title: Antipsychotic therapeutic drug monitoring: psychiatrists' attitudes and factors predicting likely future use.
abstract: BACKGROUND
  This study aimed to explore predictive factors for future use of therapeutic drug monitoring (TDM) and to further examine psychiatrists' current prescribing practices and perspectives regarding antipsychotic TDM using plasma concentrations.
  
  
  METHODS
  A cross-sectional study for consultant psychiatrists using a postal questionnaire was conducted in north-west England. Data were combined with those of a previous London-based study and principal axis factor analysis was conducted to identify predictors of future use of TDM.
  
  
  RESULTS
  Most of the 181 participants (82.9%, 95% confidence interval 76.7-87.7%) agreed that 'if TDM for antipsychotics were readily available, I would use it'. Factor analysis identified five factors from the original 35 items regarding TDM. Four of the factors significantly predicted likely future use of antipsychotic TDM and together explained 40% of the variance in a multivariate linear regression model. Likely future use increased with positive attitudes and expectations, and decreased with potential barriers, negative attitudes and negative expectations. Scientific perspectives of TDM and psychiatrist characteristics were not significant predictors.
  
  
  CONCLUSIONS
  Most senior psychiatrists indicated that they would use antipsychotic TDM if available. However, psychiatrists' attitudes and expectations and the potential barriers need to be addressed, in addition to the scientific evidence, before widespread use of antipsychotic TDM is likely in clinical practice.
authors: Institute of Psychiatry, Psychology and Neuroscience, London, UK.
authors: Suzanne
authors: S
authors: Law
authors: Greater Manchester West NHS Foundation Trust, Manchester, UK.
authors: Peter M
authors: PM
authors: Haddad
authors: University of Manchester, Manchester, UK.
authors: Imran B
authors: IB
authors: Chaudhry
authors: University of Manchester, Manchester, UK.
authors: Nusrat
authors: N
authors: Husain
authors: Manchester Mental Health and Social Care Trust, Manchester, UK.
authors: Richard J
authors: RJ
authors: Drake
authors: Institute of Psychiatry, Psychology and Neuroscience, London, UK.
authors: Robert J
authors: RJ
authors: Flanagan
authors: Institute of Psychiatry, Psychology and Neuroscience, London, UK.
authors: Anthony S
authors: AS
authors: David
authors: Institute of Psychiatry, King's College London, Box 68, 16 DeCrespigny Park, London SE5 8AF, UK.
authors: Maxine X
authors: MX
authors: Patel
keywords: antipsychotics; attitude; dose; plasma concentration; schizophrenia; therapeutic drug monitoring