Patients Attending Psychiatry Outpatient Department Research Articles

A Study on Spectrum of Clinical Variables on the Patients Attending Psychiatry Outpatient Department in a Tertiary Care Hospital

Objectives The objective of the study is to determine the spectrum of clinical variables of the patients attending psychiatry OPD in a tertiary care hospital and to determine the association of those variables with various sociodemographic factors.The study was conducted in the psychiatric Out-patient Department(OPD) of a tertiary care hospital Barak Valley region in the Northeastern part of India. Material and Methods Retrospective observational study where we assessed 1827 consecutive patients asking for psychiatric services, attending psychiatry OPD of Silchar Medical College & Hospital in the one-year period. Out of a total of 1827 cases, 1200 cases were enrolled for the study, meeting the study criteria. Data regarding sociodemographic profile, duration of illness, and provisional diagnosis were also collected, and self-design proforma was used. For socioeconomic class Modified Kuppuswamy Scale is used. The patients were diagnosed and classified on the basis of ICD-10 Criteria by consultant psychiatrists. The patient’s complete profile and data were presented in tables with the use of Microsoft excel. The data obtained was entered and analyzed by using SPSS Version 21. Any case attending psychiatry opd with psychiatric problems and who were provided psychiatric services. Results Out of a total of 1200 patients, most patients were in the age group of 21–40 years, followed by 41– 60 years. The mean age is 34.5. Majority of them were male (59.4%) belonged to Hindu religion (56.08%),were married (44.41%),and educated upto primary school level (26.75%), living in nuclear family (64%), belonged to lower class socioeconomic status (33.5%). It was seen that the majority of the patients (31.25%) belonged to the ICD-10 category of F20-F29, and Schizophrenia (F20) was the most common diagnosis (21.75%). The majority of patients in diagnostic categories of F10-F19, F20-F29, F30-F39, F40-F48, G43, and G44, were in age group 21–40 years, while among MR and G40 were of age < 20 years. Looking at the individual diagnostic category, we found that the majority of the cases belonging to the categories of F10-F19 (19.49%), F20-F29 (35.20%), F30-F39 (14.02%), G40 (3.16%), G44 (14%), and others (2.24%) were males. while majority of cases having the diagnosis of F40-F48 (30.8%), MR (13.96%) and G43 (5.54%) were females. Conclusion This study has reflected the pattern of clinical variables of the patients attending the tertiary care center. It has helped us to understand the nature and extent of psychiatric disease burden in the community with an aim to facilitate designing and planning for providing better mental health care to the community as a whole.

Level of Satisfaction Towards Healthcare Services in Patients Attending Psychiatry Outpatient Department of a Tertiary Care Hospital in Eastern India.

Patients' satisfaction with healthcare services contributes to their compliance with the treatment and thus impacts their health. Therefore, patient satisfaction is increasingly being used as an indicator of health system performance in a country. Though several studies have been reported from different parts of India, most did not include psychiatric patients. This study assessed the level of satisfaction of psychiatric outpatients and its association with socio-demographic, hospital-related, and treatment-related variables. This cross-sectional study assessed 152 patients attending psychiatry outpatient department (OPD) of a tertiary care hospital. Treatment-related satisfaction was measured using the Short Assessment of Patient Satisfaction (SAPS) scale, and variables not related to treatment were assessed using Likert scales. Most participants were satisfied with the overall cleanliness of the hospital (82.9%), the useable condition of toilets (73%), and waiting time in the OPD ticket counter, doctor's room, and pharmacy. More than 80% were pleased with the OPD staff's behavior and working efficiency. In the seven dimensions of the SAPS scale, satisfaction level was variable. Overall satisfaction with the care received in the hospital was 60.5%. The level of patient satisfaction is good in psychiatry OPD services of our hospital, and it depends on treatment-independent variables also. So, liaison between the medical- and non-medical-management teams is crucial to augment patient satisfaction.

