Last week in my blog post about shared genetics which were found to be linked to five mental illnesses, I went off on a tangent (I know, very uncharacteristic of me) about the prevalence of anti-psychotic medications prescribed for “off label” purposes. Well, thanks to our friends at the American Psychiatric Association (APA), my rant has been validated. They must be big fans.
Yesterday, the APA released a list of SPECIFIC uses for the very antipsychotic medications I was barking about due to their the increasingly growing number of prescriptions and hence individual s taking these all too common antipsychotic medications that are now acknowledged by the APA as not only potentially unnecessary, but sometimes quite harmful to the patient.
Along with the list of these medications and what should be their very specific uses, the APA included some very important recommendations about psychiatric / mental healthcare practices which include engaging their patients in conversations about their care. Additionally, in their release, the APA doesn’t just list a quick reference for physicians, but some very valuable information for physicians and patients alike regarding their having important conversations about what the treatment options are and how through these discussions, the patient becomes an active participant in their own treatment planning. APA president Jeffrey Lieberman, MD, as part of this release, stated, “”As clinicians, we know we can improve the care we deliver by engaging our patients in conversation about their care.”
As a mental health clinician, I applaud these recommendations that sound like common sense, but are not always included as part of many physicians common practices although are considered “best practices.” Conversely, there are many physicians who have such conversations with their patients and involve them in their treatment planning. By many, I’m speaking predominately of a limited number of Psychiatrists who are mostly located in the Greater Tri-State area and parts of New England.
The APA’s list is part of an initiative from the American Board of Internal Medicine (ABIM) Foundation called “Choosing Wisely.” This initiative has brought together leading specialty societies to develop 30 new evidence-based lists of tests and procedures that may be overused in their specific field.
In an accompanying statement, the ABIM’s CEO & President, Richard Baron, MD sheds some light on the creation of the “Choosing Wisely” campaign. “When the campaign was launched in 2012, we were at the threshold of a national dialogue on waste and overuse in our healthcare system. Thanks to the leadership of physician groups and consumer partners, the campaign has inspired conversations about what care is truly necessary in doctors’ offices, communities, hospitals, and health systems across the country.”
The APA’s list includes 5 recommendations:
- Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring
- Don’t routinely prescribe 2 or more antipsychotic medications concurrently
- Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia
- Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults
- Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders
Of course, there is no strict directives, as Dr. Lieberman elaborated that, “the purpose of the list is not to preclude the use of antipsychotic medications for these indications and populations but to suggest that other treatment options should be considered first, and patients should be engaged in discussion of the rationale for use and the potential benefits and risks.”
Dr. Baron gave credit where it was due (and appropriately plugged his own initiative) by stating, “The American Psychiatric Association has shown tremendous leadership by releasing its list of common uses of medication that aren’t always necessary, The content of this list and all of the others developed through the “Choosing Wisely” effort are helping physicians and patients across the country engage in conversations about what care they need and what we can do to reduce waste and overuse in our healthcare system and improve overall health.”
Since its creation in 2012, over 80 national and state medical specialty societies, regional health collaboratives, and consumer partners have joined this effort in promoting conversations about appropriate care. During the next year, more than 30 other specialty society partners will release their own “Choosing Wisely” lists.
Some of the big name organizations already already participating in the campaign include:
- American College of Surgeons
- American Academy of Orthopaedic Surgeons
- Society of General Internal Medicine
- American Academy of Family Physicians
- American College of Emergency Physicians
- American Association of Clinical Endocrinology/The Endocrine Society
- American Society of Hematology
- American Geriatrics Society
- American Academy of Allergy, Asthma, and Immunology
In all seriousness, although it’s nice to have my opinions backed by such prestige organizations, the real news is not only the list itself and the implications it will hopefully have on patients’ health as the use of anti-psychotics will be reconsidered, but the unification of these organizations in getting behind the need for improved communication between doctor and patient when it comes to treatment planning and making the most well informed decisions as possible.
To view the complete APA list and additional details about the recommendations and evidence supporting them, visit www.psychiatry.org/choosingwisely. Also, see more on the Choosing Wisely national effort.