THE ASSOCIATION OF ANTIPSYCHOTIC MEDICATION USE WITH

PRODUCTIVE ACTIVITY AMONG SCHIZOPHRENIA PATIENTS

Amy Grogg, PharmD,1 Susan C. Bolge,2 Ramy Mahmoud, MD1
1

Janssen Pharmaceutica Products LP, Titusville, NJ; 2Consumer Health Sciences, Princeton, NJ

Methods: Schizophrenia patients (N=390) identified through the National Alliance for the Mentally
Ill (NAMI) and community mental health centers completed self-administered questionnaires in
June 2000. Those reporting any paid employment, volunteer work, or school were considered
productive. To determine the association of antipsychotic medications with productive activity, a
logistic regression was used, controlling for disease severity, demographics, and other prescription
medications. The Psychological General Well-Being Scale (PGWB) was used as a surrogate
measure for disease severity.
Results: An average of 53% of respondents participated in at least one productive activity a week.
Thirty-three percent engaged in paid employment, 26% engaged in volunteer work, and 9% were in
school. Respondents with less severe disease were more likely to be productive (P=0.001).
Although risperidone users had more severe disease than did patients receiving conventional
antipsychotics (PGWB scores 60.7 vs. 66.4), this did not negatively affect productivity. Fifty-eight
percent of risperidone users were productive compared with 49% of patients receiving conventional
antipsychotics. Logistic regression found that risperidone was the only antipsychotic in either group
(conventional or atypical) that was significantly associated with productive activities (OR=1.85,
P=0.047).
Conclusion: Risperidone use had a positive impact on the productivity of community patients with
schizophrenia.

Antipsychotic Use and Productivity

The PGWB scale consists of 22 questions designed to measure individuals subjective feelings
of well-being or distress.
Scores range from 0 to 110
Higher scores indicate greater well-being

Statistical Analyses
To control for the effects of other variables that could potentially explain or confound patients
productivity, a logistic regression model was used.

OBJECTIVES
To determine the impact of antipsychotic use on the productivity and functioning of individuals
with schizophrenia in the community.

Data Collection

METHODS

Information was gathered from 390 schizophrenia patients using self-administered

questionnaires.
Respondents were asked which medications they used from a list (conventional antipsychotics,
risperidone, clozapine, quetiapine, olanzapine, antidepressants, anxiolytics, anticholinergics,
mood stabilizers, and sedatives). Productive activity was evaluated with the question, During a
typical week, how many hours do you spend doing the following:
paid employment
treatment program
volunteer or unpaid work
school or college
crafts or hobbies
watching television
relaxing or "hanging out"
other
Patients reporting any paid employment, volunteer work, or school were considered to be
productive.

Patient Sample
Patients were identified through national chapters of the National Mental Health Association
(NMHA), the National Alliance for the Mentally Ill (NAMI), and community mental health centers.

70
60
50
40
30
20
10
0

58

60

60

Clozapine
(N=81)

Most users of atypical antipsychotics were likely to be engaged in productive activity.

All statistical tests were two-tailed at an alpha level of 0.05.

Medication Use

RESULTS
Demographic characteristics by use of antipsychotic medication#

Male/female (%)

55/45

Mean age, (SD) years

45.6 (9.6)*

White/nonwhite (%)

55/45

46/54

57/43

43.3 (10.5) 39.0 (10.0)* 43.3 (10.5)

80/20

82/18

89/11

80/20

55/45
42.1 (7.6)
89/11*

Respondents could be using more than one antipsychotic medication.

*P < 0.05
#

In this population, less elderly patients (65 years) used atypical antipsychotics.
More whites than nonwhites used antipsychotics.

