Francis, Sally-Anne; (1998) Medication and quality of life: A study of people with a diagnosis of schizophrenia. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Drug therapy is the most common form of treatment for schizophrenia. Few studies have focused on the measurement of the outcome of antipsychotic drug therapy on an individual's quality of life (QoL). The conceptual model of QoL adopted in this study was based on needs satisfaction and life satisfaction models. However, individuals can vary and therefore, including an assessment of the importance of areas of life to the individual is also valuable. These models were operationalised using adapted questions from the Schedule for the Evaluation of Quality of Life (SEIQoL) and the Lancashire Quality of Life Profile. Adults aged 18-64 years with a DSM-III-R diagnosis of schizophrenia and prescribed depot antipsychotic medication were interviewed in hospital and after discharge in the community. The majority of the study sample were able to respond to the adapted SEIQoL approach. The areas of life generated questioned the content validity of the Lancashire Quality of Life Profile at an item-specific level. By combining approaches, the QoL data generated may be assured of reliability and permit comparable measurement but also with validity and relevance to the individual. Qualitative data demonstrated the positive and negative effects of medication on respondents' QoL. Quantitatively, measures of subjective well-being did not predict the rate of medication adherence. Analysis of the data suggested that current QoL instruments are not sensitive enough to measure the outcomes of antipsychotic drug therapy. Inductive analysis of the qualitative data identified different types of medication-taking behaviour that may be interpreted in relation to 'perceived coercion' and QoL. Future health care policies may focus on compulsory drug therapy in the community. While treatment orders may be justified for the care of the patient and those around them, the management of patients may be conducted so that individuals feel more involved in the process and less coerced.

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