A SELF-RATING TO MEASURE SUBJECTIVE EFFECTS OF NEUROLEPTIC DRUGS, RELATIONSHIPS TO OBJECTIVE PSYCHOPATHOLOGY, QUALITY-OF-LIFE, COMPLIANCE AND OTHER CLINICAL-VARIABLES

The benefit of neuroleptic drugs in the treatment of schizophrenic pat ients is objectively beyond any doubt. However, most patients disconti nue their neuroleptic drugs within some months. This low compliance mi ght be caused by the lack of insight into the disease and the necessit y of therapy. Also of major importance are adverse effects, not restri cted to motor symptoms, but also affecting cognition and emotion. They are often too subtle to be detected by objective examination, but rep orted by patients who complain of a reduced quality of life with restr ictions of emotionality, straight thinking and spontaneity. This syndr ome, similar to negative symptoms of schizophrenia, has been named 'ph armacogenic depression' or 'neuroleptic-induced deficit syndrome'. To investigate this issue of major clinical relevance, a self-rating scal e was developed to measure subjective well-being under neuroleptic tre atment (SWN). First analyses indicate good practicability, reliability , validity and sensitivity. Data obtained from 280 remitted schizophre nic patients showed that the SWN was significantly correlated to objec tive psychopathology (Positive and Negative Symptom Scale, PANSS; r=-0 35), quality of life (r=0.60) and other self-ratings of mood states [P rofile of Mood Scale (POMS), Self-rating Depression Scale (SDS), Befin dlichkeits Scale (BFS); r=0.25-0.75]. A repeated application after 3 m onths in 53 patients did not show any change in SWN in those with cons tant neuroleptic medication, but there were marked alterations if the dosage or the drug was changed. The SWN in 28 patients treated with cl ozapine because of therapy resistance or major side effects was, despi te negative selection, significantly better (t=1.79, p=0.03) than in 3 8 patients under classical neuroleptics. Moreover, even at dismissal, patients who were non-compliant 4-6 months later (n=14) differed signi ficantly (t=3.21, p=0.02) in SWN, but not in PANSS, from those who rem ained compliant (n=34). These data indicate that the SWN is a useful t ool for investigating a hitherto neglected psychopathological dimensio n. Subjective effects of neuroleptics are measurable, affect patients' quality of life and should be considered more thoroughly in clinical routine as well as in clinical trials of potential neuroleptic drugs.