Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode Effect of Antipsychotic Withdrawal on Negative Symptoms in Schizophrenia The risks and benefits of switching patients with schizophrenia or schizoaffective disorder from two to one antipsychotic medication: A randomized controlled trial Differences of satisfaction with medication between patients with schizophrenia treated with typical antipsychotics and atypical antipsychotics. Reasons for discontinuation and continuation of antipsychotics in the treatment of schizophrenia from patient and clinician perspectives Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment. A dose-ranging exploratory study of the effects of ethyl-eicosapentaenoate in patients with persistent schizophrenic symptoms. Reduction in psychotic symptoms as a predictor of patient satisfaction with antipsychotic medication in schizophrenia: Data from a randomized double-blind trial Different Effects of Typical and Atypical Antipsychotics on Grey Matter in First Episode Psychosis: the ÆSOP Study Correlates of subjective well-being in schizophrenic patients treated with atypical antipsychotics Factors influencing the choice of new generation antipsychotic medication in the treatment of patients with schizophrenia Relationship of Cognition to Clinical Response in First-Episode Schizophrenia Spectrum Disorders. Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs Patient perception of medication benefit and early treatment discontinuation in a 1-year study of patients with schizophrenia [Subjective and objective evaluation of treating schizophrenia with classic or atypical drugs]. Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia.
BACKGROUND Many patients recovering from a first psychotic episode will discontinue medication against medical advice , even before a 1-year treatment course is completed . Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment , treatment with typical versus atypical antipsychotic and medication side effects . METHOD In this 2-year prospect i ve study of 254 patients recovering from a first episode of schizophrenia , schizophreniform , or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about : need for treatment , antipsychotic medication benefits , and negative aspects of antipsychotic medication treatment . We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine , and objective measures of symptom response and side effects . RESULTS The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less ( HR=1.75 , 95 % CI 1.16 , 2.65 , p=0.0077 ) or who believed medications were of low benefit ( HR=2.88 , 95 CI 1.79 - 4.65 , p<0.0001 ) . Subjects r and omized to haloperidol were more likely to become medication non-adherent for > or=1 week than subjects r and omized to olanzapine ( HR-1.51 , 95 % CI 1.01 , 2.27 , p=0.045 ) . CONCLUSION Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia , schizoaffective , or schizophreniform disorder Although it is generally accepted that antipsychotic treatment improves the negative symptoms of schizophrenia  in the context of improvement of positive symptoms , exactly how and to what extent they effect “ primary ” negative symptoms remains controversial . Antipsychotic treatment may reduce only those negative symptoms secondary to positive or depressive symptoms , and may have minimal , if any effect , on negative symptoms that represent a primary psychopathological trait manifestation of schizophrenia . In an effort to further examine this issue , we prospect ively assessed negative , positive , depressive , and extrapyramidal symptoms following the discontinuation of antipsychotic medication . Fifty-nine DSM III-R schizophrenic patients underwent a three-week drug wash as part of our neuroimaging protocol s. We assessed psychopathological status and adverse effects utilizing various rating instruments ( i.e. , Scale for Assessment of Positive Symptoms [ SAPS ] , Scale for Assessment of Negative Symptoms [ SANS ] , Hamilton Rating Scale for Depression , and Simpson-Angus Extrapyramidal ) at baseline and weekly during this three-week period . Negative symptoms , as measured by the SANS , worsened significantly during the three-week drug wash . Positive symptoms showed a less consistent change with symptoms of disorganization worsening and with psychotic symptoms remaining the same . The changes in negative symptoms during the drug-free period were correlated with the changes in psychosis and disorganization , but not with changes in depression or extrapyramidal side effects . We were not able to substantiate if the worsening in negative symptoms was a direct result of the worsening of positive symptoms or if they were changing simultaneously , but independent of each other BACKGROUND Despite little evidence to support its use and practice guidelines discouraging the practice , antipsychotic polypharmacy is widely prevalent in schizophrenia . This r and omized controlled trial studied the effects of switching patients stable on two antipsychotic medications  to one antipsychotic medication . METHOD 104 adult out