S51-01 Subjective well-being under neuroleptic treatment. Relevance for compliance and remission - 17/03/09
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Résumé |
Within the last decade, success criteria of antipsychotic treatment became more ambitious. The most important change is the long overdue consideration of the patient"s perspective. Among other scales, a self-report instrument has been constructed to evaluate “subjective well-being under neuroleptics” (SWN). Studies indicate:
a. | schizophrenic patients, if no longer acutely psychotic or suffering from severe cognitive deficits, are able to reliably assess their SWN, |
b. | high SWN is correlated with high compliance, |
c. | atypical antipsychotics increase SWN, |
d. | individual improvements of SWN and of PANSS are not strongly related (r=-.30 - -.40), and e) dopamine D2 receptor blockade is highly correlated to reduced SWN (r = .66 - .76). |
Several open trials reveal the relevance of early improvement of subjective well-being: In a 12-week trial with 727 patients, 95% of those with early subjective response (within 4 weeks) showed later subjective and/or psychopathological improvement, but only 9% without early subjective response showed later improvement. In another 3-year trial of 2690 patients, again psychopathological response as well as symptomatic and functional remission were mostly related to early (within first 3 months) subjective improvement. Finally, in a first-episode study of 110 patients with a follow-up of 5 years, within the first 6 weeks of antipsychotic treatment only improvement of SWN was related to enduring symptomatic remission (p=.004) while early reduction of PANSS did not predict long-term course. These data indicate the usefulness of self-rating in schizophrenia, insufficient subjective improvement needs to be identified early.
Le texte complet de cet article est disponible en PDF.Vol 24 - N° S1
P. S251 - 2009 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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