RESEARCH ARTICLE Anjali et.

al / IJIPSR / 4 (6), 2016, 641-647

Department of Pharmacy Practice ISSN (online) 2347-2154

International Journal of Innovative

Pharmaceutical Sciences and Research
www.ijipsr.com

STUDY ON PRESCRIBING PATTERN IN PSYCHIATRIC

DISORDES IN A TERTIARY CARE HOSPITAL
1
Anjali George * , 1 Chaithra.S, 1 Jasmin Elizabeth Thomas, 2 Apollo James, 3 T.Siva Kumar
1
Pharm D Interns, Department of Pharmacy Practice, Nandha College of Pharmacy, Erode,
Tamil Nadu, INDIA
2
Asst. Professor, Department of Pharmacy Practice, Nandha College of Pharmacy, Erode, Tamil
Nadu, INDIA
3
Principal, Nandha College of Pharmacy, Erode, Tamil Nadu, INDIA

Abstract
Psychiatric disorders are one of the most important cause of global morbidity and often chronic disorders
requiring treatment with psychopharmacological agents for prolonged period, may be extending up to lifetime.
The aim of the study is to check the prescribing pattern of antipsychotic drugs in psychiatric departments.A
prospective observational study was carried out in psychiatric department of a neuro-psychiatric hospital for a
period of 3 months. Patients between 12-85 years who have been diagnosed with psychiatric illness and
prescribed with one or more antipsychotic drugs are selected. During our study period a total of 599
prescriptions were analysed.Data was analyzed using World Health Organizations ( WHO) drug indicators.
The most common disease was found to be schizophrenia. Total 1677 drugs were prescribed. Average number
of drugs per prescription is 2.79. Among all the antipsychotropic drugs, atypical antipsychotics drugs were
prescribed more (22.95%).Other prescribed drugs are benzodiazepines(24.48%), antidepressant(12.28%),
typical antipsychotic(4.05%), mood stabilizers(10.19%), anticholinergenic(18.96%).Anticholergenics are
prescribed as adjuvant therapy to lessen the extrapyramidal symptoms. Prescribing pattern of antipsychotics
drug did not differ by gender or age group. Atypical antipsychotics were prescribed more commonly than
typical ones; risperidone being the commonest antipsychotics prescribed. The study can provides more
information for improving the utilization of psychotropic drugs in psychiatry department.
Keywords: Prescribing pattern, a typical antipsychotics, Schizophrenia.

Corresponding Author:
Anjali George
Department of Pharmacy Practice,
Nandha College of Pharmacy, Erode
Tamil Nadu, INDIA
E-mail: dr.anjaligeorge19928@gmail.com
Phone: +91 9629330289

Available online : www. ijipsr.com June Issue 641

RESEARCH ARTICLE Anjali et.al / IJIPSR / 4 (6), 2016, 641-647
Department of Pharmacy Practice ISSN (online) 2347-2154

