Naber Dieter
Epidemiol Psichiatr Soc. 2008 Jul-Sep;17(3):174-6. doi: 10.1017/s1121189x00001238.
Only recently, success criteria became more ambitious and include a more thorough consideration of negative symptoms and cognitive dysfunction. The most important change within the last decade is the long overdue consideration of the patient's perspective. His/her subjective well-being, often unchanged or even worsened by typical antipsychotics, was neglected for a long time. One reason was the prejudice that schizophrenic patients are not able to self-rate their quality of life. Another reason was the belief that such data are not necessary because the psychiatrists' perspective, "objective" psychopathology, includes these domains. Among other scales, a self-report instrument has been constructed to evaluate "subjective well-being under neuroleptics" (SWN). This scale was used in numerous open and controlled trials, indicating: a) patients, if no longer acutely psychotic or suffering from severe cognitive deficits, are able to reliably assess their subjective well-being, b) high SWN is correlated with high compliance, c) atypical antipsychotics increase SWN, and d) individual improvements of SWN and of PANSS are not strongly related. Moreover, several studies found that early improvement of subjective well-being is a major predictor for the chance of remission. All these data indicate that a better consideration of the patient's perspective is possible and necessary.
直到最近，成功标准才变得更加雄心勃勃，包括对阴性症状和认知功能障碍进行更全面的考量。过去十年中最重要的变化是终于开始考虑患者的观点。患者的主观幸福感长期以来一直被忽视，而典型抗精神病药物常常使其保持不变甚至恶化。一个原因是存在偏见，认为精神分裂症患者无法对自己的生活质量进行自我评估。另一个原因是相信这类数据没有必要，因为精神科医生的观点，即“客观”精神病理学，涵盖了这些领域。在众多量表中，有一种自我报告工具被构建出来，用于评估“服用抗精神病药物后的主观幸福感”（SWN）。该量表在大量开放和对照试验中被使用，结果表明：a）如果患者不再处于急性精神病状态或患有严重认知缺陷，他们能够可靠地评估自己的主观幸福感；b）SWN得分高与依从性高相关；c）非典型抗精神病药物可提高SWN；d）SWN和阳性与阴性症状量表（PANSS）的个体改善之间没有很强的关联。此外，多项研究发现，主观幸福感的早期改善是缓解可能性的主要预测指标。所有这些数据表明，更好地考虑患者的观点是可行且必要的。
