Sir: The study by Smith & Henderson (Psychiatric Bulletin, May 2000, 24, 172-174) highlights the selectivity of information given to patients by doctors about antipsychotic medication. However, the information gathered is in effect about doctors' attitudes, about those side-effects on which they thought it worth volunteering information, and much remains to be understood about actual practice and patients' response. Psychiatrists tend not to be aware of which side-effects of antipsychotic medication are most likely to cause distress to patients (Reference Day, Kinderman and BentallDay et al, 1998). In the last few years there has been a major shift in prescribing practice from conventional antipsychotics to atypicals. Atypicals have a very different profile of side-effects and we need to know how troublesome their particular side-effects (weight gain and sedation) are to patients.

Studies have shown little positive evidence that informing patients with schizophrenia about side-effects improves adherence (Reference Macpherson, Jerrom and HughesMacPherson et al, 1996; Reference Chaplin and KentChaplin & Kent, 1998). One can certainly imagine that patients will feel happier in their awareness of side-effects when they can also be told of coping strategies, for example, “this medicine can cause weight gain but we will monitor your weight and ask the dietician to advise you about what to eat”.

We are currently studying in-patients' knowledge of the side-effects of antipsychotic medication, their sources of information and their desire for more information. We are asking doctors which side-effects they have discussed with their patients and are auditing case notes for details of the information offered. Our preliminary results show that the level of knowledge and understanding about side-effects is low, many patients suffer physical problems but are unsure whether these are caused by their antipsychotic medication and most patients say they do not wish for more information. When asked, one in three patients said their side-effects were so bad they wanted to stop their medication.