INTRODUCTION:

The clinical descriptions and diagnostic guidelines for ICD-10 mental and behavioural disorders 3 define a mental disorder as “a clinically recognizable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions”.^[1] Mental disorders are usually associated with significant distress in social, occupational, or other important activities.^[2] Major proportions of mental disorders come from low and middle income countries.^[3]Psychiatric disorders form an important public health priority and major causes of morbidity.^[4] Of the top ten health conditions contributing to the Disability Adjusted Life Years (DALYs), four are psychiatric disorders.^[5]

For the treatment of psychiatric disorders, a wide array of psychotropic drugs is available.^[6] Common psychiatric disorders include Clinical depression, anxiety disorder, bipolar disorder, Dementia, Schizophrenia, Obsessive compulsive disorder, Post-traumatic stress, attention deficit hyperactivity disorder (ADHD).

Psychotropic drug use is pivotal in psychiatric care. Widespread prescription of psychotropic medications demands for studies in understanding the factors responsible for the pattern and situational differences.^[7] These include; the nature of psychiatric morbidity, the tolerability of the medicines with respect to age and susceptibility to its adverse effects. Other patient-related (e.g. social, historical, physical, and preferential), prescriber and health system factors and relevant and combine with significant side effects of varying severity to inform the judicious use of psychotropic drugs.^[8]

Most psychotropic drugs are prescribed by the psychiatrist, therapist or health care provider to treat diagnosed mental disorders. Different types of psychotropic drugs include sedatives and hypnotics like Lorazepam, Clonazepam, Chlordiazepoxide, Etizolam, Clobazam, Pentobarbital, Chlordiazepam, Alprazolam, Diazepam, Phenobarbitone, antipsychotics like Olanzapine, Risperidone, Haloperidol, Amisulpride, Quetiapine, Clozapine, Aripiprazole, anti-depressants like Fluoxetine, Escitalopram, Paroxetine, Sertraline, Amitriptyline, Mirtazapine, mood stabilizers like Lithium, Sodium valproate, Carbamazepine, anti-obsessive agents, anti-anxiety agents, stimulants, and anti-panic agents. These agents work in different ways to address symptoms and causes of various disorders.

Rational drug prescribing is defined as the use of the least number of drugs to obtain the best possible effect in the shortest period and at a reasonable cost.^[9] Besides describing drug use pattern and prescribing behaviour, measurement of drug use in the health facilities also helps in identifying the factors responsible for the practice of polypharmacy and the problems associated with it.^[10]The study of prescribing patterns seeks to monitor therapeutic trends, evaluate and if necessary, suggest modifications in prescribing patterns so as to make medical care rational and cost effective. The expanding and challenging field of psychopharmacology is constantly seeking new and improved drugs to treat psychiatric disorders. In this way, psychiatrists are continuously exposed to newly introduced drugs that are claimed to be safe and more efficacious. Although psychotropic drugs have had a remarkable impact in psychiatry, their utilization in actual clinical practice, effectiveness and safety in the real-life situation needs continuous study, and is thus a topic of increasing interest in recent times.^[11] Many studies from the western countries have reported the prescription patterns of various psychotropic medications, which have looked into national prescription patterns, prescription patterns in general practice, and specialist care, age, and gender differences in antipsychotic prescription, prescription patterns of anti-depressants, sedative and hypnotics, antipsychotics and mood stabilizers. A few surveys of prescription patterns of various psychotropic from Asian countries are also available.^[12]

As there is no sufficient data available on their use in the population of south India, the present study was carried out to analyze the patterns of psychotropic drug utilization in the Psychiatric in-patient Department.

MATERIALS ANDMETHODS:

Human Ethical Approval:

The study protocol was submitted to Institutional ethical committee of MVJ Medical College and Research Hospital, Bengaluru and ethical approval was obtained before commencing the study.

Study design:

Prospective observational study

Study site:

MVJ Medical College and Research Hospital, Hoskote, Bengaluru.

Study period:

6 months (December 2018 – May 2019)

Study population:

100 patients admitted to psychiatric in-patient department.

Inclusion criteria:

· All psychiatric in-patients of either gender aged 18 years and above who were prescribed with psychotropic drugs.

Exclusion criteria:

· All psychiatric in-patients with intentional and accidental poisoning.

· Patients with the history of drug or substance abuse.

· Pregnant and lactating women.

· Patients who were unwilling to participate and non-cooperative during study.

Study procedure:

· The demographic, clinical and medications data were documented into a specially designed case report form.

· The data was analysed using descriptive statistics.

Analysis of data:

Statistical analyses were performed using International Business Machines- Statistical package for the social science (IBM-SPSS) 20.0. Statistical significance of difference in population means between and within participants was assessed by independent two-sample and paired sample t-test, respectively. Descriptive summary statistics are presented either as mean ± SD or as median (minimum and maximum). Choice of descriptive and inferential statistical method was based on distribution normality as determined through normal probability plot.