Prescription pattern of depressive and anxiety disorders in patients attending Psychiatry outpatient department of a tertiary hospital in Telangana

Depression and anxiety are the most common mental illnesses encountered in patients visiting psychiatry outpatient clinics. The relative safety of majority of antidepressants and anxiolytics has increased their routine use. However, limited data is available on the prescribing patterns of these drugs, especially from the state of Telangana. The aim of this study was to assess the prescription pattern in depression and anxiety disorders in patients attending Psychiatry outpatient department of a tertiary care teaching hospital in Telangana. A prospective observational study was conducted in Psychiatry outpatient department in Government General Hospital (GGH), Nalgonda over a period of 6 months (March 2021 to August 2021). A total of 45 patients suffering from anxiety and depression, based on International Classification of Diseases-10th edition (ICD-10), were selected. Data was collected using a semi-structured proforma and analyzed. A total of 103 drugs were prescribed and the average number of drugs per prescription was 2.29. It was found that majority of patients were in 15-35 years age group (60%), female (62.22%), married (60%) and from urban background (82.2%). In the study population, 55.55% were suffering from anxiety disorders, out of which 31.11% had Generalized anxiety disorder. Among the depressive disorders (44.45%) majority had Severe depressive episode (26.67%) followed by Moderate depressive episode (17.78%). The duration of illness was less than 6 months in majority of patients (75.56%). Selective serotonin reuptake inhibitors (SSRIs) were the most common group of drugs prescribed. 41 prescriptions (91.11%) contained SSRIs, and Sertraline was the most common drug followed by Escitalopram. 93.33% of the prescriptions also included Benzodiazepines (Clonazepam). 35.55% of the prescriptions had fixed dose combinations, commonest being Escitalopram 10mg + Clonazepam 0.5mg.

Presentations of Psychiatric Disorders Among Post COVID Patients

Background: Serious threat to global mental health has been posed by the COVID-19. Following COVID-19, patients may experience long term psychiatric complications with increased prevalence of post-traumatic stress disorder (PTSD), depression, anxiety and neurocognitive impairment including impaired mental processing speed, memory, concentration and impaired attention. Aims: To study the presentations of psychiatric disorders among post COVID patients attending psychiatry OPD in a tertiary care hospital. Materials & Methods: The present cross-sectional study was conducted on post COVID patients who were receiving services at outpatient department (OPD) of Government Psychiatric Diseases Hospital Jammu. About 100 patients, 50 males and 50 females were selected for the study. The diagnosis of psychiatric disorders was made by consultant psychiatrist. Purpose of the study was explained to all participants and written informed consent was taken from them before entering into the study. Results: 69% patients reported insomnia, 29% reported anxiety, 23% reported depression, 13% PTSD and 8% patients reported other psychiatric symptoms. Conclusion: From present study we conclude that there is high prevalence of psychiatric disorders in post COVID patients. Hence there is urgent need for screening, early detection and treatment of psychiatric disorders among post COVID patients. Keywords: Anxiety, Covid 19, Depression.

A STUDY OF OFF LABEL DRUG USE IN PSYCHIATRY DEPARTMENT AT TERTIARY CARE HOSPITAL

Background: US-Food and Drug Administration has dened off-label drug as “use of drugs for the indication, dosage form, regimen, patient or other use constraint not mentioned in the approved labeling.” Off-label prescription is common in Psychiatry. The aim of this study is to evaluate such off-label drug use in psychiatry department of a tertiary care teaching hospital. An observational, cross sectional study was Methods: conducted among 150 patients attending Psychiatry outpatient department for the period of 3 months. Data related to demographic parameters, diagnosis and prescription details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India and CDSCO list of approved drug use. Total 150 patients were included in this Results: study with mean age of 43.6 years. Most of the patients were diagnosed with Schizophrenia [N=36, 24%]. Out of 150, 90 patients [60%] received at least 1 off label drug. Total 478 drugs were prescribed, out of which 144 [30.12%] were off label according to CDSCO and 145 [30.33%] were off label according to NFI. The drugs most frequently prescribed as off label drug according to CDSCO were Vitamins & Minerals [13.59%], Clonazepam [2.92%], Trihexyphenidyl HCL [2.09%], Diazepam [1.88%]. The drugs most frequently prescribed as off label according to NFI were Vitamins & Minerals [12.76%], Aripiprazole [2.09%], and Trihexyphenidyl HCL [2.09%]. Off label drug Conclusion: s used among psychiatry patients was 30.12%. The most frequently used off-label drugs were Vitamins & Minerals followed by Clonazepam & Trihexyphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

