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Pharmacopsychiatry 2012; 45(07): 261-268
DOI: 10.1055/s-0032-1312609
Review
© Georg Thieme Verlag KG Stuttgart · New York

Influences on Therapist’s Decisions for Neuroleptic Treatment in Schizophrenia: The Role of Characteristics of the Patient and the Physician

M. Franz
1   Centre for Psychiatry, Justus-Liebig University Gießen, Gießen, Germany
2   Clinic for Psychiatry and Psychotherapy, Vitos Kurhessen, Bad Emstal, Germany
,
J. Ranger
3   Department of Psychology, Justus-Liebig University Gießen, Gießen, Germany
,
B. Hanewald
1   Centre for Psychiatry, Justus-Liebig University Gießen, Gießen, Germany
,
B. Gallhofer
1   Centre for Psychiatry, Justus-Liebig University Gießen, Gießen, Germany
,
B. Lay
4   Research Unit for Clinical and Social Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

received 06 December 2011
revised 13 March 2012

accepted 17 April 2012

Publication Date:
30 May 2012 (online)

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Abstract

Introduction:

We investigated factors influencing physicians’ treatment decisions regarding 4 antipsychotic treatment strategies for schizophrenia (conventional oral/conventional depot/atypical oral/atypical depot). We analysed the influence of the patient’s compliance with medication, socio-economic status (occupational prestige/educational attainment), as well as the influence of gender, age and practice setting (psychiatric/general hospital/private practice) of the prescribing physician.

Methods:

We examined the influence of these factors by means of case vignettes. 4 vignettes were constructed with varying levels for compliance and socio-economic status. For each vignette, physicians had to choose one treatment strategy from the 4 alternatives. Data were collected using a survey (n=1 342) of physicians in Germany and analysed using a weighted least-squares regression model and a random-effect logit model.

Results:

Compliance and status had interactive effects on treatment selection. Low compliance was associated with an increase in selections of depot medication. For high-status, noncompliant patients, physicians selected mainly atypical oral and atypical depot antipsychotics. Low-status, noncompliant patients were mostly given conventional and atypical depot antipsychotics. Noncompliant, low-status patients received conventional depot antipsychotics 4 times as often as noncompliant, high-status patients. The physician’s age and practice setting were also related to the treatment selection.

Discussion:

Therapeutic decisions are influenced by patients’ and the physicians’ characteristics. There might be barriers for patients with low compliance and low socio-economic status that prevent them from being prescribed newer medications. Not all physicians seem to have the same choices of treatment options available to them.

Key words

schizophrenia - schizophrenia treatment - neuroleptic treatment - medical decision making
 

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