Subjective experience and mental
side-effects of antipsychotic treatment

Gerlach J, Larsen EB
Department P, St Hans Hospital, Roskilde, Denmark.
Acta Psychiatr Scand Suppl 1999; 395:113-7


Many schizophrenic patients have a negative attitude towards antipsychotic drugs. This attitude is not only due to lack of insight into the disease, lack of recognition of the beneficial effects of the drugs, and to objective side-effects. The negative attitude is to a high degree due to mental side-effects and a sceptical opinion about antipsychotic medication in general. In a study of 53 chronic schizophrenic out-patients receiving maintenance depot antipsychotic treatment, we found that 60% were positive about the treatment, 32% were ambivalent and 8% had a negative attitude. Only 60% complained of side-effects, even though 94% had objective side-effects. Mental side-effects such as subjective akathisia, dysphoria and emotional indifference were most often observed by the patients, while hypokinesia and hyperkinesia were least noticed by them, but most often observed by the physician. No correlation was found between the patients' subjective assessment of their quality of life and the degree of psychosis and side-effects. With the new atypical antipsychotics this situation seems to be changing. These new drugs are primarily characterized by a lower level of motor extrapyramidal side-effects (EPS), and with fewer motor EPS, fewer mental EPS can be expected. In recent studies comparing the new antipsychotics with haloperidol, better effects have been observed with regard to negative symptoms and depression, and this may at least in part be a reflection of a lower level of mental side-effects of the atypical antipsychotics. This improved clinical profile of new antipsychotics is extremely valuable in the context of an integrated treatment in schizophrenia, consisting of early intervention, psychosocial rehabilitation and family/patient psycho-education.
New antipsychotics
The deficit syndrome
Atypical antipsychotics
Schizoaffective disorder
Risperidone v haloperidol
Bipolars and schizophrenics
Eltoprazine versus haloperidol
Haloperidol (Haldol) : structure
Serotonin model of schizophrenia
Dopamine model of schizophrenia
Big Pharma and drugs for schizophrenics
Atypical antipsychotics for schizophrenia
Dysphoria, anhedonia, reduced vitality, and emotional indifference

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