Monitoring Adverse Effects of Antipsychotics and Antidepressants: A Population Based Study

Abstract: Aim: To monitor the nature and incidences adverse effects of both antipsychotics and antidepressants medicines in the psychiatry outpatient department. Objectives: Reporting the incidences of adverse effects and to establish the frequency of a specific class of drug. Identifying the system affected and the assessment of the management of the adverse effects by the physician. For the study, we have adopted Global Assessment Scale (GAS), Simpson-Angus Extra pyramidal Side Effects Scale (SAS) and The Antidepressant Side-Effect Checklist (ASEC). Materials and Methods: A prospective cohort study carried out in the psychiatry out-patient department. All the patients attending psychiatry outpatient department enrolled based on the pre-specified inclusion criteria and monitored for adverse effects. Causality also assessed by WHO-UMC causality assessment system and Naranjo Causality Assessment. Results: The incidence rate of adverse effects (46.07%) and 560 adverse effects documented. Weight gain (n=29, 9.2%) followed by drowsiness (n=27, 4.82%) are most commonly reported adverse effects. Atypical antipsychotics (n=279, 49.82%) were the most common class of psychotropic drugs implicated in adverse effects. Escitalopram (n=93, 37.80%) followed by olanzapine (n=53, 21.54%) associated with a maximum number of adverse effects. Central nervous system (n=225, 40.17%) was the most affected organ system followed by gastrointestinal system (n=130, 23.21%). Conclusion: Study revealed moderate incidences of adverse effects in patients attending the psychiatry outpatient department. Majority of the adverse effects reported during the study were mild in nature and not preventable. The role of a clinical pharmacist clearly elucidated regular intensive monitoring of adverse effects may improve the quality of patients’ care, reduction in the treatment cost and augmentation of the medication adherence among patients. Key words: Adverse effects, Pharmacovigilance, Antipsychotics, Antidepressants, Extra pyramidal side effects.

Assessment of incidence, causality, severity, and preventability of suspected adverse drug reactions to antidepressant medications in a psychiatry outpatient setting of a secondary care hospital.

ABSTRACTBackground:Antidepressant medications are primarily used in the management of depression and various anxiety disorders. Antidepressant medications are known to cause adverse drug reactions (ADRs). Reporting ADRs can help in the rational use of medication and better patient drug management.Objective:The aim of this study was to monitor the incidence and nature of ADRs to antidepressant medications in a psychiatric outpatient setting of a secondary care hospital of the UAE.Materials and Methods:It was a cross-sectional study conducted in the psychiatric outpatient setting of a secondary care hospital. Patients attending psychiatry outpatient department and prescribed with antidepressant medications were included. All clinical side effects or ADRs noted by physician and reported by patients were documented and assessed according to causality, severity, and preventability scales.Results:A total of 131 patients were screened for the presence or occurrence of ADRs. During the study duration, an aggregate of 29 patients reported at least one ADR. Incidence of suspected ADR to antidepressant medications was found to be 22.1%. Most commonly documented suspected ADR was found to be weight gain in eight (18.1%) patients followed by somnolence in four (9.1%) patients. Escitalopram was the most common drug implicated with ADR in 13 (29.6%) patients followed by fluoxetine in 6 (13.6%) patients. According to World Health Organization-The Uppsala Monitoring Centre causality assessment, the predominance of the suspected ADRs was of “possible” type in 27 (61%) patients, and “mild” in severity in 40 (91%) patients, and “not preventable” in 37 (84%) patients. A statistically significant association (P = 0.019) was observed only between the presence of drug-interaction and the occurrence of ADR (relative risk: 0.429, confidence interval: 0.211–0.872).Conclusion:Most of the suspected ADRs related to antidepressants were “mild,” “predictable,” and “not preventable” in nature. Continuous monitoring may help in identifying, reducing, and preventing the risk of ADRs.

