The Comfort Level of Internists with the Prescription of Psychotropic Medication

Abstract

Empirical data indicate that patients seen in internal medicine outpatient settings have substantial rates of depression and other psychiatric disorders. Surprisingly, the training requirements established by the Residency Review Committee in Internal Medicine do not include a specific psychiatry training curriculum, but rather vaguely refer to "sufficient instruction and clinical experience" in psychiatry. In this study, internists on staff at a community hospital were surveyed to ascertain their general level of comfort with prescribing psychotropic medication. The study hypotheses were: (1) compared with other psychotropic medications, internists would generally be most comfortable with the prescription of antidepressants; (2) younger, rather than older, internists would be more comfortable with prescribing psychotropic medications; and (3) internists with greater outpatient, versus inpatient, responsibilities would be more comfortable with psychotropic medication prescription. This sample of internists demonstrated differences in prescribing comfort by medication group (F(3) = 48.99, p < .001) and was most comfortable in prescribing antidepressants and benzodiazepines, in contrast to antipsychotics and other types of psychotropic medications; comparing older with younger internists, there was a significant between-group difference in the mean number of medications positively endorsed, t(66) = 2.16, p <.05, with younger internists indicating broader comfort levels; and inpatient internists were significantly more comfortable prescribing antipsychotics than outpatient internists, t(117) = -3.38, p = .001. There are some distinct psychotropic prescription trends among internists, which have implications for future training and quality improvement programs.