patients with schizophrenia from 7 community mental health centers clinical ly stable on concurrent treatment with 2 antipsychotics  were r and omly assigned to stay on polypharmacy or to switch to antipsychotic monotherapy . Participants were followed for 1-year with assessment s of symptoms and side effects occurring every 60days ( 7 total assessment s ) . We examined differences in time trajectories in symptoms ( PANSS , CGI ) and side effects ( EPS , metabolic , other ) as a function of group assignment ( switch vs. stay ) and time , using intention-to-treat analysis . RESULTS Participants who switched to antipsychotic monotherapy experienced greater increases in symptoms than stay patients . These differences emerged in the second 6months of the trial . All-cause discontinuation rates over the 1-year trial were higher in the switch-to-monotherapy group than in the stay-on-polypharmacy group ( 42 % vs. 13 % ; p<0.01 ) . There were no differences in change over time in any of the side effect measures , except that stay patients experienced a greater decrease in Simpson Angus total scores than switch patients . CONCLUSION Clinicians should be cautious in switching patients with chronic schizophrenia who are stable on 2 antipsychotics to one antipsychotic . Given the challenges in discontinuing antipsychotic polypharmacy , adequate trials of evidence -based treatments such as clozapine and long-acting injectable antipsychotics should be undertaken in inadequately responsive schizophrenia patients before moving to antipsychotic polypharmacy Many studies have demonstrated that atypical antipsychotics are superior to typical antipsychotics in that they have fewer side-effects and produce better improvement of cognitive deficits and quality of life in patients with schizophrenia . However , most of these studies dealt with objective indices assessed by research ers rather than subjective indices that are indeed important to patients themselves . In 126 patients with schizophrenia , annoyance of side-effects and psychotic symptoms , satisfaction with medication , wish to change medication , and knowledge of atypical antipsychotics  were assessed using question naires . Patients treated with typical antipsychotics complained less of annoyance of poor attention and concentration than those treated with atypical antipsychotics , which can be explained by increased awareness of these symptoms by the patients due to the improvement of cognitive function . There were no significant differences between the two groups in other variables . The present results that satisfaction and annoyance were similar between patients treated with typical antipsychotics and those with atypical antipsychotics , may partly explain why patients hesitated and rejected changing or shifting from typical to atypical antipsychotics . But because 98 of 126 patients did not know about atypical antipsychotics , it is important to educate the patients on the merits of atypical antipsychotics Abstract Objective : To identify reasons for discontinuation and continuation of antipsychotic medications in the treatment of schizophrenia from the patients ’ and their clinicians ’ perspectives . Research design and methods : Two measures were previously developed to assess the Reasons for Antipsychotic Discontinuation/Continuation ( RAD ) , one from the patient 's perspective and another from the clinician 's perspective . These measures were administered to acutely ill schizophrenia patients enrolled in a 12-week study of antipsychotic medications ( N = 596 ) and to their clinicians . The RAD was assessed at baseline and at endpoint . Reasons were rated on a 5-point scale from ‘ primary reason ’ to ‘ not a reason . ’ The single most important reason was also identified . The ‘ single most important reason ’ and the ‘ primary reasons ’ for discontinuing the drug used prior to enrollment , and for discontinuing or continuing the study drug were identified . Levels of concordance between patients ’ and clinicians ’ reasons were assessed . Clinical trial registration : The data source for this study is a clinical trial registered at www . clinical trials.gov ( NCT00337662 ) . Main outcome measures : Reasons for Antipsychotic Discontinuation/Continuation ( RAD ) . Results : Patients and clinicians identified several reasons for medication discontinuation and continuation ( 2.3 to 6.3 reasons , on average ) . The top ‘ single most important ’ reason for discontinuing the drug used prior to enrollment and for discontinuing the study drug was ‘ positive symptoms not sufficiently improved or made worse , ’ followed by ‘ medication-related adverse events . ’ The most frequent ‘ single most important ’ reason for medication continuation was ‘ improved positive symptoms , ’ followed by ‘ patient 's perception of improvement , ’ and ‘ functional improvement . ’ A high level of concordance was observed between patients ’ and clinicians ’ ratings . Conclusions : Medication efficacy appears to be the core driver of medication discontinuation and continuation , especially with