Abstract

DRUG PRESCRIPTION PATTERN IN ELDERLY PSYCHIATRIC OUTPATIENTS OF A TERTIARY CARE HOSPITAL IN SOUTH KARNATAKA: A CROSS SECTIONAL STUDY

Vindhya N. Shambu, Hema N. G.* and Narendra Kumar M. S.

Abstract

Background: Research on geriatric psychiatric morbidity in India is limited and remains grossly under represented. Focus on indiscriminate prescription of drugs among elderly is important as they have multiple comorbidities. The objective of this study was to analyse the prescribing pattern of medications in elderly psychiatric outpatients and to assess the prevalence of polypharmacy in them. Methods: A cross sectional study was conducted among 125 eligible elderly outpatients, diagnosed with any psychiatric illness, attending the psychiatry department of Krishna Rajendra Hospital, attached to Mysore Medical College and Research Institute, Mysore from October 2020 to December 2020. Data was collected from the prescriptions of study subjects in a predesigned proforma. Prescribing pattern of psychotropic drugs was analysed using WHO core prescribing indicators, along with assessment of prevalence of other comorbidities and polypharmacy. ICD-10 Classification of Mental and Behavioural Disorders was used as reference for psychiatric diagnosis, and drugs verified based on WHO Model List of Essential Medicines (MLEM) 2019 as well as National List of Essential Medicines (NLEM) 2015. Results: Majority of patients were between the ages of 66 and 72 years with a male preponderance (59.2%). Among the psychiatric illnesses, majority of 46 (36.8%) participants were diagnosed with Somatization disorder, followed by 26 (20.8%) of them with Psychosis (nonorganic) and 10 (8%) of them with Schizophrenia. Among the psychotropics used, 45 (73.8%) patients were prescribed Olanzapine followed by 20 (32.8%) being prescribed Risperidone as the antipsychotics of choice. Lorazepam was the most prescribed sedative-hypnotic (in 39 (52.7%) patients) followed by Clonazepam (in 20 (27%) patients). Amitriptyline was the preferred antidepressant prescribed (in 17 (53.1%) patients). Other class of medications such as central anticholinergics (in 30 (24%), antimanic and mood stabilizers (in 9 (7.2%) and anxiolytic-sedatives (in 8 (6.4%) were also seen. 51.2% of the study population were found to have 1 or more other comorbidities. Hypertension (15.2%), Type2 Diabetes Mellitus (10.4%) and COPD (7.2%) were the most commonly observed comorbidities. Polypharmacy was seen in 22.4% with the average number of drugs per prescription being 3.2. 68% of all drugs prescribed were of generic names and 78% of all drugs prescribed were from the NLEM 2015. Conclusion: Our study has added evidence to commonly prescribed psychotropic drugs, associated comorbidities and prevalence of polypharmacy among the vulnerable geriatric psychiatric patients. Availability of such data helps compare changes in the pattern of psychotropic drug use over time or to compare pattern of drug use between young and elderly patients.

Keywords: Prescription pattern, Geriatric psychiatry, Psychotropics, WHO prescribing indicators, Polypharmacy.