PRESCRIPTION PATTERNS OF PSYCHOTROPIC DRUGS

Transcription

1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Anantha et al. SJIF Impact Factor Volume 4, Issue 03, Research Article ISSN PRESCRIPTION PATTERNS OF PSYCHOTROPIC DRUGS Swapna S 1, Anantha Nagappa Naik 2, Vaishnavi Naik 3, Virupaksha Devaramane 4, Bhandary PV 5 1 Department of Pharmacology, KMC, Manipal University, Manipal, Karnataka, India. 2 Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India. 3 Pharmacy Practice Department, Baptist Medical center Hospital, Karnataka. 4 Department of Psychiatry, Dr. A.V. Baliga Memorial Hospital, Udupi, Karnataka, India. 5 Department of Psychiatry, Dr. AV Baliga Memorial Hospital, Udupi, Karnataka, India. Article Received on 14 Dec 2014, Revised on 07 Jan 2015 Accepted on 02 Feb 2015 *Correspondence for Author Anantha Nagappa Naik Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India. INTRODUCTION There is no definition that satisfactorily postulates exact limits for the idea of a psychiatric disorder. The perception, like many others in medicine and science which are deficient of a dependable description that covers all circumstances. The prevalence rates in India for mental disorders was shown to be 70.5 in rural, 73 in urban and 73 both rural and urban every 1000 population. [1] Mental disorders are demarcated by a diversity of ideas (e.g., distress, disability, inflexibility, irrationality, etiology, and statistical deviation). Mental disorders can be treated with psychiatric medications. The terms have been used interchangeably as psychotropic or psychotherapeutic medications, these medications have altered the lives of people with mental disorders for the better. The consideration of a physician for a diagnosis made of a particular disease along with the medications for that particular disease is taken as a prescription. The prescription also can give information on the medications, its dose, and the duration and also the changes made over a period of time. Depending on the drugs prescribed we can also identify the root cause for drug interactions, if anything occur during the period of treatment. [3, 4, 5, 6, 7, 8, 9] Vol 4, Issue 03,

2 The aims of this study are to determine the prescription patterns and trends for psychotropic medication. This study analyses the routine of physicians when making the assessment to prescribe psychotropic drugs. Most commonly studied medications were antipsychotics, antidepressants, and anti-anxiety drugs. The study observed the prescription patterns for different types of indications: psychosis, depression, schizophrenia, anxiety and bipolar affective disorder apart from other indications. This effort led to the evaluation of the drug prescribing pattern of psychotropics in patients attending the psychiatric clinic at a hospital. MATERIAL AND METHODS We conducted a retrospective study of case records for a period of six months in the psychiatric unit of a tertiary care hospital in Udupi. Ethical approval was obtained from the institutional and hospital committee prior to study initiation. Patients who have been diagnosed with psychiatric disorders and patients receiving or prescribed with psychotropic drugs were included. Prescription records were reviewed from a random sample of 311 patients with diagnosis of schizophrenia, depression, bipolar affective disorder, schizoaffective disorder, dementia, adjustment disorder, delusional disorder or psychotic disorder. For every patient, documentation was done of the patient characteristics like the age, sex, medications that were prescribed, the dosage of the drugs, and also the indication. RESULTS In this retrospective study a total number of prescriptions evaluated were 311. The proportion of females in the study were 47% (n=145) and males were 53% (n=166). Out of them the most of them were diagnosed with Bipolar Affective Disorder which was about 34.7 % (n=108). Demography portrays a negligible impact on prescription patterns in subjects. The pattern of distribution of different age groups depending on various aspects shown in Table below. 45% of the patients were below the age of 33 years. 39.2% of the patients were in the range of 34 to 55 years of age and 15.8% of the patients were of years of age. Demographics Number Percentage Education Literate Illiterate Occupation Employed Unemployed Habits Alcoholic Vol 4, Issue 03,