regard to positive symptoms . There was a high level of concordance between patients ’ and clinicians ’ perspectives . Limitations include the study requirement that patients be at least moderately ill and experiencing acute psychotic exacerbation , a potential selection bias in the readiness to respond to measures , and small sample sizes for some analyses . Further research is needed to replicate findings in patients who are not acutely ill OBJECTIVES To determine the clinical and cost-effectiveness of different classes of antipsychotic drug treatment in people with schizophrenia responding inadequately to , or having unacceptable side-effects from , their current medication . DESIGN Two pragmatic , r and omised controlled trials ( RCTs ) were undertaken . The first RCT ( b and 1 ) compared the class of older , inexpensive conventional drugs with the class of new atypical drugs in people with schizophrenic disorders , whose current antipsychotic drug treatment was being changed either because of inadequate clinical response or owing to side-effects . The second RCT ( b and 2 ) compared the new ( non-clozapine ) atypical drugs with clozapine in people whose medication was being changed because of poor clinical response to two or more antipsychotic drugs . Both RCTs were four-centre trials with concealed r and omisation and three follow-up assessment s over 1 year , blind to treatment . SETTING Adult mental health setting s in Engl and . PARTICIPANTS In total , 227 participants aged 18 - 65 years ( 40 % of the planned sample ) were r and omised to b and 1 and 136 ( 98 % of the planned sample ) to b and 2 . INTERVENTIONS Participants were r and omised to a class of drug . The managing clinician selected the individual drug within that class , except for the clozapine arm in b and 2 . The new atypical drugs included risperidone , olanzapine , quetiapine and amisulpride . The conventional drugs included older drugs , including depot preparations . As in routine practice , clinicians and participants were aware of the identity of the prescribed drug , but clinicians were asked to keep their participating patient on the r and omised medication for at least the first 12 weeks . If the medication needed to be changed , the clinician was asked to prescribe another drug within the same class , if possible . MAIN OUTCOME MEASURES The primary outcome was the Quality of Life Scale ( QLS ) . Secondary clinical outcomes included symptoms [ Positive and Negative Syndrome Scale ( PANSS ) ] , side-effects and participant satisfaction . Economic outcomes were costs of health and social care and a utility measure . RESULTS Recruitment to b and 1 was less than anticipated ( 40 % ) and diminished over the trial . This appeared largely due to loss of perceived clinical equipoise ( clinicians progressively becoming more convinced of the superiority of new atypicals ) . Good follow-up rates and a higher than expected correlation between QLS score at baseline and at follow-up meant that the sample as recruited had 75 % power to detect a difference in QLS score of 5 points between the two treatment arms at 52 weeks . The recruitment to b and 2 was approximately as planned . Follow-up assessment s were completed at week 52 in 81 % of b and 1 and 87 % of b and 2 participants . B and 1 data showed that , on the QLS and symptom measures , those participants in the conventional arm tended towards greater improvements . This suggests that the failure to find the predicted advantage for new atypicals was not due to inadequate recruitment and statistical power in this sample . Participants reported no clear preference for either class of drug . There were no statistically significant differential outcomes for participants entering b and 1 for reasons of treatment intolerance to those entering because of broadly defined treatment resistance . Net costs over the year varied widely , with a mean of 18,850 pounds sterling in the conventional drug group and 20,123 pounds sterling in the new atypical group , not a statistically significant difference . Of these costs , 2.1 % and 3.8 % were due to antipsychotic drug costs in the conventional and atypical group , respectively . There was a trend towards participants in the conventional drug group scoring more highly on the utility measure at 1 year . The results for b and 2 showed an advantage for commencing clozapine in quality of life ( QLS ) at trend level ( p = 0.08 ) and in symptoms ( PANSS ) , which was statistically significant ( p = 0.01 ) , at 1 year . Clozapine showed approximately a 5-point advantage on PANSS total score and a trend towards having fewer total extrapyramidal side-effects . Participants reported at 12 weeks that their mental health was significantly better with clozapine than with new atypicals ( p < 0.05 ) . Net costs of care varied widely , but were higher than in b and 1 , with a mean of 33,800 pounds sterling in the clozapine group and 28,400 pounds sterling in the new atypical group . Of these costs , 4.0 % and 3.3 % , respectively , were due to antipsychotic drug costs . The