Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients: a cross sectional study from western region of Nepal

BMC Psychiatry

Archana Saha¹  Prasanta Kumar Chakraborty³  Indraneel Banerjee⁵  Brijesh Sathian²  Bedanta Roy⁴  Indrajit Banerjee¹ 

[1] Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal;Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal;Manipal Teaching Hospital, Pokhara, Nepal;Department of Physiology, Manipal College of Medical Sciences, Pokhara, Nepal;R. G. Kar Medical College, Kolkata, West Bengal, India

关键词: Schizophrenia;    Psychiatry;    Nepal;    Drug utilization study;    Antipsychotics;   

Others  :  1124098
DOI  :  10.1186/1471-244X-13-96

 received in 2012-09-02, accepted in 2013-03-18,  发布年份 2013

【 摘 要 】

Background

Currently a large number of atypical antipsychotics available in the market are endorsed as better option for treating schizophrenia than the typical antipsychotics. Information regarding the utilization pattern of antipsychotic drugs is lacking in Nepalese population particularly in Western Nepal. By means of this study one is expected to acquire an idea concerning clinician’s preference to the antipsychotic drugs in actual clinical setup. The main objective of the study was to find the commonest antipsychotics prescribed in a tertiary care center among hospitalized patients in Western Nepal.

Methods

This cross sectional study was carried out between 1st January 2009 and 31th December 2010 at Manipal Teaching Hospital, Nepal. The diagnosis of schizophrenia was based on ICD-10 (Tenth revision).The main outcome variables of the study was commonest antipsychotic drug prescribed. Z test, Chi square test and logistic regression were used for analytical purpose. P-value < 0.05 was considered to be statistically significant. This is the first study done on the utilization pattern of antipsychotics drugs among hospitalized patients in Nepal.

Results

Out of 210 cases of schizophrenia, most of the patients were less than 40 yrs. 78.6%, male 61.9%, unemployed 86.7% and having their monthly income less than NPR 10000 /month 80.5%. As far as religion, 78.1% patients were the Hindus and ethnically schizophrenia was common among the Dalit 26.2%. The study revealed that 46.2% of patients were students followed by 25.2% of housewives. Olanzapine was the commonest antipsychotic drug to be prescribed 34.3%. It was observed that the psychiatrists had a tendency of using antipsychotic drugs by trade names [OR 3.3 (1.407, 8.031)] in male patients as compared to female patients.

Conclusion

According to the utilization pattern of antipsychotics, it is concluded that atypical antipsychotics were used relatively more commonly than that of typical antipsychotics. Among the atypical antipsychotic drugs, there is a trend of using Olanzapine during Schizophrenia as compared to other atypical antipsychotic drugs in Western Nepal.

