Antipsychotics and their Impact on Biopsychosocial Outcomes in Schizophrenia: A Randomized Comparative Study

Background: Functional recovery and social integration are central goals in schizophrenia treatment, yet are seldom evaluated alongside symptom remission. Traditional trials prioritize psychosis reduction, overlooking quality-of-life (QoL), social functioning, and sexual health domains critical to personal and social recovery. Objective: To compare the impact of two antipsychotics on biopsychosocial outcomes i.e., QoL, socio-occupational functioning, and sexual functioning and to assess symptom severity correlations with these biopsychosocial outcomes. Methods: In this randomized study, 65 adults with schizophrenia received either cariprazine ( n = 33) or risperidone ( n = 32) for 10 weeks. Primary endpoints were change in Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) scores. The secondary endpoints comprised World Health Organization Quality of Life-Brief scale (WHOQOL-BREF), Social Occupational Functioning Scale (SOFS), and Arizona Sexual Experience Scale (ASEX) scores. Pearson correlations (i.e. ‘r’) assessed associations between symptoms and biopsychosocial outcomes. Results: At 10 weeks, both groups achieved comparable PANSS-total scores ( P = 0.931). Cariprazine led to significantly lower negative symptoms ( P < 0.001) and higher social relationship domain score, i.e., WHOQOL-D3 ( P = 0.001). BPRS change favored risperidone ( P < 0.001). SOFS and other WHOQOL domains were comparable. ASEX score trends favored cariprazine. Symptom reductions correlated strongly with WHOQOL-general and psychological health domain, i.e., WHOQOL-D2 ( r ≈ −0.9, P < 0.001; for both), moderately with WHOQOL-D3 ( r ≈ −0.5 to − 0.8, P < 0.001) and ASEX ( r ≈ 0.35), and weakly with SOFS ( r ≈ 0.19). Conclusion: While both antipsychotics yielded comparable symptom control, cariprazine demonstrated superior benefits in negative symptoms and social QoL. Integrating psycho-social and biological measures in therapeutic evaluation emphasizes the importance of functional recovery in schizophrenia care.