Analysis of Psychotropic Drug Utilization in Patients With Organic Mental Disorders

Introduction

Mental health problems represent a significant global public health concern, including in Indonesia. According to the World Health Organization (WHO), approximately one in four individuals will experience a mental or neurological disorder during their lifetime, and an estimated 450 million people worldwide are currently living with such conditions, making them a leading cause of global disability. These disorders encompass a wide range of clinical categories, one of which is organic mental disorders (1).

Organic mental disorders, classified under ICD-10 codes F00–F09, represent a group of psychiatric syndromes that arise as a direct consequence of cerebral pathology, systemic medical conditions, or disturbances of brain function. These disorders may present with psychotic or non-psychotic manifestations, including cognitive impairment, affective changes, and behavioral disturbances, depending on the underlying etiology. In many cases, psychiatric symptoms improve following adequate treatment of the primary medical or neurological condition; however, persistent or progressive courses are frequently observed, particularly in neurodegenerative disorders such as dementia. This heterogeneity reflects the broad spectrum of etiological factors, including vascular disease, metabolic abnormalities, infections, head trauma, and aging-related cerebral changes, which complicate both diagnosis and long-term management (2).

Psychiatric disorders frequently coexist with medical and neurological conditions, with organic mental disorders, depression, and anxiety reported in approximately 25–45% of hospitalized medical and surgical patients. These psychiatric manifestations may arise as a direct consequence of physical illness, adverse drug reactions, or increased biological vulnerability associated with chronic medical conditions. Structural brain diseases and neurological insults, including stroke, traumatic brain injury, hypoxia, infections, and metabolic disturbances, constitute major etiological factors underlying organic mental disorders and contribute to their highly heterogeneous clinical presentation (2).

Clinically, organic mental disorders may present with alterations in sensorium, including reduced alertness, fluctuating levels of consciousness, or clouded awareness. Cognitive impairment is common, typically involving deficits in memory, attention, and reasoning abilities, and is frequently accompanied by disturbances in orientation regarding time, place, or person. Perceptual abnormalities, particularly hallucinations, disruptions in thought content such as delusions, and affective symptoms ranging from depressive and anxious states to episodes of elevated mood are also commonly observed (3).

Although organic mental disorders may resemble functional psychiatric conditions, several clinical features support an organic etiology, including early cognitive impairment preceding affective or psychotic symptoms, focal neurological deficits, fluctuating symptom severity, and the presence of visual hallucinations or atypical paranoid ideation. These characteristics emphasize the importance of comprehensive medical and neurological evaluation in addition to psychiatric assessment to establish an accurate diagnosis and guide appropriate management (2).

The management of patients with organic mental disorders often requires the administration of psychotropic medications, drug classes that act on the central nervous system to alter mental processes, mood, and behavior. These medications include antipsychotics, antidepressants, anxiolytics, hypnotic–sedatives, and mood stabilizers. Appropriate drug selection must consider the specific type of disorder, symptom severity, comorbid medical conditions, and the potential risk of adverse effects. In many cases, symptomatic pharmacological treatment is required to control agitation, psychosis, affective instability, and anxiety that interfere with daily functioning and medical care (2). Therefore, monitoring the utilization of psychotropic medications is an important aspect in improving the quality and rationality of pharmacotherapy in patients with organic mental disorders.

Analyzing psychotropic drug utilization using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology and the Drug Utilization 90% (DU90%) method provides a quantitative overview of medication use based on WHO standards while identifying the drug groups most frequently prescribed. These approaches are valuable for assessing the appropriateness of prescribing practices in relation to clinical guidelines and for identifying opportunities to optimize pharmacotherapy. Nevertheless, data on the patterns of psychotropic drug utilization, particularly among outpatients with organic mental disorders in psychiatric hospitals in Indonesia, including the Jambi region, remain limited. However, data regarding patterns of psychotropic drug utilization, particularly among outpatients with organic mental disorders in psychiatric hospitals in Indonesia, including the Jambi region, remain limited. Previous quantitative evaluations using the ATC/DDD methodology have predominantly focused on antibiotic utilization rather than psychotropic medications. Therefore, this study was conducted to evaluate the utilization of psychotropic drugs among outpatients with organic mental disorders at Kolonel Haji Muhammad Syukur Regional Psychiatric Hospital in 2024. Specifically, this study aims to: (1) describe the demographic and clinical characteristics of patients receiving outpatient therapy; (2) quantify psychotropic drug utilization in terms of defined daily doses (DDD) per patient per day using the ATC/DDD method; and (3) identify the medications included in the Drug Utilization 90% (DU90%) segment.

