Title: Prescription Patterns of Psychotropic Drugs and Non-Adherence in Patients with Schizophrenia
Authors: Ashish H. Chepure, Tejas V. Bhopatkar, Apurva K. Ungratwar, Alka A. S
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.64
Context - Polypharmacy, rational or irrational, in psychiatry is a common phenomenon. One needs to understand various clinical and pharmaco-socio-economic factors associated to deal with it. Non adherence to treatment in schizophrenia leads to relapse, hospitalizations, increased cost of treatment and therapeutic failure. Complexity of treatment decreases adherence. It is important to understand relation between polypharmacy and adherence. Aims and objectives - To find out prevalence of polypharmacy, most common causes of polypharmacy, level of medication adherence and correlation between polypharmacy and medication adherence in patients with schizophrenia Settings and Methodology - A total of 277 consecutive diagnosed patients with schizophrenia were included in the study. Their latest prescriptions were studied to find out rate of polypharmacy and most common reasons for doing so. Patients were asked to answer Morisky 8-item medication adherence scale, a valid and reliable measure of self reported adherence. Obtained data was analyzed statistically. Statistical analysis and Results - About 74 % of the patients received polypharmacy vs. 26 % received monotherapy. Three most common reasons for polypharmacy were to prevent adverse effects, to treat co-morbidity and for augmentation. Polypharmacy did not have any association with age, sex, but polypharmacy had significant association with duration of illness. 36.5 % had low adherence, 21.7 % had high adherence while 41.9 % had medium adherence to prescribed regimen. Adherence did not show statistically significant association with age and sex but had significant association with total number drugs prescribed and duration of illness but failed to show any particular pattern. Conclusions - Polypharmacy is common practice in patients with schizophrenia at our centre and most common reason for it was to prevent adverse effects of primary drug, which is a justified indication. Adherence is a complex phenomenon, not related to factors such as age, sex but had association with duration of illness and total number of drugs prescribed. Most of our patients had medium adherence on MMAS. Polypharmacy did not have any significant effect on adherence across all age groups. Multiple complex factors influence polypharmacy and adherence in patients with schizophrenia like psycho-education, illness related factors and patient related factors. Probably rational polypharmacy is need of time. Keywords- schizophrenia, polypharmacy, non-adherence, prescription pattern, psychotropic drugs Key message- Rational polypharmacy is necessary in Schizophrenia to minimise non adherence and adverse effects of treatment. 1. Kingsbury SJ, Yi D, Simpson GM. Psychopharmacology: rational and irrational polypharmacy. Psychiatry Serv. 2001; 52:1033–6. 2. Medical Directors Council and State Medicaid Directors. Alexandria, Virginia: 2001. National Association of State Mental Health Program Directors: Technical Report on Psychiatric Polypharmacy. 3. Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy In Psychiatry: A Review. Mens Sana Monogr 2013; 11: 82-99. 4. Freudenreich O, Kontos N, Querques J. Psychiatric polypharmacy: A clinical approach based on etiology and differential diagnosis. Harv Rev Psychiatry. 2012; 20:79–85. 5. Preskorn SH, Lacey RL. Polypharmacy: When is it rational? J Psychiatr Pract. 2007; 13:97–105. 6. Pandurangi AK, Dalkilic A. Polypharmacy with second-generation antipsychotics: A review of evidence. J Psychiatr Pract. 2008;14 :345–67. 7. Padmini DD, Amarjeeth R, Sushma M, Guido S. Prescription patterns of psychotropic drugs in hospitalized schizophrenic patients in a tertiary care hospital. Calicut Med J. 2007; 5:e3. 8. Sawhney V, Chopra V, Kapoor B, Thappa JR, Tandon VR. Prescription trends in schizophrenia and manic depressive psychosis. J K Sci. 2005; 7:156–8. 