Morbidity pattern of patients attending psychiatry outpatient department in state mental health and rehabilitation center of a northern state of India

Morbidity pattern of patients attending psychiatry outpatient department in state mental health and rehabilitation center of a northern state of India

Care giver burden among spouse of psychiatric patients attending psychiatry outpatient department of a teaching hospital

Introductions: Caregiver burden in mental illness is a global issue. Burden is more significant and high among spouse than other caregivers. Spouse face illness-specific burdens of feeling powerlessness, fear, marital stress and partnership and family roles.
 Methods: A cross-sectional study was conducted in outpatient department of psychiatry in Patan hospital, Patan Academy of Health Sciences, Nepal, from 26th August to 23rd September, 2018. Non-probability purposive sampling technique was used. Data was collected from spouses of psychiatric patients by face-to-face interview using Burden Assessment Schedule (BAS) to assess the caregiver burden of spouses of psychiatric patients.
 Results: Out of 160 spouses interviewed, 94 (59%) had severe burden, 13 (9%) very severe, and 53 (34%) moderate. Burden was significantly associated with respondents’ relation to patient, educational status, income and diagnosis. The respondent’s age, occupation, duration of caring, and place of residence had no significant association with burden.
 Conclusions: More than half of the spouses of psychiatric patients had severe care giver burden.

Prevalence of Dissociative Convulsions in Patients with Dissociative Disorder in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Dissociative disorder is one of the common psychiatric problems encountered very frequently in the hospital setting. The aim of the study is to find out the prevalence of dissociative convulsions type in patients suffering from dissociative disorder attending Psychiatry outpatient department of a tertiary care hospital. The descriptive cross-sectional study was carried out in a tertiary care hospital from February 2019 to July 2019 after taking ethical approval (MEMG/IRC/210/GA). The patients attending Psychiatry outpatient department of Manipal Teaching Hospital, Pokhara, Nepal were included in the study. The diagnosis of dissociative convulsion and other types of dissociative disorder was done according to the International Classification of Disease-10 Classification of Mental and Behavioural Disorders - Diagnostic Criteria for Research. Statistical Package for Social Sciences version 22 was used for the analysis of the data and point estimate at 95% Confidence interval was calculated along with frequency and proportion for binary data and the analysis was done. Sixty six patients were included in the study. The prevalence of dissociative convulsion was 86.3% in the present study, at 95% Confidence interval, (78-94.6%). Five patients (7.6%) were found to be suffering from dissociative motor disorders and 4 (6.1%) patients were suffering from trance and possession disorder. The prevalence of dissociative convulsion type is high in patients suffering from dissociative disorder in the Nepalese context. Future studies should be conducted to understand this disorder and to propose therapeutic guidelines.

Study of depression in the geriatric patients attending psychiatry OPD in a tertiary care hospital

Introduction: Major depressive disorder is widely prevalent in the general population and depression in geriatric patients is quite common. Increasing geriatric population in the country coupled with lack of awareness of depression and therefore lack of adequate care may lead to the suffering of the elderly people. We attempted to study depression in geriatric patients and the associated risk factors. Aims: Our aim was to study characteristics and associated risk factors of depression in geriatric patients attending the psychiatry outpatient department (OPD) for the first time. Materials and Methods: A total of 100 geriatric patients aged above 60 years, attending psychiatric OPD for the first time were enrolled in the study. Informed consent of patients who agreed to participate in the study was taken and socio-demographic data collected. A 30 item Geriatric depression scale was used to assess the severity of depression. Cognitive functions were screened by using the Mini-mental status examination (MMSE) in those suspected of neuro-cognitive problems. We excluded patients having psychotic and substance use disorders and having cognitive impairment interfering with giving information. Results: Headache and sleep disturbances were the most common presenting symptoms in geriatric patients with depression. The two non-modifiable risk factors found to be significantly associated with depression in the geriatric population were older age group and female gender. However, the potentially modifiable risk factors for depression in the geriatric population were low socioeconomic status, loss of a spouse, living alone, chronic co-morbidities, cognitive impairment, bereavement and restricted activities of daily living (ADL). Conclusion: Geriatric patients attending psychiatry OPD primarily for their somatic symptoms should be evaluated for depression, as a high prevalence rate of depression was found among them. Better awareness regarding depression will help for early ide