【 授权许可】

   
2013 Banerjee et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lee D, Bergmen U: Studies of utilization. In Pharmacoepidemiology. 1st edition. Edited by Strom BC. New York: Churchill Livingstone; 1989:259-73.
• [2]Uppal R: Drug utilization studies: a brief overview. Annual update in clinical Pharmacology. 1993, 1:54-55.
• [3]Saha S, Chant D, Welham J, McGrath J: A systematic review of the prevalence of schizophrenia. PLoS Med 2005, 2:e141.
• [4]Bhugra D: The global prevalence of schizophrenia. PLoS Med 2005 May, 2(5):e151.
• [5]Robin RW, Gottesman II, Albaugh B, Goldman D: Schizophrenia and psychotic symptoms in families of two American Indian tribes. BMC Psychiatry 2007, 7:30. BioMed Central Full Text
• [6]McGrath JJ, Susser ES: New directions in the epidemiology of schizophrenia. Med J Aust 2009 Feb 16, 190(4 Suppl):S7-9.
• [7]McGrath J, Saha S, Chant D, Welham J: Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 2008, 30:67-76.
• [8]Jha A, Ranjan S, Pradhan PK, Jha T: Challenges of setting up psychiatric services in Nepal: Lessons from the first year of Janakpur Project. Asian J Psychiatr 2011, 4(4):297-9. Epub 2011 Dec 6
• [9]Shrestha MR, Sherchan S, Shakya R, Joshi D: Monthly pattern of psychiatric morbidity and duration of stay among the patients admitted in Mental Hospital, a central level tertiary care hospital. Nepal Med Coll J 2011 Jun, 13(2):133-6.
• [10]Tausig M, Subedi S, Subedi J, Ross J, Broughton LC, Singh R, Blangero J, Williams-Blangero S: Mental illness in Jiri Nepal. The Jirel issue 2000, 27:105-15. Jan
• [11]Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A: Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl 1992, 20:1-97.
• [12]Hartling L, Abou-Setta AM, Dursun S, Mousavi SS, Pasichnyk D, Newton AS: Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis. Ann Intern Med 2012 Oct 2, 157(7):498-511.
• [13]Tamrakar SM, Nepal MK, Koirala NR, Sharma VD, Gurung CK, Adhikari SR: An open, randomized, comparative study of efficacy and safety of risperidone and haloperidol in schizophrenia. Kathmandu Univ Med J (KUMJ) 2006, 4(2):152-60.
• [14]Shankar PR, Partha P, Shenoy N: Self-medication and non-doctor prescription practices in Pokhara valley. Western Nepal: a questionnaire-based study. BMC Fam Pract. 2002 Sep 17, 3:17.
• [15]Shankar PR, Roy S: Patterns of prescription and drug use in psychiatry outpatient department in a teaching hospital in Western Nepal. The Internet Journal of Pharmacology 2002., 1(2) Available from: http://archive.ispub.com/journal/the-internet-journal-of-pharmacology/volume-1-number-2/patterns-of-prescription-and-drug-use-in-a-psychiatry-out-patient-department-in-a-teaching-hospital-in-western-nepal.html#sthash.7PDv6HuB.dpbs webcite
• [16]Nervous System. ATC/DDD Index: WHO collaborating centre for drug statistics methodology. [online] 2011 [cited 2013 Mar 4]. 2013. Available from: URL:http://www.whocc.no/atc_ddd_index/ webcite
• [17]World Health Organization: The ICD-10 Classification of mental and behavioral disorders (Tenth Revision). Geneva: Diagnostic criteria for research; 1992.
• [18]Sathian B, Sreedharan J, Baboo NS, Sharan K, Abhilash ES, Rajesh E: Relevance of Sample Size Determination in Medical Research. Nepal Journal of Epidemiology 2010, 1(1):4-10.
• [19]Sathian B: Reporting dichotomous data using Logistic Regression in Medical Research: The scenario in developing countries. Nepal Journal of Epidemiology 2011, 1(4):111-113.
• [20]Fahmida A, Wahab MA, Rahman MM: Pattern of psychiatric morbidity among the patients admitted in a private psychiatric clinic. Bangladesh Journal of Medical Science 2009, 8(1–2):23-28.
• [21]Mant A, Lansbury G, Bridges-Webb C: Trends in psychotropic drug prescribing in Australia. Med J Aust 1987, 146(4):208-10.
• [22]Maki P, Veijola J, Jones PB, Murray GK, Koponen H, Tienari P, Miettunen J, Tanskanen P, Wahlberg KE, Koskinen J, Lauronen E, Isohanni M: Predictors of schizophrenia–a review. Br Med Bull 2005 Jun 9, 73–74:1-15.
• [23]Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Sharma VD, Nepal MK, Worthman CM: Culture in psychiatric epidemiology: Using ethnography and multiple mediator model to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol 2009, 36:261-80.
• [24]Lesen E, Anderrson K, Petzoid M, Carlsten A: Socioeconomic determinants of Psychotropic drug utilization among elderly: a national population based cross sectional study. BMC Publ Health 2010, 10:118. BioMed Central Full Text
• [25]Foster HD: The Geography of Schizophrenia: Possible Links with Selenium and Calcium Deficiencies, Inadequate Exposure to Sunlight and Industrialization. Journal of Orthomolecular Medicine 1988, 3(3):135-40.
• [26]Banerjee I, Roy B, Sathian B, Banerjee I, Kumar SS, Saha A: Medications for Anxiety: A Drug utilization study in Psychiatry Inpatients from a Tertiary Care Centre of Western Nepal. Nepal Journal of Epidemiology 2010, 1(4):119-25.
• [27]Banerjee I, Roy B, Banerjee I, Sathian B, Mondol M, Saha A: Depression and its Cure: A Drug Utilization Study from a Tertiary Care Centre of Western Nepal. Nepal Journal of Epidemiology 2011, 1(5):144-52.
• [28]Alam K, Mishra P, Prabhu M, Shankar PR, Palaian S, Bhandari RB, Bista D: A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal. Kathmandu Univ Med J (KUMJ) 2006, 4(4):436-43.
• [29]Upadhyay KD, Palaian S, Shankar PR, Mishra P: Rational drug prescribing and dispensing in a tertiary care teaching hospital of Western Nepal. Journal of Institute of Medicine 2008 Aug, 30(2):33-38.
• [30]Shankar PR, Partha P, Nagesh S: Prescribing pattern in medical outpatients. Int J Clin Pract 2002, 56:549-51.
• [31]Steinman MA, Chren MM, Landefeld CS: What's in a name? Use of brand versus generic drug names in United States outpatient practice. J Gen Intern Med 2007 May, 22(5):645-8.
• [32]Kafle KK, Prasad RR, Thapa BB: National List of Essential Medicine (forth revision draft). 2nd edition. Kathmandu: Nepalese National Formulary; 2010:443.
• [33]Bret P, Bret MC, Queuille E: Prescribing patterns of antipsychotics in 13 French psychiatric hospitals. Encephale 2009, 35(2):129-38. Epub 2008 Jul 7
• [34]Hurley SF, McNeil JJ, Jolley DJ, Harvey R: Linking prescription and patient-identifying data: a pilot study. Med J Aust 1992 Mar 16, 156(6):383-6.
• [35]Dutta SB, Dhasmana DC, Bhardwaj R: Psychotropic drug utilization pattern among patients with schizophrenia. Indian J Psychiatry 2005 Oct, 47(4):243-4.
• [36]Piparva KG, Parmar DM, Singh AP, Gajera MV, Trivedi HR: Drug utilization study of psychotropic drugs in outdoor patients in a teaching hospital. Indian J Psychol Med 2011 Jan, 33(1):54-8.
• [37]Bret MC, Bret P, Pariente A, Fourier-Réglat A: The use of atypical antipsychotics in French psychiatric hospitals. Pharm World Sci 2007, 29(5):551-6. Epub 2007 Jul 19
• [38]Kafle KK, Prasad RR, Thapa BB: National List of Essential Medicine (forth revision draft). 2nd edition. Kathmandu: Nepalese National Formulary; 2010:140-144.
• [39]Serretti A, De Ronchi D, Lorenzi C, Berardi D: New antipsychotics and schizophrenia: a review on efficacy and side effects. Curr Med Chem 2004 Feb, 11(3):343-58.
• [40]Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, Kissling W, Leucht S: Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev 2010 Mar 17., 3CD006654