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Schizophrenia Bulletin Advance Access published online on April 2, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn019
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© The Author 2008. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Principles of Antipsychotic Prescribing for Policy Makers, Circa 2008. Translating Knowledge to Promote Individualized Treatment

Joseph Parks2, Alan Radke3, George Parker4, May-Ellen Foti5, Robert Eilers6, Mary Diamond7, Dale Svendsen8 and Rajiv Tandon1,9
2 State of Missouri Department of Mental Health
3 State of Minnesota Department of Mental Health
4 State of Indiana Mental Health
5 State of Massachusetts Mental Health
6 State of New Jersey Health Services
7 State of Pennsylvania Mental Health
8 State of Ohio Department of Mental Health
9 State of Florida Mental Health Program Office

1 To whom correspondence should be addressed; e-mail: rajiv_tandon{at}dcf.state.fl.us.

Findings from 2 pivotal government-funded studies of comparative antipsychotic effectiveness undermine assumptions about the marked superiority of the more expensive second-generation "atypical" medications in comparison to the less expensive first-generation "typical" drugs. Because this assumption was the basis for the almost universal recommendation that these newer antipsychotics be used preferentially resulting in a 10-fold increase in state governmental expenditures on this class of medications over the past decade, a reassessment of policy is called for. To address the issue, the Medical Directors Council of the National Association of State Mental Health Program Directors critically reviewed findings of these studies in the context of other data and considered policy implications in the light of the obligations of state government to make available best possible and individually optimized treatment that is cost-effective. The Medical Directors Council unanimously adopted a set of recommendations to promote appropriate access, efficient utilization, and best practice use. We present our policy statement, in which we provide a succinct background, articulate general principles, and describe a set of 4 broad recommendations. We then summarize our understanding of the current state of knowledge about comparative antipsychotic effectiveness, best antipsychotic practice, and considerations for state policy that represent the basis of our position statement.

Keywords: antipsychotic / policy / schizophrenia / treatment / effectiveness / cost-effectiveness / best practice / states / costs


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