A study on drug prescribing pattern in psychiatry out-patient department from a tertiary care teaching hospital

Sonali B. Rode, Rajesh K. Ajagallay, Harsh V. Salankar, Umesh Sinha

Abstract


Background: The burden of illness resulting from psychiatric and behavioral disorders is enormous; although, it remains grossly under represented by conventional public health statistics, which focus on mortality rather than the morbidity or dysfunction. Therefore, the study was carried out to find out morbidity pattern of psychiatric diseases and prescribing trends of psychotropic drugs.

Methods: A prospective observational study was conducted in psychiatry out-patient department of a tertiary care hospital for 3 months. Diagnosis was made according to ICD-10 criteria. Prescription pattern was analyzed using World Health Organization (WHO) drug indicators.

Results: Of 520 patients analyzed, 52.31% were males and 47.69% were females, 72.31% were <45 years. Depression 42.88%, schizophrenia 23.08%, bipolar mood disorders 17.88%, and anxiety 9.04% accounted for 92.88% of cases. Among the total of 1092 psychotropic drugs prescribed, 1056 (96.7%) were oral formulations. Average number of psychotropic drugs per prescription was 2.1 ± 0.8. 20.58% of the prescriptions contained fixed dose combinations. About 28.75% drugs were prescribed by generic name. Utilization from the WHO and National essential medical list were 28.57% and 38.64%, respectively. The prescribing frequency of anxiolytics, anti-depressants, anti-psychotics, anti-cholinergics, and anti-mania drugs was 30.04% (328/1092), 25.46% (278/1092), 25.37% (277/1092), 11.54% (126/1092), and 7.6% (83/1092), respectively. Clonazepam, olanzapine, escitalopram, carbamazepine and trihexyphenidyl were the most commonly prescribed benzodiazepines (BZD), antipsychotic, antidepressants, mood stabilizer and anti-cholinergics, respectively.

Conclusion: Utilization pattern of the psychotropic drugs were in accordance to the recommendations of various treatment guidelines. BZD were the most commonly prescribed psychotropic drugs.


Keywords


Drug utilization, Psychotropic, Out-patient

Full Text:

PDF

References


Gupta N, Sharma D, Garg SK, Bhargava VK. Auditing of prescriptions to study utilization of antimicrobials in tertiary hospital. Indian J Pharmacol. 1997;29(6):411-5.

Introduction to Drug Utilization Research by World Health Organization. Available from: http://www.whocc.no/filearchive/publications/drug_utilization_research.pdf. [Last accessed on 2014 Mar 12].

WHO. How to Investigate Drug Use in Health Facilities: selected Drug Use Indicators, WHO/DAP/93. Volume. 1. Geneva: World Health Organisation; 1993:1-87.

WHO. Drugs and Therapeutics Committees - A Practical Guide. Geneva: World Health Organization; 2003.

World Health Organization. The World Health Report 2001- Mental Health: new understanding, new hope. Geneva; 2001. http://www.who.int/whr/2001/en/. [Last accessed on 2014 Mar 22].

Math SB, Chandrashekar CR, Bhugra D. Psychiatric epidemiology in India. Indian J Med Res. 2007;126(3):183-92.

Pincus HA, Tanielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA. 1998;279(7):526-31.

Costa J, Rosa MM, Ferreira JJ, Sampaio C, Vaz Carneiro A. Cardiac effects of acute poisoning with tricyclic antidepressants: systematic review of the literature. Part I. Rev Port Cardiol. 2001;20(6):671-8.

Moore S, Jaime LK, Maharajh H, Ramtahal I, Reid S, Ramsewak FS, et al. The prescribing of psychotropic drugs in mental health services in Trinidad. Rev Panam Salud Publica. 2002;12(3):207-14.

Davidson JR, Feltner DE, Dugar A. Management of generalized anxiety disorder in primary care: identifying the challenges and unmet needs. Prim Care Companion J Clin Psychiatry. 2010;12(2).

WHO Model List of Essential Medicines. Available from: http://www.who.int/medicines/publications/essentialmedicines/18th_EML_Final_web_8Jul13.pdf. [Last accessed on 2014 Mar 30].

National List of Essential Medicines of India. Ministry of Health and Family welfare, Government of India; 2011. Available from: http://cdsco.nic.in/National List of Essential Medicine- final copy.pdf. [Last accessed on 2014 Mar 30].