INTRODUCTION
According to WHO, drug utilization study is defined as a study of marketing, distribution,
prescription and uses of drugs in a society highlighting on the resulting medical, social and
economic consequences [1]. Drug utilization studies helps to identify the clear picture of real
world drug utilization pattern and identify the area where the changes and implementations were
needed. It will also help to assess the appropriateness of pharmacotherapy [2]. The field of
psychopharmacology is expanding rapidly, this make the physicians for seeking new and
improved drugs to treat psychiatric illness. Hence the use of newly introduced drugs which
claimed to be safe and more efficacious are improved.3 psychotic symptoms in wide range of
conditions like schizophrenia, bipolar disorder, psychotic depression, various organic psychosis
and drug induced psychosis can be managed by antipsycotics [2]. The antipsychotic drugs are
classified as typical antipsychotics and atypical antipsycotics. The newly arrived atypical
antipsychotics which have fewer extra pyramidal symptoms are effective against negative
symptoms which are greeted enthusiastically by psychiatrists and consumers, examples include
aripiprazole, clozapine, quetiapine, ziprasidone, olanzapine and risperidone.4 The selection of
different antipsycotics is mainly based on the occurrence of adverse reaction and its therapeutic
response.2 The present study was carried out to observe the prevalence of psychiatric illness and
to evaluate the drug utilization pattern in psychiatric department of a tertiary care hospital [3].
MATERIALS AND METHODS
It is a prospective observational study conducted in a psychiatric department of a neuro
psychiatric tertiary care hospital in New Delhi for a period of 17/12/2015-15/3/2016. The
prescription patterns of both sexes and all ages were considered. About 599 cases were evaluated
along with the occurrence of extra pyramidal symptoms. Each cases were recorded with their
name, age, sex. IP no, diagnosis and medication prescribed along with their dose, route,
frequency, classes of agents used, in combination with same group and other group.
RESULTS AND DISCUSSION
RESULTS
In our study, total 1677 individual drug were prescribed and among 599 patients ,344 (57.42%)
were men and 255 (42.5%) were women. The gender and age characteristics of the patients are
presented in figure 1.The majority of the psychiatric illnesses were observed in the age group of
15-30 with male preponderance.

Available online : www. ijipsr.com June Issue 642

RESEARCH ARTICLE Anjali et.al / IJIPSR / 4 (6), 2016, 641-647
Department of Pharmacy Practice ISSN (online) 2347-2154

Fig. 1: Age & gender wise distribution of psychiatric cases

Figure 2 shows the number of patients diagnosed with various psychiatric conditions .The
morbidity pattern of psychiatric disorder observed were schizophrenia (34.3%) which is more
common in 3 male patients , bipolar disorder (28.8%),depression (25.3%) ,mania (6.8%).Disease
such as obsessive compulsive disorder, anxiety, recurrent APD,dissociative disorder which
accounts for (3.8%) patients.

Fig. 2: Pattern of psychiatric illness

Table 1 shows the drug use pattern in psychiatric illness. A total of 1677 drugs 1646 (98.15%)
were prescribed with generic name and only about 0.29 % of drug was prescribed as injectables.
96.77% of drugs were from the WHO ‘S list of essential medical list.
Table 1: Drug use pattern in psychiatric patients
Drug use indicators Results
Average number of drugs per prescription 2.79
Average number of psychotropic drugs
Per prescription 0.26
Percentage of the drugs prescribed by
generic name 1646/1677 (98.15%)
Percentage of injectable drug prescribed 5/1677 (0.29%)
Percentage of drug prescribed from essential drug list 1623/1677 (96.77%)

Available online : www. ijipsr.com June Issue 643

RESEARCH ARTICLE Anjali et.al / IJIPSR / 4 (6), 2016, 641-647
Department of Pharmacy Practice ISSN (online) 2347-2154

Fig.3 shows the distribution of prescribing pattern of antipsychotics. The results shows that 66%
of prescriptions were mono therapy and 23% were combination therapy, 11% of patients treated
without any antipsychotics. Most of the prescriptions with typical and atypical antipsychotics
were prescribed with anti cholinergic to reduce the extra pyramidal side effects.

