Oral versus long-acting injectable antipsychotics in schizophrenia spectrum disorders: A systematic review of patients' subjective experiences

Abstract

Schizophrenia spectrum disorders significantly impact daily functioning, with antipsychotic medications regarded as the gold standard treatment. However, their efficacy is often limited by side effects and adherence rates. Understanding patient perspectives and subjective experiences, particularly regarding oral versus long-acting injectable (LAI) antipsychotics, is crucial for improving medication outcomes and patient-tailored treatments. A systematic review of qualitative studies was conducted following the ENTREQ guidelines. Data were extracted from PubMed, Scopus, and PsycInfo, with thematic synthesis used to identify key themes in patient-reported experiences. Thirty-nine studies (1.477 patients) were included and analyzed, revealing three core themes: (1) perception and experience of medication, (2) social dynamics and influence, and (3) trust and communication with healthcare providers. Side effects and lack of information were often mentioned by patients. While LAI antipsychotics were linked to symptom stability and functional improvements, many patients lacked adequate information about their effects, contributing to adherence difficulties. Stigma and negative beliefs were common across both oral and LAI formulations, thus determining significant barriers to medication adherence. This review emphasizes that patients' experiences with antipsychotic medications are shaped by three key factors: the environment, the therapeutic relationship, and the drug itself. Two critical areas warrant particular attention: psychoeducation and stigma. Bridging psychoeducational gaps and addressing stigma could significantly enhance treatment adherence and outcomes. Additionally, greater emphasis on providing comprehensive and accurate information about antipsychotic treatment options is essential to support patient-centred care and informed decision-making.