Mental Illness 2017; volume 9:7052

patients’ quality of life.

Kilian4 emphasized that the goal of
Quality of life in persons with
Correspondence: Zack Cernovsky,
schizophrenia modern psychiatry is to foster an independ- Department of Psychiatry, University of
ent lifestyle and autonomous dealing with Western Ontario, 98 Greenbrier Crescent, N6J
Zack Cernovsky the illness, as exemplified by the concept of 3X9 London, Ontario, Canada.
Department of Psychiatry, University of empowerment. Kilian’s team developed a Tel.: +1.519.471.8049.
33-item questionnaire to measure this con- E-mail: [email protected]
Western Ontario, London, Canada
cept in psychiatric outpatients. The ques-
Key words: Schizophrenia; quality of life; de-
De-institualization had been greatly tionnaire covers important aspects of the institualization.
facilitated by novel antipsychotics. Our goal patient’s life, including financial situation,
is now to foster an independent life style of living arrangements, work activity, social Conflict of interest: the author declares no
the discharged schizophrenic patients. Their life, participation in therapy, insight, accept- potential conflict of interest.
subjective views and satisfaction can be sta- ance of illness, medication management,
tistically assessed via Kilian’s empower- free time activities, political activism, sense Received for publication: 16 January 2017.
ment questionnaire, Bergold’s inventory, or of hope, self-efficacy, and family relation- Accepted for publication: 23 January 2017.
the measures of quality of life. Their med- ships. It is noteworthy that the item content
of Kilian’s empowerment questionnaire was This work is licensed under a Creative
ication compliance can hopefully be also Commons Attribution-NonCommercial 4.0
enhanced by further pharmacological stud- derived from focus groups with the partici-
International License (CC BY-NC 4.0).
ies, including also those of herbal prepara- pation of patients with major psychiatric ill-
tions such as cannabidiol or ginseng. ness, their family members, and of experts ©Copyright Z. Cernovsky, 2017
Our goal is to improve the quality of life in psychiatry. Licensee PAGEPress, Italy
of persons diagnosed with psychiatric ill- At present, we are faced with the task of Mental Illness 2017; 9:7052
ness. De-institutionalization movement in further reducing the levels of symptoms of doi:10.4081/mi.2017.7052
psychiatry in 1960s was originally driven patients in halfway houses or those living
by the hope to free the patients from highly more independently within the community. effective ingredients of therapeutic counsel-
contained institutionalized environments. Some residual symptoms of schizophrenia ing for each group of disorders.
At that time, certain charismatic psychia- in patients on clozapine or other novel The Quality of Life (QOL) research on
trists such as Franco Basaglia insisted that antipsychotics such as olanzapine are sub- patients with schizophrenia indicates that
the symptoms such as the word salad, flat jectively upsetting or disruptive and too fre-
the presence of positive and negative symp-
affect, the vacant stares, the repetitive ges- quently prevent young adults with schizo-
toms is correlated with poor QOL, as
tures and movements would, in fact, abate phrenia from successfully completing uni-
demonstrated by the meta-analysis by Eack
when the patient benefits from the freedom versity education or from being employ-
and Newhill.8 The Nigerian statistical study
of living outside, within the community.1 able, for example, concurrent symptoms of
(published in the present issue of Mental
The critics of the de-institionalization point- anxiety or obsessive compulsive symptoms.
Illness) shows that higher medication
ed out that the patients with schizophrenia Supportive psychotherapy can, at times,
adherence is associated with better QOL.
and those with bipolar illness were being help to reduce such symptoms. While there
The patients’ compliance with pharma-
dumped into the neighborhoods, many of is a wide variety of psychotherapeutic
cotherapy can be increased by eliminating
them becoming homeless, or victims of approaches, some psychotherapists may
side-effects. The search for better medica-
assaults or of suicides, or found themselves insist that their particular technique is the
most efficacious. Some others have hypoth- tions with more benign profile of side-
in jails.2 Their symptoms had not disap-
esized that certain common ingredients in effects is important. This may also include
peared. Families of former inpatients felt
the diverse psychotherapies are the main exploration of herbal substances. Ginseng
overwhelmed by having to assume an inten-
underlying cause of reduction in overall has shown some potential for reducing lev-
sive homecare without outside help, except
level of psychopathology. Tschacher, els of depression in patients with high levels
when their financial situation enabled them
Junghan, and Pfammatter investigated such of negative symptoms.9 Cannabis sativa
to pay for inpatient treatments in private
factors common to various psychotherapeu- contains numerous chemical compounds
psychiatric hospitals. The antipsychiatric
movement often criticized pharmacology as tic approaches:5 they surveyed statistically most of which have not yet been properly
essentially controlling and poisonous, how- 68 psychotherapy experts and concluded explored. While the administration of
ever, it has been also noted in several stud- that the extent of patient engagement, of tetrahydrocannabinol (THC, derived from
ies that symptoms such as dyskinesia and affective experiencing, and the overall ther- cannabis) can trigger symptoms of schizo-
parkinsonism occur even in patients never apeutic alliance were judged as most rele- phrenia, another substance from cannabis,
exposed to antipsychotic medication.3 vant. The democratization seen in devel- the cannabidiol (CBD), is not psy-
Over more recent decades, the new gen- oped countries has its parallel in our inter- chotomimetic and, in fact, reduces schizo-
eration antipsychotics and the network of est, as healthcare professionals, in how the phrenic symptoms all while showing a
halfway houses made the process of re-inte- patient perceives the therapist. The patients’ marked tolerability and safety when com-
gration into the community less aversive perceptions of their therapist can be meas- pared to current medications for schizo-
both for the patients and for their families. ured in an encompassing manner via scales phrenia.10 While modern antipsychotics
In particular, with clozapine, the back wards such as those of Bergold’s questionnaire:6,7 such as clozapine have made de-institution-
with treatment resistant patients or even Genuineness, Emotional Resonance, alization subjectively more beneficial and
entire hospitals were emptied by a few par- Empathy, Mutual Liking, Directiveness, tolerable for our patients, an intensified
ticularly skilled pharmacotherapists, e.g., Perceived Similarity, Social Reinforcement, research effort is needed to further reduce
Charles Byrne in Ireland or Kola Oyewumi Anxiety Inhibition, Modeling, and Expert their symptoms.
in Ontario, in a manner that greatly reduced Status. These studies would hopefully per-
the severity of symptoms and enhanced the mit us to statistically determine the actual

