Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

Abstract

The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two-and three-drugs in 10.4% and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

Antipsychotic prescription patterns and treatment costs of schizophrenia in northwestern Pakistan: A one-year observational study

“…In our study, the majority of patients were prescribed SGAs. These results are consistent with the results from similar studies conducted in Australia, Bahrain, Germany, and the United States, where most schizophrenic patients were treated with SGAs [7,10,11,19,20].…”

“…Antipsychotic monotherapy is recommended by most antipsychotic treatment guidelines [9,10]. In the present study, the percentage of patients receiving monotherapy was low compared with that in other countries [7,10,11]. The high incidence of polytherapy observed here may be due to the severity of symptoms; the patients from Sarhad Hospital for Psychiatrist Diseases who participated in this study were particularly unstable and may therefore have required more aggressive polytherapy treatment.…”

“…Antipsychotic drugs may be administered orally or via long-acting antipsychotic injection (LAI). LAIs have been shown to help prevent relapse and reduce hospitalizations [9,11] and are particularly useful in the 50-60% of schizophrenic patients who are noncompliant [12,13]. Combined oral administration of SGAs and LAI administration of FGAs has been shown to be particularly effective [13,14].…”

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“…8 . The average number of psychotropic drugs/prescription is this study was 3.17 which were similar to that reported by Mukherjee et al (3.39) 9 but was higher than that found in other studies where it ranged from 1.79 to 3 drugs per prescription 10,11 . Average number of drugs in a prescription audit is an important factor because higher number increases the risk of side effects and interactions.…”

Pattern of prescribing psychotropics in the outpatient department of a tertiary psychiatric hospital

“…The average number of psychotropic drugs per prescription was 2.98, which was higher than that found in similar studies, where it ranged from 1.79 to 2.5 drugs per prescription. 13,14 Average number of drugs per prescription was an important index of prescription audit. It is preferable to keep the mean number of drugs per prescription as low as possible because multiple drugs lead to increased risk of drug interaction.…”