ABSTRACT
The objective of this study is to understand psychiatrist's decisions to prescribe psychiatric medications. A survey questionnaire was prepared consisting of 15 factors. Each factor had a five-point Likert scale, rating the importance of each factor in making decisions to prescribe medications. Twenty-six psychiatrists at a state psychiatric hospital completed the questionnaire. The data analysis involved the frequencies of responses for each factor being compared using Chi square goodness-of-fit tests with null hypothesis that the response distribution will be centered around average score of three on the Likert scale. All the participants rated patient's symptom, severity, and diagnosis as the most important. This was followed by the patient's past experience with medications, then medication side effects, concurrent physical health problems, and medication interactions. Psychiatrist's experience with medications rated as more important than evidence from clinical trials. Finally, psychiatrists integrate evidence from research findings with personal experience, patient preferences, and clinical context in making decisions in prescribing medications for psychiatric disorders.
Subject(s)
Attitude of Health Personnel , Clinical Competence , Decision Making , Mental Disorders/drug therapy , Practice Patterns, Physicians' , Chi-Square Distribution , Data Collection , Drug Prescriptions , Evidence-Based Medicine , Hospitals, Psychiatric , Humans , Mental Disorders/diagnosis , Patient Preference , Psychopharmacology , Regression Analysis , Surveys and QuestionnairesABSTRACT
This retrospective study of patients treated in a ninety-day, inpatient, dual-diagnosis treatment program examined antipsychotic effectiveness in this population using length of stay in treatment and successful program completion as outcome measures. All patients with co-occurring substance dependence and schizophrenia or schizoaffective disorder treated with olanzapine, risperidone, ziprasidone, and typical depot neuroleptics from January 2001 to December 2003 (N = 55) are the subjects of this study. Patients stayed longer in treatment when taking risperidone (82 +/- 19 days) or ziprasidone (74 +/- 21 days) compared with olanzapine (44 +/- 30 days) or typicals (47 +/- 36 days). Eighty-eight percent of risperidone patients and 64% of ziprasidone patients successfully completed the program, while only 33% of olanzapine patients and 40% of patients on typicals successfully completed the program. Risperidone and ziprasidone were associated with significantly better program performance than olanzapine or depot typicals in this population. Possible reasons for this difference are discussed.
