Prescribing conventional antipsychotics in the era of novel antipsychotics: informed consent issues.
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.
Masand
Prakash S
PS
Duke University Medical Center, Department of Psychiatry, Durham, North Carolina, USA. masan001@mc.duke.edu
Schwartz
Thomas L
TL
Wang
Xiaohong
X
Kuhles
Daniel J
DJ
Gupta
Sanjay
S
Agharkar
Bhushan
B
Manjooran
Jacob
J
Hameed
M Ahmad
MA
Hardoby
William
W
Virk
Subhdeep
S
Frank
Bradford
B
D017109:Akathisia, Drug-Induced / Q000209:etiology*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007258:Informed Consent; D016347:Medical Records Systems, Computerized; D009518:New York; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D018570:Risk Assessment
D014150:Antipsychotic Agents