Psychiatry Investig.
2021 Nov;18(11):1058-1067. 10.30773/pi.2021.0169.
A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists
- Nakagami Y
1,2 - Hayakawa K3
- Horinouchi T4
- Pereira-Sanchez V5
- Tan MP6
- Park SC7
- Park YC7
- Moon SW8
- Choi TY9
- Avasthi A10
- Grover S10
- Kallivayalil RA11
- Rai Y12
- Shalbafan M13
- Chongsuksiri P14
- Udomratn P15
- Kathriarachchi ST16
- Xiang YT17
- Sim K18
- Javed A19
- Chong MY20
- Tan CH21
- Lin SK22
- Inada T23
- Murai T1
- Kanba S3
- Sartorius N24
- Shinfuku N25
- Kato TA3
- Affiliations
-
- 1Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
- 2Department of Preventive Services, School of Public Health/Medicine and Medical Science, Kyoto University, Kyoto, Japan
- 3Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- 4Department of Neuroscience, Trafford Centre for Medical Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- 5Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, USA
- 6Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- 7Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- 8Department of Psychiatry, Konkuk University Chungju Hospital, Institute of Medical Science, Chungju, Republic of Korea
- 9Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
- 10Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 11Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
- 12Essex Partnership University Trust, Colchester, UK
- 13Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- 14Buddhachinaraj Hospital, Phitsanulok, Thailand
- 15Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- 16Department of Psychiatry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
- 17Unit of Psychiatry, Department of Public Health and Medicinal Administration, University of Macau, Macao SAR, China
- 18Institute of Mental Health, Buangkok Green Medical Park, Singapore
- 19Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
- 20Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung & Chang Gung University School of Medicine, Taoyuan, Taiwan
- 21Department of Pharmacology, National University of Singapore, Singapore
- 22Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- 23Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
- 24Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
- 25Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
- KMID: 2522486
- DOI: http://doi.org/10.30773/pi.2021.0169
Abstract
Objective
Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate.
Methods
We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.
Results
The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively).
Conclusion
Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.
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