While the urgent need to take action concerning the costs of SGAMs was generally recognized in these meetings, it was also made clear that other factors play an important role in decisions about the type of treatment that will be prescribed or taken. In two European countries – Spain and Austria – the health-insurance regulations concerning reimbursement for the treatment of mental illness are similar, yet Spanish psychiatrists prescribe SGAMs nearly twice as often as their colleagues in Austria. The crucial importance of providing unbiased information and in-service training (as well as updating undergraduate and postgraduate training in psychiatry) for the best use of available treatments and technology was stressed by a number of respondents. Such education is a necessary part of the mandate that patients should at all times receive treatment that is in their best interest rather than be exposed to interventions that are designed to take mainly non-medical (e.g. economic) considerations into account.
Another subject commanding much attention was the fact that knowledge about treatment in psychiatry in general is still insufficient. Numerous gaps in knowledge were identified. Some of them were identified in the review and are listed there, but many more were noted. Data about the effects (and side-effects) of drugs given to patients in different populations are scarce. Several studies have indicated that there might be differences between patients in terms of the optimal initial and maintenance doses, but the existing evidence about these differences does not allow the formulation of specific guidelines for treatment. There have been no comparisons of effectiveness (or safety) among the first-generation antipsychotic medications (FGAMs), and evidence about the differences between the effects of high-dose and low-dose FGAMs is only now emerging. Evidence about the effectiveness and safety of the SGAMs in the treatment of psychosis in children, the elderly and pregnant women is also insufficient. Furthermore, few studies have reliably measured the quality of life of patients and their families. Understandably ( because the SGAMs have come into wider use only recently) there are no solid findings on the long-term effects of these medications.
Even the evidence that is now available needs reconfirmation. Most of the studies on SGAMs have been sponsored by the pharmaceutical companies that produced the drugs being assessed. While these studies involved leading scientists in many countries and were done with well-designed protocols, participants in national review meetings agreed on the necessity to complement these studies with others funded by agencies that could not be seen as having a conflict of interest in sponsoring studies onpsycho-pharmacological medications. The major collaborative study recently funded by the US National Institutes of Health (Clinical Antipsychotic Trials of Intervention Effectiveness) was seen as a step in the right direction and as a model that should be brought to the attention of other agencies and governments.
The initiative of the WPA in undertaking a review of the literature and preparing technical materials to serve as the basis for discussion at national level was seen as a useful method for obtaining information, and as a welcome stimulus for the activation of national psychiatric societies in technical matters of particular interest to the profession. It was felt that the evidence and experience assembled and discussed in the national meetings would provide a useful background for the consideration of the relevant Consensus Statement by the General Assembly of