increased costs in the clozapine group appeared to reflect the licensing requirement for inpatient admission for commencing the drug . There was a trend towards higher mean participant utility scores in the clozapine group . CONCLUSIONS For b and 1 , there is no disadvantage in terms of quality of life and symptoms , or associated costs of care , over 1 year in commencing conventional antipsychotic drugs rather than new atypical drugs . Conventional drugs were associated with non-significantly better outcomes and lower costs . Drug costs represented a small proportion of the overall costs of care ( < 5 % ) . For b and 2 , there is a statistically significant advantage in terms of symptoms but not quality of life over 1 year in commencing clozapine rather than new atypical drugs , but with increased associated costs of care . The results suggest that conventional antipsychotic drugs , which are substantially cheaper , still have a place in the treatment of patients unresponsive to , or intolerant of , current medication . Further analyses of this data set are planned and further research is recommended into areas such as current antipsychotic treatment guidance , valid measures of utility in serious mental illness , low-dose ' conventional ' treatment in first episode schizophrenia , QLS validity and determinants of QLS score in schizophrenia , and into the possible financial and other mechanisms of rewarding clinician participation in trials The objective was to test effects of ethyl eicosapentaenoate ( E-E ) on persistent ongoing symptoms in patients receiving different types of anti-schizophrenic drugs , typical antipsychotics , new atypical antipsychotics , and clozapine . 115 patients with DSM-IV-defined schizophrenia were studied , 31 on clozapine , 48 on new atypical drugs and 36 on typical antipsychotics . Placebo or 1 , 2 or 4 g/day of E-E was given for 12 weeks in addition to the background medication . The main assessment was change from baseline to 12 weeks on the PANSS and its sub-scales . There were no treatment-related side effects or adverse biochemical or haematological effects . Patients on 2 and 4 g/day E-E showed significant reductions in triglyceride levels which had been elevated by clozapine . In patients given 2 g/day E-E there were improvements on the PANSS and its sub-scales , but there was also a large placebo effect in patients on typical and new atypical antipsychotics and no difference between active treatment and placebo . In patients on clozapine , in contrast , there was little placebo response , but a clinical ly important and statistically significant effect of E-E on all rating scales . This effect was greatest at 2 g/day . There was a positive relationship between improvement on rating scales and rise in red blood cell arachidonic acid concentration Background Patient satisfaction with antipsychotic treatment  is important . Limited evidence suggests that satisfaction is associated with symptom improvement and compliance . Predictors of patient satisfaction with antipsychotic medication were examined in a study of patients with a recent exacerbation of schizophrenia . Methods Data are from a r and omized , double-blind trial comparing risperidone ( n = 152 ) , quetiapine ( n = 156 ) , and placebo ( n = 73 ) .  Medication Satisfaction Question naire ( MSQ ) was completed after 14 days of treatment and after 6 weeks at last study visit . Results Medication satisfaction at both time points was significantly associated in multiple regression analysis with improvement on 3 Positive and Negative Syndrome Scale ( PANSS ) factor scores ( positive symptoms p < .01 ; uncontrolled hostility/excitement , p < .0005 ; anxiety/depression , p < .04 ) and treatment with risperidone ( p < .03 ) ; at day 14 , significant association was also found with older age ( p = .01 ) . At both time points , predictor variables explained over 30 % of the variance in medication satisfaction . Change in Hamilton Depression Scale , prolactin levels , sex , and reported adverse events of extrapyramidal symptoms , sedation , and movement disorders were not significant predictors of satisfaction . Lower level of medication satisfaction at day 14 was associated with earlier discontinuation in the trial at week 6 end point . A focused principal components analysis of PANSS factors and MSQ suggested that medication satisfaction relates to 3 groups of factors in descending order of magnitude : lower levels of ( a ) uncontrolled hostility/excitement , ( b ) positive symptoms , and ( c ) negative symptoms , disorganized thoughts , and anxiety/depression . Conclusion Results give further support that treatment satisfaction is positively associated with symptom improvement , particularly psychotic symptoms , and suggest that satisfaction may also be related to compliance , as those who were more satisfied remained in the trial for a longer period of time . Trial registration numberTrial registration number Typical antipsychotic drugs act on the dopaminergic system , blocking the dopamine type 2 ( D2 ) receptors . Atypical antipsychotics have lower affinity and occupancy for the dopaminergic receptors , and a high degree of occupancy of the serotoninergic receptors 5-HT2A . Whether these different pharmacological actions produce different effects on brain structure remains unclear . We explored the effects of different types of antipsychotic treatment on brain structure in an epidemiologically based , nonr and omized sample of patients at the first psychotic episode . Subjects were recruited as part of a large epidemiological study ( ÆSOP : aetiology and ethnicity in schizophrenia and other psychoses ) . We evaluated 22 drug-free patients , 32 on treatment with typical antipsychotics and 30 with atypical antipsychotics .  