On September 20, 2013, APA released a list of specific uses of antipsychotic medications that are common, but potentially unnecessary and sometimes harmful, as part of Choosing Wisely®, an initiative of the ABIM Foundation. The list identifies five targeted, evidence-based recommendations that can prompt conversations between patients and physicians about what care is really necessary.
APA’s list includes the following five recommendations:
- Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.
- Don’t routinely prescribe two or more antipsychotic medications concurrently.
- Don’t prescribe antipsychotic medications as a first-line intervention 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.
· More than 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the Choosing Wisely effort promoting conversations about appropriate care. Over the next year, more than 30 other specialty society partners will release Choosing Wisely lists.
More information:
Complete APA List of Recommendations and Background
Additional information on medication use in children and adolescents
September 20, 2013 Press Release
Choosing Wisely Campaign Website
James Scully, MD, APA Medical Director and CEO,
talks about APA participation in Choosing Wisely®
How this list was created
The APA created a work group of members from the Council on Research and Quality Care* to identify, refine and ascertain the degree of consensus for five proposed items. Two rounds of surveys were used to arrive at the final list: the first round narrowed the list from more than 20 potential items by inquiring about the extent of overuse, the impact on patients’ health, the associated costs of care and the level of evidence for each treatment or procedure; and the second gauged membership support for the top five and asked for suggested revisions and comments. The surveys targeted the Council on Research and Quality Care; the Council on Geriatric Psychiatry; the Council on Children, Adolescents, and Their Families; and the Assembly, which is the APA’s governing body consisting of representative psychiatrists from around the country. After the work group incorporated feedback from the two large surveys, the APA’s Board of Trustees Executive Committee reviewed and unanimously approved the final list.
*Now two separate councils: Council on Quality Care and Council on Research.