Drug utilization research (DUR) is defined by the World
Health Organization (WHO,1977) as "the marketing, distribution,
prescription, and use of drugs in society, with particular emphasis on the
medical, social, and economic consequences". The main goal of drug use
research is to facilitate the rational use of drugs in the population. For an
individual patient, reasonable drug use means prescribing a well-studied medication
at an optimal dose, with correct information, and at an affordable price (1).
DUR is important in pharmacoepidemiology due to its close association with-
public health, pharmacovigilance, pharmacoeconomics, and pharmacogenetics (2).
Mental disorders are included in the Global Burden of
Diseases (3).
Epidemiological studies in India indicate an incidence rate of around 18-20 per
thousand of the population. Pharmacological therapy, psychotherapy, and
psychosocial rehabilitation are the main components of treating mental illness (4).
The prescription pattern of psychotropic medication use in psychiatric practice
has changed dramatically (5).
Many new psychotropic drugs are available to treat mental disorders and have
radically changed the therapeutic protocols (6).
The rapidly evolving field of psychopharmacology challenges traditional
concepts of psychiatric treatment and constantly seeks new and improved drugs
to treat these disorders. At the same time, the drugs should also be safer and
efficacious (7).
According to the Global Burden of Disease Study 1990–2017
across the states of India, mental disorders included depressive disorders,
anxiety disorders, schizophrenia, bipolar disorder, idiopathic development,
intellectual disability, conduct disorder, autism spectrum disorders, eating
disorders, attention-deficit hyperactivity disorder (ADHD), and other mental
disorders (8).
Among these, schizophrenia is one of the most common and burdensome psychiatric
disorders in adults worldwide (9). Some previous DUR indicates that schizophrenia (6, 7, 10)
and depression (11, )
were commonly encountered psychiatric disorders in India.
Declarations
Acknowledgment
The authors would like to thank the Professor and Head of the Department of Psychiatry, all the resident physicians, postgraduate trainees, and OPD staff of the Psychiatry Department Assam Medical College and Hospital, Dibrugarh, Assam, for their constant support and guidance.
Conflict of Interest
The authors declare no conflicting interest.
Data Availability
You can access the Supplemental Table on the ETFLIN server via the following link: https://etflin.com/file/document/20230607063455822779719.xlsx
Ethics Statement
The study was approved by the Institutional Ethics Committee of Assam Medical College with approval letter number of AMC/EC/2777-Dt 25/05/2022.
Irrational prescribing is a global problem. Prescribing
errors promote irrational use of drugs, decrease patient compliance, and increase
the cost and duration of the treatment. Such practices also lead to the emergence
of drug interactions, drug resistance, and adverse drug reactions, which increases
the rate of mortality and morbidity (13).
Psychotropic medications prescribed to manage psychiatric disorders usually
follow the guidelines formulated by various organizations. However, it is often
discussed that many patients receive irrational prescriptions, which either do
not provide any benefit to the patients or harm them (14).
Psychiatric illnesses are chronic and may profoundly impact the sufferer's
quality of life, family members, and society (15).
The problem may compound with inappropriate and irrational prescribing.
In the form of DUR, periodic prescription audits can improve
rational prescribing and prescription quality. Keeping in view the principle
aim of DUR to facilitate the rational use of drugs in the population, this
study was undertaken to investigate the prescription pattern of psychotropic
drugs and also to assess the rationality of the prescriptions in an outpatient
department of psychiatry unit in a tertiary care teaching hospital in Assam.
Materials and Methods
Study Design
The study was a hospital-based, non-interventional, prospective,
cross-sectional study conducted at the Department of Psychiatry. Further
analysis was conducted in the Department of Pharmacology, Assam Medical College
and Hospital (AMCH). The study was conducted after approval of the Institutional
Ethics Committee (H) (AMC/EC/2777-Dt 25/05/2022), for 6 months, from August 1,
2022, to January 31, 2023.
Selection Criteria
All new OPD patients of any age and gender on a psychiatric
prescription and those consented to participate in the study were included.
