Quality of life in chronic mental illnesses: Exploring new frontiers

This book is the second in series of books on quality of life (QOL), prepared as resource material for the workshop with the same title organized and published by Psychiatric Rehabilitation Services, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru. Previous book dealt with QOL in health and disease, while the current one deals particularly with QOL in chronic mental disorders. The book is organized in four sections viz. ‘Introduction & Conceptual Issues’, ‘Measurement & assessment of Quality of Life’, ‘Quality of Life in specific mental disorders’, and ‘Interventions and Quality of Life’.

The first section begins with an introduction to the concept of QOL. The authors describe that despite being a commonly discussed and intensively researched topic, the concept of QOL has still not found a uniform definition across the world, and also across the medical specialties. Additionally, other closely related concepts like functional status, life satisfaction and well-being are also discussed. Further in this section, the book deals with important determinants of QOL and cross cultural issues in patients of mental illnesses. The problem of the existing gap in mental health services in India and its impact on QOL of the patient are also discussed.

The second section consists of a review of the currently available tools for assessment of QOL. The available tools are discussed separately under the headings, ‘generic tools’, ‘purpose specific tools’ and ‘disease specific tools’. Special attention has been given to subjective versus objective assessment, and assessment during different phases of illness. A note has been made on Indian tools for assessment of QOL.

Third section deals with QOL in specific mental disorders. There are separate chapters dealing with QOL in schizophrenia, mood disorders, common mental disorders, substance use disorders, personality disorders and the special populations. Individual chapters have reviewed the available literature and research on QOL in different groups of disorders. This section highlights the special needs of different groups, and lack of disease specific tools for assessment of QOL. The authors have tried to give special attention to Indian studies in this arena, however, the discussion on QOL in patients of psychosexual disorders is missing. Furthermore, the chapters on childhood disorders and Alzheimer's disease are rather brief and lack a comprehensive discussion.

The last section of the book deals with the impact of available treatment strategies on QOL as well as other important interventions to improve the same. The first two chapters in this section deal with role of psychotropics and psychotherapy, the standard treatment offered to all patients with mental illnesses. It is particularly appreciable that due attention has been given to the role of psychiatric social workers in improving QOL in the next chapter. The chapter on QOL in professional caregivers is interesting as they often get neglected in big discussions. Following this, role of psychiatric rehabilitation services, brain stimulation, art and yoga are also discussed, which are important and yet underutilized tools to improve QOL of patients. However, routine caregivers i.e., family members of the patient have not received due attention. The concluding chapter provides future directions in this field.

This book is a brief and yet comprehensive overview of the concept of QOL in patients of chronic mental illness. The book takes a broad based view of the topic, beginning from discussion of the concept to its various determinants, tools for assessment, its relevance and implications to various psychiatric illnesses, available means and measures to improve the same and future directions. It has also reviewed the concept from past and present perspectives and from the point of view of different stakeholders, i.e., patients, their caregivers and treating clinicians. It is good to see that Indian studies in this area have been reviewed, wherever available.

This book shall be a great help to all classes of mental health professionals. The language is simple, lucid and easy to follow, and has made the otherwise complex topic, easy to comprehend. It will provide new insights to mental health professionals and motivate them to look into this aspect more frequently than what they are doing currently. As focus has now shifted from mere medical alleviation of symptoms to overall improvement in lives of the patient, this book will be of great help.