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Open Access Highly Accessed Research article

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

Sameer Jauhar1*, Sinan Guloksuz2, Olivier Andlauer3, Greg Lydall4, João Gama Marques5, Luis Mendonca6, Iolanda Dumitrescu7, Costin Roventa8, Nele De Vriendt9, Jeroen Van Zanten10, Florian Riese11, Izu Nwachukwu12, Alexander Nawka13, Raphael Psaras14, Neil Masson15, Rajeev Krishnadas16, Umberto Volpe17 and European Federation of Psychiatric Trainees' Research Group

Author Affiliations

1 Chair, EFPT Research Group, Sackler Institute for Psychobiological Research, Institute of Neurological Sciences, Southern General Hospital, 2nd Floor 1345 Govan Rd, Glasgow G51 4TF, UK

2 Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616, 6200, MD Maastricht, The Netherlands

3 EA 481 Laboratoire de Neurosciences, University of Franche-Comte, and Department of Clinical Psychiatry, University Hospital of Besancon, F-25030 Besancon, France

4 Department of Molecular Psychiatry, Mental Health Sciences, University College London, London W1T 4JF, UK

5 Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry Educator at Faculdade de Medicina de Lisboa, Lisboa, Portugal

6 Centro Hospit alar Psiquiatrico de Lisboa, Lisboa, Portugal

7 Hospital Pr Dr Al Obregia, Bucharest, Romania

8 Hospital Pr Dr Al Obregia, Bucharest, Romania

9 Openbaar Psychiatrisch Zorgcentrum Rekem, Rekem, Belgium

10 Department of Psychiatry, Neuroscience Campus Amsterdam, VU Medical Center, Amsterdam, the Netherlands

11 Psychiatric University Hospital Zurich, Zurich, Switzerland

12 St Vincent's University Hospital, Dublin 4, Ireland

13 Department of Psychiatry, 1st Faculty of Medicine, Charles University in Prague, Ke Karlovu 11, 128 00 Praha 2, Prague, Czech Republic

14 1st Psychiatric Department, Psychiatric Hospital of Attica, 374, Athinon avenue, 12462 Athens, Greece

15 Wishaw Resource Centre, 48-54 Roberts Street, Wishaw, ML2 7JF, UK

16 Sackler Institute for Psychobiological Research,, Institute of Neurological Sciences, Southern General Hospital, 2nd Floor 1345 Govan Rd, Glasgow G514TF, UK

17 Department of Psychiatry, University of Naples - SUN Largo Madonna delle Grazie, 80138 Napoli, Italy

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BMC Psychiatry 2012, 12:27  doi:10.1186/1471-244X-12-27

Published: 30 March 2012

Abstract

Background

Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making.

Methods

Cross-sectional, semi-structured questionnaire-based study.

Results

Of the 726 respondents (response rate = 66%), the majority chose second-generation antipsychotics (SGAs) if they had to prescribe it for themselves (n = 530, 93%) or for their patients (n = 546, 94%). The main factor influencing choice was perceived efficacy, 84.8% (n = 475) of trainees stating this was the most important factor for the patient, and 77.8% (n = 404) stating this was the most important factor for their own treatment. Trainees with knowledge of trials questioning use of SGAs (CATIE, CUtLASS, TEOSS) were more likely to choose second-generation antipsychotics than those without knowledge of these trials (χ2 = 3.943; p = 0.047; O.R. = 2.11; 95% C.I. = 1.0-4.48). Regarding psychotherapy, cognitive behavioural therapy (CBT) was the most popular choice for self (33.1%; n = 240) and patient (30.9%; n = 224). Trainees were significantly more likely to prefer some form of psychotherapy for themselves rather than patients (χ2 = 9.98; p < 0,002; O.R. = 1.54; 95% CIs = 1.18-2.0).

Conclusions

Trainees are more likely to choose second-generation antipsychotic medication for patients and themselves. Despite being aware of evidence that suggests otherwise, they predominantly base these choices on perceived efficacy.

Keywords:
Antipsychotics; Drug therapy; Psychiatry trainees; Evidence-based medicine; Decision-making; Efficacy; Psychotherapy; Psychosis; Treatment