Prescribing Conventional Antipsychotics in the Era of Novel Antipsychotics: Informed Consent Issues

Abstract

The goal of this study was to ascertain why patients are maintained on conventional antipsychotics and whether the risks/benefits and alternative treatments with novel antipsychotics are discussed with these patients. We reviewed the charts of 117 outpatients maintained on conventional antipsychotics at three New York hospitals: Hutchings Psychiatric Center (HPC), Syracuse Veterans Affairs Medical Center (SVA), and the Continuing Day Treatment Program (CDT). The major reasons for maintaining patients on conventional antipsychotics were good response (50%), patient choice (45%), and physician choice (36%). Despite the high incidence of tardive dyskinesia at all three hospitals (range: 12%-50%), physicians often did not discuss the risks/benefits of continuing conventional antipsychotics with the patients. The treating psychiatrist discussed alternative treatments with 37% of patients at SVA, 58% at HPC, and 68% at CDT (P = 0.066, df = 2, Pearson chi(2) test). For patients who are receiving any antipsychotic therapy, discussions about the risks/benefits of treatments are integral for optimal treatment and medicolegal purposes.

Partial compliance with antipsychotics and its impact on patient outcomes

“…This association between obesity and noncompliance was observed for both men and women. Evidence indicates that the greatest increases in weight occur in patients taking clozapine or olanzapine [60,61], whereas weight gain is less of a concern with risperidone, ziprasidone, and aripiprazole [62,65,66,67,68]. Studies directly assessing the association between medication-induced weight gain and therapeutic non-compliance that account for other confounders are needed for optimal use of antipsychotic agents to be achieved and threats to patients' health and longevity are to be averted [14].…”

“…The most common reasons patients remain on a conventional antipsychotic are good response, patient choice, and physician choice [83]. Maintenance on lower doses that can adequately provide symptom control has been proposed as a means of minimizing adverse events and improving adherence [84].…”

“…Advantages of conventional depot preparations over oral antipsychotics include lower relapse rates with depot preparations, particularly in longer-term trials [83,89,90,91]. Furthermore, these preparations facilitate more contact time between the patient and treatment team while freeing them from taking daily pills [92].…”