Profile of new Patients attending Psychiatry Out-patient Department at Lumbini Medical College-Teaching Hospital, Palpa

Introduction: Study on prevalence of psychiatric disorders in Palpa and nearby districts which lie in western Nepal, is not much studied till date. We therefore conducted this study aiming to see the pattern of psychiatric illness in an Outpatient Department of Lumbini Medical College which is a tertiary care centre located in Palpa district.Material And Method: : This is a retrospective study where outpatient record of all new cases attending the Psychiatry OPD from 29th Oct 2014 to 29th Dec 2014 were studied and statistical analysis were done. The number of new patients were 107.Results: Out of 107 patients, 60.74 % (65)) were females and 39.26 %( 42) were males. Patients of age group 31-40yrs showed the largest proportion (27.49%) followed by age group 41-50yrs (24.29%). Majority cases were illiterate (69.15%) followed by primary level of education (14.95%). The occupation of most of the cases were household work (35.51%) followed by farming (31.77%). Anxiety disorder (27.10%) was the most frequent diagnosis ahead of “Others” (18.69%) followed by depressive disorder (15.88%).Conclusion: Most of the new patients attending the psychiatry OPD of Lumbini Medical College were females, of 31-40 age group and most of the patients suffered from anxiety disorders. J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 42-44

Drug utilization study of off-label drug use in outpatient department of psychiatry: a prospective study at a tertiary care teaching hospital

Background: In the absence of standard psychiatric prescribing information, physician often use drugs in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian Drug Formulary.Methods: After taking permission from Institutional Ethics Committee (IEC), a prospective study was conducted among 285 patients attending Psychiatry outpatient department for the period of 4 months. Data related to demographic parameters, diagnosis of psychiatry conditions and drugs details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India. Multivariate binary logistic regression model was used to determine the predictors of off- label drug prescribing. The data were statistically analyzed using SPSS version 19 and chi-square test.Results: A total of 285 patients (169 males, 116 females) were included in the study with mean age of 36.54±13.91 years. Most of the patients (n=65, 22.8%) were diagnosed as schizophrenic. Out of 285 patients, 133(46.6%) received at least one off-label drug. A total 841 drugs were prescribed out of which 167(19.85%) were off-label. The drug most frequently prescribed as off-label were trihexiphenidyl HCL 29 (10.2%), clozapine 23 (8.1%) and clonazepam 13 (4.6%).Conclusions: Off label drugs used among psychiatry patients was 19.85%. The most frequently used off-label drugs was trihexiphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

Evaluation of patterns and predictors of off-label prescribing of antidepressants in psychiatry at a tertiary care hospital - An analytical cross-sectional study

Background: Off-label drug prescribing is commonly seen all medical fields including psychiatry. A regular auditing and publishing of off-label drug prescribing is important as it provides strong scientific evidence for the clinicians on the effectiveness and acceptability of these proposed treatments. Aims and Objective: To evaluate the pattern and predictors of off-label prescribing of antidepressants in psychiatry was taken up. Materials and Methods: After obtaining the permission from Institutional Ethics Committee, an analytical cross-sectional study was conducted among patients attending psychiatry outpatient department for 6 months. Demographic and drug data were noted and analyzed for off-label drug use as per Food Drug Administration approved indication. Chi-square test and Student’s t-test were used to compare the off-label and approved indication groups. Multivariate binary logistic regression model was used to determine the predictors of offlabel prescribing. Results: A total of 238 antidepressants were prescribed for 200 patients, of which 42.8% were used for off-label indication. Fluoxetine 44.1% and escitalopram 42.1% were the most frequently prescribed antidepressants in offlabel manner. The off label indications noted was somatoform disorder (12.5%), followed by generalized anxiety disorder (8.5%). There was significant causal association between off-label prescribing and number of antidepressant (odds ratio [OR] - 15.43, 95% confidence interval [CI] - 3.49-89.02, P < 0.05) and non-depressant use (OR - 74.37, 95% CI - 25.4-293.71, P ≤ 0.05). Conclusion: Off-label use of antidepressants was 42.8% in this study. A number of antidepressants and non-depressant uses were the significant predictors of off-label prescribing in our hospital.

