Abstract
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.
Key words
antipsychotics - psychosis - shared decision making - adherence - web tool
