Evaluation of Subjective Well-Being under Neuroleptics in patients with Schizophrenia using Multiple-Indicator Multiple-Cause(MIMIC) Modelling

Zusammenfassung

Zielsetzung: Ziel dieser Studie war es, den Zusammenhang zwischen klinischen Variablen und subjektivem Wohlbefinden unter Neuroleptikaeinnahme (SWN) an zwei Gruppen schizophrener Patienten (Behandlung mit Olanzapin oder Haloperidol) zu bestimmen und zu untersuchen. Methodik: Für mit Olanzapin (n = 308) bzw. mit Haloperidol (n = 188) behandelte schizophrene Patienten, die die Kurzfassung des SWN-20-Fragebogens ausgefüllt hatten, wurden separate MIMIC-Modelle getestet. Anhand der Korrelationsmatrix der Antwortscores (mit Standardabweichungen) der MIMIC-Modelle wurde geprüft, wie der Schweregrad der Schizophrenie (CGI) und die extrapyramidalen Nebenwirkungen (EPS) – nach Beurteilung des Arztes – das subjektive Wohlbefinden unter Neuroleptika – nach Einschätzung der Patienten – beeinflussen. Ergebnisse: Der Schweregrad der Schizophrenieerkrankung beeinflusste das subjektive Wohlbefinden, insbesondere den emotionalen und körperlichen Bereich, sowie die Selbstkontrolle. Kognitive Symptome wirkten sich bei Patienten unter Haloperidol, nicht aber unter Olanzapin, auf den SWN aus (β = –0,23). Insgesamt hatte der Schweregrad der Erkrankung einen deutlicheren Einfluss auf den SWN als die extrapyramidalen Nebenwirkungen (erklärte Varianz 0,26 vs. 0,11 für Haloperidol sowie 0,22 vs. 0,02 für Olanzapin). Schlussfolgerungen: Generell finden sich zwischen klinischem Schweregrad und SWN deutliche, zwischen EPS und SWN jedoch nur schwache Zusammenhänge. Hierbei spielt die Überlappung zwischen kognitiven, emotionalen und physischen Störungen und dem Neuroleptikainduzierten Defizitsyndrom (NIDS) für die Dimensionen eine besondere Rolle. Dies spiegelt die Bedeutung des NIDS für die subjektive Lebensqualität von Menschen mit schizophrenen Psychosen wider.

Abstract

Aim: The objectives of this study were to determine and to test relations between clinical variables and subjective well-being under neuroleptics (SWN) in two groups of patients with schizophrenia treated with olanzapine or haloperidol. Method: For patients with schizophrenia who completed the SWN-20 (short version) questionnaire and were treated with olanzapine (n = 308) or haloperidol (n = 188), separate multiple-indicator multiple-cause (MIMIC) models were programmed. Based on a correlation matrix of the scores of answers and their standard deviations, the MIMIC models were used to evaluate the influence of disease severity (CGI) and extrapyramidal adverse effects (EPS) as assessed by the physicians on the SWN as assessed by the patients were evaluated. Results: Schizophrenia disease severity influenced the SWN, most of all its emotional, self control and physical dimensions. In the haloperidol group but not in the olanzapine group, cognitive symptoms were found to affect the SWN (β = –0.23). The SWN was more strongly influenced by disease severity than by the EPS (explained variance of 0.26 vs. 0.11 for haloperidol and 0.22 vs. 0.02 for olanzapine groups, respectively). Conclusion: Cognitive, emotional and physical impairment overlapping with neuroleptic-induced deficit syndrome (NIDS) play a vital role in the SWN dimensions. This reflects the importance of NIDS on subjective well-being in people with schizophrenia.

