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Grover S, Avasthi A, Sinha V, Lakdawala B, Bathla M, Sethi S, Mathur DM, Kathuria P, Shah S, Baalasubramanian DS, Agarwal V, Deka K. Indian psychiatric society multicentric study: Correlates of prescription patterns of psychotropics in India. Indian J Psychiatry 2016; 58:417-424. [PMID: 28196999 PMCID: PMC5270267 DOI: 10.4103/0019-5545.196703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is a lack of information on the clinical and sociodemographic correlates of prescription of psychotropics by psychiatrists. AIM AND OBJECTIVE This study aimed to evaluate the relationship of prescription patterns with various clinical and sociodemographic variables. METHODOLOGY Data of prescription patterns, psychiatric diagnosis, sociodemographic variables, and comorbid physical illnesses were collected for 4480 patients, across 11 centers. RESULTS Females are more often prescribed escitalopram, sertraline, amitriptyline, amisulpride, nonlithium mood stabilizers, and benzodiazepines, whereas males are more often prescribed fluoxetine, olanzapine, two antipsychotics concurrently, typical antipsychotics, valproate, lithium, and more than one benzodiazepine. Elderly (>65 years) participants are more often prescribed sertraline when compared to adolescents. In addition, elderly more often receive quetiapine and less often are prescribed benzodiazepines. Those with comorbid neurological disorders are commonly prescribed antipsychotics, amitriptyline, and more than one antidepressant and are less commonly prescribed lithium, combination of two mood stabilizers, and benzodiazepines. Those with cardiac ailments are more commonly prescribed sertraline, quetiapine, and lithium and less frequently prescribed amitriptyline, fluoxetine, olanzapine, risperidone, and typical antipsychotics. Those with diabetes mellitus more often received escitalopram and quetiapine. Presence of more than one psychiatric diagnosis was associated with the use of more number of medications. Further, diagnosis of affective disorders was associated with the use of a higher number of medications. CONCLUSION Findings of the present study suggest that sociodemographic variables and physical and psychiatric comorbidity influence the prescription patterns of psychotropics.
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Affiliation(s)
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
| | - Vishal Sinha
- Department of Psychiatry, S N Medical College, Agra, Uttar Pradesh, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Manish Bathla
- Department of Psychiatry, MM Institute of Medical Sciences and Research, Mullana, Ambala, India
| | | | - D M Mathur
- Department of Psychiatry, Gitanjali Medical College Hospital, Udaipur, Rajasthan, India
| | | | - Sandip Shah
- Department of Psychiatry, SBKS MI & RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | - D Sai Baalasubramanian
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
| | - Vivek Agarwal
- Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, India
| | - Kamla Deka
- Department of Psychiatry, Guwahati Medical College, Guwahati, Assam, India
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Jain S, Upadhyaya P, Goyal J, Kumar A, Jain P, Seth V, Moghe VV. A systematic review of prescription pattern monitoring studies and their effectiveness in promoting rational use of medicines. Perspect Clin Res 2015; 6:86-90. [PMID: 25878953 PMCID: PMC4394586 DOI: 10.4103/2229-3485.154005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Prescription pattern monitoring studies (PPMS) are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of PPMS is to facilitate rational use of medicines (RUM). There is paucity of published data analysing the effectiveness of PPMS. The present review has been done to assess the effectiveness of prescription pattern monitoring studies in promoting RUM. Data search was conducted on internet. A multitude of PPMS done on different classes of drugs were collected and analyzed. PPMS using WHO prescribing indicators were also included. The present article reviews various prescription pattern monitoring studies of drugs conducted all over country and abroad. It was observed in the majority of such studies that physicians do not adhere to the guidelines made by regulatory agencies leading to irrational use of medicines. This in turn leads to increased incidence of treatment failure, antimicrobial resistance and economic burden on the patient and the community as a whole. The treatment of diseases by the use of essential drugs, prescribed by their generic names, has been emphasized by the WHO and the National Health Policy of India. We conclude that the prescription monitoring studies provide a bridge between areas like rational use of drugs, pharmacovigilance, evidence based medicine, pharmacoeconomics, pharmacogenetics and ecopharmacovigilance. In India, this is the need of the hour to utilise the data generated by so many prescription pattern monitoring studies done in every state and on every drug, so that the main aim of promoting rational use of drugs is fulfilled.
