Treatment and the Quality of Life
By Roderick Shaner, MD

We've made steady progress in our ability to decrease psychotic symptoms of psychiatric disorders. But is the successful treatment of symptoms of schizophrenia always related to an improvement in the quality of life of those who suffer from it? Treating symptoms of an illness may not improve the quality of life, if other results of the treatment are bad. If confinement in a locked facility reduces the danger of harm to a patient, but results in a monotonous and unstimulating existence, can quality of life be said to have improved? Or if an anti psychotic medication stops hallucinations but causes severe sedation or muscle stiffness, is this a better experience?

Taking into account the quality of Life. Until recently, research measurements of the efficacy of medical treatments have not taken into account quality of life. This may be because measurement of specific target symptoms for various treatments is relatively straight forward and reliable, but measurements of life quality are more difficult.

To measure life's quality, we must agree upon what it is and how to measure it. This takes effort and money, but such work is now being done. Their is a growing recognition that quality of life is a critical aspect in assessing the usefulness of treatments for schizophrenia, and several measurement techniques have been devised. Some writers have recently suggested that an assessment of quality of life should be a requirement for approval of all new anti psychotic drugs. Measuring the quality of life Investigators attempting to measure the effect of treatment on quality of life have cited several important components. One obvious component is improvement of target symptoms, which might include hallucinations, delusions, illogical thinking, and anxiety. Another component is the side effects of treatment, both physical and mental. Psychosocial performance, which includes vocational ability and interpersonal abilities, is also taken into account. Most rarely cited is how the patient himself feels about the treatment. This subjective measure has often been lacking because of a belief that patient reports are difficult to obtain or unreliable. Recent evidence, however, suggests that self-reports by patients with schizophrenia are in fact highly reliable, and correlate closely with outcome of treatment. Directions for the future during the upcoming "decade of the brain", we can expect major progress in the understanding of neuro-biochemistry, and in our ability to improve symptoms of schizophrenia. But we must also bear in mind that the suffering that schizophrenia causes is complex. Treatment that fails to take into account the resultant quality of life of patients is treatment that runs a risk of becoming a problem of its own. The recent inclusion in the scientific literature of quality of life measurements is very encouraging.

The quality of life at the Anne Sippi Clinic At the Anne Sippi Clinic, a global treatment philosophy continues to emphasize quality of life for our patients. The clinic strives to maintain a stimulating environment, unlocked and open to the community. Patients are consistently encouraged to interact not only with each other but with the outside community as well. Field trips and community service are an important part of Clinic life. Anti psychotic medication is carefully used to decrease the symptoms of psychosis, while minimizing side effects.

Since the inception of the Anne Sippi Treatment model by Jack Rosberg, the subjective experience of the patient plays a central role in treatment, and in outcome assessment. While many of our patients have long histories of treatment failures and confinement to locked facilitates in the past, they now have a higher quality of life at the Anne Sippi Clinic. If quality of life is a valid measure of treatment success, then the Anne Sippi philosophy is a step in the right direction.