subjective well - being is a major component of quality of life , influenced by the pharmacological and/or psychosocial treatment as well as by the illness itself . a multitude of components , for example patients ' attitudes toward medication or other nonpharmacological factors , possibly interfere when their subjective experience of neuroleptic drugs is investigated . naber suggested a model consisting of five dimensions of sw : emotional regulation , self - control , mental functioning , social integration , and physical functioning . lambert et al combined this concept with six influencing factors : psychopathology and symptomatic improvement , physical side effects and associated distress , attitudes toward pharmacological treatment and insight , psychosocial factors , phase , and severity of illness . one major impetus for this research was the sometimes marked subjective improvement , when patients were switched from typical antipsychotics to clozapine . similarly to the first trial , quality of life was an outcome criterion to assess the improvement by clozapine . the subjective well - being under neuroleptic treatment ( swn ) is a self - rating likert scale with 20 items ( 10 positive , 10 negative ) and good psychometric properties . recently , an algorithm has been developed to exclude patients who are unable to understand the items or to reliably fill out the scale , based on analyzing mean differences between negative and positive items for the individual subscores ( s. moritz , unpublished data ) . starting with the pioneer work of the drug attitude inventory of hogan et al , there now exist , together with the swn , several self - rating instruments to investigate the patients ' perspective of antipsychotic treatment . the relationship between psychopathology , as shown with the positive and negative syndrome scale ( panss ) , and the subjective well - being , as measured with the swn , was investigated in several trials . the total score , as well as the subscales were only moderately correlated with the panss scores ( r=-0.1 to -0.5 ) with stronger relationships to the negative and global score than to the positive score . the highest correlations ( r=-0.4 to -0.5 ) were related to the severity of depression and anxiety . regarding the impact of side effects , lambert et al found , in a study in 213 patients treated with typical neuroleptics , that sexual dysfunctions and extrapyramidal and psychic side effects were rated as subjectively more distressing than vegetative side effects and sedation . in a study by de haan et al it was shown that dosage of medication leading to dopamine ( d2 ) receptor blockade should be carefully evaluated , since it is most likely responsible for neuroleptic dysphoria , even in the absence of motor side effects : the relationship between swn and striatal d2 receptor occupancy was investigated in 22 schizophrenic patients , clinically stable under either 14.7 mg of olanzapine or 4.1 mg of risperidone . it was demonstrated that in the absence of extrapyramidal symptoms , higher striatial d2-receptor occupancy as measured by single photon - emission computed tomography ( spect ) was related to reduced swn , negative symptoms , and depression ( p<0.01 ) . naber investigated the subjective perception of neuroleptic treatment with the swn and found it to be significantly related to noncompliance . six months later , 14 patients were noncompliant . compared with 34 patients who remained compliant , however , the psychiatrists did not see a difference between future compliant or noncompliant patients ; the panss scores did not differentiate between both groups . in another patient population , it was shown that the swn of 28 patients treated with the atypical antipsychotic clozapine because of therapy resistance or motor side effects was , despite negative selection , significantly better than the swn score of 38 patients under classical neuroleptics ( p=0.03 ) . in a later study , olanzapine and clozapine were compared in a double - blind , controlled trial in 114 patients , over a 26-week period . regarding swn , the total score - as well as all subscores , excluding mental functioning - showed a significant relationship between low swn and noncompliance ( p<0.005 - p<0.01 ) . again , this study showed that the improvement of swn and of panss are not strongly related ( r=-0.3 to -0.4 ) . the soho study also found a relevant relationship between subjective well - being and compliance . it is a 3-year investigation of the health outcomes associated with antipsychotic treatment in europe . data were collected in a prospective , nonrandomized observational study of 10 972 patients with schizophrenia , recruited in 10 european countries between january and december 2001 . in the german study population with 2 960 patients , patients and physicians categorized compliance as  almost always compliant ,   partly compliant ,  or the relationship between changes in compliance ( improvement n=225 , no change n=1366 , worsening n=78 ) and clinical variables were assessed by factor analysis . this revealed the strongest correlations for swn ( r=0.866 ) , followed by symptoms ( r=0.772 ) and side effects ( r=0.480 ) ( karow et al , unpublished data ) . sw seems to be of potent influence on adherence during maintenance treatment , but not in the acute phase , as mutsatsa et al did not find a significant relationship between swn and early medication adherence in 101 first - episode patients . numerous studies show the advantages of atypical versus typical antipsychotics , and these advantages are most prominent from the patients ' perspectives : atypical antipsychotics improve subjective quality of life more than typical antipsychotics , subjective response is significantly better under atypical compared with typical drugs , and , not surprisingly , switching from a typical to atypical antipsychotic is associated with a marked subjective improvement . in the soho study , swn was used as an important single component