Patients who refused to participate and prescriptions that did not contain any
psychotropic drugs were excluded.
Data Collection Method
The data collection method was individual consultations. All
participating patients received a patient information card, and informed
consent was obtained in their native language. Data were collected through
direct observation in a specially designed form containing relevant details
such as patient demographics, prescription information, diagnosis, and prescription
details- hospital prescription number, date, medication number, generic
names/individual brand names and any fixed-dose combinations (FDCs) prescribed.
Sample Size
The sample size was determined using Eq. 1 (16).
Where n is the sample size, z is the standard
deviation and is fixed at 1.96 for a 95% Confidence interval, Ɛ
is the desired level of precision (i.e., the margin of sampling error
tolerated), and is fixed at 5% (0.05), p is prevalence.
n=ε2z2×p(1−p)
Equation 1
No previous studies related to DUR were conducted in the Department of Psychiatry, AMCH. To calculate the prevalence of new patients prescribed psychotropic drugs, previous OPD prescriptions (June 2020 – May 2021) of the Psychiatry department were collected from Medical Record Department, analyzed, and found to be around 41%. Taking this as prevalence and with a desired precision of around 5% and 95% Confidence Interval, the calculated sample size was about 371. However, 655 samples were collected as per WHO guidelines, which mention that at least 600 encounters to be included in a cross-sectional survey, with a greater number if possible (17).
Data Analysis
For measuring WHO core prescribing indicators, WHO /INRUD
(International Network of Rational Use of Drugs) guidelines were followed (17).
To assess the rational use of drugs, the mathematical model developed and
validated by Zhang and Zhi (18)
was applied to appraise medical care comprehensively. This method
was used in various medical and health research, called the Index of Rational
Drug Prescribing (IRDP) (19).
There are five indicators of rational drug prescribing from which the optimal
prescribing indicators were defined. Prescriptions with five or more drugs were
defined as polypharmacy. These five prescribing indicators (prescriptions
including antibiotics, polypharmacy prescription, prescriptions including
injection, drugs prescribed by generic name, and drugs prescribed from National
List of Essential Medicines of India (NLEM)(19)
had the same optimal index of 1. A prescription is considered more rational;
when it’s all prescribing indicators are closer to 1. The Index of Rational
Drug Prescribing (IRDP) was calculated by adding the index values of all
prescribing indicators. Based on the index values, IRDP was defined (19, 20).
For the calculated indices; index of non-polypharmacy (NP), index of rational
antibiotic use (RA), and index of safe injection use (SI), Eq. 2 was
used. On the other hand, Eq. 3 was used to calculate the other indices, index
of generic name(GN) and index of prescription from NLEM (20).
IndexofNP,RA,SI=ObservedvalueOptimalvalue
Equation 2
IndexofGN,NLEM=OptimalvalueObservedvalue
Equation 3
Statistical Analysis
Standard prescriptions, patient care, and facility-specific
indicators were used for data analysis. Data reliability was ensured by
following WHO guidelines and methods (17).
The results are presented with descriptive statistics such as percentages,
ratios, or averages. The data was recorded and evaluated with Microsoft Excel
2007.
Results
Characteristics of Study Participants
A total of 655 prescriptions were analyzed, comprising a demographic split where 54.96% were Male participants and 45.04% were Female participants. Interestingly, the prevalence of psychiatric illnesses, amounting to 27.79%, was notably concentrated within the age group of 21 to 50 years across both sexes. The relative distribution of various psychiatric disorders across different age groups and genders is detailed in Table 1, providing a comprehensive view of these trends within the analyzed dataset.
The Pattern of Psychiatric Disorders
The percentage of prescriptions for schizophrenia, bipolar mood disorders, major depression, anxiety disorders and alcohol-related disorders were 37.86%, 4.88%,11.30%,10.23% and 18.78% respectively. Psychiatric illnesses like erectile dysfunction, premature ejaculation, panic disorders, neuropathy, sleep disturbances, seizure disorders, ADHD, internet addiction, stress-related disorders, dementia/alzheimer's disease, other substance abuse, mental retardation, post-stroke sequelae, and personality disorders – were grouped as ‘other psychiatric illnesses (16.95%). The morbidity pattern and sex difference among different psychiatric illnesses are summarized in Table 2.
