Catálogo de publicaciones - libros

While interest has grown steadily in understanding how persons with schizophrenia appraise their disorder and subsequent needs, the nature of the impact of awareness or admission of disorder on various domains of quality of life has remained a matter of considerable debate. At the level of both theory and empirical study it has been alternately held that acknowledgement of one’s mental illness is a detriment and a key to successful adaptation. From one perspective, acceptance of illness has been advanced as a key to making informed decisions about one’s future, to free oneself from blame for difficulties linked with illness and to forming bonds with others who are aware of one’s difficulties. From another view, however, “awareness of illness” has been suggested to represent the acceptance of a system of social power in which one’s individuality and dignity is at risk of being diminished. Indeed empirical studies suggest both awareness and lack of awareness have significant risks associated with them. In this chapter we review this evidence and present data which suggest that the impact of insight on quality of life may be mitigated by the degree to which persons have internalized stigmatizing beliefs about their illness. Clinical and theoretical implications are discussed

Major depression (MD) is a public health problem that is associated with grave consequences in terms of excessive mortality, disability, and secondary morbidity. Indeed, it ranked fourth in 1990 and could rise to second by 2020 in terms of the overall burden of all diseases worldwide. Therefore, it is now clear that current research on the health impact of depression should go beyond estimating its prevalence, symptoms severity, and complications to include studies that seek to establish how it influences the quality of life (QOL) of the affected individuals. In the present chapter we will outline how measures of QOL may reveal differences between patients with depression and control groups, be sensitive to change in status during treatment, have predictive value for outcome measures and provide additional information about timelines for improvement in psychosocial functioning, which may occur at a different rate than changes in other depressive symptoms. More specifically, we will summarize recent investigations that have generally shown that: (1) depressed patients have QOL deficits that are directly attributable to the mood disturbance, (2) the degree of the decrement in QOL is proportional to the severity of depressive symptoms, (3) the negative relation between depression and QOL is as great as (or worse than) that observed in chronic medical disorders such as rheumatoid arthritis and diabetes, and (4) the adequate treatment of depression is usually associated with a significant improvement in the QOL of patients. Finally, we will discuss future perspectives involved in the evaluation of QOL in populations of depressed subjects

This chapter will present an overview of what is currently known about quality of life (QoL) in bipolar disorder (BD). While there is growing consensus that the QoL concept provides an important counterpoint to the objective symptom measures that dominate psychiatry, the implications of this position are yet to be systematically addressed in the BD field. The literature reviewed in this chapter is not informed by any model or theory of QoL as it applies to BD. The data presented are largely empirical in the negative sense of this term, drawn from studies making different assumptions, addressing different questions in BD. In many cases, the measurement of QoL has been incidental to the major thrust of the research design. Indeed, even at the empirical level there is a lack of agreement about the best measure of QoL in this population, and no disorder-specific measure currently exists. In this context, the present chapter aims to capture the range of applications of the QoL concept in BD, and highlight any reliable findings. To structure the presentation, it is useful to categorize data into three general areas: studies that have looked at QoL impairment in BD compared with non-clinical and other diagnostic groups, studies that have looked at QoL differences across the states of BD and studies that have looked at QoL changes as an outcome of treatment. We will briefly set the scene for these three investigations by presenting the findings of four manuscripts that have reviewed research into QoL and BD. The final section of this chapter will make some recommendations about future QoL research in BD, highlighting the need for work at both the theoretical and measurement levels. At the theoretical level, the implications of the vulnerability model of health-related QoL (HRQOL) (e.g., Ritsner, Chapter of this collection) will be briefly reviewed. At the measurement level, we will present some data on the ongoing development of a patient-centred disorder-specific QoL measure for BD

There is a growing consensus that practitioners must broaden the scope of assessment for anxiety disorders from signs and symptoms to include the measurement of quality of life (QOL) appraisals and social functioning. However, there is not a consensus about the definition of quality of life nor is there agreement about how to operationalize the construct of quality of life. Most measures of QOL assess an individual’s perceptions about social relationships, physical health, work and activity functioning, economic status, and an overall sense of well-being. Objective functional impairment can be quantified by measuring work productivity, mental health functioning, and physical health functioning. One of the challenges faced by the field is understanding the relationship between objective measures of functioning and subjective measures of QOL. In this chapter, we will present findings from epidemiologic studies and empirical research investigations on QOL and functional impairment in generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and generalized social phobia. We will discuss the findings, address strengths and weakness of the current research, and suggest future areas of focus to expand our knowledge and competencies including appropriating data from clinical populations in order to better understand and treat this growing population

Obsessive-compulsive disorder (OCD) is a severe mental disorder with a lifetime prevalence of 1.6{%} in the US population, although the identified obsessive-compulsive spectrum may affect up to 10{%} of the US population. Furthermore, OCD is a chronic, profoundly disabling illness that impacts negatively on the academic, occupational, social and family patients’ functioning as well as on their families’ lives. Indeed, OCD is tenth in the World Bank’s and WHO’s ten leading causes of disability ranking. A growing number of treatments have been recently shown to be useful for OCD symptoms and, to a less degree, for the disabilities that the disorder involves. In spite of all the above mentioned benefits and disabilities, there are relatively few reports on quality of life in patients with OCD and on the relationship between patients’ quality of life and clinical variables, particularly about the effect of available treatments on quality of life. Since the first published paper on the topic, there has been a general agreement that moderate and severe OCD show lower quality of life level than that of the general population, other mentally ill patients (depressed and heroin dependent patients) and that of patients with chronic medical conditions (such as diabetes type II and kidney transplant patients). Areas that have been found to be the most impaired are social functioning and role limitations due to emotional problems. In this chapter we will discuss in depth recent findings, controversies and concerns regarding quality of life of obsessive-compulsive disorder patients and its treatment, as well as provide future direction and areas of interest

