Vinod K Mathew, Kishore Gnana Sam, Beulah Milton, Amit Kumar Das
Vinod K Mathew1*, Kishore Gnana Sam2, Beulah Milton3, Amit Kumar Das4
1Dept. of Pharmacy Practice, Krupanidhi College of Pharmacy, Bangalore – 35.
2Associate Professor, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE.
3Professor, Department of Pharmacy Practice, Krupanidhi College of Pharmacy, Bangalore – 35.
4Principal, Krupanidhi College of Pharmacy, Bangalore – 35.
Volume - 14,
Issue - 8,
Year - 2021
Background: Schizophrenia is a burdensome illness which virtually affects all aspects of the patient’s life. There is a lack of national level data from India on prescription pattern of Antipsychotics Polypharmacy and other drugs combination in the treatment of Schizophrenia. Aim and Objectives: To evaluate Prescription pattern of Antipsychotic Polypharmacy in schizophrenia. Methodology: The medication records of patients admitted from August 2006 to May 2007 were reviewed to evaluate the prescription pattern of antipsychotics poly pharmacy, Demography of the patients like age, sex, were also evaluated. Results: The medical records of 139 schizophrenic patients were reviewed, out of 139 patients 30.93% (n = 43) patients received combination therapy. In combination therapy 28.77% (n=40) were prescribed two antipsychotics and 0.007% (n= 3) were prescribed three antipsychotic drugs. The average age was 34.4±11.9 years. F 20.0 Paranoid schizophrenia received maximum prescriptions for combination therapy 18.71% (n=26). Comparison of adjunct medication showed Anxiolytics and Anticholinergics 17.26% (n=25) received maximum prescriptions for combination therapy A total of 20.86% (n=29) received combination of Second Generation Antipsychotics SGA + First Generation Antipsychotics FGA, maximum patients 18 was in the combination of Haloperidol + Resperidone. Conclusion: The present study revealed an increasing trend of polypharmacy among schizophrenia patients admitted in a tertiary care hospital. The present study demonstrate the rate of antipsychotic polypharmacy is relatively low in India
Cite this article:
Vinod K Mathew, Kishore Gnana Sam, Beulah Milton, Amit Kumar Das. Prescription Pattern of Antipsychotics Polypharmacy in patients with Schizophrenia in an Indian Hospital. Research Journal of Pharmacy and Technology. 2021; 14(8):4265-9. doi: 10.52711/0974-360X.2021.00740
Vinod K Mathew, Kishore Gnana Sam, Beulah Milton, Amit Kumar Das. Prescription Pattern of Antipsychotics Polypharmacy in patients with Schizophrenia in an Indian Hospital. Research Journal of Pharmacy and Technology. 2021; 14(8):4265-9. doi: 10.52711/0974-360X.2021.00740 Available on: https://rjptonline.org/AbstractView.aspx?PID=2021-14-8-46
1. Centorrino F, Goren JL, Hennen J, Salvatore P, Kelleher JP, RJ. Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. Am J Psychiatry. 2004; 161: 700-706.
2. Stahl SM, Grady MM. High-cost use of second-generation antipsychotics under California's Medicaid program. Psychiatr Serv. 2006; 57: 127-129.
3. Correll CU, Frederickson AM, Kane JM, Manu P. Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophr Res. 2007; 89: 91-100.
4. Fleischhacker WW, Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. Int J Neuropsychopharmacol. 2012:1-11. [Epub ahead of print]
5. Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, et al; World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Treatment Guidelines for Schizophrenia. World Federation of Societies of Biological Psychiatry. (WFSBP) guidelines for biological treatment of schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry. 2012; 13:318- 378.
6. Lehman AF, Lieberman JA, Dixon LB, McGlashan TH, Miller AL, Perkins DO, et al; American Psychiatric Association; Steering Committee on Practice Guidelines. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161(2 Suppl): 1-56.
7. Ahn YM, Kwon JS, Bahk WM, Kim CE, Park JI, Lee SY, et al. The feasibility test of Korean medication algorithm for the treatment with schizophrenic patients (II): the problem for applying algorithm to the real clinical situation and opinion of revision. Korean J Psychopharmacol. 2006;17: 35-49.
8. Paton C, Lelliott P, Harrington M, Okocha C, Sensky T, Duffett R. Patterns of antipsychotic and anticholinergic prescribing for hospital inpatients. J Psychopharmacol. 2003; 17: 223-229.
9. Procyshyn RM, Honer WG, Wu TK, Ko RW, McIsaac SA, Young AH, et al. Persistent antipsychotic polypharmacy and excessive dosing in the community psychiatric treatment setting: a review of medication profiles in 435 Canadian outpatients. J Clin Psychiatry. 2010; 71: 566-573.
10. Santone G, Bellantuono C, Rucci P, Picardi A, Preti A, de Girolamo G. Patient characteristics and process factors associated with antipsychotic polypharmacy in a nationwide sample of psychiatric inpatients in Italy. Pharmacoepidemiol Drug Saf. 2011; 20: 441-449.
11. Sim K, Su A, Fujii S, Yang SY, Chong MY, Ungvari GS, et al. Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. Br J Clin Pharmacol. 2004; 58:178-183.
12. Suokas JT, Suvisaari JM, Haukka J, Korhonen P, Tiihonen J. Description of long-term polypharmacy among schizophrenia outpatients. Soc Psychiatry Psychiatr Epidemiol. 2013; 48: 631-638.
13. Stahl SM, Grady MM. A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. Curr Med Chem. 2004;11: 313-327.
14. Shim IH, Woo YS, Jun TY, Kim KS, Bahk WM. Changes in antipsychotic drug usage in the psychiatric inpatients at a university hospital between 1997, 2003-2004 and 2009- 2010. Korean J Psychopharmacol. 2012 ;23: 57-64.
