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)