Skip to main content
NCBI home page
Neuropsychiatric Disease and Treatment logoLink to Neuropsychiatric Disease and Treatment
. 2026 Oct 9;22:640272. doi: 10.2147/NDT.S640272

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

Bernhard T Baune 1,2,3,✉, Wolfgang Janetzky 4
PMCID: PMC13660839  PMID: 42872256

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords: schizophrenia, treatment goal, patient centered, oral antipsychotic, long-acting injectable

Introduction

Schizophrenia is a complex disorder with large inter-individual variations in symptoms and disease course.1,2 Core symptoms of schizophrenia can be categorized in three main groups: positive symptoms, negative symptoms and cognitive impairment.1 Many patients living with schizophrenia experience impairments in psychosocial functioning3 and quality of life.4 Since schizophrenia is such a complex disease, its treatment may have many different goals.5 Individual goals may depend on patient preferences, social situation, educational/occupational situation, disease course, and other factors. Regarding preference of one treatment goal over others, there may be differences in the perspectives of patients and physicians.6–10

Adherence to schizophrenia treatment is low in many cases.11 Lack of adherence leads to increased risks of clinical deterioration, unfavorable outcomes, hospitalization, and suicidality.11 Adherence may be increased if it is based on a deliberate decision for a specific treatment in conjunction with patient-defined goals.12 Psychiatrists can help their patients in making treatment decisions by using structured communication tools, in particular shared decision making (SDM) and motivational interviewing (MI).12

Two fundamental pharmacologic treatments include oral antipsychotics and LAI antipsychotics. Antipsychotics are the mainstay pharmacological treatment for schizophrenia.13,14 While oral formulations are typically taken daily, LAI formulations allow for dosing intervals between two weeks and up to six months. Patients perceive that oral formulations offer more sense of personal control (since intake can be stopped any day and does not require injection, which may be important for patients with fears of needles).15 LAIs, on the other hand, have a number of advantages in terms of outcomes over oral formulations: reduced mortality,16 relapses,17 hospitalizations,18 and treatment failures19 and enhanced treatment continuation20 and tolerability (due to more stable plasma concentrations)21 in comparison to the same substance in oral formulation. Some of these advantages become even more pronounced in LAIs with injection intervals > 1 month, with the additional advantages of offering more room for discussions of topics besides medication, reduced caregiver burden, and easier transitioning from in- to outpatient treatment.22 However, it is unclear whether patients are aware of these advantages and whether they play a role in treatment decisions. Treatment goals may differ between psychiatrists and their patients – while psychiatrists typically emphasize symptom resolution and functioning, patients tend to focus on well-being and quality of life.5 This might also play a role in decision-making on oral vs LAI treatment. The PRELAPSE trial has demonstrated that use of SDM and MI techniques can increase the patient’s willingness to try treatment with an LAI.23

Previous studies on treatment goals in schizophrenia that included patients and their treating physicians found that agreement between both groups was high.10,24,25 A US study also assessed subgroups with oral or LAI medication and found some differences in goal valuations and goals that were met or not met by the current medication.25 So far, to our knowledge, no study has evaluated both agreement on treatment goals between patients and physicians in conjunction with preference for a specific medication formulation to reach these goals.24,25

In the present study, patients with schizophrenia were asked about their treatment goals, and their treating physicians were asked which treatment goals they had for this specific patient. Additionally, both were asked if they considered oral or LAI treatment best to achieve these goals.

The primary objective of this study was to assess and rank treatment goals from a patient’s and psychiatrist’s perspective. Secondary objectives were to assess concordance of the treatment goals between psychiatrists and patients, assess the psychiatrist’s and patient’s choice of oral antipsychotic vs LAI to reach the treatment goals, and concordance of treatment choice.

Materials and Methods

A survey of treatment goals and medication modalities was conducted in matched pairs of patients with schizophrenia and their treating psychiatrists. Psychiatrists in outpatient clinics, hospitals or private practice were randomly chosen from the IQVIA OneKey™ reference database. Between September 2024 and May 2025, 1487 mailings were sent out. The aim was to involve 50 psychiatrists and 150 patients in the survey.

We asked participating psychiatrists to choose up to 3 of their patients who were willing to participate. Eligibility criteria for patients were a diagnosis of schizophrenia according to ICD-10 criteria, at least 18 years of age, and provision of informed consent. Participating psychiatrists chose the patients at their own discretion; there was no guideline on who and how to choose. Psychiatrists were not explicitly told about any study hypothesis. The survey was done in accordance with the declaration of Helsinki, and participation was voluntary. Participating patients filled in a questionnaire on treatment goals and medication modalities, and their treating psychiatrist filled in a similar questionnaire for each patient. Psychiatrists were asked not to help their patients fill in the questionnaires, but instead to ask someone else (eg, a nurse) if the patient needed help, so that influence by the psychiatrist could be avoided. Questionnaires of psychiatrist-patient pairs were matched using a simple numbering system.

