The Prescription of Discretionary Antipsychotic Medication by State Mental Hospital Psychiatrists

Despite the predominance of drug treatment within psychiatry and public policy debates surrounding psychotropic drug use, American medical sociology has largely neglected the study of psychiatrists' medication prescribing practices. The present study examines the influence of patient clinical and social characteristics, as well as physician and treatment-setting factors, on the prescription of PRN (as needed) antipsychotic drugs by a sample of psychiatrists practicing in 2 North Carolina state mental hospitals in 1979. Two aspects of prescribing PRN drugs are analyzed: the initial decision to prescribe (or not prescribe) PRN antipsychotic medication for a patient; and, if medication is prescribed, the determination of daily PRN drug dosage. Patient clinical characteristics, including diagnosis, psychiatric impairment level, and concurrent non-PRN antipsychotic drug treatment, were found in a multivariate analysis to be the major determinants of PRN drug prescription. This finding suggests clinically appropriate use. Some researchers have suggested that the influence of patient social characteristics on psychiatric treatment is greatest when patient symptomatology is less severe; however, when the conditional effect of patient socialfactors on PRN drug prescription was examined by levels of patient impairment, no differences were noted. Finally, when PRN drug dosage was examined, only non-PRN antipsychotic drug employment was found to be related to the dependent variable in the analysis. Thus it appears, in contrast to the initial decision to prescribe medication, that clinicians' determination of PRN antipsychotic drug dosage is largely idiosyncratic. Study implications and limitations are discussed, with the need for further sociological study of psychiatrist drug prescribing emphasized.