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Letters to the Editor   |    
Life Satisfaction Among Individuals With Schizophrenia in the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) Study
Gagan Fervaha, B.Sc.; Ofer Agid, M.D.; Hiroyoshi Takeuchi, M.D., Ph.D.; George Foussias, M.D., M.Sc.; Gary Remington, M.D., Ph.D.
Am J Psychiatry 2013;170:1061-1062. doi:10.1176/appi.ajp.2013.13010060
View Author and Article Information

Data used in the preparation of this article were obtained from the limited access data sets (Version 1) distributed from the NIH-supported study Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia (CATIE-Sz). This letter reflects the views of the authors and may not reflect the opinions or views of the CATIE-Sz study investigators or the NIH.

Supported by NIMH grant N01MH90001 to the University of North Carolina at Chapel Hill.

Clinicaltrials.gov identifier: NCT00014001.

Dr. Agid has received research support, funding, consultant fees, or speaker’s fees from Janssen-Ortho, Eli Lilly, Novartis, Pfizer, Sepracor, and Sunovion. Dr. Takeuchi has received fellowship grants, speakers honoraria, or manuscript fees from the Astellas Foundation, Dainippon Sumitomo Pharma, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutical, Meiji Seika Pharma, and Otsuka Pharmaceutical. Dr. Foussias has received consultant fees, research support, advisory board fees, or speakers fees from Hoffman-La Roche, Medicure, Neurocrine Bioscience, and Novartis. Dr. Remington has received research support, consulting fees, or speakers fees from the Canadian Diabetes Association, the Canadian Institutes of Health Research, Hoffman-La Roche, Laboratorios Farmacéuticos Rovi, Medicure, Neurocrine Biosciences, Novartis Canada, Research Hospital Fund–Canada Foundation for Innovation, and the Schizophrenia Society of Ontario. Mr. Fervaha reports no financial relationships with commercial interests.

From the Schizophrenia Division, Centre for Addiction and Mental Health, Toronto; and the Institute of Medical Science and the Department of Psychiatry, University of Toronto.

Copyright © 2013 by the American Psychiatric Association

Accepted March , 2013.

To the Editor: Schizophrenia is often characterized by poor psychosocial functioning, which in turn has been linked to clinical features such as anhedonia and diminished general well-being, as measured by constructs such as subjective quality of life (1). However, some evidence, including research from our own group, argues against the notion that individuals with schizophrenia are by definition anhedonic (2) and has demonstrated that despite marked functional impairment, individuals with schizophrenia are as happy as healthy comparison subjects (3).

To explore this issue further, we used data from the CATIE schizophrenia study to examine the prevalence and consequences of overall satisfaction with life among individuals with chronic schizophrenia. We found that 46% of patients (N=1,224 total, excluding those with a current major depressive episode) were generally satisfied with their life (Figure 1). This rate is striking, especially given that the sample was symptomatic (i.e., they were entering a treatment trial), and may actually be higher in stable patients.

 
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FIGURE 1.Histogram of Frequency Distribution of Overall Satisfaction With Life Responses in Individuals With Schizophreniaa

a Participants were asked “How do you feel about your life in general?” General life satisfaction or happiness was taken as a score of 5 or greater.

Individuals who rated themselves as being satisfied with life had fewer positive and depressive symptoms and better psychosocial functioning (t values >3 in all cases, df=1,219, p<0.002). Fewer psychotic symptoms suggest that ratings of happiness were not merely secondary to reality distortion; moreover, this group did not differ in terms of negative symptoms, neurocognition, or clinical insight compared with those less satisfied with life (t values <1.8 in all cases, df=1,219, p>0.05). The instruments employed to assess these symptoms have been reported elsewhere (4).

Longitudinally, the majority (76%) of these satisfied patients remained so after 6 months despite no significant improvements in psychosocial functioning (t=−1.9, df=357, p=0.06, Cohen’s d=0.2). This result is somewhat intuitive, as we would not expect individuals to strive for change if they were satisfied with their current situation. Of note, it has been reported that individuals with schizophrenia overestimate their level of functioning and environmental assets (1). Both biological and psychological factors have been implicated (3), although underlying mechanisms remain poorly understood. Our findings here affirm that level of functioning is not without importance, and it remains that many individuals are in fact not satisfied. Those individuals involved in care need to be aware that patients with schizophrenia, even early in the illness’ course (3), may undergo a considerable shift in terms of goals and values. This clearly affects rehabilitation efforts and may, at least in part, explain the difficulty engaging individuals in programs that fail to take this into account.

Katschnig  H:  How useful is the concept of quality of life in psychiatry? Curr Opin Psychiatry 1997; 10:337–345
[CrossRef]
 
Foussias  G;  Remington  G:  Negative symptoms in schizophrenia: avolition and Occam’s razor.  Schizophr Bull 2010; 36:359–369
[CrossRef] | [PubMed]
 
Agid  O;  McDonald  K;  Siu  C;  Tsoutsoulas  C;  Wass  C;  Zipursky  RB;  Foussias  G;  Remington  G:  Happiness in first-episode schizophrenia.  Schizophr Res 2012; 141:98–103
[CrossRef] | [PubMed]
 
Stroup  TS;  McEvoy  JP;  Swartz  MS;  Byerly  MJ;  Glick  ID;  Canive  JM;  McGee  MF;  Simpson  GM;  Stevens  MC;  Lieberman  JA:  The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development.  Schizophr Bull 2003; 29:15–31
[CrossRef] | [PubMed]
 
References Container

FIGURE 1. Histogram of Frequency Distribution of Overall Satisfaction With Life Responses in Individuals With Schizophreniaa

a Participants were asked “How do you feel about your life in general?” General life satisfaction or happiness was taken as a score of 5 or greater.

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References

Katschnig  H:  How useful is the concept of quality of life in psychiatry? Curr Opin Psychiatry 1997; 10:337–345
[CrossRef]
 
Foussias  G;  Remington  G:  Negative symptoms in schizophrenia: avolition and Occam’s razor.  Schizophr Bull 2010; 36:359–369
[CrossRef] | [PubMed]
 
Agid  O;  McDonald  K;  Siu  C;  Tsoutsoulas  C;  Wass  C;  Zipursky  RB;  Foussias  G;  Remington  G:  Happiness in first-episode schizophrenia.  Schizophr Res 2012; 141:98–103
[CrossRef] | [PubMed]
 
Stroup  TS;  McEvoy  JP;  Swartz  MS;  Byerly  MJ;  Glick  ID;  Canive  JM;  McGee  MF;  Simpson  GM;  Stevens  MC;  Lieberman  JA:  The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development.  Schizophr Bull 2003; 29:15–31
[CrossRef] | [PubMed]
 
References Container
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