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Pharmacopsychiatry 2021; 54(02): 53-59
DOI: 10.1055/a-1298-4546
Review

Treatment Goals for Patients with Schizophrenia — A Narrative Review of Physician and Patient Perspectives

Gerhard Gründer‡
1   Department of Molecular Neuroimaging,Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Philipp Bauknecht‡
2   Dr. Carl GmbH, Stuttgart, Germany
,
Stefan Klingberg
3   Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
,
Karolina Leopold
4   Vivantes Klinikum Am Urban, Department of Psychiatry and Psychotherapy, Berlin, Germany
5   Carl Gustav Carus University Hospital, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany
,
Michael Paulzen 
6   Alexianer Hospital, Aachen, Germany
7   Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
8   JARA – Translational Brain Medicine, Jülich, Germany
,
Stefanie Schell
9   Harzklinikum Dorothea Christiane Erxleben, Klinikum Blankenburg, Akademisches Lehrkrankenhaus der Otto-von-Guericke-Universität Magdeburg, Germany
,
Katarina Stengler
10   Helios Parkklinikum Leipzig, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Universität Leipzig, Germany
,
Stefan Leucht
11   Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Germany
› Author Affiliations Funding: This review was sponsored by Lundbeck GmbH, Hamburg, Germany and Otsuka Pharma GmbH, Frankfurt, Germany. All authors drafted and reviewed successive versions of the manuscript and had final control over the content. Lundbeck and Otsuka did not review or provide comments on the manuscript content. Medical writing and editorial support, including styling and editing for journal submission and performing the literature search, was provided by Dr. Carl GmbH, Stuttgart, Germany and was financially supported by Lundbeck and Otsuka.
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Abstract

Introduction There are many possible treatment goals for patients with schizophrenia. Two major perspectives on treatment goals are the patient’s and the physician’s perspective. Patient-centered treatment mandates that an individual patient’s treatment goals are taken into account when treatment is planned. In this narrative review, we address the commonalities and differences of the patient’s and physician’s perspectives.

Methods We searched for literature on treatment goals for patients with schizophrenia from the last 10 years.

Results Fifty-two relevant records were identified, 4 of which directly compare patient’s and physician’s perspectives. Two further articles used the same set of goals to ask patients or physicians for their assessment.

Discussion Agreement between patients and physicians regarding valuation of treatment goals was high. However, physicians tended to put more emphasis on the classical “textbook” goals of symptom resolution and functioning, while patients stressed well-being and quality of life more. Results on treatment goals from patients are difficult to generalize, since recruiting representative patient samples is challenging and patient subgroups may have differing priorities.

Key words

schizophrenia - treatment goal - adherence - patient perspective - physician perspective

