ASSESSMENT OF THE SUBJECTIVE QUALITY OF LIFE IN THE HANDLING OF THE SCHIZOPHRENICS AT THE NEURO-PSYCHO PATHOLOGICAL CENTER, KINSHASA. [Original Research]
Kaswa. KJ , MD1, Mampunza MS, PhD1, Yassa P, PhD3, Ngoma M, PhD1, Kayembe T, PhD1, Okitundu LD, PhD1, Mananga LG, PhD1, Tshishimbi KE, PhD2, Kaswa KM, MD4, MSc, MPH, Ndaya MA, Assistant2, Mutapayi DV, Stat.5, Mutombo J, Stat.5
1. University of Kinshasa School of Medicine, Dept of Psychiatry CNPP Kinshasa, DR Congo.
2. University of Kinshasa, Dept of Sociology.
3. University of Zambia School of Medicine, Dept Biomedical Sciences, Lusaka, Zambia.
4. Head of Division National TB Program DR Congo
5. University of Kinshasa? Statistician, DR Congo

[emedpub – Psychiatry and Mental Health: Vol 1:7] [Date of Publication: 09.07.2014]
ISSN 2231-6019

September 7, 2014 at 8:15 PM

Correspondence: Dr Jean KASIAMA KASWA

University of Kinshasa, Department of Psychiatry CNPP, Kinshasa, DR CONGO.

Contact : + 243 99 71 36 894, E-mail : kaswajean@yahoo.fr – Web  site: http://kaswa.blog4ever.com -

www.scibd.com/doctakaswa

SUMMARY:

Context. The quality of life of the schizophrenics always let to want. This survey looks for the role to the improvement with the psycho education.

Objective. To value the efficiency of the psycho education on the quality of life of the schizophrenics.

Method. In a therapeutic trial survey achieved in Kinshasa, from 2007 to 2013, four hundred schizophrenics (DSM-IV criteria), consolidated with the help of the neuroleptic, had left, by drawing, in two groups (therapeutic and control). They valued their quality of life with the WHOQOL-26 scale.

Results. The middle age of patients was of 33 ± 9 years, the sex ratio 3H: 1F (p = 0,001).

To the recruitment, without psycho education, the score of the life quality varied 52,47±9,635, therapeutic group against 54,82±10,122, control group. With a score, 75% (WHOQOL-26 scale), the quality of life was bad in the two groups. The observed difference didn’t have statistically any significance (p˃0,050).

After the psycho education, the middle score of the life quality was of 69,20±10,651, therapeutic group (treaty with the psycho education) against 52,89±8,545, control group, with a progression of the level of good quality of life, 14,5% among 58 subjects. The observed difference was highly meaningful (p=0,001).

One month after the psycho education, the middle score of the life quality was of 72,62±9,069, therapeutic group (treaty with the psycho education) against 50,92±7,745, control group, with a progression of the level of good quality of life of 22,25% among 89 subjects. The observed difference was highly meaningful (p=0,001).

Conclusion. The quality of life of the schizophrenics is not good.

The patients who benefit from a psycho educational gait present a better subjective life quality that those no beneficiary. The psycho education has a positive effect on the quality of life of the schizophrenics.

A big longitudinal scale survey imposes itself to validate data of this research.


RESUME:

Contexte. La qualité de vie des schizophrènes a toujours laissé à désirer. Cette étude cherche le rôle   à l’amélioration avec la psychoéducation.

Objectif. Evaluer l’efficacité de la psychoéducation sur la qualité de vie des schizophrènes.

Méthode. Dans une étude d’essai thérapeutique réalisée à Kinshasa, de 2007 à 2013, quatre cent schizophrènes (critères DSM-IV), stabilisés à l’aide des neuroleptiques, étaient repartis, par tirage au sort, en deux groupes (thérapeutique et témoin). Ils ont évalué leur qualité de vie avec l’échelle WHOQOL-26.

Résultats. L’âge moyen de patients était de 33 ± 9 ans, le sex ratio 3H : 1F (p = 0,001).

Au recrutement, le score global moyen de la qualité de vie de la population d’étude était de 53,64±9,937. Sans psychoéducation, le score de la qualité de vie variait de 52,47±9,635, groupe thérapeutique contre 54,82±10,122, groupe témoin. Avec un score ˂75% (échelle WHOQOL-26), la qualité de vie était mauvaise dans les deux groupes. La différence observée n’avait statistiquement aucune signification (p˃0,050).

Après la psychoéducation, le score moyen de la qualité de vie était de 69,20±10,651, groupe thérapeutique (traité avec la psychoéducation) contre 52,89±8,545, groupe témoin, avec une progression du niveau de bonne qualité de vie, 14,5% chez 58 sujets. La différence observée était  hautement significative (p=0,001).

Un mois après la psychoéducation, le score moyen de la qualité de vie était de 72,62±9,069, groupe thérapeutique (traité avec la psychoéducation) contre 50,92±7,745, groupe témoin, avec une progression du niveau de bonne qualité de vie de 22,25% chez 89 sujets. La différence observée était hautement significative (p=0,001).

Conclusion. La qualité de vie des schizophrènes n’est pas bonne.

Les patients qui bénéficient d’une démarche psycho éducative présentent une meilleure qualité de vie subjective que ceux non bénéficiaires. La psychoéducation a un effet positif sur la qualité de vie des schizophrènes.

Une étude longitudinale à grande échelle s’impose pour valider les données de cette recherche.


INTRODUCTION:

Frequent and universal, the schizophrenia stays, to the world scale, one of the most serious reasons of the invalidity, a real psychic handicap with an important reverberation on the working and on the quality of life (1, 2).

After the hospitalization to the Neuro-Psycho Pathological Center of the University of Kinshasa (C.N.P.P.), the consolidated schizophrenics feel some difficulties a lot to recover their home environment and to function as before. In spite of the availability of the antipsychotic treatments, the quality of life of the schizophrenic patients is not good (3, 4, 5, 6, 7).

Before the character chronic of the illness, the hindrance to the social and professional working, the sufferings that it generates for the individual reach and his family, there is the necessity to develop the therapeutic and the programs of cares extra hospitable adapted.

