Psychiatrists' Cognitive and Affective Biases and the Practice of Psychopharmacology: Why Do Psychiatrists Differ From One Another in How They View and Prescribe Certain Medication Classes?
Abstract
Cognitive and affective biases impact clinical decision-making in general medicine. This article explores how such biases might specifically affect psychiatrists' attitudes and prescribing patterns regarding two medication classes (stimulants and benzodiazepines) and addresses related issues. To supplement personal observations, selective PubMed narrative literature searches were conducted using relevant title/abstract terms, followed by snowballing for additional pertinent titles. Acknowledging that there are many more types of biases, we describe and use clinical vignettes to illustrate 17 cognitive and affective biases that might influence clinicians' psychopharmacological practices. Factors possibly underlying these biases include temperamental differences and both preprofessional and professional socialization. Mitigating strategies can reduce the potentially detrimental impacts that biases may impose on clinical care. How extensively these biases appear, how they differ among psychiatrists and across classes of medication, and how they might be most effectively addressed to minimize harms deserve further systematic study.
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Some clinicians may be influenced by cognitive and affective biases and/or concerns regarding social or professional approbation, which might lead to denial.
“Some may be influenced by a host of cognitive and affective biases and/or concerns regarding social or professional approbation [25–27], which might lead some clinicians to forms of denial, in which they essentially avoid facing the realities of these terminal states.”
Cites
Tversky, A., & Kahneman, D. (1974) · Science · doi:10.1126/science.185.4157.1124 · Cited by 28,810 · see citing works
Implicit bias in healthcare professionals: a systematic review
FitzGerald, C., & Hurst, S. (2017) · BMC Medical Ethics · doi:10.1186/s12910-017-0179-8 · Cited by 2,398 · see citing works
The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them
Croskerry, P. (2003) · Academic Medicine · doi:10.1097/00001888-200308000-00003 · Cited by 1,675 · see citing works
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., et al. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.01.022 · Cited by 1,545 · see citing works
Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities
Chapman, E., Kaatz, A., & Carnes, M. (2013) · Journal of general internal medicine · doi:10.1007/s11606-013-2441-1 · Cited by 1,167 · see citing works
Cognitive biases associated with medical decisions: a systematic review
Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0377-1 · Cited by 1,001 · see citing works
Achieving quality in clinical decision making: cognitive strategies and detection of bias
Croskerry, P. (2002) · Academic Emergency Medicine · doi:10.1197/aemj.9.11.1184 · Cited by 938 · see citing works
Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias
Croskerry, P. (2002) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2002.tb01574.x · Cited by 938 · see citing works
Cognitive debiasing 1: origins of bias and theory of debiasing
Croskerry, P., Singhal, G., & Mamede, S. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001712 · Cited by 605 · see citing works
Cognitive debiasing 2: impediments to and strategies for change
Croskerry, P., Singhal, G., & Mamede, S. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001713 · Cited by 419 · see citing works
Checklists to Reduce Diagnostic Errors
Ely, J. W., Graber, M. L., & Croskerry, P. (2011) · Academic Medicine · doi:10.1097/acm.0b013e31820824cd · Cited by 366 · see citing works
Patterns in Outpatient Benzodiazepine Prescribing in the United States
Agarwal, S. D., & Landon, B. E. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.7399 · Cited by 319 · see citing works
Treatment strategies for ADHD: an evidence-based guide to select optimal treatment
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019) · Molecular Psychiatry · doi:10.1038/s41380-018-0116-3 · Cited by 303 · see citing works
Royce, C. S., Hayes, M. M., & Schwartzstein, R. M. (2019) · Academic Medicine · doi:10.1097/acm.0000000000002518 · Cited by 242 · see citing works
Following the Script: How Drug Reps Make Friends and Influence Doctors
Fugh‐Berman, A., & Ahari, S. B. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040150 · Cited by 235 · see citing works
Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016
Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, D. Y., Caggiano, J. F., Nichols, S. D., & McCall, K. L. (2018) · PLOS ONE · doi:10.1371/journal.pone.0206100 · Cited by 170 · see citing works
Institutional academic industry relationships.
