Quality al life in the rehabilitation al schizaphrenics

Abstract

Recently (1993) Norman Sartorius presenting a WHO method for the assessment of Health-related Quality of Life, pointed out that litle attention has been paid to research concerning Quality of Life in relation to health care. Many physicians neglect this aspect in spite of its importance for prevention and for a good therapeutic choice. This is due not only to some Iimitation of medical practice, but also to some confusion on the concept of Q. of L. First of all, we have to consider the relationship between objective socio-economic aspects of Q. of L. and subjective psychological ones. In many definitions of Q. of L. the two poles (the social objective and the individual subjective) are always present although with different weight or importance. Glatzer in 1991 thought that: "Q. of L. in the broad sense is the individual's constellation of objective and subjective components of welfare. In the restricted sense it lays the main emphasis on the perception and evaluation of Iife; it is concerned with satisfaction with life domains and general well-being." Psychologists and Psychiatrists have to take in consideration particularly this ''restricted sense of Q. of L.", In the last years most studies regarding Q. of L. derived from different field of biomedicine and many researches investigated the instruments of evaluation and the effects of diseases and therapies on the Q. of L. of somatic patients. In 1993 Hunt and McKenna observed that this field has developed much slower in Psychiatry than in other disciplines such as cardiology, oncology and rheumatology. Nevertheless, the interest for the Q. of L. of psychotic patients has recently increased due to the emergence of problems regarding dehospitalisation, community care, pharmacological treatment and psychiatric rehabilitation. Of particular interest are studies on Q. of L. during schizophrenics' rehabilitation with cognitive behavioral methods. For example Liberman and Kopelowicz confirmed that "comprehensive, continuous, and integrated biobehavioral therapy - aiming at early detection and treatment of schizophrenic symptoms, family and social skills training, and teaching coping and illness self-management skills - has been documented to improve the course and outcome of schizophrenia as measured by symptom recurrence, social functioning and Q. of L.". We summarize here the conclusions of the last fifteen years' experience of our Milanese group on this topic. First of all to modify the Q. of L. of our patients their living conditions must be taken into account to improve their objective social conditions. Secondly our work in psychosocial rehabilitation with cognitive behavioral methods is also useful to ameliorate the Q. of L. in its subjective dimension Training on daily life skills, social skills, problem solving, self instruction and so on, can improve ability of prevision, socialization, stress coping, emotional control and adjustment of aspirations and expectations. These abilities can promote a better style of life that is the base for a greater happiness and a better Q. of L. of the schizophrenic patients. The family training can better the Q. of L. of the whole family by improving social competence, communication style, expressed emotion and problem solving ability. Nevertheless improving the general life satisfaction of our patients in the field of inner experiences (according Skantze and coworkers), remains a problem. Particularly we have to focus on ways to increase positive self perception, self satisfaction, self esteem, pleasure, joy and love, that are the care of Q. of L.