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

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.