Campbell, E., Weissman, J., Ehringhaus, S., Rao, S. R., Moy, B., Feibelmann, S., & Goold, S. (2007) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.298.15.1779 · Cited by 169 · see citing works
NOISE: How to overcome the high, hidden cost of inconsistent decision making
Kahneman, D. J., Rosenfield, A. M., Gandhi, L., & Blaser, T. (2016) · Harvard business review · Cited by 156 · see citing works
Parasuraman, R., & Jiang, Y. (2011) · NeuroImage · doi:10.1016/j.neuroimage.2011.04.040 · Cited by 145 · see citing works
Akiskal, K. K., Savino, M., & Akiskal, H. S. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.08.003 · Cited by 94 · see citing works
Board, A. R., Guy, G., Jones, C. M., & Hoots, B. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108297 · Cited by 79 · see citing works
Why are benzodiazepines not yet controlled substances?
Moore, N., Pariente, A., & Bégaud, B. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.2190 · Cited by 62 · see citing works
Clinicians’ Cognitive and Affective Biases and the Practice of Psychotherapy
Yager, J., Kay, J., & Kelsay, K. (2021) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20200025 · Cited by 56 · see citing works
Self-citationFiscella, K. A., Epstein, R. M., Griggs, J. J., Marshall, M., & Shields, C. G. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257794 · Cited by 56 · see citing works
Benzodiazepines: it's time to return to the evidence
Silberman, E., Balon, R., Starcevic, V., Shader, R., Cosci, F., Fava, G. A., Nardi, A. E., Salzman, C., & Sonino, N. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2020.164 · Cited by 54 · see citing works
Key opinion leaders: where they come from and how that affects the drugs you prescribe
Meffert, J. J. (2009) · Dermatologic Therapy · doi:10.1111/j.1529-8019.2009.01240.x · Cited by 51 · see citing works
How to Identify, Understand, and Unlearn Implicit Bias in Patient Care.
Edgoose, J. Y. C., Quiogue, M., & Sidhar, K. (2019) · PubMed · Cited by 43 · see citing works
Radović, A., Farris, C. A., Reynolds, K. A., Reis, E. C., Miller, E. P., & Stein, B. D. (2013) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000008 · Cited by 39 · see citing works
Clinicians’ Attitudes Toward the Use of Long-Acting Injectable Antipsychotics
Samalin, L., Charpeaud, T., Blanc, O., Heres, S., & Llorca, P. (2013) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31829829c4 · Cited by 29 · see citing works
Alkhateeb, F. M., Khanfar, N. M., & Loudon, D. L. (2009) · Services Marketing Quarterly · doi:10.1080/15332960903408575 · Cited by 28 · see citing works
Pichon, S., Rieger, S. W., & Vuilleumier, P. O. (2012) · NeuroImage · doi:10.1016/j.neuroimage.2012.06.004 · Cited by 27 · see citing works
Professionals’ attitudes towards the use of cognitive enhancers in academic settings
Ram, S., Russell, B., Kirkpatrick, C. M. J., Stewart, K., Scahill, S. L., Henning, M. A., Curley, L. E., & Hussainy, S. Y. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241968 · Cited by 26 · see citing works
Kovshoff, H., Vrijens, M., Thompson, M. J. J., Yardley, L., Hodgkins, P., Sonuga-Barke, E. J. S., & Danckaerts, M. (2013) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-013-0393-y · Cited by 22 · see citing works
Cotes, R. O., Janjua, A. U., Broussard, B., Lazris, D., Khan, A., Jiao, Y., Kopelovich, S. L., & Goldsmith, D. R. (2021) · Community Mental Health Journal · doi:10.1007/s10597-021-00847-0 · Cited by 21 · see citing works
Physicians' attitudes toward the legalization of marijuana use.
