In an upcoming study in Psychiatric Services, US and Canadian researchers report that the strongest predictors for over-medicating of people being treated for schizophrenia is not severity of patient symptoms but doctors’ habits. The research team analyzed pharmaceutical drug records for 12,150 individuals in Quebec being treated for schizophrenia, and found that 11.9% were on excessively high doses of antipsychotics and 10.4% were taking multiple antipsychotics, with 3.7% in both groups. “Given the harms associated with both highdose prescribing and antipsychotic polypharmacy, measures to reduce such prescribing are urgently needed,” they write.
After factoring for different variables, the researchers determined that “high-dose prescribing and antipsychotic polypharmacy cannot be explained simply as responses by individual physicians to particularly difficult clinical situations. Rather, they appear to result, to a significant extent, from a minority of physicians’ and of hospital departments’ more atypical prescribing practices.”
The researchers suggested regular auditing and reporting of these practices. “Given the weight of the evidence against high-dose prescribing and antipsychotic polypharmacy, measures addressed to physicians and hospitals most likely to prescribe high doses, antipsychotic polypharmacy, or both should be considered.”
Variation in Long-Term Antipsychotic Polypharmacy and High-Dose Prescribing Across Physicians and Hospitals (Latimer, Eric A. et al. Psychiatric Services 2014; doi: 10.1176/appi.ps.201300217)
This is actually a very important finding! I always hear from psychiatrists that “we all know there are situations where polypharmacy makes sense” and “we don’t know that Practitioner A isn’t working with a very difficult population…” as explanations for why certain doctors “overprescribe.” It sounds here like it’s simply a matter of their attitude – some doctors don’t really care about the impact of drugging their patients into submission, and those are the ones who use the drugs most ruthlessly, regardless of the difficulties their patients are having. It will make it easier to de-bunk these arguments when I next hear them put forth.
“researchers report that the strongest predictors for over-medicating of people being treated for schizophrenia is not severity of patient symptoms but doctors’ habits”
Discussion about anti-psychotics per se aside – that is just pure and simple laziness. The kind of doctors who tick off “schizophrenia” and write down the same 3 drugs in the same doses. Takes 5 minutes per patient and doesn’t strain the physician’s brain too much.