APA Joins 'Choosing Wisely' Project With Cautions on Antipsychotic Prescribing

Friday marked the inauguration of APA’s public involvement in the Choosing Wisely campaign—an initiative sponsored by the American Board of Internal Medicine Foundation that encourages physicians, patients, and other health care stakeholders to engage in a dialogue concerning unnecessary medical procedures that, in some instances, could result in harm. As part of the Choosing Wisely campaign, APA has released a list of cautionary principles that should be considered when prescribing antipsychotic medications, noting that they are sometimes prescribed inappropriately.

“Antipsychotic medications have tremendous benefits and improve the quality of life for many people with serious mental illness; however, they carry risks including potentially harmful side effects. Unnecessary use or overuse of antipsychotics can contribute to chronic health problems, such as metabolic, neuromuscular, or cardiovascular problems, in people with serious mental illness,” said Joel Yager, M.D., chair of the APA Council on Quality Care (COQC). “Because of these risks, APA has recommended that antipsychotics should not be used routinely, and should never be used without considerable thought...”

The cautionary principles, developed by the COQC and unanimously approved by the APA Board of Trustees Executive Committee are as follows:

• Do not prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.
• Do not routinely prescribe two or more antipsychotic medications concurrently.
• Do not use antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia.
• Do not routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.
• Do not routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.

To view the complete APA list and additional information, see http://www.psychiatry.org/choosingwisely. And for information on prescription practices for antipsychotic  medications, see the Psychiatric News articles, “Caution Urged for Clinicians Who Prescribe Opioids” and "Prescribing for Mentally Ill Children Generally in Line With Best Practices."

(Image: choosingwisely.org)