9. Shrivastava A, Johnston M, Terpstra K, Stitt L,Shah N. Atypical antipsychotics usage in long-term follow-up of first episode schizophrenia. Indian J Psychiatry. 2012; 54: 248–52. 10. Stahl S. Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. 2nd Ed. New York: Cambridge University Press; 2000. 11. Murray MD, Kroenke K. Polypharmacy and medication adherence: small steps on a long road. J Gen Intern Med. 2001; 16: 137–9. 12. Misawa F, Shimizu K, Fujii Y, Miyata R, Koshiishi F, Kobayashi M, et al. Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects: A cross-sectional study BMC Psychiatry. 2011; 11:118. 13. Mackay AV. High-dose antipsychotic medication. Adv Psychiatr Treat 1994; 1:16-23. 14. Marken PA, Stoner SC, Bunker MT. Anticholinergic drug abuse and misuse. CNS Drugs 1996; 5:190-9. 15. Indian Psychiatric Society. Clinical practice guidelines for Psychiatrists in India, 2004. 16. Kaplan HI, Sadock BJ. Synopsis of psychiatry. 8thed. New Delhi: BI Waverly 1998. 17. Morris LS, Schulz RM. Patient compliance - an overview. J Clin Pharm Ther 1992;17:283-95. 18. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self reported measure of medication adherence. Med Care. 1986; 24:67–74. 19. Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive Validity of a Medication Adherence Measure for Hypertension Control. Journal of Clinical Hypertension 2008; 10(5):348-354 20. Krousel-Wood MA, Islam T, Webber LS, Re RS, Morisky DE, Muntner P. New Medication Adherence Scale Versus Pharmacy Fill Rates in Seniors With Hypertension. Am J Manag Care 2009; 15 (1):59-66. 21. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: Final response. J Clin Epidemio 2011; 64:258-263. PMID:21144706 22. Sarkar P, Chakraborty K, Misra A, Shukla R, Swain SP. Pattern of psychotropic prescription in a tertiary care center: A critical analysis. Indian J Pharmacol 2013;45:270-3 23. Fourrier, A., Gasquet, I., Allicar, M. P., Bouhassira, M., Lépine, J. P. and Bégaud, B. (2000), Patterns of neuroleptic drug prescription: a national cross-sectional survey of a random sample of French psychiatrists. British Journal of Clinical Pharmacology, 49: 80–86. 24. Nolan L, O’Malley K. Prescribing for the elderly: Part II. Prescribing patterns: Differences due to age. J Am Geriatr Soc. 1988;36:245–54. 25. Karadag H, Orsel S, Akkoyunlu S, Kahilogullari AK, Guriz O, Turkcapar H, et al. Comparison of polypharmacy in schizophrenia and other psychotic disorders in outpatient and inpatient treatment periods: a naturalistic one year follow-up study. Klinik Psikofarmakoloji Bulteni - Bulletin of Clinical Psychopharmacology 2012; 22(2):130-8. 26. Razali SM, Yusoff MZ. Medication adherence in schizophrenia: a comparison between outpatients and relapse cases. East Asian Arch Psychiatry. 2014 Jun;24(2):68-74. 27. Kousalya K, Vasantha J, Ponnudurai R, Sumitkumar G, Ramalakshmi S, Saranya P, et al. Study on non-adherence and the effect of counseling in the pharmacol-ogical management of psychiatric patients. Int J Pharm Bio Sci 2012;3:102-9 28. Buchanan A: A two-year prospective study of treatment compliance in patients with schizophrenia. Psychological Medici-ne 22:787-797, 1992 29. Meichenbaum D and Turk D C (1987): Facilitating treatment adherence: A practit-ioner’s guidebook. New York: Plenum Press 30. Hulka BS, Cassel JC, Kupper LL, Burdette JA. Communication, compliance, and concordance between physicians and patients with prescribed medications. Am J Public Health. Sep; 1976, 66(9):847–853. 31. Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. 2011;6:CD002831. 32. Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: A literature review. P T. 2012;37(1):45–55. 33. Shiloh R, Zemishlany Z, Aizenberg D, Radwan M, Schwartz B, Dorfman-Etrog P, et al. Sulpiride augmentation in people with schizophreniapartially responsive to clozapine. A double-blind, placebo-controlled study. Br J Psychiatry. 1997;171:569–73. Ashish H. Chepure Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 8097304979Abstract
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