Methodology

Research Design

The study adopted a retrospective descriptive design using secondary data obtained from hospital medical records. Ethical approval was secured from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Universitas Jambi (Approval No. 3068/UN21.8/PT.01.04/2025). A total sampling strategy was employed to include all eligible patients who met the predefined inclusion criteria.

Study Location and Period

The study was conducted at the Regional Mental Hospital Kolonel Haji Muhammad Syukur in Jambi Province using retrospective data from 2024, with data collection carried out in October 2025.

Population and Sample

The study population comprised all outpatients formally diagnosed with organic mental disorders (ICD-10 codes F00–F09) who received psychotropic medication services at the Regional Mental Hospital Kolonel H. M. Syukur, Jambi Province, throughout the year 2024. To ensure consistency in the analysis of drug utilization patterns using the ATC/DDD methodology, this study focused on adult patient aged ≤ 65 years. Hospital medical records documented a total of 100 patients who met these criteria. A total sampling (saturated sampling) technique was applied, ensuring that all eligible patients within the population were included in the analysis; therefore, no separate sample size calculation was required.

The final sample selection adhered to predefined inclusion and exclusion criteria. The inclusion criteria consisted of patients aged 18–65 years, diagnosed with an organic mental disorder (F00–F09), who had received at least one psychotropic prescription, and whose medical records were complete. Patients were excluded if the prescribed psychotropics did not have a Defined Daily Dose (DDD) code established by the WHO Collaborating Centre for Drug Statistics Methodology or if their medical records were incomplete or unreadable. After applying these criteria, the final sample comprised all 100 eligible patients.

Variables

The variables extracted from the medical records included the drug name, dosage strength, quantity dispensed, duration of use, dosage form, and patient characteristics such as gender, age, occupation, diagnosis, education level, and marital status. From these data, secondary variables were generated, including psychotropic drug classification and the Defined Daily Dose (DDD)/Patient/Day. The DDD/Patient/Day for each psychotropic medication was calculated using the following formula Eq. 1:

The DDD values were sourced from the WHO Collaborating Centre for Drug Statistics Methodology database (https://www.whocc.no/atc_ddd_index), referenced according to the drug name and its route of administration.

Data Processing

Data processing was conducted using Microsoft® Excel, where raw clinical records were meticulously organized to ensure analytical integrity. The DDD/Patient/Day values for each specific formulation were aggregated according to the generic name of the psychotropic drug, allowing for a standardized comparison of utilization patterns across the patient cohort. To provide a comprehensive overview of the study population, patient characteristics were analyzed using univariate methods, facilitating a detailed description of demographic and clinical distributions including gender, age, occupation, primary diagnosis, educational attainment, and marital status. These foundational descriptive statistics served to identify key trends and potential outliers within the data set, ensuring a robust basis for subsequent multivariate analysis.Data processing was carried out using Microsoft® Excel. The DDD/Patient/Day values for each formulation were aggregated according to the generic name of the psychotropic drug. Patient characteristics were analyzed using univariate methods to describe their distribution by gender, age, occupation, diagnosis, educational attainment, and marital status.

Results

Demographic and Socioeconomic Profile

Based on Table 1, the demographic and socioeconomic characteristics of the respondents showed considerable variation. The majority of patients were male (65%) compared to female (35%), indicating a higher proportion of males in this sample. These findings are consistent with previous reports stating that the prevalence of organic neuropsychiatric disorders is higher in males following brain injury, for instance, a study on patients with craniocerebral injuries in Shanghai also demonstrated a male predominance in the occurrence of organic personality disorders (4).