Table 1. Age and gender-wise distribution of psychiatric disorders.
Psychiatric Disorder
Age group in Years
Gender
0-10
11-20
21-30
31-40
41-50
51-60
˃60
Male
Female
Schizophrenia and other Psychoses (n=248)
0
29
74
62
46
18
19
121
127
Bipolar Mood Disorders (n=32)
0
6
12
8
1
5
0
23
9
Anxiety Disorder (n=67)
0
10
22
17
12
3
3
30
37
Major Depression (n=74)
0
7
23
14
18
8
4
36
38
Alcohol-related Disorder ( n=123)
0
1
20
52
38
9
3
117
6
Others (n=111)
6
23
31
16
17
10
8
33
78
Total (n= 655)
6
76
182
169
132
53
37
360
295
Table 2. Morbidity pattern and sex difference among different psychiatric illnesses.
Percentage of drugs
prescribed by generic name (%)
100
39.80
3.
Percentage of encounters
with an antibiotic prescribed (%)
20.0-26.8
0.00
4.
Percentage of encounters
with an injection prescribed (%)
13.4-24.1
1.00
5.
Percentage of drugs
prescribed from NLEM (%)
100
48.49
Patient Care Indicators
1.
Average consultation time
(min)
≥10
13.78
2.
Average dispensing time
(sec)
≥90
377
3.
Percentage of drugs
dispensed (%)
100
61.53
4.
Percentage of drugs
adequately labeled (%)
100
100
5.
Percentage of patients'
knowledge of correct dosage (%)
100
44.03
Health Facility Indicators
1.
Availability of a Copy of
the National List of Essential Medicines of India (NLEM)
100
Yes
2.
Availability of key drugs
(%)
100
66.08
Table 4. Use of psychotropic drugs in different psychiatric illnesses.
Drugs Groups
Schizophrenia and other Psychoses % (n=248)
Bipolar Mood Disorders % (n=32)
Anxiety Disorder % (n=67)
Major Depression % (n=74)
Alcohol-related Disorder % (n=123)
Others % (n=111)
Total (n= 655)
[n(%)]
Antianxiety drugs
122
14
50
38
102
70
396(60.4)
Antipsychotic drugs
Atypical
Typical
Total
262
30
37
1
6
3
12
3
19
4
40
0
379(57.86)
78(11.91)
457(69.77)
Antidepressant drugs
SSRI
TCA
Atypical
Others
Total
18
1
2
1
2
0
1
0
47
0
0
2
52
7
17
4
4
0
1
0
20
1
1
2
143(21.83)
9(1.84)
22(3.36)
9(1.84)
183(27.93)
Mood stabilizers
Lithium
Alternative drugs
Total
0
7
1
12
0
0
0
0
0
0
0
0
0
0
0
0
1(0.15)
19(2.9)
20(3.05)
Anticholinergic drugs
86
0
0
6
4
9
112(17.09)
Anti ChE
2
0
0
0
0
3
7(1.07)
Analysis of Prescription Patterns According to Various WHO/INRUD Drug Use Indicators
The 655 prescriptions contained a total of 1691 drugs. Out of these, 1074 were psychotropic drugs. The other drugs commonly co-prescribed were Vitamin D3, Vitamin B12, Ursodeoxycholic Acid, Melatonin, Benfotiamine, Pantoprazole, Calcium, Silymarine, and Multivitamins/Multimineral. There was no prescription for more than five drugs.
Table 3 summarizes the Prescription Patterns According to Various WHO / INRUD Drug Use Indicators. Table 4 summarizes the use of psychotropic drugs in different psychiatric illnesses. The most frequently encountered psychotropic medications were the antianxiety drugs in all groups of psychiatric illnesses.
