Purpose: There is little information regarding antipsychotic prescription in primary care, despite general practitioners issuing most ongoing prescriptions.  We sought to investigate changes in oral antipsychotic prescriptions in primary care from Jan 1998 to Dec 2007.

Methods: We conducted a cohort analysis of patients diagnosed with schizophrenia in primary care in the United Kingdom, using The Health Improvement Network database, to determine the proportions of antipsychotics prescribed.  We investigated the yearly estimates of the overall time patients spent in treatment with any antipsychotic as well as the class of antipsychotic and individual antipsychotic agent.

Results: We found that in any one calendar year, approximately 24% of patients previously prescribed antipsychotics do not receive treatment in primary care.  Over the last decade, people with schizophrenia have been prescribed antipsychotic treatment for a greater proportions of the time.  The greatest increase was observed in older women.  The overall increase in treatment time can be attributed to the increased prescription of second-generation antipsychotics (SGAs).  The annual proportion of time in SGA treatment increased from 16.6% to 51.2% within the study period, whereas time in first-generation antipsychotic treatment reduced from 37.1% to 15.0%.  Overall, olanzapine, risperidone and sulpiride were prescribed for the longest periods of time.

Conclusions: Over the last decade, the general practice of prescribing SGAs has increased whereas first-generation antipsychotic prescriptions have declined.  By 2007, patients with schizophrenia were prescribed antipsychotics for greater proportions of time, perhaps reflecting the greater acceptability of SGAs or a shift from secondary to primary care prescription.