Prevents Seroquel Mania-Hypomania

Schizophrenia and manic psychoses: Neuroleptics improve the quality of life

There is a close connection and even overlap between schizophrenia and mania in bipolar disorder. Both diseases likely have a genetic background that appears to overlap. This is already indicated by epidemiological studies: relatives of schizophrenic patients have an increased lifetime risk of developing schizophrenia themselves. At the same time, however, there is also a significantly increased risk of developing bipolar disorder; both diseases occur more often than not in a family.

The reason for this is likely to be a common genetic background, whereby there are different candidate genes that may be responsible for the disease. The neuroregulin-1 gene, which is of pathogenetic importance in both schizophrenia and mania, has been particularly well studied. Other genetic influences come into play and seem to decide on the severity of the disorder and ultimately also on whether schizophrenia or mania develops.

Effective against depression and mania

Both schizophrenic and manic episodes are treated with neuroleptics, with atypical neuroleptics in particular gaining acceptance recently. They show good clinical effectiveness and are significantly better tolerated compared to conventional neuroleptics. The active ingredient quetiapine (Seroquel®) causes fewer extrapyramidal side effects. The frequency of this accompanying reaction of many neuroleptics, which is otherwise highly stressful and downright stigmatizing for the patient, is below the atypical at the placebo level.

According to the studies, quetiapine can be used to control acute psychotic states of excitement and its effectiveness has been documented in both psychotic and manic episodes. It could be shown that the atypical neuroleptic has an effective effect on the positive as well as the negative symptoms, improves aggressive and psychotic symptoms quickly and sustainably and leads to affect stabilization. It does not have a depressive effect like many conventional neuroleptics, which is particularly important in the case of bipolar disorders. At the same time, quetiapine has a favorable side effect profile, which promotes compliance.

Compliance issues

Ultimately, the decisive factor for compliance is the patient's quality of life under long-term treatment. This is severely limited in patients with schizophrenia or mania and this long before the first psychotic symptoms become manifest. The restriction of the quality of life is comprehensive, it affects the working life, the partnership as well as social activities, the emotionality and in general the psychological well-being and it is an essential reason for the often insufficient compliance. Around half of the patients who have already had multiple illnesses are non-compliant in the first year of therapy. The problem of non-compliance is even more severe in the case of first-time patients, although many patients in both groups are only partially compliant, i.e. take the medication, but not regularly but with reduced doses or with so-called drug holidays.

If the therapy succeeds in increasing the quality of life again, the chances of reliable compliance are good. In this regard, too, there are positive data for quetiapine. In a study in 1238 patients with schizophrenia, the active ingredient led to a significant increase in quality of life, measured using the SWN (subjective well-being under neuroleptic treatment) scale, which is used to determine subjective well-being. A good quality of life can be assumed from 80 points, with quetiapine increasing the SWN value from an average of 57.7 points at the time of admission to 80.6 points at discharge. Comparable data are also available for patients with mania in bipolar disorder.