It is more and more allowed today that the chronic character of the illness and its sufferings especially derives cognitive unrests that include difficulties of concentration, memorization, attention and planification; they have an impact on the general working (8,9).

The bio-psycho social model, in medicine, takes in account of the factors psychological, social and biologic of the pathologies (10,11). It is from then on unacceptable that the psychiatry only treats the mental illness and no its consequences (10).

The handling of the schizophrenia requires, in addition to a pharmacological contribution, of the psychosocial interventions of which the psycho educational approach (11).

The psycho education constitutes today a recommendation in the international guidelines (12).

In Africa, more especially in RD Congo, it is rarely processed in the therapeutic follow-up and the quality of life of the schizophrenic patients (12).

A question himself pose: the psycho education on lived  of the patient could it improve the quality of life of the schizophrenics and could it constitute a new turn thus in the handling and the follow-up of these patients in the Neuro-Psycho Pathological Center of the university of Kinshasa ?

The goal of this survey is to search for to improve, by the psycho education on lived it, the level of the life quality subjective of the schizophrenics, during a psychiatric handling. The objective  is to value the effect of the psycho education on the quality of life of the schizophrenics.

MATERIAL AND METHOD:

In a survey of prospective, imposing observation a compilation of the longitudinal data, we had looked for, from November 2007 to February 2011, to know the association between the psycho education (69) and the quality of life in a cohort of the schizophrenics left in two groups by drawing. The two groups was initially comparable (13, 14).

The comparison of results between these different samples (treaty with psycho education and unprocessed) was going to permit to measure the effect of this therapeutic approach on the quality of life, through the time. It was about a therapeutic trial survey.

All recommendations of ethics for the medical research had been respected strictly (respect of anonymity and confidentiality in the harvest and the analysis of data). The beneficiary patients and non recipients of the psycho education didn’t run any risk. A verbal consent was gotten of all participants to the survey.

MATERIAL

We had resorted to a module of psycho education of the schizophrenics and families of which the techniques of basis consist to the attentive monitoring, the understanding monitoring and the advice.

The patient’s active involvement was essential. The main stains were to inform the schizophrenic patient, to teach him to reconcile patient’s life with one life of quality and have improved this life.

The under-themes to land were precise, according to the module of psycho education, with one or several patients in company of their families. The program had a length of 45 days, at the rate of a session of one hour by visit; all fifteen days for each topic. The number of sessions was of 3 and the under-themes: Schizophrenia, treatment and involvement to the active life.

To value the quality of life us had used the structured questionnaire and standardized, WHOQOL-26 (Worth Health Organization Quality 0f brief Life). It is about a scale of auto assessment resorting to a conventional segmentation of the daily life in 6 domains: Health and quality of life in general, physical Health, psychic Health, Independence, social Relations and Environment (16).

METHOD:

We had recruited, to the Center Pathological Neuro-Psycho (C.N.P.P.) of Kinshasa, 400 patients suffering from schizophrenia diagnosed according to the criteria of DSM-IV-TR (16), under antipsychotic treatment and in clinical stabilization phase (observance of the treatment and positive symptomatology absence) (17).

The neuroleptic typical and atypical (also named antipsychotic) were the main medicines used in the treatment of the schizophrenias in hospitalization. In this survey, for the follow-up in ambulatory cure, the antipsychotic monotherapy was the rule. As the symptomatology, in post cure was not too loud and the patient was consolidated, there was interest to avoid the condemnation bound to the hospitalization and to encourage the conservation of the domestic and social ties. Most schizophrenics were either under Halopéridol with Artane as proofreader of the undesirable effects either under Haldol décanoas (neuroleptic delay) for the prevention of the relapses.

The prescriptions were limited for the second generation of antipsychotic (Risperidone, Olanzapine, Aripiprazole, Amisulpiride, Quétiapine) because of the cost in the pharmacies. The Clozapine (Leponex) was used in the resistant shapes (dissatisfactory answer to two antipsychotic treatments of correctly led different classes).

It is known that if the neuroleptic typical and atypical act well on the symptoms positive of the illness and offer a good protection opposite the relapses, they are, however, less efficient on the negative symptoms, on the cognitive unrests and on the social maladjustment bound to the illness. The quality of life of the schizophrenics bad rest.

We had first chosen the psycho education, to remain, as psychiatrist Engel, on the biopsychosocial model in the handling and the follow-up of the schizophrenics, then for among others reasons, a least cost, an easiness to achieve her and the socio cultural raisons. 

The objective of the psycho education, in this survey, was not at all to substitute itself for the traditional therapeutic approaches, but to complete them as replacing the topic reaches schizophrenia in position of actor of its illness. The psycho education came to reinforce the different handlings of the device of existing cares only.

The psycho educational measures had initiated in the “therapeutic” group since the first contact. Durand the same period group   ” non therapeutic” followed a simple consultation of post cure.

The collaboration between psychiatrists and the nursing staff other members, psychologists, sociologists, male nurses, social workers and ergothérapeutists had proven to be primordial.  It had to permit a sharing of information, of lived it emotional and of a help useful to the resolution of the problems. The therapists didn’t look to culpabiliser for the patients and their near, but to help them to become partners of cares and to manage the illness and its effects.

Were excluded of this survey, the unsteady or sick schizophrenic patients with another associated psychiatric pathology, as the depression, the craze, the craziness, the unrests somatoforms, the phobia, the compulsive or other obsessional unrests,.

The size of the sample depended on the importance to take in account some slant : the non answer, the investigator’s influence, the dwindle (abandonment, transfer, death) and the constraints in terms of times and costs, without forgetting that, according to the chronologic set, un individual measured several times are each different time. Even though one makes anything, the level of knowledge on its illness and the result won’t be the same when one will see it later again. There will be variation due to the individual, the maturation (the person looks for by himself) and the contamination (contribution of the public, of the media) (18).

We had, therefore, valued the dwindle to more au less 30%.   While applying the statistical formula of the size of the sample for the proportions (Ear Info version 6), our cohort had the size of 400 schizophrenics left in two groups: 200 topics in the group therapeutic B (treaty  with psycho education and 200 other in the witness group (unprocessed) (19).