The total numbers of drugs that were prescribed in OPD were 45 nos. Out of these, 35 nos. of drugs were from the psychotropic group: Antianxiety drugs (lorazepam, alprazolam, etizolam, zolpidem, oxazepam, chlordiazepoxide, propranolol, clobazam, clonazepam); Antipsychotic drugs (Atypical: olanzapine, risperidone, clozapine, aripiprazole, quetiapine; Typical: amisulpride, flupenthixol, fluphenazine); Antidepressant drugs (SSRI: escitalopram, citalopram, sertraline, fluoxetine, fluvoxamine, paroxetine; TCA: amitriptyline; Atypical: mirtazapine; Others: desvenlafaxine, vortioxetine); Mood Stabilizers: ( lithium, Alternative drugs: sodium valproate, carbamazepine, oxcarbazepine); Anticholinergic drugs: trihexyphenidyl, benzhexol); Anti ChE:( donepezil); Anti-craving drug (baclofen, acomprosate).
Fixed Dose Combinations of Psychotropic Drugs (FDCs)
In the examined population, a variety of fixed-dose combinations (FDCs) comprising psychotropic drugs were identified in the prescribed regimens. These included risperidone 3 mg plus trihexyphenidyl 2 mg, which was administered to 62 patients. Similarly, risperidone 2 mg plus trihexyphenidyl 2 mg was prescribed to 19 patients, while risperidone 4 mg plus trihexyphenidyl 3 mg was prescribed to 9 patients. Furthermore, paroxetine 12.5 mg plus clonazepam 0.25 mg was observed in the treatment of 2 patients, alongside paroxetine 12.5 mg plus clonazepam 0.5 mg also prescribed to 2 patients. Another combination, escitalopram 10 mg plus clonazepam 0.5 mg, was utilized in the management of 16 patients, whereas escitalopram 10 mg plus clonazepam 0.25 mg was employed in the treatment of 2 patients. Additional FDCs included fluoxetine 20 mg plus olanzapine 5 mg, which was prescribed to 4 patients, and propranolol 20 mg plus clonazepam 0.5 mg, administered to 3 patients. These findings demonstrate the diverse range of FDCs utilized in the pharmacological management of psychiatric conditions within the studied population.
Drugs Used in Various Psychiatric Disorders
Figure 1 provides an overview of the pharmacological treatment options used in a range of psychiatric disorders. It highlights the drugs prescribed specifically for schizophrenia and other psychosis (Figure 1A), anxiety disorder (Figure 1B), bipolar disorder (Figure 1C), major depression (Figure 1D), and alcohol-related disorder (Figure 1E). This comprehensive visual representation serves to illustrate the diverse array of medications employed in the management of these psychiatric conditions.
Figure 1. Drugs prescribed in schizophrenia and other psychosis (A), anxiety disorder (B), bipolar disorder (C), major depression (D) and alcohol-related disorder (E). Note: X-axis is the prescribed drug's name.
Table 5. Optimal levels of prescribing drug indicators and IRDP value.
Prescribing indicators
Optimal level (%)
Optimal index
Observed value (%)
Index of rational drug prescribing
Indices
Prescriptions including antibiotic
<30
1
0
Rational antibiotic index
1
Polypharmacy prescription
0
1
0
Index of polypharmacy
1
Prescriptions including injection
<10
1
1
Index of safety injection
1
Drugs prescribed by generic name
100
1
39.80
Generic name index
0.39
Drugs prescribed by NLEM
100
1
48.49
NLEM index
0.48
Total calculated IRDP value
5
3.87
Index of Rational Drug Prescribing (IRDP)
The overall IRDP of the present study was 3.87, with an optimal level of 5 (Table 5). The overall IRDP of 3.87 was made up of adding the index of antibiotic 1, index of polypharmacy 1, index of injection 1, index of generic name 0.39, and drugs from NLEM 0.48 (19-21).
Discussion
Study Participants
Male patients (54.96%) frequently visited psychiatric OPD compared
to female patients (45.04%). Many studies have
shown similar results of male preponderance (4, 6, 7).
