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Master Thesis

Étude de l'évolution de la qualité de vie et des profils de perfusion cérébrale en SPECT dans une population de patients atteints de schizophrénie

Abstract : Introduction : Quality of life (QoL) is considered as a valid predictor of relapse in schizophrenia and of a long-term symptomatic remission, functional recovery and disability. The evaluation of QoL in clinical practice remains underused. The neurobiological basis of QoL in schizophrenia have been therefore investigated, demonstrating several associations between microstructural changes in cerebral areas involved in emotional and social functional networks. Few studies investigate the determinants of QoL using a longitudinal approach. Objectives: The aim of this longitudinal study was to explore the clinical and neuronal determinants of quality of life in a population of patients with schizophrenia using SPECT. Method: 47 patients with a diagnosis of schizophrenia were included at baseline and were reassessed at 1-year follow-up. A QoL measurement using the S-QoL 18 scale was performed. At the same time, patients had a SPECT exam to assess brain perfusion. A delta was calculated which enabled us to identify two groups of patients according to the "deteriorated" and "improved" QOL. Results: First, in the deteriorated QoL group, the S-QoL 18 index was negatively correlated with the general subscale PANSS score and with the total CDSS score. In the improved QoL group, the S-QoL 18 index was negatively correlated with the total CDSS score and positively correlated with the Chlorpromazine-equivalent daily dose. In the whole-group of patients, the S-QoL 18 index at 1-year follow-up was positively correlated with rCBF of the left temporal pole (BA 38), of the left amygdala and of the left anterior insula at baseline. Finally, The S-QoL 18 index showed significant effects with time on the brain SPECT perfusion of the left temporal pole (BA 38), of the left amygdala and of the left anterior insula at baseline and at the 1-year follow-up. Discussion and perspectives: In conclusion, we report clinical and neural determinants of QoL in 1-year follow-up study in schizophrenia. The perfusions of brain regions involved in Theory of Mind and in emotion processing at baseline are associated with the course of the QoL at 1-year follow-up. Several clinical implications can arise from this, such as the need for a systematic evaluation of quality of life at the start of follow-up and at regular points during follow-up. The development of targeted interventions on emotions, mind theories and depression would also be interesting.
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https://dumas.ccsd.cnrs.fr/dumas-01886893
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Submitted on : Wednesday, October 3, 2018 - 12:48:42 PM
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François-Elie Schlama. Étude de l'évolution de la qualité de vie et des profils de perfusion cérébrale en SPECT dans une population de patients atteints de schizophrénie. Sciences du Vivant [q-bio]. 2017. ⟨dumas-01886893⟩

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