15. Fourrier A, Gasquet I, Allicar MP, Bouhassira M, Lepine JP, Begaud B. Pattern of neuroleptic drug prescription: A national cross sectional survey of a random sample of French psychiatrists. Br J Clin Pharmacol. 2000; 49: 80-86.
16. Centorrino F, Eakin M, Bahk W, Kelleher JP, Goren J, Salvatore P et al. Inpatient antipsychotic drug use in 1998, 1993, and 1989. Am J Psychiatry. 2002;159(11): 1932-35.
17. Andor E, Peter M, Hess L, Valterio C. Antipsychotic use in patients with schizophrenia treated in private psychiatry. Swiss Med Wkly. 2005; 135: 109-115.
18. Burns T, Christova L, Cooper S, Harrison L, Mckendrick J, Laugharne R et al. Maintenance antipsychotic medication pattern in outpatients Schizophrenia patients: a naturalistic cohort study. Acta Psychiatr Scand. 2006; 113(2): 126-134.
19. Dutta SB, Dhasmana DC, Bhardwaj R. Psychotropic drug utilization pattern among patients with schizophrenia. Indian J Psychiatry. 2005; 47(4): 243 – 44.
20. Chaudhary PK, Deka K, Chetai D. Disability associated with mental disorders. Indian J Psychiatry. 2006; 48: 95-101.
21. Padmavati R., Rajkumar S, Srinivasan TN. Schizophrenic patients who were never treated – a study in an Indian urban community. Psychological Medicine. 1998; 28: 1113-117.
22. Meltzer HY, Rabinowitz J, Lee MA, Philip A, Cola PA, Rajan R et al. Age at onset and gender of schizophrenic patients in relation to neuroleptic resistance. Am J Psychiatry. 1997; 154(4): 475-82.
23. Welham JL, Richard J, Thomis RJ, McGrath JJ. Age-at-first-registration for affective psychosis and schizophrenia. Schizophrenia Bulletin. 2004; 30(4): 849-53.
24. Malinger JB, Fisher SG, Brown T, Lamberti JS. Racial disparities in the use of second- generation antipsychotics for the treatment of schizophrenia. Psychiatric services. 2006; 57(1): 133-36.
25. Rosenheck R, Stroup S, Keefe RS, Mcevoy J, Swartz M, Perkins D et al. Measuring outcome priorities and preferences in people with schizophrenia. British J Psychiatry. 2005: 187: 529 – 36.
26. Ren X S, Kazis L E, Lee A F, Hamed A, Huang YH, Chunninghamg F et al. Patient characteristics and prescription pattern of atypical antipsychotics among patients with Schizophrenia. J Clin Pharm Ther. 2002; 27: 441-451.
27. Ritsner M, Sherina O, Ginath Y. Genetic epidemiological study of schizophrenia: Reproductive behaviour. Acta Psychiatr Scand. 1992; 85: 423-9.
28. Lane A, Byrne M, Mulvany F, Kinsella A, Waddington JL, Walsh D et al. Reproductive behaviour in schizophrenia relative to other mental disorders: Evidence for increased fertility in men despite reduced marital rate. Acta Psychiatr Scand. 1995; 91: 222-8.
29. Nanko S, Moridaira J. Reproductive rate in schizophrenic outpatients. Acta Psychiatr Scand 1993; 87: 400-4.
30. Odegaard O. Fertility of psychiatric first admissions in Norway. Acta Psychiatr Scand. 1980; 62: 212-20.
31. Thara R, Srinivasan TN. Marriage and gender in schizophrenia. Indian J Psychiatry. 1997; 39: 64-9.
32. Thara R, Padmavathi R, Lakshmi A, karpagavalli P. Family education in schizophrenia: A comparison of two approaches. Indian J Psychiatry. 2005;47(4):218 – 21.
33. Ponnudurai R, Jayakar J, Sekar BS. Assessment of mortality and marital status of schizophrenic patients over a period of 13 years. Indian J Psychiatry. 2006; 48: 84-87.
34. Acquaviva E, Gansquet L, Falissard B. Psychotropic combination in schizophrenia. Eur J Clin Pharmacol. 2005; 61: 855-61.
35. Ungavari GS, Chung YG, Chee YK, Fung N, Kwong TW. The pharmacological treatment of Schizophrenia in Chinese patients: A comparison of prescription pattern between 1996 and 1999. Br J Clin Pharmacol. 2002; 54: 437-444.
36. Volz A, Khorsand V, Gillies D, Leucht S. Benzodiazepines for schizophrenia. (Cochrane Review) In: The Cochrane Library, Issue 1;2007.
37. Magliano L, Fiorillo A, Guarneri M, Marasco C, Rosa CD, Malangone C. Prescription of psychotropic drugs to patients with schizophrenia: An Italian national survey. Eur J Clin Pharmacol. 2004; 60: 513–22.
38. Kingsbury SJ, Yi D, Simpson GM. Rational and irrational polypharmacy. Psychiatric Services. 2001; 52(8): 1033-36.
39. Covell NC, Carlos T, Jackson T, Evans C, Essock SM. Antipsychotic prescribing practices in Connecticut's public mental health system: Rates of changing medications and prescribing styles. Schizophrenia Bulletin. 2002; 28(1): 17-29.
40. Clark RE, Bartels SJ, Mellman TA, Peacock WA. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorders: Implications for state mental health policy. Schizophrenia Bulletin. 2002; 28(1): 75-84.
41. Mccue RE, Waheed R, Urcuyo L. Polypharmacy in patients with schizophrenia. J Clin Psychiatry. 2003; 64: 984 – 89.