Management of schizophrenia patients in acute setting – a multinational survey of prescription patterns in five European countries

Objective: To analyse the use of antipsychotics for first-episode of psychosis (FEP) and relapsed schizophrenia, and the impact of predominant symptoms on decision making. Methods: A survey among 150 European psychiatrists was conducted using computer-assisted web interviewing to assess preferred medications, switching, dose adjustments, and maintenance therapy in acute FEP and relapse settings. Results: Negative or affective symptoms were reported as prevalent in 55% of FEP and 59% of relapsed schizophrenia cases, indicating significant unmet treatment needs. Olanzapine and risperidone were the most commonly prescribed antipsychotics for FEP, with treatment choices influenced by symptom profiles. Long-acting injectables (LAIs) were prescribed to 28% of FEP patients, with notable variation across countries (15–43%; p < 0.05). During hospitalisation, 41% of patients required therapy adjustments, while discharge decisions were driven by drug tolerability and symptom severity. For relapsed patients, non-adherence was identified as the primary cause of relapse (71%), and olanzapine, risperidone, and aripiprazole were the most prescribed treatments. Post-discharge adjustments for relapsed patients focused on adherence and long-term treatment goals. Conclusion: Despite the prevalence of negative or affective symptoms in FEP and relapsed patients, traditional antipsychotics remain the most prescribed treatments. Non-adherence and variability in LAI usage highlight the need for improved symptom-specific approaches and standardised LAI protocols.