Drug Utilization Pattern and Adverse Drug Profile of Psychotropic Drugs in Outpatient Department of Psychiatry of Tertiary Care Teaching Hospital
Authors/Creators
- 1. MD Pharmacology, Tutor in Pharmacology Department, NAMO Medical Education and Research Institute, Silvassa. Dadra and Nagar Haveli and Daman and Diu
- 2. Associate Professor, Pharmacology Department, Shri M P Shah Government Medical College, Jamnagar, Gujarat
- 3. Assistant Professor, Department of Anaesthesia, NAMO Medical Education and Research Institute, Silvassa, Dadra and Nagar Haveli and Daman and Diu
- 4. Professor and Head, Department of Pharmacology, Shri M P Shah Government Medical College, Jamnagar
Description
Background: Psychiatric illnesses are one of the major causes of morbidity nowadays. Mental and behavioral disorders are universal across all regions, societies and countries not exclusively limited to any special group. Prescription of psychotropic drugs are increasing day by day which results increase health care cost of person and country, occurrence of number of adverse drug reactions (ADRs), noncompliance, discontinuation of therapy and prolong hospitalization. In developing countries like India, various factors like cost and availability of drugs, local paradigms, decision of physician, and social and culture-specific barriers play important role in prescription of psychotropic drugs. Material and Methods: A prospective cross sectional drug utilization study was carried out in 600 patients visiting psychiatric outpatient department after approval from institutional ethics committee. Drug use indicators and adverse drug reactions (ADRs) due to psychotropic drugs were analyzed as per study criteria. Results: Major depressive disorder (34.66%) and schizophrenia (30%) accounts highest morbidity among observed psychiatric illnesses. Most of the psychiatric illnesses were found in the age group of 35-44 years in both sexes. Out of the 600 patients surveyed, 299(49.83%) and 301(50.16%) belonged to male and female respectively. Around 93.33% drugs are prescribed by generic name among the prescribed drugs. 42.85% drugs are prescribed from WHO Essential drug list (2017) and National Essential drug list (2015). Atypical antipsychotics were more prescribed than typical antipsychotics in schizophrenia. Anticholinergic drug was co-prescribed in schizophrenic encounters parallel to antipsychotic drugs suggest its overuse and irrational use. Prescribing frequency of selective serotonin reuptake inhibitors (SSRI) was found greater than tricyclic antidepressant in major depression. Lithium (36.73%) and sodium valproate (35.71%) were prescribed in bipolar mood disorders in decreasing order. Average cost for psychotropic drugs per encounter was 60.54 INR per month. 64 patients (10.66%) from the total of 600 patients developed ADR. ADRs were observed most commonly in age group of 25-34 years according to preferred term (PT), tremor (21.87%) followed by salivation (12.5%) and rigidity (9.375%) were most commonly reported reactions. Risperidone was responsible for most of the ADR (37.5%) followed by lithium (14.06%) and fluoxetine (12.5%). Conclusion: Major depressive disorder was the most common psychiatric illness followed by schizophrenia, bipolar mood disorder and schizoaffective disorder. Females were more affected with depressive disorder while males with schizophrenia, bipolar mood disorder. Most of the psychiatric illnesses were found in the age group of 35-44 years in both sexes. Atypical antipsychotics were more prescribed than typical antipsychotics in schizophrenia. Prescribing frequency of selective serotonin reuptake inhibitors (SSRI) was found greater than tricyclic antidepressant in major depression. Lithium and sodium valproate were prescribed in bipolar mood disorders in decreasing order.
Abstract (English)
Background: Psychiatric illnesses are one of the major causes of morbidity nowadays. Mental and behavioral disorders are universal across all regions, societies and countries not exclusively limited to any special group. Prescription of psychotropic drugs are increasing day by day which results increase health care cost of person and country, occurrence of number of adverse drug reactions (ADRs), noncompliance, discontinuation of therapy and prolong hospitalization. In developing countries like India, various factors like cost and availability of drugs, local paradigms, decision of physician, and social and culture-specific barriers play important role in prescription of psychotropic drugs. Material and Methods: A prospective cross sectional drug utilization study was carried out in 600 patients visiting psychiatric outpatient department after approval from institutional ethics committee. Drug use indicators and adverse drug reactions (ADRs) due to psychotropic drugs were analyzed as per study criteria. Results: Major depressive disorder (34.66%) and schizophrenia (30%) accounts highest morbidity among observed psychiatric illnesses. Most of the psychiatric illnesses were found in the age group of 35-44 years in both sexes. Out of the 600 patients surveyed, 299(49.83%) and 301(50.16%) belonged to male and female respectively. Around 93.33% drugs are prescribed by generic name among the prescribed drugs. 42.85% drugs are prescribed from WHO Essential drug list (2017) and National Essential drug list (2015). Atypical antipsychotics were more prescribed than typical antipsychotics in schizophrenia. Anticholinergic drug was co-prescribed in schizophrenic encounters parallel to antipsychotic drugs suggest its overuse and irrational use. Prescribing frequency of selective serotonin reuptake inhibitors (SSRI) was found greater than tricyclic antidepressant in major depression. Lithium (36.73%) and sodium valproate (35.71%) were prescribed in bipolar mood disorders in decreasing order. Average cost for psychotropic drugs per encounter was 60.54 INR per month. 64 patients (10.66%) from the total of 600 patients developed ADR. ADRs were observed most commonly in age group of 25-34 years according to preferred term (PT), tremor (21.87%) followed by salivation (12.5%) and rigidity (9.375%) were most commonly reported reactions. Risperidone was responsible for most of the ADR (37.5%) followed by lithium (14.06%) and fluoxetine (12.5%). Conclusion: Major depressive disorder was the most common psychiatric illness followed by schizophrenia, bipolar mood disorder and schizoaffective disorder. Females were more affected with depressive disorder while males with schizophrenia, bipolar mood disorder. Most of the psychiatric illnesses were found in the age group of 35-44 years in both sexes. Atypical antipsychotics were more prescribed than typical antipsychotics in schizophrenia. Prescribing frequency of selective serotonin reuptake inhibitors (SSRI) was found greater than tricyclic antidepressant in major depression. Lithium and sodium valproate were prescribed in bipolar mood disorders in decreasing order.