The data sociodemographics (age, sex, civil status, level of education) and clinics (insight, number of hospitalization), had been collected. For the presentation, age was regrouped sliced of eleven from the minimum of 16 years, the number of hospitalization to one or more a hospitalization, the civil status to married and unmarried (only, detached and included divorced person).

For the education, two levels were kept, the primary (secondary level lower to the) and beyond primary (level equal or superior to the secondary); the insight, the conscience of patient’s state (yes or no) to the receipt of the questionnaire was important.

Once the score of every item, of every domain of life and the questionnaire known for all schizophrenics, we had only to conduct analyses of comparison of middle scores of the subjective life quality between the two groups, in witness and “therapeutic” B (with psycho education), to the 1st, 2nd and 3rd stage of the assessment. The average has been used to calculate a central tendency and the standard duration was the adapted scattering measure for the average.

The T test of Student for quantitative variables was recommended to compare the two averages (20). The qualitative variables, presented as proportion, were compared by the test of Chi 2 and the survey of interrelationship was made by means of test of Pearson interrelationship. In all statistical tests, the doorstep of signification was stationary to 0, 05 with the confidence limit to 95%.

The quality of life of the schizophrenics, for the WHOQOL-26 scale, was bad with a score lower to 75%, good with an equal score or more of 75% and excellent with 100%.

RESULTS:

General features of the population of survey

Table 1. General features of the population of survey

Variable Modes Number Percentage p
Age

16-26 126 31,25 ,000
27-37 158 39,75
38-48 85 21,25
49-59 31 7,75
Sex Woman 100 25 ,000
Man 300 75
Education ≤ primary 276 69,0 ,000
> primary 124 31,0
Civil State Bachelor 379 94,8 ,000
married 21 5,2
Number of hospitalizations 1 time 111 27,8 ,000
>1 times 289 72,2
Insight

No 148 37,0 ,000
Yes 252 63,0

To the reading of the Table 1, the age of the population of survey varied 16 to 54 years, with an average to the tour of 33 years; 72% of the schizophrenics met between 16 and 37 years.

The sex ratio was of 3 Man: 1 Woman; 69% of the schizophrenics had not passed the primary level and 94% were unmarried. The difference of the number of topics in different variable was statistically meaningful (p=0.000).

The schizophrenic patients having known more a hospitalization were from afar more numerous (72%). Most (63%) were conscious of their patient’s state. According to data of the Table 1, the differences noted of the number of topics in the variables were statistically very meaningful (p=0,000).

Quality of life of the schizophrenics to the recruitment

Global score means of the life quality

Table 2. Score global means of the quality of life of the population of the schizophrenics to the recruitment

Quality of life
To the recruitment

N (schizoph.) Minimum Maximum Mean±Et
400 16 81 53,64±9,937

To the recruitment, the quality of life of the population of survey (n=400) was not good with a score of? 75% according to the WHOQOL-26 scale (Tab.2).

Level of quality of life

Table 3. Proportion of the level of bad and good quality of life of the population of the schizophrenics to the recruitment

Level of life quality Score N (5%°) P
To the recruitment
Bad

Good

<75 396 (99%)
≥ 75 4 (1%) 0,000

The quality of life was bad with a score below 75% and good with an equal score or to the over of 75%, according to the WHOQOL-26 scale. To the picture 3, to the recruitment, very few topics (1%) had a good quality of vie ; the difference of the level of life quality noted among the schizophrenics, in the population of survey, was highly meaningful p = 0,000 (Tab.3).

Domains of life

Stage of QV evaluat. General health and QV Mean±Et Physical health

Mean±Et

Health psychological Mean±Et independence  Mean±Et Social relation

Mean±Et

Environment

Mean±Et

Recruitment

58,79±21,28

58,29±18,64

55,66±17,01

50,82±18,24

50,65±20,99

50,14±14,25

Table 4. Mean score of the domains of the quality of life of the population of the

Schizophrenics to the recruitment

Three domains (General Health, physical Health and psychological Health), were valued exceptionally by the schizophrenics in relation to the three other (Independence, social Relation, Environment). The quality of life was not good in none of six domains with the score below 75% (Tab.4).

Variable influencing the quality of life of the schizophrenics

Quality of life of the schizophrenic and socio demographic  and clinic  variables

To the recruitment of the schizophrenics

Variable Distribution N (%) QV Mean±ET P
Age 16 – 26 126(31,25%) 54,17±9,37
27 – 37 158(39,75%) 53,38±11,08
38 – 48 85(21,25%) 53,56±9,00
49 – 59 31(7,75%) 53,03±9,00 0,958
Sex Women 100 (25%) 54,43±9,736
Man 300(75%) 53,37±10,007 0,359
Education ≤ Primary 276 (69%) 52,74±10,198
> Primary 124(31%) 55,64±9,055 0,007
Civil State Married 21(5,2%) 58,29±11,141
Bachelor 379(94,8%) 53,38± 9,819 0,028
Insight No 148 (37%) 51,10±10,057
Yes 252(63%) 55,13±9,577 0,000
Nb of Hospit. 1 111(27,8%) 55,25±8,919
>1 289(72,2%) 53,02±10,249 0,044

Table 5. Quality of life of the schizophrenic and socio demographic variable to the recruitment

To the recruitment the Table 5 showed the score of the quality of life of the schizophrenics according to the socio demographic and clinic variable. It demonstrated that the best quality of life for the schizophrenics met in the age group of 16-37 years, in youth and beginning of the adult age.

Statistically, the difference of middle score of life quality between the different age groups of the schizophrenics, to the recruitment, had no significance, p˃0,050. It was evident from data of the picture 5 that the men had bad quality of life, while comparing it to the women. This difference between the two sexes was not meaningful, p˃0,050. The sex didn’t influence the level of the life quality not at all.

The schizophrenics, with a school level beyond the primary, had better quality of life. The score of the life quality, in favor of the superior education level, was highly meaningful p=0,007. A meaningful difference, p˂0,050, was observed in favor of the married compared to the bachelors.

