[New antipsychotics in the treatment of schizophrenia. A European survey]

Abstract

Atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine, sertindole) make up a much larger proportion of the prescriptions for antipsychotic medications in the United States than in Europe. It is certain that these atypical neuroleptics are not all available throughout Europe; nonetheless the size of the disparity reveals certain tendencies in the different nations. In an attempt to identify the reasons for the lesser usage of the new antipsychotics in Europe, a telephone survey was conducted with 686 psychiatrists in 9 countries. This opinion survey was intended to identify, using open-ended questions and multiple choice, the reasons for which practitioners have or have not used the new antipsychotics; their perceived advantages and disadvantages in comparison with typical antipsychotics; and the hindrances in prescribing them. The results revealed that the new antipsychotics have a positive image with psychiatrists: whereas they estimate the proportion of their patients using the new antipsychotics to be at 50% (an amount larger than the objective European amounts), more than 80% of psychiatrists say they would be ready to use them more frequently if certain problems were overcome. Significant obstacles related to the product are the cost and the lack of a depot formulation; two hindrances with respect to the patient are the difficulty in using them in an emergency situation, and the fear of destabilizing a patient who is well-controlled with a classical treatment. The discussion re-addresses these points, using literature relevant to the products and the patients. The European data, which are often homogeneous, are discussed as a whole, with the exception of certain characteristics that are specific to an individual country. French psychiatrists, notably, serve as an exception, because they describe themselves as being more restrained in their prescriptions because of the lack of a depot formulation rather than because of the cost of the product.