Good tolerability equals good results: the patient's perspective

Although conventional antipsychotics are useful for the treatment of schizo phrenia, many patients discontinue taking them within a few months. As well as the positive influence of a good doctor-patient relationship, evidence suggests that the patient's initial subjective experience during antipsycho tic therapy is a major predictor of compliance. In addition to motor sympto ms, conventional antipsychotics can cause significant adverse effects on dr ive, emotion and cognition, which are reflected in patients complaining of a reduced quality of life, although may not be detected by objective examin ation. This syndrome, which is similar to the negative symptoms of schizoph renia, is known by numerous terms including 'pharmacogenic depression' and 'pharmacogenic anhedonia'. The introduction of atypical antipsychotics broa dened the criteria for effective antipsychotic treatment to include the sub jective assessment of improvement in patients' quality of life. The previou s lack of interest in this domain may have been due to the inability to imp rove it with conventional agents and the misconception that schizophrenic p atients were unable to subjectively evaluate their quality of life. However , numerous studies have shown that 63-95% of patients in remission are able to self-rate their affective state of well being or quality of life. Atypi cal antipsychotics are superior to conventional antipsychotics in improving quality of life and reducing the stigma of schizophrenia, particularly fro m the patient's perspective and are strong reasons for the widespread use o f these drugs. (C) 2001 Elsevier Science BM All rights reserved.