Psychiatrists' Cognitive and Affective Biases and the Practice of Psychopharmacology: Why Do Psychiatrists Differ From One Another in How They View and Prescribe Certain Medication Classes?

Abstract

Cognitive and affective biases impact clinical decision-making in general medicine. This article explores how such biases might specifically affect psychiatrists' attitudes and prescribing patterns regarding two medication classes (stimulants and benzodiazepines) and addresses related issues. To supplement personal observations, selective PubMed narrative literature searches were conducted using relevant title/abstract terms, followed by snowballing for additional pertinent titles. Acknowledging that there are many more types of biases, we describe and use clinical vignettes to illustrate 17 cognitive and affective biases that might influence clinicians' psychopharmacological practices. Factors possibly underlying these biases include temperamental differences and both preprofessional and professional socialization. Mitigating strategies can reduce the potentially detrimental impacts that biases may impose on clinical care. How extensively these biases appear, how they differ among psychiatrists and across classes of medication, and how they might be most effectively addressed to minimize harms deserve further systematic study.

Eating disorders and palliative care specialists require definitional consensus and clinical guidance regarding terminal anorexia nervosa: addressing concerns and moving forward

“…Some clinicians might publicly voice denial that terminal AN exists while privately acknowledging that terminality exists for some patients. Some may be influenced by a host of cognitive and affective biases and/or concerns regarding social or professional approbation [25][26][27], which might lead some clinicians to forms of denial, in which they essentially avoid facing the realities of these terminal states. In any case, those who persist in denying even the possibility that the condition of terminal AN exists do these patients and their families a great disservice.…”

Responding to the Shrinking Scope of Psychiatrists’ Prescribing Practices

“…Recently, Yager et al [16] discussed several biases that potentially impact prescribing practices. They reviewed 16 cognitive and affective biases that can affect decision making, including commission bias (i.e., the tendency to act rather than to wait and see), confirmation bias (i.e., the tendency to look for confirming evidence to support a belief rather than look for disconfirmation, even when substantial evidence exists to refute it), overconfidence bias (i.e., a universal tendency to believe one knows more than one does), and representativeness restrain bias (i.e., the tendency to look for prototypical patterns and then stop thinking about atypical variants).…”

“…Implicit biases can also alter prescribing practices [18]. In discussing them, Yager et al note that "young physicians are automatically socialized into prescribing patterns according to the microcultures in which they are trained, often via implicit learning… These local microcultures are often strongly influenced by routinized practices, traditions, attitudes, and prior experiences" ( [16], p. 5) of the group's senior opinion or thought leaders.…”

“…Psychopharmacology education should be balanced, covering all classes of psychotropic medications with equal adequate depth and expertise. As Yager et al [16] noted, psychiatrists at teaching sites frequently differ in their attitudes and prescribing behaviors toward certain classes of medications, such as stimulants and benzodiazepines. These differences need to be addressed in discussions and seminars.…”

“…Biases can be modified through various strategies, such as using introspection, mindfulness, perspective taking, learning to slow down and reflect, individuation, and checking one's messaging to others [20]. Yager et al [16] suggest further "debiasing" strategies, such as what they call "early psychological immunization," that is, educating trainees about biases early in training and continuing to address them. They also recommend that clinicians practice "meta-cognitive" reflection by reviewing their attitudes, biases, and practices on an encounter-to-encounter basis.…”