study Results .org identifier 2347 We developed a self-administered instrument to assess  health-related quality of life ( HRQL ) among people with schizophrenia . The S-QoL , based on Calman 's approach to the subject 's point of view , is a multidimensional instrument that is sensitive to change . The scale is a 41-item question naire with eight subscales ( psychological well-being , self-esteem , family relationships , relationships with friends , resilience , physical well-being , autonomy and sentimental life ) and a total score . In-depth interviews with patients determined the pertinent issues for item development . The validation study , performed with 207 patients , showed high internal consistency reliability , reproducibility and responsiveness . Construct validity was confirmed using established clinical and HRQL measures . S-QoL covers domains that differ from areas tapped in other measures , with greater responsiveness . The S-QoL is an efficient instrument for the measurement of the impact of schizophrenia  on individuals ' lives OBJECTIVE The main objective of the study was to estimate a preference-based Short Form (SF)-6D index from the SF-36 for Japan and compare it with the UK results . STUDY DESIGN AND SETTING The SF-6D was translated into Japanese . Two hundred and forty-nine health states defined by this version of the SF-6D were then valued by a representative sample of 600 members of the Japanese general population using st and ard gamble ( SG ) . These health-state values were modeled using classical parametric r and om-effect methods with individual-level data and ordinary least squares ( OLS ) on mean health-state values , together with a new nonparametric approach using Bayesian methods of estimation . RESULTS All parametric models estimated on Japanese data were found to perform less well than their UK counterparts in terms of poorer goodness of fit , more inconsistencies , larger prediction errors and bias , and evidence of systematic bias in the predictions . Nonparametric models produce a substantial improvement in out-of- sample predictions . The physical , role , and social dimensions have relatively larger decrements than pain and mental health compared with those in the United Kingdom . CONCLUSION The differences between Japanese and UK valuations of the SF-6D make it important to use the Japanese valuation data set estimated using the nonparametric Bayesian technique presented in this article OBJECTIVES The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey ( SF-36 ) as a written , self-administered survey in out patients with chronic schizophrenia . METHODS Thirty-six schizophrenic out patients completed a written and oral form of the SF-36 . A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology . Cognitive functioning and academic achievement were also assessed . Internal consistency , test-retest reliability , concurrent and discriminative validity of the oral and written versions were determined . RESULTS The SF-36 in both forms was shown to have good internal consistency , stability , and concurrent validity . The mental health SF-36 subscales had poor discriminant validity , compared with the physical functioning scale that demonstrated good discriminant validity . CONCLUSIONS The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated . The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs BACKGROUND Prospect i ve outcome studies based on a community sample of mostly neuroleptic naive cases of schizophrenia are uncommon . OBJECTIVES To describe short-term symptomatic and functional outcomes of schizophrenia , and potential predictors of outcome . METHODS After a baseline assessment , 63 incident and 208 prevalent cases of schizophrenia were followed by a yearly clinical assessment for an average of 2.5 ( range 1 - 4 ) years . Scores of negative symptoms and positive symptoms were used as indicators of symptomatic outcomes . SF-36 scores of physical and social functioning , and role limitation due to mental health problems were used as indicators of functional outcomes . Several variables were evaluated as potential predictors of outcome in r and om coefficient models . RESULTS Functioning and other measures of health related quality of life were significantly diminished in cases as compared to the general population of the area at baseline and follow up . Of the socio-demographic and clinical factors evaluated , only lower negative and positive symptom scores were significantly associated with improvements in functioning . The level of functioning observed in cases from Butajira was lower than that reported for cases from developed countries . CONCLUSIONS Our findings are not in accord with other outcome studies that have reported better functional outcome for cases of schizophrenia from developing countries OBJECTIVE Time to all-cause treatment discontinuation is considered a composite proxy measure of treatment efficacy , safety , and tolerability . Longer time to discontinuation of antipsychotic medication for any cause has been shown to be associated with greater symptom improvements in the treatment of schizophrenia . This study examines whether longer time to all-cause medication discontinuation is also linked to better functional outcomes . METHOD Using pooled data from 4 r and omized , double-blind antipsychotic trials of 24- to 28-weeks ' duration , this study examined the association between time to all-cause treatment discontinuation and functional outcomes , as assessed by a disease-specific , clinician-rated measure ( Quality of Life Scale [ QLS ] ) and a generic , patient-reported measure ( Medical Outcomes Study Short Form 36 [ SF-36 ] ) . Patients in these trials had a DSM-IV diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder . This post hoc analysis used Pearson partial correlations to assess relationships between time to treatment discontinuation and changes in functional scores , adjusting for baseline scores . Repeated measures analyses were also conducted to compare post-baseline functional outcome change over time between completers and noncompleters . RESULTS Longer time to all-cause treatment discontinuation was found to be significantly associated with greater improvements in all assessed functional domains ( p < .05 ) . Patients who completed their respective trials ( 46.8 % , 761/1627 ) experienced significantly greater improvement in functional outcome measures ( in 4 QLS domains and SF-36 mental health component summary score ; all , p < .001 ) compared to patients who discontinued for any cause . In addition , greater symptom improvement was significantly associated with greater functional improvements in assessed domains . CONCLUSIONS Findings from this post hoc analysis illustrate the importance of longer treatment duration with antipsychotics for improving functional outcomes in the treatment of patients with schizophrenia UNLABELLED Schizophrenia leads to impairments in mental , social , and physical functioning , which should be included in evaluations of treatment . OBJECTIVES This study was design ed to determine the reliability and validity of the Medical Outcomes Study Short Form Health Survey ( SF-36 ) for schizophrenic patients , to characterize perceived functioning and well being and to compare short-term change in SF-36 scores for patients treated with olanzapine or haloperidol .  RESEARCH DESIGN Data were obtained from a r and omized , double-blind trial comparing these agents for safety , efficacy , and cost effectiveness . A 6-week acute treatment portion preceded a 46-week " responder extension " phase . SUBJECTS A sub sample ( n = 1,155 ) completing a pre-treatment SF-36 provided data for this study . MEASURES Psychometric analyses were conducted , and perceived level of functioning was compared with that for the US adult population . Change from baseline to 6 weeks was examined by treatment group . RESULTS Clear evidence was obtained for the instrument 's reliability and validity for these patients . There were marked deficits in General health , Vitality , Mental health , Social functioning , and in Role limitations result ing from both physical and emotional problems . Olanzapine-treated patients improved in 5 of 8 domains to a significantly greater degree than did haloperidol patients . CONCLUSIONS The SF-36 can be a reliable and valid measure of perceived functioning and well being for schizophrenic patients . The perceptions of functioning can be valuable indices of disease burden and can help to demonstrate the effectiveness of newer antipsychotic medications such as olanzapine
target: Most of the evidence concerns the SF-36 and EQ-5D , and for these instruments there was evidence for known group validity .
  Although the evidence base is limited in a number of important respects , including problems with the measures used to develop constructs in the validation studies , it is sufficient to raise doubts about the use of generic measures of health like the EQ-5D and SF-36 in patients with schizophrenia
background: OBJECTIVES Generic health status measures such as the short form health survey ( SF-36 ) and EuroQol-5D ( EQ-5D ) are increasingly being used to inform health policy .
  They are cl aim ed to be applicable across disease areas and have started to be used within mental health research .
  This review aims to assess the construct validity and responsiveness of four generic health status measures in schizophrenia , including the preference-based SF-6D and EQ-5D .