How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication?

Abstract

Background: Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups.

Aims: This study examines how APs are prescribed, from the perspective of recipients.

Methods: 757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey.

Results: Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life.

Conclusions: Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.

Keywords: Antipsychotics; adverse effects; informed consent; psychosis; therapeutic relationship.