The European psychiatric association (EPA) – early career psychiatrists committee survey on trainees’ and early-career psychiatrists’ attitudes towards therapeutic drug monitoring (TDM) use and utility during antipsychotic treatment

Abstract

Objectives

This survey assessed psychiatry residents’/early-career psychiatrists’ attitudes towards the utility of therapeutic drug monitoring (TDM) of antipsychotics.

Methods

A previously developed questionnaire on attitudes on TDM utility during antipsychotic treatment was cross-sectionally disseminated by national coordinators between 01/01/2022–31/12/2023. The frequency of using TDM for antipsychotics other than clozapine was the main outcome in a linear regression analysis, including sex, clinical setting, caseload, and factors generated by an exploratory factor analysis. Comparisons between residents and early-career psychiatrists, respondents working in in- and outpatient settings, and low-/middle- and high–income countries were performed.

Results

Altogether, 1,237 respondents completed the survey, with 37.9% having never used TDM for antipsychotics. Seven factors explained 41% of response variance; six of them were associated with frequency of TDM use (p < 0.05). Items with highest loadings for factors included clinical benefits of TDM (factors A and E: 0.7), negative expectations for beliefs of patients towards TDM (factor B: 0.6–0.7), weak TDM scientific evidence (factor C: 0.8), and TDM availability (factor D: −0.8). Respondents from low-/middle-income countries were less likely to frequently/almost always use TDM compared to high-income countries (9.4% vs. 21.5%, p < 0.001).

Discussion

TDM use for antipsychotics was poor and associated with limited knowledge and insufficient availability.

Keywords:

• Early career psychiatrists (ECPs)
• therapeutic drug monitoring (TDM)
• personalised medicine
• psychopharmacology
• schizophrenia

Acknowledgements

Authors are indebted to the following persons for their support during survey dissemination: Association Fédérative Française des Etudiants en Psychiatrie (AFFEP), Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V.’ (DGPPN), European Federation of Psychiatric Trainees (EFTP), Dr. Mohamed Abdulhakim, Dr. Marton Asztalos, Dr. Franziska Baessler, Dr. Giovanni Briganti, Dr. Berker Duman, Prof. Chin-Bin Eap, Dr. Chiara Gastaldon, Dr. Sundar Gnanavel, Dr. Xenia Hart, Prof. Alkomiet Hasan, Dr. Aram Hovsepyan, Dr. Nikolina Jovanovic, Dr. Efthymios Kouppis, Dr. Markku Lahteenvuo, Dr. Simone Marchini, Dr. Shevonne Matheiken, PD Dr. Sabrina Mörkl, Prof. Matthias J Müller, Dr. Shakhla Mustafayeva, Dr. Matilda Naesström, Dr. Camile Noël, Dr. Dorottya Őri, PD Dr. Michael Paulzen, Dr. Cátia Pinheiro Ramos, Dr. Flavian Rădulescu, Dr. Robertas Strumilas, PD Dr. Elias Wagner, Dr. Alina Wilkowska.

Ethical approval

Ethics approval was obtained centrally for the study from the Ethics Committee of Region of Calabria, Central Area Section, Italy (Reg. number 355, 22/10/2020).

Statement of interest

Dr. A. Agorastos has been an advisor to Janssen-Cilag Pharmaceuticals SACI and has received travel grant support or speaker`s honoraria from Janssen-Cilag Pharmaceuticals SACI, ELPEN Pharmaceutical Co. Inc. S.A., Lundbeck Hellas S.A., Viatris Hellas Ltd., Pharmaserve – Lilly S.A., iDNA Genomics, Angelini Pharma Hellas and Recordati Hellas Pharmaceuticals. Dr. T. M. Gondek received honoraria for lectures from Valeant Polska, Lundbeck Poland, Apotex Poland/Aurovitas Pharma Polska, Celon Pharma and Neuraxpharm Polska, and support for attending meetings from Lundbeck Poland, EGIS, and GL Pharma. Dr. M. Højlund has been consultant or has received honoraria: H. Lundbeck, The Lundbeck Foundation and Otsuka. Dr. G. Schoretsanitis has served as a consultant for Dexcel Pharma, HLS Therapeutics, Saladax and Thermo Fisher and has received speaker’s fees from HLS Therapeutics and Saladax. Dr. C. U. Correll has been a consultant and/or advisor to or has received honoraria from AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Boehringer-Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, Intracellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supermus, and Teva. He has received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic. He received grant support from Janssen and Takeda. Dr. de Filippis has received speaker’s fees from Angelini, Janssen Pharmaceutica and Lundbeck, and travel support from Janssen Pharmaceutica, Lundbeck, Otsuka and ROVI Pharma Industrial Services. Dr. M. Tveito has received speaker´s fees from Otsuka and Lundbeck. All other authors do not report any conflict of interest.

Data availability statement

No primary data were included in this study.

Additional information

Funding

No funding was provided.