Naturalistic data on actual use of antipsychotics in different psychiatric settings are scarce. Following guidelines and recommendations an increase in the use of atypical antipsychotics should be anticipated and was confirmed in numerous studies. On the other hand various naturalistic reports have confirmed the ongoing use of typical antipsychotics from 20 to up to 80% in different countries. Since the actual prescription pattern can be influenced by legislation and insurance policies, Slovenia offers excellent place for the study of prescription patterns, since all registered antipsychotics are free for insured patients and there are no limits for psychiatrists to prescribe any single antipsychotic.

We have studied trends in prescribing antipsychotics in University Psychiatric Hospital from 1999 to 2006. Since the hospital covers almost half of the country and annually treats 3500 inpatients, our data are representative for inpatient situation in Slovenia. The data were collected retrospectively using computer records on the drug use.

The results show a systematic and solid decrease in the use of typical antipsychotics and increase in the use of atypicals. A 5-fold atypical/typical ratio increase was observed in acute psychiatric inpatients. A 3-fold decrease in the use of IM antipsychotics formulations was observed as well as the decrease in the use of depot formulations. Different trends were observed for newer antipsychotics generally their prescription rates follow the time on the market.

The observed changes can in part be explained by evidence-based knowledge although other issues might be important in prescribing patterns of antipsychotics.