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Pharmacopsychiatry 2005; 38(3): 132-138
DOI: 10.1055/s-2005-864125
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Correlation of Subjective Well-being in Schizophrenic Patients with Gait Parameters, Expert-rated Motor Disturbances, and Psychopathological Status

A. Putzhammer1 , M. Perfahl1 , L. Pfeiff1 , G. Hajak1
  • 1Department of Psychiatry, University of Regensburg
Further Information

Publication History

Received: 13.8.2004 Revised: 5.10.2004

Accepted: 4.11.2004

Publication Date:
18 May 2005 (online)

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Introduction: Subjective well-being of schizophrenic patients can be impaired by symptoms of the disease and by adverse effects of antipsychotic medication. We assessed the correlations of subjective well-being with objectively measured gait parameters, expert-rated motor disturbances, and psychopathological status in 25 conventionally treated, 25 atypically treated, and 16 drug-naive patients. Methods: Main variables were the SWN scores (Subjective Well-being under Neuroleptic Treatment Scale), the ESRS scores (Extrapyramidal Symptoms Rating Scale), and the PANSS scores (Positive and Negative Syndrome Scale). Gait parameters were determined by using an ultrasonic system for gait analysis. Results: In conventionally treated patients, the SWN total score significantly correlated with stride length (R 2 = 0.39; P < 0.01), whereas in atypically treated and drug-naive patients, it significantly correlated with the PANSS score (atypically treated: R 2 = 0.25, P < 0.05; drug-naive: R 2 = 0.64, P < 0.01), mainly due to the correlations with the ”negative symptoms” and the ”general psychopathology” sub-scores. Correlations with stride length were significant not only in the ”physical functioning” sub-score of the SWN but also in all other sub-scores. Correlations of the SWN scores with ESRS scores were weak. Conclusion: Under conventional antipsychotic treatment, subjective well-being particularly depends on major side effects, whereas in atypically treated and drug-naive schizophrenic patients, it is mainly influenced by psychopathological status. Motor adverse effects of conventional antipsychotic treatment cannot be considered as isolated physical side effects but have severe implications for other aspects of the patients’ well-being.