Questionnaires

Patient participants were asked about their treatment goals, while physicians were asked about the goals they envisioned for each corresponding participating patient. Categories of goals and individual goals in the questionnaire were based on a selection identified previously in a Delphi study.10 Goals had been translated into lay language by a patient group.10 For this survey, a subset of goals that had been indicated most often in the previous studies was used (Table 1).

Table 1.

Treatment Goals Used in This Study. The Categories of Goals and Individual Goals are Based on Results from a Delphi study10

Category effectiveness/symptom reduction
1. To reduce delusions (fear of persecution, observation, manipulation, being influenced)
2. To achieve clear thinking
3. To reduce hallucinations (eg hearing voices)
4. To increase motivation/drive/energy/to decrease exhaustion
5. To improve concentration/learning capacity/attention
6. To improve the mood
7. To reduce relapses/hospitalizations
Category tolerability
8. To avoid medications making the heart or other organs sick
9. To avoid restlessness
10. To avoid being tired
11. To avoid getting fat
12. To avoid getting diabetes or other diseases
13. To avoid feeling subdued
Category quality of life/functioning/participation
14. To become or remain able to establish and maintain close relationships (family, children, friends, intimate relationships)
15. To become or remain able to live independently and autonomously
16. To increase satisfaction with the current life situation
17. To become or remain able to do well at school, university or work
18. To become or remain able to take care of oneself (nutrition, hygiene, clothing, physical health)
Open in a new tab

Participants were asked to indicate if they considered the given treatment goals relevant and to rate the treatment goals on a Likert scale (very important/important/less important/not important).

We calculated grouped importance scores for physicians and patients separately by weighing the answers (very important = 3, important = 2, less important = 1, not important = 0) and calculating means and standard deviations.

Next, we matched physician and patient data to describe the agreement/disagreement of treatment goals between the two groups. For patients and physicians who gave the same relevance level for a goal, we counted the answers as “equally important”. If the answers differed, we counted it as “more important” for whoever had given the higher relevance level.

As a next question, participants were asked if they considered oral or LAI treatment most suitable to reach each of the goals. Additionally, all participants were asked to rate their experience with oral and LAI medication (very good, good, neither good nor bad, bad, or very bad). Finally, participants were asked whether they had discussed LAI treatments, if yes, how frequently (sometimes, often, or regularly).

Statistical Analysis

Data were summarized using descriptive techniques, including calculations of mean, standard deviation, median, minimum and maximum values for continuous variables, as well as counts and percentages for categorical and binary variables. Analyses were descriptive; no formal multilevel modeling was performed due to sample size. Data was processed using SAS 9.4 (SAS Institute Inc., Cary, NC).

Results

Participant Demographics

We obtained responses from 43 matched physician-patient pairs involving 14 physicians (0.9% of mailings). Characteristics of participating physicians are shown in Table 2. Participating physicians were, on average, experienced psychiatrists with a mean of 22.0 years (SD 8.2) experience in psychiatry, and almost as long experience in treating patients with schizophrenia (mean 21.6 years, SD 8.5). The majority (57%) worked in private practice.

Table 2.

Characteristics of Participating Physicians

Physicians
(n = 14, If Not Indicated Otherwise)
Age, years, mean (SD) 53.6 (8.3)
Specialty, n (%)
 Psychiatry 9 (64)
 Psychiatry and Neurology 4 (29)
 Neurology 1 (7)
Experience in psychiatry, years (SD) (n = 13) 22.0 (8.2)
Experience treating patients with schizophrenia, years (SD) 21.6 (8.5)
Current place of occupation, n (%)
 Clinic 1 (7)
 Clinic and Psychiatric Institutional Outpatient’s Department (PIA) 2 (14)
 Psychiatric Institutional Outpatient’s Department (PIA) 2 (14)
 Clinic and PIA and Private Practice 1 (7)
 Private Practice 8 (57)
Open in a new tab

Characteristics of the patients who took part in the survey are shown in Table 3. They were predominantly middle-aged (mean, 43.4 years, SD 11.0), with long illness duration (mean, 17.3 years, SD 10.5). The majority were treated with oral antipsychotics (67%) on an outpatient basis (84%) and were moderately (42%) or markedly (37%) ill.

Table 3.

