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Subjective effects of neuroleptics predict compliance

  • Conference paper
Prediction of Neuroleptic Treatment Outcome in Schizophrenia

Summary

The low compliance of long-term neuroleptic treatment might be explained not only by extrapyramidal motor side effects (EPMS) but also by other subjective effects, hardly measurable by usual clinical rating scales. Therefore, a self-rating scale to measure subjective well-being on neuroleptics (SWN) was developed; first analyses indicate good practicability, reliability, validity and sensitivity. As the acute psychosis subsides, schizophrenic patients are able to fill out the questionnaire in 15–20 minutes.

Data, obtained from 216 remitted patients, showed that SWN correlates with psychiatrist’s ratings (PANSS), self-ratings of mood states (POMS, SDS, BfS) and EPMS; but variables explained only 19–47% of SWN variance. A repeated application after 3 months in 53 patients did not show any altered SWN in those with constant neuroleptic medication. Marked alterations were noted if dosage or drug was changed. SWN in 28 patients, treated with clozapine because of therapy resistance or major side-effects, was despite of the negative selection, significantly better (t=2.34, p =.02) than in 38 patients under classical neuroleptics. Moreover, already at discharge, patients who 4–6 months later were non-compliant (n=14), differed significantly (t=2.31, p =.02) in SWN, but not in BPRS or PANSS from those who remained compliant (n=34).

These data agree with clinical experience and show that SWN is a useful tool to investigate a hitherto neglected psychopathological dimension. The early detection of major subjective effects of neuroleptics might be helpful in identifying patients at risk of noncompliance. In these patients, strategies such as depot-injection, reduction of dosage or change of medication should be considered.

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References

  • Awad AG (1993) Subjective response to neuroleptics in schizophrenia. Schizophr Bull 19:609–618.

    PubMed  CAS  Google Scholar 

  • Awad AG, Hogan TP (1994) Subjective response to neuroleptics and quality of life — implications for treatment outcome. Acta Psychiatr Scand 89[Suppl 380]:27–32.

    Article  Google Scholar 

  • Axelrod S, Wetzler S (1989) Factors associated with better compliance with psychiatric aftercare. Hosp Commun Psychiatry 40:397–401.

    CAS  Google Scholar 

  • Bandelow B, Müller P, Gaebel W, Köpcke W, Linden M, Müller-Spahn F, Pietzcker A, Reischies FM, Tegeler J (1990) Depressive syndromes in schizophrenic patients after discharge from hospital. Eur Arch Psychiatry Clin Neurosci 140:113–120.

    Article  Google Scholar 

  • Bandelow B, Müller P, Frick U, Gaebel W, Linden M, Müller-Spahn F, Pietzcker A, Tegeler J (1992) Depressive syndromes in schizophrenic patients under neuroleptic therapy. Eur Arch Psychiatry Clin Neurosci 141:291–295.

    Article  Google Scholar 

  • Barnes TR, Curson DA, Liddle PF, Patel M (1989) The nature and prevalence of depression in chronic schizophrenic in-patients. Br J Psychiatry 154:486–491.

    Article  PubMed  CAS  Google Scholar 

  • Belmaker RH, Wald D (1977) Haloperidol in normals. Br J Psychiatry 131:222–223.

    Article  PubMed  CAS  Google Scholar 

  • Brenner HD, Böker W, Rui C (1986) Subjektive Neuroleptikawirkung bei Schizophrenen und ihre Bedeutung für die Therapie. In: Hinterhuber H, Schubert H, Kulhanek F (Hrsg) Seiteneffekte und Störwirkungen der Psychopharmaka. Schattauer, Stuttgart, S 97–107.

    Google Scholar 

  • Brown SL, Sweeney DR, Schwarz GE (1979) Differences in self-reported and observed pleasure in depression and schizophrenia. J Nerv Ment Dis 167:410–415.

    Article  PubMed  CAS  Google Scholar 

  • Craig TJ, Van Natta PA (1976) Recognition of depressed affect in hospitalized psychiatric patients: staff and patient perceptions. Dis Nerv Syst 37:561–566.

    PubMed  CAS  Google Scholar 

  • Craig TJ, Richardson MA, Pass R, Bregman Z (1985) Measurement of mood and affect in schizophrenic inpatients. Am J Psychiatry 142:1272–1277.

    PubMed  CAS  Google Scholar 

  • Diamond R (1985) Drugs and the quality of life: the patient’s point of view. J Clin Psychiatry 46:29–35.

    PubMed  CAS  Google Scholar 

  • Emerich DF, Sanberg PR (1991) Neuroleptic dysphoria. Biol Psychiatry 29:201–203.

    Article  PubMed  CAS  Google Scholar 

  • Ernst K (1954) Psychopathologische Wirkungen des Phenothiazin-Derivates “Largactil” (=“Megaphen”) im Selbstversuch und bei Kranken. Arch Psychiat Z Neurol 192:573–590.

    Article  CAS  Google Scholar 

  • Gebhardt R (1972) Veränderungen der subjektiven Befindlichkeit psychotischer Patienten unter neuroleptischer Therapie. Pharmakopsychiat 5:295–300.

    Google Scholar 

  • Hare EH, Willcox DRC (1967) Do psychiatric inpatients take their pills? Br J Psychiatry 113:1435–1439.

    Article  PubMed  CAS  Google Scholar 

  • Heimann H, Witt PN (1955) Die Wirkungen einer einmaligen Largactilgabe bei Gesunden. Monatsschr Psychiat Neurol 129:104–128.