For the insight, conscience of patient’s state (answer Yes), a difference of score of highly meaningful life quality (p=0,000) was observed in disfavor of the schizophrenics who had not recognized to be even sick (answer No).

The quality of life was better in favor of those that had only known one hospitalization. The observed difference (p˂0,050) was statistically meaningful (Tab.5).

With the psycho education

Table 6. Quality of life of the schizophrenic and socio demographic variable with the psychoéducation in the therapeutic group

Variable Distribution N (%) QV Mean±ET P
Age 16 – 26 126(31,25%) 61,41±13,397
27 – 37 158(39,75%) 61,24±12,365
38 – 48 85(21,25%) 59,74±12,154
49 – 59 31(7,75%) 62,16±12,474 0,786
Sex Woman 100 (25%) 61,43±12,421
Man 300(75%) 60,92±12,738 0,728
Education ≤Primary 276 (69%) 60,96±12,425
> Primary 124(31%) 61,24±13,149 0,837
Civil State Married 21(5,2%) 59,57±13,128
Bachelor 379(94,8%) 61,13±12,623 0,583
Insight No 148 (37%) 60,96±12,425
Yes 252 (63%) 61,24±13,149 0,837
Nb of Hospit. 1 111(27,8%) 61,53±11,543
>1 289(72,2%) 60,86±13,048 0,636

According to the Table 6, with intervention educational psycho in the therapeutic group, the best quality of life of the schizophrenics (n=400) met in the last age group (49-59).

In relation to the first assessment, there was on the whole for age, an improvement. The differences of the score of life quality noted between different age groups had no statistical significance with p˃0,050. Such was also the case for the variables. There was an improvement on the whole. The differences of the score of life quality noted in the distributions of these variables had no statistical significance with p˃0,050. The mean score of the quality of life of the bridegrooms had fallen in favor of the one of the bachelors.

One month after the psycho education

Table 7. Quality of life of the schizophrenic and socio demographic variable, one month after the psycho education in the therapeutic group

Variable Distribution N (%) QV Mean±ET P
Age 16 – 26 126(31,25%) 62,04±14,617
27 – 37 158(39,75%) 61,63±13,590
38 – 48 85(21,25%) 61,32±13,118
49 – 59 31(7,75%) 62,55±13,150 0,399
Sex Women 100 (25%) 62,07±13,196 0,811
Man 300(75%) 61,69±13,961
Education ≤ Primary 276 (69%) 61,63±13,769 0,777
> Primary 124(31%) 62,06±13,745
Civil State Married 21(5,2%) 59,33±14,069 0,406
Bachelor 379(94,8%) 61,90±13,734
Insight No 148 (37%) 62,06±13,745 0,777
Yes 252( 63%) 61,63±13,769
Nb of hospitalization 1 111(27,8%) 62,05±13,257 0,801
>1 289(72,2%) 61,66±13,950

According to the Picture 7, one month after intervention educational psycho in the therapeutic group, the best score of life quality met in the age group (49-59) to the adult age.

The differences observed in all variables were not statistically meaningful, p˃0,050. As to the previous stage, the difference of the life quality was again in disfavor of the bridegrooms.

Figure 1. Quality of life of the schizophrenics according to the civil status to different stages of assessment

To the different moments of assessment, he/it was demonstrated to the Face 2 that the middle score of the life quality deteriorated more at the bridegrooms (on the right) that at the bachelors (on the left).

Quality of life of the schizophrenic in the two groups and psycho education variable

Score global means of the life quality in the witness group A and therapeutic B

Picture 8. Score global means of the quality of life of the schizophrenics in the two groups to different stages of assessment

Stages of assessment TO-B groups QV Minimum QV Maximum Moy± AND P
To the recruitment of the schizophrenics A 16 81 54,82±10,122

0,180

B 16 75 52,47±9,635
With the psycho education Witness A 8 69 52,89±8,545

0,000

Therapeutic B 33 99 69,20±10,651
One month after the psycho education Witness A 22 70 50,92±7,745

0,000

Therapeutic B 47 98 72,62±9,069

It proved to be, to the reading of the Table 8, that, without psycho education in witness group, the quality of life was bad with a mean global score below 75% (WHOQOL-26 scale). Between the two groups TO and B, the difference of the observed averages didn’t have statistically any significance, p˃0,050 (Tab.8).

With the psycho education, to the Table 8, the quality of life had improved distinctly in the group therapeutic B (with psycho education) in disfavor of the witness A (without psycho education). Between the two   groups, the difference of average observed was highly meaningful, p=0,000 (Tab. 8). With a middle global score below 75%, WHOQOL-26 scale, the quality of life, in the two groups, was bad (Tab. 8).

One month after the psycho education (Tab. 8), the level of the life quality was different distinctly in the group therapeutic B in disfavor of the witness and in regression. Between the two groups, the difference of average observed was highly meaningful, p=0,000. On the whole, for the two groups, la quality of life was bad with a middle global score below 75% (WHOQOL-26 scale).

Level of life quality in the witness group A and therapeutic B.

Table 9. Proportion of the level of bad and good quality of life in the two groups to different stages of assessment

Stages of assessment Score of the Life Quality A Witness N (%) B Therap.  N (%) Schizophrenic N (%) P

To the recruitment of the schizophrenics < 75 quality of bad life 196 (98%) 200 (100%) 396(99%)

0,308

˃ 75 quality of good life 4 (2%) 0(0%) 4(1%)
With the psycho education < 75 quality of bad life 200(100%) 138(69%) 338(84,5%)

0,001

˃75 quality of good life 0 (0%) 62(31%) 62(15,5%)
One month after the psycho education < 75 quality of bad life 200(100%) 107(53,5%) 307(76,75%) 0,001
˃75 quality of good life 0 (0%) 93(46,5%) 93(23,25%)

To the recruitment (Tab.9), contrary to the B group where all topics (n=200) had declared their bad life quality, a small number (2%), in the A group, had estimated it good with a score of more than 75%. The difference between the two groups was not statistically meaningful, p˃0,050 (Tab. 9). With the psycho education in the B group, the quality of life was declared to hundred percent bad by the topics of the witness group A while 31% of the therapeutic group B had estimated it good (Tab.9).