Characteristics of Participating Patients

Patients
(n = 43, If Not Indicated Otherwise)
Age, years, mean (SD) 43.4 (11.0)
Sex, female, n (%)/male, n (%) (n = 42) 18 (43)/24 (57)
Age at diagnosis, years (n = 41) 25.9 (7.8)
Duration of schizophrenia, years (SD) (n = 41) 17.3 (10.5)
Current drug treatment, n (%) (n = 42)
 Long-acting injectable antipsychotics 3 (7)
 Oral antipsychotics 28 (67)
 Both long-acting injectable and oral antipsychotics 11 (26)
Current treatment mode, n (%)
 Outpatient 36 (84)
 Inpatient 7 (16)
Current disease severity as rated by the treating psychiatrist, n (%)
 Not at all ill 1 (2)
 Moderately ill 18 (42)
 Markedly ill 16 (37)
 Severely ill 7 (16)
 Very severely ill 1 (2)
Patient required help filling in patient sheet, n (%)
 Yes 4 (9)
 No 39 (91)
Open in a new tab

Ratings of Treatment Goals

Ratings in the Category Effectiveness/Symptom Reduction

The mean importance scores calculated for physicians indicated that reduction of delusions, clear thinking, and avoiding relapses were the top goals. For patients, the most important goals were good concentration, clear thinking and avoiding relapses (Table 4).

Table 4.

Importance Scores for Goals in the Category Effectiveness/Symptom Reduction

Physicians Patients
Goal Number of
Responses		 Mean (SD) Goal Number of
Responses		 Mean (SD)
To reduce delusions 42 2.81 (0.50) To improve concentration 38 2.65 (0.57)
To achieve clear thinking 42 2.76 (0.48) To achieve clear thinking 37 2.57 (0.59)
To reduce relapses/hospitalizations 40 2.70 (0.56) To reduce relapses/hospitalizations 38 2.55 (0.68)
To reduce hallucinations 37 2.65 (0.67) To increase motivation 37 2.30 (0.95)
To increase motivation 37 2.51 (0.60) To improve the mood 36 2.25 (0.72)
To improve concentration 39 2.44 (0.59) To reduce delusions 39 2.18 (0.93)
To improve the mood 34 2.41 (0.60) To reduce hallucinations 34 2.15 (1.06)
Open in a new tab

Notes: Scores are means of weighted Likert responses (very important = 3, important = 2, less important = 1, not important = 0).

Abbreviations: SD, standard deviation.

For all goals in the category effectiveness/symptom reduction, the importance ratings were equal for a large proportion of physician-patient pairs (39–66%, Figure 1). Physician ratings of delusions and hallucinations as well as mood improvement appeared higher than those of patients in 42%, 39% and 39% of pairings, respectively, while 40% of patients rated “good concentration” as more important than their physicians in this sample.

Figure 1.

A stacked bar graph showing treatment goal importance ratings for physician and patient pairs. A stacked bar graph shows importance ratings for treatment goals. X-axis: percent (0-100% in 10% increments). Y-axis: goals with sample sizes. Legend: More important for physician, Equally important, More important for patient. Goals: Reduction of delusions (n=38): 42% more important for physician, 58% equal, 0% more important for patient. Clear thinking (n=37): 27% physician, 65% equal, 8% patient. Reduction of hallucinations (n=31): 39% physician, 55% equal, 6% patient. More motivation/less exhaustion (n=33): 30% physician, 48% equal, 21% patient. Good concentration/learning capacity (n=35): 14% physician, 46% equal, 40% patient. Mood improvement (n=31): 39% physician, 39% equal, 23% patient. Reduction in relapses/hospitalizations (n=35): 26% physician, 66% equal, 9% patient.

Open in a new tab

Comparison of ratings of treatment goals from the category effectiveness/symptom reduction.

Ratings in the Category “Tolerability”

By mean importance score, the top goals for physicians in this sample were avoidance of cardiac damage, avoidance of feeling subdued, and avoiding fatigue, while for patients, the top goals were avoiding cardiac damage, metabolic disorders and feeling subdued (Table 5).

Table 5.

Importance Scores for Goals in the Category Tolerability

Physicians Patients
Goal Number of
Responses		 Mean (SD) Goal Number of
Responses		 Mean (SD)
To avoid medications making the heart or other organs sick 39 2.41 (0.59) To avoid medications making the heart or other organs sick 41 2.71 (0.51)
To avoid feeling subdued 41 2.37 (0.72) To avoid getting diabetes or other diseases 37 2.65 (0.58)
To avoid being tired 39 2.36 (0.62) To avoid feeling subdued 35 2.57 (0.55)
To avoid getting diabetes or other diseases 37 2.35 (0.67) To avoid restlessness 36 2.56 (0.50)
To avoid restlessness 36 2.17 (0.73) To avoid being tired 39 2.54 (0.63)
To avoid getting fat 38 2.11 (0.72) To avoid getting fat 34 2.41 (0.81)
Open in a new tab

Notes: Scores are means of weighted Likert responses (very important = 3, important = 2, less important = 1, not important = 0).

Abbreviation: SD, standard deviation.

Agreement on importance of treatment goals in the category tolerability appeared to be less pronounced in this sample, with proportions between 30–56% agreement (Figure 2). For all goals, a larger proportion of patients rated them as more important than their physician (27–52%) than vice versa (6–23%). “Not getting fat” stood out as more important for patients compared to their physicians in 52% of the cases.

Figure 2.

