Subjective Well-being of Patients with Schizophrenia as a Target of Drug Treatment
E. Karamatskos, C. Mulert, M. Lambert and D. Naber
Affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
An important development within the last decades is the consideration of the patient's perspective and the acknowledgement
that the majority of patients are able to judge their state of well-being. Several self-report scales such as
the “The Subjective Well-being under Neuroleptics Scale” (SWN) have been established. Additionally to their beneficial
impact, current antipsychotics have considerable limitations. Antipsychotic-related side effects, such as extrapyramidalmotor
symptoms, weight gain and obesity, apathy and anhedonia have an important influence on the patient’s wellbeing.
Evidence suggests that the so-called neuroleptic-induced deficit syndrome under antipsychotics might be caused by the
inhibition of the dopaminergic reward system. A reduced activation of the ventral striatum, including the nucleus accumbens
is associated with negative symptom severity. Second-generation antipsychotics (henceforth SGA) block striatal D2
receptors less and show a weaker binding to D2 receptors, have interactions with several other neurotransmitters and inhibit
to a lesser degree the reward functions compared to first-generation antipsychotics (henceforth FGA). This may support
the reduction of negative symptoms, contributes to a higher subjective well-being, a better medication adherence and
thereby an improved therapeutic outcome. The involvement of the patient and the consideration of his/her subjective
wellbeing will be a major aspect in the development of new treatment strategies in schizophrenia and has a significant impact
on the adherence and the long-term prognosis.
Keywords: Schizophrenia, subjective well being, reward system, antipsychotic agents, "extrapyramidalmotor
symptoms", syndrome, antipsychotics, eurotransmitters, therapeutic, long-term prognosis, treatment strategies, ventral striatum
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