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Just as a debate about the fundamental nature of physical entities arose after Descartes, a similar issue arose after Newton. Like Descartes, but of course with very different epistemological and methodological considerations, Newton held that the most fundamental conserved quantity was “quantity of motion” or momentum. Leibniz opposed this, arguing instead for vis viva or “living force.” This controversy introduced two kinds of problems: 1) whether and how empirical proofs could be generated for metaphysical conceptions, and consequently 2) how to understand the relationship between metaphysics and experimental philosophy. These concerns were handled quite differently by two important philosophers: Gravesande and Du Châtelet. Their moves partly resolved older debates, but also partly reconfigured them into new questions we are still attempting to answer.
The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.
We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.
Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.
The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.
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