Treatment of schizophrenia evaluated via the pharmacopsychometric triangle—An integrative approach with emphasis on well-being and functioning

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Abstract

Quantification of treatment response is crucial to optimize outcomes for patients with schizophrenia. In this study, we evaluated the relationship between quantitative measures of clinician-rated symptom severity and self-rated side effects, well-being, and functioning among inpatients with schizophrenia using the six-item version of the Positive and Negative Syndrome Scale (PANSS-6), the Glasgow Antipsychotic Side-effect Scale (GASS), the WHO-Five Well-being Index (WHO-5), and the Sheehan Disability Scale (SDS). All measurements were conducted as close to admission and discharge as possible. Well-being and functioning were found to be most strongly associated with the additive effect of symptoms and side effects, while changes in side effects, well-being, and functioning appeared to be relatively independent from changes in symptom severity. The use of both symptom and side effect measures should inform clinical decision-making in the treatment of schizophrenia, as it has the potential to optimize functioning and well-being.

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Most cited references 55

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The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

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The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

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Christian Topp, Søren Dinesen Østergaard, Susan Søndergaard … (2015)

The 5-item World Health Organization Well-Being Index (WHO-5) is among the most widely used questionnaires assessing subjective psychological well-being. Since its first publication in 1998, the WHO-5 has been translated into more than 30 languages and has been used in research studies all over the world. We now provide a systematic review of the literature on the WHO-5.

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Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.

Madhukar Trivedi, A Rush, Stephen R Wisniewski … (2006)

Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in "real world" patients are not established. The authors' primary objectives in this study were to evaluate the effectiveness of citalopram, an SSRI, using measurement-based care in actual practice, and to identify predictors of symptom remission in outpatients with major depressive disorder. This clinical study included outpatients with major depressive disorder who were treated in 23 psychiatric and 18 primary care "real world" settings. The patients received flexible doses of citalopram prescribed by clinicians for up to 14 weeks. The clinicians were assisted by a clinical research coordinator in the application of measurement-based care, which included the routine measurement of symptoms and side effects at each treatment visit and the use of a treatment manual that described when and how to modify medication doses based on these measures. Remission was defined as an exit score of or=50% in baseline QIDS-SR score. Nearly 80% of the 2,876 outpatients in the analyzed sample had chronic or recurrent major depression; most also had a number of comorbid general medical and psychiatric conditions. The mean exit citalopram dose was 41.8 mg/day. Remission rates were 28% (HAM-D) and 33% (QIDS-SR). The response rate was 47% (QIDS-SR). Patients in primary and psychiatric care settings did not differ in remission or response rates. A substantial portion of participants who achieved either response or remission at study exit did so at or after 8 weeks of treatment. Participants who were Caucasian, female, employed, or had higher levels of education or income had higher HAM-D remission rates; longer index episodes, more concurrent psychiatric disorders (especially anxiety disorders or drug abuse), more general medical disorders, and lower baseline function and quality of life were associated with lower HAM-D remission rates. The response and remission rates in this highly generalizable sample with substantial axis I and axis III comorbidity closely resemble those seen in 8-week efficacy trials. The systematic use of easily implemented measurement-based care procedures may have assisted in achieving these results.

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Author and article information

Contributors

Pernille Kølbæk: perpet@rm.dk

Journal

Journal ID (nlm-ta): Schizophrenia (Heidelb)

Journal ID (iso-abbrev): Schizophrenia (Heidelb)

Title: Schizophrenia

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2754-6993

Publication date (Electronic): 16 December 2023

Publication date PMC-release: 16 December 2023

Publication date Collection: 2023

Volume: 9

Issue: 1

Electronic Location Identifier: 88

Affiliations

[1 ]Psychosis Research Unit, Aarhus University Hospital—Psychiatry, ( https://ror.org/040r8fr65) Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark

[2 ]Department of Clinical Medicine, Aarhus University, ( https://ror.org/01aj84f44) Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark

[3 ]Division of Psychiatry Research, The Zucker Hillside Hospital, ( https://ror.org/05vh9vp33) 75–59 263rd Street, Glen Oaks, NY 11004 USA

[4 ]Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, ( https://ror.org/01ff5td15) 500 Hofstra Blvd, Hempstead, NY 11549 USA

[5 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Child and Adolescent Psychiatry and Psychotherapy, , Charite Universitätsmedizin, ; Augustenburger Platz 1, 13353 Berlin, Germany

[6 ]Department of Affective Disorders, Aarhus University Hospital—Psychiatry, ( https://ror.org/040r8fr65) Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark

Author information

Søren D. Østergaard http://orcid.org/0000-0002-8032-6208

Article

Publisher ID: 420

DOI: 10.1038/s41537-023-00420-6

PMC ID: 10725501

PubMed ID: 38104195

SO-VID: 9df9d58a-f78c-4422-b715-c525353b9d57

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 8 July 2023

Date accepted : 23 November 2023

Funding

Funded by: FundRef https://doi.org/10.13039/501100002739, Aarhus Universitets Forskningsfond (Aarhus University Research Foundation);

Funded by: FundRef https://doi.org/10.13039/501100006309, Riisfort Fonden (Riisfort Foundation);

Funded by: FundRef https://doi.org/10.13039/100012526, Aarhus University | Sundhedsvidenskabelige Fakultet, Aarhus Universitet (Faculty of Health Sciences, Aarhus University);