Overprescribing of Psychotropic Drugs

  • J. Guy Edwards

Abstract

During recent years we have seen startling increases in the manufacture, distribution, prescription and cost of psychotropic drugs. Many figures have been quoted from Department of Health and Social Security and other sources (for example Trethowan, 1975) to illustrate these increases. The figures quoted are often said to be out of proportion to the prevalence of the psychiatric disorders for which they are prescribed. This, however, cannot be accepted as a statement of fact, because the prevalence of mental illness in general, let alone that of specific psychiatric disorders that call for drug treatment, is not known. The figures are, none the less, suggestive.

Keywords

Placebo Sugar Toxicity Depression Lithium 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Biron, P. (1973). A hopefully biased pilot survey of physicians’ knowledge of the content of drug combinations. Can. med. Ass. J., 109, 35–39PubMedCentralPubMedGoogle Scholar
  2. Blackwell, B. (1973). Rational drug use in psychiatry. In Rational Psychopharmacotherapy and the Right to Treatment (Ed. F. J. Ayd ), Ayd Medical Communication, BaltimoreGoogle Scholar
  3. Blackwell, B. (1976). Treatment adherence. Br. J. Psychiat., 129, 513–531CrossRefGoogle Scholar
  4. British Medical Journal Leading Article (1977). Keep on taking the tablets. Br. med. J., 1, 793CrossRefGoogle Scholar
  5. Coleman, J., Katz, E. and Menzel, H. (1957). The diffusion of an innovation among physicians. Sociometry, 20, 253–270CrossRefGoogle Scholar
  6. Coleman, J., Katz, E. and Menzel, H. (1966). Medical Innovation—a Diffusion Study. Bobbs-Merril Company, IndianapolisGoogle Scholar
  7. Coleman, J., Menzel, H. and Katz, E. (1959). Social processes in physicians’ adoption of a new drug. J. chronic Dis., 9, 1–19CrossRefPubMedGoogle Scholar
  8. Coleman, V. (1975). The Medicine Men: Drug Makers, Doctors and Patients. Temple Smith, LondonGoogle Scholar
  9. Daniel, E. E. and Leedham, L. (1966). Effect on student attitudes of a programme of critical evaluation of claims for drugs. J. med. Educ., 41, 49–60PubMedGoogle Scholar
  10. D’Arcy, P. F. (1976). Iatrogenic disease: a hazard of multiple drug therapy. R. Soc. Hlth J., 96, 277–283Google Scholar
  11. Dunlop, Sir Derrick M. (1971). The use and abuse of psychotropic drugs. Scot. med. J., 16, 345–349PubMedGoogle Scholar
  12. Dunlop, Sir Derrick M. (1972). Drug interactions. Community Health, 4, 8–13Google Scholar
  13. Dunlop, Sir Derrick M. (1973). Medicines, governments, doctors and pharmacists. Lister Memorial Lecture. Chemistry and Industry, Feb. 3, 127–131Google Scholar
  14. Eaton, G. and Parish, P. (1976). General practitioners’ views of information about drugs. J. R. Coll. gen. Pract., 26, Supplement No. 1, 64–68Google Scholar
  15. Edwards, J. G. (1974). Doctors, drugs and drug abuse. Practitioner, 212, 815–822PubMedGoogle Scholar
  16. Edwards, J. G. (1977). Unwanted effects of psychotropic drugs. I—Some general considerations. Practitioner 218 556–562PubMedGoogle Scholar
  17. Findley, T. (1953). The placebo and the physician. Med. Clinics N. Am., 37, 1821–1826Google Scholar
  18. Finnerty, F. A., Mattie, E. C. and Finnerty, F. A. (1973). Hypertension in the inner city. I. Analysis of clinic dropouts. Circulation, 47, 76–78CrossRefGoogle Scholar
  19. Francis, V., Kotsch,B. M. and Morris, M. J. (1969). Gaps in doctor—patient communications. Patients’ response to medical advice. New Engl. J. Med., 280, 535–540CrossRefPubMedGoogle Scholar
  20. Garb, S. (1958). The reaction of medical students to drug advertising. New Engl. J. Med., 259, 121–123CrossRefPubMedGoogle Scholar