A stacked horizontal bar graph showing ratings of tolerability treatment goals by physician and patient. A stacked horizontal bar graph compares importance ratings for tolerability goals. The X-axis ranges from 0% to 100%. The Y-axis lists goals with sample sizes: Medications should not make organs sick (n=39); Not being restless (n=34); Not being tired (n=37); Not getting fat (n=33); Not getting diabetes or other diseases (n=35); Not feeling subdued (n=33). Legend categories: More important for physician, Equally important, More important for patient. Values by row: Medications should not make organs sick: 10% more important for physician, 49% equal, 41% more important for patient. Not being restless: 6% physician, 56% equal, 38% patient. Not being tired: 19% physician, 54% equal, 27% patient. Not getting fat: 18% physician, 30% equal, 52% patient. Not getting diabetes or other diseases: 23% physician, 31% equal, 46% patient. Not feeling subdued: 15% physician, 48% equal, 36% patient.

Open in a new tab

Comparison of ratings of treatment goals from the category tolerability.

Ratings in the Category Quality of Life/Functioning/Participation

Mean relevance scores revealed that the top priorities for physicians were autonomy, self-care and the capacity for close relationships, which was similar for patients, for whom capacity for close relationships was the second most important goal (Table 6).

Table 6.

Importance Scores for Goals in the Category Quality of Life/Functioning/Participation

Physicians Patients
Goal Number of
Responses		 Mean (SD) Goal Number of
Responses		 Mean (SD)
To become or remain able to live independently and autonomously 40 2.73 (0.45) To become or remain able to live independently and autonomously 38 2.76 (0.48)
To become or remain able to take care of oneself 39 2.62 (0.62) To become or remain able to establish and maintain close relationships 37 2.73 (0.44)
To become or remain able to establish and maintain close relationships 37 2.57 (0.55) To become or remain able to take care of oneself 37 2.65 (0.62)
To increase satisfaction with the current life situation 37 2.51 (0.55) To increase satisfaction with the current life situation 39 2.62 (0.54)
To become or remain able to do well at school, university or work 32 2.13 (0.76) To become or remain able to do well at school, university or work 36 2.31 (0.88)
Open in a new tab

Notes: Scores are means of weighted Likert responses (very important = 3, important = 2, less important = 1, not important = 0).

Abbreviation: SD, standard deviation.

In the category quality of life/functioning/participation, agreement on treatment goal importance ranged from 41–71% (Figure 3). Ratings appeared fairly balanced in this sample, only “doing well at school, university or work” stood out as more important for 41% of patients compared to their physicians.

Figure 3.

Horizontal bar graph of treatment goal ratings in life quality and participation.

Open in a new tab

Comparison of ratings of treatment goals from the category quality of life/functioning/participation.

Treatment Experience

Participants were asked about previous treatment with oral or LAI medications. Treatment experience was rated as very good, good, neither good nor bad, bad, or very bad. Answers appeared rather similar for physicians and patients, with the exception of experience with LAI medication, which 47% of physicians rated as very good, compared to only 21% of patients (Figure 4).

Figure 4.

A stacked bar graph showing ratings of experience with oral medication and long acting injectable medication. A stacked bar graph compares ratings by group and medication type. Y-axis: Percentage of responses (0-100%). X-axis categories: Physicians (n=37) and Patients (n=35) for oral medication; Physicians (n=17) and Patients (n=19) for long-acting injectable medication. Legend: Very good, Good, Neither good nor bad, Bad, Very bad. Values: Oral medication - Physicians: Very good 24%, Good 59%, Neither 0%, Bad 14%, Very bad 3%. Patients: Very good 20%, Good 69%, Neither 9%, Bad 0%, Very bad 3%. Long-acting injectable medication - Physicians: Very good 47%, Good 29%, Neither 12%, Bad 6%, Very bad 6%. Patients: Very good 21%, Good 37%, Neither 26%, Bad 5%, Very bad 11%.

Open in a new tab

Ratings of experience with oral or LAI medication.

Suitability of Drug Formulation to Reach Goals

Participants were asked, for each treatment goal that played a role in their treatment, whether they considered that this goal would rather be reached by using LAI treatment, oral treatment, or if both treatments were equally suitable. Responses were recorded per goal and per pair; here, we report summarized results.

The majority of patients in our sample (53%) felt that oral medication would be more suitable to reach their effectiveness goals than LAI medication, while 34% of physicians thought that an LAI formulation would be more appropriate (Figure 5a). Similar proportions were found in the categories tolerability (Figure 5b) and quality of life/functioning/participation (Figure 5c). For all categories, it appeared that most patients (45%–53%) preferred oral treatment, while the largest proportion of physicians (46%–52%) felt that oral and LAI medications were equally suitable for reaching the goals.

Figure 5.

