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BMC Psychiatry. 2012; 12: 27.
Published online Mar 30, 2012. doi:  10.1186/1471-244X-12-27
PMCID: PMC3337226
Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?
Sameer Jauhar,corresponding author1 Sinan Guloksuz,2 Olivier Andlauer,3 Greg Lydall,4 João Gama Marques,5 Luis Mendonca,6 Iolanda Dumitrescu,7 Costin Roventa,8 Nele De Vriendt,9 Jeroen Van Zanten,10 Florian Riese,11 Izu Nwachukwu,12 Alexander Nawka,13 Raphael Psaras,14 Neil Masson,15 Rajeev Krishnadas,16 and Umberto Volpe17, European Federation of Psychiatric Trainees' Research Group
1Chair, EFPT Research Group, Sackler Institute for Psychobiological Research, Institute of Neurological Sciences, Southern General Hospital, 2nd Floor 1345 Govan Rd, Glasgow G51 4TF, UK
2Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616, 6200, MD Maastricht, The Netherlands
3EA 481 Laboratoire de Neurosciences, University of Franche-Comte, and Department of Clinical Psychiatry, University Hospital of Besancon, F-25030 Besancon, France
4Department of Molecular Psychiatry, Mental Health Sciences, University College London, London W1T 4JF, UK
5Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry Educator at Faculdade de Medicina de Lisboa, Lisboa, Portugal
6Centro Hospit alar Psiquiatrico de Lisboa, Lisboa, Portugal
7Hospital Pr Dr Al Obregia, Bucharest, Romania
8Hospital Pr Dr Al Obregia, Bucharest, Romania
9Openbaar Psychiatrisch Zorgcentrum Rekem, Rekem, Belgium
10Department of Psychiatry, Neuroscience Campus Amsterdam, VU Medical Center, Amsterdam, the Netherlands
11Psychiatric University Hospital Zurich, Zurich, Switzerland
12St Vincent's University Hospital, Dublin 4, Ireland
13Department of Psychiatry, 1st Faculty of Medicine, Charles University in Prague, Ke Karlovu 11, 128 00 Praha 2, Prague, Czech Republic
141st Psychiatric Department, Psychiatric Hospital of Attica, 374, Athinon avenue, 12462 Athens, Greece
15Wishaw Resource Centre, 48-54 Roberts Street, Wishaw, ML2 7JF, UK
16Sackler Institute for Psychobiological Research,, Institute of Neurological Sciences, Southern General Hospital, 2nd Floor 1345 Govan Rd, Glasgow G514TF, UK
17Department of Psychiatry, University of Naples - SUN Largo Madonna delle Grazie, 80138 Napoli, Italy
corresponding authorCorresponding author.
Sameer Jauhar: sameerjauhar/at/gmail.com; Sinan Guloksuz: sguloksuz/at/yahoo.com; Olivier Andlauer: olivier.andlauer/at/gmail.com; Greg Lydall: greg.lydall/at/gmail.com; João Gama Marques: anthropophobe/at/hotmail.com; Luis Mendonca: lpmendonca/at/gmail.com; Iolanda Dumitrescu: jolly_marc/at/yahoo.com; Costin Roventa: croventa/at/yahoo.com; Nele De Vriendt: nele.devriendt/at/opzcrekem.be; Jeroen Van Zanten: jvanzanten/at/rkz.nl; Florian Riese: florian.riese/at/bli.uzh.ch; Izu Nwachukwu: izunwachukwu/at/hotmail.com; Alexander Nawka: nawka/at/seznam.cz; Raphael Psaras: raphaelpsaras/at/yahoo.gr; Neil Masson: neil_masson/at/doctors.org.uk; Rajeev Krishnadas: Rajeev.Krishnadas/at/glasgow.ac.uk; Umberto Volpe: umberto.volpe/at/unina2.it
Received May 19, 2011; Accepted March 30, 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
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