Patient preferences concerning the efficacy and side-effect profile of schizophrenia medications: a survey of patients living with schizophrenia (original) (raw)
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CNS Spectrums, 2019
Study objectivePatient-reported outcomes and preferences rely on reports of the status of a patient’s health condition that comes directly from the patient, without interpretation or qualification by clinicians or investigators. Patient-reported outcomes and preferences have become an accepted approach in drug development. As part of this effort, we assessed the relative importance to patients with schizophrenia of trying a new antipsychotic that might improve symptoms in the context of common antipsychotic side effects, especially weight gain. Information from surveys such as this one can provide pilot guidance about what might be acceptable versus unacceptable trade-offs when considering new therapies for schizophrenia.MethodsWe prospectively administered a cross-sectional survey to 250 patients with clinical diagnoses of schizophrenia or schizoaffective disorder, aged ≥18 years, from five US outpatient community clinics, regarding the importance of efficacy and side effects on tr...
Patients’ Preferences Related to Benefits, Risks, and Formulations of Schizophrenia Treatment
Psychiatric Services, 2015
The objective of this study was to quantify patients' preferences related to benefits and risks of antipsychotic treatments for schizophrenia and to assess the relative importance of treatment attributes and adherence. Methods: Treatment-related preferences among U.S. residents with a self-reported physician diagnosis of schizophrenia were assessed via a discrete-choice experiment. Patients chose between competing hypothetical scenarios characterized by improvements in positive symptoms, negative symptoms, and social functioning; incidence of weight gain, extrapyramidal symptoms (EPS), hyperprolactinemia, and hyperglycemia; and medication formulation. Preferences were estimated by using a random-parameters logit model, and the impact of adherence was estimated with conditional logit models. Results: The final sample consisted of 271 patients. Complete improvement in positive symptoms was the most preferred outcome (relative importance score of 10.0), followed by elimination of hyperglycemia (3.6, 95% confidence interval [CI]=2.6-4.6), improvement in negative symptoms (3.0, CI= 1.6-4.3), reduced weight gain (2.6, CI=1.2-4.0), avoidance of hyperprolactinemia (1.7, CI=.9-2.6), improved social functioning (1.5, CI=.4-2.5), and avoidance of EPS (1.0, CI= .3-1.8). Patients judged a daily pill superior to monthly injections (p,.01) and monthly injections superior to injections every three months (p,.01) for adherent patients and monthly injections superior to a daily pill for nonadherent patients (p=.01). Conclusions: Persons who self-identified as having schizophrenia judged improvement in positive symptoms as the most important treatment benefit. Hyperglycemia was identified as the most important adverse event. Patients judged oral formulations to be better than monthly injections for adherent patients and monthly injections to be a better choice for nonadherent patients.
Journal of Clinical Nursing, 2011
Aims and objectives. This research aimed to: (i) investigate the prevalence and perceived severity of antipsychotic side effects in people with schizophrenia and related disorders living in communities in Singapore; (ii) examine the relationship between antipsychotic variables (type, dose, route, prescription duration) and side effects; and (iii) examine the relationship between side effects and attitudes towards medication. Background. Antipsychotics are the mainstay treatment in schizophrenia and other psychotic disorders. However, antipsychotics are associated with a wide range of side effects, which potentially have adverse effects on patients' functioning. A lack of studies comparing the frequency of side effects and their associated levels of distress across multiple antipsychotics and different medication variables has been noted. Additionally, it is essential to assess patients' attitudes towards antipsychotics in relation to their experience of side effects. Design. A cross-sectional, non-experimental research design was used. Method. A convenience sample of 96 adults with schizophrenia and related disorders on antipsychotic treatment and attending the hospital's outpatient clinic was recruited. Variables collected included antipsychotic type, dose, route, prescription duration and side effects, attitudes towards medication and demographic and clinical variables. They were analysed with descriptive statistics and correlational analyses. Results. Many participants experienced psychic (80AE2%), extrapyramidal (69AE8%) and miscellaneous side effects (61AE5%). Side effects positively correlated with dose (p = 0AE016) and negatively correlated with prescription duration (p = 0AE014). Negative attitudes towards medication were positively correlated with side effects in general (p = 0AE023), along with hormonal (p = 0AE013) and psychic side effects (p = 0AE008). Conclusion. Findings revealed that majority of the participants experienced and were distressed over psychic, extrapyramidal and weight gain, which may be related to high doses and treatment duration. Additionally, patients experiencing psychic and hormonal side effects are at risk of developing negative attitudes towards medication. Relevance to clinical practice. Findings guide the development of appropriate nursing interventions that aim to alleviate side effects, reduce negative attitudes towards medication and prevent compliance problems.