Supporting Information



Publication History

Received: 26 August 2020

Accepted: 21 October 2020

Article published online:
08 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261-276
    CrossrefPubMedGoogle Scholar
  • 2 Nicotra E, Casu G, Piras S. et al. On the use of the Positive and Negative Syndrome Scale in randomized clinical trials. Schizophr Res 2015; 165: 181-187
    CrossrefPubMedGoogle Scholar
  • 3 Obermeier M, Mayr A, Schennach-Wolff R. et al. Should the PANSS be rescaled?. Schizophr Bull 2010; 36: 455-460
    CrossrefPubMedGoogle Scholar
  • 4 Marder SR, Davis JM, Chouinard G. The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: Combined results of the North American trials. J Clin Psychiatry 1997; 58: 538-546
    CrossrefPubMedGoogle Scholar
  • 5 Hopkins SC, Ogirala A, Loebel A. et al. Transformed PANSS factors intended to reduce pseudospecificity among symptom domains and enhance understanding of symptom change in antipsychotic-treated patients with schizophrenia. Schizophr Bull 2018; 44: 593-602
    CrossrefPubMedGoogle Scholar
  • 6 Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet 2016; 388: 86-97
    CrossrefPubMedGoogle Scholar
  • 7 Wolfers T, Doan NT, Kaufmann T. et al. Mapping the heterogeneous phenotype of schizophrenia and bipolar disorder using normative models. JAMA Psychiatry 2018; 75: 1146-1155
    CrossrefPubMedGoogle Scholar
  • 8 Seidman LJ, Mirsky AF. Evolving notions of schizophrenia as a developmental neurocognitive disorder. J Int Neuropsychol Soc 2017; 23: 881-892
    CrossrefPubMedGoogle Scholar
  • 9 Harvey PD, Green MF, Bowie C. et al. The dimensions of clinical and cognitive change in schizophrenia: evidence for independence of improvements. Psychopharmacology 2006; 187: 356-363
    CrossrefPubMedGoogle Scholar
  • 10 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
    CrossrefPubMedGoogle Scholar
  • 11 Bullinger M, Kuhn J, Leopold K. et al. Quality of life as a target criterion in schizophrenia therapy. Fortschr Neurol Psychiatr 2018; 87(06): 348-356
    PubMedGoogle Scholar
  • 12 Vita A, Barlati S. Recovery from schizophrenia: is it possible?. Curr Opin Psychiatry 2018; 31: 246-255
    CrossrefPubMedGoogle Scholar
  • 13 Upthegrove R, Marwaha S, Birchwood M. Depression and schizophrenia: Cause, consequence, or trans-diagnostic issue?. Schizophr Bull 2017; 43: 240-244
    PubMedGoogle Scholar
  • 14 Khokhar JY, Dwiel LL, Henricks AM. et al. The link between schizophrenia and substance use disorder: a unifying hypothesis. Schizophr Res 2018; 194: 78-85
    CrossrefPubMedGoogle Scholar
  • 15 Šimunović Filipčić I, Filipčić I. Schizophrenia and physical comorbidity. Psychiatr Danub 2018; 30: 152-157
    PubMedGoogle Scholar
  • 16 Kane JM, Correll CU. Past and present progress in the pharmacologic treatment of schizophrenia. J Clin Psychiatry 2010; 71: 1115-1124
    CrossrefPubMedGoogle Scholar
  • 17 Bjørkedal STB, Torsting AMB, Møller T. Rewarding yet demanding: client perspectives on enabling occupations during early stages of recovery from schizophrenia. Scand J Occup Ther 2016; 23: 97-106
    CrossrefPubMedGoogle Scholar
  • 18 Allott KA, Killackey E, Sun P. et al. Improving vocational outcomes in first-episode psychosis by addressing cognitive impairments using Cognitive Adaptation Training. Work 2017; 56: 581-589
    CrossrefPubMedGoogle Scholar
  • 19 Potkin SG, Bera R, Eramo A. et al. A pilot study of cultural/racial differences in patient perspectives on long-acting injectable antipsychotics for the treatment of schizophrenia. Clin Schizophr Relat Psychoses 2017; 10: 211-221
    CrossrefPubMedGoogle Scholar
  • 20 Bridges JF, Beusterien K, Heres S. et al. Quantifying the treatment goals of people recently diagnosed with schizophrenia using best-worst scaling. Patient Prefer Adherence 2018; 12: 63-70
    CrossrefPubMedGoogle Scholar
  • 21 Zipursky RB, Cunningham CE, Stewart B. et al. Characterizing outcome preferences in patients with psychotic disorders: a discrete choice conjoint experiment. Schizophr Res 2017; 185: 107-113
    CrossrefPubMedGoogle Scholar
  • 22 Byrne R, Morrison AP. Service users’ priorities and preferences for treatment of psychosis: a user-led Delphi study. Psychiatr Serv 2014; 65: 1167-1169
    CrossrefPubMedGoogle Scholar
  • 23 Berk M, Berk L, Udina M. et al. Palliative models of care for later stages of mental disorder: maximizing recovery, maintaining hope, and building morale. Aust N Z J Psychiatry 2012; 46: 92-99
    CrossrefPubMedGoogle Scholar
  • 24 Pietrini F, Albert U, Ballerini A. et al. The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia. Neuropsychiatr Dis Treat 2019; 15: 1045-1060
    CrossrefPubMedGoogle Scholar
  • 25 Bridges JFP, Slawik L, Schmeding A. et al. A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia. Health Expect 2013; 16: 164-176
    CrossrefPubMedGoogle Scholar
  • 26 Kuhnigk O, Slawik L, Meyer J. et al. Valuation and attainment of treatment goals in schizophrenia: perspectives of patients, relatives, physicians, and payers. J Psychiatr Pract 2012; 18: 321-328
    CrossrefPubMedGoogle Scholar
  • 27 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: 2403-2410
    CrossrefPubMedGoogle Scholar
  • 28 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: 424-435
    CrossrefPubMedGoogle Scholar
  • 29 Levitan B, Markowitz M, Mohamed AF. et al. Patients’ preferences related to benefits, risks, and formulations of schizophrenia treatment. Psychiatr Serv 2015; 66: 719-726
    CrossrefPubMedGoogle Scholar
  • 30 Markowitz MA, Levitan BS, Mohamed AF. et al. Psychiatrists’ judgments about antipsychotic benefit and risk outcomes and formulation in schizophrenia treatment. Psychiatr Serv 2014; 65: 1133-1139
    CrossrefPubMedGoogle Scholar
  • 31 Phelan M, Slade M, Thornicroft G. et al. The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 1995; 167: 589-595
    CrossrefPubMedGoogle Scholar
  • 32 Balaji M, Chatterjee S, Brennan B. et al. Outcomes that matter: a qualitative study with persons with schizophrenia and their primary caregivers in India. Asian J Psychiatr 2012; 5: 258-265
    CrossrefPubMedGoogle Scholar
  • 33 Benítez I, Pino O, Padilla JL. et al. Integrating scale data and patient perspectives for assessing functionality in schizophrenia. Community Ment Health J 2016; 52: 914-920
    CrossrefPubMedGoogle Scholar
  • 34 Glick ID, Stekoll AH, Hays S. The role of the family and improvement in treatment maintenance, adherence, and outcome for schizophrenia. J Clin Psychopharmacol 2011; 31: 82-85
    CrossrefPubMedGoogle Scholar
  • 35 Eiring Ø, Landmark BF, Aas E. et al. What matters to patients? A systematic review of preferences for medication-associated outcomes in mental disorders. BMJ Open 2015; 5: e007848
    CrossrefPubMedGoogle Scholar
  • 36 Piotrowski P, Gondek TM, Królicka-Deręgowska A. et al. Causes of mortality in schizophrenia: an updated review of European studies. Psychiatr Danub 2017; 29: 108-120
    CrossrefPubMedGoogle Scholar
  • 37 Firth J, Rosenbaum S, Stubbs B. et al. Preferences and motivations for exercise in early psychosis. Acta Psychiatr Scand 2016; 134: 83-84
    CrossrefPubMedGoogle Scholar