Antipsychotic medicines in Australian community practice: Effectiveness, adverse effects and quality of life for people with schizophrenia

Introduction: Atypical antipsychotics are increasingly recommended as first-line treatments in international clinical guidelines. However, recent meta-analyses and effectiveness studies have found few differences between typicals and atypicals. We aimed to assess the use of atypical and typical antipsychotic medicines, their perceived effectiveness and tolerability, and associated health-related quality of life among Australian community patients with an established diagnosis of schizophrenia or related disorders. Methods: A random sample of people with schizophrenia spectrum disorders (n = 83) attending four public mental health clinics, and their treating clinicians and family carers, completed questionnaires on the effectiveness, acceptability and side-effects of current, previous and early antipsychotic medicine. Medicine use was determined from clinical notes. The Assessment of Quality of Life, Drug Attitude Inventory and Friendship Scale were also used. Results: A significant shift over time towards atypical medicine use was reported: 66% of current antipsychotic use. Perceived effectiveness, satisfaction and side-effects did not differ when comparing medicine type (typical/depot/atypical) for early, previous and current medicines used. Health-related quality of life was associated with reported side-effects, but not with current medicine type. Agreement was poor between patients, case managers and carers about medicine use. Discussion: Consistent with recent effectiveness trials, the findings suggest that any differences in the experience of typical and atypical antipsychotics of patients with established illnesses are obscured in the complex setting of real-world practice. Further, poor agreement between patients, case managers and carers about medicine use may indicate that they each have different understandings of the medicines that are being used.