Antipsychotic prescribing choices in patients with First Episode Psychosis

INTRODUCTION: As all first line options in treating First Episode Psychosis (FEP) are similarly effective there is a consensus among prescribing guidelines that clinicians and patients should consider side-effect profile as the ‘driver’ of initial choice of antipsychotic. Anecdotally it has been observed that different care teams prescribe particular medications preferentially. OBJECTIVES: To evaluate the patterns of antipsychotic prescribing in patients with FEP at the time of initial treatment and over the first year with the Early Intervention Service (EIS). METHODS: Medical records of all patients who had completed 1 year of follow-up with EIS in Sussex Partnership Foundation Trust (n=274) were reviewed. The first antipsychotic prescribed and antipsychotic prescribed at 12-months was recorded alongside initiating care team (EIS, non-EIS community services, inpatient services). RESULTS: 99% (n=272) of patients were prescribed an antipsychotic. 46% were initiated by inpatient serves, 40% non-EIS community services and 14% EIS. Aripiprazole, olanzapine, quetiapine and risperidone accounted for 95% of initial prescriptions. Different care teams prescribed antipsychotics preferentially (p=<0.005) (Fig.1). Rates at which initial medication was continued at 12-months varied according to initial prescription (P=<0.05) (Fig.2). CONCLUSIONS: The frequency that specialist EIS services prescribed aripiprazole as initial treatment contrasts the preference for olanzapine in other services. Olanzapine has a significant metabolic side effect profile, is sedating and was least likely to be continued at 12 months. This raises questions about why non-FEP specialist services prefer olanzapine and whether EIS services can support these services around initial medication choices more likely to be continued throughout the key first year of treatment. DISCLOSURE: No significant relationships.