# Antipsychotic prescribing patterns and determinants in first-episode psychosis: a 2019–2024 cross-sectional study from Zambia

## TL;DR

This study examines antipsychotic prescribing patterns in Zambia for first-episode psychosis, finding a preference for first-generation drugs influenced by gender and treatment adherence.

## Contribution

The study provides the first analysis of antipsychotic prescribing in Zambia, highlighting local factors affecting treatment choices in a low-resource setting.

## Key findings

- First-generation antipsychotics were more commonly prescribed than second-generation ones.
- Female patients had higher odds of receiving second-generation antipsychotics.
- Partial treatment adherence reduced the likelihood of second-generation antipsychotic prescriptions.

## Abstract

First-episode psychosis represents a critical period in psychotic disorders, during which timely, appropriate treatment can greatly influence long-term outcomes. Antipsychotics remain the foundation of first-episode psychosis management, yet prescribing patterns vary across settings due to patient characteristics, clinical factors, and resource availability. Although factors influencing antipsychotic choice are increasingly recognized, these have not been examined in the Zambian context. Understanding local prescribing practices is essential to optimizing care and outcomes for individuals with first-episode psychosis.

To describe antipsychotic prescription patterns in adults with first-episode psychosis and identify demographic and treatment-related factors associated with second-generation antipsychotic use.

A cross-sectional review of medical records was conducted among 213 adults (≥ 18 years) prescribed an antipsychotic for First-episode psychosis between 2019 and 2024 at Chainama Hills College Hospital in Lusaka, Zambia. A data abstraction form captured sociodemographic, clinical, and prescriber information. Descriptive statistics characterized the sample and prescribing patterns, and multivariable logistic regression identified factors independently associated with prescribing second-generation versus first-generation antipsychotics.

The mean age of participants was 30.23 years (SD = 11.47), with 72.3% being male, 65.3% single, and 62.0% unemployed. Other psychoses (54.0%) and brief/acute psychosis (34.7%) were the most common diagnoses in our sample. Chlorpromazine (n = 74) and haloperidol (n = 75), both first-generation agents, were the most frequently prescribed, followed by risperidone (n = 65), a second-generation agent. Overall, first-generation antipsychotics accounted for a slightly larger share of prescriptions. In multivariable logistic regression analysis, females had higher odds of receiving a second-generation antipsychotic prescription (AOR = 7.55, 95% CI 3.27–17.41, p < 0.001), while partial adherence to treatment reduced the odds of second-generation antipsychotic prescription (AOR = 0.39, 95% CI 0.16–0.92, p < 0.05).

The findings indicate a relative preference for first-generation antipsychotics, with prescribing influenced by gender and treatment adherence. Prescribing reflects pragmatic, context-driven decision-making shaped by medication availability and affordability in a low-resource setting. This calls for policies that strengthen evidence-based prescribing practices, integrate sex-sensitive and adherence-focused approaches, and improve access to effective antipsychotic options within health systems.

Not applicable. This study is a secondary analysis of de-identified electronic health records and does not constitute a clinical trial.

The online version contains supplementary material available at 10.1186/s12888-026-07847-y.