One month after the psycho education, the quality of life was completely bad in the group A witness while in the group therapeutic B 50% au less of topics had declared it good. The observed life quality difference, between the two groups, was highly meaningful, p=0,001 (Tab.9).

Mean score of the life domains in the witness group A  and therapeutic B

Table 10. Middle score of the domains of life of the schizophrenics to different middle Score of the domains of life of the schizophrenics to different stages

Stages Group General health and QV Mean±ET Health physical Mean ±ET Health psychological Mean±ET independence Mean±ET Relation social Mean±ET environment Mean±ET
Recruitment A 61,49±18,65 56,24±18,55 58,03±15,46 55,82±18,74 51,32±18,25 48,42±15,08
B 56,11±23,33 60,31±18,55 53,31±18,14 45,86±16,32 50,00±23,41 51,84±13,19
Psychoéducat. AWitness 64,20±18,08 59,52±17,19 62,74±15,08 47,63±14,08 39,90±15,50 45,80±10,83
BTherap. 78,76±16,77 70,10±16,87 73,89±15,55 73,13±17,18 66,24±16,51 55,65±14,53
One month after psycho AWitness 54,57±15,78 50,54±16,71 50,29±13,87 53,53±15,99 46,86±16,00 52,1±14,04
BThérap. 81,29±14,68 72,30±16,50 75,51±14,79 75,59±15,78 71,31±14,95 61,72±12,25

To the recruitment (Table 10), the highest score met in the domain general Health and quality of life and lowest in the domain Environment, for the A  group. The highest score, for the B group, met in the domain, physical and lowest Health in the domain, Independence.

The quality of life, to the Table 10, had not reached, in none of the domains, the score besides au less 75% (good quality of vie) by the WHOQOL-26 scale of the WHO; it was declared bad in the two   groups.

With the psycho education, According to the Picture 10, the quality of life was declared bad in the domains of the witness group A. Its more highest score met in the domain, general Health and quality of life and lowest in the domain social Relation.

For the group therapeutic B,       the highest score met in the domain, general Health and quality of life with good quality of life (score more of 75%) and lowest in the domain, Environment.

One month after the psycho education (Tab. 10), the quality of life was always declared bad in the domains of the witness group A. its more highest score met in the domain, general Health and quality of life and lowest in the domain social Relation.

For the group therapeutic B, the highest score, met in the domain, general Health and quality of life with a score beyond 75% (very good quality of life) and lowest in the domain, Environment.

In this group therapeutic B, data of the Table 10 demonstrated more that 3 domains had reached the level of a good quality of life, respectively general Health and quality of life, psychological Health and Independence.

Evolution of the quality of life of the groups of schizophrenics in the time

Figure 2. Comparison of the evolution in the time of the level of the quality of life of the schizophrenics in the A-B groups

With the evolution of the illness, the level of the quality of life of the schizophrenics in the group therapeutic B was better in relation to the group TO witness as demonstrated him the Figure 2. While this level lowered in the group TO witness, it went, during the same period, to the rise in the group therapeutic B.

DISCUSSION:

If the antipsychotic medication remained the corner stone of the treatment of the schizophrenia, the approach educational psycho has, certainly, an impact on the the evolution of the illness, the relapses, the working and the quality of life (20).

With the psycho education, the present survey appears in the continuity of the works developed by the services of mental health that showed the importance to value the quality of life by patients affected by a psychiatric trouble (20 – 21).

General features of the population of survey

It is about : age, the sex, the education, the civil status, the insight and the number of hospitalization. In this survey to the Neuro-Psycho Pathological Center of Kinshasa, the differences of the number of topics noted in the variables were statistically very meaningful. The schizophrenia appeared at youngsters, to adolescence and in the beginning of the adult life, in the age group of 16 to 37 years. The average of age was of 33 years.

The explanation is known, the schizophrenia appears, in general, to adolescence and in the beginning of the age adult ; in most cases it is located before 25 years. It is not necessary to forget however that it is possible to diagnose it outside of these statistics: earlier or later (23).

This survey confirms data returned in the literature. Age, for the schizophrenia, varies between 14 and 68 years and the average is of 31. She/it starts the most frequently between 16 and 30 years and in a least measure, after the age of 45 years (23-24) (3, 25-26).

It is evident from this survey that the sex ratio was of 3H:1F. The schizophrenia affects the two sexes as much, it seems to declare at the man enters 15 and 25 years and a little later at the woman enters 25 and 35 years (3, 17, 26-28). The masculine sex being exposed more, it meets easily, in bigger number, in hospitalization (27-28). A shape exists to belated beginning (toward 40-45 years) that is on the other hand two times more frequent at the woman (22 – 23,29).

Several reasons can explain this masculine vulnerability. One speaks more and more intersexual differences in psychiatry. Among other explanations, there is the morphological survey of the brain of psychotic patients that indicates again that the men have a rate of anatomical anomalies meaningfully more elevated than the women (24, 27).

The masculine vulnerability in this survey confirms some numerous research.

A survey of follow-up on eight years indicates that after a first psychiatric hospitalization, the stays of the women with a schizophrenia to the hospital are briefer and that they remain longer in the community in comparison of the men (30).

To the look of results gotten in this study, le numbers topics not having passed the primary level or not having been even at the school was raised. Only 31% of schizophrenics (n=400) went beyond the primary.

The number of more important topics for the primary level can itself explain.  The schizophrenia is a chronic illness that touches the normal working. It appears early in youth and its demonstrations start sometimes with unrests of education and the decrease of the performances. Because it weighs heavy, the schizophrenia entails a reduction of the school and professional benefits and the output of the activities, with the dismissal, the isolation of the sick person and the loss of the employment. Data of this survey don’t contradict numerous recent or old investigations that demonstrated that the cognitive development is frequently disrupted at the future of schizophrenics; it can result in a school output decrease (31-32). In the present survey, in a population of 400 schizophrenics, 94, 8% of topics were unmarried.

