Psychiatr Prax 2004; 31: 230-232
DOI: 10.1055/s-2004-828486
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Subjektive Befindlichkeit unter neuroleptischer Behandlung und ihre Bedeutung für Compliance und Krankheitsverlauf

Subjective Well-Being under Antipsychotic Treatment and its Meaning for Compliance and Course of DiseaseDieter  Naber1 , Martin  Lambert1 , Anne  Karow1
  • 1Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie
Further Information

Publication History

Publication Date:
08 December 2004 (online)

Zusammenfassung

Erst seit 5 - 10 Jahren bzw. eng verknüpft mit der Entwicklung der atypischen Antipsychotika, sind die Erfolgskriterien einer antipsychotischen Behandlung sehr viel umfassender definiert und zeigen eine stärkere Berücksichtigung der Negativsymptomatik und der kognitiven Störungen, beide für die Langzeitprognose von großer Bedeutung. Die deutlichste Veränderung aber ist die stärkere Berücksichtigung der Patientenperspektive, die für lange Zeit weitgehend vernachlässigt wurde. Die Lebensqualität und ein wichtiger Teilbereich, die subjektive Befindlichkeit, sind zunehmend von wissenschaftlichem Interesse und in zahlreichen Studien untersucht worden. Übereinstimmend wurde festgestellt, dass schizophrene Patienten sehr wohl in der Lage sind, Selbstbeurteilungen konsistent und reliabel auszufüllen und dass ihre Einschätzung zum Erfolg einer antipsychotischen Behandlung sich von der psychiatrischen Perspektive deutlich unterscheidet. Angesichts der Vielfalt der atypischen Antipsychotika und den daraus resultierenden Fragen zu Differenzialindikation ist für Compliance und Langzeitverlauf eine stärkere Berücksichtigung der Patientenperspektive sinnvoll und nötig.

Abstract

Since the introduction of atypical antipsychotics success criteria of an effective antipsychotic treatment are more comprehensive. For instance these criteria include negative symptoms as well as cognitive deficits which are both important for the long-term prognosis of schizophrenia. However, the most fundamental change was the inclusion of the patients' perspective with respect to the treatment. Quality of life assessments as well as evaluation of subjective well-being are of increasing scientific interest and have been assessed in numerous studies. Accordingly there has been ascertained that schizophrenic patients are indeed able to fill out self reports consistently and reliably and it has been shown that patients' perspective differs enormously from the evaluation of psychiatrists with regard to antipsychotic treatment. In consideration of the variety of atypical antipsychotics and different resulting effects for compliance and prognosis of schizophrenia it seems needful to strengthen patients' perspective as an important success criterion of antipsychotic treatment.

