Psychological medicine. Psychotropic drugs in general practice.

Abstract

Earlier articles in this series have examined the indications for prescribing in a wide range of diseases and for defined prob lems in the hospital setting and in general practice. They have highlighted the side effects of most relevance to the patient and to try to repeat or even summarize this information would be regarded as unnecessary. My intention is to focus on three selected topics, each of which has a broader relevance to pre scribing in general practice than might appear on the surface. These are: the variation in use of different hypnotic prepara tions by general practitioners; the range of the individual doc tor's pharmacopoeia; and the hidden risks of prescribing psy chotropic drugs. But before discussing these topics a brief consideration of some of the implications of the widely different published estimates of the incidence of psychological illness in patients consulting general practitioners is necessary. Psycho logical illness is usually reported as the cause of approximately 5% of consultations in general practice. This figure is, how ever, an average of many widely divergent figures. Shepherd et al. have shown that individual doctors may attribute up to half of their consultations to psychological illness.l Some of this difference is due to prevalent psychosocial factors or as pects of the doctor's personality as seen by his patients, but a large variation remains which appears to reflect different doctors' perceptions of whether the nature of the illnesses is principally physical or psychological. The issues discussed in this article are not the doctor's ability to recognize the non-physical elements of illness but