A pilot study of antipsychotic prescribing decisions for acutely-Ill hospitalized patients.
BACKGROUND
Evidence on antipsychotic prescribing decisions is limited. This pilot study quantified factors considered in choosing an antipsychotic and evaluated the influence of metabolic status on treatment decisions.


METHODS
Prescribing decisions by 4 psychiatrists were examined based on 80 adult patients initiated on antipsychotic medication diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder by DSM-IV criteria, who were admitted to an acute inpatient psychiatric program of an urban Veterans Affairs Medical Center. The primary analysis examined the association between antipsychotic treatment choice and predictions of symptom control and metabolic risk. Secondary analyses included comparison of the chosen and next best treatments in predicted symptom control and metabolic risk, the frequency of reasons cited for drug choice, and the association between treatment choice and patients' baseline metabolic parameters. Mean differences and odds-ratios (OR) with 95% confidence intervals were used to compare relationships between treatment choice, ratings of risk and metabolic data.


RESULTS
Antipsychotic choice correlated significantly with ratings of predicted symptom control (OR = .92, p = 0.02) and metabolic risk (OR = .88, p = 0.01). Mean differences between the chosen and next best drugs were significant but small in predicted symptom control (F = 2.81, df = 3, 76; p<0.05) compared with larger differences in anticipated metabolic risk (F = 14.80, df = 3, 76; p = 0.0001). Nevertheless, among 24 identified reasons influencing drug selection, anticipated metabolic risk of chosen antipsychotics was cited less often than efficacy measures. In contrast to psychiatrists' expectations of metabolic risk with selected treatments, we found that patients' actual baseline BMI, fasting glucose, blood pressure, and Framingham risk levels did not necessarily predict antipsychotic treatment choice independent of other factors.


CONCLUSIONS
In the context of an acute psychiatric hospitalization, pilot data suggest that predictions of symptom control and metabolic risk correlated significantly with antipsychotic choice, but study psychiatrists were willing to assume relative degrees of metabolic risk in favor of effective symptom control. However, prescribing decisions were influenced by numerous patient and treatment factors. These findings support the potential utility of the ATCQ questionnaire in quantifying antipsychotic prescribing decisions. Further validation studies of the ATCQ questionnaire could enhance translation of research findings and application of treatment guidelines.
Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania School of Medicine, VA Medical Center-116A, University & Woodland Aves, Philadelphia, PA 19104, United States. Cabrina.campbell@va.gov
E Cabrina
EC
Campbell
Melissa
M
DeJesus
Barry K
BK
Herman
Brian J
BJ
Cuffel
Kafi N
KN
Sanders
William
W
Dodge
Vasant
V
Dhopesh
Stanley N
SN
Caroff
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003657:Decision Making; D004363:Drug Utilization; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced*; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011618:Psychotic Disorders / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult
D014150:Antipsychotic Agents; D001786:Blood Glucose