Assessment of socio-demographic determinants of psychiatric patients attending psychiatry outpatient department of a tertiary care hospital of Central India

BACKGROUND: Mental disorders are among the most burdensome in the world, and their burden will increase over the next decades. The mental and behavioral disorders account for about 12% of the global burden of disease. By 2020, it is likely to increase to 15%. Depression, OCD, schizophrenia, anxiety, phobia and bipolar disorders constitute the top 10 conditions contributing to the global burden of disease among mainly the age group of 15-44 years. In India, little is known about the extent, severity and unmet need of treatment of mental disorders. The objective of the study was to assess the socio-demographic determinants of psychiatric patients. Methods: This was an observational cross sectional study which was undertaken in a psychiatric outpatient department (OPD) of a tertiary care hospital (S.G.M.H) affiliated to S. S. Medical College Rewa, MP, India. The total sample size was 108; it was collected randomly by face to face interviews with the help of pre-designed questionnaire based proforma. All new cases were selected in the study. Duration of study was three months i.e. from 1st November 2014 to 30 January 2015. Data were analysed by using EPI info 2000. Results: Out of total 108 interviewed patients, 59.25% were males 40.74% were female; most of them (45.37%) were belong to age group of 21-40 years. Mental disorders (78.70%) were more common in un-married or separated patients. In case of educational status most of them (87.96%), belong to low education status. Depression was most common mental illness 43 (39.81%) among of all types of disorders. Conclusions: As per the findings of the present study it can be concluded that there must be a kin observation for prevention and control of mental disorders over particularly low educational status group and unmarried/separated group of people hence mental disorders are more common among of those group. Infact we need more studies for validate our findings. Key words: Psychiatric illness, OPD, Patients Language: en

Effects of cannabis use on cognitive function and clinical features of bipolar disorder

Aims: This study aims to compare the cognitive function of patients having dual diagnosis of bipolar affective disorder and cannabis dependence with those having either diagnosis alone and with healthy controls. Settings and Design: Hospital-based study. Subjects and Methods: Study subjects were selected from patients attending psychiatry outpatient department in the presence of two senior consultant psychiatrists. Among the pool of the patients, only those who meet the inclusion and exclusion criteria were selected for the study. Then the selected patients were administered the semi-structured sociodemographic data sheet, Young Mania Rating Scale, Hamilton Depression Rating Scale, General Health Questionnaire-12, Trail Making Test Part A and Part B, verbal fluency tests, Stroop Neuropsychological Screening Test, clock drawing test. Statistical analysis was done by using appropriate statistical methods. Statistical analysis was done with the help of Statistical Package for Social Science-20 (SPSS-20, International Business Machines Corporation (IBM)). Results: The results of our study showed there was significant impairment of cognitive function of the patients of bipolar with cannabis dependence than the patients of bipolar disorder or cannabis dependence alone. It had been also found that with an increase in age of onset of bipolar disorder, there was decrease in no of episode, decrease current duration, and inter-episodic recovery was better. Conclusions: The significant cognitive function impairment exists in bipolar with cannabis dependence and the severity of bipolar outcome correlate with the extent of cannabis use also. In spite of certain limitations such as small sample size, short follow-up time, absence of Indian version of neuropsychological tests, and referral bias inherent in hospital-based studies; present study provides valuable empirical insight into complex relationship between cannabis dependence, bipolar disorder, and cognitive dysfunction.

Off-label drug use in Psychiatry Outpatient Department: A prospective study at a Tertiary Care Teaching Hospital.