We explain it because the affection especially touches the youngsters, the most often between 15 and 35 years. The rate raised of hospitalization, at the men and the young women and of middle age, put in light the effect of the schizophrenia at people who are in their most productive years, period where most people start a family, establish their career and, in general, create themselves a life. Feeling stigmatized, the schizophrenic isolates herself and lives in his corner; he doesn’t have the opportunity to express its feelings and to lead a life of couple. With the chronicity of the affection, the majority of the schizophrenics unmarried rest.

Data of this work are near of those of the literature where we find the same explanations. In” Survey to become he of the patients suffering from schizophrenia”, the author gets 87% of bachelors (108). Although some people have healthy relations, most schizophrenics (60% to 70%), have limited social contacts and don’t get married (33).

The results of this survey informed us that the consolidated schizophrenics were more numerous with good insight that those that had estimated not to be sicker. The ignorance of the unrests is a particularly frequent symptom in psychiatry and the patients for which this defect is the most marked are the schizophrenics.

The stability of the affection, in this survey, was synonymous of the conscience level by the patient of his  mental trouble (31-32, 34). The fact that it was one of the elements important of the inclusion of the patients, to the recruitment, explains the number important of patients with good insight. These data are in conformity with those of other studies in the literature. Many authors demonstrated that the absence of insight had deleterious consequences on the evolution of the illness because of a bad therapeutic observance, of an increase of the risk of relapse and a reduction of the life quality (32, 34).

On the other hand, data of this survey don’t always meet the same explanations in the literature. Some authors consider the lack of insight like a primary symptom of the pathology of schizophrenic, of others as a psychological defense mechanism (52-53).  Its change, to the sense of the conscience to be reached of a mental trouble, is a central characteristic of the schizophrenia (33 – 36). The reliability of the appreciation subjective of the life quality has been criticized a long time considering the frequent unrests of the insight raised among these schizophrenics (33 – 36).

Data of the present survey demonstrated that 72,2% of schizophrenic topics had declared have been hospitalized more of once and 27,8% had only known one hospitalization.

The explanation is known; most schizophrenic patients knew more a hospitalization because the schizophrenia is a chronic psychosis, with numerous relapses. Data on the hospitalization of the schizophrenics, in this survey, are in conformity with those of the literature where one finds that the majority of patients knows dune hospitalization more especially at the young adults (17).

Quality of life of the schizophrenics to the recruitment

It was important, in this doctoral survey, to know the level of the quality of life of 400 patients recruited at the Neuro-Psycho Pathological Center of the University of Kinshasa first and to look for, then, how to improve it with the psycho education.

Data of this survey demonstrated, to the recruitment, that the quality of life the schizophrenics were not good with an average of 53, 64% (minimum 16% and maximum 81%), to the Neuro-Psycho Pathological Center (CNPP). According to the WHOQOL-26 scale, the quality of life is good from 75% or more. To the recruitment, only 1% of schizophrenics (n=400) had a good quality of life. The problem especially arose in the domains: Independence, social Relation and Environment. In the domains : general Health, physical Health and psychological Health, the schizophrenics estimated to have better satisfaction.          It explains itself by the nature of the illness, the chronicity and the negative symptoms whose cognitive unrests are in disfavor of a normal working and a good quality of life.

It is necessary, in this survey, to mention the 9 items of the domain   “Environment” in the WHOQOL-26 scale. The schizophrenic patient had to express himself to these questions:

  1. Do have yourselves enough money to satisfy your needs?
  2. Do you feel yourselves in security in your life of all days?
  3. Do you have access easily to the cares (medical) of which you need?
  4. Is your environment healthy of the viewpoint of pollution, of the noise, of the healthiness?
  5. Summers – satisfies you of the place where you live?
  6. Do you have the feeling to be informed enough to face the life of all days?
  7. Do you have the possibility to have the activities of leisure?
  8. Are you satisfied with your means of transport?
  9. Your beliefs (personal convictions) they give a sense to your life?

The results of this dissertation, come corroborated those of the literature where the quality of life of the patients affected by schizophrenia has been studied extensively. It is known well that the schizophrenics don’t have a good quality of life (18, 38-40). The dissatisfaction of the life quality touches close to 50% of the schizophrenics ; same antipsychotic coins, the middle score doesn’t pass 50% in general (15, 21, 40-41).

Variable influencing the quality of life of the schizophrenics

Several parameters are susceptible to alter the quality of life of the schizophrenics. It was quite indicated to search for the effect of   socio demographic and clinic variables, as well as the one of the psycho education on the quality of life of the population of survey, to different stages of assessment (43-44).

Quality of life and socio demographic and clinic profiles

The practice of the research of the effects of socio demographic and clinic factors are spilled little and present an evolution recent ; what can be interpreted as linked resistances to cultures of cares” (44).

To the recruitment of the schizophrenics

The illness, real psychic handicap, has an important and lasting reverberation on the person’s global working and in particular on his quality of life. To this stage, evaluation given, in this survey, a quality of life altered in a meaningful way with the education, the civil status, the insight and the number of hospitalization.

Age didn’t have any effect on the quality of life of the schizophrenics. No meaningful difference of middle score of life quality existed between the slices of age.

To this subject, the literature is very poor. The results of this survey join those of “life Quality, schizophrenia and progress in age”.   Age doesn’t have any meaningful effect because of the chronicity of the illness (5). On the other hand, this survey contradicts those of other authors that think that the age of the schizophrenic patient and his level of working exercises an influence on the family and can contribute to the improvement of the quality of life of the patient (45-46).

In this survey, the men were himself auto valued negatively with a score of life quality inferior to the one of the women. To equal severity, the sex didn’t exercise any influence on the quality of life, the difference of score in this work didn’t have significance.

These data confirm those of the literature to the level of the social life of the schizophrenics. The most often the woman finishes her studies, find an use, get married and lead a more balanced emotional and social life than the man. If the prognosis of the illness is immediately better at elle (124), the quality of life remains however bad (45-46).

The bridegroom’s presented a better score of life quality that the bachelors (detached and divorced persons understood). The difference of score of life quality in disfavor of the bachelors was meaningful and could explain itself because the sick person could enjoy his/her/its partner’s help.