The reproductive age group (20–40 years) accounted for the majority (73.74%) of
all psychiatric disorders, as has been seen in many other studies (4, 6).
In this study, schizophrenia and other psychoses were the most common diagnosis,
followed by alcohol-related disorders, depression, anxiety disorders and bipolar
mood disorder (Table 2). Piparva et al. (7)
have found that schizophrenia was the most common diagnosis, followed by
depression whereas, in this study, alcohol-related disorder came in second with
a male preponderance, with the age group of 21-50 years.
Analysis of Prescriptions as per the WHO/INRUD Drug
Used Indicators
The average number of prescription drugs was 2.58, which was
similar to other studies (4, 6, 7).
A maximum of five drugs were prescribed in a few prescriptions where other
co-morbidities were present. Otherwise, no polypharmacy was observed.
Polypharmacy can lead to poor compliance, drug interactions, and adverse drug
reactions. It is a growing global issue affecting primary and secondary care,
predominantly driven by an aging, multimorbid population coupled with the
increasing use of evidence-based clinical guidelines (22).
WHO’s “Medication without Harm –Global patient safety challenge” targets one of
the most pressing public health issues of present times: iatrogenic harm.
Multimorbidity, polypharmacy, and fragmented health care (i.e., patients
attending appointments with multiple physicians in various healthcare settings)
are key drivers of medication-related harm, which can result in negative
functional outcomes, high hospitalization rates, and excess morbidity and
mortality (23).
Generic names were prescribed for 39.80% of total drugs. The reason behind more
branded medication in this study may be clinicians' belief that the therapeutic
equivalence of generic drugs is unproven, and patients may believe they are
getting inferior drugs (24).
However, if adequate quality control is assured, generic substitution can
benefit the patient. In this study, injections (1.00%) prescribed were
lorazepam, fluphenazine, haloperidol decanoate 5 mg, promethazine, thiamine,
olanzapine, pantoprazole, ondansetron in people with schizophrenia, and other
alcohol-related disorders. Several Indian studies have evaluated the efficacy
of depot antipsychotics in schizophrenia and found their usefulness in treating
acute schizophrenia and as maintenance therapy. Concerns about the side effects
and economics of the drug's parenteral administration probably explain the
depot injection's low use (25).
48.49% of the drugs were prescribed by the National Essential Medicines List of
India 2022. The main goal of the NLEM is to promote the rational use of
medicines, considering three important aspects: cost, safety, and
effectiveness. In addition, it will also encourage the prescription of drugs
with their generic names (26).
Observed Prescription Pattern in Schizophrenia
In our study, the most commonly prescribed drugs were
atypical antipsychotics (89.73%), olanzapine (36.98%), followed by risperidone
(32.87%) in comparison with typical antipsychotics (10.27%). No single
prescription was observed for clozapine and ziprasidone in the study group
(Figure 1). In diagnosed schizophrenia and other psychoses, lorazepam (63.93%)
was prescribed, followed by clonazepam (13.93%). Guidelines for the rational
use of benzodiazepines recommend short-term use (maximum 4 weeks) or
intermittent treatments with minimally effective doses, which should be
prescribed only for severe symptoms. (27).
Some studies found that first-generation drugs are just as useful as
second-generation drugs, except for clozapine, which is superior to all of them
(28).
Jones PB et al. concluded that initiating treatment with typical rather than
atypical antipsychotics in people with schizophrenia whose medication was
changed due to intolerance or inadequate response over one year had no adverse
effects on quality of life, symptoms, or related outcomes associated with care
costs (29).
In patients with chronic schizophrenia, olanzapine was more effective than the
other drugs tested, and no significant differences in effectiveness were found
between the conventional drug perphenazine and the other second-generation
drugs. Olanzapine has been associated with increased weight gain, HbA1C,
cholesterol, and triglycerides and has been responsible for metabolic syndrome(30).
