A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Yukako Nakagami, Kohei Hayakawa, Toru Horinouchi, Victor Pereira-Sanchez, Marcus P.J. Tan, Seon Cheol Park, Yong Chon Park, Seok Woo Moon, Tae Young Choi, Ajit Avasthi, Sandeep Grover, Roy Abraham Kallivayalil, Yugesh Rai, Mohammadreza Shalbafan, Pavita Chongsuksiri, Pichet Udomratn, Samudra T. Kathriarachchi, Yu Tao Xiang, Kang Sim, Afzal JavedMian Yoon Chong, Chay Hoon Tan, Shih Ku Lin, Toshiya Inada, Toshiya Murai, Shigenobu Kanba, Norman Sartorius, Naotaka Shinfuku, Takahiro A. Kato

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objective Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate. Methods We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. Results The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). Conclusion Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

Original languageEnglish
Pages (from-to)1058-1067
Number of pages10
JournalPsychiatry Investigation
Issue number11
Publication statusPublished - Nov 2021

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Biological Psychiatry


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