Abstract

A RETROSPECTIVE STUDY ON PRESCRIBING PATTERN OF ANTIPSYCHOTICS IN PSYCHIATRIC DEPARTMENT OF A TERTIARY CARE HOSPITAL

Mariya Antony*, Clari Mariya, Blessy Sara Kurian, Bincy K Chacko, Archana Vijai and Dr. Santhosh M Mathews

ABSTRACT

Background: Despite the fact that most guidelines recommend antipsychotic mono pharmacy majority of psychiatric patients receive antipsychotic poly pharmacy. Prescribing pattern studies can reveal polypharmacy and the results obtained by conducting these studies can help physicians in rational prescribing of antipsychotics. Aims: To identify the commonly prescribed antipsychotics and their combinations, commonly prescribed concomitant drugs and the prevalence of both the risk of ADR and polyphamacy. Methodology: A retrospective study was conducted in the psychiatry department of a tertiary care setting for a period of 6 months. We studied 103 prescriptions which satisfied the inclusion and exclusion criteria. Prescription and demographic data were extracted using a proforma. Association between types of therapy and ADR were studied using Chi-square test. Results: Out of 103 prescriptions studied chlorpromazine (63%) was the commonly prescribed antipsychotic. Among the fixed dose combinations, atypical antipsychotic (Risperidone) and anticholinergic (Trihexyphenidyl) combination were more frequently given. Polypharmacy was more common in practice (53 %). Overall prevalence of ADR in study population was 49.5% and EPS was the most documented ADR. Anticholinergic drugs were found to be commonly co-prescribed with typical antipsychotics. Antipsychotic polypharmacy was associated with EPS (0.052), dyslipidemia (0.044) and sedation (0.030). Conclusion: Atypical antipsychotics were prescribed more commonly when compared with typical antipsychotics, mainly due to the low tendency of atypical antipsychotics to cause EPS, efficacy against refractory cases and better control over negative symptoms. Chlorpromazine was most frequently prescribed antipsychotic because it is a low potency drug which has low chance of causing neurological side effects and its cost effectiveness makes it more suitable for middle income countries. Even though prescribing two or more antipsychotic drugs concurrently is irrational, majority of patients in our study received antipsychotic polypharmacy, because of its usage in treatment for different symptom domain like negative symptoms and to enhance the response to the second antipsychotic. When percentage of individual ADRs were taken into consideration, the most common ADR was EPS. Anticholinergic drugs are most co-prescribed drug along with antipsychotics to reduce EPS associated with it and for its prophylactic action.

Keywords: antipsychotic polypharmacy, prescription pattern, ADR, retrospective, anticholinergic drugs, EPS.