Subjective well-being and quality of life under atypical antipsychotic treatment

The increasing interest in subjective well-being and quality of life of schizophrenic patients represents a conceptual shift in therapeutic outcome criteria. Symptom reduction alone was the most essential outcome parameter for a long time; with the development of atypical antipsychotics more ambitious success criteria, including the patients' perspective, are considered today. While effects on (positive) psychopathology do not differ markedly between typical and atypical antipsychotics, the lack of motor symptoms, the improvement of negative, affective and cognitive symptoms, and particularly the better subjective well-being as well as quality of life are major advantages for the new antipsychotic drugs. Quality of life assessment is a new methodological approach to differentiate therapeutic effects and to give more consideration to the patient's perspective. A number of disease-specific or generic scales have been used to measure quality of life of schizophrenic patients under neuroleptic treatment. There is strong evidence by seven controlled and eight open trials that in comparison to typical neuroleptics, atypicals increase the quality of life significantly, and the difference is of major clinical relevance in many patients. This review describes the development of quality of life research in schizophrenic patients, and summarises the methodological problems and the numerous clinical trials. Furthermore, the benefit of introducing atypical antipsychotics early in the course of illness and their particular benefit in combination with rehabilitative non-pharmacological treatment is discussed.