References

  • 1 Allan E R, Sison C E, Alpert M, Connolly B, Crichton J. The relationship between negative symptoms of schizophrenia and extrapyramidal side effects with haloperidol and olanzapine.  Psychopharmacol Bull. 1998;  34 71-74
    PubMedGoogle Scholar
  • 2 Allison D B, Mackell J A, McDonnell D D. The impact of weight gain on quality of life among persons with schizophrenia.  Psychiatr Serv. 2003;  54 565-567
    CrossrefPubMedGoogle Scholar
  • 3 Awad A G, Voruganti L N, Heslegrave R J, Hogan T P. Assessment of the patient’s subjective experience in acute neuroleptic treatment: implications for compliance and outcome.  Int Clin Psychopharmacol. 1996;  11 Suppl 2 55-59
    PubMedGoogle Scholar
  • 4 Browne S, Garavan J, Gervin M, Roe M, Larkin C, O’Callaghan E. Quality of life in schizophrenia: insight and subjective response to neuroleptics.  J Nerv Ment Dis. 1998;  186 74-78
    CrossrefPubMedGoogle Scholar
  • 5 Browne S, Roe M, Lane A, Gervin M, Morris M, Kinsella A, Larkin C, Callaghan E O. Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia.  Acta Psychiatr Scand. 1996;  94 118-124
    CrossrefPubMedGoogle Scholar
  • 6 Casey D E. Motor and mental aspects of extrapyramidal syndromes.  Int Clin Psychopharmacol. 1995;  10 Suppl 3 105-114
    PubMedGoogle Scholar
  • 7 Chouinard G, Ross-Chouinard A, Annable L, Jones B D. The Extrapyramidal Symptoms Rating Scale.  Can J Neurol Sci. 1980;  7 233-244
    PubMedGoogle Scholar
  • 8 de Haan L, Lavalaye J, Linszen D, Dingemans P M, Booij J. Subjective experience and striatal dopamine D(2) receptor occupancy in patients with schizophrenia stabilized by olanzapine or risperidone.  Am J Psychiatry. 2000;  157 1019-1020
    CrossrefPubMedGoogle Scholar
  • 9 de Haan L, Lavalaye J, van Bruggen M, van Nimwegen L, Booij J, van Amelsvoort T, Linszen D. Subjective experience and dopamine D2 receptor occupancy in patients treated with antipsychotics: clinical implications.  Can J Psychiatry. 2004;  49 290-296
    PubMedGoogle Scholar
  • 10 de Haan L, van Bruggen M, Lavalaye J, Booij J, Dingemans P M, Linszen D. Subjective experience and D2 receptor occupancy in patients with recent-onset schizophrenia treated with low-dose olanzapine or haloperidol: a randomized, double-blind study.  Am J Psychiatry. 2003;  160 303-309
    CrossrefPubMedGoogle Scholar
  • 11 de Haan L, Weisfelt M, Dingemans P M, Linszen D H, Wouters L. Psychometric properties of the Subjective Well-Being Under Neuroleptics scale and the Subjective Deficit Syndrome Scale.  Psychopharmacology (Berl). 2002;  162 24-28
    CrossrefPubMedGoogle Scholar
  • 12 Fenton W S, Blyler C R, Heinssen R K. Determinants of medication compliance in schizophrenia: empirical and clinical findings.  Schizophr Bull. 1997;  23 637-651
    Google Scholar
  • 13 Garavan J, Browne S, Gervin M, Lane A, Larkin C, O’Callaghan E. Compliance with neuroleptic medication in outpatients with schizophrenia; relationship to subjective response to neuroleptics; attitudes to medication and insight.  Compr Psychiatry. 1998;  39 215-219
    CrossrefPubMedGoogle Scholar
  • 14 Gerlach J, Larsen E B. Subjective experience and mental side-effects of antipsychotic treatment.  Acta Psychiatr Scand Suppl. 1999;  395 113-117
    PubMedGoogle Scholar
  • 15 Gervin M, Browne S, Garavan J, Roe M, Larkin C, O’Callaghan E. Dysphoric subjective response to neuroleptics in schizophrenia: relationship to extrapyramidal side effects and symptomatology.  Eur Psychiatry. 1999;  14 405-409
    CrossrefPubMedGoogle Scholar
  • 16 Guy W. Abnormal Involuntary Movement Scale (AIMS). ECDEU Assessment Manual for Psychopharmacology. Public Health Service Washington, DC; 1976
    Google Scholar
  • 17 Jaeger J, Bitter I, Czobor P, Volavka J. The measurement of subjective experience in schizophrenia: the Subjective Deficit Syndrome Scale.  Compr Psychiatry. 1990;  31 216-226
    PubMedGoogle Scholar
  • 18 Kay S R, Fiszbein A, Opler L A. The positive and negative syndrome scale (PANSS) for schizophrenia.  Schizophr Bull. 1987;  13 261-76
    CrossrefPubMedGoogle Scholar
  • 19 Lacro J P, Dunn L B, Dolder C R, Leckband S G, Jeste D V. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature.  J Clin Psychiatry. 2002;  63 892-909
    CrossrefPubMedGoogle Scholar
