The Association of Antipsychotic Treatment and Side Effects With Societal Recovery and Happiness: A Naturalistic Cohort Study of People in Long-term Care for a Psychotic Disorder.

Antipsychotics are used to manage symptoms and reduce the risk of relapse. However, the antipsychotic side effects are associated with a lower quality of life and are seen as major barriers to achieving societal recovery by antipsychotic users. In this study, we investigate the association of side effects, antipsychotic dose, and antipsychotic polypharmacy with societal recovery and happiness. Data were used from a large, naturalistic, longitudinal cohort of people using an antipsychotic in long-term care (Pharmacotherapy Monitoring and Outcome Survey PHAMOUS, 2013-2021). The association between subjective antipsychotic side-effect burden (measured with the Subjective Response to Antipsychotics questionnaire), antipsychotic dose, and antipsychotic polypharmacy with societal recovery and happiness was investigated using mixed-effect linear regression models. In an exploratory analysis, the associations between individual side effects with societal recovery and happiness were assessed. Data from 5971 observations nested in 2490 participants were used. The subjective antipsychotic side-effect burden, total antipsychotic dose, and antipsychotic polypharmacy were significantly negatively associated with societal recovery. Subjective antipsychotic side-effect burden and total antipsychotic dose were significantly negatively associated with happiness, but antipsychotic polypharmacy was not. Cognitive, mood, and physical anticholinergic side effects were most strongly negatively associated with societal recovery. Mood-, sedation-, cognitive-, and sexual-related side effects were most strongly negatively associated with happiness. These results show that side effects and a higher dose of antipsychotic medication are negatively associated with societal functioning and happiness. Future research should focus on whether dose reduction is beneficial for societal recovery and happiness in the long-term.