S236. QUALITY OF LIFE AND ASSOCIATION WITH SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA SIX YEARS AFTER FIRST EPISODE PSYCHOSES
Authors: Andersen Gitte , Schaebel Helle , Gehr Johannes , Glenthoj Birte , Nielsen Mette Ødegaard 
Published: May 2020

Abstract

Background
Quality of Life in patients with schizophrenia is an important part of successful treatment outcome. Our previous results showed, that despite symptomatic improvement after six weeks of antipsychotic treatment, the overall Quality of Life was not improved.
The aim of the present study is to explore Quality of Life after six years, and the association with symptomatic remission or symptoms in general.
The following hypothesizes were tested: Quality of life will be improved after six years, and patients in remission will report a better Quality of Life compared to patients not in remission. Further, low Quality of Life will be associated with high level of negative symptoms.

Methods
In this study 69 antipsychotic drug-naïve, first episode patients with schizophrenia (ICD-10) were included between 2009–2013, and 31 patients where re-examined after 6.7 years (range 4.2–8.3).
Quality of Life was reported by answering a validated questionnaire counting 18 questions, divided into three domains: Housing Situation, Social Relations and Life Satisfaction. Higher scores indicate higher satisfaction within the domain.
Symptoms were assessed using Positive and Negative Syndrome Scale (PANSS) at baseline and follow up. Additionally, at follow up negative symptoms were assessed with Brief Negative Symptoms Scale (BNSS), focusing on three domains: Anhedonia, Asociality, and Avolition.
For statistical analysis, Spearman Rank, paired T-test and Mann-Whitney U-test were used.

Results
The overall Quality of Life was improved (p=0.013) after six years. The improvement was found in Housing Situation (p&lt;0.001) and Social Relation (p&lt;0.001) but not in Life Satisfaction (p=0.9)
Symptomatic remission was observed in 15 (48%) patients. Quality of Life in patients in remission did not differ from patients without remission (p=0.16)
Patients improved in PANSS total, positive, negative and general score (all p&lt;0.001). A negative correlation was observed between Quality of Life (Social Relations) and PANSS-negative (r=-0.40, p&lt;0.05), and PANSS-total score (r=-0.43 p&lt;0.05), and between Quality of Life (Life Satisfaction) and PANSS-general (r=-0.53, p&lt;0.01) and PANSS-total score(r=-0.44, p=0.05). There was no correlation between Quality of Life and positive symptoms.
All three Quality of Life subdomains correlated with BNSS total (p&lt;0.05, r&lt;-0.42). This was driven by a high correlation with Anhedonia (all r&lt;-0.55, all p&lt;0.005) and Asociality (all r&lt;-0.51, all p&lt;0.005) but no correlation with Avolition.

Discussion
Patients in this study improved their subjective Quality of Life over a six-year period. This improvement was found within their Social Relations and an improved Housing Situation. In contrast, there was no improvement in patients’ Life Satisfaction.
Remission was found in half of the patients. Although Quality of life was associated with total symptom severity, it seemed to be independent of symptomatic remission. Quality of life was most associated with the level of negative symptoms, especially with Anhedonia and Asociality. This is in line with previous findings of associations between negative symptoms and the ability to maintain social relations and to function in everyday life. The results underline the importance of increased focus on negative symptoms.