Measures of functional status and quality-of-life in schizophrenia
Pharmacotherapy has been reasonably effective in treating positive symptoms associated with schizophrenia and less effective in treating negative symptoms. Humanistic outcomes - quality of life and functionality - are more difficult to assess than changes in symptom severity and are equally important in assessing the overall effectiveness of treatment. The correlation between negative symptoms and poorer outcomes in patients with schizophrenia underscores the need for more effective treatment, and a large number of instruments have been devised to provide quantitative assessment of the humanistic outcomes associated with the treatment of schizophrenia. Some were developed specifically for schizophrenia, and others were originally developed for other clinical conditions but later adapted for schizophrenia. The value of such instruments depends on their intrinsic validity, selection criteria, and how the selected instrument is used by physicians and other clinical professionals. This review is aimed at increasing clinicians' awareness of these instruments and improving their ability to use them appropriately as an adjunct to sound clinical judgment. We provide an overview of the issues pertinent to the use of rating instruments for quality of life and functionality, and based on a literature search, we provide a brief description of the 20 instruments most commonly used to assess these humanistic outcomes in patients with schizophrenia. Each instrument is discussed in terms of content and organization, formal validation, and use in patients with schizophrenia. An accompanying table reveals the domains relating to quality of life and functionality addressed by each instrument.