Abstract
BACKGROUND: 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. PURPOSE: 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. METHODS: 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: 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. CONCLUSION: 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.