Understanding patient preferences to increase treatment adherence in schizophrenia

Schizophrenia is a debilitating and lifelong mental health disorder characterized by disorganized thinking, hallucinations, and impaired social functioning.1 However, with the aid of antipsychotic agents, treatment can start to target these symptoms and increase functional recovery so that the patient can be integrated back into the community. Despite this, relapse is frequent and most patients are experiencing multiple relapses during the course of the illness.2 In fact, approximately 80% of patients with schizophrenia experience relapse within five years of their initial diagnosis.3 This relapse, often stemming from treatment non-adherence, can have profound and far-reaching consequences, including exacerbated symptoms, increased hospitalization rates and a higher risk of suicide.4 In Barcelona, a symposium at the 36th ECNP Congress explored the critical issue of medication adherence in the maintenance treatment of schizophrenia and the valuable insights that can be gleaned from understanding patient preferences.

Approximately 80% of schizophrenia patients relapse within 5 years3

Treatment non-adherence in patients with schizophrenia

Maintenance treatment with antipsychotic medications play a pivotal role in reducing the risk of relapse in individuals with schizophrenia. It has been demonstrated that patients who continue antipsychotic treatment experience significantly fewer relapses compared to those who discontinue it.3 However, more than 50% of patients with schizophrenia do not adhere to their initial antipsychotic prescription after their hospitalization.5 Some of these patients do not even collect their prescriptions, while others will discontinue within 30 days of hospital discharge.

>50% of patients with schizophrenia do not adhere to their initial antipsychotic prescription after their hospitalization5

This issue of non-adherence is especially prominent in the early phase of the illness when patients are still coming to terms with their diagnosis and the prospect of long-term treatment.6 This can especially be seen in patients with a shorter initial hospitalization as they are at a much greater risk of discontinuation than those with an initial longer stay.6 Adverse drug reactions of antipsychotic medications, including tremors, constipation and sedation, also contribute significantly to treatment non-adherence.7

The consequences of discontinuation are clear to see. In one study it has been shown that of the 61% of patients who discontinue their antipsychotic medication after a median of just six months of treatment, 46% experience a relapse within a year.8

Adverse drug reactions of antipsychotic medications, including tremors, constipation and sedation, also contribute significantly to treatment non-adherence7


The role of patient preferences in treatment adherence

Adherence to maintenance therapy is crucial for the prevention of relapse, so choosing a treatment option for patients with schizophrenia is an important responsibility. Debate around preferred second-generation antipsychotics seems to be driven more by values than data; with some placing emphasis on cost, while others focus on adverse events.9 However, for the best results the choice of medication should be tailored to the individual patient through a shared decision-making approach. Patient perceptions and attitudes, such as patient expectations, treatment objectives and the current phase of illness, play a pivotal role in treatment adherence and should not be overlooked.10

One significant aspect of patient preferences in schizophrenia treatment is the choice between long-acting injectable (LAI) antipsychotics and daily oral medications. There are multiple considerations when making this decision, such as self-empowerment and health-related quality of life goals as well as self-sufficiency and ease of use. In these measures LAIs often came out on top, with one study finding that 77% of patients expressed a preference for LAIs over daily oral antipsychotics.10 The reasons stated for this preference include feeling healthier, being able to get back to their favorite activity, not having to think about taking medication and LAIs being easier to take.

77% of patients expressed a preference for LAIs over daily oral antipsychotics10

However, some patients still experience stigma associated with LAIs, with 46% stating that they felt less embarrassed when taking pills, showing that psychiatrists must be aware of what the most important factor is for their patient.10

The first years after the first psychotic episode represent a therapeutic window that should not be missed.11 By understanding and respecting patients’ preferences, clinicians can encourage adherence and increase the likelihood of patients achieving their treatment objectives.10 The principles of shared decision-making and motivational interviewing can be powerful tools in engaging patients in their care and helping them set common treatment goals.12 Ultimately, by recognizing the significance of patient preferences and incorporating them into treatment plans, psychiatrists may be able to enhance the overall quality of care for individuals living with schizophrenia and reduce the devastating impact of relapse on their lives.10,12


Educational financial support for this session was provided by Otsuka Pharmaceutical Europe Ltd. and H. Lundbeck A/S.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

  1. Patel KR, et al. P T. 2014;39(9):638-45.
  2. Emsley R, et al. BMC Psychiatry 2013;13:50.
  3. Leucht S, et al. Lancet 2012;379(9831):2063-71.
  4. Higashi K, et al. Ther Adv Psychopharmacol 2013;3(4):200-18.
  5. Tiihonen J, et al. Am J Psychiatry 2011;168(6):603-9.
  6. Rubio JM, et al. Schizophr Bull 2021;47(6):1611-1620.
  7. DiBonaventura M, et al. BMC Psychiatry 2012;12:20.
  8. Bowtell M, et al. Schizophr Res 2018;197:9-18.
  9. Leucht S, et al. Psychol Med 2009;39(10):1591-602.
  10. Blackwood C, et al. Patient Prefer Adherence 2020;14:1093-1102.
  11. McGorry PD, et al. World Psychiatry 2008;7(3):148-56.
  12. Elwyn G, et al. Ann Fam Med 2014;12(3):270-5.
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