A stacked bar graph showing patient and physician ratings of oral and long acting injectable suitability. Three horizontal stacked bar graphs (A, B, C) compare preferences between patients and physicians for oral, both equal and long-acting injectable treatments. Graph A, category effectiveness, symptom reduction: - Patients (n=32-37): Oral better 53%, Both equal 26%, Injectable better 21%. - Physicians (n=34-42): Oral better 20%, Both equal 46%, Injectable better 34%. Graph B, category tolerability: - Patients (n=28-34): Oral better 45%, Both equal 30%, Injectable better 25%. - Physicians (n=35-41): Oral better 17%, Both equal 52%, Injectable better 31%. Graph C, category quality of life, functioning, participation: - Patients (n=30-39): Oral better 53%, Both equal 25%, Injectable better 21%. - Physicians (n=32-42): Oral better 15%, Both equal 51%, Injectable better 34%. Each graph′s X-axis ranges from 0% to 100% with increments of 20%. The Y-axis categorizes responses from patients and physicians.

Open in a new tab

Ratings of suitability of drug formulations to reach goals in three categories: (a) Category effectiveness/symptom reduction; (b) Category tolerability; (c) Category quality of life/functioning/participation.

Conversations About LAIs

The majority of both physicians and patients in our sample reported that they at least “sometimes” had conversations about LAIs (Figure 6). Both physicians (33%) and patients (45%) reported more frequent conversations about LAIs with patients who had already tried LAI treatment.

Figure 6.

A stacked bar graph showing physician and patient responses about conversations about LAIs. A stacked bar graph compares conversations about LAIs by group and medication type. Y-axis: Percentage of responses (0-100%). X-axis categories: Physicians of patients who only tried oral medication (n=19), Physicians of patients who tried long-acting injectables (n=18), Patients who only tried oral medication (n=19), and Patients who tried LAI (n=20). Legend: Yes, regularly; Yes, often; Yes, sometimes; Yes; No. Values: Physicians of patients who only tried oral medication, Regularly 16%, Often 11%, Sometimes, 68%, No, 5%. Physicians of patients who tried LAI, Regularly 33%, Often 22%, Sometimes 39%, No 6%. Patients who only tried oral medication, Regularly 5%, Often 21%, Sometimes 58%, Yes 5%, No 11%. Patients who tried LAI, Regularly, 45%, Often 10%, Sometimes 40%, No 5%.

Open in a new tab

Conversations about LAIs.

Discussion

Here we report ratings of treatment goals and medication formulations by matched physician-patient pairs. In our cohort, patients were more concerned about side effects than their physicians. Also, patients tended to consider oral medication most suitable to reach their goals. While most of the surveyed patients had at least some discussions about LAI medication with their physician, they may not fully appreciate the potential advantages of LAIs or may value them differently compared to physicians. However, much of this is speculative, since we did not assess what the patients knew about LAIs.

In a previous study of a similar set of treatment goals by Gründer and colleagues, agreement between patients and physicians concerning goals was high.10 This was especially true for goals in the effectiveness category. Patients tended to prioritize clear thinking, mood improvement and ability to experience joy a bit more than physicians did, while physicians placed a higher emphasis on reduction of delusions and decrease in relapses and hospitalizations. Tolerability goals saw more differences between the groups, with patients being more concerned about cardiac/other organ dysfunction, metabolic disturbances and restlessness/agitation, while physicians felt it more important to avoid fatigue/slowing down and feelings of being subdued. These results are largely in line with ours, as we saw more agreement between psychiatrists and patients on goals in the effectiveness and quality of life categories, and more differences in the tolerability category, with a tendency for patients to value goals in this category higher than psychiatrists. In the study by Gründer et al, psychiatrists placed more emphasis on avoiding fatigue than patients, which was not the case in our sample. Likewise, in the study by Gründer et al, psychiatrists more often stated that maintenance of autonomy was a top priority for them, compared to their patients; this was not the case in our survey. However, for most goals, agreement levels seemed fairly high, with 30% − 71% agreement.

Ascher-Svanum and colleagues conducted a study similar to ours, surveying 596 acutely ill patients with schizophrenia and their treating psychiatrists about their reasons for continuing or discontinuing treatment.7 These reasons were often linked to whether treatment goals were met or unmet. High agreement between patients and psychiatrists on reasons for continuing or discontinuing medication was found.

