The American Psychiatric Association has released a set of recommendations for the use of antipsychotic medications, the latest in the "Choosing Wisely" series from medical organizations working in collaboration with the American Board of Internal Medicine Foundation.
The list, designed with input from the ABIM and several workgroups within the APA, is not intended to revise clinical procedures on treating patients with psychotic disorders but instead to educate patients and physicians about unnecessary treatment and spark conversations "between patients and physicians about what care is really necessary."
"We think patients really need to be part of the partnership with the physician about their own treatments. It’s a true partnership when it works well," Dr. James H. Scully Jr., medical director and CEO of the APA, said in a video released with the guidelines.
The recommendations include:
• Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and ongoing monitoring, as metabolic, neuromuscular, and cardiovascular side effects are relatively common with antipsychotics.
• Avoid prescribing two or more antipsychotic medications at the same time, since there is little evidence to show the efficacy of such treatments in most patients. Only in cases of three separate failed monotherapies should psychiatrists look to multiple concurrent medications.
• Don’t prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia, as the risks tend to outweigh the benefits and could cause troubling side effects, such as cerebrovascular problems, increased mortality rates, parkinsonism, or extrapyramidal signs. Practitioners should only look into antipsychotics when other therapies are ineffective or the patient’s dementia is a risk to themselves or others.
• Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults; there is "inadequate evidence" to prove the efficacy of such therapies.
• Avoid the routine prescribing of antipsychotics as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.