Subjective utility ratings of neuroleptics in treating schizophrenia.
ABSTRACT This study developed a method for measuring subjective costs and benefits of psychiatric treatments. Forty-one patients rates the relative bothersomeness of symptoms of schizophrenia and side effects of neuroleptics. Thirty-four psychiatrists made parallel ratings from the perspective of the average patient (individual utility) and of the patient's family and society (institutional utility). Psychiatrists predicted patients' ratings moderately well, but misjudged the bothersomeness to patients of 24% of side effects and 20% of symptoms. When considering the patient's perspective, both schizophrenic patients and psychiatrists rated symptoms as no more bothersome than side effects. However, psychiatrists saw side effects as significantly less bothersome than symptoms when considering costs to society. The subjective utility of neuroleptic medications for schizophrenia is most justifiable from an institutional perspective.
SourceAvailable from: Robert Schoevers[Show abstract] [Hide abstract]
ABSTRACT: A limited number of studies have evaluated sexual functioning in patients with schizophrenia. Most patients show an interest in sex that differs little from the general population. By contrast, psychiatric symptoms, institutionalization, and psychotropic medication contribute to frequently occurring impairments in sexual functioning. Women with schizophrenia have a better social outcome, longer lasting (sexual) relationships, and more offspring than men with schizophrenia. Still, in both sexes social and interpersonal impairments limit the development of stable sexual relationships. Although patients consider sexual problems to be highly relevant, patients and clinicians not easily discuss these spontaneously, leading to an underestimation of their prevalence and contributing to decreased adherence to treatment. Studies using structured interviews or questionnaires result in many more patients reporting sexual dysfunctions. Although sexual functioning can be impaired by different factors, the use of antipsychotic medication seems to be an important factor. A comparison of different antipsychotics showed high frequencies of sexual dysfunction for risperidone and classical antipsychotics, and lower frequencies for clozapine, olanzapine, quetiapine, and aripiprazole. Postsynaptic dopamine antagonism, prolactin elevation, and α1-receptor blockade may be the most relevant factors in the pathogenesis of antipsychotic-induced sexual dysfunction. Psychosocial strategies to treat antipsychotic-induced sexual dysfunction include psychoeducation and relationship counseling. Pharmacological strategies include lowering the dose or switching to a prolactin sparing antipsychotic. Also, the addition of a dopamine agonist, aripiprazole, or a phosphodiesterase-5 inhibitor has shown some promising results, but evidence is currently scarce.Schizophrenia Bulletin 02/2015; 41(3). DOI:10.1093/schbul/sbv001 · 8.61 Impact Factor
Drugs 01/2004; 64(20):2291-2314. DOI:10.2165/00003495-200464200-00003 · 4.13 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Hyperprolactinemia (HPRL) has until recently been considered an unavoidable side effect inherent to antipsychotic treatment and probably this has been the reason why its clinical effects are underestimated in daily clinical practice. In this review we evaluate the different prolactin (PRL) raising potential of the antipsychotic (AP) drugs as well as the clinical and individual situations where special precautions must be taken when using these medications. The most common and better known clinical consequences of HPRL-induced by APs are sexual and reproductive symptoms, with different characteristics depending on gender, but recently more evidence has been provided of also an involvement in bone mineral density, carcinogenesis and cardiovascular system. Though these effects still require more evidence, they are important to be taken into account when prescribing APs drugs in susceptible patients. It is essential to prevent and minimize the effect of HPRL-induced by APs and, once established, to consider its severity and clinical effects and to provide a proper management, treatment and consideration of other disciplines.Psiquiatria Biologica 07/2013; 20(3):27-34. DOI:10.1016/j.psiq.2013.06.011