Subjective Experiences of Antipsychotic Treatment: A Comparison of First and Second-generation Medications among Patients with Schizophrenia

Aims: The patient’s perspective of antipsychotic treatment has been a relatively neglected area of
research. Whether subjective experiences of antipsychotic treatment are better among patients on
second-generation antipsychotics (SGAs), than those on first-generation antipsychotics (FGAs) has
also evoked some controversy. This study attempted a longitudinal comparison of attitudes toward
treatment, subjective well-being and quality of life (QOL) between patients on SGAs and FGAs. Sociodemographic
and clinical correlates of these subjective experiences were also examined.
Methodology: Standardised ratings of insight, psychopathology, side-effects, attitudes, subjective
well-being and QOL were carried out among 40 patients with schizophrenia on SGAs and 30 on
FGAs, over a 6-month period.
Results: Both groups were similar in the first 3-month period, apart from the slightly greater severity
of illness in the FGA group. Differences in symptom-severity and side-effects emerged between the
groups over the course of follow-up. Moreover, as the study progressed, differences also became
apparent in subjective experiences; patients on SGAs had significantly better attitudes, subjective
well-being and QOL than those on FGAs. However, differences between individual SGAs (olanzapine
and risperidone) on these indices were minimal. The three indices of subjective experience were
highly correlated with each other. Older age, being employed, greater insight, lower symptom-severity
and the absence of side-effects demonstrated significant positive associations with different aspects
of subjective experiences.
Conclusions: Patients on SGAs had a more favourable profile of subjective experiences with
treatment than those on FGAs. These differences seemed to be determined mainly by differences in
symptom-severity and side-effects.