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A cluster-analytical approach toward real-world outcome in outpatients with stable schizophrenia

Published online by Cambridge University Press:  23 March 2020

P. Rocca ,
C. Montemagni ,
C. Mingrone ,
B. Crivelli ,
M. Sigaudo  and
F. Bogetto
P. Rocca*
Affiliation:
Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
*
*Corresponding author. University of Turin, Unit of Psychiatry, Department of Neuroscience, via Cherasco 11, 10126 Turin, Italy. Tel.: +0039 011 6336780; fax: +0039 011 673473. E-mail address: [email protected] (P. Rocca).
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Abstract

Background

This study aims to empirically identify profiles of functioning, and the correlates of those profiles in a sample of patients with stable schizophrenia in a real-world setting. The second aim was to assess factors associated with best profile membership.

Methods

Three hundred and twenty-three outpatients were enrolled in a cross-sectional study. A two-step cluster analysis was used to define groups of patients by using baseline values for the Heinrichs-Carpenter Quality of Life Scale (QLS) total score. Logistic regression was used to construct models of class membership.

Results

Our study identified three distinct clusters: 50.4% of patients were classified in the “moderate” cluster, 27.9% in the “poor” cluster, 21.7% in the “good” cluster. Membership in the “good” cluster versus the “poor” cluster was characterized by less severe negative (OR = .832) and depressive symptoms (OR = .848), being employed (OR = 2.414), having a long-term relationship (OR = .256), and treatment with second-generation antipsychotics (SGAs) (OR = 3.831). Nagelkerke R2 for this model was .777.

Conclusions

Understanding which factors are associated with better outcomes may direct specific and additional therapeutic interventions, such as treatment with SGAs and supported employment, in order to enhance benefits for patients, as well as to improve the delivery of care in the community.

Keywords

SchizophreniaQuality of lifeReal-world outcomeMilestonesCluster analysis
Type
Original article
Information
European Psychiatry , Volume 32 , February 2016 , pp. 48 - 54
Copyright
Copyright © European Psychiatric Association 2016

