Thursday, July 7, 2016

RAISE Study Suggests Shared Decision Making May Influence Antipsychotic Prescribing Patterns

Most individuals experiencing a first episode of psychosis who participated in the RAISE (Recovery After Initial Schizophrenia Episode) Connection Program were prescribed first-line antipsychotic agents within recommended dosage ranges, according to a report in Psychiatric Services in Advance. The findings suggest the benefits of training and clinical supervision sessions for psychiatrists led by experts in these approaches.

The RAISE CP Implementation and Evaluation Study is part of a landmark National Institute of Mental Health study looking at treatments for first-episode psychosis. For this report, researchers developed the RAISE CP Schedule of Recommended First and Second Line Antipsychotic Medications to guide the selection of antipsychotic treatment within a shared decision-making framework. They then conducted a longitudinal, observational study to evaluate the adherence of psychiatrists to the schedule.

Sixty-five individuals with a first episode of psychosis were enrolled in the two RAISE CP clinics. Two psychiatrists received training and ongoing consultation with experts in the psychopharmacological management of psychosis, treatment of adolescents with psychotic disorders, and shared decision making. The authors then analyzed the extent to which patterns of antipsychotic prescribing and side-effect monitoring were consistent with the Antipsychotic Schedule.

Ninety-two percent of participants were prescribed an antipsychotic medication and received the medication on an average of 76% of the days they were in treatment—a percentage the authors suggested may be due to the use of a shared decision-making approach, in which participants were able to continue to receive services and meet with the psychiatrist, even if they did not receive antipsychotic treatment. 

“These ongoing psychiatrist visits provided the opportunity for close monitoring of symptoms and a restart of antipsychotic medication if symptoms worsened, and they also facilitated the use of nonpharmacological approaches to symptom management, all of which were jointly agreed upon by the treatment team and the participant,” the authors wrote.

Although all study participants prescribed an antipsychotic received at least one medication side-effect evaluation (over the course of the study, 92% of participants had at least one weight recorded, 72% had at least one blood glucose measure recorded, and 62% had at least one lipid profile recorded), the authors noted that these measurements occurred less frequently than is recommended. “This demonstrates that even specialized services may have difficulty attaining recommended antipsychotic side effect–monitoring goals,” they wrote.

The authors concluded, “The implementation of shared decision making was enhanced by training and clinical supervision sessions for psychiatrists led by experts in these approaches. … The extent to which these components of the approach to the pharmacological treatment of this population can be feasibly disseminated and implemented in regular clinical practice requires additional investigation.”

For more about the RAISE study, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis.”

(Image: iStock/sturti)


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