Antipsychotic Medication Preferences: A Large-Scale Survey

Abstract

Introduction

Antipsychotic medications are essential in treating psychotic disorders; yet, large-scale studies examining individual patient preferences are lacking. The current study explores variations in patient perspectives on antipsychotic treatment.

Methods

Data were derived from the online decision aid Personal Antipsychotic Choice Index in the Netherlands. This freely available 30-item questionnaire assessed preferred treatment effectiveness, side effects, administration routes, and demographics, psychosis history, and antipsychotic use. Non-parametric tests compared responses by sex, age, and D₂-receptor affinity of used medication.

Results

Of 23,733 completed questionnaires, 8,743 individuals with at least one psychotic episode were included (mean age: 38.8 and male: 58.8%). Psychotic symptom efficacy was rated most important (75.4%) followed by cognitive (61.9%) and depressive (49.5%) symptom efficacy (both p<0.001). Women rated psychotic and depressive symptom efficacy more important than men (p=0.003 and p<0.001), while adolescents prioritized cognitive symptom efficacy over adults (p=0.004). Extrapyramidal symptoms (73.2%) and weight gain (68.0%) were least acceptable side effects, particularly among women (both p<0.001). Men found sexual dysfunction less tolerable than women (p<0.001). Daily tablets were considered most acceptable (91.0%), followed by weekly tablets (40.1%), injectables (32.7%), and drops (27.9%). Patients using low D₂-affinity agents were more willing to accept dizziness (p=0.002) and hypersalivation (p<0.001) than high-affinity users, who in turn accepted sexual dysfunction and menstrual problems more often (both p<0.001).

Discussion

Patient preferences regarding antipsychotic medication vary widely. Incorporating these perspectives through shared decision-making may improve trust and adherence.

