title: First-generation antipsychotics: not gone but forgotten.
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.
authors.affiliation: Norfolk and Suffolk NHS Foundation Trust, UK.
authors.forename: Claire R M
authors.initials: CR
authors.lastname: Dibben
authors.affiliation: University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK.
authors.forename: Golam M
authors.initials: GM
authors.lastname: Khandaker
authors.affiliation: Cambridgeshire and Peterborough NHS Foundation Trust, UK.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Underwood
authors.affiliation: Cambridgeshire and Peterborough NHS Foundation Trust, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Loughlin
authors.affiliation: Norfolk and Suffolk NHS Foundation Trust, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Keep
authors.affiliation: Cambridgeshire and Peterborough NHS Foundation Trust, UK.
authors.forename: Louisa
authors.initials: L
authors.lastname: Mann
authors.affiliation: University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones