Subjective Experiences of Antipsychotic Treatment: A Comparison of First- and Second-generation Medications among Patients with Schizophrenia

Aims: The patient’s perspective of antipsychotic treatment has been a relatively neglected area of research. Whether subjective experiences of antipsychotic treatment are better among patients on second-generation antipsychotics (SGAs), than those on first-generation antipsychotics (FGAs) has also evoked some controversy. This study attempted a longitudinal comparison of attitudes toward treatment, subjective well-being and quality of life (QOL) between patients on SGAs and FGAs. Socio-demographic and clinical correlates of these subjective experiences were also examined.

Methodology: Standardised ratings of insight, psychopathology, side-effects, attitudes, subjective well-being and QOL were carried out among 40 patients with schizophrenia on SGAs and 30 on FGAs, over a 6-month period.

Results: Both groups were similar in the first 3-month period, apart from the slightly greater severity of illness in the FGA group. Differences in symptom-severity and side-effects emerged between the groups over the course of follow-up. Moreover, as the study progressed, differences also became apparent in subjective experiences; patients on SGAs had significantly better attitudes, subjective well-being and QOL than those on FGAs. However, differences between individual SGAs (olanzapine and risperidone) on these indices were minimal. The three indices of subjective experience were highly correlated with each other. Older age, being employed, greater insight, lower symptom-severity and the absence of side-effects demonstrated significant positive associations with different aspects of subjective experiences.

Conclusions: Patients on SGAs had a more favourable profile of subjective experiences with treatment than those on FGAs. These differences seemed to be determined mainly by differences in symptom-severity and side-effects.