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.
"Sexual dysfunction is a common condition in patients taking antipsychotic medication, with a reported prevalence of 45~80% in males and 30~80% in females. It is the most bothersome symptom and adverse drug effect in men and women with schizophrenia, resulting in a negative effect on treatment compliance.1-3 "
[Show abstract][Hide abstract] ABSTRACT: Sexual dysfunction is a common condition in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. It is known that hyperprolactinemia is a major cause of sexual dysfunction. Based on the blockade of dopamine D2 receptors, haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics, while olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole are classed as prolactin-sparing drugs. Risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction as compared to olanzapine, clozapine, quetiapine, and aripiprazole. With regard to treatment in patients suffering from sexual dysfunction, sildenafil was associated with significantly more erections sufficient for penetration as compared to a placebo. Subsequent studies are needed in order to provide physicians with a better understanding of this problem, thereby leading toward efficacious and safe solutions.
"Patients themselves report that the sexual side effects of medication are distressing . For example, Finn and colleagues  found that patients with schizophrenia rated impotence, as a treatment side effect, as worse than any symptoms of the illness itself. Men may perceive sexual dysfunction as more distressing than women , but the experience of sexual dysfunction in women with schizophrenia has been underresearched. "
[Show abstract][Hide abstract] ABSTRACT: The impact of antipsychotic drug treatment on sexual function was investigated during a randomised trial comparing first generation antipsychotics (FGAs) to (nonclozapine) second generation antipsychotics (SGAs). Sexual function and quality of life were (rater-blind) assessed in 42 patients with DSM-IV schizophrenia (aged 18-65) using the self-report version of the Derogatis Interview for Sexual Function (DISF-SR) and the Heinrichs Quality of Life Scale (QLS), prior to, and 12 weeks following, a change in medication from an FGA drug to either an FGA or SGA drug. SGAs significantly improved sexual function compared to FGAs. Change in sexual function was associated with change in quality of life. Where impaired sexual functioning is a distressing adverse effect of treatment with an FGA agent, consideration should be given to switching to an SGA.
"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. "
[Show abstract][Hide abstract] 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.
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