Patient Priorities in Psychosis: A Factor-Analytical Examination of Treatment Preferences

This study aimed to investigate treatment preferences among individuals diagnosed with schizophrenia or schizoaffective disorder, with a particular focus on the specific symptoms they wish to alleviate and the types of interventions they prefer.

A cross-sectional online survey was conducted with 182 participants diagnosed with schizophrenia or schizoaffective disorder. The survey assessed sociodemographic data, psychiatric history, current symptom burden, symptom priorities, and therapy preferences. A factor analysis was performed on treatment preferences to identify key therapy domains to be targeted.

Factor analysis revealed 5 main treatment domains: depression/anxiety, memory/attention, executive functioning, positive symptoms, and anger. Participants prioritized affective symptoms (eg, depression, anxiety, low self-esteem) and neurocognitive deficits (eg, memory, attention) over traditional treatment targets such as hallucinations and delusions. Preferred therapies included physical exercise, relaxation, metacognitive training, and creative therapies. Antipsychotic medication was endorsed by less than half of the participants.

The findings challenge the traditional emphasis on positive symptoms in the treatment of schizophrenia. Patients consistently expressed a clear preference for interventions that target emotional well-being and neurocognitive functioning. Future studies should recruit participants from a broader range of clinical settings such as inpatient units, community mental health services, and supported housing to decrease the potential risk of selection bias. Our results underscore the need for more personalized, psychosocially oriented care models that align with patient priorities. Meeting patients' preferences may improve adherence with antipsychotic medication and thus overall outcomes.