Since the introduction of neuroleptics in 1952, many studies have examined objective aspects of efficacy and tolerability. Despite the fact that neuroleptic treatment should also improve the patient's subjective experiences, this outcome criterion has been neglected in the past. This is unfortunate, as subjective well-being with treatment appears to be strongly related to patients' readiness to take their medication. The few existing studies differ in methodology and are difficult to compare due to a number of weaknesses, including varying underlying concepts, used assessment scales, or small sample sizes. Negative subjective well-being may manifest itself throughout the entire neuroleptic treatment, even as early as in the first 48 hours after neuroleptic treatment starts (initial dysphoric reaction, IDR). The aetiology of reduced subjective well-being or IDR is not fully explained; neuroleptic side effects, especially affective, cognitive and motor adverse events, differential effects of varying psychopathology or biopsychosocial are factors in discussion. The clinical impression is characterised by symptoms as dysphoria/anhedonia, reduced vitality, and emotional indifference, which could have a negative impact on relevant clinical factors such as response or medication adherence, and therefore on outcome. With regard to pharmacological treatment, evidence suggests that atypical antipsychotics induce less negative subjective effects than conventional neuroleptics, and that various new-generation antipsychotics could be evaluated differently by patients. This article reviews existing literature in order to approach relevant questions for pharmacotherapy.