Linn, L. S., Yager, J., & LEAKE, B. D. (1989) · PubMed · Cited by 19 · see citing works
Self-citationDeterminants of physicians’ prescribing behaviour of methylphenidate for cognitive enhancement
Ponnet, K. S., Wouters, E., Hal, G. F. V., Heirman, W., & Walrave, M. (2013) · Psychology Health & Medicine · doi:10.1080/13548506.2013.802361 · Cited by 19 · see citing works
A Narrative Review of Slow Medicine Outcomes
Marx, R., & Kahn, J. G. (2021) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2021.06.210137 · Cited by 17 · see citing works
Vaddadi, S., Czelatka, N., Gutierrez, B. D., Maddineni, B., Torres-Teran, C. D., Tron, D. N., McCall, K. L., & Piper, B. J. (2021) · PeerJ · doi:10.7717/peerj.12619 · Cited by 17 · see citing works
ZULLINO, D. F., Kurt, H., Broers, B., Drexler, A., Graf, H.-P., Khazaal, Y., Blocʼh, Y. L., Pegard, B.-L., Borgeat, F., & Preisig, M. (2007) · Community Mental Health Journal · doi:10.1007/s10597-007-9103-x · Cited by 16 · see citing works
Meixner, F., Montag, C., & Herbert, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00068 · Cited by 16 · see citing works
Professional vs. Personal Factors Related to Physicians' Attitudes toward Drug Testing
Linn, L. S., Yager, J., & LEAKE, B. D. (1990) · Journal of Drug Education · doi:10.2190/lf0n-cwvl-0yyu-8unr · Cited by 14 · see citing works
Self-citationMurshid, M. A., Mohaidin, Z., & Zayed, M. (2019) · Pharmacy Practice · doi:10.18549/pharmpract.2019.4.1616 · Cited by 14 · see citing works
Eden, A. S., Dehmelt, V., Bischoff, M., Zwitserlood, P., Kugel, H., Roesmann, K., Zwanzger, P., & Dobel, C. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01226 · Cited by 12 · see citing works
Variations in Physician Attitudes Regarding ADHD and Their Association With Prescribing Practices
Sheldrick, R. C., Leslie, L. K., Rodday, A. M., Parsons, S. K., Saunders, T. S., & Wong, J. B. (2012) · Journal of Attention Disorders · doi:10.1177/1087054712461689 · Cited by 11 · see citing works
Learning positive social information reduces racial bias as indexed by N400 response
Brusa, A., Pesič, A., & Proverbio, A. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260540 · Cited by 10 · see citing works
Attending a Biopsychosocially Focused Buprenorphine Training Improves Clinician Attitudes
Russell, H. A., Smith, B., Sanders, M., & Loomis, E. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.639826 · Cited by 8 · see citing works
Genetic Variance in Homophobia: Evidence from Self- and Peer Reports
Zapko–Willmes, A., & Kandler, C. (2017) · Behavior Genetics · doi:10.1007/s10519-017-9884-9 · Cited by 6 · see citing works
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1 of the 48 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Yager, J., Gaudiani, J. L., & Treem, J. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00659-x · Cited by 24 · see citing works
Self-citationIm, D. S., & Tamarelli, C. M. (2023) · Advances in Medical Education and Practice · doi:10.2147/amep.s398196 · Cited by 19 · see citing works
Responding to the Shrinking Scope of Psychiatrists’ Prescribing Practices
Balon, R., Morreale, M. K., Aggarwal, R., Coverdale, J., Beresin, E. V., Louie, A. K., Guerrero, A. P. S., & Brenner, A. M. (2022) · Academic Psychiatry · doi:10.1007/s40596-022-01705-1 · Cited by 2 · see citing works
Psychotropes et personnalité borderline : prescrire, ne pas prescrire, déprescrire ?
Berna, F. S., Musso, M., Weibel, S., & Brunn, M. (2026) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2026.03.011 · Cited by 1 · see citing works
Medical intelligence vs. artificial intelligence — How psychiatrists arrive at treatment algorithms
Vogel, D. H. V., & Kambeitz, J. P. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117002
Im, D. S., & Tamarelli, C. M. (2026) · Advances in Medical Education and Practice · doi:10.2147/amep.s597099
Jameson, A., Fylan, B., Sagoo, G. S., Dalton, C., Cardno, A. G., Sohal, J., Bristow, G. C., & McLean, S. L. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1837118
- Authors
- Yager, J., Ritvo, A. D., & MacPhee, E. R.
- Affiliations
- University of Colorado Anschutz (US)
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2022-06-08
- Volume
- 210
- Issue
- 10
- Pages
- 729-735
- ISSN
- 0022-3018 (ISSN-L)
- 1539-736X
- OpenAlex
- W4281616837
- Cited by
- 7
- References
- 48
- Citations by year
- 2026: 4 · 2023: 1 · 2022: 2
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Keywords
- cognitive biases, clinical decision-making, psychopharmacology, prescribing patterns, psychiatrists, stimulants, benzodiazepines, clinician attitudes, professional socialization, bias mitigation
- MeSH terms
- Benzodiazepines, Cognition, Humans, Psychiatry, Psychopharmacology, Bias
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