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References

Leung, W.W., Bowie, C.R., Harvey, P.D.Functional implications of neuropsychological normality and symptom remission in older outpatients diagnosed with schizophrenia: a cross-sectional study. J Int Neuropsychol Soc 2008; 14(3): 479–88.CrossRefGoogle ScholarPubMed
Stroup, T.S.Heterogeneity of treatment effects in schizophrenia. Am J Med 2007; 120(1): 26–31.CrossRefGoogle Scholar
Lambert, M., Schimmelmann, B.G., Naber, D., Schacht, A., Karow, A., Wagner, T., et al.Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. J Clin Psychiatry; 2006; 67: 1690–7.CrossRefGoogle ScholarPubMed
Lipkovich, I.A., Deberdt, W., Csernansky, J.G., Buckley, P., Peuskens, J., Kollack-Walker, S., et al.Defining “good” and “poor” outcomes in patients with schizophrenia or schizoaffective disorder: a multidimensional data-driven approach. Psychiatry Res; 2009; 170: 161–7.CrossRefGoogle ScholarPubMed
Schennach-Wolff, R., Jäger, M., Seemüller, F., Obermeier, M., Messer, T., Laux, G., et al.Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disorders. Schizophr Res; 2009; 113: 210–7.CrossRefGoogle ScholarPubMed
Hofer, A., Baumgartner, S., Bodner, T., Edlinger, M., Hummer, M., Kemmler, G., et al.Patient outcomes in schizophrenia II: the impact of cognition. Eur Psychiatry; 2005; 20: 395–402.CrossRefGoogle ScholarPubMed
Hofer, A., Baumgartner, S., Edlinger, M., Hummer, M., Kemmler, G., Rettenbacher, M.A., et al.Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects. Eur Psychiatry; 2005; 20: 386–94.CrossRefGoogle ScholarPubMed
Awad, A.G., Voruganti, L.N.Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics 2012; 30: 183–9.CrossRefGoogle ScholarPubMed
Heinrichs, D.W., Hanlon, T.E., Carpenter, W.T. Jr.The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984; 10(3): 388–98.CrossRefGoogle ScholarPubMed
Harvey, P.D., Raykov, T., Twamley, E.W., Vella, L., Heaton, R.K., Patterson, T.L.Validating the measurement of real-world functional outcomes: phase I results of the VALERO study. Am J Psychiatry 2011; 168(11): 1195–201.CrossRefGoogle ScholarPubMed
Leifker, F.R., Patterson, T.L., Heaton, R.K., Harvey, P.D.Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel. Schizoph Bull 2011; 37(2): 334–43.CrossRefGoogle ScholarPubMed
Ascher-Svanum, H., Novick, D., Haro, J.M., Aguado, J., Cui, Z.Empirically driven definitions of “good”, “moderate” and “poor” levels of functioning in the treatment of schizophrenia. Qual Life Res 2011; 22(8): 2085–94.CrossRefGoogle Scholar
Beck, E.M., Cavelti, M., Wirtz, M., Kossowsky, J., Vauth, R.How do socio-demographic and clinical factors interact with adherence attitude profiles in schizophrenia?. A cluster-analytical approach. Psychiatry Res 2011; 187: 55–61.CrossRefGoogle ScholarPubMed
Cuyún Carter, G.B., Milton, D.R., Ascher-Svanum, H., Faries, D.E.Sustained favorable long-term outcome in the treatment of schizophrenia: a 3-year prospective observational study. BMC Psychiatry 2011;11:143.CrossRefGoogle ScholarPubMed
Lora, A., Cosentino, U., Rossini, M.S., Lanzara, D.A cluster analysis of patients with schizophrenia in community care. Psychiatr Serv 2011; 52(5): 682–4.CrossRefGoogle Scholar
Stahl, S.M., Malla, A., Newcomer, J.W., Potkin, S.G., Weiden, P.J., Harvey, P.D., et al.A post hoc analysis of negative symptoms and psychosocial function in patients with schizophrenia: A 40-week randomized, double-blind study of ziprasidone versus haloperidol followed by a 3-year double-blind extension trial. J Clin Psychopharmacol; 2010; 30(4): 425–30.CrossRefGoogle ScholarPubMed
Leucht, S., Kane, J.M., Kissling, W., Hamann, J., Etschel, E., Engel, R.R.What does the PANSS mean?. Schizoph Res 2005; 79: 231–8.CrossRefGoogle ScholarPubMed
Ware, J.E. Jr., Snow, K.K., Kosinski, M., Gandek, B.SF-36 health survey manual and interpretation guide Boston: The Health Institute, New England Medical Center; 1993.Google Scholar
Rocca, P., Giugiario, M., Montemagni, C., Rigazzi, C., Rocca, G., Bogetto, F.Quality of life and psychopathology during the course of schizophrenia. Compr Psychiatry 2009; 50(6): 542–8.CrossRefGoogle ScholarPubMed
