How do psychiatrists choose among different antipsychotics?
OBJECTIVE
We attempted to determine the decision rules psychiatrists use in the choice of antipsychotic drugs for inpatients with schizophrenia.


METHODS
Interviews were conducted with 50 hospital psychiatrists in Southern Germany. Each physician was interviewed with respect to the reasons for his antipsychotic drug choice in the cases of three patients with a diagnosis of schizophrenia. Interviews were audiotaped and subsequently analyzed using a standardized coding scheme.


RESULTS
The clinical decision rules identified are highly complex, with a mean of eight categories cited per patient. Categories named included the patient's past treatment response, side effects, intended route of administration and co-morbidities. Moreover, psychiatrists strongly take the patient's target symptoms and the assumed efficacy of certain compounds into account in their choice of medication.


CONCLUSIONS
Psychiatrists' explanations for their antipsychotic drug choice seem for the most part reasonable and overlap substantially with drug-choice algorithms of clinical guidelines. However, psychiatrists additionally use indicators that--in their view--might predict treatment response. For these indicators, which are derived from personal experience, it is still unclear whether they are valid and simply have not yet been proven in clinical trials or whether they merely represent unfounded assumptions on the part of the doctors.
Hamann
Johannes
J
Department for Psychiatry and Psychotherapy, Technische Universität, Möhlstrasse 26, 81675 Munich, Germany. j.hamann@lrz.tum.de
Kolbe
Grit
G
Cohen
Rudolf
R
Leucht
Stefan
S
Kissling
Werner
W
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians'; D011570:Psychiatry; D012559:Schizophrenia / Q000188:drug therapy*
D014150:Antipsychotic Agents