Long-term clinical and social outcome studies in schizophrenia in relation to the cognitive and emotional side effects of antipsychotic drugs.

Evaluation of neuroleptics should include not only the effects on symptoms but also social functioning and the quality of life. Akathisia, cognitive and emotional impairment (cognitive and emotional parkinsonism) are probably the most important reasons for lack of compliance with classical neuroleptics. Atypical neuroleptics such as clozapine and remoxipride offer an advantage because of little impairment of cognitive and emotional functioning. In 122 schizophrenic and schizoaffective therapy-resistant patients treated with clozapine for up to 17 years, the treatment was stopped in only 8 cases (7%) because of lack of compliance. In patients treated for more than 2 years, 40% were employed and functioned well socially. It is concluded that, in many schizophrenic patients, atypical neuroleptics should be preferred in long-term maintenance treatment because of a low incidence of extrapyramidal syndromes as well as cognitive and emotional parkinsonism. An "awakening" is often seen when changing from a classical neuroleptic to an atypical one.