Rocca, P., Montemagni, C., Castagna, F., Giugiario, M., Scalese, M., Bogetto, F.Relative contribution of antipsychotics, negative symptoms and executive functions to social functioning in stable schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33(2): 373–9.CrossRefGoogle ScholarPubMed
Lysaker, P.H., Roe, D., Yanos, P.T.Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 2007; 33(1): 192–9.CrossRefGoogle ScholarPubMed
Montemagni, C., Castagna, F., Crivelli, B., De Marzi, G., Frieri, T., Macrì, A., et al.Relative contribution of negative symptoms, insight, and coping strategies to quality of life in stable schizophrenia. Psychiatry Res; 2014; 220: 102–11.CrossRefGoogle Scholar
Rocca, P., Castagna, F., Mongini, T., Montemagni, C., Bogetto, F.Relative contributions of psychotic symptoms and insight to quality of life in stable schizophrenia. Psychiatry Res 2010;177(1-2):71–6.CrossRefGoogle ScholarPubMed
American Psychiatric Association, Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR) Washington (DC): American Psychiatric Press; 2000.CrossRefGoogle Scholar
First, M.B., Gibbon, M., Spitzer, R.L., Williams, J.B.W., Benjamin, L.S.Structured Clinical Interview for DSM-IV Disorders (SCID) Washington, (DC): American Psychiatric Press; 1997.Google Scholar
Jäger, M., Becker, T., Weinmann, S., Frasch, K.Treatment of schizoaffective disorder. A challenge for evidence-based psychiatry. Acta Psychiatr Scand 2010; 121: 22–32.CrossRefGoogle ScholarPubMed
Lehman, A.F., Lieberman, J.A., Dixon, L.B., McGlashan, T.H., Miller, A.L., Perkins, D.O., et al.American Psychiatric Association practice guideline for the treatment of patients with schizophrenia; Washington, (DC): American Psychiatric Press; 2004.Google ScholarPubMed
Guy, W.Clinical global impressions. ECDEU assessment manual for psychopharmacology (ADM 76-338) Rockville: US Department of Health, Education and Welfare, National Institute for Mental Health; 1976. 217–22.Google Scholar
Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2): 261–76.CrossRefGoogle Scholar
Addington, D., Addington, J., Schissel, B.A depression rating scale for schizophrenics. Schizophr Res 1990; 3(4): 247–51.CrossRefGoogle ScholarPubMed
Jones, S.H., Thornicroft, G., Coffey, M., Dunn, G.A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry 1995; 166(5): 654–9.CrossRefGoogle Scholar
Altshuler, L.L., Gitlin, M.J., Mintz, J., Leigh, J.L., Frye, M.A.Subsyndromal depression is associated with functional impairment in patients with bipolar disorder. J Clin Psychiatry 2002; 63: 807–11.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Colom, F., Torrent, C., Sánchez-Moreno, J., Reinares, M., et al.Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord; 2004; 6: 224–32.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Torrent, C., Sanchez-Moreno, J., Goikolea, J.M., Salamero, M., et al.Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord; 2007; 9: 103–13.CrossRefGoogle ScholarPubMed
Amador, X.F., Strauss, D.H., Yale, S.A., Flaum, M.M., Endicott, J., Gorman, J.M.Assessment of insight in psychosis. Am J Psychiatry 1993; 150(6): 873–9.Google ScholarPubMed
Bushnell, D.M., Patrick, D.L., Martin, M.L., Kody, M.C., Buesching, D.P., Breier, A.The Quality of Life Scale (QLS) for schizophrenia: assessment of responsiveness to clinical change. Qual Life Res 2000;9:336.Google Scholar
Cramer, J., Rosenheck, R., Xu, W., Henderson, W., Thomas, J., Charney, D.Department of veterans affairs cooperative study group on clozapine in refractory schizophrenia (2001) Detecting improvement in quality of life and symptomatology in schizophrenia. Schizophr Bull 2001; 27: 227–324.CrossRefGoogle Scholar
Falissard, B., Sapin, C., Loze, J.Y., Landsberg, W., Hansesn, K.Defining the minimal clinically important difference (MCID) of the Heinrichs–carpenter quality of life scale (QLS). Int J Methods Psychiatr Res; 2015 http://dx.doi.org/10.1002/mpr.1483.CrossRefGoogle Scholar
Fayers, P.M., Machin, D.Quality of life: assessment, analysis and interpretation, chichester. John Wiley & Sons; 2000. http://dx.doi.org/10.1002/sim.941.CrossRefGoogle Scholar
