Weiss C, Bouerat Duvold L, Lenderking WR, Cooper O, Shalhoub H, Kleinman L, Bender R, Hartry A, Green M, Meehan SR, Tandon R. The impact of second-generation antipsychotic medication side-effects on functioning from a schizophrenia patient perspective: a cross-sectional, observational, patient centered, web survey study. Poster presented at the 2018 Annual Meeting of the American Society of Clinical Psychopharmacology (ASCP); May 2018. Miami Beach, FL.

BACKGROUND: Second-generation anti-psychotics (SGAs) used to treat patients with schizophrenia generally have lower risk of motor side effects than first generation antipsychotics but are associated with other well-known side-effects (SE). The goal of the study was to understand how specific side effects of SGAs impact daily functioning, emotional wellbeing, and overall quality of life (QoL) of patients from the patient’s perspective.

METHODS: This study was a cross-sectional, patient-reported web survey, conducted in the United States (n=180) in the fall of 2017. The survey included patient socio-demographics, the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF), the Glasgow Antipsychotic Side-Effect Scale (GASS), and questions about the impact of SEs on functioning and emotions. Patients noted on a visual analog scale (VAS) the degree of impact each reported SE had, 0 indicating ‘no impact at all’, and 100 indicating the ‘largest degree of impact’. Patients with schizophrenia (≥18 years), stable for at least one month, taking an SGA for 1-12 months, and self-reporting at least one SE were included.

RESULTS: The 180 participants had a mean age of 35 (range 18-61) years, with 58.3% being female. 69.4% were White, and 16.7% were Black or African American. The majority (63.9%) of the participants were diagnosed within the last 5 years: 58.3% reported living with a spouse, partner, or child, while 17.8% lived with a parent/s, and 11.1% lived alone. The lowest Q-LESQ-SF (1=Very Poor to 5=Very Good) scores were satisfaction with one’s ‘economic status’ (M=2.61, SD=1.12), followed by ‘sexual drive’ (2.72, 1.22), ‘work’ (2.75, 1.15), ‘mood’ (2.88, 1.02), and ‘social relationships’ (2.94, 1.23). The most prevalent SEs were ‘difficulty sleeping’ (81.1%), ‘feeling sleepy during the day’ (77.2%), ‘dry mouth’ (70.6%), and ‘restlessness’ (60.6%). Almost half (48.0%) of the participants stated they have experienced gaining weight. Feeling “drugged or like a zombie”, “sleepy during the day”, having “difficulties sleeping”, feeling “restless”, and gaining weight were self-reported as having an impact on their functioning (Yes, No) by 80.6%, 63.7%, 63.3%, 62.4%, and 63.1% of participants respectively. These SEs had at least a moderate to severe impact (defined by a VAS score ≥ 50) on all aspect of functioning (physical, psychological, social, and vocational). For” difficulty sleeping”, the highest impact on functioning was on one’s” energy level” (VAS=72.3). Having “shaky hands” or “feeling restless” had the most severe effect on one’s” ability to get or do a job” (mean VAS score of 76.1 and 69.8 respectively) as had “feeling sleepy” (mean VAS score=68.8).” Feeling drugged/like a zombie” had the greatest effect on one’s” ability to concentrate” (mean VAS score 70.2) while gaining weight had the most impact on “one’s fear of being rejected” (mean VAS score 79.7). “Problems enjoying sex” affected “intimate relationships” (mean VAS score=74.8).

Findings suggest that patients taking SGAs have many SEs including activating SEs (restlessness, difficulty sleeping) and sedating SEs (feeling drugged, sleepiness) and weight gain. These SEs have considerable negative impact on patient’s daily functioning and quality of life satisfaction, including on work, sexual drive and psychosocial effects.

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