The incidence of tardive dyskinesia (TD) during the first five years of neuroleptic treatment of adult schizophrenic patients, may rise to 35%. Yet, the prevention of this iatrogenic effect remains a secondary objective for clinicians. This study explored how medication decisions might vary depending on patient characteristics and medical specialty, and to identify correlates of prescribing aimed at the prevention of TD.
Simulated medication decisions were elicited from 352 psychiatrists and 279 general practitioners in response to 12 brief written descriptions of a male schizophrenic outpatient treated for 5 years with 20 mg/day of haloperidol. Patient age, psychotic symptoms, signs of dyskinesia, and effectiveness of past treatment varied systematically in the descriptions.
Every variable except patient age affected decisions. Most physicians reduced doses for stable patients. In cases of active psychosis, decisions were affected by presence of dyskinesia and treatment effectiveness. Psychiatrists were more likely to increase or reduce doses, general practitioners to change medication. Very few physicians opted to cease medication. Younger psychiatrists made the most prudent decisions.
From a tardive dyskinesia prevention perspective, similar prescriptions to older and younger patients are worrying. We need to understand why physicians might believe that older patients require just as aggressive medication regimen as younger patients. Respondents within and between specialties tend make similar simulated decisions, but these do not necessarily reflect recommendations from controlled research on chronic neuroleptic treatment.