On this day, little study compared the civil status and the quality of life. However, data of this survey, to this stage of assessment, confirm the one of French Academic Presses: the bridegrooms have better quality of life that the bachelors (47).

The schizophrenics who had passed the primary level had, in this survey, a better level of life quality. There is controversy because the illness starts very early in youth and remain chronic ; what complicates the formation.

On this day, very little study was interested in search of the effect of the education on the quality of life of the schizophrenics. The authors exploit, especially the function of the instruction level without searching for the interrelationship directly between the level of education and the quality of life (124).

Data of this research are, however, in harmony with those of the authors that raised, about the degree of investment of the consultations in after-care, that 40 % of the patients, with an elevated survey level, accept to come to consult alone. They got a statistically meaningful difference, p = 0,01, in disfavor of the patients with a low survey level (48-49).

On the other hand, data of this work, to the recruitment, are contradictory with those of the authors that declare that, even though the education brings somewhat of the improvement, it doesn’t have any effect on the quality of life (49).

The recognition of the unrests and the importance of the treatments (insight), in this survey, had a highly meaningful effect on the quality of life to the recruitment. The schizophrenics, who had recognized their unrests, had a score of life quality superior to those that were unconscious of it.

The best recognition of patient’s state, in relation with the decrease of negative and cognitive unrests explain this difference to this beginning of assessment.

To this stage of assessment, data of this survey don’t contradict those that demonstrated, in a population of schizophrenic patients consolidated, that the quality of life was influenced in a meaningful manner by some neuro psycho logics disruptions (insight and unrests neuro cognitive) (50).

On the other hand, the relations between the insight and the quality of life are very variously in the literature studied and are the most often contradictory, active of a negative relation between quality of life and insight to the notion that the non conscience of the illness would be associated with an overestimate of the life quality. All studies don’t correspond with data of the present research and a little controversy  exists.  If a good level of insight is associated to a better psychosocial working and an improvement of the functional prognosis, it is also correlated to a loss of the esteem of oneself and to a bigger frequency of the depressive symptoms and the suicidal tendencies (53). The patients having a conscience of trouble more elevated schizophrenic feel less autonomous, less independent, less free to act and to take some decisions that those having a weaker conscience level (52, 53).

Among the factors of confusion capable to be implied in the relations between the insight and the quality of life, he/it seems that the unrests of the cognitive functions play a central role. He/it remains however difficult to know how these different factors interact between them (54).

The number of hospitalization had its importance. Those of schizophrenics that had known that only one hospitalization had a score of better life quality. This report was statistically meaningful. The illness being chronic, the growth of the number of hospitalization had to have a negative impact on the quality of life of the schizophrenics because the illness, with its long evolution, damages the normal working and the social relations.

Data of this survey come closer of those of another on the socio demographic and environmental factors of 65 schizophrenic patients. The survey returns a statistically meaningful difference (p = 0,04) concerning the middle number of hospitalizations (17).

With the psycho education

To the second assessment, with the psycho education in the therapeutic group, had, for the population of survey (n=400), an improvement of score of the quality of life of the variables : Age, Sex, Education, civil State, Insight and Number of hospitalization. However, the socio demographic and clinic variable had on the whole, to the second assessment, no influence on the quality of life.

It is evident from this survey that the differences noted between distributions in variables, to this stage of assessment, had statistically no significance, p˃0,50.

The therapeutic evolution and the best knowledge of the illness, in this research, seemed to have disturbed the life of couple and provoked a negative effect at the bridegrooms.

Data of this survey corroborate those of several others that demonstrated a major therapeutic interest on numerous clinical measurements in the illness schizophrenic, as well for the patients that for the couple and the family. On the other hand, they are in contradiction with those that describe that the schizophrenics, with less cognitive unrests (essentially the ministerial functions, the memory and the verbal flow) have a quality of life altered. These patients could value the stigmata and linked handicaps better to their illness, what would be able to, according to the authors, to have a negative influence on their quality of life (44, 54).

One month after the psycho education

To the third stage of assessment, there was always, for the population of survey, an improvement of middle score of the life quality. The differences observed in the distributions of the socio demographic  and clinic  variables, in this survey, were not however, statistically meaningful, p˃ 0, 050. The level of the life quality in relation to age varied with the evolution of the illness. For the bridegrooms, in this survey, he was always bearish.

The survey confirms the negative impact of the illness on the schizophrenic’s setting. The fact to be joined of this patient appears like a factor of risk importing. The unmarried schizophrenic, who only has his person to manage, meeting less problems than the married schizophrenic, often depressed after the received information. In addition to his illness, he/it must manage the couple again.

In this survey, these results can be interpreted as the fact that a weak level of conscience of the illness can be a better strategy of defense facing the condemnation and to the handicaps bound to the diagnosis of schizophrenia.

The results are near of those of” the therapeutically benefits of psycho education.” The quality of life of married schizophrenic patients is altered meaningfully more that the one of the control group (56). Besides, the improvement of the life quality to this stage of assessment doesn’t correspond, for example, to the progress of the insight.  With the evolution of the illness, good insight doesn’t mean necessarily good quality of life. This explanation, in this survey, corroborates the one driven by other authors.  It is recovered, in” Quality of life in mental disorders”, a meaningful interrelationship between the level of conscience of the illness and the presence of depressive demonstrations in a population of patients suffering from schizophrenia (53).

On the other hand, data of this work contrast a little with those, more categorical, gotten after use of the S-Qol and the SUMD. The authors put initially in evidence, in a population of patients suffering from schizophrenia and consolidated, that the conscience of trouble is the aspect of the insight the more specifically associated with a bad subjective life quality (52).

While browsing the three stages of assessment, the quality of life of the population of survey improved during the therapeutic evolution without meaningful impact of the socio démographic and clinic  variables on this one.

Quality of life of the schizophrenic and variable psycho education

There is grounds to recall here that, in this survey (therapeutic test), the population of the schizophrenics (n=400) had left at random in two groups: TO Witness, without psycho education (n=200) and B Therapeutic, dealt with psycho education (n=200).

