August 08, 2004

Medical decision making in antipsychotic drug choice for schizophrenia

Medical decision making in antipsychotic drug choice for schizophrenia.
Hamann J, Langer B, Leucht S, Busch R, Kissling W
Am J Psychiatry. 2004 Jul;161(7):1301-4.

This article seeks to discern what factors are associated with prescribing patterns amongst physicians in the community. The authors looked at practices in Germany; 50 hospital based and 50 private practice psychiatrists. They conducted survey and followed prescriptions patterns with these doctors to see what their attitudes were towards newer versus older medications and other important treatment decisions. The groups differed in a couple of important ways. The hospital based psychiatrists were on the average 10 years younger and had been in practice less time, though were closer to their training.

The authors report that older patients, patients with more severe positive symptoms (hallucinations, delusions, paranoia, bizarre thinking), and those with a longer duration of illness were more likely to receive the first generation antipsychotics (i.e. haloperidol/Haldol, fluphenazine/Prolixin, etc.) versus the second generation antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, clozapine, aripiprazole.) However, people who requested newer medications or who had a history of a bad reaction with particular med were more likely to receive the newer medications. However, the only statistically significant predictor of receiving an older medication was the age of the physician (by up to 5 fold.) The other factors were important, but did not meet statistical significance. However, there were a small number of physicians polled and a small number of prescriptions written for older antipsychotics regardless of any factor.

While older physicians were more likely to use older drugs, that may be a factor of their being more used to them than the younger doctors. This may not always be a bad thing, new drugs are expensive and not always more effective or with fewer side effects than older meds, however it just brings to light the importance of advocacy for yourself or your loved one when a physician suggests a treatment. Advocacy on your own behalf for a newer medication may make the difference between trying an older one first or just going to the newer medicine right away. This decision is not always totally the doctor's decision, but when funding is not an impediment to drug choice, appropriate assertiveness by patients and families can help influence the ultimate choice in treatment.

This work was funded by unrestricted grants from Sanofi Synthelabo, Germany, and Astra Zeneca, Germany.

link to article on pubmed

Author: Jacob Ballon


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