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Prescribing patterns of psychotropic medications in psychiatric disorders: a descriptive study from Palestine

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Abstract

Background The practice patterns of psychiatrists have changed over the last two decades. Objectives This study describes the pattern of prescribing psychotropic drugs in treating common psychiatric disorders, and investigates the rate of polypharmacy and potential drug-drug interactions. Setting Psychiatry governmental outpatient clinic in the north of West Bank, Palestine. Methods Cross-sectional study that included all prescriptions which were issued over the period October 2018 to January 2019, for patients diagnosed with schizophrenia, depression, anxiety, bipolar disorder and schizoaffective disorders, and checked for the presence and the grade of potential drug-drug interactions using “Medscape drug interactions checker". Main outcome measure Prescribing patterns of psychotropic drugs. Results A total of 1045 prescriptions were examined. The mean age of the patients was 47.3 years (SD = 13.6), two-thirds of the patients (64.5%) were males. Fifty-two percent of the patients were diagnosed with schizophrenia while 15.2% were diagnosed with depression. The later third was diagnosed with bipolar disorder, schizoaffective and anxiety disorders (15.8%, 11.1% and 5.1% respectively). The most commonly prescribed drugs were typical antipsychotics for schizophrenia, bipolar and schizoaffective disorders, selective serotonin reuptake inhibitors for depression and tricyclic anti-depressants for anxiety. Polypharmacy was found in 877 prescriptions (84%), and drug-drug interactions (DDIs) were identified in 823 (94%) prescriptions. The DDIs were classified as minor (4, 0.5%), significant (418, 50.8%) and serious (401, 48.7%). Conclusions Our results suggest that the pharmacotherapy of psychiatric disorders in Palestine may not be in accordance to international guidelines and the incidence of polypharmacy and DDIs is high.

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References

  1. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines. [Internet]. Available from: https://www.ranzcp.org/practice-education/guidelines-and-resources-for-practice. Accessed 06 Nov 2020.

  2. MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ. 2003;326(7397):1014.

    Article  CAS  Google Scholar 

  3. Australian-Clinical-Guidelines-for-Early-Psychosis [Internet]. Available from: https://orygen.org.au/Campus/Expert-Network/Resources/Free/Clinical-Practice/Australian-Clinical-Guidelines-for-Early-Psychosis/Australian-Clinical-Guidelines-for-Early-Psychosis.aspx?ext. Accessed 06 Nov 2020.

  4. De Cuevas Las C, Sanz EJ. Polypharmacy in psychiatric practice in the Canary Islands. BMC Psychiatry. 2004;4:18.

    Article  Google Scholar 

  5. Chakos MH, Glick ID, Miller AL, Hamner MB, Miller DD, Patel JK, et al. Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial. Psychiatry Serv Wash DC. 2006;57(8):1094–101.

    Article  Google Scholar 

  6. Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry. 2010;67(1):26–36.

    Article  Google Scholar 

  7. Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11(1):82–99.

    Article  Google Scholar 

  8. Freudenreich O, Kontos N, Querques J. Psychiatric polypharmacy: a clinical approach based on etiology and differential diagnosis. Harv Rev Psychiatry. 2012;20(2):79–85.

    Article  Google Scholar 

  9. Chong S-A, Ravichandran N, Poon L-Y, Soo K-L, Verma S. Reducing polypharmacy through the introduction of a treatment algorithm: use of a treatment algorithm on the impact on polypharmacy. Ann Acad Med Singapore. 2006;35(7):457–60.

    PubMed  Google Scholar 

  10. Procyshyn RM, Kennedy NB, Tse G, Thompson B. Antipsychotic polypharmacy: a survey of discharge prescriptions from a tertiary care psychiatric institution. Can J Psychiatry Rev Can Psychiatry. 2001;46(4):334–9.

    Article  CAS  Google Scholar 

  11. Grüber L, Falkai P, Hasan A. Depressive symptoms in schizophrenia. Fortschr Neurol Psychiatry. 2015;83(4):238–46 (quiz 247–8).

    Article  Google Scholar 

  12. Sernyak MJ, Rosenheck R. Clinicians’ reasons for antipsychotic coprescribing. J Clin Psychiatry. 2004;65(12):1597–600.

    Article  Google Scholar 

  13. Tanaka E, Hisawa S. Clinically significant pharmacokinetic drug interactions with psychoactive drugs: antidepressants and antipsychotics and the cytochrome P450 system. J Clin Pharm Ther. 1999;24(1):7–16.

    Article  CAS  Google Scholar 

  14. Preskorn SH. Drug-drug interactions in psychiatric practice, part 1: reasons, importance, and strategies to avoid and recognize them. J Psychiatry Pract. 2018;24(4):261–8.

    Article  Google Scholar 

  15. Marie M, Hannigan B, Jones A. Mental health needs and services in the West Bank. Palestine Int J Ment Health Syst. 2016;10:23.

    Article  Google Scholar 

  16. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476–93.

    Article  Google Scholar 

  17. Baxter AJ, Charlson FJ, Cheng HG, Shidhaye R, Ferrari AJ, Whiteford HA. Prevalence of mental, neurological, and substance use disorders in China and India: a systematic analysis. Lancet Psychiatry. 2016;3(9):832–41.

    Article  Google Scholar 

  18. Tayem Y, Jahrami H, Ali M, Hattab S. Ambulatory pharmacotherapy of five psychiatric disorders in Bahrain: a descriptive study. Psychiatr Q. 2020;91(2):289–98.

    Article  Google Scholar 

  19. Ren XS, Huang Y-H, Lee AF, Miller DR, Qian S, Kazis L. Adjunctive use of atypical antipsychotics and anticholinergic drugs among patients with schizophrenia. J Clin Pharm Ther. 2005;30(1):65–71.

    Article  CAS  Google Scholar 

  20. Azorin J-M, Kaladjian A, Fakra E. Current issues on schizoaffective disorder. L’Encephale. 2005;31(3):359–65.

    Article  Google Scholar 

  21. Wang S-M, Han C, Bahk W-M, Lee S-J, Patkar AA, Masand PS, et al. Addressing the side effects of contemporary antidepressant drugs: a comprehensive review. Chonnam Med J. 2018;54(2):101–12.

    Article  Google Scholar 

  22. DeFilippis M, Wagner KD. Management of treatment-resistant depression in children and adolescents. Pediatr Drugs. 2014;16(5):353–61.

    Article  Google Scholar 

  23. Müller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. The Lancet. 2002;359(9302):241–7.

    Article  Google Scholar 

  24. Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium poisoning. J Intensive Care Med. 2017;32(4):249–63.

    Article  Google Scholar 

  25. Bespalov AY, van Gaalen MM, Gross G. Antidepressant treatment in anxiety disorders. Curr Top Behav Neurosci. 2010;2:361–90.

    Article  Google Scholar 

  26. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93–107.

    Article  Google Scholar 

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Acknowledgements

An-Najah National University and the Palestinian Ministry of health are acknowledged for facilitating and making this study possible.

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Correspondence to Suhaib Hattab.

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Hattab, S., Qasarweh, L., Ahmaro, M. et al. Prescribing patterns of psychotropic medications in psychiatric disorders: a descriptive study from Palestine. Int J Clin Pharm 43, 1101–1108 (2021). https://doi.org/10.1007/s11096-020-01223-w

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