The Prescribing of Psychotropic Drugs by Primary Care Physicians : an International Collaborative Study

This article addresses the issues of recognition of psychiatric disorders by general physicians (GPs) and the effects of recognition on management and course. Among 1994 patients who were screened with the General Health Questionnaire and who were rated by their GP, 1450 (72.7%) had not been identified by the GP as having a psychiatric disorder in the year before the index visit. Among these "new" patients, 557 (38.4%) had positive General Health Questionnaire scores. Only 47% of the new patients who met Bedford College diagnostic criteria for anxiety, depression, or ill-defined disorder had their psychiatric disorder recognized by their GP. Among patients who met Bedford College criteria, mean episode durations were longer for anxiety disorders (20 to 22 months) than for depressive disorders (9 to 10 months). Among the new patients, those with psychiatric disorders recognized by the GP were more likely to receive mental health interventions. Recognition was associated with shorter episode duration among patients with an anxiety disorder, but not among patients with depressive or ill-defined disorders.

This paper examines the causes behind the gender differences in the prescription of psychotropic medications by primary care physicians. The 1985 National Ambulatory Medical Care Survey data were used for the analysis. Women were more likely than men to receive prescriptions for anxiolytics and antidepressants but were equally likely to receive prescriptions for hypnotics/barbiturates and antipsychotics. Controlling for statistically significant presenting symptoms, physician diagnoses, and sociodemographic and health services factors, women were still more likely to receive a prescription for anxiolytics and antidepressants. The reasons, true and artifactual, for these differences are discussed. It is suggested that the artifactual reasons must be explored through experimental and/or observational research designs and not with cross-sectional data.

In a double-blind, parallel group trial, 78 subjects with social phobia received moclobemide (a new reversible inhibitor of monoamine oxidase A) phenelzine, or placebo. After eight weeks, both active drugs – phenelzine somewhat more than moclobemide – were clinically and statistically significantly more effective than placebo, as assessed by rating scales. There was some further improvement between weeks 8 and 16, particularly in the moclobemide group; at week 16, 82% of the moclobemide and 91% of the phenelzine-treated patients were almost asymptomatic. Moclobemide was, however, much better tolerated than phenelzine. Patients withdrawn from active drugs had relapsed by week 24, providing additional support for the efficacy of the active drugs.