The Personal Antipsychotic Choice Index

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.