  21. Gardos, G. and Cole, J. 0. (1976). Maintenance antipsychotic therapy: is the cure worse than the disease? Am. J. Psychiat., 133, 32–36CrossRefPubMedGoogle Scholar
  22. Gatley, M. S. (1968). To be taken as directed. J. R. Coll. gen. Pract., 16, 39–44PubMedCentralPubMedGoogle Scholar
  23. George, C. F. (1974). The investigation of new drugs in man. Br. J. Hosp. Med., 11, 780–787Google Scholar
  24. Greenblatt, D. J. and Shader, R. I. (1971). Meprobamate: a study of irrational drug use. Am. J. Psychiat., 127, 1297–1303CrossRefPubMedGoogle Scholar
  25. Hammond, C. V. (1974). Polypharmacy. Personal communication with and quoted by D’Arcy, P. F.Google Scholar
  26. Hare, E. H. and Willcox, B. R. C. (1967). Do psychiatric in-patients take their pills ? Br. J. Psychiat., 113, 1435–1439CrossRefGoogle Scholar
  27. Hemminki, E. (1975). Review of literature on the factors affecting drug prescribing. Soc. Sci. Med., 9, 111–116CrossRefPubMedGoogle Scholar
  28. Honigfeld, G. (1964). Non-specific factors in treatment. I. Review of placebo reactions and placebo reactors. Dis. Nerv. Syst., 25, 145–156PubMedGoogle Scholar
  29. Irwin, D. S., Weitzel, W. D. and Morgan, D. W. (1971). Phenothiazine intake and staff attitudes. Am. J. Psychiat., 127, 1631–1635CrossRefPubMedGoogle Scholar
  30. Jeffreys, M., Brotherston, J. H. F. and Cartwright, A. (1960). Consumption of medicines on a working-class housing estate. Br. J. prevent. soc Med., 14, 64–76Google Scholar
  31. Lader, M. H. (1976) Basic trial design. Br. J. clin. Pharmac., 3, Supplement (2), 375–379CrossRefGoogle Scholar
  32. Lancet. Commentary from Westminster (1977). Curbing expenditure on drugs. Lancet i 962–963Google Scholar
  33. Lee, J. A. H. (1964). Prescribing and other aspects of general practice in three towns. Proc. R. Soc. Med., 57, 1041–1043PubMedCentralPubMedGoogle Scholar
  34. Lee, J. A. H., Draper, P. A. and Weatherall, M. (1965). Primary medical care: prescribing in three English towns. Milbank Memorial Fund Q., 43, 285–290CrossRefGoogle Scholar
  35. Lee, J. H., Branchey, M., Haher, E. J., Varga, E. and Simpson, G. M. (1974). Once versus thrice daily thiothixine in the treatment of schizophrenic in-patients. Br. J. Psychiat., 125, 73–78CrossRefGoogle Scholar
  36. Linn, L. S. (1971). Physician characteristics and attitudes towards legitimate use of psychotherapeutic drugs. J. Hlth soc Behay., 12, 132–140CrossRefGoogle Scholar
  37. Mallahy, B. (1966). The effect of instruction and labeling on the number of medication errors made by patients at home. Am. J. Hosp. Pharmac., 23, 283–292Google Scholar
  38. Manheimer, D. I., Mellinger, G. D. and Baiter, M. B. (1968). Psychotherapeutic drugs: use among adults in California. Cali. Med., 109, 445–451Google Scholar
  39. Martin, J. P. (1957). Social Aspects of Prescribing. Heinemann, LondonGoogle Scholar
  40. McClellan, T. A. and Cowan, G. (1970). Use of antipsychotic and antidepressant drugs by chronically ill patients. Am. J. Psychiat., 126, 1771–1773CrossRefPubMedGoogle Scholar
  41. Mellinger, G. D., Baiter, M. B. and Manheimer, D. I. (1971). Patterns of psychothe rapeutic drug use among adults in San Francisco. Archs gen. Psychiat., 25, 385–394CrossRefGoogle Scholar
  42. Menzel, H. and Katz, E. (1955–56). Social relations innovation in the medical profession: the epidemiology of a new drug. Public Opinion Q., 19, 337–352CrossRefGoogle Scholar
  43. Miller, R. R. (1974). Prescribing habits of physicians: a review of studies on prescribing of drugs. Drug Intelligence clin. Pharm., 8, 81–91Google Scholar
  44. Mindham, R. H. S., Howland, C. and Shepherd, M. (1973). An evaluation of continuation therapy with tricyclic antidepressants in depressive illness. Psychol. Med., 3, 5–17CrossRefPubMedGoogle Scholar
