title: Importance of open access to atypical antipsychotics for the treatment of schizophrenia and bipolar disorder: a European perspective.
abstract: OBJECTIVE
  To assess European psychiatrists' prescribing behaviour and their perceived need for access to a wide range of atypical antipsychotics for patients with schizophrenia and bipolar disorder.
  
  
  METHODS
  A blinded, internet survey of psychiatrists from the UK, Germany, Italy and the Netherlands occurred in 2007. Key inclusion criteria for psychiatrists: practising full time; practising for 5-35 years; prescribed atypical antipsychotics in prior 6 months to > or =20 patients with schizophrenia or bipolar disorder. Eligible psychiatrists selected records for four patients with schizophrenia or bipolar disorder for whom they prescribed > or =1 atypical antipsychotic since January 2004.
  
  
  RESULTS
  Survey response rates were: UK, 14.8% (n = 107); Germany, 9.6% (n = 104); Italy, 8.9% (n = 101) and the Netherlands, 3.7% (n = 51); 363 psychiatrists reported on 1442 patients. Psychiatrists perceived a greater difference among atypical antipsychotics as a class (mean, 5.1 on a 7-point scale [7 = 'highly differentiated']) but not selective serotonin reuptake inhibitors (mean, 3.6). On average, psychiatrists used 6.8 different atypical antipsychotics across their patients with schizophrenia and 4.4 across their patients with bipolar disorder, with 2.5 and 2.4 changes required following first-line treatment to stabilise therapy, respectively. The most common reason for switching medication was lack of efficacy. Psychiatrists reported that expected consequences for patients should access to atypical antipsychotics be restricted would include illness deterioration, non-adherence and hospitalisation.
  
  
  CONCLUSIONS
  Although this study is limited by potential selection biases, these data suggest that European psychiatrists tailor antipsychotic medications for patients with schizophrenia or bipolar disorder according to patients' needs and specific drug attributes.
authors.affiliation: Department of Psychiatry, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Altamura
authors.forename: D
authors.initials: D
authors.lastname: Armadoros
authors.forename: M
authors.initials: M
authors.lastname: Jaeger
authors.forename: R
authors.initials: R
authors.lastname: Kernish
authors.forename: J
authors.initials: J
authors.lastname: Locklear
authors.forename: H-P
authors.initials: HP
authors.lastname: Volz
mesh_terms: D014150:Antipsychotic Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003625:Data Collection; D005060:Europe; D006297:Health Services Accessibility; D006801:Humans; D008499:Medical Records; D011570:Psychiatry; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome; D000078329:Workforce
chemical_list: D014150:Antipsychotic Agents