神经系统疾病

Antipsychotic Polypharmacy among Psychiatric Patients in Hospital Kajang, Malaysia

Abstract

Muthanna FMS, Zainal ZA, Che Mi N and Paneerselvam GS

Background: Using antipsychotic polypharmacy is a routine practice despite the instructions and guidelines of avoiding such combinations till several successful trials upon antipsychotic combinations usage. This practice exposes severe side effects over the patient and also poses burden by unnecessary expenses. On the other hand, antipsychotic polypharmacy also has some benefits and most medical practitioners prescribe antipsychotic combinations in order to treat difficult and acute psychosis. Now-a-days, use of antipsychotic polypharmacy is common among psychiatric patients. There is gap due to low empirical evidences in support of its benefits, safety, risks, efficacy and proper way of practicing till now. There is no data available published at local level in Malaysia in spite of recurrent and more prevalent usage of antipsychotic polypharmacy. To determine the proportion and pattern of antipsychotic polypharmacy prescriptions and their possible risks among patients, this study was conducted. Methodology: This cross-sectional study was conducted over the patients prescribed with antipsychotic polypharmacy at Kajang Hospital, Malaysia from June until August 2017. Retrospective data was collected for patients who were admitted in the past 1 year (January 2016 to December 2016). The risk and usage of polypharmacy were assessed on the basis of clinical outcomes and range of prescription as medication non-adherence, adverse drug effects, drug-drug interaction, inappropriate prescriptions, hospitalization, functional decline and mortality resulted either by antipsychotic polypharmacy or due to monotherapy effects. Results: A total of 100 patients were included in this study. Overall there were 120 cases detected in this research. Sixty-two cases out of the total 120 were prescribed antipsychotic monotherapy, while 58 cases prescribed with antipsychotic polypharmacy medications. The use of polypharmacy as antipsychotic medications accounted for almost half of total cases with 48%. It was also found from this study that duration of illness had statistically significant association with antipsychotic polypharmacy (P<0.05). Polypharmacy in antipsychotic treatment caused adverse effects like hyperprolactinemia and EPS. Some other adverse effects were associated with monotherapy and polytherapy medications such as weight gain, hyperlipidemia, and metabolic syndrome but these were not statistically significant. Conclusion: The antipsychotic polypharmacy was high in proportion. Prescription of antipsychotic polypharmacy was concerned with severe side effects. While prescribing antipsychotics for diabetics and obese patients, caution must be taken. To enhance the prevention and management of these medications, there must be more information about risk and usage of antipsychotic polypharmacy.