Percent

n=

31

119

23
9
29
22
38
15
31
25
6

91
35
114
85
147
60
119
97
23

Traditional antipsychotics
Atypical antipsychotics
Risperidone
Quetiapine
Olanzapine
Clozapine
Antidepressants
Anxiolytics
Anticholinergics
Mood stabilizers
Sedatives

Traditional
antipsychotics Risperidone Quetiapine Olanzapine Clozapine
n=119
n=91
n=35
n=114
n=85

Odds Ratio

95% CI

0.0001
0.2325
0.0094
0.0057
0.6925
0.0473
0.6749
0.3960
0.2599
0.3158
0.6816
0.0231
0.0511
0.1708

1.0233
0.7473
2.3063
0.9671
1.1238
1.8504
1.1901
1.2838
1.4274
1.2947
1.1522
0.5247
0.5780
0.4434

1.0115 1.0352
0.4632 1.2055
1.2276 4.3331
0.9445 0.9903
0.6303 2.0037
1.0073 3.3992
0.5277 2.6835
0.7210 2.2860
0.7686 2.6511
0.7816 2.1447
0.5855 2.2673
0.3008 0.9154
0.3332 1.0026
0.1385 1.4198

53

49

Traditional Risperidone Quetiapine Olanzapine

Antipsychotics (N=89)
(N=35)
(N=109)
(N=114)

Control variables included schizophrenia severity (as measured by the PGWB), gender, age, and
race, and use of other prescription medications including: antidepressants, anxiolytics,
anticholinergics, mania drugs, and sedatives.

INTRODUCTION
The improvement of quality of life and productivity is a major challenge in the treatment of
schizophrenic patients. Ideal drug treatment is important in the management of patients disease
and social functioning.

Logistic Regression Analyses Productive Activity by

Antipsychotic Use (N=343)

Severity was defined using the Psychological General Well-Being Scale (PGWB).
Percent with
Productive Activities

Objective: To evaluate the association of antipsychotic medication with the productivity of people
with schizophrenia.

Measures

Severity (PGWB)
Gender (female)
Race (white)
Age
Traditional antipsychotic
Risperidone
Quetiapine
Olanzapine
Clozapine
Antidepressant
Anxiolytic
Anticholinergic
Mood stabilizer
Sedative

Younger patients were more likely to be productive regardless of type of medication use
(P < 0.01).
Patients with less severe disease were more likely to be productive regardless of type of
medication use (P < 0.01).
Caucasian patients were more likely to be productive regardless of type of medication use
(P < 0.01).

Patients could have used more than one type of psychotropic agent.

Traditional
antipsychotics

More patients used atypical antipsychotics than traditional neuroleptics.

Patients prescribed quetiapine were significantly younger than other patients.

Patients prescribed traditional antipsychotics were significantly older than other patients.

Risperidone

Severity of Schizophrenia

Quetiapine

Productive Activity
Those who reported any hours of paid employment, volunteer or unpaid work, or school or
college were classified as engaging in productive activity.
Fifty-three percent of respondents participated in at least one productive activity in an average
week for a mean of 7.16 hours per week.

Productive Activities by Schizophrenic Patients

Paid employment (n=127)

33%

Volunteer or unpaid work (n=103)

26%

School or college (n=36)

9%

Patients could have participated in more than one productive activity.

Mean PGWB Score

ABSTRACT

67.0
66.0
65.0
64.0
63.0
62.0
61.0
60.0
59.0
58.0
57.0

Olanzapine

66.4
65.4

Clozapine

Odds of Productivity Associated with Each Antipsychotic

62.6

62.6

The lines represent 95% confidence intervals for each groups odds ratio.

60.7

Logistic regression revealed that only patients using risperidone were 1.85 times more likely to
engage in a productive activity than those not using risperidone (P < 0.05).

Traditional Risperidone
Antipsychotics
(N=89)
(N=114)

Quetiapine
(N=35)

Olanzapine
(N=109)

Clozapine
(N=81)

Patients given risperidone appeared to have more severe illness than did other antipsychotic
users.

CONCLUSIONS
Although risperidone users were more severely ill compared with conventional antipsychotic
users (PGWB scores 60.7 vs. 66.4), this did not negatively affect productivity.
Risperidone use had a positive impact on the productivity of people with schizophrenia in the
community.