Treatment Goals in Schizophrenia: Subgroup Analysis of a Survey in Matched Physician-Patient Pairs

Gerhard Gründer,1,2 Philipp Bauknecht,3 Stefanie Schell,4 Karolina Leopold,5,6 Michael Paulzen,7– 9 Stefan Leucht10,11 1Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; 2German Center for Mental Health, Partner Site Mannheim/Heidelberg/Ulm, Mannheim, Germany; 3Dr. Carl GmbH, Stuttgart, Germany; 4Klinikum Blankenburg, Harzklinikum Dorothea Christiane Erxleben, Academic teaching hospital of Otto von Guericke University Magdeburg, Blankenburg, Germany; 5Department of Psychiatry and Psychotherapy, Vivantes Klinikum Am Urban, Berlin, Germany; 6Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany; 7Alexianer Center for Mental Health, Aachen, Germany; 8Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; 9JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany; 10Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technische Universität München, Munich, Germany; 11German Center for Mental Health, Partner Site Munich/Augsburg, Munich, GermanyCorrespondence: Gerhard Gründer, Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Abteilung Molekulares Neuroimaging, Zentralinstitut für Seelische Gesundheit (ZI), J 5, Mannheim, 68159, Germany, Tel +49 621 1703-1900, Fax +49 621 1703-80-1900, Email [email protected]: Schizophrenia is a complex disease that affects many aspects of the lives of people living with the disease. Therefore, many different treatment goals are possible. Treatment goals in schizophrenia may differ between patients and physicians. Here, we set out to explore whether there are subgroups in which differences between patient goals and treating psychiatrist’s goals are especially marked, which would highlight the need for better dialogue between psychiatrists and patients belonging to these subgroups.Methods: In a survey, patients with schizophrenia and their treating psychiatrists were asked about treatment goals. To this end, questionnaires were sent to psychiatrists all over Germany. Psychiatrists were asked to rank and rate a prespecified set of treatment goals for up to 3 specific patients. Furthermore, these same patients were asked to rank and rate the goals for themselves. Responses are analyzed in subgroups of patients stratified by sex, disease duration (≤ 5 years/> 5 years) and treatment by psychiatrists in private practice vs hospital-based psychiatrists.Results: We obtained answers from 28 physicians, 17 of which worked exclusively in private practice, and 80 patients. Of the patients, 13 had a disease duration ≤ 5 years, 31 were female, and 52 were treated by psychiatrists in private practice. Concordance between patients and their physicians was fairly high, and none of the subgroups (shorter/longer disease duration, male/female sex, treatment by psychiatrists in private practice vs hospital-based psychiatrists) stood out as markedly different from the total cohort. The most marked differences between patients and physicians regarded avoidance of different possible medication side effects.Conclusion: We did not find any major differences between the subgroups in this study. Overall, there was a high concordance of rankings and ratings of treatment goals. Patients tended to focus on different side effects than physicians, indicating that these should be discussed thoroughly when making a treatment decision.Keywords: schizophrenia, treatment goals, patient-centered, survey