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Subjective Experiences of Antipsychotic Treatment: A Comparison of First and Second-generation Medications among Patients with Schizophrenia | Chapter 01 | Innovations in Medicine and Medical Research Vol. 1

Aims: The patient’s perspective of antipsychotic treatment has been a relatively neglected area of research. Whether subjective experiences of antipsychotic treatment are better among patients on second-generation antipsychotics (SGAs), than those on first-generation antipsychotics (FGAs) has also evoked some controversy. This study attempted a longitudinal comparison of attitudes toward treatment, subjective well-being and quality of life (QOL) between patients on SGAs and FGAs. Socio-demographic and clinical correlates of these subjective experiences were also examined.

Methodology: Standardised ratings of insight, psychopathology, side-effects, attitudes, subjective well-being and QOL were carried out among 40 patients with schizophrenia on SGAs and 30 on FGAs, over a 6-month period.

Results: Both groups were similar in the first 3-month period, apart from the slightly greater severity of illness in the FGA group. Differences in symptom-severity and side-effects emerged between the groups over the course of follow-up. Moreover, as the study progressed, differences also became apparent in subjective experiences; patients on SGAs had significantly better attitudes, subjective well-being and QOL than those on FGAs. However, differences between individual SGAs (olanzapine and risperidone) on these indices were minimal. The three indices of subjective experience were highly correlated with each other. Older age, being employed, greater insight, lower symptom-severity and the absence of side-effects demonstrated significant positive associations with different aspects of subjective experiences.

Conclusions: Patients on SGAs had a more favourable profile of subjective experiences with treatment than those on FGAs. These differences seemed to be determined mainly by differences in symptom-severity and side-effects.

Author(s) Details

Nisha Warikoo Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Prof. Subho Chakrabarti Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Sandeep Grover Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

View Volume: http://bp.bookpi.org/index.php/bpi/catalog/book/139

#Subjective experiences #antipsychotics #schizophrenia

How is it that people think they know so well what goes on inside other people's brains?

I'm not talking about just making assumptions about what someone else is thinking. We all do that. It's kind of necessary to communication, even if we get it wrong a lot of the time. No, I'm talking about just flat-out denying things that there's no reason to deny at all. Like one time I went to this neurologist. My mom, who's also neurodivergent but in different ways than I am, came with me. During the course of the conversation, it came up that I don't think in language. The neurologist said of course I did, because thinking is language, period. And my mom said "But it's not, I'm a visual thinker, I see pictures in my head, then I have to translate those into words." And the neurologist basically accused both of us of either lying or being mistaken, one or the other. He insisted that it was impossible to have thought without language. What this had to do with the actual reasons for the appointment were anyone's guess -- other than the fact that he denied the reality of so many things that, for years afterwards, I suffered long-term damage to my body rather than tell a doctor again about the things I told him about. And that neurologist isn't alone -- I've talked to tons of people, both laypeople and doctors, who seem personally offended by the very notion that thought exists that is outside of language. Which is really weird, because even mainstream neuroscience shows that everyone thinks outside of language at least some of the time. Being a visual thinker isn't even always a sign of neurodivergence in general let alone any specific kind. Lots of perfectly ordinary people think in pictures at least some of the time. It may be unusual to think so exclusively in pictures that translating into words is difficult, but simply thinking in pictures is pretty normal. And you'd think a neurologist would know that. But at any rate, I see people all the time saying "Your experience of the world can't possibly be the way you say it is" about things that are harmless and subjective variations in how people think or experience the world. Like, I can see someone arguing with someone about their experiences, if their experiences or the way they describe them are hurting someone in some way. And I can see someone arguing with someone if the experience was not very subjective. But for things that really are subjective, and really are harmless? Why do people even bother? And why are people so offended by the existence of people who are different from them in ways that can only be subjectively experienced? And by subjective, I mean things that relate to internal experiences that can't be externally verified in the first place. Like whether you think in words, pictures, or something else. Or like things that relate to your internal identity and sense of self. Or anything else like that. Why are people so offended -- and it really does seem like people take personal offense in these matters -- that someone might experience their thoughts, their feelings, their sense of self, in a way that's different from most people's expectations? Why do they feel it necessary to proclaim their offense loudly, and to mock and belittle anyone who defies them and says "My experience of thinking, feeling, or existing is just as real as anyone else's." Why the offense? Why the mocking? Why the belittling? And why, above all, are people constantly sticking their nose into other people's minds and acting like they have business there? Like I'd understand it a little more if having, or claiming to have, picture thoughts, was hurting someone. But it's not, so that particular justification doesn't hold water. People just seem to assume that if you admit to deviating internally from the norm -- even if they way you're deviating is actually well within the norm -- then you're fair game. Fair game for being "corrected" at best, to being mercillessly bullied (and possibly being grouped together with others like you into some hateable group or another) at worst. Which makes no sense to me at all. So people seem to do this kind of thing: 1. "I know better than you what form your thoughts stake, subjectively." 2. "I am going to 'correct' you for getting your own subjective experiences 'wrong'." 3. "I am going to be really really mean about this." 4. "I am going to enlist the help of others in being really really mean about this." And of course #3 and #4 can take place in too many ways to write down. If I tried, I'd possibly be sitting here all night at best. Anyway, there's no good reason at all to be like this to people who are just different from you in some way that harms nobody. But people do it all the time. It's weird.