We used high-resolution MRI and voxel-based methods of image analysis . The MRI analysis suggested that both typical and atypical antipsychotics are associated with brain changes . However , typicals seem to affect more extensively the basal ganglia ( enlargement of the putamen ) and cortical areas ( reductions of lobulus para central is , anterior cingulate gyrus , superior and medial frontal gyri , superior and middle temporal gyri , insula , and precuneus ) , while atypical antipsychotics seem particularly associated with enlargement of the thalami . These changes are likely to reflect the effect of antipsychotics on the brain , as there were no differences in duration of illness , total symptoms scores , and length of treatment among the groups . In conclusion , we would like to suggest that even after short-term treatment , typical and atypical antipsychotics may affect brain structure differently Objective A growing body of research indicates that a low subjective well-being ( SW ) may be predictive of non-adherence and less favourable outcome . This study examined baseline variables and variables in the course of treatment hypothesised to be associated with later SW . Methods Sixty-three in patients with schizophreniform disorder or schizophrenia were r and omly assigned to treatment with various atypical antipsychotics after a wash-out phase of 2 days . Subjects were evaluated with a protocol that examined psychopathology ( Positive and Negative Symptom Scale , PANSS ) , side effects ( Sc and inavian Society of Pharmacology , UKU ) , and subjective well-being ( Subjective Well-being under Neuroleptic treatment , SWN ) at baseline and endpoint ( mean duration of treatment 39.9 days ) . Two-thirds of subjects were multiple episode schizophrenic in patients pre-treated with antipsychotics . Results Multiple regression analyses revealed that the PANSS negative score , neurological side effects , and SWN at baseline , as well as change of the PANSS positive score between baseline and endpoint , were associated independently with SW at endpoint ( R2=0.55 after exclusion of two subjects ) . Conclusions Patients with low SW , severe negative symptoms , and neurological side effects , all at baseline , as well as those without improvement or deterioration of positive symptoms are at risk of low SW later in treatment and , most likely , of non-adherence OBJECTIVE This prospect i ve , naturalistic study investigated the factors influencing physicians ' choice of antipsychotic drug therapy in the treatment of patients with schizophrenia . METHOD 108 in- and out patients treated at the Department of Psychiatry of the Medical University Innsbruck who started treatment with a new generation antipsychotic ( except clozapine ) were included . The following factors were investigated : sociodemographic and illness-related variables , pretreatment , the reasons for change of treatment ( lack of efficacy , side effects , non-compliance ) , side effects of pretreatment and body-mass-index ( BMI ) . RESULTS Sociodemographic and most illness-related variables did not have an influence on the physicians ' choice of medication . Risperidone was more frequently prescribed in patients with severe positive symptoms than amisulpride or quetiapine .  Rigidity , orthostatic dizziness and gynecomastia during pretreatment were frequently associated with starting patients on ziprasidone . In patients with diminished  sexual desire  ziprasidone was preferred over olanzapine . Amisulpride was used more commonly than olanzapine if patients had experienced weight gain during pretreatment . Moreover , patients who were prescribed amisulpride had a significantly higher BMI in comparison to patients who were prescribed olanzapine . The reasons for current change of treatment , as well as the drug history ( total number of antipsychotic drugs prescribed during the course of the illness ) did not have an influence on the physicians ' choice of antipsychotic . CONCLUSION In summary , the data suggest that side effects have a larger influence on the choice of antipsychotic than demographic or illness-related variables , except the severity of positive symptoms First-episode schizophrenia ( FES ) spectrum disorders are associated with pronounced cognitive dysfunction across all domains . However , less is known about the course of cognitive functioning , following the first presentation of psychosis , and the relationship of cognition to clinical course during initial treatment . The present longitudinal study examined the magnitude of neurocognitive impairment , using the MATRICS Consensus Cognitive Battery , in patients experiencing their first episode of psychosis at baseline and after 12 weeks of r and omized antipsychotic treatment with either aripiprazole or risperidone .  