A total of 47% of patients were in the 18–39-year age group, followed by 39% in the 40–60-year age group, indicating that nearly half of the cases of organic mental disorders (OMD) occur in young adults. This finding is consistent with neuroepidemiological literature, which reports that OMD often emerges during the productive age, associated with a high burden of mental health problems, a known risk factor for developing organic mental disorders (5). In this study, the highest proportion of patients was observed in the 18–39-year age group. This finding is comparable to a study on psychotropic prescribing patterns in Latin America, where the mean age of the study population was reported to be 58 years (6). In addition, 50% of patients were classified as unemployed, reflecting the significant functional impact of OMD. Organic brain dysfunction can lead to cognitive impairments such as deficits in memory, attention, and executive function, accompanied by mood and perceptual disturbances as well as reduced adaptive abilities, which collectively contribute to limitations in maintaining employment.

Regarding educational level, the largest proportion of patients with organic mental disorders had a high school education (37%), followed by primary school education (29%). This finding can be viewed within the framework of social determinants of health, where, although organic mental disorders are directly caused by physiological conditions, their impact on cognitive and psychosocial functioning is also influenced by an individual’s cognitive reserve. In addition, 51% of patients were unmarried, which may reflect difficulties in forming and maintaining long-term relationships due to the cognitive, affective, and social impairments often associated with organic mental disorders.

According to the ICD-10 classification, organic mental disorders are a group of psychiatric syndromes that arise as secondary consequences of identifiable cerebral diseases or systemic medical conditions affecting brain function. Their clinical manifestations are diverse, including psychotic symptoms, mood disturbances, anxiety, cognitive decline, and behavioral dysfunction, which may be transient or persistent if the underlying pathology is irreversible.

Although the primary management focuses on identifying and treating the underlying medical condition, symptomatic psychiatric interventions are often required to control agitation, psychosis, affective instability, and anxiety, which can disrupt patient functioning as well as the medical care process. The wide spectrum of etiologies and the fluctuating clinical course of organic mental disorders provide a rationale for the use of various classes of psychotropic medications, such as antipsychotics, antidepressants, and anxiolytics, tailored to the dominant neuropsychiatric manifestations (2).

Based on Table 2, the most frequently observed diagnosis in this study was F06, which refers to other mental disorders due to brain damage and dysfunction as well as physical disease, accounting for 36% of all patients. This diagnostic code is applied when there is evidence or strong suspicion of an organic process affecting the brain or a general physical condition leading to mental disturbances, but the clinical presentation does not fully meet the criteria for a more specific F06 subcategory. Such conditions may include alterations in cognitive, affective, or behavioral functioning arising as a consequence of various etiologies, including medical illnesses, neurological disorders, infections, head trauma, metabolic dysfunctions, or other physiological conditions impacting brain function (7).

Table 2 shows that 33% of patients are diagnosed with F06.9 (Unspecified mental disorder) and 20% with F09 (Unspecified organic mental disorder). This pattern likely reflects common challenges in routine clinical practice, where etiological clarification may be limited by the availability of diagnostic investigations, time constraints, and the need for immediate symptom-based management. Despite these limitations, the current prescribing patterns still reflect efforts to manage complex neuropsychiatric symptoms in a clinically appropriate manner.

Defined Daily Dose (DDD) was used in this study as a standard unit to assess the intensity of psychotropic drug use in patients with organic mental disorders (OMD). DDD is a technical indicator representing the average maintenance dose per day of a drug for its main indication in adult patients, allowing for an objective and standardized evaluation of drug use patterns at the population level. Data from the most recent outpatient visits in 2024 were utilized to minimize bias from repeated prescriptions, providing a more representative overview of actual prescribing patterns.

Based on Table 3, the total psychotropic drug utilization observed in this study reached 9.89 DDD/patient/day, which at first glance may appear exceptionally high when interpreted as a single-drug dose. However, this value should be understood as the cumulative DDD across multiple psychotropic medications prescribed concurrently, rather than reflecting excessive dosing of an individual agent.

Patients with organic mental disorders (OMD) typically present with complex and overlapping symptom domains, including psychotic, affective, anxiety, and behavioral disturbances, which often necessitate combination pharmacotherapy (polypharmacy) involving antipsychotics, antidepressants, and anxiolytics.

Antipsychotics accounted for the largest proportion of use (41.46%), followed by antidepressants (33.97%) and anxiolytics (24.57%). This distribution reflects the heterogeneous clinical manifestations of organic mental disorders, which commonly encompass psychotic, affective, and anxiety-related symptoms.

