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Subjective well-being when on neuroleptic treatment (SWBN), has been established as a good predictor of adherence, early response and prognosis in patients with schizophrenia(1, 2). The 20-item subjective well-being under neuroleptic treatment scale (SWN-K 20) is a self-rating scale that has been validated to measure SWBN(3). However, the SWN-K20 has not been previously used in a Low- and Middle-income country (LMIC). Aims and Objectives: This study explored the psychometric properties of SWN-K20 in a sample of Xhosa speaking African patients with schizophrenia, and investigated factors associated with SWBN in this population. Methods: As a part of a large genetic study, 244 study participants with a confirmed diagnosis of schizophrenia completed the translated SWN-K 20 scale. Internal consistency analysis was performed, and convergent analysis and exploratory analysis were conducted using Principal Component Analysis (PCA).Varimax rotation method was selected as we did not assume any correlation of the factors(4). Linear regression methods were used to determine predictors of SWBN in the sample population. Results: The PCA extracted 4 components which cumulatively explained 52.21% of the total variance. The internal consistency of the SWN-K 20 was 0.86 and those of the sub-scales ranged between 0.47 and 0.59. The total scores of the SWN-K 20 demonstrated moderate correlation r= 0.44 with GAF scores. The sub-scale scores had lower correlations ranging between r=.41 and r=.30 with the GAF scores. The total scores on SWN-K20 scale were used to explore factors influencing SWBN. There was a significant correlation between overall subjective well-being score with higher education level, increased illness severity and GAF scores. Discussion and Conclusion: The isiXhosa version of the SWN-20 scale can be used for clinical and research purposes in LMICs but predictors of SWBN in this population differed from those previously established in (high income countries) HICs. The individual sub-scales of the SWN-K20 were less reliable when translated into isiXhosa and hence the subs-scales were not a meaningful measure of specific domains of wellbeing . These findings merit evaluation to determine whether cultural and linguistic specific sub-cales might provide further insight and recommendations for use in South African context. Predictors of SWBN in this LMICs population were not comparable to those in HICs setting(5, 6). Older patients with lower baseline level of education, poor global functioning and less severe symptoms were noted to have lower SWBN and hence at risk of poor compliance. This information could provide guidance for clinicians, researchers and interventions that aim at improving compliance and the treatment experiences of this patient group.

This thesis sought to explore the phenomenon of discontinuing neuroleptic medication for psychosis. It comprises three standalone papers. Papers one and two have been prepared for submission to journals and in accordance with the journal guidelines. Paper one is a systematic literature review synthesising studies investigating the association between neuroleptic discontinuation and functional outcomes. Databases were systematically searched and thirteen studies were included in the review. Evidence regarding the association between discontinuation from neuroleptic medication and functional outcomes was mixed. Findings are limited by the scarcity of evidence, diversity in the study methods and designs used, and methodological and design quality issues. Paper two is a qualitative study exploring personal accounts of making choices about neuroleptic medication, specifically considering decisions to discontinue. Twelve participants were interviewed and a constructivist grounded theory approach was used to analyse transcripts. The findings suggest that making sense of choices relates to a continuation-discontinuation spectrum and involves three interrelated tasks. The tasks are: forming a personal theory of the need for, and acceptability of, neuroleptic medication; negotiating the challenges of forming alliances with others; and weaving a safety net to safeguard wellbeing. A theoretical model explaining the processes involved in the tasks and the mediating factors is presented and discussed. The clinical implications of the findings are discussed with reference to existing literature. Paper three is not intended for publication and is a critical review of the research process, in which the strengths and weaknesses of the systematic review and empirical study are evaluated. Personal and professional reflections on the experience of conducting a systematic review and an empirical qualitative study are discussed and the implications of the research for future clinical practice and research are considered.

Lietuvoje sparčiai daugeja asmenų sergančių depresija skaičius. Ir tai verčia susimastyti apie šių žmonių reabilitacijos galimybes, o ne vien tik apie medikamentinį gydymą. Baigiamojo darbo tikslas - ištirti ergoterapijos efektyvumą asmenims vartojantiems neuroleptinius vaistus.Tyrimo uždaviniai: 1. Įvertinti asmenų, sergančius depresija ir naudojančių neuroleptikus, rankų koordinacijos sutrikimų lygį. 2. Įvertinti asmenų, sergančių depresija ir naudojančių neuroleptikus, savarankiškumo lygį. 3. Įvertinti rankų koordinacijos ir savarankiškumo pokyčius po ergoterapijos. / Lithuanian numbers of persons suffering from depression grow up rapidly. It makes people wonder about possibilities of rehabilitation, not only about medical treatment. Final aim of master work – to explore occupational therapy effectivess for the persons with depression illness and using neuroleptic pharmaceuticals. Research task: 1. Assess individuals hands coordination disorders from depression and neuroleptic pharmaceuticals use. 2. Assess level of independece for persons wiht depression illlness and using neuropeltic pharmaceuticals. 3. Assess hands coordination and changes of independence after occupational therepy.

The present study attempted to predict the serious side effects of akathisia and parkinsonism on the basis of individualized measurement of changes in visuomotor functioning. The following were the hypotheses for this investigation. 1. A deterioration of visuomotor ability as measured by a modification of Haase and Janssen' s (1965) Handwriting Test will predict which patients undergoing neuroleptic therapy will experience the extrapyramidal symptoms of akathisia and parkinsonism (symptom group) and which will not (no-symptom group). 2. A deterioration of visuomotor ability as measured by the Bender-Gestalt will predict which patients undergoing neuroleptic therapy will experience the extrapyramidal symptoms of akathisia and parkinsonism (symptom group) and which will not (no-symptom group). It was not possible to predict the symptom group as a whole on the basis of the Handwriting Test scores since a t test of the difference was not significant between group means. However, inspection of these scores showed clear deterioration of performance among the patients who experienced parkinsonian reactions as opposed to those who experienced akathisia or who did not experience extrapyramidal symptoms at all. The symptom group was separated into akathisic and parkinsonian groups and compared to the subjects who did not experience extrapyramidal side effects (no-symptom group). A one-way ANOVA showed a nonsignificant difference between the three groups. Similar analysis of the Bender-Gestalt scores failed to support the second hypothesis since no significant difference was found between groups.

Drug-induced tardive dyskinesia, an irreversible involuntary movement disorder caused by neuroleptic drugs, may reflect cholinergic hypofunction in the corpus striatum. Therapeutic results have been reported in trials of choline and lecithin, nutritional substrates which may enhance cholinergic neurotransmission. Lecithin's effects on dyskinetic symptoms were examined in 50 male patients in a double-blind, placebo-controlled trial. Patients were randomly assigned to treatment or control groups; 31 patients were retained in the analytic cohort. Experimental patients were treated with 60 gm/day lecithin (55% phosphatidyl choline) for 11 days. Symptom frequency was rated from videotapes made at baseline, 3 and 11 days of treatment, and 1 week follow-up.