The American Psychiatric Association (APA) has issued a list of five uses of antipsychotic drugs that healthcare providers should avoid as part of efforts to cut back on unproven and disproven treatments and procedures.

The list includes not using antipsychotics as a first-line therapy for conditions including dementia and insomnia in adults, or as first-line therapy in children and adolescents for any diagnoses other than psychotic disorders.

Other prescribing behaviors the APA cautioned against included prescribing two or more antipsychotics concurrently, or for any indication without appropriate initial evaluation and follow-up.

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“The recommendations from APA […] provide valuable information to help patients and physicians start important conversations about treatment options and make informed choices about their healthcare,” APA President Jeffrey Lieberman, MD, said in a press release. “This is not to preclude the use of antipsychotic medications for these indications and populations, but to suggest that other treatment options should be considered first and patients should be engaged in discussion of the rationale for use and the potential benefits and risks.”

Health risks associated with unnecessary antipsychotic use or overuse include chronic health problems such as metabolic, neuromuscular and cardiovascular problems, the APA warned.

“Because of these risks, APA has recommended that antipsychotics should not be used routinely, and should never be used without considerable thought, good clinical reasoning and discussion with patients, as to why under particular circumstances, such a course would be preferable to alternative options,”  Joel Yager, MD, chair of the APA Council on Quality Care, said in a press release.

The APA’s efforts are part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, a public health initiative that seeks to empower patients to choose evidence-based care and reduce the amount of unnecessary and duplicate tests and procedures.