Prescription patterns of Psychotropic medications for treatment naive patients with mental disorder in Amanuel hospital - a record-based study.

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Addis Ababa University


Psychotropic medications have been leading treatments for a broad range of mental disorders. But they have also a risk of adverse effects. These adverse effects can potentially decrease drug compliance, predispose to drug induced movement disorders and are associated with an increased risk for several physical diseases. Guideline based prescribing may reduce the risk but there is a gap between guidelines and prescribing practices in commonly prescribed drugs such as antidepressants and antipsychotics. These discrepancies may be associated with lower efficacy (e.g. insufficient dosage or duration) or with increased risk of adverse effects (e.g. hazardous co-prescription). This discrepancy may have the most impact among treatment naive patients. Psychotropic medication experiences for patients at the beginning of treatment may have a lasting impact on their attitudes toward medication and course of illness, this is a critical time to optimize prescribing. There is no adequate information on the patterns of drug prescribing among this population. A study on prescribing practices will help identify opportunities for corrective measures to enhance achievement of therapeutic goals and patients’ quality of life. Study objective The study aimed to describe the patterns of Psychotropic medications prescription among treatment naive patients with mental illness. The secondary aim was to evaluate concordance with treatment guidelines. Method A retrospective record review was conducted on 384 treatment naive patients with mental disorder in Amanuel hospital out-patient department (between March 10/2019 and March 29/2019). All records during the study period were evaluated. Results Records of 384 treatment naive patient’s prescribed with psychotropic medications were evaluated. The overall age of the sample ranged from 15 to 95 years, the mean age was 34.2 years with standard deviation of 16. The prescriptions were ordered to 224 (58.3%) males and 160 (41.7%) females. From these 384 cases patients were prescribed a mean of 2 psychotropic medications. The most common combination psychotropic medications are Antipsychotic with antidepressant, Antipsychotic with benzodiazepine and Two Antipsychotics with Benzodiazepine which are seen in (n=70; (28.6%), (n=51; (20.8%), and, (n=41; (16.7%) respectively. Among the different classes of drugs prescribed, nearly half of psychotropic medication were Antipsychotics (n=317; (49.3%), followed by Antidepressant (n=147; 22.86% (96 TCA, 51 SSRI)), Benzodiazepine (n=118; (18.35%), Anticholinergic agent (n=37; (5.6%), and Anticonvulsant Mood stabilizer (n=24; (3.7%). And of the antipsychotic medications, Risperidone (n=190; (29.5%) (1 mg - 4 mg, mean 2.2 mg) was the most frequent drug under use followed by Haloperidol (n=65; (10.1%) (1.5 mg - 6 mg, mean 2.3 mg). Chlorpromazine, Trifluoperaziane, Olanzapine and Thioridazine were the rest of prescribed antipsychotic drugs. Amitriptyline and imipramine were among tricyclic antidepressants frequently prescribed (n=80; (12.5%) (25 mg - 75 mg, mean 30.6 mg) and (n=16; (2.5%) (25 mg - 50 mg, mean 26.6 mg) times respectively. From SSRI’s Fluoxetine (n=33; (5.1%) (20 mg - 40 mg, mean 21.2 mg) and Sertraline (n=18; (2.8%) (25 mg - 50 mg, mean 48.6 mg) are prescribed. In the present study from Benzodiazepine class Diazepam (n=77; (12%) (5 mg - 20 mg, mean 5.8 mg), Clonazepam (n=29; (4.5%) (0.5 mg - 4 mg, mean 1.5 mg), Lorazepam (n=7; (1.1%) (1 mg - 3 mg, mean 1.9 mg), and Bromazepam (n=5; (0.8%) (Mean 1.5 mg) were the most frequently prescribed medications. From Anticonvulsant Mood stabilizer class Carbamazepine (n=22; (3.4%) (200 mg - 600 mg, mean 363.6 mg) and valproate (n=2; (0.3%) (500 mg - 800 mg, mean 650 mg) were prescribed. Trihexyphenidyl is the only medication from anticholinergics class (n=37; (5.8%) (2 mg - 5 mg, mean 2.9 mg). Out of 140 prescribed parenteral medications assessed Diazepam and Haloperidol were near equally prescribed. The remaining prescribed medication was Fluphenazine Decanoate. Among 270 patients who were seen in 24 hrs or come back for first follow up only (n=5; (0.02%) psychotropic medication associated side effects were recorded. Majority of patients were diagnosed with Schizophrenia Spectrum and Other Psychotic Disorders and was prescribed with (n=122; (62.9%) SGA and (n=63; (32.5%) FGA. Depressive Disorders were the second common diagnosis and was given SGA, TCA, FGA, and SSRIs in (n=40; (47.8%), (n=19; (23.2%), (n=12; (14.6%), (n=10; (1.5%) patients respectively. Bipolar and Related Disorders were prescribed with SGA (n=20; (80%), FGA (n=4; (16%) and Mood stabilizers (n=1; (4%). Conclusion This is the first study examining psychotropic prescribing patterns in treatment naive mental illness patients in ASMH. In the present study, antipsychotic drugs were the most prescribed psychotropic drug, followed by antidepressant drugs. There is also moderate use of benzodiazepines, mood stabilizers and anticholinergic drugs. Risperidone was the most frequently prescribed drugs from second generation antipsychotics and tricyclic antidepressants (mainly amitriptyline) remain the most frequently prescribed class of antidepressants. The current study showed a significant psychotropic medication combination is prescribed to treatment naive patients. This study also showed off-label prescription of (n=11; (17.5%) intravenous administration of haloperidol for treatment naive patients and (n=15; (10.7%)patients were prescribed with long acting antipsychotic Fluphenazine Decanoate. Avery low side effects associated with psychotropic medications were recorded among patients who were seen in 24 hrs or come back for first follow up.



Psychotropic medications , naive patients , mental disorder