Impact of atypical antipsychotics on quality of life, self-report of symptom severity, and demand of services in chronically psychotic patients.
OBJECTIVE: The study investigated whether the introduction of atypical neuroleptics in the formulary of a large community mental health clinic had any impact on demand for services, quality of life, symptom presentation and cost of care of patients with chronic psychotic illnesses over a 3-year period. METHODS: BJC Behavioral Health Services provides and coordinates mental health services for citizens residing in St. Louis City, St. Louis County and the counties of St. Francois, Iron and Washington, MO. We searched the BJC Behavioral Health Services and the Missouri Pharmacy Database to identify patients who had been switched from a typical to an atypical neuroleptic for a minimum of 3 months between 5/1/1997 and 4/30/2000. We excluded patients treated with more than one neuroleptic simultaneously and those with incomplete records. The primary outcome measures were: level of care assignment. Secondary outcomes were a quality of life scale, and a symptom severity inventory. Twenty-five patients met final entry criteria (out of a census of 6280 patients on 3/6/2000). RESULTS: In this naturalistic sample of patients with chronic severe psychotic symptoms, atypical neuroleptic treatment resulted in a marked reduction in demand of services, marked improvement on perception of quality of life, and a trend towards reduction in symptom severity, particularly in the cluster of affective symptoms of the SLSS, over a 3-year period. We also found that the cost of care after switching to atypical neuroleptics was increased, which coincided with increased number of services provided to the patients. These changes appeared to be the result of improved compliance with outpatient services such as follow-up visits and rehabilitative activities.