Sense in subjectivity Antipsychotics, shared decision making and subjective well-being in psychotic disorders

The overarching aim of this thesis was to increase the understanding of factors that influence subjective well-being of patients with a psychotic disorder.
Subjective well-being has become a highly valued and independent treatment outcome in schizophrenia care over the last decade. The first part of this thesis describes the development of the Personal Antipsychotic Choice Index, the first shared decision making tool for supporting patients in prioritizing and choosing a specific antipsychotic agent. The acknowledgement of the priorities of the individual user, should lead to a better shared decision process and ultimately, to a better adherence. The second part of this thesis reveals that both pharmacological and psychological factors influence subjective well-being of patients with a psychotic disorder. Healthy siblings and unrelated controls were used as comparisons. Up to now, the optimal dosing of an antipsychotic agent is supposed to be more important than the choice of the agent based on its D₂-receptor affinity. Also, we found that 1 in 7 patients keeps having a low subjective well-being over the course of six years. The personality trait neuroticism contributes to such a trajectory, regardless of psychotic symptoms or the use of antipsychotic medication. Finally, we tentatively found that active coping styles contribute to a better subjective well-being of patients with a psychotic disorder, whereas passive reacting to negative life events seems to reduce subjective well-being. In the final chapter, all findings are discussed in the light of future research perspectives and ways to improve resilience among patients with a psychotic disorder.