Files
IJTPR,Vol12,Issue7,Article3.pdf
Files
(354.2 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:bcf188c78e4de3f4bec69c100bc01f3c
|
354.2 kB | Preview Download |
Additional details
Dates
- Accepted
-
2022-06-01
Software
References
- 1. World Health Organization. Introduction to drug utilization research. World Health Organization; 2003. 2. Mittal N, Mittal R, Singh I, Shafiq N, Malhotra S. Drug utilisation study in a tertiary care center: Recommendations for improving hospital drug dispensing policies. Indian journal of pharmaceutical sciences. 2014;76(4):308. 3. Piparva K, Parmar D, Singh A, Gajera M, Trivedi H. Drug utilization study of psychotropic drugs in outdoor patients in a teaching hospital. Indian journal of psychological medicine. 2011;33(1):54–8. 4. Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N, et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019;18(5):459–80. 5. Kasper DL Fauci AS, Hauser SL, Longo DL, Jameson JL 4. Psychiatry disorders and psychoactive substance use. In: Harrison's manual of medicines. 16th ed. New York: McGraw Hill; 2005. p. 955–61. 6. Glassman AH, Bigger Jr JT. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. American Journal of Psychiatry. 2001;158(11):1774– 82. 7. Cooper C, Bebbington P, King M, Brugha T, Meltzer H, Bhugra D, et al. Why people do not take their psychotropic drugs as prescribed: results of the 2000 National Psychiatric Morbidity Survey. Acta Psychiatrica Scandinavica. 2007;116(1):47–53. 8. Park K. Epidemiology of mental disease. In: Park's text-book of Preventive and Social medicine. 22nd ed. Jabalpur: Banarsidas: Bhanot; 2013. 285–328 p. 9. BJ K. Kaplan and Sadock's synopsis of psychiatry. Behavioral science/clincal psychiatry 10th ed Philadelphia: Lippincott Williams & Wilkins. 2007;385–7. 10. Memon A, Patel K. Drug use pattern of antidepressant agents in psychiatric patients–A prospective study. NHL Journal of medical sciences. 2013;2:33–6. 11. Rode SB, Ajagallay RK, Salankar HV, Sinha U. A study on drug prescribing pattern in psychiatry out-patient department from a tertiary care teaching hospital. 2014; 12. 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. Journal of clinical and diagnostic research: JCDR. 2013;7(12):2759. 13. Rimland B. Controversies in the treatment of autistic children: vitamin and drug therapy. Journal of child neurology. 1988;3(1_suppl):S68–72. 14. Quick JD, Hogerzeil HV, Velásquez G, Rägo L. Twenty-five years of essential medicines. Bulletin of the World Health Organization. 2002;80:913–4. 15. Lahon K, Shetty HM, Paramel A, Sharma G. Pharmacoepidemiological study of antipsychotics in the psychiatry unit of a tertiary care hospital: A retrospective descriptive analysis. International Journal of Nutrition, Pharmacology, Neurological Diseases. 2012;2(2):135. 16. Dhasmana D, Rawat Y, Mishra K. What is so atypical about atypical antipsychotics! Indian journal of pharmacology. 2003;35(5):322. 17. Rössler W, Salize HJ, Van Os J, RiecherRössler A. Size of burden of schizophrenia and psychotic disorders. European neuropsychopharmacology. 2005;15(4):399–409. 18. Aburamadan HAR, Sridhar SB, Tadross TM. Intensive monitoring of adverse drug reactions to antipsychotic medications in the inpatient psychiatry department of a secondary care hospital of UAE. International Journal of Pharmaceutical Investigation. 2018;8(3):151–6. 19. Kuruvilla A, Kuruvilla K. Incidence of adverse reactions to commonly prescribed psychopharmacological agents during early phase of therapy. Indian Journal of Psychiatry. 1995;37(3):113.