Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients׳ subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.
The global burden of disease attributable to mental disorders exceeds that for all other medical conditions (Murray, 2012). Unlike some chronic diseases, these illnesses will frequently impact not only the patient, but also those in close contact with the patient and society at large. Treatment of mental disorders often involves the use of psychotropic medications (Happell et al., 2004 and Wolters et al., 2009). In Australia in 2008–2009, 1 in 10 prescription claims was for psychotropics; they comprised mainly of antipsychotics (51%) and antidepressants (41%) (AIHW, 2010). Similarly both classes of drugs rank high in terms of sales and prescriptions dispensed in the United States in 2011(Lindsley, 2012) with evidence of significant increase in polypharmacy in recent years involving these drugs (Castle et al., 2002 and Mojtabai and Olfson, 2010).
A significant dilemma facing this patient group and their clinicians is the use of medications that on one hand will ameliorate their symptoms but on the other hand will almost always result in debilitating and intolerable side effects (Gerlach and Larsen, 1999, Fakhoury et al., 2001, Castle et al., 2002 and Farcas et al., 2010). The emergence of these side effects some of which include severe weight gain, impotence, insomnia, chronic sedation, lack of ability to concentrate and function in daily activities has been linked to very high rates (up to 90%) of patients discontinuing pharmacological treatment (Lieberman et al., 2005, Llorca, 2008 and Goff et al., 2010).
Discontinuing treatment or non-adherence often leads to rehospitalization, relationship breakdown, loss of housing, loss of employment, involvement in substance abuse, crime and suicide (Ascher-Svanum et al., 2008, Yen et al., 2009 and Chapman and Horne, 2013). This vicious cycle of illness, prescribed medication leading to intolerable side effects, non-adherence, discontinuation effects (which can mimic and be practically indistinguishable from illness relapse) (Cerovecki et al., 2013) and/or frank illness relapse is seen in a large number of mental health patients with serious consequences and who in the worse cases, take their own life (Naber and Karow, 2001 and Llorca, 2008).
At the core of the problem is the means for effective communication between patients and clinicians (Gerlach and Larsen, 1999, Naber and Karow, 2001 and Happell et al., 2004). Psychiatrists have recognized this problem and there is an urgent need in clinical practice for an effective communication tool for patients to describe their subjective beliefs about the side effects of medications and their likelihood to alter or discontinue treatment (Cabeza et al., 2000, Dott et al., 2001, Dassori et al., 2003 and Goff et al., 2010). Such a tool will give the clinician additional insight into the patient׳s experience with these medications and facilitate open dialogue with this group of patients, who as well, often have difficulty in effective communication in part due to poor or diminished cognitive ability (Dassori et al., 2003 and Naber, 2008).
The aims of this systematic review were: 1) to identify all currently available SRQs used in the assessment of mental health patients׳ subjective experiences of side effects, 2) evaluate the characteristics of the SRQs and 3) to assess the psychometric properties of each of the SRQs.
