Prescribing pattern of antipsychotic medications in patients with schizophrenia in a tertiary care hospital

H. K. Sushma, C. H. Jyothi, H. S. Somashekar, E. Avanthi, M. Imran, Babool Raja

Abstract


Background: The objective of thisstudy was to study the prescribing pattern of antipsychotic medications in patients with schizophrenia in a tertiary care hospital.

Methods: An observational study was conducted in psychiatry outpatient department (OPD) of Bapuji and Chigateri hospital attached to Jagadguru Jayadeva Murugarajendra medical college, Davangere. The data collected, had information about age, gender, education, occupation, marital status and drug prescription that included trade name, generic name, dosage and frequency of administration of 100 outpatients who attended the psychiatry OPD.

Results: A total of 100 prescriptions were analyzed of which 6% was monotherapy, where Asenapine was the only drug used and rest 94% was combination therapy. About 94% of the combination therapy included the use of single antipsychotic with anticholinergic drug and multiple antipsychotics with anticholinergic drug. A combination of multiple antipsychotics with anticholinergic was most commonly used, that is trifluoperazine and chlorpromazine  (36%), followed by trifluoperazine and risperidone (13%), trifluoperazine and quetiapine (8%), risperidone and quetiapine (7%), trifluoperazine, chlorpromazine along with quetiapine (3%). Among single antipsychotic with anticholinergic, risperidone (20%) was most commonly used, followed by Trifluoperazine (7%). Use of the anticholinergic drug, Trihexyphenidyl accounts to 94% of the total prescriptions.

Conclusions: Schizophrenia is mostly seen in males, middle age group and unemployed people. The present study showed that combination therapy is preferred for the treatment of Schizophrenia. Despite several side-effects, typical antipsychotics, especially trifluoperazine was the most commonly used drug, followed by chlorpromazine either alone or in combination. Among atypical antipsychotics, risperidone was commonly used followed by quetiapine and asenapine. Most of the patients received trihexyphenidyl, an anticholinergic drug along with antipsychotics to reduce extra pyramidal side-effects.


Keywords


Atypical antipsychotics, Prescribing pattern, Schizophrenia

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References


Insel TR. Rethinking schizophrenia. Nature. 2010;468(7321) :187-93.

Purcell SM, Moran JL, Fromer M, Ruderfer D, Solovieff N, Roussos P, et al. A polygenic burden of rare disruptive mutations in schizophrenia. Nature. 2014;506(7487):185-90.

Padmini Devi D, Amarjeeth R, Sushma M, Guido S. Prescription patterns of psychotropic drugs in hospitalized schizophrenic patients in a tertiary care hospital. Calicut Med J. 2007;5(4):e3.

Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2:e141.

Sadock BJ, Sadock VL. Kaplan and Sadock’s Synopsis of Psychiatry. 10th Edition. New Delhi: Wolter and Kluwer Pvt Ltd.; 2007: 467-98.

Gelder M, Harrison P, Cowen P. Shorter Oxford Textbook of Psychiatry. 5th Edition. New York: Oxford University Press; 2008: 267-306.

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th Edition, Text Revision. Washington: American Psychiatric Association; 2000.

Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull. 2004;30(2):279-93.

Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12(3):426-45.

Rajji TK, Ismail Z, Mulsant BH. Age at onset and cognition in schizophrenia: meta-analysis. Br J Psychiatry. 2009;195(4):286-93.

Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophr Bull. 2000;26(1):119-36.

Dutta SB, Dhasmana DC, Bhardwaj R. Psychotropic drug utilization pattern among schizophrenics. Indian J Psychiatry. 2004;46(4):381-2.

Berger A, Edelsberg J, Sanders KN, Alvir JM, Mychaskiw MA, Oster G. Medication adherence and utilization in patients with schizophrenia or bipolar disorder receiving aripiprazole, quetiapine, or ziprasidone at hospital discharge: a retrospective cohort study. BMC Psychiatry. 2012;12:99.

Kane JM. Treatment of schizophrenia. Schizophrenia Bull. 1987;13:13-15.

Stip E. Novel antipsychotics: issues and controversies. Typicality of atypical antipsychotics. J Psychiatry Neurosci. 2000;25(2):137-53.

Keefe RS, Silva SG, Perkins DO, Lieberman JA. The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis. Schizophr Bull. 1999;25(2):201-22.