Jones, P.B., Barnes, T.R., Davies, L., Dunn, G., Lloyd, H., Hayhurst, K.P., et al.Randomized controlled trial of the effect on Quality of Life of second vs first-generation antipsychotic drugs in schizophrenia: Cost-Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUt- LASS 1). Arch Gen Psychiatr; 2006; 63: 1079–87.CrossRefGoogle Scholar
King, D., Knapp, M., Thomas, P., Razzouk, D., Loze, H.J., Kan, M., et al.Cost-effectiveness analysis of aripiprazole vs standard-of-care in the management of community-treated patients with schizophrenia: STAR study. Curr Med Res Opin; 2011; 27(2): 365–74.CrossRefGoogle ScholarPubMed
Naber, D., Hansen, K., Forray, C., Baker, R.A., Sapin, C., Beillat, M., et al.Qualify: a randomized head-to-head study of aripiprazole once-monthly and paliperidone palmitate in the treatment of schizophrenia. Schizophr Res; 2015; 168: 498–504.CrossRefGoogle ScholarPubMed
Harvey, P.D., Sabbag, S., Prestia, D., Durand, D., Twamley, E.W., Patterson, T.L.Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: overlap between milestones and specificity of ratings. J Psychiatr Res 2012; 46: 1546–52.CrossRefGoogle ScholarPubMed
Clatworthy, J., Buick, D., Hankins, M., Weinman, J., Horne, R.The use and reporting of cluster analysis in health psychology: a review. Br J Health Psychol 2005; 10(3): 329–58.CrossRefGoogle ScholarPubMed
Bischof, G., Rumpf, H.J., Hapke, U., Meyer, C., John, U.Types of natural recovery from alcohol dependence: a cluster analytic approach. Addiction 2003; 98(12): 1737–46.CrossRefGoogle ScholarPubMed
Chiu, T., Fang, D., Chen, J., Wang, Y., Jeris, C.A robust and scalable clustering algorithm for mixed tipe attributes in large database environment Proc 7th ACM SIGKDD Int Conf Knowledge Discovery and Data Mining; 2001. 263–8.Google Scholar
Theodoritis, S., Koutrumbas, K.Pattern Recognition New York: Academic Press; 1999.Google Scholar
Lysaker, P.H., Davis, L.W., Tsai, J.Suspiciousness and low self-esteem as predictors of misattributions of anger in schizophrenia spectrum disorders. Psychiatry Res 2009; 166: 125–31.CrossRefGoogle ScholarPubMed
Miller, G.A., Chapman, J.P.Misunderstanding analysis of covariance. J Abnorm Psychol 2001; 110: 40–8.CrossRefGoogle ScholarPubMed
Santone, G., Rucci, P., Muratori, M.L., Monaci, A., Ciarafoni, C., Borsetti, G.Attitudes toward medication in inpatients with schizophrenia: a cluster analytic approach. Psychiatry Res 2008; 158: 324–34.CrossRefGoogle ScholarPubMed
Brissos, S., Dias, V.V., Balanzá-Martinez, V., Carita, A.I., Figueira, M.L.Symptomatic remission in schizophrenia patients: relationship with social functioning, quality of life, and neurocognitive performance. Schizoph Res 2011; 129: 133–6.CrossRefGoogle ScholarPubMed
Erickson, M., Jaafari, N., Lysaker, P.Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia. Psychiatry Res 2011; 189: 161–5.CrossRefGoogle Scholar
Karow, A., Moritz, S., Lambert, M., Schoder, S., Krausz, M.PANSS syndromes and quality of life in schizophrenia. Psychopathology 2005; 38: 320–6.CrossRefGoogle Scholar
Lambert, M., Schimmelmann, B.G., Karow, A., Naber, D.Subjective wellbeing and initial dysphoric reaction under antipsychotic drugs — concepts, measurement and clinical relevance. Pharmacopsychiatry 2003; 36(3): 181–90.Google Scholar
Llorca, P.M., Blanc, O., Samalin, L., Bosia, M., Cavallaro, R.Factors involved in the level of functioning of patients with schizophrenia according to latent variable modeling. Eur Psychiatry 2012; 27(6): 396–400.CrossRefGoogle ScholarPubMed
Mohamed, S., Rosenheck, R., Swartz, M., Stroup, S., Lieberman, J.A., Keefe, R.S.Relationship of cognition and psychopathology to functional impairment in schizophrenia. Am J Psychiatry 2008; 165: 978–87.CrossRefGoogle Scholar
Lambert, M., Naber, D., Eich, F.X., Schacht, M., Linden, M., Schimmelmann, B.G.Remission of severely impaired subjective wellbeing in 727 patients with schizophrenia treated with amisulpride. Acta Psychiatr Scand 2007; 115: 106–13.CrossRefGoogle ScholarPubMed