[Mental Illness 2017; 9:7052] [page 1]

Editorial

Groenemeyer A. & Vieseler S. (Hrsg). 8. Eack SM, Newhill CE. Psychiatric

References Soziologie sozialer Probleme und symptoms and quality of life in schizo-
sozialer Kontrolle. Wiesbaden: VS phrenia: a meta-analysis. Schizophr
1. Davidson L, Rakfeldt J, Strauss J (eds).
The roots of the recovery movement in Verlag für Sozialwissenschaften; 2008. Bull 2007;33:1225-37.
psychiatry: lessons learned. Hoboken: 5. Tschacher W, Junghan UM, Pfammatter 9. Chiu S, Cernovsky Z, Husni M, et al.
John Wiley and Sons; 2010. M. Towards a taxonomy of common Ginseng augmentation of subsyndromal
2. Palermo GB. The 1978 Italian Mental factors in psychotherapy - results of an depressive symptoms (SSD) in schizo-
Health Law: a personal evaluation. J R expert survey. Clin Psychol Psychother phrenia secondary analysis of a multi-
Soc Med 1991;84:99-102. 2014;21:82-96. site RCT study. Paper presented at the
3. McCreadie RG, Padmavati R, Thara R, 6. Cernovsky ZZ, Bergold JB. Annual Meeting of the American
Srinivasan TN. Spontaneous dyskinesia Quantifying patients’ reports about psy- Psychiatric Association, New Orleans,
and parkinsonism in never-medicated, chotherapists via Bergold’s inventory. LA, May 22-26, 2010.
chronically ill patients with schizophre- Internet J Psychiatry 2015;5:1. 10. Leweke FM, Piomelli D, Pahlisch F, et
nia: 18-month follow-up. Br J 7. Cernovsky ZZ, Bergold JB. Appendices al. Cannabidiol enhances anandamide
Psychiatry 2002;181:135-7. 1-3: quantifying patients’ reports about signaling and alleviates psychotic
4. Kilian R. Lebensqualität und psychotherapists via Bergold’s invento- symptoms of schizophrenia. Transl
Empowerment in der Psychiatrie. In ry. Internet J Psychiatry 2016;5: 1. Psychiatry 2012;2:e94.

[page 2] [Mental Illness 2017; 9:7052]