Antipsychotic Medication Preferences: A Large-Scale Survey

Antipsychotic medications are essential in treating psychotic disorders; yet, large-scale studies examining individual patient preferences are lacking. The current study explores variations in patient perspectives on antipsychotic treatment.

Data were derived from the online decision aid Personal Antipsychotic Choice Index in the Netherlands. This freely available 30-item questionnaire assessed preferred treatment effectiveness, side effects, administration routes, and demographics, psychosis history, and antipsychotic use. Non-parametric tests compared responses by sex, age, and D₂-receptor affinity of used medication.

Of 23,733 completed questionnaires, 8,743 individuals with at least one psychotic episode were included (mean age: 38.8 and male: 58.8%). Psychotic symptom efficacy was rated most important (75.4%) followed by cognitive (61.9%) and depressive (49.5%) symptom efficacy (both p<0.001). Women rated psychotic and depressive symptom efficacy more important than men (p=0.003 and p<0.001), while adolescents prioritized cognitive symptom efficacy over adults (p=0.004). Extrapyramidal symptoms (73.2%) and weight gain (68.0%) were least acceptable side effects, particularly among women (both p<0.001). Men found sexual dysfunction less tolerable than women (p<0.001). Daily tablets were considered most acceptable (91.0%), followed by weekly tablets (40.1%), injectables (32.7%), and drops (27.9%). Patients using low D₂-affinity agents were more willing to accept dizziness (p=0.002) and hypersalivation (p<0.001) than high-affinity users, who in turn accepted sexual dysfunction and menstrual problems more often (both p<0.001).

Patient preferences regarding antipsychotic medication vary widely. Incorporating these perspectives through shared decision-making may improve trust and adherence.