La percezione soggettiva della tollerabilità dei trattamenti antipsicotici nei soggetti con schizofrenia: uno studio clinico controllato randomizzato

Schizophrenia is a psychiatric patohology needing usually an antipsychotic (AP) long-term treatment. It affects as much as 1% of the population worldwide (Mueser & McGurk, 2004). The incidence of schizophrenia is the same across sexes, onset before the age of 30 is the norm, with men tending to present some four years younger than women (Jones & Cannon, 1998). It is characterised by psychotic symptoms, negative symptoms and cognitive impairment (Flaum & Schultz, 1996). Psychotic symptoms include delusions (commonly persecutory delusions) and hallucinations (commonly auditory hallucinations, e.g. hearing voices). Negative symptoms are characterised by “loss of function” (flattened affect, thought blocking, cognitive disturbances, poor grooming, lack of motivation, social withdrawal, poor speech content). Cognitive impairment includes problems in attention, concentration, learning, memory, abstract thinking. Schizophrenia has an episodic course with a severe prognosis in around one third of cases (Tamminga et al., 1998). The role of antipsychotics in producing better outcomes for people with psychotic illness has been clearly demonstrated (Chen, 1991; Hirsch et al., 1996). However, antipsychotics also produce a range of adverse effects that impact on the quality of life of the patients (Keks, 1996; Hamer & Haddad, 2007; Naber, 2008). The adverse effects can cause even greater level of distress than the symptoms of illness (Morrison et al., 2000). Recent research indicates that subjective experience of adverse effects of antipsychotics drugs are associated with a number of relevant clinical outcomes, such as, treatment adherence and long-term effectiveness (Awad and Voruganti, 2004). Naber also pointed out how important is the patient’s point of view; the most relevant criterion to evaluate the outcome of a treatment is the tolerability of the medication (Naber & Karow, 2001). There are a few scales commonly used for the routine clinical measurement of a broad array of antipsychotic adverse effects. Recently a scale has been developed: the Liverpool University Neuroleptic Side Effects Rating Scale (LUNSERS) a self-reported scale with good statystical characteristics (Day et. al., 1995).