Subjective utility ratings of neuroleptics in treating schizophrenia

Department of Psychology, University of Texas, Austin 78712.
Psychological Medicine (Impact Factor: 5.43). 12/1990; 20(4):843-8. DOI: 10.1017/S0033291700036539
Source: PubMed

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.

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    • "Is the clinician's perspective overlapping with the patient's perspective? Finn et al. (1990), who carried out a study that measured the subjective burden of both psychotic symptoms and medication side effects in patients and clinicians, found that the side effects of antipsychotics were perceived as being as troublesome as the symptoms they were being used to treat by patients; psychiatrists, by contrast, considered side effects less bothersome than symptoms. Moreover, a substantial disagreement between patients' and psychiatrists' ratings of troublesomeness of specific side effects was found. "
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    ABSTRACT: This contribution initially describes some traditional tools that are commonly used to measure drug tolerability, including measures that take into considerations both clinicians' and patients' views. Subsequently, it highlights a few studies that compared the patient and clinician's perspective in the evaluation of drug tolerability, trying to understand whether health care providers and patients perceive antipsychotic tolerability in different ways, and whether these different ways may have implications in terms of treatment adherence and outcome. Finally, some clinical and research implications are suggested and discussed.
    Epidemiologia e psichiatria sociale 09/2008; 17(3):182-5. DOI:10.1017/S1121189X00001251 · 3.16 Impact Factor
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    • "Routinely and sensitively questioning patients with schizophrenia about their sexual function is an important initial approach that may improve therapeutic outcomes (Kelly and Conley, 2003). Sexual dysfunction is considered by many schizophrenia patients to be more troublesome than most other symptoms and adverse drug effects (Finn et al., 1990; Lambert et al., 2004) and is a major cause of poor quality of life (Olfson et al., 2005), negative attitude to therapy and treatment non-compliance (Lambert et al., 2004). In an assessment of schizophrenia patients treated with conventional antipsychotics, those who experienced sexual dysfunction were significantly ( p < 0.001) more at risk of developing a negative attitude towards treatment and, therefore, at risk of later non-adherence compared with those who experienced sedative or vegetative side effects (Lambert et al., 2004). "
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    ABSTRACT: Antipsychotic medications are known to be commonly associated with sexual dysfunction. Sexual dysfunction is estimated to affect 30-80% of patients with schizophrenia and is a major cause of poor quality of life. However, few comparative studies on the sexual dysfunction effects associated with antipsychotic medication have been published and the effects of the newer atypical antipsychotics have been largely unexamined. This review aims to examine the latest evidence regarding the sexual function effects of different antipsychotic medications, particularly the newer prolactin-sparing drugs, quetiapine and aripiprazole, in patients with schizophrenia and schizoaffective psychosis. A literature search was conducted within PubMed/MEDLINE using the terms risperidone, haloperidol, clozapine, olanzapine, ziprasidone, quetiapine, aripiprazole; sexual dysfunction; schizophrenia. The results were limited to studies published since 2002. Recently published studies show that the relative impact of antipsychotics on sexual dysfunction can be summarised as risperidone > typical antipsychotics (haloperidol) > olanzapine > quetiapine > aripiprazole. The availability of prolactin-sparing antipsychotics should enable psychiatrists to consider and manage proactively the sexual function consequences of pharmacological intervention, thereby improving sexual side effects, which may lead to improved treatment adherence and psychiatric outcome in patients with schizophrenia.
    Human Psychopharmacology Clinical and Experimental 04/2008; 23(3):201-9. DOI:10.1002/hup.924 · 1.85 Impact Factor
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    • "We are not aware of any studies on the correlation between compliance and sexual side effects due to antipsychotic drugs. Studies suggest that clinicians tend to underestimate the frequency and importance of sexual side effects in patients with schizophrenia (Finn et al. 1990; Peuskens et al. 1998) and other psychiatric disorders (Singh and Beck 1997). Further research is required on sexual side effects induced by antipsychotics, the possible mechanisms involved and on the relationship of specific side effects on compliance. "
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    ABSTRACT: To compare sexual functioning in patients treated with quetiapine or risperidone. This open-label study included patients with schizophrenia or a related psychotic illness who were randomized to quetiapine (200-1200 mg/d) or risperidone (1-6 mg/d) for 6 weeks. Sexual dysfunction was assessed by a semistructured interview, the Antipsychotics and Sexual Functioning Questionnaire (ASFQ), based upon the Utvalg for Kliniske Undersogelser (UKU). Four of 25 quetiapine-treated patients (16%) and 12 of 24 risperidone-treated patients (50%) reported sexual dysfunction (chi 2 = 6.4; df = 1; P = 0.006) on the ASFQ. Six patients (11.7%; 4 on risperidone, 2 on quetiapine) spontaneously reported sexual dysfunction. The mean+/-SD dose was 580+/-224 mg/d for quetiapine and 3.2 +/- 1.3 mg/d for risperidone. Mean +/- SD prolactin levels in quetiapine- and risperidone-treated patients were 13.8 +/- 17.9 and 57.7 +/- 39.7 ng/mL, respectively. Sexual dysfunction was less common in patients treated with quetiapine than with risperidone. Direct questioning about sexual functioning is necessary to avoid underestimating the frequency of sexual side effects in patients with schizophrenia and related psychotic disorders.
    Journal of Clinical Psychopharmacology 03/2004; 24(1):56-61. DOI:10.1097/ · 3.76 Impact Factor
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