Clinical and Social Characteristics, Quality of Life, Adherence to Therapy of Out-Patients with Schizophrenic Spectrum Disorders: Cross-Sectional Study

Abstract

Background: clinical diversity of schizophrenic spectrum disorders determines a variety of long-term management and treatment outcomes of out-patients.Aim of the study: to analyze the interrelationships of clinical and social characteristics, quality of life and adherence to therapy in patients with schizophrenic spectrum disorders.Patients and methods: data of 120 patients observed in a neuropsychiatric dispensary with diagnoses of schizophrenic spectrum disorders (F20, F21, F25 according to ICD-10) were studied.Results: three categories of individuals were identified, taking into account the high degree of intragroup similarity of clinical and social characteristics. Patients of the first group (29%) have a stable-positive characteristics of social adaptation and a high adherence to therapy. They were characterized by a younger age, mainly an attack-like course of the disease with an affective-delusional structure of exacerbations and weakly pronounced personality changes. Significantly more often than patients of other groups, they received therapy with second-generation antipsychotic drugs of prolonged action. Patients of the second group (39%) have the negative dynamic characteristics of social adaptation and a low adherence to therapy. They were characterized by older age, continuous or episodic types of disease course with increasing defect, higher prevalence of moderately and strongly pronounced positive and negative symptoms at the time of remission. Treatment and rehabilitation measures did not give sufficient results, despite the active use of prolonged antipsychotic drugs of the second generation. In this category of patients, there were phenomena of social drift, with the collapse of social ties, loss of work skills. Patients of the third group (32%) were characterized by contradictory characteristics with stable negative characteristics of social adaptation and high adherence to therapy. A significant part of the patients had negative personality changes and often a low-grade course of the disease with a predominance of neurosis-like and depressive symptoms. Receiving for many years mainly therapy with firstgeneration antipsychotics (APP1) and practically not hospitalized in a psychiatric hospital, they found pronounced social isolation, loneliness and feelings of hostility of the surrounding world.Conclusions: the management of out-patients with schizophrenic spectrum disorders represent clinical problems depending of different forms of social adaptation and adherence to therapy, for the effective solution of which it is necessary to optimize complex social rehabilitation measures.