Artículos de revistas
Quality al life in the rehabilitation al schizaphrenics
La Qualítá della Vita nella Riabilitazione degli Schizofrenici
Franco Goldwurm, Gian
Gomez Ocaña, Concha
Recently (1993) Norman Sartorius presenting a WHO method for the assessment of Health-related Quality of Life, pointed out that litle attention has been paid to research concerning Quality of Life in relation to health care. Many physicians neglect this aspect in spite of its importance for prevention and for a good therapeutic choice. This is due not only to some Iimitation of medical practice, but also to some confusion on the concept of Q. of L. First of all, we have to consider the relationship between objective socio-economic aspects of Q. of L. and subjective psychological ones. In many definitions of Q. of L. the two poles (the social objective and the individual subjective) are always present although with different weight or importance. Glatzer in 1991 thought that: "Q. of L. in the broad sense is the individual's constellation of objective and subjective components of welfare. In the restricted sense it lays the main emphasis on the perception and evaluation of Iife; it is concerned with satisfaction with life domains and general well-being." Psychologists and Psychiatrists have to take in consideration particularly this ''restricted sense of Q. of L.", In the last years most studies regarding Q. of L. derived from different field of biomedicine and many researches investigated the instruments of evaluation and the effects of diseases and therapies on the Q. of L. of somatic patients. In 1993 Hunt and McKenna observed that this field has developed much slower in Psychiatry than in other disciplines such as cardiology, oncology and rheumatology. Nevertheless, the interest for the Q. of L. of psychotic patients has recently increased due to the emergence of problems regarding dehospitalisation, community care, pharmacological treatment and psychiatric rehabilitation. Of particular interest are studies on Q. of L. during schizophrenics' rehabilitation with cognitive behavioral methods. For example Liberman and Kopelowicz confirmed that "comprehensive, continuous, and integrated biobehavioral therapy - aiming at early detection and treatment of schizophrenic symptoms, family and social skills training, and teaching coping and illness self-management skills - has been documented to improve the course and outcome of schizophrenia as measured by symptom recurrence, social functioning and Q. of L.". We summarize here the conclusions of the last fifteen years' experience of our Milanese group on this topic. First of all to modify the Q. of L. of our patients their living conditions must be taken into account to improve their objective social conditions. Secondly our work in psychosocial rehabilitation with cognitive behavioral methods is also useful to ameliorate the Q. of L. in its subjective dimension Training on daily life skills, social skills, problem solving, self instruction and so on, can improve ability of prevision, socialization, stress coping, emotional control and adjustment of aspirations and expectations. These abilities can promote a better style of life that is the base for a greater happiness and a better Q. of L. of the schizophrenic patients. The family training can better the Q. of L. of the whole family by improving social competence, communication style, expressed emotion and problem solving ability. Nevertheless improving the general life satisfaction of our patients in the field of inner experiences (according Skantze and coworkers), remains a problem. Particularly we have to focus on ways to increase positive self perception, self satisfaction, self esteem, pleasure, joy and love, that are the care of Q. of L.La qualità deIla vita (Qdv) è un concetto molto ampio che nasee in contrapposizione a concezioni meramente quantitative e material della vita, per valorizzare al contrario la percezione soggettiva del benessere individuale, della soddisfazione sia globale che nelle varíe aree della vita, edella felicità come stato emotivo e come processo di valutazione cognitiva. Nell'ambito della medicina sono state fatte numerose ricerche sul rapporto fra Salute e Qdv, in relazione sia alla promozione della salute sia alla cura delle varie malattie somatiche. Paradossalmente si trovano meno lavori in ambito psichiatrico. Tuttavia l' interesse per la Qdv dei pazienti psicotici è andato aumentando in questi ultimi anni, in relazione sia ai problemi della deistituzionalizzazione ospedaliera, sia del trattamento psicofarmacologico che di quello riabilitativo.Particolarmente interessanti sono i lavori sulla riabilitazione degli schizofrenici con metodi cognitivo-comportamentali e la valutazione della loro Qdv. Vengono accennate a questo proposito le esperienze riabilitative milanesi, sviluppatesi negli ultimi quindici anni. La terapia comprensiva e la riabilitazione comportamentale e cognitiva ha avuto, a nostro avviso, un effetto positivo anche sulla Qdv dei pazienti psicotici e delle loro famiglie, benché rimangano aperti molti problemí dí misuraziune e di più specifica incisivitá dell'intervento sul benessere soggettivo dei soggetti schizofrenici.
Quality of life, subjective self-being; life satisfaction; happiness; cognitive-behavioral rehabilitation; psychotics; schizophrenics; psychiatry.