As part of its Choosing Wisely Canada campaign, a joint working group of the Canadian Psychiatric Association, the Canadian Academy of Child and Adolescent Psychiatry (CACAP), and the Canadian Academy of Geriatric Psychiatry has issued a 13-point list of recommendations to physicians for reducing the inappropriate use of psychotropic medications.
“We know there has been a disproportionate use of second-generation antipsychotics during the last 10 years, but the incidence of child youth mental health has not increased,” University of Calgary psychiatrist and president of CACAP Chris Wilkes told Medscape Medical News. “But as a community, we are medicalizing more of our kids and do not always use age-appropriate supports, like ensuring adequate sleep, nutrition, and exercise. Also, we have an epidemic of obesity, and some of these meds carry a significant risk of obesity.”
“Using antipsychotics to treat insomnia is a little like using a sledgehammer to drive in a thumbtack, especially in light of a variety of effective treatment options, both nonmedication and medication, with far fewer side effects,” a physician not affiliated with the CWC program commented to Medscape.
Each recommendation from the working group comes with a one-paragraph summary of research evidence. The recommendations include:
- Do not routinely use antipsychotics to treat primary insomnia in any age group.
- Do not use SSRIs as the first-line intervention for mild to moderately depressed teens.
- Do not use psychostimulants as a first-line intervention in preschool children with ADHD.
- Do not routinely prescribe high-dose or combination antipsychotic treatment strategies in the treatment of schizophrenia.
- Do not use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
Psychiatry: Thirteen Things Physicians and Patients Should Question (Choosing Wisely Canada, June 2, 2015)
Antipsychotics as First-Line Insomnia Treatment a No-No (Medscape Medical News, June 8, 2015)