In this context, the aggregated DDD value represents the overall intensity of drug utilization at the patient level, rather than inappropriate prescribing. This interpretation is consistent with the World Health Organization (WHO) ATC/DDD methodology, which is designed as a standardized unit for population-level drug utilization analysis and not as a direct measure of the prescribed daily dose in individual patients.

Nevertheless, the relatively high cumulative DDD observed in this study highlights the complexity of pharmacological management in OMD and underscores the need for careful evaluation of prescribing practices. While polypharmacy may be clinically justified in managing multifaceted neuropsychiatric symptoms, it is also associated with an increased risk of adverse drug events, drug interactions, and reduced treatment adherence, thereby requiring close clinical monitoring and periodic medication review to ensure rational and safe pharmacotherapy.

The use of antipsychotics in this study was recorded at 4.10 DDD per patient per day, indicating that the management of psychotic symptoms and agitation is a key component in the treatment of organic mental disorders (OMD). This finding is consistent with previous reports indicating that antipsychotics are prescribed in more than 80% of patients with OMD (8-9). Olanzapine was the most frequently used antipsychotic (1.95 DDD), followed by aripiprazole, risperidone, quetiapine, and haloperidol. The predominance of atypical antipsychotics reflects a global shift in clinical practice that emphasizes safety considerations, particularly their lower risk of extrapyramidal side effects compared with typical antipsychotics. In addition, atypical antipsychotics generally demonstrate better tolerability, with olanzapine reported to have one of the lowest incidences of adverse drug reactions (ADRs) (10).

Antidepressants also contributed substantially to the total use of psychotropic drugs, accounting for 3.36 DDD per patient per day, with escitalopram and fluoxetine being the most frequently prescribed (1 DDD each). This pattern is consistent with findings from a study on antidepressant use in a tertiary referral hospital in Nagpur, India, which reported that selective serotonin reuptake inhibitors (SSRIs) were the most commonly used class of antidepressants, particularly escitalopram and fluoxetine, due to their superior efficacy and tolerability profiles compared to tricyclic antidepressants (11).

Meanwhile, the use of anxiolytics reached 2.43 DDD per patient per day, with alprazolam, lorazepam, clobazam, and diazepam being the most frequently prescribed drugs. This pattern reflects the high prevalence of anxiety, agitation, and sleep disturbances in patients with OMD, which may be associated with neurochemical imbalances or the direct effects of brain injury.

Drug Utilization 90% (DU90%) is an analytical method used to identify the most frequently prescribed drugs based on the distribution of Defined Daily Dose (DDD) volumes. This method provides an overview of the main drugs targeted in clinical therapy and serves as an indicator of rational drug use in healthcare facilities. In this study, the drugs included in the DU90% segment comprised antipsychotics, antidepressants, and anxiolytics, collectively reflecting the complexity of clinical symptoms in patients with organic mental disorders, as presented in Table 4. Cumulatively, the DU90% segment consisted of eleven drugs, ranging from olanzapine to quetiapine, accounting for 92.62% of the total psychotropic drug use.

Olanzapine was the most frequently used drug in this study, with a usage of 1.95 DDD per patient per day (19.72%). The high use of olanzapine among patients with organic mental disorders is consistent with national survey data showing that antipsychotics are the most commonly prescribed class of drugs for patients with organic mental disorders, accounting for 81.7% of prescriptions (8).

Escitalopram and fluoxetine each contributed 1 DDD per patient per day (10.11%), underscoring the role of antidepressants as a key component in the pharmacotherapy of organic mental disorders. The use of alprazolam (0.86 DDD/patient/day) and lorazepam (0.62 DDD/patient/day) reflects the significant role of benzodiazepines in managing anxiety and agitation in this condition. However, their use requires careful therapeutic monitoring due to the potential risks associated with long-term use, including tolerance and dependence. Additionally, the usage of sertraline (0.64 DDD/patient/day), aripiprazole (0.61 DDD/patient/day), and clobazam (0.56 DDD/patient/day) indicates that pharmacotherapy for organic mental disorders is comprehensive, addressing not only psychotic or depressive symptoms but also chronic anxiety, irritability, and sleep disturbances. Risperidone (0.56 DDD/patient/day) was also included in the DU90% segment, as was amitriptyline (0.47 DDD/patient/day), although its use was lower compared to selective serotonin reuptake inhibitors. The DU90% segment was further complemented by haloperidol (0.45 DDD/patient/day) and quetiapine (0.44 DDD/patient/day) as additional antipsychotics. The antipsychotic medications included in the DU90% segment indicate consistent prescribing patterns, reflecting rational drug use in psychiatric care.  Overall, the DU90% findings demonstrate a structured pharmacotherapeutic approach aligned with symptom complexity and current clinical treatment principles.

