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A study titled «Prescription of psychotropic drugs by non-psychiatrist specialists in Morocco: Current practices and educational needs» was published in the peer-reviewed BMC Medical Education journal. Nine researchers from various Moroccan universities conducted the study to describe the knowledge and practices of non-psychiatrists in prescribing psychotropic medications and assess their training needs.
The research took place from September 1 to October 15, 2021, in three Moroccan health facilities and involved private practitioners in Kenitra. The researchers surveyed 150 non-psychiatrist physicians about their knowledge, current practices, and training needs related to prescribing psychiatric medications.
The majority of participants (92%) received their medical education in Morocco. Of the 150 surveyed, 105 (70%) were medical specialists, and 45 (30%) were surgeons. Around half (48%) worked in the private sector, while 31.3% had more than 20 years of professional experience.
Knowledge gaps and training needs
The study revealed several gaps in knowledge among participants. Most were unaware of the recommended treatment duration for depressive disorders (61.3%) and the proper treatment duration of insomnia with hypnotics (81.3%). Additionally, 82% of participants were unaware that sertraline can be safely prescribed to elderly patients, and 89.3% did not know it is safe for use during pregnancy.
Nearly half of the participants (46%) reported they had never prescribed psychotropic drugs, and 43.3% said they prescribed them less than once a week. A significant portion (22.7%) did not feel comfortable prescribing psychotropic drugs, while only 18.6% expressed confidence in doing so. Anxiolytics were the most commonly prescribed psychotropic drugs, accounting for 30.7% of prescriptions, with anxiety (35.3%), insomnia (34.7%), and depression (31.3%) being the most common reasons for prescribing them.
Most participants (72%) reported receiving some clinical training in psychiatry, and 74.7% were satisfied with the undergraduate training in psychiatry, while 7.3% were dissatisfied. However, only 11.3% of participants took part in at least one CME training in psychiatry in the last two years. Still, 54.7% expressed interest in expanding their knowledge of prescribing psychotropic drugs, with workshops and masterclasses (30%), grand rounds (26%), and articles and newsletters (24%) as preferred training methods.
In terms of training preferences, 40% of participants preferred trainings in psychotropic drug prescription related to their specialty, 26% preferred general training, and 34% were not interested in receiving further training.
Risks of underprescribing
The study highlighted that many non-psychiatrist physicians lacked knowledge in managing common psychiatric disorders. This knowledge gap can have serious consequences, potentially leading to improper prescribing practices, which could result in side effects, complications, prolonged patient suffering, or even worsening symptoms.
The most commonly prescribed psychotropic medications by non-psychiatrists were anxiolytics and antidepressants, reflecting the high prevalence of depressive and anxiety disorders in Morocco.
The study stressed that, given Morocco's shortage of mental health professionals, improving psychiatry training for non-psychiatrists could enhance the management of psychiatric disorders and reduce the need for specialist referrals. Such training could also help non-psychiatrists better recognize the psychological manifestations of medical conditions and understand the interactions between psychiatric medications and other treatments.
A 2005 national study revealed that mental health disorders are prevalent in Morocco, with 40.1% of the population over the age of 15 suffering from at least one psychiatric disorder, with depressive disorders (26.5%) and anxiety disorders (9.3%) being the most common.
Mental health care in Morocco is provided through 83 primary healthcare facilities and psychiatric units in both public and private hospitals. However, with only 428 psychiatrists, equivalent to 1.17 psychiatrists per 100,000 citizens (as of 2020), access to psychiatric care is limited. Cultural factors also play a role, as patients often present psychological issues as physical symptoms due to the stigma surrounding mental illness, causing them to seek treatment from non-psychiatrist specialists first.
