Subjective well-being under neuroleptic treatment and its relevance for compliance Introduction Despite significant advances in the pharmacother- apy of schizophrenia, non-compliance remains a major problem, particularly in long-term treatment (1–4). Although estimated rates of non-compliance vary, because of inconsistent definitions and hetero- geneous samples, studies agree that 25–70% of all schizophrenic patients are non-compliant; most of them in the first year of treatment. Although there is some improvement under treatment of atypical antipsychotics, adherence rates at 6 and 12 months were only moderately higher compared with patients receiving typical agents (5). There is overwhelming evidence that medication non-adherence is the most important risk factor regarding psychotic relapse. On the basis of seven international studies, Fenton et al. (1) concluded that non-compliant patients have a 3.7% greater risk of relapse than compliers (within 6–24 months). Therefore, an enhanced medication adherence is an urgent task. An indi- vidualized approach is clearly warranted to address the specific reasons for medication non-compliance. Studies on general factors such as psychopathology, attitudes towards medication or insight of illness continue to be controversial. However, there is agreement about two major determinants; the qua- lity of the doctor–patient relationship and the impact of antipsychotic drugs on subjective well- being (SW) (1–3, 6–8). For approximately 30 years after the introduc- tion of neuroleptic treatment, psychiatrists focused on motor symptoms, among drug-induced com- plaints, and reasons for non-compliance. More subtle complaints such as affective blunting, cogni- tive slowing as well as volition and loss of sponta- neity were often neglected (9–14). It is rather difficult and in most patients it is not possible to differentiate the subjective side-effects from primary negative symptoms. The complex subjective complaints have been described in various ways: Ôneuroleptic dysphoriaÕ, Ôpharmacogenic depres- sionÕ, Ôakinetic depressionÕ, Ôneuroleptic depressionÕ, and Ôneuroleptic-induced anhedoniaÕ (15). The term Naber D, Karow A, Lambert M. Subjective well-being under neuroleptic treatment and its relevance for compliance. Acta Psychiatr Scand 2005: 111 (Suppl. 427): 29–34. ª Blackwell Munksgaard 2005. Objective: To review the concept of Ôsubjective well-being under neuroleptic treatmentÕ, its development and clinical relevance, particularly regarding compliance. Method: The manuscript includes a review of the limited literature and recent open and controlled clinical trials. Results: The patientsÕ perspective of antipsychotic treatment was largely neglected for a long time. Scientific interest in this field of strong clinical relevance started mainly with the development of atypical antipsychotics. Recent research indicates that subjective well- being (SW) is a major determinant of medication compliance in schizophrenia. There are several self-report instruments with sufficient internal consistency and good construct validity. Effects of antipsychotic treatment on psychopathology and SW are only partly related. Most patients strongly prefer the atypical over typical antipsychotics. The assessment of SW is helpful for selecting the optimal drug for the individual patient. Conclusion: SW, under antipsychotic treatment, is a valid construct; its assessment provides an independent outcome variable, which is relevant to compliance. D. Naber, A. Karow, M. Lambert Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University of Hamburg, Hamburg, Germany Key words: neuroleptics; atypical antipsychotic; subjective well-being; schizophrenia Dieter Naber, Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany. E-mail: naber@uke.uni-hamburg.de Acta Psychiatr Scand 2005: 111 (Suppl. 427): 29–34 All rights reserved Copyright ª Blackwell Munksgaard 2005 ACTA PSYCHIATRICA SCANDINAVICA 29