Discussion

Demographic and Socioeconomic Profile Related to OMD

This study identified several factors related to the demographic and socioeconomic profile of patients with organic mental disorders (OMD). The higher prevalence of male patients compared to females is thought to be influenced by biological factors and sex differences that contribute to vulnerability to OMD. Specifically, males tend to be at higher risk for physical trauma, such as head injuries, stroke, or systemic diseases, which can trigger the development of organic mental disorders. Clinically, various reports indicate that male populations with a history of brain injury and OMD exhibit relatively higher prevalence rates, supporting the findings of this study (4, 12). Therefore, the predominance of male patients in this sample may reflect both a higher organic risk profile among males and potential differences in access to and utilization of healthcare services between males and females.

The high incidence of OMD in the productive age group is likely associated with exposure to various risk factors, such as head trauma, systemic diseases, metabolic disorders, psychoactive substance use, and other neurological conditions that can lead to organic brain dysfunction. A large-scale population study in Russia reported that OMD is most commonly observed in working-age individuals, with the 18–44-year age group accounting for approximately 50–59% of all disability cases due to organic mental disorders (13). These findings underscore that OMD is not solely a condition of older age or degenerative in nature but is also frequently experienced by young adults as a consequence of various organic etiologies. Therefore, the results of this study highlight the importance of early detection and close monitoring of young individuals with organic risk factors to enable timely interventions before more severe functional decline occurs.

Clinical literature indicates that organic mental disorders result in a combination of cognitive deficits and psychological changes that directly affect social functioning, work performance, and individual participation in society. Longitudinal studies on patients with traumatic brain injury (TBI) or acquired brain injury (ABI) consistently report difficulties in returning to work and low job stability due to persistent neurocognitive impairments (14). Therefore, the high proportion of unemployed patients in this study likely reflects the neurocognitive and social dysfunction experienced by individuals with organic mental disorders. These findings underscore that the management of organic mental disorders cannot be limited to pharmacological therapy alone but should be complemented with vocational rehabilitation, cognitive interventions, and comprehensive social support.

Additionally, educational level plays an important role in determining vulnerability to organic mental disorders. Several causal studies using Mendelian randomization approaches have shown that higher educational attainment contributes to the development of a stronger cognitive reserve, thereby increasing resilience against the clinical manifestations of brain dysfunction. Individuals with a high school education, who have relatively limited cognitive reserve compared to those with higher education, are more frequently exposed to organic risk factors such as head injuries, infections, or metabolic disorders through occupational or lifestyle-related factors, placing them in a more vulnerable position. Although this group generally has adequate cognitive capacity and health awareness to access medical services, their cognitive reserve may not be sufficient to prevent or mitigate the severity of organic mental disorders experienced (15).

Employment status is a significant factor influencing medication adherence in psychiatric treatment, as supported by several studies (16, 17). This relationship may be linked to lower family income, which has also been identified as a determinant of poor adherence among patients with psychiatric disorders (18). In addition, educational level plays an important role, as patients with lower educational attainment tend to demonstrate poorer adherence compared to those with higher education. Limited understanding of medical instructions, therapeutic recommendations, and treatment procedures may hinder proper adherence, ultimately leading to suboptimal treatment outcomes and negatively affecting patient health (19).

Clinical literature published by the World Health Organization (WHO) indicates that organic mental disorders can lead to personality changes, emotional disturbances, and cognitive deficits that significantly disrupt family functioning and social interactions (14). Similar findings have been reported in studies of patients with organic epilepsy and other neurological disorders, showing that limitations in social functioning can hinder the formation of intimate relationships and the maintenance of long-term partnerships (12). This underscores the importance of a comprehensive management approach that integrates social rehabilitation, family counseling, and psychosocial support as part of the care for organic mental disorders, aiming to improve patients’ overall quality of life.

