Psychiatrists’ attitudes to antipsychotic depot injections (i): Preferences and choice

Abstract

Background:Antipsychotic depot injections can improve adherence compared to tablets. However, depot prescribing practices differ amongst psychiatrists. Previously, some clinicians perceived an “image” problem for typical antipsychotic depots. This study investigated psychiatrists’ attitudes and knowledge concerning antipsychotic depots (typical and atypical) in an era when patient choice is a pertinent issue.Method:Cross-sectional postal survey of consultant psychiatrists working in NorthWest England. A pre-existing questionnaire on clinicians’ attitudes and knowledge regarding depots was updated.Results:The sample comprised 102 consultant psychiatrists (response rate 102/143, 71%). Their use of depots over the past 5 years had: decreased (50%), not changed (27%), increased (23%). In a forced-choice selection of factors that would persuade them to use depots more, the factor cited as most important was ‘having more atypicals available in long-acting depot form’ (43%). Most regarded depots as being associated with better compliance (89%) and reduced relapse rates (98%) compared to oral medication but only 62% agreed that depots can be used for those with first episode psychosis. A significant minority (33%) believed patients always prefer to have oral medication instead of a depot. 68% believed that patients taking medication of their own free choice is more likely for oral than depot.Conclusions:During the last 5 years, overall depot prescribing rates have reduced. Most regarded depots as offering better adherence and reduced relapse rates but some remain concerned about the acceptability of depots to patients. These clinician concerns are important but, if extreme, could compromise medication choices offered to patients.

Antipsychotic prescribing of consultant forensic psychiatrists working in different levels of secure care with patients with schizophrenia

“…Haddad et al 21 report that 50% of psychiatrists said that their use of depot antipsychotics had reduced in the previous 5 years, and 23% said that their use had increased (the 5-year time-span included the introduction of second-generation depot agents). Despite 89% opining that depot administration was associated with better adherence, and 98% opining that depot administration was associated with reduced relapse rates, only 4% said that depot was their ‘first choice’ route of administration for patients requiring long-term treatment.…”