Schlüsselwörter

MIMIC - Schizophrenie - Strukturgleichungsmodell - SWN

Key words

MIMIC - schizophrenia - SEM - SWN

References

• 1 McSweeny A J, Creer T L. Health-related quality-of-life assessment in medical care.  Dis Mon. 1995;  41 1-71
• 2 Guyatt G H, Feeny D H, Patrick D L. Measuring health-related quality of life.  Ann Intern Med. 1993;  118 622-629
• 3 Ritsner M, Modai I, Endicott J. et al . Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients.  J Clin Psychiatry. 2000;  61 880-889
• 4 Scottish executive social research . Well-being and quality of life: measuring the benefits of culture and sport. 2005.  Accessed 20.6.2006;  , http://www.scotland.gov.uk/Resource/Doc/ 89 281 / 0 021 350.pdf
• 5 Packer S, Husted J, Cohen S. et al . Psychopathology and quality of life in schizophrenia.  J Psychiatry Neurosci. 1997;  22 231-234
• 6 Lader M. Neuroleptic-induced deficit syndrome. Historical introduction.  Acta Psychiatr Scand Suppl. 1994;  380 6-7
• 7 Windgassen K. Treatment with neuroleptics: the patient’s perspective.  Acta Psychiatr Scand. 1992;  86 405-410
• 8 Naber D. A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables.  Int Clin Psychopharmacol. 1995;  10 133-138
• 9 Emerich D F, Sanberg P R. Neuroleptic dysphoria.  Biol Psychiatry. 1991;  29 201-203
• 10 Haan de L, Weisfelt M, Dingemans P M. et al . Psychometric properties of the Subjective Well-Being Under Neuroleptics scale and the Subjective Deficit Syndrome Scale.  Psychopharmacology. 2002;  162 24-28
• 11 Hox J J, Bechger T M. An introduction to structural equation modeling.  Family Science Review. 1998;  11 354-373
• 12 Tomarken A J, Waller N G. Structural equation modeling: strengths, limitations, and misconceptions.  Annu Rev Clin Psychol. 2005;  1 31-65
• 13 Muthén B O. Latent variable modeling in heterogeneous populations.  Psychometrika. 1989;  54 557-585
• 14 Guy W. Early Clinical Drug Evaluation Unit (ECDEU) assessment manual for psychopharmacology. Revised. NIMH publication. DHEW Publ. N° Adm 76 – 338. Bethesda MD; National Institute of Mental Health 1976: 217-222
• 15 Bech P, Malt U F, Dencker S J. et al . Scales for assessment of diagnosis and severity of mental disorders.  Acta Psychiatrica Scandinavica. 1993;  372 (Suppl) 87
• 16 Holloman L C, Marder S R. Management of acute extrapyramidal effects induced by antipsychotic drugs.  Am J Health-Syst Pharm. 1997;  54 2461-2477
• 17 Ware J E, Kosinski M, Keller S D. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity.  Medical Care. 1996;  34 220-233
• 18 Schmidt P, Naber D, Clouth J. et al . Constructing an Index for the Subjective Well-being Under Neuroleptics Scale (SWN), Short Form: Applying Structural Equation Modeling for Testing Reliability and Validity of the Index.  Qual Life Res. 2006;  15 1191-1202
• 19 Naber D, Moritz S, Lambert M. et al . Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs.  Schizophr Res. 2001;  50 79-88
• 20 Arbuckle J L. Amos 5.0 Update to the Amos User’s Guide. Chicago IL; Smallwaters Corporation 2003
• 21 Marsh H W, Hau K, Wen Z. In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu & Bentler’s findings.  SEM. 2004;  11 320-341
• 22 Kline R B. Principles and practice of structural equation modeling. New York, NY; Guilford Press 1998
• 23 Hoyle R H, Panter A T. Writing about structural equation models. Hoyle RH Structural equation modeling: concepts, issues, and applications Newbury Park, CA; Sage 1995
• 24 Browne M W, Cudeck R. Alternative ways of assessing model fit. Bollen KA, Long S Testing Structural Equation Models Newbury Park CA; 1993: 136-162
• 25 Karow A, Moritz S, Lambert M. et al . PANSS Syndromes and quality of life in Schizophrenia.  Psychopathology. 2005;  38 320-326
• 26 Sacristan J A, Gomez J C, Ferre F. et al . Incidence of extrapyramidal symptoms during treatment with olanzapine, haloperidol and risperidone: results of an observational study (Spanish).  Actas Esp Psiquiatr. 2001;  29 25-32
• 27 Sacristan J A, Gomez J C, Montejo A L. et al . Doses of olanzapine, risperidone, and haloperidol used in clinical practice: results of a prospective pharmacoepidemiologic study. EFESO Study Group. Estudio Farmacoepidemiologico en la Esquizofrenia con Olanzapina.  Clin Ther. 2000;  22 583-599
• 28 Carlson C D, Cavazzoni P A, Berg P H. et al . An integrated analysis of acute treatment-emergent extrapyramidal syndrome in patients with schizophrenia during olanzapine clinical trials: comparisons with placebo, haloperidol, risperidone, or clozapine.  J Clin Psychiatry. 2003;  64 898-906
• 29 Tran P V, Dellva M A, Tollefson G D. et al . Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia.  J Clin Psychiatry. 1997;  58 205-211
• 30 Dossenbach M, Erol A, el Mahfoud Kessaci M. et al . IC-SOHO Study Group. Effectiveness of antipsychotic treatments for schizophrenia: interim 6-month analysis from a prospective observational study (IC-SOHO) comparing olanzapine, quetiapine, risperidone, and haloperidol.  J Clin Psychiatry. 2004;  65 312-321
• 31 Gomez J C, Sacristan J A, Hernandez J. et al . The safety of olanzapine compared with other antipsychotic drugs: results of an observational prospective study in patients with schizophrenia (EFESO Study). Pharmacoepidemiologic Study of Olanzapine in Schizophrenia.  J Clin Psychiatry. 2000;  61 335-343
• 32 Moritz S, Woodward T S, Krausz M. et al . Relationship between neuroleptic dosage and subjective cognitive dysfunction in schizophrenic patients treated with either conventional or atypical neuroleptic medication. PERSIST Study Group.  Int Clin Psychopharmacol. 2002;  171 41-44
• 33 Putzhammer A, Perfahl M, Pfeiff L. et al .  Correlation of subjective well-being in schizophrenic patients with gait parameters, expert-rated motor disturbances, and psychopathological status.  Pharmacopsychiatry. 2005;  38 132-138
• 34 Kim H, Rojewski J W. Using structural equation modeling to improve research in career and technical.  JVER. 2002;  27 , http://scholar.lib.vt.edu/ejournals/JVER/v27n2 /kim.html. Accessed 14.3.2006
• 35 Karow A, Naber D. Subjective well-being and quality of life under atypical antipsychotic treatment.  Psychopharmacology. 2002;  162 3-10
• 36 Os van J, Verdoux H, Maurice-Tison S. et al . Self-reported psychosis-like symptoms and the continuum of psychosis.  Soc Psychiatry Psychiatr Epidemiol. 1999;  34 459-463
• 37 Dickerson F B, Ringel N B, Parente F. Subjective quality of life in out-patients with schizophrenia: clinical and utilization correlates.  Acta Psychiatr Scand. 1998;  98 124-127