Antipsychotic use in a resource-limited setting: Findings in an Eastern Cape psychiatric hospital

BACKGROUND: Second-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. AIMS: This 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. METHOD: The 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. RESULTS: Of 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. CONCLUSION: SGAs, 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.