Measuring side effects of antipsychotics

In psychometrics we use mathematical techniques to aid development and testing of psychological measures for use in research and clinical practice. This is crucial in mental healthcare and research, where symptoms cannot always be directly observed, and we rely on patients’ descriptions of their difficulties.

Patient-reported outcome/experience measures (PROMs/PREMs) are questionnaires which directly capture patients' perspectives; important because patients often discuss different concerns to their healthcare professionals. Our Psychometrics Lab ensured the reliability and validity of the first self-report, high quality PROM to assess antipsychotic medication side effects- the Maudsley Side-Effects (MSE) measure.

Maudsley Side Effects measure

Antipsychotic medication side-effects (e.g., impotence, insomnia, sedation, lack of concentration) interfere with daily life activities and impair quality-of-life. Side-effects contribute to long-term physical health problems, stigma, poor medication adherence and mental health distress. These consequences result in discontinuation or dose reduction by patients, with multiple harmful outcomes.

Close monitoring of side-effects is important, especially when the patient is actively involved. The Maudsley Side Effects measure is designed specifically to encourage patient involvement, to allow the patient to report the severity, impact and distress of their medication side-effects. This acts as a starting point for joint decision-making on the type and dose of medication, and so contributes to a positive therapeutic relationship and optimises treatment planning.

Co-production with patients and practitioners

The Maudsley Side Effects measure was co-produced with patients and clinicians/practitioners. An initial list of potential side-effects underwent a structured survey with a group of psychiatrists and pharmacists. Patient discussion groups and clinician/practitioner panels were then held, which contributed to the final list of side effects and wording for the Maudsley Side Effects measure.

Two groups of patients used the measure to report on the medication side-effects. Their responses were used to establish the quality of the measure with psychometric methods, supporting its use as a reliable and valid measure of antipsychotic treatment side effects. 

The responses revealed that poorer mental and physical health were related to side-effect burden, but not psychotic symptoms. The endorsement of side effects is highly variable, and the severity of distress caused by a particular side-effect was not predicted by its frequency. The Maudsley Side Effects measure is now being included in ongoing studies, and its development provides an example of how new measurement tools will be co-produced in this theme.

IMPACT AREAS:

Developing Resources for Research | Whole Person Care | Involving Patients in Research | Personalising Treatment to Patients