From our results on medication formulation, it seems that patients estimate the suitability of oral medication to reach their goals to be higher than that of LAI formulations. The reasons for this are speculative and might be related to lack of information, or values that differ from those of the treating physicians. To learn more about this phenomenon, studies that directly measure knowledge and beliefs about LAIs would be needed. Preference for oral medication may be related to the fact that most people are familiar with oral medications for other conditions but have never received an LAI medication for any other condition (familiarity bias). In a survey among healthy individuals who were presented with oral and LAI treatment options for schizophrenia, depression, multiple sclerosis, and rheumatoid arthritis, the majority of participants expressed preference for oral treatment, independent of the disease.26

Our results also imply that while psychiatrists do discuss LAI with their patients, they do so infrequently in many cases. One might speculate that psychiatrists already have a formulation option in mind before they enter the discussion with the patient, and limit discussion about LAI to a minimum if they feel that oral medication would be the preferred option for this patient; however, we did not directly assess reasons for initiating or omitting such conversations. Results of a survey among psychiatrists suggest that prescribers will not discuss LAI with their patients if they think that the patient is doing well with oral medication.27 On top of that, psychiatrists tend to overestimate their patient’s adherence.28 Therefore, many patients probably never learn about the advantages that LAIs offer. A qualitative synthesis of experiences of 1477 patients from 39 studies found that lack of information about LAIs was a problem for many patients.29 Additionally, patients have reported not having understood the information about LAIs that was presented to them.30 Psychiatrists may be hesitant to propose LAI treatment because of concerns regarding side effects and worries about damaging the therapeutic alliance.31 Additionally, they tend to over-estimate the concerns their patients might have towards LAI treatment.32 Still, there are negative perceptions of LAIs among patients, eg an association with lack of autonomy and compulsory treatment33 and increased illness severity.34

LAI uptake can be promoted by having a structured discussion about LAI with every patient, as has been shown in the PRELAPSE trial.23 It is important for physicians and patients to find common ground regarding treatment goals, as these form the basis for clinical decision-making. Long-term adherence to treatment may critically rely on treatment goals that are endorsed by both the patient and physician and that both expect to be feasible through the chosen treatment. It is therefore important to employ an SDM process that acknowledges potential differences in goal valuations, makes them explicit and leads to negotiation of a shared hierarchy of goals. It might be helpful to employ a list of goals, such as the one used in our study, for these discussions, and combine it with SDM and/or MI techniques.

Strengths of This Study

Our survey involved matched pairs of patients with schizophrenia and the physicians who treated them. The physicians were very experienced in the treatment of schizophrenia. The treatment goals that we asked about had previously been agreed upon by experts in a Delphi process10 and had been translated into lay language by patients with schizophrenia. This is, to our knowledge, the first report linking physician and patient perspectives on goal setting with perception of treatment modalities and may present an important resource in promoting patient-centered treatment of schizophrenia.

Limitations of This Study

The surveyed psychiatrists form a convenience sample. The response rate was very low at 0.9%, and we failed to reach our target sample size of 50 psychiatrists and 150 patients. Therefore, the external validity of our findings is strongly limited, and our results should be viewed as exploratory. We cannot control for or exclude inadvertent selection of participating psychiatrists and patients. Our survey was not powered to detect statistical differences between groups, goals, or treatments, and therefore our results are purely descriptive of the sample and can only be considered hypothesis-generating. We did not assess the information that patients had about the different treatment modalities and therefore can only speculate about the reasons for preferring either modality.

Conclusions

In this study, patients tended to have a stronger focus on avoiding side effects than their physicians. Additionally, they seemed to prefer oral medication to achieve their treatment goals, with less confidence in LAIs. We hypothesize that in physician-patient conversations, there is room for improvement in the topics of tolerability and advantages of LAIs, which should be tested in future studies. Ideally, a tool to elicit treatment goals would be used in a structured SDM intervention, and during follow-up, goal attainment, treatment satisfaction and adherence would be assessed.

Acknowledgments

We thank Stefanie Schell and her therapy group of patients living with schizophrenia who translated the treatment goals into lay language. We also would like to thank Philipp Bauknecht (co.medical, Berlin, Germany) for medical writing support on behalf of Lundbeck GmbH and Otsuka Pharma GmbH.

Funding Statement

This study was funded by Lundbeck GmbH and Otsuka Pharma GmbH.

Abbreviations

ICD, International Statistical Classification of Diseases and Related Health Problems; LAI, Long-acting injectable; MI, Motivational interviewing; SD, Standard deviation; SDM, Shared decision making.

Data Sharing Statement

The data that form the basis for this article is available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

The survey conducted within this study was presented to the International Medical and Dental Ethics Commission IMDEC, Freiburg, resulting in a positive vote (approval number: 2024/115). Participating physicians informed eligible patients verbally and in writing about the purpose and procedure as well as other details (including data protection) in connection with the interview. The patient was given a patient information leaflet containing all relevant points and, after an appropriate reflection period, gave written consent to participate.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr. Baune has received speaker honoraria from AstraZeneca, Bristol-Myers Squibb, Janssen, LivaNova, Lundbeck, Novartis, Otsuka, Pfizer, Servier, Wyeth, Biogen, Angelini, Boehringer-Ingelheim and Sumitomo Pharma. Dr. Janetzky is employed at Lundbeck GmbH.