The 2010 National Institute of Clinical Excellence (NICE) guidelines suggested
that it is not necessary to prescribe an "atypical" drug as a
first-line treatment, and clozapine can only be offered after the primary
failure of two antipsychotics (31).
Observed Prescription Patterns in Bipolar Mood Disorders
For bipolar mood disorder, Divalproex was prescribed most
frequently (23.53%). Lithium was found in only one prescription. Second-generation
antipsychotics prescribed were olanzapine (29.41%), followed by risperidone
(25.4%).49%), and quetiapine (17.65%). Studies have shown that extreme states
of mania and depression can be managed with mood-stabilizing medications, which
can reduce the number of manic and depressive episodes. Kessing et al.
found that lithium is superior to valproate in general (32),
having the most robust evidence of long-term relapse prevention, and is the
first-line treatment for both acute and maintenance treatment of bipolar mood
disorder. Despite its global therapeutic use, the benefits of lithium are
restricted by its narrow therapeutic index and the incidence of adverse effects
(33).
Concerns about the narrow therapeutic index and difficulties in monitoring
serum lithium concentrations at our facility explain the low lithium
consumption observed in this study.
Observed Prescription Pattern in Major Depression
Among the antidepressants, escitalopram (41.25%) was the most
commonly prescribed drug, followed by mirtazapine (21.25%) and amitriptyline
(8.75%). Overall, SSRIs (65%) were prescribed more often than TCAs (8.75%).
This is consistent with current recommendations (APA guidelines) and practices
for treating mood disorders, which recommend a second-generation antidepressant
due to the reduced risk of side effects (34).
According to guidelines from the American College of Physicians, all of these
agents have similar efficacy, and the choice of different second-generation
antidepressants should be based on side effects, cost, and patient preference.
Patient response to treatment and side effects of antidepressants should be
assessed within 1-2 weeks of starting treatment (35).
Observed Prescription Patterns in Anxiety
Disorders
Clonazepam (44.44%) was the most commonly prescribed
antianxiety drug, followed by SSRI - paroxetine (24.24%), escitalopram
(14.14%), and others (17.18%). The NICE guidelines for treating anxiety
disorders state that SSRIs, or serotonin-norepinephrine reuptake inhibitors
(SNRIs), should be a first choice.
In general, benzodiazepines should be
avoided and used only briefly in times of crisis (36).
Combining a benzodiazepine with an SSRI may provide faster anxiety control,
reduction in SSRI-induced anxiety or agitation that may occur early in
treatment, better antidepressant adherence, and better control of episodic or
situational anxiety in response to specific stimuli. These benefits must be
weighed against the potential risks of combination therapy, including side
effects, drug abuse, and potential worsening of depressive symptoms(37).
Alprazolam and lorazepam were not used for anxiety disorders, as evident from
the prescriptions in this study.
Observed Prescription Patterns in Alcohol-related
Disorders (ARDs)
In this study, the incidence of ARDs was high (18.78%).
Chlordiazepoxide (39.33%) was the most commonly prescribed antianxiety drug for
ARD, followed by oxazepam (12%), lorazepam (7.33%), and atypical antipsychotic
olanzapine (10%). Other drugs commonly prescribed for ARDs were ursodeoxycholic
acid, baclofen, acamprosate, and pantoprazole. Alcohol use has increased
globally, with varying trends in different parts of the world, and has been
identified as one of the ten leading risk factors for the burden of disease.
There have been a series of global initiatives to reduce the harmful use of
alcohol, including WHO’s global strategy to reduce the harmful use of alcohol (38).
Central anticholinergic drug trihexyphenidyl (a few
Benhexol) was prescribed in various psychiatric illnesses and was found to be
the maximum in schizophrenia (75.44%). They are recommended to avoid
extrapyramidal side effects (EPS) associated with typical antipsychotics. In
schizophrenia, the prescribing frequency of atypical antipsychotics (57.86%)
was higher than the typical one (11.91%), and most patients were prescribed
anticholinergic agents. Co-prescribing of anticholinergic drugs may add to new
or additive adverse effects (e.g., dry mouth, blurred vision, constipation),
further reducing the quality of life. As routine use of anticholinergic agents
adds to the complexity, side effects, and expenses, whether they should be
prescribed routinely or reserved for the cases of overt EPS remains open to
question (7).