Keywords

Psychosis - antipsychotic drugs - survey - preferences

Publication History

Received: 16 June 2025

Accepted after revision: 08 January 2026

Article published online:
19 February 2026

• References

• 1 Kuipers E, Yesufu-Udechuku A, Taylor C. et al. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ 2014; 348: g1173
• 2 World Health Organization. Adherence to long-term therapies : evidence for action. WHO; 2003
• 3 Semahegn A, Torpey K, Manu A. et al. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Syst Rev 2020; 9: 17
• 4 Lambert M, Conus P, Cotton S. et al. Prevalence, predictors, and consequences of long-term refusal of antipsychotic treatment in first-episode psychosis. J Clin Psychopharmacol 2010; 30: 565-572
• 5 Ceraso A, Lin JJ, Schneider-Thoma J. et al. Maintenance treatment with antipsychotic drugs in schizophrenia: a cochrane systematic review and meta-analysis. Schizophr Bull 2022; 48: 738-740
• 6 Ceraso A, Lin JJ, Schneider-Thoma J. et al. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2020; 8: CD008016
• 7 Thompson A, Winsper C, Marwaha S. et al. Maintenance antipsychotic treatment versus discontinuation strategies following remission from first episode psychosis: systematic review. BJPsych Open 2018; 4: 215-225
• 8 Garcia S, Martinez-Cengotitabengoa M, Lopez-Zurbano S. et al. Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review. J Clin Psychopharmacol 2016; 36: 355-371
• 9 Kikkert MJ, Dekker J. Medication adherence decisions in patients With schizophrenia. Prim Care Companion CNS Disord 2017; 19: 17n02182
• 10 Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res 2015; 225: 14-30
• 11 Wade M, Tai S, Awenat Y. et al. A systematic review of service-user reasons for adherence and nonadherence to neuroleptic medication in psychosis. Clin Psychol Rev 2017; 51: 75-95
• 12 Aoki Y, Yaju Y, Utsumi T. et al. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11: CD007297
• 13 Dixon LB, Holoshitz Y, Nossel I. Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry 2016; 15: 13-20
• 14 Hamann J, Holzhuter F, Blakaj S. et al. Implementing shared decision-making on acute psychiatric wards: a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS). Epidemiol Psychiatr Sci 2020; 29: e137
• 15 Stovell D, Morrison AP, Panayiotou M. et al. Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis. Br J Psychiatry 2016; 209: 23-28
• 16 Calcedo-Barba A, Fructuoso A, Martinez-Raga J. et al. A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare. BMC Psychiatry 2020; 20: 339
• 17 Pons EV, Salvador-Carulla L, Calcedo-Barba A. et al. The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: a scoping review. Health Sci Rep 2020; 3: e179
• 18 van Dijk F, de Wit I, Blankers M. et al. The personal antipsychotic choice index. Pharmacopsychiatry 2018; 51: 89-99
• 19 Eiring O, 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
• 20 Grunder G, Bauknecht P, Klingberg S. et al. Treatment goals for patients with schizophrenia – a narrative review of physician and patient perspectives. Pharmacopsychiatry 2021; 54: 53-59
• 21 Barbui C, Nose M, Bindman J. et al. Sex differences in the subjective tolerability of antipsychotic drugs. J Clin Psychopharmacol 2005; 25: 521-526
• 22 Gareri P, De Fazio P, De Fazio S. et al. Adverse effects of atypical antipsychotics in the elderly: a review. Drugs Aging 2006; 23: 937-956
• 23 Kapur S, Zipursky R, Jones C. et al. Relationship between dopamine D(2) occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. Am J Psychiatry 2000; 157: 514-520
• 24 Lieberman JA. Dopamine partial agonists: a new class of antipsychotic. CNS Drugs 2004; 18: 251-267
• 25 [Anonymous]. IBM SPSS Statistics for Windows. 28.0 ed: IBM Corp.; 2021
• 26 Gannon L, Mullen E, McGorry P. et al. Prevalence and predictors of admission at the time of presentation in first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2024; 59: 1143-1151
• 27 Ma HJ, Zheng YC, Shao Y. et al. Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia. BMC Psychiatry 2022; 22: 818
• 28 Gould F, McGuire LS, Durand D. et al. Self-assessment in schizophrenia: accuracy of evaluation of cognition and everyday functioning. Neuropsychology 2015; 29: 675-682
• 29 Sanchez-Torres AM, Moreno-Izco L, Gil-Berrozpe GJ. et al. Assessment of cognitive impairment in psychosis spectrum disorders through self-reported and interview-based measures. Eur Arch Psychiatry Clin Neurosci 2022; 272: 1183-1192
• 30 Etchecopar-Etchart D, Korchia T, Loundou A. et al. Comorbid major depressive disorder in schizophrenia: a systematic review and meta-analysis. Schizophr Bull 2021; 47: 298-308