Indian Journal of Psychological Medicine 2014;36: 288-293
Background: Given the paucity of research in this area, this study attempted to assess attitudes toward antipsychotic medications and its correlates among patients with schizophrenia, either on first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs) medications. Materials and Methods: Structured assessments of attitudes to antipsychotics, psychopathology, insight and side-effects were carried out in 120 patients with DSM-IV schizophrenia; 89 of these were on SGAs and 31 on FGAs. Results: Patients had predominantly positive attitudes toward antipsychotics. Severity of side-effects was the principal correlate of attitudes, explaining 19.5% of the variance, followed by greater insight (4.2% of the variance). Other factors such as younger age, male gender, employment, higher family income, urban residence and lower symptom-severity explained only a negligible proportion of the variance (0.2%) in attitudes. Patients on SGAs had more positive views of their medications than those on FGAs. They felt more normal on their medications, believed that their thoughts were clearer on medications, felt that good things about their medications outweighed the bad and believed that their medications helped them from falling ill again. In addition, they did not feel as tired and sluggish on their medications and did not believe that medications were unnatural or controlled their bodies. Conclusions: Positive attitudes toward antipsychotics were common among patients with schizophrenia. Attitudes were principally determined by severity of side-effects and insight levels. Patients on SGAs had better attitudes, possibly because of less severe side-effects and greater insight among them. The importance of exploring patients’ attitudes toward their antipsychotics is highlighted by this study.
Journal of Pharmacy Practice, 2019
Background: Selection of schizophrenia or bipolar disorder treatments is complicated by treatment-effect heterogeneity. Objectives: This study assessed how clinicians’ beliefs and health system/ insurace policies impact choice of atypical antipsychotic agent in schizophrenia and bipolar disorder. Methods: A cross-sectional survey was conducted of members of the American College of Clinical Pharmacy and College of Psychiatric & Neurologic Pharmacists. Beliefs regarding atypical antipsychotic effectiveness and safety, impact of comorbidity on drug selection, and factors influencing atypical antipsychotic therapy selection were assessed. Results: Twenty-four psychiatric pharmacists and 18 psychiatrists participated. Mean age was 39.6 years, 57.1% were female. Most clinicians (64.3%) believed medication effectiveness and safety equally important, while 26.2% believed safety and 9.4% believed effectiveness more important. The most important medication properties for schizophrenia were re...
Schizophrenia Research, 2016
To investigate the interest in the attitudes toward antipsychotic medication in exploring medication non-adherence. Methods: Schizophrenic patients (N = 120) completed the Beliefs about Medicines Questionnaire and measures of medication adherence, and clinical outcomes. Comparison between four attitudinal groups and logistic regressions were performed. Results: High level of adherence varied significantly between attitudinal groups (Accepting, 70%; Indifferent, 63%; Ambivalent, 50%; Sceptical, 14%; p b 0.001). Poor insight and psychic side effects were the most significant predictors of negative beliefs. Conclusion: The attitudinal groups approach could facilitate the identification of patients with non-adherence and determine individual targets of interventions to improve negative beliefs.