WHO does not recommend anticholinergics to be used routinely for preventing EPS
in psychotic disorders treated with antipsychotics. Short-term use of
anticholinergics may be considered only in individuals with significant EPS
when dose reduction and switching strategies have proven ineffective or when
these side effects are acute or severe (39).
FDCs have advantages and disadvantages, susceptibility for
EPS differs from person to person, and not all patients require the addition of
trihexyphenidyl to overcome EPS. Moreover, the antipsychotic-anticholinergic
combination does not permit the need-based dose titration of trihexyphenidyl.
This could cause additional peripheral and central anticholinergic side effects
in the patients, and the long-term use of trihexyphenidyl may cause cognitive impairment
and tardive dyskinesia (39).
An interesting case has come to light in which a 14-year-old
boy with internet addiction disorder (IAD) was counseled with behavioral
therapy. Cognitive behavioral therapy shows promising results in IAD. Methylphenidate
reduces internet usage time in children with IAD co-existing with ADHD (40).
However, there is still no consensus on which treatment to offer first.
Conclusion
In this study, the use of psychotropic drugs for different
indications followed current guidelines despite the low prevalence of generic
prescribing. There is no gender and age difference in prescribing pattern. No
polypharmacy was seen, and the use of FDCs was also less. Antianxiety drug
lorazepam was extensively prescribed in almost all types of psychiatric
illnesses, with a maximum percentage in anxiety and schizophrenia. Rational use
of Benzodiazepines requires attention in terms of dose and duration. Atypical
antipsychotic olanzapine was more frequently prescribed. Prescribing frequency
and pattern of the central anticholinergic drug were similar to antipsychotic
drugs irrespective of typical or atypical. Routine use of trihexyphenidyl along
with atypical antipsychotic drugs is not justified. The increasing number of
alcohol-related disorders in young adults is also a great concern. DUR is an
effective tool to promote rational drug prescribing. Despite all the
limitations, such as small sample size, shorter study duration, single study
center, etc., the study may be an eye-opener for the healthcare provider. Conducting
similar studies on larger study populations will further strengthen the
database regarding the drug utilization research of psychotropic drugs.
Mental and behavioral disorders are common around the world. Pharmacotherapy, psychotherapy, and psychosocial rehabilitation are three treatment components for these disorders. Drug therapy is an essential part of the comprehensive treatment of these diseases. Their use pattern in psychiatric practice has changed dramatically in recent years. Mental disorders require long-term treatment. Therefore, it is crucial to study the prescribing practices of these groups of drugs. This study aims to assess drug use patterns using the WHO/INRUD Core Prescribing Indicators. Patients of both genders and ages with mental illness and prescription psychiatric drugs were evaluated from the outpatient department of the Psychiatry Unit (OPD). The prescription data were collected and analyzed using the indicators recommended by the WHO/INRUD. The data were analyzed using Microsoft Excel-2007. The percentage and average values of the variables were compared. A total of 655 prescriptions were analyzed. Male patients (54.96%) were more than women (45.04%). The morbidity profile included schizophrenia (37.86%), alcohol use disorder (18.78%), major depressive disorder (11.30%), anxiety disorder (10.23%), bipolar disorder (4.88%), and others (16.95%). The newer antipsychotic were the most commonly prescribed drugs (particularly olanzapine), along with a central anticholinergic (trihexyphenidyl) and a benzodiazepine (lorazepam). The percentage of drugs prescribed with generic names was 39.80%, and that of drugs prescribed by NLEM was 48.49%. The average number of drugs prescribed per prescription was 2.58. This study's Index of Rational Prescribing (IRDP) was 3.87, whereas the optimal score was 5. Prescriptions were complete, and principles of rational prescribing were followed, except for a low generic prescribing rate.
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