• 31 Li W, Yang Y, An FR. et al. Prevalence of comorbid depression in schizophrenia: A meta-analysis of observational studies. J Affect Disord 2020; 273: 524-531
• 32 Lappalainen M, Harkanen M, Laukkanen E. et al. Effectiveness of providing information on antipsychotic medication to patients with psychotic disorders: an integrative review. Issues Ment Health Nurs 2023; 44: 373-386
• 33 Zhu Y, Zhang C, Siafis S. et al. Prolactin levels influenced by antipsychotic drugs in schizophrenia: a systematic review and network meta-analysis. Schizophr Res 2021; 237: 20-25
• 34 Grover S, Sahoo S, Bn S. et al. Attitude and perceptions of patients towards long acting depot injections (LAIs). Asian J Psychiatr 2019; 44: 200-208
• 35 Caroli F, Raymondet P, Izard I. et al. Opinions of French patients with schizophrenia regarding injectable medication. Patient Prefer Adherence 2011; 5: 165-171
• 36 Zhu J, Chen Y, Lu W. et al. Attitudes and willingness to accept long-acting injections for patients with schizophrenia in Beijing: a cross-sectional investigation based on samples from the communities. Front Public Health 2021; 9: 770276
• 37 Carter B, Wootten J, Archie S. et al. Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis. Arch Womens Ment Health 2022; 25: 679-691
• 38 Harris RZ, Benet LZ, Schwartz JB. Gender effects in pharmacokinetics and pharmacodynamics. Drugs 1995; 50: 222-239
• 39 Seeman MV. Secondary effects of antipsychotics: women at greater risk than men. Schizophr Bull 2009; 35: 937-948
• 40 Yonkers KA, Kando JC, Cole JO. et al. Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication. Am J Psychiatry 1992; 149: 587-595
• 41 Seeman MV. Schizophrenia: women bear a disproportionate toll of antipsychotic side effects. J Am Psychiatr Nurses Assoc 2010; 16: 21-29
• 42 Divac N, Prostran M, Jakovcevski I. et al. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int 2014; 2014: 656370
• 43 Yassa R, Jeste DV. Gender differences in tardive dyskinesia: a critical review of the literature. Schizophr Bull 1992; 18: 701-715
• 44 Kinon BJ, Gilmore JA, Liu H. et al. Hyperprolactinemia in response to antipsychotic drugs: characterization across comparative clinical trials. Psychoneuroendocrinology 2003; 28 Suppl 2 69-82
• 45 Melkersson KI, Hulting AL, Rane AJ. Dose requirement and prolactin elevation of antipsychotics in male and female patients with schizophrenia or related psychoses. Br J Clin Pharmacol 2001; 51: 317-324
• 46 Olfson M, Uttaro T, Carson WH. et al. Male sexual dysfunction and quality of life in schizophrenia. J Clin Psychiatry 2005; 66: 331-338
• 47 Halbreich U, Kahn LS. Hormonal aspects of schizophrenias: an overview. Psychoneuroendocrinology 2003; 28 (Suppl. 02) 1-16
• 48 Huhn M, Nikolakopoulou A, Schneider-Thoma J. et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet 2019; 394: 939-951
• 49 Leucht S, Cipriani A, Spineli L. et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 2013; 382: 951-962
• 50 Fortier P, Mottard JP, Trudel G. et al. Study of sexuality-related characteristics in young adults with schizophrenia treated with novel neuroleptics and in a comparison group of young adults. Schizophr Bull 2003; 29: 559-572
• 51 Nagaraj AK, Pai NB, Rao S. A comparative study of sexual dysfunction involving risperidone, quetiapine, and olanzapine. Indian J Psychiatry 2009; 51: 265-271
• 52 Perez V, Canas F, Tafalla M. et al. A 12-month, open-label, comparative study of quetiapine and risperidone in the acute and long-term treatment of schizophrenia. Int Clin Psychopharmacol 2008; 23: 138-149
• 53 Bhugra D, Grenade JL, Dazzan P. Psychiatric inpatients’ satisfaction with services: A pilot study. Int J Psychiatry Clin Pract 2000; 4: 327-332
• 54 Gray R, Rofail D, Allen J. et al. A survey of patient satisfaction with and subjective experiences of treatment with antipsychotic medication. J Adv Nurs 2005; 52: 31-37
• 55 Shimizu T, Ochiai H, Asell F. et al. Bioinformatics research on inter-racial difference in drug metabolism II. Analysis on relationship between enzyme activities of CYP2D6 and CYP2C19 and their relevant genotypes. Drug Metab Pharmacokinet 2003; 18: 71-78
• 56 Xiang YT, Wang CY, Si TM. et al. Tardive dyskinesia in the treatment of schizophrenia: the findings of the research on Asian psychotropic prescription pattern (REAP) survey (2001–2009). Int J Clin Pharmacol Ther 2011; 49: 382-387
• 57 Lambert M, Conus P, Eide P. et al. Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence. Eur Psychiatry 2004; 19: 415-422