The socio demographic and clinic  variables were comparable, in the two groups, and didn’t have any meaningful effects on the quality of life of the schizophrenics. It permitted to reduce the slants of interpretation of the reverberation of these variables on the improvement of quality of life of the schizophrenics.

The mean age of the topics was similar with the average of 33,28±9,83 years (minimum = 16 and maximum=54). The sex ratio distributed the two samples in an identical way 1Women : 3 Men.

To the recruitment of the schizophrenics

Score global means of the life quality in the witness group A and therapeutic B

The first assessment of the life quality takes place outside of the psycho education.  It is evident from this survey that the middle score of the life quality, to the recruitment, was of 54,82% for the control group (n=200) against 52% for the therapeutic or treated with psycho education (n=200).

Four schizophrenics, in the control group, were himself auto valued with a good score of life quality (more or equal to 75%)  et, in the group therapeutic, no patient had not met with good quality of life.

The domains where the schizophrenics were himself best estimated:

-          For the witness group, General Health  and quality of life,

-          For the therapeutic group, Physical Health.

They were himself underestimated:

-          for the control group, in the domain Environment,

-          For the therapeutic group, in Independence.

With a middle score below 75% according to the Whoqol-26 scale, the quality of life was not good in the two groups and the observed difference didn’t have statistically any significance

With the psycho education in the therapeutic group

To this stage of assessment, the survey had demonstrated that with the psycho education the global score of the life quality was for the control group of 52% against 69% for the therapeutic. With a score below 75% according to the Whoqol-26 scale, the quality of life in the two groups was bad even though, in the therapeutic group, it was better. Sixty two patients had a bone quality of life in the therapeutic (n=200) and none in the non therapeutic (n=200).

For the two groups, their preference went in a same domain of life. The schizophrenics had valued themselves better, to this stage with the psycho education, in the domain General Health and Quality of life. They had underestimated themselves on the other hand, for the control group, in social Relation and, for the therapeutic group, in Environment.

In relation to the first evaluation, there was progress. The difference of score of life quality noted between the two groups was very meaningful because of the effect positive of the psycho education in the therapeutic group.

One month after the psycho education

We tried to know the effect of the approach educational psycho in the length with the evolution of the illness. With a score below 75% according to the Whoqol-26 scale, the present survey demonstrated, one month after the psycho education that the quality of life in the two groups was bad. The middle score of the life quality was for the control group of 50% against 72% for the therapeutic group. Contrary to 46,5% of topics in the group therapeutic, no schizophrenic, in the control group, was not himself auto valued with a good score of life quality (score more or equal to 75%).

To this last stage of assessment, the present survey demonstrated that the patients of the therapeutic group had presented, for the set of domains, the best scores of life quality. The domain where the schizophrenics were himself estimated best, to this stage, one month after the psycho education, was again the same for the two groups : Health general and quality of life. They were himself valued coins, for the control group, in the domain psychological Health and for the therapeutic, in Environment. The schizophrenic patients of the therapeutic group had revalued the quality of vie exceptionally to those of the control group that had always seen it again to kisses it:

-          Quality of life 54,82% in the beginning against 50,92% à the end, control group,;

-          Quality of life 52,47% in the beginning against B 72,62% at the end, therapeutic group.

To different stages of assessment, the domain estimated best in the therapeutic group was always the same, Health general and quality of vie ; the environment was the main domain that disturbed and corresponded well to lived it in general daily of the population. In the control group, the domains changed with time.

The level of good quality of life of the schizophrenic patients had progressed, to the second assessment, of 14,5% either 58 topics of the therapeutic group and to the third assessment, one month after, of 22,25% either 89 topics of the same group. Those of the control group had known, to every stage of assessment, a deterioration of the level of their life quality. The difference of scores in the two groups is bound meaningfully to the effect of this therapeutic intervention.

The present research confirms the beneficial effect of the psycho education in the handling of the patients schizophrenic and precise the important domains that disturb and that it is necessary to take in account in the quality of cares of these patients : Independence or Autonomy, social Relation and Environment. For the working of the schizophrenics, these domains are the most important because they allow the patient to live well.

With time and the therapeutic evolution, he/it is evident from the present survey that the effects of the psycho education seem relatively steady and lasting.

To the look of all these observations, there is grounds to note that the present survey permitted to identify the effects positive of the psycho education to the different stages of the assessment of the life quality and to the progression of the improvement of his its level by schizophrenics to the Center Pathological Neuro-Psycho of the university of Kinshasa.

This demonstration is confirmed by the Institute of Neuro psychopharmacology (143-144). A gait educational psycho centered on information and the illness can improve the quality of life subjective of the schizophrenic patients followed to the hospital of day and this improvement encouraged by this approach can maintain itself in the time.

On the other hand, after a brief magazine of the literature, it is the controversy. The authors demonstrate that a positive interrelationship not only exists between assessment of the present life and levels of expectations and aspirations, but also of the negative interrelationships between the gap of aspiration or expectation and the Expressed Life Quality.

Data of this doctoral survey are not always near of those of the authors that suggest that the psycho education could improve the observance of the treatment and the quality of life, but the range of this improvement remains uncertain. These authors invite us to be very prudent when we want to make of the life quality an indicator of success of the therapeutic programs (20,56).

Besides, data of this survey are in contradiction with those of QOL Evaluation: the quality of life can be, enough paradoxically, less good at the time of a retest whereas the patient’s clinical situation improved. This reduction of the life quality would be in this case not to a suffering again by the therapeutic process and the psychic overhauls that it drags, but by an increase of awareness (by the psycho education) and of the individual’s expectations (57).

CONCLUSION:

The quality of life of the schizophrenics is not good to the Neuro-Psycho Pathological Center of the University of Kinshasa. Henceforth, in the follow-up of the handling of the schizophrenia, there is interest to resort with time to the psycho education, therapeutic approach that produces a positive effect on the quality of life subjective of these patients.

A big longitudinal scale survey imposes itself to validate data of this research.

ACKNOWLEDGEMENT:

Authors thank Dr. Danny Bate Boerop for his editorial assistance in preparation of this manuscript. This was done with the spirit of capacity-enhancement of colleagues in Kinshasa.

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