Role of pharmaco-epidemiology in psychopharmacology: a study in psychiatric out-patient department of a tertiary care teaching hospital at Dehradun, Uttarakhand

Abstract

INTRODUCTIONPhysicians/medical professionals are continuously exposed to newly introduced drugs that are claimed to be safer and more efficacious. Their utilization and consequences on real-life effectiveness and safety in actual clinical practice need continuous study.1 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. Measurement of drug use in health facilities not only describes drug use patterns and prescribing behavior, but also helps in the identification of factors responsible for the practice of polypharmacy and the problems associated with it.2 Drug utilization study has been defined by the World Health Organization (WHO) as "the marketing, distribution, prescription and uses of drugs in a society with special emphasis on the resulting medical and social and economical consequences." 3Studies on the process of drug utilization focus on the factors related to the prescribing, dispensing, administering, and taking of medication, and its associated events, covering the medical and non-medical determinants of drug utilization, the effects of drug utilization, as well as studies of how drug ABSTRACT Background: Prescription auditing studies are a part of drug utilization studies, are beneficial in clinical practice for rational prescribing of drugs and helpful for minimizing the medication errors. They are important tool to promote rational prescribing. Methods: This was a prospective drug utilization study conducted by the Department of Pharmacology in Psychiatry out-patient department at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun for a period of 6 months. A total of 311 prescriptions were evaluated for prescribing pattern using World Health Organization drug indicators and National Essential Medicine List (NEML) 2011. Results: A total of 311 prescriptions were evaluated, 157 (50.48%) were females, and 154 (49.52%) were males, mean age was 37.14±0.8 years. Majority of patients were married 207 (66.56%), housewife 116 (37.30%) and belong to middle socioeconomic group 205 (65.92%). A total of 1250 drugs were prescribed, anti-anxiety (anti-A) 379 (30.32%), anti-depressants (anti-Ds) 348 (27.84%), anti-psychotics (anti-Ps) 118 (9.44%), anti-epileptics (anti-Es) 64 (5.12%), mood stabilizer 20 (1.6%), anticholinergics 28 (2.24%) and others 293 (23.44%). Oral formulations 1247 (99.76%), 4.02 drugs/prescription, 100% drugs were prescribed by brand names. 220 (17.6%) fixed dose combinations were prescribed. Most frequently prescribed among anti-A drugs were propranolol 160 (42.22%) and diazepam 105 (27.70%), among anti-Ds drugs were amitriptyline 65 (18.68%) and escitalopram 59 (16.95%) and among anti-Ps risperidone 49 (41.53%) and olanzapine 38 (32.20%), respectively. About 51.36% drugs were prescribed from the NEML 2011. Result has revealed polypharmacy in the practice. Conclusions: Anti-A drugs were the most commonly prescribed drugs followed by anti-Ds, anti-Ps and anti-Es res...

A psychotropic drug use study among depression patients attending private psychiatric practitioners of Dehradun, Uttarakhand

“…Out of 196 prescriptions analyzed, male-to-female ratio was 1:1.17, correlating with the fact that depression is higher in females, which is consistent with studies by Grover et al, [11] Memon and Patel [12] , and Avanthi et al [13] Majority of patients were in the age group of 30-51 years in both sexes, which is similar to those reported in studies by Dutta et al, [14] Trivedi et al [15] , and Grover et al [11] Pediatric and geriatric groups together constituted less than 10% of our patient population, which is comparable to a previous study. [12] Depression was more common among housewives, which is comparable to a previous study.…”

“…Trihexyphenidyl was the most common anticholinergic prescribed, similar to previous studies. [14,16,17] Although the frequency of prescribing atypical antipsychotic was higher in our study, yet anticholinergic agents were also prescribed to the patients. Similar observation was made in a study by Ren et al [23] in which when anticholinergic agents were used concomitantly with atypical antipsychotics, patients tend to stay on target drug significantly longer than those who did not use any anticholinergic agents.…”

“…[11,16,17] Fluoxetine and escitalopram were the most commonly prescribed SSRIs, which is consistent with previous studies by Grover et al [11] and Piparva et al [17] Venlafaxine and duloxetine among SNRIs, and mirtazapine among atypical antidepressants were prescribed, similar to previous studies. [11,14] SSRIs are generally free of sedative effects and safer at higher doses. Better tolerability, combined with their mild adverse effects, accounts for their popularity as the most widely prescribed antidepressants.…”

“…Olanzapine and risperidone were the most commonly prescribed atypical antipsychotics, which is consistent with previous studies. [14,15,17,22] Among the typical antipsychotics, haloperidol was most commonly prescribed drug. Atypical antipsychotics are now rated as first-line agents because of their low propensity to cause extrapyramidal side effects, efficacy against refractory cases, better tolerance, low relapse rate, and safer adverse effect profile.…”

Comparative evaluation of Amisulpride and Escitalopram on Hamilton Anxiety Rating Scale among depression patients in a tertiary care teaching hospital in Nepal

“…21 The mean age group in our study was 46.84±1.1 years which were comparable with previous studies by Dutta et al and Grover et al where incidence of depression was seen in more commonly in 30-51 years age group. 22,23 More depression patients were seen in rural areas as compared to urban areas in the present study. This was comparable with previous studies by Giel and Harding; Gautam and Kapur where rural background subjects were found to be somatising more than the urban subjects.…”