Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort

Abstract

Background: Antipsychotics are associated with a range of side-effects that can influence patients’ subjective well-being negatively resulting in poor adherence. In order to limit the negative consequences of side-effects, they should be regularly systematically assessed. The aim of this study was to systematically assess antipsychotic side-effects in an inpatient cohort using validated rating scales. Methods: Eligible individuals prescribed an antipsychotic for at least 2 weeks were invited to have their side-effects assessed systematically. Results: A total of 208 individuals were assessed systematically for antipsychotic side-effects; 71.5% ( n = 138) stated that they had not reported side-effects to their clinician prior to the assessment. The most commonly reported side-effects were daytime drowsiness (75%), dry mouth (58.2%) and weight gain (50.0%), while the most distressing side-effects reported were erectile dysfunction (35.0%), sexual dysfunction (26.3%) and amenorrhoea (26.3%). There was no evidence of an association between side-effect severity/number of side-effects reported/distress caused by those taking high dose/combination antipsychotics versus standard dose monotherapy. Conclusion: Side-effects must be regularly and systematically assessed using a validated rating scale. As distress caused by side-effects plays a major role in non-adherence, assessment should examine distress and data on distressing side-effects should be available to those choosing an antipsychotic. Given the lack of correlation between high dose/combination antipsychotics and side-effects, treatment should be tailored to the individual based on response/tolerance and dose reduction/avoidance of polypharmacy should not be recommended to minimise side-effects.

The role of lumateperone in the treatment of schizophrenia

“…Future clinical trials to detect relapse will benefit from the careful design, checking cognitive 85 and other adverse effects, 78,86,87 cautious discontinuation, and measurement of environmental influences to minimize the confounding effects of withdrawal. 88…”

“…Low to very low confidence in published articles limits the ability to assess the value of lumateperone and other antipsychotics in comprehensive reviews. 34,83,84 Future directions Future clinical trials to detect relapse will benefit from the careful design, checking cognitive 85 and other adverse effects, 78,86,87 cautious discontinuation, and measurement of environmental influences to minimize the confounding effects of withdrawal. 88 When data from multiple centers without financial interest in lumateperone for schizophrenia are available, well-conducted systematic reviews 34,83,84 can be conducted.…”

Atypical antipsychotics: Managing adverse effects

“…Then, as each patient will respond differently to atypical antipsychotics, the management of adverse effects should be carefully tailored to each patient's clinical and psychosocial situation. When assessing patients, the PMHNP should take into account not only the objective rating of symptom severity but also the level of distress caused by those adverse effects 35 . Both symptoms that pose a clinical risk to the patient and those that trigger the most discomfort and concerns should be addressed 35 .…”

“…The PMHNP should explain, in detail, how and at which frequency the patient will be monitored. As patients have been found to underreport their symptoms, 35 PMHNPs will need to encourage them to disclose any new concerns as soon as they arise so that they can be addressed promptly. Key resources explaining adverse effects may be shared (including, http://www.movementdisorders.org; http://www.dystonia-foundation.org; and http://www.talkabouttd.org).…”

Antipsychotic Polypharmacy and High-Dose Antipsychotic Regimens in the Residential Italian Forensic Psychiatric Population (REMS)

“…However, a systematic review and meta-analysis showed comparable mortality risk between patients with serious mental illness treated with antipsychotic polypharmacy vs. monotherapy ( Buhagiar et al, 2020 ). A lack of association between high dose or combination antipsychotics and side effects has been reported on a mixed-diagnosis sample of 208 inpatients ( Hynes et al, 2020 ). There is also initial evidence that antipsychotic combination therapy might prevent rehospitalization in a subset of patients with schizophrenia ( Faden et al, 2021 ).…”