Subjective Well- Being under Neuroleptic Treatment (SWN)- a Self-Rating for Patients with Schizophrenia	PDF file
Dieter Naber,  MD HUniversity Medical Center Hamburg- Eppendorf, Department of Psychiatry Keywords : antipsychotic treatment, neuroleptic treatement, health-related quality of life (HRQL), schizophrenia, SWN questionnaire, subjective well-being

The subjective experience of antipsychotic drugs in the treatment of schizophrenia received little scientific attention, at least during the period of typical antipsychotics. For 20–30 years after the introduction of antipsychotic treatment, most research on side effects and reasons for non-medication adherence focused on motor symptoms. The more subtle emotional restrictions, cross-sectionally difficult to differentiate from primary or secondary negative symptoms, were excluded from contemporary research. Among the pioneers recognising the importance of the patients’ perspective were van Putten et al.1, who revealed the significant relationship between subjective experience and compliance as well as Awad whose group developed the first self-report to predict medication compliance2.

There are several reasons, which might explain why the patients’ perspective was neglected over such a long period: Many psychiatrists were convinced that their patients are not able to reliably assess their subjective well-being. Their complaints were attributed to the illness and they were “only” subjective. However, numerous studies have shown that most patients with schizophrenia, if no longer acutely psychotic and not suffering from severe cognitive impairment, are able to self-rate their affective state, subjective well-being or quality of life in a reliable manner3. Another major reason for the late scientific interest in the patients’ perspective was probably the belief of many psychiatrists that they know their patients sufficiently well and do not need information on their subjective experience. Again, several trials revealed that both perspectives differ markedly regarding efficacy and tolerability of antipsychotic treatment. A good example is the study by Voruganti et al.4, who found in a double-blind comparison between typical and atypical antipsychotics that many of the advantages of the atypicals, particularly the improvement in quality of life, were detected “only” by patients’ self-reports, but were missed by their psychiatrists.