Journal of Clinical Psychopharmacology, 2004
In routine practice, subjective response to antipsychotics is becoming a critical outcome measure among schizophrenia patients. This study sought to compare subjective response to atypical (risperidone and olanzapine) and typical antipsychotic drugs. Using a naturalistic cross-sectional design, we examined subjective response to antipsychotics (satisfaction with medication and subjective tolerability), psychopathology, side effects, emotional distress, and awareness in schizophrenia patients stabilized on atypical (n = 78) and typical (n = 55) drugs. Analysis of variance and multiple regression analysis were applied. We found that atypical drugs were superior to typical antipsychotics in both measures of subjective response, which were positively correlated (r = 0.52, P < 0.001). Poor subjective response was associated with severity of emotional distress, negative, and activation symptoms in the atypical group and with extrapyramidal side effects and positive symptoms in the typical group. Awareness of treatment is a positive factor that accounted for 20% and 34% of variation in the subjective responses to atypical and typical antipsychotic drugs, respectively. Demographic variables, age of onset, illness duration, and adjunctive drugs did not relate significantly to subjective response to antipsychotic drugs. Thus, atypical drugs are characterized by better subjective response compared with typical antipsychotics; their determinants differed considerably. Satisfaction with medication together with subjective tolerability needs to be considered in clinical trials. (J Clin Psychopharmacol 2004;24:245-254)
Pharmacopsychiatry, 2005
Medication compliance is a key issue in the prevention of relapse in schizophrenia. Despite the development of new atypical antipsychotics with better efficacy and fewer side effects, non-adherence is still considerable . A recent review by Zygmunt et al. shows that psychoeducational interventions that do not specifically focus on attitudinal and behavioral change were largely unsuccessful . In a study by Kemp et al. [22], significant improvement in compliance was achieved with the use of compliance therapy ± a brief cognitive-behavioral intervention ± and was associated with improvement in attitudes and insight. However, this positive finding could not be replicated by O'Donnell et al. [32], who found that compliance therapy was not superior to nonspecific therapy in improving compliance at one year. However, they showed that attitudes to treatment at baseline predict-ed adherence one year later. Three other recent reviews also underscore the importance of attitudes towards medication as a key factor for compliance.
Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia
JAMA Psychiatry, 2016
In treatment-resistant schizophrenia, clozapine is considered the standard treatment. However, clozapine use has restrictions owing to its many adverse effects. Moreover, an increasing number of randomized clinical trials (RCTs) of other antipsychotics have been published. OBJECTIVE To integrate all the randomized evidence from the available antipsychotics used for treatment-resistant schizophrenia by performing a network meta-analysis. DATA SOURCES MEDLINE, EMBASE, Biosis, PsycINFO, PubMed, Cochrane Central Register of Controlled Trials, World Health Organization International Trial Registry, and clinicaltrials.gov were searched up to June 30, 2014. STUDY SELECTION At least 2 independent reviewers selected published and unpublished single-and double-blind RCTs in treatment-resistant schizophrenia (any study-defined criterion) that compared any antipsychotic (at any dose and in any form of administration) with another antipsychotic or placebo. DATA EXTRACTION AND SYNTHESIS At least 2 independent reviewers extracted all data into standard forms and assessed the quality of all included trials with the Cochrane Collaboration's risk-of-bias tool. Data were pooled using a random-effects model in a Bayesian setting. MAIN OUTCOMES AND MEASURES The primary outcome was efficacy as measured by overall change in symptoms of schizophrenia. Secondary outcomes included change in positive and negative symptoms of schizophrenia, categorical response to treatment, dropouts for any reason and for inefficacy of treatment, and important adverse events. RESULTS Forty blinded RCTs with 5172 unique participants (71.5% men; mean [SD] age, 38.8 [3.7] years) were included in the analysis. Few significant differences were found in all outcomes. In the primary outcome (reported as standardized mean difference; 95% credible interval), olanzapine was more effective than quetiapine (−0.29; −0.56 to −0.02), haloperidol (−0. 29; −0.44 to −0.13), and sertindole (−0.46; −0.80 to −0.06); clozapine was more effective than haloperidol (−0.22; −0.38 to −0.07) and sertindole (−0.40; −0.74 to −0.04); and risperidone was more effective than sertindole (−0.32; −0.63 to −0.01). A pattern of superiority for olanzapine, clozapine, and risperidone was seen in other efficacy outcomes, but results were not consistent and effect sizes were usually small. In addition, relatively few RCTs were available for antipsychotics other than clozapine, haloperidol, olanzapine, and risperidone. The most surprising finding was that clozapine was not significantly better than most other drugs. CONCLUSIONS AND RELEVANCE Insufficient evidence exists on which antipsychotic is more efficacious for patients with treatment-resistant schizophrenia, and blinded RCTs-in contrast to unblinded, randomized effectiveness studies-provide little evidence of the superiority of clozapine compared with other second-generation antipsychotics. Future clozapine studies with high doses and patients with extremely treatment-refractory schizophrenia might be most promising to change the current evidence.