The aims of this cross-sectional survey were to assess psychotic sufferers' perception of the effectiveness of their medication, the distress caused by adverse effects and the impact these might have on overall patient satisfaction with treatment. Three hundred and forty-one people diagnosed with psychosis who called a national mental health helpline (SANELINE) in the UK, between July 1998 and February 1999, were asked to take part in the survey. They were given a choice of either a postal questionnaire or a telephone interview in which the same questionnaire was used. One hundred and nineteen were interviewed on the telephone and 83 (out of 222) returned completed questionnaires. In total, information was available from 202 callers. Almost one-half of the respondents were dissatisfied with their medication, and almost all of them reported experiencing at least one adverse effect. Depression (or low mood), sedation and difficulty thinking and concentrating were the most prevalent adverse effects. Weight gain was the most distressing, particularly to women. Those taking atypical antipsychotics were significantly more likely than those on typical antipsychotics to experience insomnia and dry mouth, but were less likely to perceive depression and difficulty thinking/concentrating as quite or extremely distressing. Low satisfaction, as opposed to high satisfaction, was significantly associated with reporting weight gain, difficulty thinking/concentrating, insomnia and sexual dysfunction. It was also significantly associated with reporting weight gain, difficulty thinking/concentrating, muscle/joint stiffness and depression as quite or extremely distressing. Attention should be given to the management of cognitive impairment and weight gain as adverse effects of antipsychotics. Doctors should be more open to discussing the risks and nature of adverse effects with patients who should also be encouraged to do so.

Experience from a UK national telephone helpline SANELINE (run by the mental health charity SANE), showed that availability and access to better medications and services are among the most important issues for patients with mental illness. SANELINE, therefore, conducted a survey of patients' satisfaction with antipsychotic medication between July 1998 and February 1999. A total of 202 completed questionnaires were available for analysis. A majority of patients (56%) were treated with conventional neuroleptics, 20% with new 'atypical' antipsychotics and 11% were on a combination of conventional and novel antipsychotics. Virtually all respondents (99%) reported suffering from at least one side-effect, of which 31% were perceived as 'severe' or 'very severe'. The most common side-effects reported were depression/low mood (90%), sedation (88%), difficulty in thinking/concentrating (78%), insomnia (68%), dry mouth (65%), muscle/joint stiffness (45%), sexual dysfunction (43%) and weight gain (39%). Notably, 73% of those who had experienced weight gain reported it to be 'quite or extremely distressing'. Depression was rated as 'quite or extremely distressing' by 67% of sufferers and insomnia was similarly rated by 66% of patients. Despite the methodological limitations of the survey, the results suggest there is a high level of patient dissatisfaction and distress related to the currently available medications, which may have unfavourable effects on compliance and treatment outcome.

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