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. 2025 Dec 15.
doi: 10.1007/s00406-025-02169-8. Online ahead of print.

Quality of life, disability and antipsychotics-related side effects in schizophrenia spectrum and bipolar disorder: the role of patient-reported outcome measures

Sofia Francesca Aprile #  1 , Alessandro Rodolico #  2   3   4 , Sabrina Castellano  1 , Pierfelice Cutrufelli  3 , Antonio Di Francesco  3 , Stefan Leucht  2   4 , Filippo Caraci  5   6 , Andrea Fiorillo #  7 , Maria Salvina Signorelli #  3   8
Affiliations

Quality of life, disability and antipsychotics-related side effects in schizophrenia spectrum and bipolar disorder: the role of patient-reported outcome measures

Sofia Francesca Aprile et al. Eur Arch Psychiatry Clin Neurosci. .

Abstract

Background: Schizophrenia and bipolar disorder significantly impair daily functioning and quality of life. Effective treatment monitoring requires tools assessing both clinical symptoms and everyday impairment.

Aim: This cross-sectional study explored relationships between symptoms, side effects, and functioning using clinician-rated and patient-reported measures. We examined whether the Glasgow Antipsychotic Side-Effect Scale (GASS), a patient-reported outcome measure (PROM), is associated with disability and quality of life comparably to the clinician-administered Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale.

Methods: We recruited 100 individuals with schizophrenia spectrum or bipolar disorders receiving antipsychotic treatment. Linear regressions and network analyses were conducted. Linear regressions assessed the association between side effects, disability (World Health Organization Disability Assessment Schedule, WHODAS) and quality of life (EuroQol 5-Dimension scale, EQ-5D). Network analyses were conducted to explore the interplay between side effects, disability, quality of life and symptoms, the latter assessed using the Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS), and Montgomery-Åsberg Depression Rating Scale (MADRS).

Results: Side effects assessed with GASS and UKU significantly impacted disability (GASS: p < .001, 95% CI [0.274; 0.635]; UKU: p < .001, 95% CI [0.313; 1.021]) and reduced quality of life (GASS: p < .001, 95% CI [-1.391; -0.511]; UKU: p < .001, 95% CI [-3.176; -1.668]). Network analysis identified depressive symptoms as central in the UKU network and autonomic side effects as central in the GASS network.

Conclusion: GASS total and subgroup scores showed comparable associations with disability and quality of life as UKU. Integrating both perspectives enables comprehensive monitoring and patient-centred care.

Keywords: Antipsychotic; Bipolar disorder; Network analysis; Quality of life; Schizophrenia; Side effects.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: All procedures involving human patients were approved by the Institutional Review Board of the University of Catania (Protocol number: 1521). Consent to participate: All subjects provided written informed consent for their scores to be used for research purposes.

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