Antipsychotic Drug Prescription in a Serbian Long-Stay Psychiatric Care Facility
This study evaluated the current use of antipsychotic drugs in a long-stay psychiatric care facility.
Design and Setting
The study was a cross-sectional survey of drug therapy in a long-stay psychiatric care facility, performed in the Institute for Psychiatric Care of Adults (IPCA) in Male Pcelice, Serbia, FR Yugoslavia.
The drug therapy of 806 inpatients was surveyed.
The survey was performed on a randomly chosen day. The following data were collected from patient files and drug charts: age, gender, diagnosis, age of onset of illness, age of first hospitalisation, and current dosage of psychotropic drugs.
Main Outcome Measures
The main outcome measures were the spectrum of drugs used for a particular disorder, the number of drugs used per patient, the average dose of each drug, and the average length of therapy.
The majority of the inpatients had schizophrenia (396) or mental retardation (330). Fifteen percent of the patients did not take any psychotropic medication. Among 682 patients taking psychotropic medication, 547 (80.2%) were receiving antipsychotics. The median daily dose of antipsychotic s was 450mg of chlorpromazine (CPZ) equivalent. 133 patients (24% of those taking antipsychotics) with schizophrenia were maintained on depot antipsychotics. The dosage of antipsychotics in patients with schizophrenia was higher than that in patients with other diagnoses (median 500 vs 400mg of CPZ equivalent per day; U = 42467; p = 0.0005; significant difference). Of the patients taking antipsychotics, 237 (43.4%) were taking one, 254 (46.4%) were taking two, and 56 (10.2%) were taking three or more agents. 243 (44.4%) patients were taking an anticholinergic antiparkinsonian agent, trihexyphenidyl, in a median daily dose of 5mg. 351 (64.1%) patients were taking some other psychotropic drug. The patients receiving both antipsychotics and other psychotropic drugs were on slightly lower dosages of antipsychotics than the patients receiving antipsychotics only (median 400 vs 450mg of CPZ equivalent per day; U = 35239.8, p = 0.691; NS).
Significant irrationalities in psychotropic drug use were observed: maintenance dosages of antipsychotics were higher than those recommended by international guidelines; two or more antipsychotics were administered to an unacceptably high proportion of patients, and adjuvant psychotropic medication was overused. There is a need for translating international guidelines into Serbian to allow Serbian practitioners to prescribe psychotropic drugs in line with modern views.
KeywordsSchizophrenia Clozapine Psychotropic Medication Psychotropic Drug Anticholinergic Medication
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