Koro CE, Fedder DO, L’Italien GJ, Weiss SS, Magder LS, Kreyenbuhl J, et al. Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study. BMJ. 2002;325(7358):243.

Deniker P. Psychopharmacology and biologic psychiatry. Historical review. Soins Psychiatr. 1983;37:5-6.

Shalini S, Ravichandran V, Mohanty BK, Dhanaraj SK, Saraswathi R. Drug utilization studies-An overview. Int J Pharm Sci Nanotechnol. 2010;3(1):803-10.

Sachdeva PD, Patel BG. Drug utilization studies-scope and future perspectives. Int J Pharm Bio Res. 2010;1(1):11-7.

Fahmida A, Wahab MA, Rahman MM. Pattern of psychiatric morbidity among the patients admitted in a private psychiatric clinic. Bangladesh J Med Sci. 2009;8(1-2):23-8.

Banerjee I, Roy B, Sathian B, Banerjee I, Chakraborty PK, Saha A. Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients: a cross sectional study from western region of Nepal. BMC Psychiatry. 2013;13:96.

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

Banerjee I, Roy B, Sathian B, Banerjee I, Kumar SS, Saha A. Medications for anxiety: a drug utilization study in psychiatry inpatients from a tertiary care centre of Western Nepal. Nepal J Epidemiol. 2010;1(4):119-25.

Banerjee I, Roy B, Banerjee I, Sathian B, Mondol M, Saha A. Depression and its cure: a drug utilization study from a tertiary care centre of Western Nepal. Nepal J Epidemiol. 2011;1(5):144-52.

Gilmer TP, Dolder CR, Folsom DP, Mastin W, Jeste DV. Antipsychotic polypharmacy trends among Medicaid beneficiaries with schizophrenia in San Diego County, 1999-2004. Psychiatr Serv. 2007;58(7):1007-10.

Kreyenbuhl J, Valenstein M, McCarthy JF, Ganoczy D, Blow FC. Long-term combination antipsychotic treatment in VA patients with schizophrenia. Schizophr Res. 2006;84(1):90-9.

Combination and high-dose atypical antipsychotic therapy in patients with schizophrenia: systematic review. CADTH Technol Overv. 2012;2(3):e2301.

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.

Kane JM. Pharmacologic treatment of schizophrenia. Biol Psychiatry. 1999;46(10):1396-408.

Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry. 1999;156(11):1686-96.

Wirshing DA, Spellberg BJ, Erhart SM, Marder SR, Wirshing WC. Novel antipsychotics and new onset diabetes. Biol Psychiatry. 1998;44(8):778-83.

Meyer JM. A retrospective comparison of lipid, glucose, and weight changes at one year between olanzapine­ and risperidone­ treated inpatients. Biol Psychiatry. 2001;49(8):536.

Coulter DM, Bate A, Meyboom RH, Lindquist M, Edwards IR. Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study. BMJ. 2001;322(7296):1207-9.

Lieberman JA, Golden R, Stroup S, McEvoy J. Drugs of the psychopharmacological revolution in clinical psychiatry. Psychiatr Serv. 2000;51(10):1254-8.

Lieberman J, Stroup T. The NIMH-CATIE Schizophrenia Study: what Did We Learn? Am J Psychiatry. 2011. 168(8):770–5. Available at http://www.ajp.psychiatryonline.org/article.aspx?articleid=116011. Cited 03 Nov 2012.

Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on quality of life of second- vs. first generation antipsychotic drugs in schizophrenia: cost Utility of the Latest Anti–psychotic Drugs in Schizophrenia Study (CUtLASS 1). Archives of general psychiatry. 2006;63(10):1079-87. Available at http://www.ncbi.nlm.nih.gov/pubmed/17015810.org/content.aspx?bookid=28& section id=1682213. Cited 03 Nov 2012.

Dixon L, Perkins D, Calmes C. Guideline Watch: practice Guideline for the Treatment of Patients with Schizophrenia. American Psychiatric Association; 2009.Available at http://www.psychiatryonline.com. Cited 10 Oct 2012.

National Collaborating Centre for Mental Health. The Nice Guideline on Core Interventions in The Treatment and Management of Schizophrenia in adults in Primary and Secondary Care. Royal College of Psychiatrist’s Research Unit. The British psychological Society. Leicester; 2010. Available at http://www.nice.org.uk/nicemedia/pdf/CG82FullGuideline.pdf. Cited 03 Sep 2012.