Abstract
The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three-drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; poly-therapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.
Highlights
Numerous studies have reported that there are wide inter-country [1,2,3,4] and intra-country [4,5,6] variations in antipsychotic prescribing pattern for patients with psychotic disorders. These variations include the prevalence of antipsychotic polytherapy compared to monotherapy, typical versus atypical antipsychotics, preference for highdose antipsychotics or depot antipsychotics, and anticholinergic co-prescription
A recent report [12] has confirmed that there is a wide variation in anticholinergic medication prescribing across various countries; a combination of clinical, social, economic and cultural factors are the determinants of the use of these drugs suggesting that there are considerable differences between treatment guidelines and clinical practice
Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain 411 of patients who were on antipsychotic monotherapy was 38.4 ± 15.1, whereas 38.7 ± 11.7 was for patients who were on antipsychotic polytherapy
Summary
Numerous studies have reported that there are wide inter-country [1,2,3,4] and intra-country [4,5,6] variations in antipsychotic prescribing pattern for patients with psychotic disorders These variations include the prevalence of antipsychotic polytherapy compared to monotherapy, typical versus atypical antipsychotics, preference for highdose antipsychotics or depot antipsychotics, and anticholinergic co-prescription. Such variations have been attributed to difficulty in adhering to treatment guidelines and therapeutic alogarithms in clinical practice, differences in healthcare settings, availability and cost of antipsychotics, introduction of atypical antipsychotics with improved adverse effects profile and efficacy, and socio-. A recent report [12] has confirmed that there is a wide variation in anticholinergic medication prescribing across various countries; a combination of clinical, social, economic and cultural factors are the determinants of the use of these drugs suggesting that there are considerable differences between treatment guidelines and clinical practice
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