Lambert, M., Schimmelmann, B.G., Schacht, A., Karowa, A., Wagner, T., Wehmeier, P.M., et al.Long-term patterns of subjective wellbeing in schizophrenia: cluster, predictors of cluster affiliation, and their relation to recovery criteria in 2842 patients followed over 3 years. Schizoph Res; 2009; 107: 165–72.CrossRefGoogle ScholarPubMed
Levine, S.Z., Rabinowitz, J.Trajectories and antecedents of treatment response over time in early-episode psychosis. Schizophr Bull 2010; 36: 624–32.CrossRefGoogle ScholarPubMed
Addington, D., Addington, J., Maticka-Tyndale, E.Specificity of the Calgary Depression Scale for schizophrenics. Schizophr Res 1994; 11: 239–44.CrossRefGoogle ScholarPubMed
Addington, D., Addington, J., Patten, S.Depression in people with first-episode schizophrenia. Br J Psychiatry Suppl 1998; 172(33): 90–2.CrossRefGoogle ScholarPubMed
Addington, J., Leriger, E., Addington, D.Symptom outcome 1 year after admission to an early psychosis program. Can J Psychiatry 2003; 48(3): 204–7.CrossRefGoogle Scholar
Bressan, R.A., Chaves, A.C., Shirakawa, I., de Jesus Mari, J.Validity study of the Brazilian version of the Calgary Depression Scale for Schizophrenia. Schizophr Res 1998; 22: 41–9.Google Scholar
Tomotake, M.Quality of life and its predictors in people with schizophrenia. J Med Invest 2011;58(3–4):167–74.CrossRefGoogle ScholarPubMed
Schulze, B., Angermeyer, M.C.Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mentalhealth professionals. Soc Sci Med 2003; 56(2): 299–312.CrossRefGoogle Scholar
Angermeyer, M.C., Beck, M., Dietrich, S., Holzinger, A.The stigma of mental illness: patients’ anticipations and experiences. Int J Soc Psychiatry 2004; 50(2): 153–62.CrossRefGoogle ScholarPubMed
Corrigan, P.W., Watson, A.The paradox of self-stigma and mental illness. Clin Psychol 2002; 9: 35–53.Google Scholar
Vauth, R., Kleim, B., Wirtz, M., Corrigan, P.W.Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatr Res 2007; 50(1): 71–80.CrossRefGoogle Scholar
Mintz, A.R., Dobson, K.S., Romney, D.M.Insight in schizophrenia: a metaanalysis. Schizophr Res 2003; 61(1): 75–88.CrossRefGoogle Scholar
Rocca, P., Bellino, S., Calvarese, P., Marchiaro, L., Patria, L., Rasetti, R., et al.Depressive and negative symptoms in schizophrenia: different effects on clinical features. Compr Psychiatry; 2005; 46: 304–10.CrossRefGoogle ScholarPubMed
Bora, E., Erkan, A., Kayahan, B., Veznedaroglu, B.Cognitive insight and acute psychosis in schizophrenia. Psychiatry Clin Neurosci 2007; 61: 634–9.CrossRefGoogle ScholarPubMed
Larøi, F., Fannemel, M., Rønneberg, U., Flekkøy, K., Opjordsmoen, S., Dullerud, R., et al.Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res; 2000; 100: 49–58.CrossRefGoogle ScholarPubMed
Varga, M., Magnusson, A., Flekkøy, K., Rønneberg, U., Opjordsmoen, S.Insight symptoms and neurocognition in bipolar 1 patients. J Affect Disord 2006; 91: 1–9.CrossRefGoogle Scholar
Varga, M., Babovic, A., Flekkoy, K., Ronneberg, U., Landro, N.I., David, A.S., et al.Reduced insight in bipolar 1 disorders, neurofunctional and neurostructural correlates: a preliminary study. J Affect Disord 2009;11(1–2):56–63.CrossRefGoogle Scholar
Health care reform for Americans with severe mental illnesses: report of the National Advisory Mental Health Council. Am J Psychiatry; 1993; 150(10): 1447–65.CrossRefGoogle Scholar
Priebe, S.Social outcomes in schizophrenia. Br J Psychiatry 2007;191:S15–20.CrossRefGoogle Scholar
Evans, S., Huxley, P., Priebe, S.A comparison of the quality of life of severely mentally ill people in UK & German samples. Int J Soc Psychiatry 1999; 46: 47–56.CrossRefGoogle Scholar
Ruggeri, M., Gater, R., Bisoffi, G., Barbui, C., Tansella, M.Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona outcome project 5. Acta Psychiatr Scand 2002; 105: 131–40.CrossRefGoogle ScholarPubMed
UK700Group Predictors of quality of life in people with severe mental illness. Study methodology with baseline analysis in the UK700 trial. Br J Psychiatry 1999; 175: 426–32.CrossRefGoogle Scholar
Aldenderfer, M.S., Blashfield, R.K.Cluster analysis Beverly Hills, CA: Sage Publications; 1984.CrossRefGoogle Scholar
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