Clinical Diagnosis Patterns of Organic Mental Disorders

The diagnosis of other mental disorders due to brain damage and dysfunction, as well as physical disease (F06), is frequently encountered in clinical practice, particularly when symptom manifestations are mixed or atypical, or when available clinical information is limited. Such conditions may occur, for example, in patients with impaired consciousness, disorientation, or cognitive disorganization, which restrict the ability to conduct a comprehensive psychiatric assessment (20). Several studies have also reported that organic mental disorders are often difficult to classify into more specific subcategories due to the wide variation in clinical manifestations and the diverse underlying medical etiologies (21). These findings are consistent with previous research on secondary psychiatric disorders resulting from general medical conditions, where “other” or “unspecified” diagnostic categories often predominate as a consequence of the complexity of the clinical presentation (20).

The high proportion of F06 diagnoses observed in this study underscores the inherent challenges in assessing mental disorders of organic etiology, particularly in situations with limited diagnostic information or when symptoms reflect a combination of cognitive, affective, and behavioral impairments. This highlights the importance of a multidisciplinary evaluation approach involving psychiatry, neurology, and relevant supportive medical investigations to enhance diagnostic accuracy and optimize therapeutic planning in patients with organic mental disorders.

Defined Daily Dose (DDD) per Patient per Day in Organic Mental Disorders

The high use of antipsychotics in the pharmacological management of organic mental disorders can be attributed to the frequent occurrence of psychotic symptoms accompanying various organic conditions, such as brain tumors, postictal epilepsy, head trauma, hypercortisolism, and cerebral anoxia (22). The concurrent use of multiple antipsychotic agents may result in antipsychotic polypharmacy. Although this practice is frequently observed in clinical settings, it is generally discouraged by most treatment guidelines due to limited evidence supporting its efficacy. Nevertheless, antipsychotic combinations may be considered in certain clinical situations, such as treatment-resistant symptoms or inadequate response to monotherapy. Despite these considerations, the use of multiple antipsychotics concurrently may increase the risk of adverse drug events (ADEs), including both single and multiple drug-related adverse effects, thereby requiring careful clinical monitoring (23). Olanzapine is one of the most commonly used antipsychotics, characterized by higher affinity for serotonin 5-HT2A receptors compared to dopamine D2 receptors, a hallmark of atypical antipsychotics (24). Atypical antipsychotics are generally preferred due to their more favorable safety profile, particularly in reducing the risk of extrapyramidal symptoms and motor disturbances, which is highly relevant for patients with organic brain damage (25, 26). In addition, atypical antipsychotics provide benefits in controlling affective symptoms and behavioral dysfunction commonly associated with neurologically based disorders (26). In contrast, the use of typical antipsychotics such as haloperidol is relatively limited but remains important in acute conditions or severe agitation requiring rapid symptom control (12). This prescribing pattern reflects clinicians’ efforts to balance short-term symptom management with long-term safety considerations, especially in patient populations with neurological vulnerability.

The use of anxiolytics in patients with organic mental disorders aims to control anxiety and agitation while improving quality of life, with benzodiazepines being the most commonly used class. This finding is consistent with prescription pattern studies in psychiatric units of tertiary referral hospitals in India, which reported benzodiazepines as among the most frequently prescribed psychotropic drugs for managing anxiety disorders and related psychiatric conditions (27). In organic mental disorders, benzodiazepines are selected due to the clinical need for rapid anxiolytic effects, stabilization of agitation, and control of fluctuating hyperactive symptoms (28). However, the high use of alprazolam warrants caution due to its potential for dependence and withdrawal symptoms. In contrast, lorazepam and clobazam, with more stable pharmacokinetic profiles and lower risk of metabolite accumulation, are generally safer for vulnerable populations. Careful use of benzodiazepines remains crucial given their potential to worsen cognitive function, cause excessive sedation, and increase the risk of falls, particularly in patients with neurocognitive impairments or cerebral atrophy. In the study by Panes et al. (2020), agitation was the most frequently reported adverse effect of benzodiazepine use, indicating a relatively high incidence compared to other outcomes (29). In contrast, neurological symptoms, such as cognitive impairment or falls, as well as suicidal ideation, were reported least frequently (29). The impact of benzodiazepines on cognitive function appears to be variable, however, long-term use has been associated with a greater risk of cognitive decline (30, 31). In addition to cognitive impairment, prolonged benzodiazepine use has also been shown to induce negative changes in sleep microstructure, particularly in patients with insomnia (32).

