Patients’ subjective rating of mental health improvement on clozapine [Abstract]

Background: The subjective experience of patients with schizophrenia, receiving antipsychotic medication has been a neglected research area.Methods: In a randomised controlled trial comparing the impact of new atypical antipsychotic drugs versus clozapine, 67 out of 136 patients with schizophrenia were randomised to receive clozapine. Baseline and 12 week assessments included the PANSS, DAI, and the Kemp Compliance scale.Results: The greater percentage improvement in total PANSS scores in patients randomised to clozapine was statistically significant when compared to the atypical group at 12 weeks (p < 0.05). Patients’ subjective rating of their mental health improvement since commencing clozapine treatment correlated significantly with actual percentage improvement in PANSS scores from baseline to week 12 (p < 0.01). Significant correlations were also observed between the patients’ subjective rating of their mental health improvement and both DAI score and theg12 PANSS insight item (p < 0.05). In a regression analysis, DAI score at week 12 explained 26% of the variance in patients’ subjective rating of mental health improvement with clozapine. Percentage PANSS improvement explained a further 8% of the variance.Conclusion: Patients in an RCT of clozapine versus atypicals were able to subjectively rate their own improved mental health status, validated by objective improvement on the PANSS. This was predicted by drug attitude as measured by the DAI. Subjective reports are a useful and valid outcome measure in drug treatment trials