Introduction:Off-label drug prescribing is very common in Psychiatry. US-Food and Drug Administration has defined off-label drug as “use of drugs for the indication, dosage form, regimen, patient or other use constraint not mentioned in the approved labeling.”Objective:The objective was to evaluate off-label drug use in patients attending Outpatient Department of Psychiatry.Materials and Methods:One year prospective, cross sectional study was conducted on patients attending Psychiatry Outpatient Department. Demographic data, clinical history, and complete prescription were noted in the predesigned proforma and prescriptions were analyzed for off-label drug use as per British National Formulary-2011.Result:A total of 250 patients were enrolled with mean age 40.36 ± 12.3 years. Most common diagnosis was major depressive disorder 101 (40.4%). A total of 980 drugs (mean 3.68 ± 1.42) were prescribed out of which 387 (39.5%) were off-label. Of 250 patients, 198 (79.2%) received at least one off-label drug. Psychopharmacological agents most frequently used in off-label manner were clonazepam 31 (12.4%), lorazepam 30 (12%), and trihexyphenidyl HCl 25 (10%). Prevalence of off-label use of these three drugs was significantly higher than other off-label drugs (P < 0.0001, P < 0.0001 and P < 0.0001 respectively). Inappropriate indication was the most common category of off-label use. There was positive and significant correlation between off-label prescribing and number of drugs (r = 0.722, P ≤ 0.000). Off-label prescribing was statistically significantly higher in 21–40 year age group, but no difference was seen in any co-morbid condition or in between any psychiatric disorder.Conclusion:Off-label drugs use is common in psychiatric OPD in our setup. Clonazepam, lorazepam, and trihexyphenidyl HCl were the most frequently used drugs in off-label manner.

Profile and pattern of follow-ups of psychiatry outpatients at Christian Medical College, Ludhiana

Context: As psychiatric illness requires long-term treatment, some patients are lost to follow-up. Aims: The present study aimed to find the follow-up pattern of psychiatric patients attending psychiatry outpatient department (OPD) and to determine the correlation of follow-up with socio-demographic profile and diagnosis, if any. Settings and Design: This study was a retrospective data analysis study carried out at the OPD of Psychiatry, Christian Medical College and Hospital, Ludhiana. Subjects and Methods: New cases attending the OPD from April 2010 to March 2011 were included in this study. The data were scrutinized 1 year after the initial assessment. Socio-demographic data, diagnosis and follow-up information were obtained from the files. The collected data were statistically analyzed. Statistical Analysis Used: Chi-square and P value. Results: 53.1% of the patients dropped out after first visit, 29.4% patients had 1-3 follow-up, 14.9% had 4-10 follow-ups and only 2.6% had more than 10 follow-ups. Correlation between follow-up and various socio-demographic variables such as age, gender, place of living or distance from hospital, occupation, religion and marital status was not statistically significant. It was, however, seen that cognitive disorders, conversion disorder, mental retardation, and patients in which diagnosis was deferred, had more dropout rate after first visit. Conclusions: In our study 53.1% of the patients did not attend follow-up at all and only 2.6% had more than 10 follow ups. Correlation between follow-up and various socio-demographic variables was not statistically significant. Patients in which diagnosis was deferred had more drop out rate than patients who had a diagnosis and the difference was statistically significant.

A prospective study on sleep disorders related to antidepressant drugs use in a tertiary care teaching hospital

Background: Prescription of antidepressants has been increased from the last decade and responsible for producing sleep disorders as adverse drug reactions (ADRs). Sleep disorders can be divided into 3 large groups: (1) insomnia, (2) primary complaint of daytime sleepiness, and (3) Association of disruptive behaviours during sleep, the disorders of arousal. So active surveillance is needed to access these ADRs. Aims and Objective: To analyze the sleep disturbances as ADRs of various antidepressants prescribed to the patients attending psychiatry outpatient department (OPD). Methods: This prospective study was conducted on patients aged ≤74 years attending Department of Psychiatry OPD and were prescribed Antidepressants for the duration of 8 months (December, 2013-July, 2014). The ADRs reported were confirmed by WHO UMC Causality Assessment Scale. Results: Total number of patients enrolled on the basis of inclusion and exclusion criteria (n=50). Total number of ADRs related to drugs prescribed were found to be n=69. Total number of patients with sleep disturbances as ADRs were found to be n=28. Conclusion: The drug, most frequently implicated to cause sleep disturbances, was mirtazapine. Increased sleep was the most common ADR, found to occur. Unusual ADRs such as sleep talking was also seen.