Overall, the observed patterns of anxiolytic, antidepressant, and antipsychotic use indicate that the management of organic mental disorders requires a multidimensional pharmacotherapeutic approach. The predominance of antipsychotic use underscores the importance of controlling psychotic and behavioral symptoms, while the substantial use of antidepressants, particularly SSRIs, highlights the significant role of affective symptoms in the clinical course of OMD. Benzodiazepine use reflects the need to stabilize anxiety and agitation, although close monitoring remains essential. These findings emphasize the complexity of therapeutic needs in OMD, requiring integrated consideration of neurological, psychiatric, and pharmacological safety aspects.

Drug Utilization 90% (DU90%) Segment of Drug Therapy in Organic Mental Disorders

The Drug Utilization 90% (DU90%) method is an important analytical approach for evaluating the rationality of drug use and the quality of prescribing by identifying the group of drugs that account for 90% of total consumption. This approach allows assessment of the appropriateness of drug selection, dosing, and therapeutic indication in accordance with rational prescribing principles. In the context of mental disorders, including bipolar disorder, DU90% analysis has been used to evaluate the accuracy of mood stabilizer and antipsychotic use, demonstrating a high level of precision in dose and indication selection, consistent with rational drug use principles (33). In patients with organic mental disorders, antipsychotics, antidepressants, and anxiolytics included in the DU90% segment reflect therapeutic needs to control psychotic, affective, and anxiety symptoms, although their use still requires individual risk–benefit considerations.

Atypical antipsychotics are the most dominant drug class within the DU90% segment, particularly among patients with dementia and other neurological conditions, with quetiapine, risperidone, and olanzapine being the most frequently prescribed agents due to their effectiveness in controlling behavioral and psychological symptoms of dementia (BPSD) (34). As an atypical antipsychotic, olanzapine exerts therapeutic effects through antagonism of dopamine D2 and serotonin (5-HT2A/5-HT1A) receptors, making it effective in managing psychotic symptoms commonly observed in organic conditions such as cerebral anoxia, traumatic brain injury, postictal epilepsy, and brain tumors (22). In addition to reducing psychotic symptoms, olanzapine is also beneficial for controlling agitation, sleep disturbances, and affective instability, with a relatively favorable motor side effect profile compared to typical antipsychotics, supporting its use as a first-line therapy in patients with neurological vulnerability.

In addition to olanzapine, aripiprazole is also included in the DU90% segment. As a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at 5-HT2A receptors, aripiprazole has an adaptive pharmacodynamic profile, making it effective for patients with organic mental disorders who present with a combination of psychotic and affective symptoms (35). Its relatively favorable metabolic profile makes aripiprazole a suitable alternative for patients at risk of weight gain or lipid disturbances, which are often associated with olanzapine use. Although its usage rate is lower, risperidone remains important in the management of organic mental disorders due to its effectiveness in controlling psychotic symptoms and aggression, with a lower risk of extrapyramidal symptoms compared to typical antipsychotics. This finding aligns with evidence from clinically stable adult psychiatric populations, indicating that long-term risperidone use is associated with good tolerability and a relatively low incidence of motor side effects (36).

The use of haloperidol, also included in the DU90% segment, is primarily associated with the management of acute clinical conditions, particularly in patients with organic mental disorders experiencing severe agitation, delirium, or sudden onset of psychotic symptoms. Its rapid onset of action makes haloperidol essential in emergency practice and for controlling acute behavioral disturbances that may endanger the patient or their surroundings (10). In contrast, quetiapine is more often selected for patients with predominant affective symptoms or sleep disturbances, consistent with its sedative effects. Nevertheless, quetiapine use requires careful monitoring due to the risk of metabolic side effects, particularly with long-term therapy (37). The inclusion of both drugs in the DU90% segment reflects clinicians’ efforts to balance the need for rapid symptom control during acute phases with considerations of long-term safety and tolerability.