References

  • 1.Owen MJ, Sawa A, PB M. Schizophrenia. Lancet. 2016;388(10039):86–13. doi: 10.1016/S0140-6736(15)01121-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Wolfers T, Doan NT, Kaufmann T, et al. Mapping the heterogeneous phenotype of schizophrenia and bipolar disorder using normative models. JAMA Psychiatry. 2018;75(11):1146–1155. doi: 10.1001/jamapsychiatry.2018.2467 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Bechi M, Bosia M, Spangaro M, et al. Exploring functioning in schizophrenia: predictors of functional capacity and real-world behaviour. Psychiatry Res. 2017;251:118–124. doi: 10.1016/j.psychres.2017.02.019 [DOI] [PubMed] [Google Scholar]
  • 4.Bullinger M, Kuhn J, Leopold K, Janetzky W, Wietfeld R. Lebensqualitat als Zielkriterium in der Schizophrenietherapie [Quality of life as a target criterion in schizophrenia therapy]. Fortschr Neurol Psychiatr. 2019;87(6):348–356. doi: 10.1055/a-0646-3951 [DOI] [PubMed] [Google Scholar]
  • 5.Gründer G, Bauknecht P, Klingberg S, et al. Treatment goals for patients with schizophrenia - a narrative review of physician and patient perspectives. Pharmacopsychiatry. 2021;54(2):53–59. doi: 10.1055/a-1298-4546 [DOI] [PubMed] [Google Scholar]
  • 6.Arvidsson H. Gender differences in needs and care of severely mentally ill persons: findings from a Swedish cross-sectional and longitudinal study. Int J Soc Psychiatry. 2010;56(4):424–435. doi: 10.1177/0020764009106631 [DOI] [PubMed] [Google Scholar]
  • 7.Ascher-Svanum H, Nyhuis AW, Stauffer V, et al. Reasons for discontinuation and continuation of antipsychotics in the treatment of schizophrenia from patient and clinician perspectives. Curr Med Res Opin. 2010;26(10):2403–2410. doi: 10.1185/03007995.2010.515900 [DOI] [PubMed] [Google Scholar]
  • 8.Bridges JF, Slawik L, Schmeding A, Reimer J, Naber D, Kuhnigk O. A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia. Health Expect. 2013;16(2):164–176. doi: 10.1111/j.1369-7625.2011.00704.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Kuhnigk O, Slawik L, Meyer J, Naber D, Reimer J. Valuation and attainment of treatment goals in schizophrenia: perspectives of patients, relatives, physicians, and payers. J Psychiatr Pract. 2012;18(5):321–328. doi: 10.1097/01.pra.0000419816.75752.65 [DOI] [PubMed] [Google Scholar]
  • 10.Gründer G, Bauknecht P, Schell S, Leopold K, Paulzen M, Leucht S. Identification and rating of treatment goals in schizophrenia: Delphi process and concordance survey in matched physician-patient pairs. Patient Prefer Adherence. 2025;19:1029–1046. doi: 10.2147/PPA.S499331 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Curto M, Fazio F, Ulivieri M, Navari S, Lionetto L, Baldessarini RJ. Improving adherence to pharmacological treatment for schizophrenia: a systematic assessment. Expert Opin Pharmacother. 2021;22(9):1143–1155. doi: 10.1080/14656566.2021.1882996 [DOI] [PubMed] [Google Scholar]
  • 12.Correll CU. Using patient-centered assessment in schizophrenia care: defining recovery and discussing concerns and preferences. J Clin Psychiatry. 2020;81(3). doi: 10.4088/JCP.MS19053BR2C [DOI] [PubMed] [Google Scholar]
  • 13.Ceraso A, Lin JJ, Schneider-Thoma J, et al. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev. 2020;8(8):CD008016. doi: 10.1002/14651858.CD008016.pub3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Schneider-Thoma J, Chalkou K, Dorries C, et al. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet. 2022;399(10327):824–836. doi: 10.1016/S0140-6736(21)01997-8 [DOI] [PubMed] [Google Scholar]
  • 15.Fagiolini A, Cuomo A, De Berardis D, Dell’osso B, Pompili M, Serafini G. Differentiating aspects of oral and long-acting injectable antipsychotic drugs for tailoring the therapy of schizophrenia in clinical practice: a narrative review. Int Clin Psychopharmacol. 2025;40(6):e1–e13. doi: 10.1097/YIC.0000000000000578 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Taipale H, Mittendorfer-Rutz E, Alexanderson K, et al. Antipsychotics and mortality in a nationwide cohort of 29, 823 patients with schizophrenia. Schizophr Res. 2018;197:274–280. doi: 10.1016/j.schres.2017.12.010 [DOI] [PubMed] [Google Scholar]
  • 17.Kishimoto T, Hagi K, Kurokawa S, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry. 2021;8(5):387–404. doi: 10.1016/S2215-0366(21)00039-0 [DOI] [PubMed] [Google Scholar]