  45. Muller, C. (1972). The over-medicated society: forces in the marketplace for medical care. Science, 176, 488–492CrossRefPubMedGoogle Scholar
  46. National Disease and Therapeutic Index, Reference, File, Diagnosis. July 1967—June 1968. Lea Associates Inc., Amber, PennsylvaniaGoogle Scholar
  47. Parry, H. J. (1968). Use of psychotropic drugs by U. S. adults. Public Hlth Rep., 83, 799–810CrossRefGoogle Scholar
  48. Parry, H. J., Balter, M. B., Mellinger, G. D., Cisin, I. H. and Manheimer, D. I. (1973). National patterns of psychotherapeutic drug use. Archs gen. Psychiat., 28, 769–783CrossRefGoogle Scholar
  49. Paykel, E. S., Dimascio, A., Haskell, D. and Prusoff, B. A. (1975). The effects of maintenance amitriptyline and psychotherapy on symptoms of depression. Psychol. Med., 5, 67–77CrossRefPubMedGoogle Scholar
  50. Porter, A. M. H. (1969). Drug defaulting in a general practice. Br. med. J., 1, 218–222PubMedCentralCrossRefPubMedGoogle Scholar
  51. Prien, R. F., Klett, J. and Caffey, E. M. (1973). Lithium carbonate and imipramine in prevention of affective episodes: a comparison in recurrent affective illness. Archs gen. Psychiat., 29, 420–425CrossRefGoogle Scholar
  52. Reynolds, E., Joyce, C. R. B., Swift, J. L., Tooley, P. H. and Weatherall, M. (1965). Psychological and clinical investigation of the treatment of anxious out-patients with three barbiturates and placebo. Br. J. Psychiat., 111, 84–95CrossRefGoogle Scholar
  53. Rickels, K., Baumm, C. and Fales, K. (1964). In Neuro-psychopharmacology, Vol. 3 ( Ed. P. B. Bradley, F. Flugel and P. Hoch), Elsevier, AmsterdamGoogle Scholar
  54. Sackett, D. L. and Haynes, R. B.(1976). An annotated bibliography on the compliance of patients with therapeutic regimens. In Compliance with Therapeutic Regimens Johns Hopkins University Press, BaltimoreGoogle Scholar
  55. Sainsbury, Lord (Chairman) (1967). Report of the Committee of Enquiry into the Relationship of the Pharmaceutical Industry with the National Health Service. ( 1965–1967 ), H.M.S.O., LondonGoogle Scholar
  56. Salzman, C., Kochansky, G. E., Schader, R. I., Porrino, L. J., Harmatz, J. S. and Sweet, C. P. (1974). Chlordiazepoxide-induced hostility in a small group setting. Archs gen. Psychiat., 31, 401–404CrossRefGoogle Scholar
  57. Shapiro, A. K. (1968). The placebo response. In Modern Perspectives in World Psychiatry (Ed. J. G. Howells) Oliver and Boyd, EdinburghGoogle Scholar
  58. Smart, R. G. and Fejer, D. (1972). Drug use among adolescents and their parents: closing the generation gap in mood modification. J. abnorm. Psychol., 79, 153–160CrossRefPubMedGoogle Scholar
  59. Stimson, G. V. (1976a). The extent of advertising of pharmaceutical products. J. R. Coll. gen. Practit., 26, Supplement No. 1, 69–76Google Scholar
  60. Stimson, G. V. (1976b) Doctor — patient interaction and some problems for prescribing. J. R. Coll. gen. Practit., 26, Supplement No. 1, 88–96Google Scholar
  61. Trethowan, W. H.(1975). Pills for personal problems. Br. med. J., 4, 749–751CrossRefGoogle Scholar
  62. Webb, B. and Stimson, G. V. (1976). People’s accounts of medical encounters. In Sociology of Everyday Medical Life (Ed. M. Wadsworth and D. Robinson ), Martin Robertson, LondonGoogle Scholar
  63. Wilson, C. W. M., Banks, J., Mapes, R. and Courte, S. M. T. (1964). The assessment of prescribing: a study in operational research. In Problems and Progress in Medical Care (Ed. G. McLachlan), Oxford University Press, LondonGoogle Scholar
  64. Worthen, D. B. (1973). Prescribing influences: an overview. Br. J. med. Educ., 7, 109–117CrossRefPubMedGoogle Scholar

Copyright information

© Raghu N. Gaind and Barbara L. Hudson 1979

Authors and Affiliations

  • J. Guy Edwards

There are no affiliations available

Personalised recommendations