At baseline , FES patients evidence d marked impairments in cognitive functioning . Notably , performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial . Performance on indices of general cognitive function , working memory , and verbal learning improved over time , but these improvements were mediated by improvements in both positive and negative symptoms . We did not detect any differential effects of antipsychotic medication assignment ( aripiprazole vs risperidone ) on cognitive functioning . Our results suggest that a brief paper- and -pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication . However , improvements in cognitive functioning over time were related to clinical symptom improvement , reflecting " pseudospecificity . Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia . However , it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects . A self-report instrument has been constructed to evaluate ' subjective well-being under neuroleptics  ' ( SWN ) . The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient 's subjective well-being . The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics .  The short form of the SWN showed sufficient internal consistency and good construct validity . The SWN was only moderately correlated with positive and negative syndrome scale ( PANSS ) scores or changes in psychopathology ( r=-0.20 to -0.37 ) . SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being . Clozapine reduced global psychiatric symptoms significantly more than risperidone . It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance Objective : The objective of this study was to examine the relationship between patient beliefs about medication use and their likelihood of discontinuing treatment prematurely . Associations of patient beliefs about medication with clinical psychopathology and their life satisfaction were also assessed . Methods : This post-hoc analysis used data from a r and omized , open label , 1-year trial of  antipsychotics in the treatment of patients with schizophrenia or schizoaffective disorders ( N = 664 ) .  Medication management including dosage adjustment and medication switching was at doctors ’ discretion , reflecting naturalistic treatment in usual clinical care setting s. Early treatment discontinuation was defined as all-cause study drop out . Patient-reported beliefs about medication were assessed by Rating of Medication Influences ( ROMI ) , degree of clinical psychopathology was measured by Positive and Negative Syndrome Scale ( PANSS ) , and patient quality of life was measured by Lehman Quality of Life Interview ( LQLI ) . Results : Patient perception of medication benefit was the only strong predictor of treatment duration among the 5 underlying dimensions of medication influence . Higher level of perceived beneficial effect of medication was associated with reduced risk of early treatment discontinuation ( Hazard ratio = 0.56 , 95 % Confidence Interval [ 0.40 , 0.79 ] , p = 0.001 ) . Patients with greater beliefs in the beneficial effect of treatment also had better clinical psychopathology outcome and were more satisfied with their quality of life and well-being . Conclusion : Underst and ing the predictors of early treatment discontinuation in the care of schizophrenia patients is important for the development of interventions to improve treatment outcome . Current findings suggest that patient perception of beneficial effect of medication may be a critical factor in achieving treatment persistence and a satisfactory treatment outcome Subjective and objective evaluation of pharmacological treatment was made in 105 schizophrenic in- patients .  PANSS and Calgary scale as well as Van Putten scale were used . Fifty-four percent of subjects received classic neuroleptics and 46%--new atypical drugs for an average period of 8 weeks . The severity of schizophrenic symptoms during treatment as well as subjective evaluation of first effects of the drug did not differ among subjects treated with classic or atypical drugs .  