  • 20 Lambert M, Schimmelmann B G, Karow A, Naber D. Subjective well-being and initial dysphoric reaction under antipsychotic crugs - concepts, measurement and clinical relevance.  Pharmacopsychiatry. 2003;  36 Suppl 3 S181-190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Larsen E B, Gerlach J. Subjective experience of treatment, side-effects, mental state and quality of life in chronic schizophrenic out-patients treated with depot neuroleptics.  Acta Psychiatr Acand. 1996;  93 381-388
    PubMedGoogle Scholar
  • 22 Lewander T. Neuroleptics and the neuroleptic-induced deficit syndrome.  Acta Psychiatr Scand Suppl. 1994;  380 8-13
    PubMedGoogle Scholar
  • 23 Lindstrom L H. Long-term clinical and social outcome studies in schizophrenia in relation to the cognitive and emotional side effects of antipsychotic drugs.  Acta Psychiatr Scand Suppl. 1994;  380 74-6, 74 - 76
    PubMedGoogle Scholar
  • 24 Loffler W, Kilian R, Toumi M, Angermeyer M C. Schizophrenic patients’ subjective reasons for compliance and noncompliance with neuroleptic treatment.  Pharmacopsychiatry. 2003;  36 105-112
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Marder S R. Facilitating compliance with antipsychotic medication.  J Clin Psychiatry. 1998;  59 Suppl 3 21-25
    PubMedGoogle Scholar
  • 26 Naber D. A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables.  Int Clin Psychopharmacol. 1995;  10 Suppl 3 133-8
    CrossrefPubMedGoogle Scholar
  • 27 Naber D, Hippius H. Drug treatment of schizophrenia: current concepts.  Pharmacopsychiatry. 1991;  24 43-44
    PubMedGoogle Scholar
  • 28 Naber D, Karow A. Good tolerability equals good results: the patient’s perspective.  Eur Neuropsychopharmacol. 2001;  11 Suppl 4 S391-396
    CrossrefPubMedGoogle Scholar
  • 29 Naber D, Karow A, Lambert M. Subjective well-being under neuroleptic treatment and its relevance for compliance. Acta Psychiatr Scand Suppl 2004: in print
    Google Scholar
  • 30 Naber D, Moritz S, Lambert M, Pajonk F G, Holzbach R, Mass R, Andresen B, Rajonk F. Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs.  Schizophr Res. 2001;  50 79-88
    CrossrefPubMedGoogle Scholar
  • 31 Prosser E S, Csernansky J G, Kaplan J, Thiemann S, Becker T J, Hollister L E. Depression, parkinsonian symptoms, and negative symptoms in schizophrenics treated with neuroleptics.  J Nerv Ment Dis. 1987;  175 100-105
    PubMedGoogle Scholar
  • 32 Putzhammer A, Heindl B, Broll K, Pfeiff L, Perfahl M, Hajak G. Spatial and temporal parameters of gait disturbances in schizophrenic patients.  Schizophr Res. 2004;  69 159-166
    CrossrefPubMedGoogle Scholar
  • 33 Putzhammer A, Mueller J, Heindl B, Broll K, Pfeiff L, Perfahl M, Hess L, Koch H. Threedimensional ultasonic gait analysis in schizophrenic patients.  Psychiatr Praxis. 2003;  30 (S2) 110-114
    PubMedGoogle Scholar
  • 34 Ramaekers J G, Louwerens J W, Muntjewerff N D, Milius H, de Bie A, Rosenzweig P, Patat A, O’Hanlon J F. Psychomotor, Cognitive, extrapyramidal, and affective functions of healthy volunteers during treatment with an atypical (amisulpride) and a classic (haloperidol) antipsychotic.  J Clin Psychopharmacol. 1999;  19 209-221
    CrossrefPubMedGoogle Scholar
  • 35 Rettenbacher M A, Burns T, Kemmler G, Fleischhacker W W. Schizophrenia: attitudes of patients and professional carers towards the illness and antipsychotic medication.  Pharmacopsychiatry. 2004;  37 103-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Ritsner M, Ponizovsky A, Endicott J, Nechamkin Y, Rauchverger B, Silver H, Modai I. The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study.  Eur Neuropsychopharmacol. 2002;  12 31-38
    PubMedGoogle Scholar
  • 37 Saunders J B, Inman V T, Eberhardt H D. The major determinants of normal and pathological gait.  J Bone Joint Surg. 1953;  35A 543-558
    PubMedGoogle Scholar
  • 38 Spohn H E, Coyne L. The effect of attention/information processing impairment of tardive dyskinesia and neuroleptics in chronic schizophrenics.  Brain Cogn. 1993;  23 28-39
    PubMedGoogle Scholar
  • 39 Van Putten T. Why do schizophrenic patients refuse to take their drugs?.  Arch gen Psychiatry. 1974;  31 67-72
    PubMedGoogle Scholar
  • 40 Van Putten T, May P R, Marder S R, Wittmann L A. Subjective response to antipsychotic drugs.  Arch Gen Psychiatry. 1981;  38 187-190
    PubMedGoogle Scholar

Albert Putzhammer, M.D.

Department of Psychiatry

University of Regensburg

D-93042 Regensburg

Germany

Phone: +49-941-941-2053

Fax: +49-941-941-2091

Email: albert.putzhammer@medbo.de