Abstract

BackgroundSecond-generation antipsychotics (SGAs) are commonly prescribed despite the fact that large, naturalistic studies have failed to show superior efficacy and tolerability when compared with first-generation antipsychotics (FGAs). In addition to this, the availability of SGAs in the South African public health sector is limited because of higher acquisition costs. Therefore, judicious use of FGAs, which are affordable and more widely available, should be considered.AimsThis study aimed to (1) determine how frequently patients are switched from an FGA to an SGA in an acute psychiatric hospital in the Eastern Cape, (2) determine reasons for switching and (3) compare the profiles of the switch group to the non-switch group.MethodThe study is a cross-sectional survey conducted as a retrospective chart review at a psychiatric hospital in the Eastern Cape over a study period of 2 months. The demographics, diagnostic data, antipsychotic drug used and whether a switch from an FGA to an SGA took place were recorded using a data collection document. The sample included 169 patients.ResultsOf the 169 patients, 125 (74%) were initiated on an FGA and 44 (26%) on an SGA on admission. Of the 125 patients who were initiated on an FGA, 43 (34%) were switched to an SGA during the course of the admission. Therefore, 87 (51%) participants were discharged on an SGA. The main reasons for switching were the emergence of extrapyramidal side-effects (EPSE) (63%) followed by lack of efficacy (19%). The only statistically significant difference between the switch and non-switch groups was that the switch group was on average younger than the non-switch group.ConclusionSGAs, with the exception of clozapine, have not been proven to be superior to FGAs. Although FGAs are more prone to cause EPSE, SGAs carry significant risks of their own. FGAs are also more freely available and cost effective in South-Africa. Despite these facts the prescribing of and switching to SGAs remain prevalent in our setting with a switch rate of 34% and more than half of our patients being discharged on SGAs.

Highlights

  • Antipsychotic medications are used to manage the symptoms of several psychiatric disorders.[1]

  • These agents are commonly divided into two classes: first-generation antipsychotics (FGAs), referred to as ‘typical antipsychotics’, and second-generation antipsychotics (SGAs), known as ‘atypical antipsychotics’

  • In the group of patients who were initiated on an FGA (n = 125), 43 patients (34%) were switched to an SGA while 82 (66%) remained on an FGA

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Summary

Introduction

Antipsychotic medications are used to manage the symptoms of several psychiatric disorders.[1] These agents are commonly divided into two classes: first-generation antipsychotics (FGAs), referred to as ‘typical antipsychotics’, and second-generation antipsychotics (SGAs), known as ‘atypical antipsychotics’.2. The former show a high affinity for dopamine 2 (D2) receptors, while the latter are dopamine-serotonin antagonists with a high affinity for serotonin 2A (5HT-2A) receptors.[2]. The introduction of FGAs changed the way that patients with psychotic disorders were managed.[1] Following the introduction of the early antipsychotics, clinicians began noticing signs of parkinsonism in patients treated with these drugs. Judicious use of FGAs, which are affordable and more widely available, should be considered

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