Depressive symptoms decreased significantly during treatment with atypicals but not with classic drugs . Also a significant decrease of depression was found under olanzapine treatment . The severity of neuroleptic-induced side-effects did not differ in both groups . Neurological side effects were more prominent in subjects after 4 weeks of therapy with risperidone , in comparison to patients receiving olanzapine . Forty-seven per-cent of patients showed a dysphoric reaction to the first dose of medication . After treatment with atypical drugs , better subjective evaluation of pharmacotherapy correlated with less severe general and depressive schizophrenia symptoms . Patients ' better evaluation of olanzapine treatment correlated with less severe schizophrenic general symptomatology . The subjective evaluation of treatment was better in patients with less severe neurological side-effects of atypical drugs ( including olanzapine but not risperidone ) and less severe autonomic side-effects of classic drugs . The evaluation of pharmacotherapy made by patients ' family members did not correlate with subjects ' opinions after distribution of the first dose of the drugs , but correlated significantly with patients ' opinion after 8-weeks of treatment . The treatment received by the patients was judged better by the family members if less severe neurological side-effects were present OBJECTIVE This study examined the relative effects of the second-generation antipsychotic drugs and an older representative agent on psychosocial functioning in patients with chronic schizophrenia . METHOD Consenting patients were enrolled in the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness ( CATIE ) project . In phase 1 , patients were r and omly assigned to receive olanzapine , perphenazine , quetiapine , risperidone , or ziprasidone for up to 18 months . Clozapine was included for patients who chose this pathway after discontinuing phase 1 due to inefficacy ; all other patients received another second-generation antipsychotic .  Psychosocial functioning was assessed using the Quality of Life Scale . RESULTS Psychosocial functioning modestly improved for the one-third of phase 1 patients who reached the primary Quality of Life Scale analysis endpoint of 12 months ( average effect size 0.19 SD units ) . Although for several of the drugs individually there were significant changes from baseline , overall there were no significant differences between the different agents . Results were similar at 6 and 18 months . There were no significant differences among the treatment groups in the amount of change in the Quality of Life Scale total score or subscale scores at 6 , 12 , or 18 months . Patients treated with clozapine in the efficacy pathway made comparable gains . Early treatment discontinuations , especially among patients most impaired at baseline , limited the ability to achieve more substantial functional gains . CONCLUSIONS All antipsychotic treatment groups in all phases made modest improvements in psychosocial functioning . There were no differences among them after 6 , 12 , or 18 months . More substantial improvements would likely require more intensive adjunctive psychosocial rehabilitation interventions BACKGROUND Violence is an uncommon but significant problem associated with schizophrenia . AIMS To compare antipsychotic medications in reducing violence among patients with schizophrenia over 6 months , identify prospect i ve predictors of violence and examine the impact of medication adherence on reduced violence . METHOD Participants ( n=1445 ) were r and omly assigned to double-blinded treatment with one of five antipsychotic medications . Analyses are presented for the intention-to-treat sample and for patients completing 6 months on assigned medication . RESULTS Violence declined from 16 % to 9 % in the retained sample and from 19 % to 14 % in the intention-to-treat sample . No difference by medication group was found , except that perphenazine showed greater violence reduction than quetiapine in the retained sample . Medication adherence reduced violence , but not in patients with a history of childhood antisocial conduct . Prospect i ve predictors of violence included childhood conduct problems , substance use , victimisation , economic deprivation and living situation . Negative psychotic symptoms predicted lower violence . CONCLUSIONS Newer antipsychotics did not reduce violence more than perphenazine . Effective antipsychotics are needed , but may not reduce violence unrelated to acute psychopathology
CONCLUSIONS This review provides some support to the notion that patients experiencing antipsychotic side-effects are at risk of developing more negative attitudes toward medication .
BACKGROUND Antipsychotics are associated with a wide range of side-effects .
Many patients experience antipsychotics as unpleasant and something they would rather avoid , leading some of them to discontinue taking their medication .
The importance of evaluating the patients ' perspective , especially their attitudes toward medication in the presence of side-effects , has long been emphasized .
However , no definite conclusion has been made to date on the relationship between antipsychotic side-effects and attitudes toward medication .
OBJECTIVES The objective of this systematic review was to determine the best available evidence regarding the impact of antipsychotic side-effects on attitudes toward medication in patients with schizophrenia and related disorders , which include schizoaffective and schizophreniform disorders .
SEARCH STRATEGY The search aim ed to find published studies using a range of data bases .