Schizophrenia, social functions and quality of life

Abstract: A good quality of life (QoL) can be regarded as the ultimate goal of psychiatric treatment and rehabilitation. The objective of the present thesis was to study the how the QoL of patients with schizophrenia was related to their social functions and varying social environments. Psychiatric services have undergone major changes in the last 50 years, from an asylum-based model to community psychiatry, radically changing the social environment of patients with schizophrenia. The first paper focused on the effects of deinstitutionalization on QoL, and showed that patients in four living habitats in the city of Malmö (hospital wards, treatment collectives, group homes, apartments of their own) did not differ in self-rated QoL. However, we found evidence suggesting that the patients, and in particular those with predominantly negative symptoms, were unable to assess their QoL by the measurement instrument used (QLS-100). In the second paper, we found that self-monitoring problems of schizophrenic patients was linked to cognitive impairments rather than to the presence of negative symptoms. In the third paper, we found that the social functions of even the most severely disabled patients with schizophrenia could be improved by social skills training. In paper four, data from a case-finding study of schizophrenia in the city of Malmö (population 250 000; 1344 schizophrenic patients were identified) were combined with data from a sociological study of the self-reported sense of security and social organisation in the local domicile involving 7 000 randomly selected inhabitants. The prevalence of schizophrenia was particularly high in areas with high levels of social disorganization and unsafety, which may further detract form the QoL of these patients.