The importance of quality of life in patients with alcohol abuse and dependence.

LEARNING OBJECTIVES: After participating in this educational activity, the reader should be better able to identify the instruments that are currently being used to measure quality of life (QoL) in alcohol abuse and dependence; determine the impact of alcohol abuse and dependence on QoL; and evaluate the impact of treating alcohol abuse and dependence on QoL. OBJECTIVE: Quality of life, which consists of the physical, mental, and social domains, has been shown to be negatively affected by alcohol abuse and dependence. This review aims to examine QoL in alcohol abuse and dependence by reviewing the instruments used to measure it and by analyzing the impact of alcohol abuse and dependence and of treatment on QoL. METHODS: Studies were identified using a database search of PubMed and PsycINFO from the past 40 years (1971-2011) using the following keywords: abuse OR dependence, OR use AND alcohol, AND Quality of Life, QoL, Health-related quality of life, HRQOL. Two authors agreed independently on including 50 studies that met specific selection criteria. RESULTS: Although several global measures of QoL have established reliability and validity, many alcohol-specific measures of QoL have not yet been validated. Nevertheless, QoL has been shown to be significantly impaired in those with alcohol abuse and dependence, particularly in the domains of mental health and social functioning, the very areas that show the greatest improvement with abstinence and its maintenance. Moreover, the literature demonstrates the utility of using QoL measures throughout assessment and treatment as a motivational tool and as a marker for treatment efficacy. CONCLUSIONS: Measuring and monitoring QoL during assessment and treatment can add important value to patient recovery, for QoL improves with treatment and successful abstinence. Therefore, targeted, disease-specific assessments of QoL are warranted to address the impairments in the physical, mental, and social domains in alcohol abuse and dependence, thereby improving long-term outcomes.

Quality of life in borderline personality disorder.

OBJECTIVE: To review the literature on quality of life (QoL) in borderline personality disorder (BPD) by examining the use of QoL instruments, the extent of QoL impairments in BPD, and the impact of treatment on QoL in BPD. METHODS: Studies were identified through PubMed and PsycINFO searches for articles from 1980 to 2011 using the following keywords: quality of life OR health-related quality of life OR QOL OR HRQOL AND borderline personality disorder. We focused our search on studies that actually measured QoL. Two authors agreed independently on including 25 studies that met specific selection criteria. RESULTS: The data on QoL in BPD are still sparse, with high heterogeneity in the instruments used to measure QoL, which decreases the comparability of existing studies. EQ-5D, WHOQOL, SF-36, Satisfaction Profile, and Q-LESQ have been utilized as QoL measures in BPD research. The reviewed studies uniformly demonstrated grave impairments in QoL of BPD patients. The available evidence indicates that BPD treatments improve not only psychiatric symptoms but also QoL, as shown by psychotherapy and pharmacotherapy studies. Nevertheless, it remains unclear whether current treatments are able to restore QoL to community norms. CONCLUSIONS: QoL is gaining more importance as an outcome measure of psychiatric interventions. Research evidence confirms that QoL is seriously impaired in BPD and that QoL improves with treatment. Further research is needed to build a consensus on the utilization of QoL measures and to improve their validity in BPD. More importantly, future studies need to develop and test interventions to improve QoL in BPD.

The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression.

BACKGROUND: Quality of life (QOL) is known to be negatively affected during the course of major depressive disorder. Various studies have documented the benefits of pharmacotherapy or psychotherapy alone on QOL in depression, with few studies examining combined treatment. This review will examine the evidence for the impact of each modality, as well as their combination, on QOL in depression. METHODS: Using the key terms depression, depress*, major depress*, quality of life, antidepressant*, and psychotherapy, MEDLINE and PsycINFO searches were conducted to identify treatment-outcome studies that used known QOL measurements over the past twenty-six years (1984 to 2010). RESULTS: Significant improvements in depressive symptomatology and QOL measurements were found with pharmacotherapy, psychotherapy, and their combination, with some studies showing greater improvement following combined treatment than with either intervention alone. CONCLUSIONS: Substantial evidence suggests that psychotherapy, pharmacotherapy, and their combination have favorable effects on QOL in depression. While some studies have shown that combined therapy is superior than either of the two forms alone in improving QOL, additional research is needed to elucidate this effect. QOL measurement is an important dimension of treatment-outcome assessment in patients with depression.