| dc.description.abstract | Introduction: In 2016, an online decision aid was developed to involve patients with a psychotic disorder in shared decision-making regarding the choice for antipsychotic medication. The tool combines the needs of the patient, indicated by the patient on a 5 -point Likert scale, with evidence-based ranking of risks or probabilities on a set of criteria. Criteria, based on patient panels, were: effectiveness concerning psychotic, depressive and cognitive symptoms, weight gain, sexual dysfunction, sedation, hypersomnia, extrapyramidal symptoms, anticholinergic adverse effects, hypersalivation, nausea, dizziness, fatigue and blunted affect/less need for companionship. The tool produces a personalised ranking of antipsychotic agents that matches the patients’ preferences. The aim of this paper is to update the tool by adding caripiprazine and brexpiprazol and refining the ranking of amisulpride.
Method: A systematic search was performed in PubMed, EMBASE and Cochrane. Effect sizes from meta-analyses, receptor affinities and summaries of product characteristics were used to rank the antipsychotics per criterion. Updates were applied to the originally included agents where necessary. The rankings were tested in an expert panel of clinicians to translate the evidence-based data into clinical use.
Results: High-level evidence was available for ranking weight gain, sedation, sexual dysfunction, menstrual disorders, extrapyramidal symptoms, anticholinergic side effects and effectiveness for psychotic and depressive symptoms for all antipsychotic agents, including the newer ones. There was lower-level evidence ranking the remaining criteria.
Discussion & conclusion: A comprehensive update was devised in a systematic approach, resulting in an applicable tool for shared-decision making for current prescription tendencies. | |