Schizophrenia as a long term disabling illness generally runs a chronic course with acute psychotic relapses that frequently requires hospitalizations. Antipsychotic medications have emerged as the cornerstone in treatment of the disorder in addition to other important interventions such as rehabilitation, psychosocial and economic support. Unfortunately antipsychotic medications has presented a number of significant limitations in terms of inconveniencing or serious side effects as well as there inability to improve certain symptoms at different stages of the illness. 30{%} to 50{%} of patients on antipsychotic medications develop serious dislike to medication as a result of becoming dysphoric, a situation that lead to compromised adherence to medications and subsequent relapse and compromised quality of~life. ∈dent Reviewing published studies involving both new and old antipsychotic medications reveal a good deal of methodological limitations that make it difficult to reach any definitive conclusion about the impact of antipsychotic medications on quality of life. However, the weight of the evidence so far can only suggest a trend favouring the new antipsychotics in terms of their positive impact on quality of life. On the other hand it is clear that medications by themselves can not directly improve quality of life but certainly can improve the potential for patients to benefit from other important interventions such as rehabilitation and psychosocial support that can have direct impact on quality of life. A number of methodological and conceptual issues are proposed to improve the quality of quality of life studies. Finally, though quality of life by itself is an important outcome it is time for the field to look beyond quality of life measurements. In addition to being an outcome, quality of life improvement can be also construed as mediator of other important outcomes such as decreased relapse rate, re-hospitalization and medical resources utilization. Similarly, improvement in quality of life can enhance strategies for improving adherence to medications and other therapeutic regimens as well as better and longer tenure in the community

Electroconvulsive therapy (ECT) continues to stand the test of time. There is a growing demand for patient reported outcome data including measures of HRQL, patient satisfaction and utility. ECT is efficacious for a number of psychiatric conditions but it is often reserved for the most ill patients because compared to drugs or psychotherapy it has a higher cost per unit of treatment, requires anesthesia, and because of a continuing stigma. As well, ECT has a particular set of side effects including the potential for memory impairment, and cardiac death. Mental illness produces profound deficits in HRQL and loss of HRQL is linear to severity of illness, and may therefore be part of decision to refer for ECT. At baseline studies have shown that ECT patients have reduced HRQL and functioning. ECT treatment improves HRQL and functioning in a lasting way for patients with major depression and schizophrenia. HRQL improvements are related to ECT’s effect on mood whereas functional improvements are more closely related to cognition

This chapter describes the nature of current community mental health services and the concept of Quality of Life (QOL) as it relates to them. It also provides an understanding of the nature, scale and content of the current evidence base for QOL research in mental health service settings. A search strategy for isolating the most relevant sources and types of published material is included, and the best quality evidence relating to the QOL of people in receipt of community mental health care is reviewed. Finally, QOL measurement and outcomes for people with severe mental illnesses (SMI) in receipt of community based care are compared with those for people with more common mental disorders (CMD) such as anxiety and depression, and mentally healthy general population groups, to provide a broad understanding of the impact of illness on life-quality

Due to the great variation in approaches to psychiatric rehabilitation, the literature does not provide a uniform description of these methods. In this review, outcomes in terms of subjective quality of life are discussed in relation to vocational training, activity-based rehabilitation, case management, and social skills training. Relationships between aspects of daily life and subjective quality of life are also illuminated. In all the rehabilitation approaches studied, clients have shown an improved quality of life during the rehabilitation period, but no more than the respective comparison group receiving some other form of intervention. Concerning daily life, having employment, being engaged in and satisfied with daily activities, having a supportive social network, and living in the community have consistently been shown to be related to a better quality of life. The reasons why subjective quality of life has not been shown to improve to any substantial degree as a result of psychiatric rehabilitation are probably manifold, and research so far has left many questions unanswered. More, well-designed studies, including multi-methodological approaches and long follow-up periods, are needed to elucidate how subjective quality of life is affected by various rehabilitation strategies

Cost-utility analysis is a method which is most often used when benefits cannot be expressed in monetary (profit) or metric values (days of sick leave). The utilities in cost-utility analyses are in fact preferences of each person, a selected group, or the whole population. Since quality of life is one of the preferences, estimation of quality of life is frequently used in health economics. The results of cost-utility analyses are expressed in QALY – quality adjusted life years. QALY indicates the average number of years of quality life which a person with a defined health status will be able to live in a case that a certain intervention is carried out. This indicator therefore shows the cost of intervention with regard to a specific outcome, life in quality. In psychiatry the measurements of health outcome like survival, disability, sick leave, quality of life, satisfaction of clients, etc., were traditionally important but in the recent years the awareness of costs associated with any health intervention has grown. In studying mental disorders the situation seems somewhat specific since traditional outcome indicators do not always reflect the many (complex) faces of mental disorder. Although the methodology is appropriate to compare health economic issues of different mental disorders these studies are scarce, probably due to a complicated design. It is much easier to conduct an outcome study with a single diagnostic category. On the other hand there were many studies that were comparing costs and other outcomes of different preventive and therapeutic interventions in a single diagnostic category. The results of cost-utility analyses are useful in many situations: planning of service development, resource allocations, to find out the best available intervention for persons with a certain health status, etc. This chapter provides a short introduction to economic analysis giving a special emphasis to a cost-utility analysis and defining its place among other methods in health economics. Beside theoretical considerations, several practical applications of cost-utility analysis using QALYs are discussed