Best Practices for Matching Patients With Effective Antipsychotics and Mitigating Adverse Effects

(Part 1 of 2)

In this video, Jacob Ballon, MD, MPH, Standford University, California, discusses key best practices for matching patients with schizophrenia with an effective antipsychotic, why patients do not adhere to their medication treatment, and how to mitigate the adverse effects experienced by patients.

Dr. Ballon gives a preview to his upcoming session at the Psych Congress Elevate virtual meeting titled “A Focused Schizophrenia Update: Emerging Pharmacological Solutions for Management of Metabolic Disruptions” taking place Friday, June 11, 2021 at 2pm.

In the upcoming Part 2, Dr. Ballon discusses tips for clinicians to improve medication adherence rates among their patients.

Read the transcript:

I'm Dr. Jacob Ballon. I'm a clinical professor of psychiatry at Stanford University, California. I focus my work on schizophrenia, primarily, and I am the co-director of the INSPIRE Clinic at Stanford as well as the medical director of one of our inpatient units here at Stanford.

Q: What are the key best practices for matching patients with an effective antipsychotic?

A: When thinking about matching a patient with an effective antipsychotic, I usually start out by asking the patient about what are the kinds of things that they're hoping to gain from taking the medication.

It's important to recognize what are some of the side effects and trade-offs that people may be willing or less willing to take on. Are they more willing to take on the possibility of sedation or less willing? Are they more willing to take on the possibility of weight gain or less welling? How is it going to fit in a person's life?

From there, we can start to think about the different medications. I'm usually going to start with an atypical antipsychotic, as those are currently the standard of care to start out with.

Amongst those, we can choose around what are the ones that are both going to fit in what the type of side effects the patient is willing to endure, as well as thinking about, what sort of efficacy and what kind of picture I'm going to get from that medication.

Things that I may also be considering are, how rapid am I looking for effect? Is agitation a concern? Is there a mood component? Are people having difficulty sleeping? Are there ways that we can utilize the medications to best help match the patient's needs?

Q: What are the key strategies to mitigate adverse effects among patients with schizophrenia?

A:  There could be a number of different adverse effects for medications for treatment of schizophrenia. Focusing on the metabolic side effects in particular, it's important to remember that we should be treating our patients as full individuals, thinking about, what are the overall health consequences?

That means that I talk about exercise at every patient visit. It's a core part of every encounter I have with patients. I'm asking about diet, I'm asking about ways that people are staying active in their life.

Q: What are the main reasons patients do not adhere to their medication treatment?

A: There could be a number of different reasons that people don't want to take medication. Regardless of whether a person appreciates their illness or not, many people find taking medication to be difficult.

They don't want to endure side effects and they don't want to be part of something where they feel like they are people who have to take medication.

When you add in the possibility of anosognosia, or difficulty in appreciating illness that a person might have, it makes it even more difficult for a person to want to take medication if they can't appreciate that there's even a reason they should be taking it.

When you add in side effects like weight gain and sedation that can be there, many people are going to say, "That doesn't make me feel better anyway. Why would I want to endure something like this?"

Making sure that thinking about what those side effects are that people are having and thinking about ways to mitigate them, whether through adjunctive medications, through diet and exercise, or through working with people on how to schedule the medication in the best possible manner are ways that I would think about helping to mitigate the risk of side effects.

Jacob S. Ballon, MD, MPH, specializes in the treatment of people with psychotic disorders including schizophrenia. He is the Co-Director of the INSPIRE Clinic at Stanford, California, which provides interdisciplinary care for people experiencing psychosis. He is also the medical director of H2 acute inpatient unit and the co-director of the specialty psychiatry clinics section in the Department of Psychiatry. Dr. Ballon completed his residency at Stanford in 2009 and in 2011 a Schizophrenia Research Fellowship at Columbia University, New York, New York.