3 Smoker Sex Male Female Age wise prescribing frequency for drugs The number of drugs prescribed is of high importance as it can show the extent of risk of interactions. The number of drugs per prescription and the numbers are as below. 96.4% of the patients received more than 2 drugs. Table 1: Polypharmacy No. per prescription No. prescriptions The commonly prescribed drugs in this set up were: Olanzepine, Lorazepam, Lithium, Risperidone, Trihexyphenidyl hydrochloride, Nitrazepam, Clonazepam and Escitalopram. Prescription patterns differed by age, gender and clinical conditions, with mono-therapies and combination therapy. The incidence of monotherapy was 3.5% and that of polypharmacy was high (96.4%). 8.3% patients were diagnosed with Schizophrenia and 3.8% with Depression, 12.9% with Psychosis. The Table 3 shows the percentage of occurrence of various conditions of which the most extensively seen was bipolar affective disorder followed by psychosis, schizophrenia and depression. Table 4 portrays the frequencies with which selected drugs were prescribed. Table 3: Occurrence of conditions Indications Number Percentage Bipolar affective disorder Anxiety Psychosis Schizophrenia Depression Others Vol 4, Issue 03,

4 Table 4: Various drug categories commonly prescribed Drug group Number of patients Percentage Antianxiety drugs Antidepressants Antimuscarinic drugs Antimanic drugs Atypical Antipsychotic drugs The contents of the prescriptions were assessed on the basis of drugs used for psychiatric disorders, the comorbidities and brand names were interpreted to generic names using standard CIMS India. DISCUSSION There are only scarce amount of studies that have assessed the prescription patterns of psychotropic drugs from India. Taking a glance at the adverse effect profile, atypical antipsychotics have been the desired choice of treatment. In one of the early studies they assessed the psychotropic drug prescription pattern in chronic patients and compared the prescription inclinations in the year 1984 and In a study from Jammu, showed that the prescriptions of 270 outpatients were prescribed formulation of trifluperazine, chlorpromazine, and trihexyphenidyl followed by chlorpromazine and quetiapine. In 82.72% of the cases typical anti-psychotics were prescribed and polypharmacy was observed in 72.72% of the cases 9 which almost matched with the results of this study wherein, we had trifluperazine, chlorpromazine, and trihexyphenidyl put together was about 38.2% which was followed by chlorpromazine [39.3%], quetiapine [30.5%], olanzepine [32.2%], lithium [24.7%], Lorazepam [17.6%] and 96.4% of the cases showed polypharmacy. Although these dint not match with a recent study, from Lucknow in which it was observed that out of 100 patients, olanzapine was the frequently used which was about (64%) and it was shadowed by risperidone (48%) and typical anti-psychotics were used in rest of the cases. [10] From this data it is evident that whatever data signifies the prescription pattern can also depend on the availability of drugs in that particular hospital setting or dispensary and also will be dependent on the locality which may also be one of the factors that will influence the prescribing patterns. In this study we observed that the most commonly used drugs were olanzapine, lithium and lorazepam. The use of typical antipsychotics were obsolete. Vol 4, Issue 03,

5 In this study 73.3% received atypical antipsychotic drugs followed by 49.1% received antianxiety drugs, 34.7% antimanic drugs, 9.6% antimuscarinic drugs and lastly 4.8% antidepressants. The age that was most affected was among the of 22 up to 55 years of age. Among these the affected population was males and very closely followed by females where in the percentage were 53% males and 47 % of females. The average number of drugs per prescription in this study was about 3. There was a high prevalence of bipolar affective disorder which was treated most commonly with a combination of olanzepine, lorazepam and lithium. The use of anti-anxiety drugs (Benzodiazepines) was widespread in numerous disorders. The limitations were that this study was totally dependant on the case sheets for all the information which is also dependent on the laboratory investigations and thereby has an impact on the prescribing. The data were shown to be consistent throughout the observation period hence not considered as a limitation. Of course, this data cannot be amplified and cannot be applied to all the hospitals per se, but it does add to the information present among other evidences available. It may be possible to apply this data in hospitals which have similar systems with guidelines that may be similar to this set up. Details of patients illness, treatment history, indication for prescribing high dose combination, and the response to drugs were not determined. Despite the limitations, our study presents important findings. It highlights the necessity of guidelines which can be implemented to improve clinical practice from the point of view of prescribing more than one drug may help in improving the quality of life of the patient. CONCLUSION The understanding of prevailing prescription patterns in the treatment and concomitant use of psychotropic drugs can provide valuable information for refining clinical practice in this field. We ought to attempt to accomplish a balanced, yet reasonable, treatment strategy to curtail the risks and at the same time exploiting the benefits of these combination treatments for patients. Vol 4, Issue 03,

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