    Article  CAS  Google Scholar 

  • Heinrich K (1967) Zur Bedeutung des postremissiven Erschöpfungs-Syndroms für die Rehabilitation Schizophrener. Nervenarzt 38:487–491.

    PubMed  CAS  Google Scholar 

  • Helmchen H, Hippius H (1969) Pharmakogene Depressionen. In: Hippius H, Seibach H (Hrsg) Das depressive Syndrom. Schattauer, München, S 443–448.

    Google Scholar 

  • Hogan TP, Awad AG, Eastwood R (1983) A self report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 13:177–183.

    Article  PubMed  CAS  Google Scholar 

  • Jaeger J, Bitter I, Czobor P, Volavka J (1990) The measurement of subjective experience in schizophrenia: the subjective deficit syndrome scale. Comp Psychiat 31:216–226.

    Article  CAS  Google Scholar 

  • Johnson DAW (1977) Practical considerations in the use of depot neuroleptics for the treatment of schizophrenia. Br J Hosp Med 17:564–569.

    Google Scholar 

  • Johnson DAW (1981) Studies of depressive symptoms in schizophrenia. The prevalence of depression and its possible causes. Br J Psychiatry 139:89–101.

    Article  PubMed  CAS  Google Scholar 

  • Knights A, Hirsch SR (1981) ‘Revealed’ depression and drug treatment for schizophrenia. Arch Gen Psychiatry 38:806–811.

    Article  PubMed  CAS  Google Scholar 

  • Liddle PF, Barnes TRE (1988) The subjective experience of deficits in schizophrenia. Comp Psychiat 29:157–164.

    Article  CAS  Google Scholar 

  • Maurer Y, Dittrich A (1979) Vergleich von Selbst-und Fremdbeurteilung bei schizophrenen Patienten. Pharmakopsychiat 12:375–382.

    Article  CAS  Google Scholar 

  • Möller HJ, v. Zerssen D (1981) Depressive Symptomatik im stationären Behandlungsverlauf von 280 schizophrenen Patienten. Pharmacopsychiat 14:172–179.

    Article  Google Scholar 

  • Naber D, Holzbach R, Perro C, Hippius H (1992) Clinical management of clozapine patients in relation to efficacy and side-effects. Br J Psychiatry 160[Suppl 17]:54–59.

    Google Scholar 

  • Prosser ES, Csernansky JG, Kaplan J, Thiemann S, Becker TJ, Hollister LE (1987) Depression, parkinsonian symptoms, and negative symptoms in schizophrenics trated with neuroleptics. J Nerv Ment Dis 175:100–105.

    Article  PubMed  CAS  Google Scholar 

  • Rifkin A, Quitkin F, Klein DF (1975) Akinesia. A poorly recognized drug-induced extrapyramidal behavioral disorder. Arch Gen Psychiatry 32:672–674.

    Article  Google Scholar 

  • Selten JP, Sijben NES, van den Bosch RJ, Omloo-Visser J, Warmerdam H (1993) The subjective experience of negative symptoms: a self-rating scale. Comp Psychiat 34:192–197.

    Article  CAS  Google Scholar 

  • Van Putten T (1974) Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 31:67–72.

    Article  PubMed  Google Scholar 

  • Van Putten T, May PR (1978) ‘Akinetic depression’ in schizophrenia. Arch Gen Psychiatry 35:1101–1107.

    Article  PubMed  Google Scholar 

  • Van Putten T (1978) Subjective response as a predictor of outcome in pharmacotherapy. Arch Gen Psychiatry 35:477–480.

    Article  PubMed  Google Scholar 

  • Wilson JD, Enoch MD (1967) Estimation of drug rejection by schizophrenic inpatients with analysis of clinical factors. Br J Psychiatry 113:209–211.

    Article  PubMed  CAS  Google Scholar 

  • Windgassen K (1992) Treatment with neuroleptics: the patient’s perspective. Acta Pychiatr Scand 86:405–410.

    Article  CAS  Google Scholar 

  • Wise RA (1991) Neuroleptic-induced anhedonia. Recent studies. In: Tamminga CA, Schulz SC (eds) Advances in neuropsychiatry and psychopharmacology, vol I. Schizophrenia research. Raven Press, New York, pp 323–331.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of Munich, Germany

    Prof. Dr. D. Naber, A. Walther, T. Kircher, D. Hayek & R. Holzbach

  2. Department of Psychiatry, University of Munich, Nußbaumstrasse 7, D-80336, Munich, Germany

    Prof. Dr. D. Naber

Authors
  1. Prof. Dr. D. Naber
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  2. A. Walther
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  3. T. Kircher
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  4. D. Hayek
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  5. R. Holzbach
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Editors and Affiliations

  1. Department of Psychiatry, Heinrich-Heine-University, Rheinische Landes- und Hochschulklinik, Düsseldorf, Germany

    W. Gaebel

  2. Department of Psychiatry, The Wellesley/St. Michael’s Hospitals, University of Toronto, Toronto, Ontario, Canada

    A. G. Awad

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© 1994 Springer-Verlag Wien

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Naber, D., Walther, A., Kircher, T., Hayek, D., Holzbach, R. (1994). Subjective effects of neuroleptics predict compliance. In: Gaebel, W., Awad, A.G. (eds) Prediction of Neuroleptic Treatment Outcome in Schizophrenia. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6636-9_10

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  • DOI: https://doi.org/10.1007/978-3-7091-6636-9_10

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-82602-7

  • Online ISBN: 978-3-7091-6636-9

  • eBook Packages: Springer Book Archive

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