This cross-sectional study used a postal questionnaire to find out if there are regional differences in the attitudes of doctors and nurses to antipsychotic polypharmacy and the use of clinical guidelines.

A survey was sent to 2 pairs of treatment settings in Denmark, characterized by low and high prevalence of antipsychotic polypharmacy, respectively. The questionnaire investigation was conducted during November 2007 to February 2008 and a good response rate was obtained (physicians: 93%; nurses: 87%).

The results highlighted a number of differences in attitude:

• The treatment settings with low use of antipsychotic polypharmacy were characterized by raised knowledge/awareness of local antipsychotic treatment guidelines (P = .02 for physicians; P = .01 for nurses)
• Among physicians, these settings were also characterized by an elevated confidence in these guidelines (P = .01), frequent local educational activities (P < .0001), and increased recent involvement in research (P = .01)
• Among nurses, a perception of an overwhelming work load (P = .01) and time pressure (P = .003) was significantly more prevalent in treatment settings with high rates of antipsychotic coprescribing, as was the belief in the benefit of antipsychotic polypharmacy augmentation (P = .001).

The authors concluded:

Albeit no causal relationships can be inferred from this cross-sectional observational study, we recommend the furtherance of a treatment environment characterized by easily accessible clinical guidelines, frequent academic activities, and an unruffled atmosphere.

Baandrup L, Allerup P, Nordentoft M, Lublin H, Glenthoj BY. Exploring regional variation in antipsychotic coprescribing practice: a Danish questionnaire survey. J Clin Psychiatry. 2010 Nov;71(11):1457-64. Epub 2010 Oct 19. [PubMed abstract]