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Affiliation(s)
- Shipra Jain
- Department of Pharmacology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Prerna Upadhyaya
- Department of Pharmacology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Jaswant Goyal
- Department of Pharmacology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Abhijit Kumar
- Department of Pharmacology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Pushpawati Jain
- Department of Pharmacology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Vikas Seth
- Department of Pharmacology, Mayo Institute of Medical Sciences, Gadia, Barabanki, Uttar Pradesh, India
| | - Vijay V Moghe
- Department of Pharmacology, Terna Medical College, Nerul, Navi Mumbai, Mumbai, Maharashtra, India
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Grover S, Avasthi A, Sinha V, Lakdawala B, Bathla M, Sethi S, Mathur DM, Kathuria P, Shah S, Baalasubramanian DS, Agarwal V, Deka K. Indian Psychiatric Society multicentric study: Prescription patterns of psychotropics in India. Indian J Psychiatry 2014; 56:253-64. [PMID: 25316936 PMCID: PMC4181180 DOI: 10.4103/0019-5545.140632] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is a lack of national level data from India on prescription of psychotropics by psychiatrists. AIM AND OBJECTIVE This study aimed to assess the first prescription handed over to the psychiatrically ill patients whenever they contact a psychiatrist. MATERIALS AND METHODS Data were collected across 11 centers. Psychiatric diagnosis was made as per the International Classification of Diseases Classification of Mental and Behavioural Disorders 10(th) edition criteria based on Mini International Neuropsychiatric Interview, and the data of psychotropic prescriptions was collected. RESULTS Study included 4480 patients, slightly more than half of the subjects were of male (54.8%) and most of the participants were married (71.8%). Half of the participants were from the urban background, and about half (46.9%) were educated up to or beyond high school. The most common diagnostic category was that of affective disorders (54.3%), followed by Neurotic, stress-related and somatoform disorders (22.2%) and psychotic disorders (19.1%). Other diagnostic categories formed a very small proportion of the study participants. Among the antidepressants, most commonly prescribed antidepressant included escitalopram followed by sertraline. Escitalopram was the most common antidepressant across 7 out of 11 centers and second most common in three centers. Among the antipsychotics, the most commonly prescribed antipsychotic was olanzapine followed by risperidone. Olanzapine was the most commonly prescribed antipsychotic across 6 out of 11 centers and second most common antipsychotic across rest of the centers. Among the mood stabilizers valproate was prescribed more often, and it was the most commonly prescribed mood stabilizer in 8 out of 11 centers. Clonazepam was prescribed as anxiolytic about 5 times more commonly than lorazepam. Clonazepam was the most common benzodiazepine prescribed in 6 out of the 11 centers. Rate of polypharmacy was low. CONCLUSION Escitalopram is the most commonly prescribed antidepressant, olanzapine is the most commonly prescribed antipsychotic and clonazepam is most commonly prescribed benzodiazepine. There are very few variations in prescription patterns across various centers.
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Affiliation(s)
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
| | - Vishal Sinha
- Department of Psychiatry, S N Medical College, Agra, Uttar Pradesh, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Manish Bathla
- Department of Psychiatry, MM Institute of Medical Sciences and Research, Mullana, Ambala, India
| | | | - D M Mathur
- Department of Psychiatry, Gitanjali Medical College Hospital, Udaipur, Rajasthan, India
| | | | - Sandip Shah
- SBKS MI & RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | | | | | - Kamla Deka
- Guwahati Medical College, Guwahati, Assam, India
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Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr 2013; 11:82-99. [PMID: 23678240 PMCID: PMC3653237 DOI: 10.4103/0973-1229.104497] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/07/2012] [Accepted: 12/07/2012] [Indexed: 11/04/2022] Open
Abstract
Psychiatric polypharmacy refers to the prescription of two or more psychiatric medications concurrently to a patient. It can be categorised as same-class, multi-class, adjunctive, augmentation and total polypharmacy. Despite advances in psychopharmacology and a better understanding of the principles of therapeutics, its practice is increasing rapidly. The prevalence of polypharmacy in psychiatry varies between 13%-90%. There are various clinical and pharmaco-economic factors associated with it. Dealing with polypharmacy requires an understanding of its associated factors. Education, guidelines and algorithms for the appropriate management of various conditions are effective ways to avoid irrational polypharmacy.
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Affiliation(s)
- Sanjay Kukreja
- Research Associate, Lokmanya Tilak Medical College and Sion General Hospital, Sion, Mumbai 400 022, India
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Grover S, Kumar V, Avasthi A, Kulhara P. An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India. Indian J Pharmacol 2012; 44:319-25. [PMID: 22701239 PMCID: PMC3371452 DOI: 10.4103/0253-7613.96302] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 02/08/2012] [Accepted: 02/28/2012] [Indexed: 11/29/2022] Open
Abstract
Background: Although almost all psychotropic medications available worldwide are readily available in India, there is meager data in this country on the prescription patterns of psychiatrists. Aim: To study the first prescription handed over to patients attending the psychiatry outpatient clinic of a tertiary care hospital. Materials and Methods: Data of all patients (for the period of January 1, 2009 to November 30, 2010; diagnosed with an ICD-10 diagnosis of F2-F4) were extracted from the computer-based registry and analyzed. Results: Ten thousand two hundred and fourteen (10 214) patients were diagnosed to have a diagnosis of F2-F4 ICD-10 category. In all diagnostic groups, olanzapine was the most commonly prescribed antipsychotic followed by risperidone. Very few patients (8%) received typical antipsychotic medication. In all diagnostic groups, escitalopram was the most commonly prescribed antidepressant; other frequently prescribed antidepressants were sertraline, paroxetine, and venlafaxine. Among the mood stabilizers, valproate was preferred over lithium. In all the groups, more than half of the patients were prescribed benzodiazepines, clonazepam being the most commonly prescribed agent, followed by lorazepam. The mean number of psychotropic medications was highest in the bipolar disorder group. Very few patients received the combination of same group of drugs. Conclusions: Olanzapine, escitalopram, and clonazepam are the most commonly prescribed antipsychotic, antidepressants, and benzodiazepines, respectively. Valproate was preferred over lithium as a mood stabilizer. In general, the prescription trends were in accordance to the recommendations of various treatment guidelines, except for the use of benzodiazepines, which was higher.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Grover S, Avasthi A. Anti-psychotic prescription pattern: A preliminary survey of Psychiatrists in India. Indian J Psychiatry 2010; 52:257-9. [PMID: 21180412 PMCID: PMC2990827 DOI: 10.4103/0019-5545.70982] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although anti-psychotic medications are available in India since a long time, little is known about the prescription patterns of Indian psychiatrists. An email survey was sent to 1100 psychiatrists, of which 168 responded. The three most commonly prescribed anti-psychotics were risperidone, olanzapine, and haloperidol. It was also found that typical anti-psychotics comprise of 25.15% (SD=21.66; range 0-100) of all prescriptions and in about 22.36% of the cases the psychiatrists were using more than one anti-psychotic in the same patient.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India
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