Maravic Melissa Culhane, Birch Kelly, Nguyen Anh Thy H, Subasinghe Alicia, Stafford Elizabeth, Zacker Christopher
Precision AQ, New York, NY, USA.
Cerevel Therapeutics, Cambridge, MA, USA.
Patient Prefer Adherence. 2025 Sep 9;19:2821-2834. doi: 10.2147/PPA.S466742. eCollection 2025.
Antipsychotic medications are considered the mainstay of treatment for schizophrenia. However, these medications are associated with a wide range of side effects, which may be tolerated differently by patients, and may impact initiation and continuation of treatment.
This study aimed to assess the tolerability of antipsychotic medication side effects for patients with schizophrenia and understand how side effects may impact decisions to initiate and remain in treatment.
A cross-sectional survey was conducted with 200 people living with schizophrenia and 100 caregiver proxies for those with severe disease presentation. The survey utilized the Maximum Difference Scaling (MaxDiff) approach to quantify preferences and a direct elicitation survey to rank specific side effects. Descriptive analysis and statistical analyses were conducted to address the study objectives.
Results indicated that extrapyramidal side effects such as pseudoparkinsonism and tardive dyskinesia, as well as feeling detached and memory and cognitive issues were ranked as the least tolerable. In contrast, side effects such as reduced interest in/enjoyment of sex, feeling tired or drowsy, and dry mouth were perceived as more tolerable. Caregivers' perspectives closely aligned with the care recipients' rankings, with an additional particular concern for high blood sugar that may lead to diabetes. Side effects such as pseudoparkinsonism, memory and cognitive problems, and weight gain were associated with unwillingness to initiate or continue an effective antipsychotic medication.
These findings highlight the importance of considering side effect profiles when selecting and discussing treatment options with patients. Side effects can potentially impact patients' willingness to start or switch medications, therefore, prescribing decisions should take into consideration patients' tolerance for potential adverse effects. Engaging patients and caregivers in treatment decisions can enhance shared decision-making and treatment satisfaction. Healthcare providers should consider these findings when prescribing antipsychotic medications to people living with schizophrenia.
抗精神病药物被认为是精神分裂症治疗的主要手段。然而，这些药物会引发多种副作用，患者对这些副作用的耐受程度可能各不相同，且可能影响治疗的启动和持续。
本研究旨在评估精神分裂症患者对抗精神病药物副作用的耐受性，并了解副作用如何影响治疗启动和持续治疗的决策。
对200名精神分裂症患者和100名患有严重疾病的患者的照料者代理人进行了横断面调查。该调查采用最大差异标度法（MaxDiff）来量化偏好，并通过直接询问调查对特定副作用进行排序。进行描述性分析和统计分析以实现研究目标。
结果表明，锥体外系副作用如假性帕金森症和迟发性运动障碍，以及情感淡漠、记忆和认知问题被列为最难以耐受的副作用。相比之下，对性兴趣/快感降低、感到疲倦或困倦以及口干等副作用被认为更易于耐受。照料者的观点与受照料者的排名密切一致，他们还特别关注可能导致糖尿病的高血糖问题。假性帕金森症、记忆和认知问题以及体重增加等副作用与不愿意启动或继续使用有效的抗精神病药物有关。
这些发现凸显了在与患者选择和讨论治疗方案时考虑副作用情况的重要性。副作用可能会影响患者开始或更换药物的意愿，因此，开药决策应考虑患者对潜在不良反应的耐受性。让患者和照料者参与治疗决策可以加强共同决策并提高治疗满意度。医疗保健提供者在为精神分裂症患者开抗精神病药物时应考虑这些发现。
