Prescribers' nonadherence to treatment guidelines for schizophrenia when prescribing neuroleptics

Treatment guidelines are frequently not followed. The authors examined the neuroleptic prescribing practices of psychiatrists responsible for 47 patients with schizophrenia who were being treated at health centers of the Department of Veterans Affairs. For 22 of these patients, a medication change was indicated by guidelines previously endorsed by the prescriber; for 21 of these 22 patients, prescribers indicated that a change in neuroleptic would not be attempted; for 15 patients (71 percent), the reason given was the patient's refusal to change medication or the patient's noncompliance with medication treatment. The results suggest that patients' agreement with treatment guidelines should be taken into account in the evaluation of prescribers' use of such guidelines.