The Personal Antipsychotic Choice IndexIntroducing a Tool for Shared Decision-Making in Selecting Antipsychotic Medication
received 13 December 2016
revised 15 May 2017
accepted 13 July 2017
15 August 2017 (eFirst)
Introduction We present an online decision aid to involve patients with a psychotic disorder in shared decision-making concerning the selection of antipsychotic medication.
Method Patients selected effectiveness and adverse effects criteria from the Subject’s Response to Antipsychotics-34 questionnaire. Numerical data from meta-analyses, clinical trial data, receptor affinities and expert opinions were used to rank antipsychotics on each criterion. When using the the tool, patients indicate on a 5-point Likert scale how they value each (adverse) effect. The Likert scale values are combined in an algorithm with the rank orders of antipsychotics to create a personalized ranking.
Results Criteria used were: effectiveness concerning psychotic, depressive and cognitive symptoms, weight gain, sexual dysfunction, drowsiness, hypersomnia, extrapyramidal symptoms, anticholinergic adverse effects, hypersalivation, nausea, dizziness, energy loss, blunted affect/less need for companionship. High-level evidence was available for ranking weight gain, sexual dysfunction, menstrual disorders, extrapyramidal symptoms and effectiveness on psychotic symptoms. We used lower level evidence ranking the remaining criteria.
Discussion A transparent procedure has resulted in an updateable tool to produce individual ranking of antipsychotics based on the patients’ input.