Beyond the Hamilton Depression Scores in Long-Term Treatment of Manic-Melancholic Patients: Prediction of Recurrence of Depression by Quality of Life Measurements

Abstract

This study should be considered as a pilot study to investigate the applicability and validity of quality of life scales in manic-melancholic patients in long-term, prophylactic treatment. The quality of life instruments included the SmithKline Bee-cham Quality of Life (SBQOL) scale, the PCASEE questionnaire (a modified paper-and-pencil version of the computerized SBQOL), the Psychological General Weil-Being (PGWB) scale, and the Medical Outcomes Study (SF-36) scale. The patients (n = 23) fulfilled the DSM-IV criteria of bipolar or recurrent depressive disorders. They were investigated in a symptom-free period (HAM-D < 14) and again 4 weeks later. The results showed that the quality of life scales had an adequate applicability and internal validity. Furthermore, at first visit a factor analysis identified two factors of which the quality of life scales loaded on the first factor (positive well-being) and the Hamilton scales loaded on the second factor (negative well-being). At the second visit, only one, general, factor emerged, because some of the patients had relapsed. Those patients with a relapse had low quality of life scores at the first visit indicating that the quality of life scales can predict recurrence of depression.

Quality of Life Among Bipolar Disorder Patients Misdiagnosed With Major Depressive Disorder

“…Both demonstrated that people with bipolar disorder contributed reliable self-reports of their life quality. 38,39 Similarly, the reliability of patients' self reports have been extensively demonstrated in other psychotic disorders including schizophrenia and schizoaffective disorders. [40][41][42] As this was a cross-sectional, observational study, it is also possible that there were some unmeasured determinants of misdiagnosis that also explain lower life quality.…”

“…In 2 previous studies evaluating the same scales used in this analysis (PGWB and SF-8), the QOL scales had an adequate applicability and internal validity when used with people with bipolar disorder. Leidy and colleagues 38 used the Hamilton and Young Rating Scales to longitudinally validate QOL, while Thunedborg's group 39 successfully used QOL scales to predict recurrence of depression. Both demonstrated that people with bipolar disorder contributed reliable self-reports of their life quality.…”

Subjective Quality of Life: Its Relationship with Clinician-Rated and Patient-Rated Psychopathology

“…To date findings have been inconsistent. Some studies have found significant associations between subjective quality of life and clinician-rated psychopathology [11, 12, 13, 14]; on the other hand, a number of studies have reported only weak correlation between satisfaction with life and clinically assessed symptom severity [15, 16, 17], while others have failed to demonstrate any significant association between subjective quality of life and clinically evaluated levels of psychopathology [18, 19, 20]. These latter findings are consistent with the results of a recent study conducted by our group, which confirmed the lack of association, both cross-sectionally and longitudinally, between clinician-rated psychopathology and subjective quality of life [21].…”

What Is the Role of Psychotherapy in the Treatment of Bipolar Disorder?

“…Psychoeducation should prove its usefulness in reducing hospitalization, recurrences, chronicity and suicide, as medication does. In addition, since many patients show socioeconomic, psychosocial and clinical deterioration, in spite of lithium prophylaxis and sustained resolution of symptoms for years [63], psychoeducation should also address improvement of psychosocial adjustment, well-being and quality of life [64, 65]. Personal and familiar psychoeducation may be added to cognitive-behavioral techniques in order to treat mild dysfunctions such as maintained mild hypothymia, apathy, etc., that cannot be pharmacologically treated without a high risk of drug-induced episodes.…”