Literatur

  • 1 Dolder C R, Lacro J P, Dunn L B, Jeste D V. Antipsychotic Medication Adherence: Is There a Difference Between Typical and Atypical Agents?.  Am J Psychiatry. 2002;  159 103-108
  • 2 Awad A G, Hogan T, Voruganti L, Heslegrave R J. Patients' Subjective Experiences on Antipsychotic Medications: Implications for Outcome and Quality of Life.  Int Clin Psychopharmacol. 1995;  10 (Suppl 3) 123-132
  • 3 Fenton W S, Blyler C R, Heinssen R K. Determinants of medication compliance in schizophrenia: empirical and clinical findings.  Schizophr Bull. 1998;  23 637-651
  • 4 Putten T van. Why do schizophrenic patients refuse to take their drugs?.  Arch Gen Psychiatry. 1974;  31 67-72
  • 5 Putten T van, May P RA, Marder S R. Subjective response to antipsychotic drugs.  Arch Gen Psychiatry. 1981;  38 187-190
  • 6 Windgassen K. Treatment with neuroleptics: the patient's perspective.  Acta Psychiatric Scand. 1992;  86 405-410
  • 7 Lewander T. Neuroleptics and the neuroleptic-induced deficit syndrome.  Acta Psychiatric Scand. 1994;  Suppl 380 8-13
  • 8 Weiden P J, Mann J J, Dixon L, Haas G, Dechillo N, Frances A J. Is neuroleptic dysphoria a healthy response?.  Compr Psychiatry. 1998;  30 546-552
  • 9 Gerlach J, Larsen E B. Subjective experience and mental side-effects of antipsychotic treatment.  Acta Psychiatr Scand. 1999;  99 (Suppl 395) 113-117
  • 10 Hellewell J SE. Patients' Subjective Experiences of Antipsychotics. Clinical Relevance.  CNS Drugs. 2002;  16 457-471
  • 11 Voruganti L, Awad A G. Neuroleptic dysphoria: towards a new synthesis.  Psychopharmacology. 2004;  171 121-132
  • 12 Putten T van, May P. Akinetic depression in schizophrenia.  Arch Gen Psychiatry. 1978;  35 1101-1107
  • 13 Liddle P F, Barnes T RE. The subjective experience of deficits in schizophrenia.  Comparative Psychiatry. 1988;  29 157-164
  • 14 Jaeger J, Bitter I, Czobor P, Volavka J. The measurement of subjective experience in schizophrenia: the subjective deficit syndrome scale.  Comparative Psychiatry. 1990;  31 216-226
  • 15 Selten J P, Sijben N ES, Bosch R J van den, Omloo-Vissen J, Warmerdam H. The subjective experience of negative symptoms: a self-rating scale.  Compr Psychiatry. 1993;  34 192-197
  • 16 Singh M M, Smith J M. Dysphoric Response to Neuroleptic Treatment in Schizophrenia and Its Prognostic Significance.  Dis Nerv Syst. 1976;  37 191-196
  • 17 Hogan T P, Awad A G, Eastwood M R. A Self-Report Scale Predictive of Drug Compliance in Schizophrenia: Reliability and Discriminate Validity.  Psychol Med. 1983;  13 177-183
  • 18 Lambert M, Schimmelmann B Graf, Karow A, Naber D. Subjective Well-being and Initial Dysphoric Reaction under Antipsychotic Drugs - Concepts, Measurement and Clinical Relevance.  Pharmacopsychiatry. 2003;  36 1-10
  • 19 Naber D. A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life and other clinical variables.  Int Clin Psychopharmacol. 1995;  10 (Suppl 3) 133-138
  • 20 Voruganti K, Heslegrave R J, Awad A G, Seeman M. Quality of Life Measurement in Schizophrenia: Reconciling the Quest for Subjectivity with the Question of Reliability.  Psychol Med. 1998;  28 165-172
  • 21 Karow A, Naber D. Subjective well-being and quality of life under atypical antipsychotic treatment.  Psychopharmacology. 2002;  162 3-10
  • 22 Lambert M, Naber D. Current issues in schizophrenia: overview of patient acceptability, functioning capacity and quality of life.  CNS Drugs. 2004;  18, Suppl 2 1-13
  • 23 Naber D, Gaussares C, Moeglen J M, Tremmel L, Baily P E. Efficacy and tolerability of SDZ HDC 912, a partial dopamine D-2 agonist, in the treatment of Schizophrenia. In: Meltzer (ed) Novel Antipsychotic Drugs. New York; Raven Press 1992: pp 99-107
  • 24 Naber D, Moritz S, Lambert M, Pajonk F, Holzbach R, Mass R, Andresen B. Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs.  Schizophr Res. 2001;  50 79-88
  • 25 Haan L de, Lavalaye J, Linszen D, Dingemans P MAJ, Booji J. Subjective experiences and striatal dopamine D2 receptor occupancy in patients with recent onset schizophrenia treated with olanzapine or risperidone.  Am J Psychiatry. 2000;  157 1019-1020
  • 26 Hogan T P, Awad A G. Subjective Response to Neuroleptics and Outcome in Schizophrenia: A Reexamination of Two Measures.  Psychol Med. 1992;  22 347-352
  • 27 Voruganti L, Cortese L, Owyeumi L, Kotteda V, Cernovsky Z, Zirul S, Awad A. Switching from conventional to novel antipsychotic drugs: results of a prospective naturalistic study.  Schizophr Res. 2002;  57 201-208
  • 28 Weiden P J, Rapkin B, Mott T. Rating of Medication Influences (ROMI) Scale in Schizophrenia.  Schizophr Bull. 1994;  20 297-310
  • 29 Naber D. et al .Randomized Double Blind Comparison of Olanzapine and Clozapine on Subjective Well-Being and clinical Outcome in Patients with Schizophrenia. 2004 Submitted
  • 30 García Cabeza I, Sanz Amador M, Arango López C, González de Chávez M. Subjective response to antipsychotics in schizophrenic patients: clinical implications and related factors.  Schizophr Res. 1999;  41 349-355
  • 31 Garavan J, Browne S, Gervin M, Lane A, Larkin C, O'Callaghan E. Compliance with neuroleptic medication in outpatients with schizophrenia; relationship to subjective response to neuroleptics; attitudes to medication and insight.  Compr Psychiatry. 1998;  39 215-219
  • 32 Ritsner M, Ponizovsky A, Endicott J, Nechamkin Y, Rauchverger B, Silver H, Modai I. The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study.  Eur Neuropsychopharmacol. 2002;  12 31-38
  • 33 Ritsner M, Pereöroyzen G, Ilan H, Gibel A. Subjective Response to Antipsychotics of Schizophrenia Patients Treated in Routine Clinical Practice. A Naturalistic Comparative Study.  J Clin Psychopharmacol. 2004;  24 245-254
  • 34 Mutsatsa S H, Joyce E M, Hutton S B, Webb E, Gibbins H, Paul S, Barnes T RE. Clinical correlates of early medication adherence: West London first episode schizophrenia study.  Acta Psychiatr Scand. 2003;  108 439-446

Prof. Dr. Dieter Naber

Universitätsklinikum Hamburg-Eppendorf · Klinik für Psychiatrie und Psychotherapie

Martinistraße 52

20246 Hamburg

Email: naber@uke.uni-hamburg.de