The influence of social capital and evidence-based orientation on psychiatrists’ attitudes toward antipsychotic polypharmacy in schizophrenia

Despite showing no superiority over monotherapy, antipsychotic polypharmacy (APP) is used in up to half of schizophrenia patients. However, no standardized instrument currently exists to systematically evaluate clinicians' attitudes toward APP and the role of social capital, underscoring the need for such a tool. This study presents the development of a scale designed to measure psychiatrists' attitudes toward APP. It further investigates factors associated with more evidence-based medicine (EBM) attitudes, including social capital, general EBM orientation, and demographics. The Knowledge and Attitude scale toward Antipsychotic Polypharmacy in Schizophrenia (KAAPS) was developed and pre-tested. The questionnaire also incorporated measures of professional social capital, the Evidence-Based Practice Attitude Scale (Aaron et al., 2004), and demographic variables. The web-based survey was distributed to 1618 Belgian psychiatrists and psychiatry residents. Psychometric characteristics of the KAAPS were assessed to ensure validity and factors potentially associated with the KAAPS score were tested. Among 152 complete respondents, the mean KAAPS score was 55.8 out of 102 (SD = 13.7), indicating a tendency toward evidence-based knowledge and attitudes. Factors associated with lower evidence-based attitudes included higher professional social capital (β= -0.254, p < 0.01), working in non-multidisciplinary settings (β= -9.1435, p < 0.001), belonging to the Dutch-speaking community (β= -5.133, p = 0.036) and higher APP prescription rates (β= -0.194, p < 0.001). Practicing cognitive behavioural therapy (β = 6.366, p < 0.01) was associated with higher KAAPS scores, whereas intrinsic EBM orientation showed no significant association (β = 0.231, p = 0.083). Applied across diverse populations or countries, the KAAPS scale may help identify clinical circumstances in which antipsychotic polypharmacy is most frequently considered appropriate, thereby informing targeted educational interventions and supporting the evaluation of implementation strategies. Incorporating social network dynamics into these approaches, given the influence of social capital on psychiatrists' attitudes toward antipsychotic polypharmacy, may further contribute to reducing inappropriate prescribing.