of the complete remission criterion , according to the new consensus statement on criteria and the time frame of remission in schizophrenia published by the remission in schizophrenia working group . in contrast to previous definitions , the consensus included the incorporation of subjective rating next to sustained symptomatic ( ie , positive , negative , and cognitive symptoms ) as well as functional remission ( ie , activities of daily living , employment ) . remission criteria and predictor variables were assessed at baseline , at 3 , 6 , 12 , 18 , and 24 months with standardized scales . complete remission was defined as patients fulfilling all criteria for ( i ) symptomatic , ( ii ) functional , and ( iii ) subjective well - being over a period of at least 6 months ( ie , at the 18-month and 24-month visits ) . symptomatic remission was defined as receiving a clinical global impressions scale ( cgi)-schizophrenia score of no worse than  mild  ( 3 ) in assessments of overall severity , positive , and cognitive subscores and a score of no worse than  moderate  ( 4 ) in the negative subscore . functional remission was defined as a positive occupational / vocational status , ie , paid or unpaid , full- or part - time employment , being an active student or head of a household with an employed partner , and independent living , ie , living alone , living with a partner , living with peers . subjective well - being was met if a swn total score of  80 points was achieved . predictor variables were ( i ) baseline predictors , ( ii ) early course of treatment predictors defined as fulfilled remission criteria at 3 months , and ( iii ) course of treatment predictors defined as variables assessed continuously throughout the complete 24-month period . the baseline predictors were ( i ) age , gender , and duration of illness , ( ii ) symptomatic status assessed with the expanded version of the cgi - schizophrenia including an overall severity of illness score and 4 subscores for the severity of positive , negative , cognitive , and depressive syndromes , ( iii ) functional variables included the occupational / vocational status and independent living assessed in yes / no categories , ( iv ) subjective well - being assessed with the swn . the early course of treatment predictors were early symptomatic , functional , and subjective well - being remission at 3 months . the course of treatment predictors were compliance with antipsychotic medication , ( noncompliance was defined as missing 50 % of medication over at least 4 weeks ) and comorbid substance use disorder ( sud ) according to diagnostic and statistical manual of mental disorders ( dsm - iv ) criteria , categorized into ( i ) no sud ; ( ii ) remitted sud ( remission during follow - up with sud at baseline ) ; and ( iii ) persistent sud . lambert et al ( unpublished data ) found that 50 % of the patients achieved symptomatic remission and about 40 % subjective well - being remission , whereas only one third sustained functional remission . including symptomatic and functional criteria , 19 % achieved complete remission in the soho study ; following the consensus statement including the subjective quality of life , remission rate decreased to 14 % . it is of particular interest that 32 % of all patients achieved none of the three remission criteria . first antipsychotic treatment proved to be a predictor of all remission criteria . similarly to the study by robinson , the functional remission criterion of 24.5 % was the main barrier in achieving complete remission . consistent with previous studies , early remission within the first 3 months predicted all remission criteria including complete remission . therefore , early detection of incomplete remission or treatment resistance and subsequent treatment adaptation are mandatory in the treatment of multiple - episode patients as well as first - episode patients . persistent sud when compared with no sud was associated with a decreased probability of symptomatic remission , while baseline sud was not found to have significant influence on symptomatic remission , consistent with previous findings . similar to findings from many previous studies , medication noncompliance was associated with symptomatic nonremission . for a long period , many psychiatrists believed that they knew their patients well enough not to need additional self - ratings by the patients . however , numerous trials have revealed that both perspectives differ markedly regarding the relevance of side effects or success of antipsychotic treatment . subjective well - being is at least a valuable addition to objective ( ? ) psychopathology , and should become an integral part of shared decision - making . a better consideration of the patients ' perspective can improve therapeutic alliance , medication adherence , and , finally , the long - term prognosis .
the patients ' perspective of antipsychotic treatment was largely neglected for a long period . 
 it has only been during the last 10 years , with the development of atypical antipsychotics , that scientific interest in this issue has markedly increased . 
 numerous studies have shown that the majority of schizophrenic patients are able to fill out a self - rating scale in a meaningful way , and several self - report scales with sufficient internal consistency and good construct validity have been developed . 
 the effects of antipsychotic treatment on psychopathology and on subjective well - being ( sw ) are not strongly related ; the perspectives of the patient and his / her psychiatrist markedly differ . 
 recent research indicates that sw / quality of life , much more improved by atypical than by typical antipsychotics , has a strong impact on compliance , as well as on the chance of achieving remission . 
 the data strongly suggest that a systematic evaluation of the patient 's perspective of antipsychotic treatment is meaningful and necessary to increase compliance , functional outcome , and long - term prognosis .