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Article Excerpt
We designed this study to explore the relationship between an anxiety disorder diagnosis and the number of prescribed psychotropic medications. We retrospectively reviewed the medical records of 337 psychiatry outpatients, who were being seen in a psychotherapy training clinic, with regard to psychiatric diagnosis and the number of psychotropic medications. We grouped diagnoses into three categories: (a) anxiety disorders, (b) mood disorders, and (c) other Axis I disorders. Approximately 16% of persons were prescribed no psychotropic medications, while 41.5%, 30.0%, 8.6%, 2.7%, and 0.9% were prescribed one, two, three, four, and five psychotropic medications, respectively. The proportion of individuals on more than one medication with anxiety disorders was significantly greater than the base rate in the overall sample (z = 3.21, p < .001) or the proportion diagnosed with mood (z = 2.53, p = .01) or other Axis I disorders (z = 3.90, p < .001). In addition, for persons who were diagnosed with different diagnostic groupings, when one was anxiety disorders, they were more likely to be prescribed multiple psychotropic medications. In an outpatient psychiatry clinic, an anxiety disorder diagnosis appears to heighten the likelihood of being prescribed a greater number of psychotropic medications. We discuss the possible implications of these findings in outpatient mental health settings.
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Anxiety disorders are fairly prevalent in mental health settings (Kent & Gorman, 1997; Parker et al., 1999: Zimmerman, McDermut, & Mattia, 2000), often in combination with depression. For example, Parker and colleagues found that anxiety disorders were over-represented in a cohort of 269 individuals suffering from major depression, and Zimmerman and colleagues found that two-thirds of 373 depressed outpatients had a comorbid anxiety disorder.
With regard to the prescription of psychotropic medications among sufferers of anxiety disorders, there is scant empirical information. However, prescription patterns appear to be changing over time, both in the types as well as number of medications. For example, among a cohort of persons with anxiety disorders, Salzman, Goldenberg, Bruce, and Keller (2001) found that there were changes in prescribing patterns between the years 1989 and 1996, with exclusive benzodiazepine prescription shifting to a combination of benzodiazepines and an antidepressant (i.e., an increased number of medications). In examining the treatment of panic disorder and changes in prescribing patterns from 1992 to 1997, Uhlenhuth, Balter, Ban, Thomas, and Yang (1998) found an overall increase in the number of medications. Phillips and colleagues (2001) found that those anxiety sufferers with a comorbid personality disorder were prescribed a greater number of medications than those without Axis II psychopathology. Finally, Pillay (2002) clarified the reasons for polypharmacy among those with anxiety disorders, highlighting issues such as the potential for high levels of psychiatric comorbidity, current availability of broader types of medications, and clinician and individual medication patterns.
These preceding data suggest that anxiety sufferers may be prescribed more medications than those without anxiety, and that diagnostic comorbidity may be a contributory variable. However, previous studies have been limited by the absence of control groups (i.e., comparison of those with versus without anxiety disorders; Salzman et al., 2001); the examination of a specific anxiety disorder (e.g., panic disorder) rather than various types of anxiety disorders (Uhlenhuth et al., 1998); and the examination of comorbidity among anxiety sufferers with only one additional disorder (e.g., those with versus without personality disorder; Phillips et al., 2001).
We undertook this retrospective study among psychiatric outpatients to determine: (a) if an anxiety disorder diagnosis, versus other types of psychiatric disorders, increased the likelihood of being prescribed multiple...
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