Side Effects of Antipsychotics and Patient Preferences in the Treatment of Schizophrenia
Although a number of antipsychotics are currently available, many patients still suffer from unpleasant side effects associated with the treatment of schizophrenia. To determine how individuals with schizophrenia and schizoaffective disorders perceive antipsychotic treatment, a larger survey was conducted in the USA in 2016.
Side Effects of Antipsychotics as a Reason for Discontinuing Treatment
In the past, the majority of antipsychotic side effects were predominantly motor disorders (secondary parkinsonism, dystonia, akathisia, tardive dyskinesia). With the introduction of atypical antipsychotics, a different group of side effects came to the forefront, with sedation, weight gain, and metabolic disorders predominating. These side effects also contribute to an increased cardiovascular risk in patients. These pharmacological side effects lead to patients discontinuing their treatment on their own and are also a frequent reason for medication changes. Therefore, psychiatrists aim to choose the appropriate antipsychotic that provides the best control of schizophrenia symptoms for the patient while having the fewest possible side effects.
Survey
The study included a total of 250 patients over the age of 18 with a primary diagnosis of schizophrenia or schizoaffective disorder. The research was conducted at 5 clinics in 4 states in the USA from October to December 2016. Patients filled out a questionnaire in the medical facility, indicating their gender, age, height, weight, and answering questions about the significance of the efficacy and side effects of antipsychotics for their decision to use the treatment. Responses were mainly based on a 5-point scale ranging from 'not important to me' to 'most important to me.'
Most Important Aspects of Efficacy and Safety of Antipsychotics from the Patients' Perspective
Of the 250 participants, 64% were men (2% did not provide their gender). The average age of respondents was 43 years (range 18–72 years), the average weight was 91 kg (49–182 kg), and the average BMI was 30 kg/m2 (15–63 kg/m2).
The ability to think more clearly was considered a very important/most important effect of the treatment by the majority of patients (87.6%). A total of 76.4% considered the elimination of hallucinations, delusions, and paranoia to be a very important/most important effect of the treatment. According to the survey, 71.6% of patients consider the elimination of the side effects accompanying their current therapy to be very important or most important.
When evaluating motivation to adhere to treatment, 93.6% of patients stated that efficacy was the most important or very important factor, and 83.6% cited side effects. The most bothersome side effects were weight gain (61.6%), restlessness or akathisia (60.8%), and somnolence (58.8%). Differences in the evaluation of side effects between genders were noted.
Generally, women considered the side effects of treatment more significant than men (weight gain was a problem for 70.9% of women compared to 56.3% of men, and fatigue and sleepiness were a problem for 61.6% of women compared to 56.9% of men). The willingness to use the treatment would be reversed by the expected weight gain of more than 9 kg in 73.6% of respondents, an expected gain of 5 kg in 67.2% of patients, an expected gain of 2.7–4.5 kg in 44% of patients, and 29.6% of respondents would be concerned about an expected weight gain of less than 2.3 kg.
49.4% of patients expressed a willingness to try new medication if it offered the possibility of improving disease control. Those who reported lower willingness to change medication cited good efficacy of the current therapy or fear of unknown side effects of the new drug as the reason.
The Importance of an Individualized Therapeutic Plan
The survey results indicate that the most important aspect of antipsychotic treatment for patients is its efficacy (i.e., the elimination of positive symptoms of schizophrenia and clearer thinking). For maintaining compliance with the treatment, a low occurrence of side effects is crucial, with weight gain being rated as the biggest issue. Previous studies that showed low adherence to antipsychotic treatment cited side effects of antipsychotics as the most common reason. Other important factors may include the simplicity of medication administration and the intervals between doses.
It follows that the treatment of schizophrenia should be individualized, considering the needs, comorbidities, and preferences of the specific patient and their expectations for the outcomes of the therapy.
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Source: Achtyes E., Simmons A., Skabeev A. Patient preferences concerning the efficacy and side-effect profile of schizophrenia medications: a survey of patients living with schizophrenia. BMC Psychiatry 2018; 18 (1): 292, doi: 10.1186/s12888-018-1856-y.
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