  • 18.Taipale H, Mehtala J, Tanskanen A, Tiihonen J. Comparative effectiveness of antipsychotic drugs for rehospitalization in schizophrenia-A Nationwide study with 20-year follow-up. Schizophr Bull. 2018;44(6):1381–1387. doi: 10.1093/schbul/sbx176 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a Nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry. 2017;74(7):686–693. doi: 10.1001/jamapsychiatry.2017.1322 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Rubio JM, Taipale H, Tanskanen A, Correll CU, Kane JM, Tiihonen J. Long-term continuity of antipsychotic treatment for schizophrenia: a Nationwide study. Schizophr Bull. 2021;47(6):1611–1620. doi: 10.1093/schbul/sbab063 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Correll CU, Kim E, Sliwa JK, et al. Pharmacokinetic Characteristics of long-acting injectable antipsychotics for schizophrenia: an overview. CNS Drugs. 2021;35(1):39–59. doi: 10.1007/s40263-020-00779-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Baune BT. Aripiprazole 2-month ready-to-use 960 mg (ari 2MRTU): review of its possible role in schizophrenia therapy. Curr Med Res Opin. 2024;40(1):87–96. doi: 10.1080/03007995.2023.2287612 [DOI] [PubMed] [Google Scholar]
  • 23.Kane JM, Schooler NR, Marcy P, Achtyes ED, Correll CU, Robinson DG. Patients with early-Phase schizophrenia will accept treatment with sustained-release medication (long-acting injectable antipsychotics): results from the recruitment Phase of the PRELAPSE trial. J Clin Psychiatry. 2019;80(3). doi: 10.4088/JCP.18m12546 [DOI] [PubMed] [Google Scholar]
  • 24.Gründer G, Bauknecht P, Schell S, Leopold K, Paulzen M, Leucht S. Treatment goals in schizophrenia: subgroup analysis of a survey in matched physician-patient pairs. Patient Prefer Adherence. 2025;19:3559–3571. doi: 10.2147/PPA.S543844 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Fitzgerald HM, Shepherd J, Bailey H, Berry M, Wright J, Chen M. Treatment goals in schizophrenia: a real-world survey of patients, psychiatrists, and caregivers in the United States, with an analysis of Current treatment (long-acting injectable vs oral antipsychotics) and goal selection. Neuropsychiatr Dis Treat. 2021;17:3215–3228. doi: 10.2147/NDT.S330936 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Berna F, Goritz AS, Behr G, Moritz S. Pill or needle? Determinants of the preference for long-acting injection over oral treatment in people facing chronic illness. Prog Neuropsychopharmacol Biol Psychiatry. 2020;98:109798. doi: 10.1016/j.pnpbp.2019.109798 [DOI] [PubMed] [Google Scholar]
  • 27.Citrome L, Belcher E, Stacy S, Suett M, Mychaskiw M, Salinas GD. Management of schizophrenia with long-acting injectable antipsychotic medications: an assessment of the educational needs of clinicians. Neuropsychiatr Dis Treat. 2022;18:111–123. doi: 10.2147/NDT.S326299 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Velligan D, Salinas GD, Belcher E, et al. Clinician differences in attitudes and perceptions on the use of long-acting injectable antipsychotic agents in treating patients with schizophrenia: results from the US decide survey. BMC Psychiatry. 2025;25(1):232. doi: 10.1186/s12888-025-06565-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Aprile SF, Rodolico A, Di Francesco A, et al. Oral versus long-acting injectable antipsychotics in schizophrenia spectrum disorders: a systematic review of patients’ subjective experiences. Psychiatry Res. 2025;348:116460. doi: 10.1016/j.psychres.2025.116460 [DOI] [PubMed] [Google Scholar]
  • 30.Iyer S, Banks N, Roy MA, et al. A qualitative study of experiences with and perceptions regarding long-acting injectable antipsychotics: part I-patient perspectives. Can J Psychiatry. 2013;58(5 Suppl 1):14S–22S. doi: 10.1177/088740341305805s03 [DOI] [PubMed] [Google Scholar]
  • 31.Potkin S, Bera R, Zubek D, Lau G. Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia. BMC Psychiatry. 2013;13:261. doi: 10.1186/1471-244X-13-261 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Cahling L, Berntsson A, Broms G, Ohrmalm L. Perceptions and knowledge of antipsychotics among mental health professionals and patients. BJPsych Bull. 2017;41(5):254–259. doi: 10.1192/pb.bp.116.055483 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Moritz S, Peters MJ, Karow A, Deljkovic A, Tonn P, Naber D. Cure or curse? Ambivalent attitudes towards neuroleptic medication in schizophrenia and non-schizophrenia patients. Ment Illn. 2009;1(1):e2. doi: 10.4081/mi.2009.e2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Das AK, Malik A, Haddad PM. A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections. Ther Adv Psychopharmacol. 2014;4(5):179–185. doi: 10.1177/2045125314542098 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that form the basis for this article is available from the corresponding author upon reasonable request.

Articles from Neuropsychiatric Disease and Treatment are provided here courtesy of Dove Press

RESOURCES