Table 1: Descriptive summary of Demographics of study population

Parameters		Number of patients (%) N=100
Age	18-36 (years)	56
Age	37-60 (years)	44
Gender	Male	56
Gender	Female	44
Smoking	Smoker	33
Smoking	Non-smoker	67
Alcohol	Alcoholic	33
Alcohol	Non-alcoholic	67
Marital status	Married	85
Marital status	Unmarried	15

RESULTS:

100 patients who fulfilled the inclusion criteria were enrolled in study.Among enrolled subjects 56 were of age between 18-36 years and 44 were of age between 37-60 years, 56 were male and 44 were female. Statistical significance in difference of age was not found between gender (P = 0.732, 95 % CI). Majority of study subjects were non-smoker, non-alcoholic and married.

Distribution of study population based on diagnosis:

Among enrolled subjects majority were having schizophrenia followed by ADS, depression, mania and bipolar disorder, anxiety OCD, dementia, trance and possession disorder, attention deficit hyperactivity and alzheimer’s diseace

Figure 1: Distribution of study population based on diagnosis

Drug utilization pattern:

194 different psychotropic drugs were prescribed. Sedatives and hypnotics were prescribed in majority of the patients followed by antipsychotics, antidepressants and mood stabilizers.

Figure 2: Drug utilization pattern

Drug utilization pattern of sedatives and hypnotics:

Lorazepam accounts for the 50% of the different sedatives and hypnotics prescribed followed by Clonazepam, Chlordiazepoxide, Etizolam, Zolpidem, Phenobarbitol, Clobazam and Chlordiazepam.

Figure 3: Drug utilization pattern of sedatives and hypnotics

Figure 4: Drug utilization pattern of Antipsychotic

Figure 5: Drug utilization pattern of Antidepressants

Drug utilization pattern of Antipsychotics:

Typical antipsychotics were used in 11.42% of study population while atypical antipsychotics were used in 88.58% study population.

Drug utilization pattern of Antidepressants:

In patients who are prescribed with antidepressants, majority were on Selective Serotonin reuptake inhibitors (SSRIs). Fluoxetine accounts for 30.55% of antidepressants used followed by Sertraline, Escitalopram, Paroxetine, Amitriptyline and Mirtazapine.

Drug utilization pattern of mood stabilizer:

Lithium accounts for the 78.57% of total mood stabilizers used followed by valproic acid and carbamazepine.

Figure 6: Drug utilization pattern of mood stabilizer

DISCUSSION:

Psychotropic are a class of medications used to treat a wide range of mental disorders. These drugs decrease the intensity of psychiatric symptoms such as delusions, hallucinations and depression and thereby enhance the mental well-being of psychiatric patients. However, the diverse range of adverse effects induced by these drugs, has led to patient non-compliance. The common adverse effect of anti-psychiatric medications include weight gain, tremors, sedation, dyskinesia etc., These adverse effects which significantly deteriorates both the physical and mental wellbeing of the patient had led to patient non-compliance to therapy. Weight gain caused by anti-psychotic medications was shown to be a cause of non-adherence and subjective distress. Sexual dysfunction during psychiatric therapy was also shown to cause significant subjective distress which leads to non-adherence. The study was carried out in a hospital specialized in psychiatry at Bengaluru. This observational prospective study was carried out for a period of 6 months in the inpatient department of the hospital. Consent from the concerned authorities was obtained and permission was granted to follow up prescriptions in the selected departments in a regular ward round basis with the physicians. A separate data entry form was designed and the collected data was carefully noted. The parameters that were chosen and assessed include age wise segregation, gender wise distribution, social history of the patient, associated diseases, family history, occupation, diagnosis, drugs used. This study was designed to analyze the drug use pattern of psychotropic drugs.

In this study majority of the cases are of Schizophrenia, which are prescribed with psychotropic drugs mainly sedatives and hypnotics followed by antipsychotics, antidepressants and mood stabilizers. Commonest sedatives and hypnotics was Lorazepam. Quetiapine and Risperidone was the commonest antipsychotic drugs prescribed. Fluoxetine and lithium are the commonest antidepressant and mood stabilizer respectively which are prescribed in study population.

Findings of this study are similar to that of study conducted by Vandana Goyal et al., Richa C et al., Adelugbaolajide et al., Roopadevi HS et al. They found similar results on Prescribing pattern of psychotropic drugs.^[13-16]

CONCLUSION:

The burden of Psychiatric illness leads to public health problem. Psychotropic substances are commonly used in patients with various prescription habits of prescriber. The study found that schizophrenia was the most common illness in psychiatric patients. Male patients were more prone to psychiatric disorders than female. Most of the study populations were non-alcoholic and non-smokers. Sedatives and hypnotics of benzodiazepine class were found to be the most commonly used drugs followed by antipsychotics, anti-depressants and mood stabilizers in the studied population. Future studies to evaluate the drug utilization evaluation of psychotropic drugs in large patient populations are much needed to promote patient safety and increase the quality of psychiatric treatment.

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13. Roopadevi HS, Ramesh KN, Nagabushan H. Pattern of psychotropic prescription in a tertiary care teaching hospital: a critical analysis. Asian J Pharm Clin Res. 2015;8(5):252-5.

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16. Olajide A, Mansfield M, Olubankole O, Udoka O. Psychotropic drug prescription practice in psychiatric in-patients in Saskatchewan, Canada. J Neuropsychopharmacol Mental Health. 2016;1(114):2.

Received on 30.01.2020 Modified on 21.04.2020

Research J. Pharm. and Tech. 2021; 14(2):1033-1036.

DOI: 10.5958/0974-360X.2021.00184.0