Psychotropic drug prescribing in a Nigerian psychiatric hospital

Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa

Background

Long-acting injectable antipsychotics (LAI – APs) improve adherence to antipsychotics and decrease functional decline in schizophrenia. Yet they are prescribed late, in patients with established functional decline. Although LAI – APs are widely prescribed in South Africa, there is a paucity of research regarding the prescription profile for LAI – APs.

Aim

This study aimed to describe prescribing practices for LAI – APs at psychiatric clinics.

Setting

Community psychiatric clinics in South Africa.

Methods

A retrospective review of the psychiatric files of all patients on LAI – APs attending the clinics over the study period was conducted. Sociodemographic, clinical and pharmacological information regarding the LAI – AP prescribed was extracted from the files.

Results

A total of 206 charts were examined. The mean age of the study population was 46 (SD ± 12) years. Significantly more patients were male (n = 154; 74.8%), single (n = 184, 89.3%) and unemployed (n = 115; 55.8%) (p < 0.001). Approximately half had a comorbid substance use disorder (47.6%). The most common indication for the prescription of a LAI – AP was non-adherence (66%). Only 9.7% of the patients were prescribed a LAI – AP alone. No significant socio-demographic or clinical characteristic was associated with this prescribing habit. A LAI – AP was prescribed in combination with an oral antipsychotic, mood stabiliser or antidepressant in 53.9%, 44.7% and 7.8% of patients, respectively.

Conclusion

Long-acting injectable antipsychotics were prescribed mainly following noncompliance with oral antipsychotics and may represent a missed opportunity to prevent functional decline. The high prevalence of LAI – AP polypharmacy has been highlighted.

Patterns of antipsychotics' prescription in Portuguese acute psychiatric wards: A cross-sectional study

This study aimed to establish the prescribing patterns of antipsychotics in acute psychiatric wards across Portugal, to determine the prevalence of polypharmacy and "high-doses" treatment, and to identify possible predictors. Twelve acute psychiatric inpatient units and 272 patients were included. The majority (87.5%) was treated with antipsychotics regardless of diagnosis, and 41.6% had at least two antipsychotics prescribed in combination. Age, use of depot antipsychotics, and antipsychotic "high-doses" were significant predictors of antipsychotic polypharmacy. Excluding 'as required' prescriptions, 13.8% of the patients were prescribed "high-doses" of antipsychotics. When antipsychotics 'as required' prescriptions were considered, 49.2% of the patients were on antipsychotic "high-doses". Age, use of depot antipsychotics, previous psychiatric hospitalization and involuntary admission were significant predictors of antipsychotic "high-doses". These results show that in Portugal the antipsychotics prescribing practices in psychiatric inpatient units diverge from those that are universally recommended, entailing important clinical and economic implications. It seems advisable to optimize the prescription of these drugs, in order to prevent adverse effects and improve the quality of the services provided.

Prevalence and predictors of poor medication adherence among out-patients at a psychiatric hospital in Benin City, Nigeria

OBJECTIVE

To determine the prevalence and predictors of poor or non-compliance with medications among respondents attending an adult psychiatry out-patient clinic in Benin City, Nigeria.

METHODS

Respondents (n = 137) were randomly selected over a 3-month period using a cross-sectional study design. They were administered a questionnaire adapting the Factors Influencing Neuroleptic Medication Taking Scale as well as the Brief Psychiatric Rating Scale (BPRS) to ascertain medication, illness-related and psychosocial variables. Medication adherence was determined by self report and for the purpose of the study confined to the week prior to interview.

RESULTS

Almost half (42.3%) were poorly adherent to medications. Most admitted to good psychosocial support, but believed that their illness had a spiritual aetiology. Stigma, higher frequency of medication dosing as well as illness severity as measured by their BPRS scores were significant predictors of poor medication adherence.

CONCLUSION

The prevalence of poor medication adherence in this environment is higher than in studies from Western cultures, and replicates rates from previously published reports in this environment. Factors responsible for poor adherence can form the template for intervention studies and programs to improve compliance.