Antidepressants are an important component in the management of organic mental disorders, with the largest contribution in this study coming from escitalopram and fluoxetine. This finding aligns with international prescribing patterns that position selective serotonin reuptake inhibitors (SSRIs) as first-line therapy for depression in populations with organic mental disorders, primarily due to their superior tolerability and safety profile compared to other classes (11). Depression is a common clinical manifestation in organic mental disorders, particularly in patients with frontal lobe involvement or neurodegenerative processes. Escitalopram and fluoxetine are generally preferred because of their low risk of anticholinergic effects and cardiotoxicity, making them safer for patients with brain injury or autonomic dysfunction.

In contrast, the use of amitriptyline in this study was relatively lower compared to escitalopram and fluoxetine. This suggests that the use of tricyclic antidepressants in organic mental disorders tends to be selective, particularly for patients with specific comorbidities such as neuropathic pain or severe insomnia. Given the higher risk of anticholinergic effects, excessive sedation, and cardiotoxicity, amitriptyline is generally not positioned as a first-line therapy. Therefore, its presence in the DU90% segment likely reflects specific clinical indications rather than routine use in patients with organic mental disorders.

Benzodiazepines, such as alprazolam and lorazepam, remain widely used in the management of organic mental disorders, particularly for controlling anxiety symptoms arising from neurotransmitter dysregulation and cortical instability, which require rapid pharmacological stabilization. This finding is consistent with a study conducted in a hospital in Uttarakhand, India, which reported that benzodiazepines were the most frequently prescribed drug class for anxiety management in psychiatric services, accounting for 33.13% of prescriptions, highlighting the clinical relevance of this drug class (27). Nevertheless, benzodiazepine use requires caution due to the risks of excessive sedation and cognitive impairment, which may exacerbate underlying organic conditions. In this context, lorazepam is considered a relatively safer option, as it is metabolized via non-hepatic pathways, making it more suitable for patients with neurological or metabolic disorders.

Overall, the DU90% profile observed in this study indicates that the management of organic mental disorders relies on a combination of atypical antipsychotics, SSRIs, and benzodiazepines with relatively favorable safety profiles. This pattern is highly consistent with existing literature, which emphasizes that patients with organic mental disorders exhibit a broad spectrum of symptoms arising from underlying neurological disturbances, including psychotic, affective, anxiety-related, agitation, and sleep-related symptoms. The high utilization of olanzapine, SSRIs, and benzodiazepines underscores the need for a multidimensional therapeutic approach that integrates psychotic symptom stabilization, affect regulation, and anxiety control. Consequently, the DU90% findings suggest that the prescribing patterns observed in this study are generally consistent with commonly reported pharmacological approaches in the management of organic mental disorders.

Conclusion

At the Regional Psychiatric Hospital Kolonel H. M. Syukur Jambi, psychotropic use for organic mental disorders was led by antipsychotics, followed by antidepressants and anxiolytics, reflecting the varied neuropsychiatric symptoms of these conditions. The DU90% concentration suggests consistent prescribing centered on medications with established efficacy and safety, notably atypical antipsychotics and SSRIs. While these choices align with modern therapeutic standards for better tolerability, the significant use of benzodiazepines necessitates careful monitoring for dependence risks. Ultimately, these patterns highlight a commitment to evidence-based care while providing a baseline to further promote rational drug use and enhance patient safety in outpatient psychiatric management.The pattern of psychotropic drug utilization among outpatients with organic mental disorders at the Regional Psychiatric Hospital Kolonel H. M. Syukur Jambi was predominantly characterized by the use of antipsychotics, followed by antidepressants and anxiolytics. This distribution reflects the complex neuropsychiatric manifestations commonly observed in organic mental disorders, including psychotic, affective, and anxiety-related symptoms. The concentration of commonly prescribed drugs within the DU90% segment suggests relatively consistent prescribing practices and may indicate an effort to prioritize medications with established efficacy, tolerability, and clinical familiarity. From a clinical perspective, the predominance of atypical antipsychotics and selective serotonin reuptake inhibitors aligns with current therapeutic approaches that emphasize improved safety profiles and better tolerability compared with older agents. However, the notable use of benzodiazepines highlights the need for careful monitoring due to the potential risks associated with long-term use, including tolerance and dependence. Overall, these findings provide important insights into prescribing patterns in routine psychiatric outpatient care and may contribute to ongoing efforts to promote rational psychotropic drug use, enhance patient safety, and support evidence-based pharmacotherapy in the management of organic mental disorders.