Grover S, Kumar V, Avasthi A, Kulhara P. An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India. Indian J Pharmacol. 2012;44(3):319-25.

Piparva KG, Parmar DM, Singh AP, Gajera MV, Trivedi HR. Drug utilization study of psychotropic drugs in outdoor patients in a teaching hospital. Indian J Psychol Med. 2011;33(1):54-8.

Dutta S, Beg MA, Kaul V, Dutta S, Dhasmana DC. Psychotropic drug utilization study in psychiatric opd of a tertiary care teaching hospital in Dehradun, Uttarakhand. J Adv Res Biol Sci. 2013;5(4):386-91.

Mant A, Lansbury G, Bridges-Webb C. Trends in psychotropic drug prescribing in Australia. Med J Aust. 1987;146(4):208-10.

Thakkar KB, Jain MM, Billa G, Joshi A, Khobragade AA. A drug utilization study of psychotropic drugs prescribed in the psychiatry outpatient department of a tertiary care hospital. J Clin Diagn Res. 2013;7(12):2759-64.

González HM, Tarraf W, West BT, Chan D, Miranda PY, Leong FT. Research article: antidepressant use among Asians in the United States. Depress Anxiety. 2010;27(1):46-55.

Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry. 9th Edition. New York: Lippincott Williams and Wilkins; 2003: 534-78.

Lahon K, Shetty H, Paramel A, Sharma G. A retrospective drug utilization study of antidepressants in the psychiatric unit of a tertiary care hospital. J Clin Diagn Res. 2011;5(5):1069-75.

Rittmannsberger H, Meise U, Schauflinger K, Horvath E, Donat H, Hinterhuber H. Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics. Eur Psychiatry. 1999;14(1):33-40.

Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11(1):82-99.

Atanasova I, Terziivanov D. Investigation on antibiotics in a hospital for a one-year period. Int J Clin Pharmacol Ther. 1995;33(1):32-3.

Pradhan SC, Shewade DG, Tekur U, Zutshi S, Pachiappan D, Dey AK, et al. Changing pattern of antimicrobial utilization in an Indian teaching hospital. Int J Clin Pharmacol Ther Toxicol. 1990;28(8):339-43.

Dutta SB, Dhasmana DC, Bhardwaj R. Psychotropic Drug Utilization Pattern among Schizophrenics. Indian J Psychiatry. 2004;46(4):381-2.

Trivedi JK, Dhyani M, Yadav VS, Rai SB. Anti-psychotic drug prescription pattern for schizophrenia: observation from a general hospital psychiatry unit. Indian J Psychiatry. 2010;52(3):279.

Lader MH, Bond AJ, James DC. Clinical comparison of anxiolytic drug therapy. Psychol Med. 1974;4(4):381-7.

Ashton H. Guidelines for the rational use of benzodiazepines. When and what to use. Drugs. 1994;48(1):25-40.

Zito JM, Safer DJ, DosReis S, Gardner JF, Magder L, Soeken K, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med. 2003;157(1):17-25.

McVoy M, Findling R. Child and adolescent psychopharmacology update. Psychiatr Clin North Am. 2009;32(1):111-33.

Potter WZ, Hollester LE. Antidepression agents. In: Katzung BG, editor. Basic and Clinical Pharmacology. 10th Edition. Boston: McGraw-Hill; 2007: 475-88.

Hemeryck A, Belpaire FM. Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update. Curr Drug Metab. 2002;3(1):13-37.

Kamath A, Bheemesh V, Reddy S, Thunga R. Psychotropic drug utilization in psychiatry inpatients in atertiary healthcare setting. Int J Med Pharm Sci. 2012;3(4):16-22.

Dhasmana DC, Rawat Y, Mishra KC. What is so atypical about atypical antipsychotic? Indian J Pharmacol. 2003;35:322-4.

Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, et al. Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2010;(3):CD006654.

Baldessarini RJ, Leahy L, Arcona S, Gause D, Zhang W, Hennen J. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv. 2007;58(1):85-91.

Broekema WJ, de Groot IW, van Harten PN. Simultaneous prescribing of atypical antipsychotics, conventional antipsychotics and anticholinergics-a European study. Pharm World Sci. 2007;29(3):126-30.