Better prescribing for schizophrenia requires guidelines, frequent academic activities and a relaxed working environment

Assorted pills

People with schizophrenia are sometimes prescribed multiple antipsychotic drugs, even though clinical guidelines rarely recommend this course of action.

This cross-sectional observational study from Denmark explored the reasons behind this prescribing practice in two treatment centres; one that had high rates of antipsychotic polypharmacy and the other that had low rates.

The researchers sent a questionnaire to doctors and nurses in the two treatment centres and got a decent response rate (doctors: 93%; nurses: 87%).

The treatment centre with low use of antipsychotic polypharmacy were characterised by:

  • raised knowledge/awareness of local antipsychotic treatment guidelines (P = .02 for doctors; P = .01 for nurses)
  • elevated confidence in these guidelines by doctors (P = .01)
  • frequent local educational activities by doctors (P < .0001)
  • increased recent involvement in research by doctors (P = .01).

The treatment centre with high use of antipsychotic polypharmacy were characterised by:

  • a perception amongst nurses of an overwhelming work load (P = .01)
  • time pressure for nurses (P = .003)
  • the belief in the benefit of antipsychotic polypharmacy augmentation (P = .001).

The authors concluded:

Albeit no causal relationships can be inferred from this cross-sectional observational study, we recommend the furtherance of a treatment environment characterized by easily accessible clinical guidelines, frequent academic activities, and an unruffled atmosphere.

Baandrup L, Allerup P, Nordentoft M, Lublin H, Glenthoj BY. Exploring regional variation in antipsychotic coprescribing practice: a Danish questionnaire survey. J Clin Psychiatry. 2010 Nov;71(11):1457-64. Epub 2010 Oct 19. [PubMed abstract].
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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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