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First-generation antipsychotics: not gone but forgotten

  • Claire R. M. Dibben (a1), Golam M. Khandaker (a2) (a3), Benjamin R. Underwood (a3), Christopher O'Loughlin (a3), Catherine Keep (a1), Louisa Mann (a3) and Peter B. Jones (a2) (a3)...
Abstract
Aims and method

To identify training needs of the next generation of psychiatrists and barriers in prescribing first-generation antipsychotics (FGAs). We have surveyed psychiatry trainees in East Anglia with regard to their training experience, knowledge and attitudes to the use of oral FGAs as regular medication.

Results

Two-thirds of trainees were aware that first- and second-generation antipsychotics (SGAs) have similar efficacy, and a similar proportion perceived the older drugs to have more or ‘stronger’ side-effects. Lack of training experience was noted as the second leading concern for prescribing FGAs. A quarter of trainees received no training exposure to the older drugs and two-thirds had never initiated these drugs themselves. Although nearly 90% of trainees felt confident about initiating an oral SGA as a regular medication, only about 40% felt confident with FGAs (P<0.001).

Clinical implications

The survey highlights worrying gaps in training. FGAs can be used effectively, minimising side-effects, by careful dose titration, avoiding antipsychotic polypharmacy, high-dose, and high-potency drugs, thus ensuring they are not lost to future generations of psychiatrists.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Claire Dibben (Claire.Dibben@nsft.nhs.uk)
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Declaration of interest

P.B.J. has received an honorarium from Roche for taking part in an advisory board on education about schizophrenia for psychiatrists; this he donated to his department.

Footnotes
References
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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First-generation antipsychotics: not gone but forgotten

  • Claire R. M. Dibben (a1), Golam M. Khandaker (a2) (a3), Benjamin R. Underwood (a3), Christopher O'Loughlin (a3), Catherine Keep (a1), Louisa Mann (a3) and Peter B. Jones (a2) (a3)...
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