Treatment Goals in Schizophrenia as Seen by Matched Patients and Physicians: Preferences and Medication Formulation Strategies

In the treatment of schizophrenia, it is important that physicians and patients discuss treatment goals and measures to reach these, including medication formulations (oral or long-acting injectable, LAI).

A survey was conducted in matched pairs of patients with schizophrenia and their treating psychiatrists. The questionnaires contained treatment goals that were rated by the participants, along with questions about oral and LAI medication. Study objectives were to rank treatment goals from a patient's and psychiatrist's perspective, assess the psychiatrist's and patient's choice of oral antipsychotic vs LAI to reach the goals, and assess concordance of treatment goals and treatment choice between psychiatrists and patients.

Responses from 43 physician-patient pairs involving 14 individual physicians (0.9% of contacted physicians) were received. Treatment goals were rated equally for a large proportion (39-71%) of physician-patient pairs in the goal categories "effectiveness/symptom reduction" and "quality of life/functioning/participation", but less so for the category "tolerability" (30-56%), which appeared more important to patients. The majority of surveyed patients preferred oral medication, while physicians tended to perceive oral and LAI medication as equally suitable. Conversations about LAIs were more frequent if patients had already tried LAI.

Patients tended to have a stronger focus on avoiding side effects than their physicians and seemed to prefer oral medication to reach their goals. Our results come from a small convenience sample with low response rate and should be interpreted as exploratory. Still, there may be room for improvement of physician-patient conversations.