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. 2016 Apr;40(2):93-6.
doi: 10.1192/pb.bp.115.050708.

First-generation antipsychotics: not gone but forgotten

Claire R M Dibben  1 , Golam M Khandaker  2 , Benjamin R Underwood  3 , Christopher O'Loughlin  3 , Catherine Keep  1 , Louisa Mann  3 , Peter B Jones  2
Affiliations

First-generation antipsychotics: not gone but forgotten

Claire R M Dibben et al. BJPsych Bull. 2016 Apr.

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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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Training experience with first-generation antipsychotics (FGAs).
Fig. 2
Fig. 2
Trainee confidence regarding the use of oral first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs).
See this image and copyright information in PMC

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