Fig.3: Distribution of antipsycotic prescribing patterns

Table 2 shows the prescribing pattern of individual antipsychotic drugs. A total of 452
antipsychotic drugs were prescribed, atypical antipsychotics (85.17%) typical antipsychotics
(14.82%),mood stabilizer (8.4%), followed by benzodiazipines (24.48%) ,antidepressents
(12.28%),anticholinergics (18.96%). Risperidone ,clonazepam,fluoxitine is the most commonly
prescribed atypical antipsychotics ,benzodiazepine, antidepressants respectively. Valproate is
preferred over lithium as a mood stabilizer.
Table 2: Prescribing prevalence of individual psychotropic
Drug class Drugs No of drugs (n=1677) % of drugs
Clonazepam 220 53.6
Benzodiazipine Lorazepam 181 44.1
n = 410(24.48 %) Clobazam 4 0.95
Others 5 1.21
Fluoxetine 145 70.38
Escitalopram 14 6.79
Antidepressant Imipramine 17 8.25
n= 206 (12.28%) Chlopromazine 6 2.91
Amitryptalline 23 11.16
Clomipramine 1 0.48
Typical antipsychotic Haloperidol 49 72.05
n = 68 (4.05%) TFP 19 27.94
Olanzapine 72 18.70
Risperidone 270 70.12
Atypical antipsychotic
Quetiapine 11 2.85
n = 385 (22.95%)
Aripiprazole 12 3.11
Clonazapine 15 3.89

Available online : www. ijipsr.com June Issue 644

RESEARCH ARTICLE Anjali et.al / IJIPSR / 4 (6), 2016, 641-647
Department of Pharmacy Practice ISSN (online) 2347-2154

Amisulpride 5 1.55
Anticholinergics THP 316 99.36
n =318 (18.96%) 2 0.62
Lithium 48 28.07
Mood stabilizers
Valproate 112 65.4
n = 171 (10.19%)
Carbamazipine 11 6.4

DISCUSSION
The burden of illness resulting from psychiatric and behavioral disorders is enormous, although it
remains grossly under represented by conventional public health statistics [5]. Drug utilization
study is essential for evaluating patient care to improve service delivery through awareness
creations for appropriate choice of drugs. The present study was conducted to describe the current
prescribing pattern and drug utilization in psychotropic patients using the WHO core prescribing
indicators [4].
A total of 599 cases were evaluated. A previous study showed that comparing to female patients
males received more psycotropic medications. 6 In our study male patients were prescribed more
psycotropic drugs when compared to female patients. Moreover, study subjects of schizophrenia
and bipolar disorder accounts for majority of the patients(about 63.2%)followed by depression
and mania .Schizophrenia (n=206,34.3%) ranks first among the patients who visited psychiatry
department .Similar conclusions were observed in other studies too [7]. Psychotropic drugs are
mainly prescribed between the age group 15-30 years . Increasing use of psychotropic drugs in
this age group is due to increased incidence of mental ill health, improved mental health literacy
in general population,increased in drug treatment and due to strong marketing of such
medications [7].
In our study 99.2% oral and 0.8% parenteral preparations were used which is contrary to 93.5%
oral and 6.5% parenteral to study by Dutta et al., [6]. An average of 2.79 drugs were used per
prescription. About 98.15% are prescribed by generic name.
The majority of the patients (22.95%) [385/1677] in this study,were receiving atypical
antipsychotic medications particularly risperidone and olanzepine followed by typical
antipsychotics (4.05%) and this was supported by Padmini Devi D et al., [9].
In this study 66% of patients were treated with monotherapy, 23% were with combination therapy
and 11% were treated without any antipsycotics. It was also seen prescription containing
atypical antipsychotic with anticholinergic agent due to the protective effect against

Available online : www. ijipsr.com June Issue 645

RESEARCH ARTICLE Anjali et.al / IJIPSR / 4 (6), 2016, 641-647
Department of Pharmacy Practice ISSN (online) 2347-2154

extrapyramidal side effects [8]. Trihexyphenidyl was the only anticholinergic drug prescribed in
psychiatry.
Concomitant administration of psychotropic was identified in most of the patients and these can
be justified in comorbidities,treatment of adverse drug reaction or to boost efficacy of primary
treatment [4] about (24.48%) patients received adjunctive benzodiazepines, with clonazepam
(53.6%) and clobazam (0.95%)least commonly used. Antidepressants were used in (12.28%)
cases suggesting the coexistence of psychosis and depression. Fluoxitine (70.38%) is the most
commonly used antidepressant.Only few psychotic patients were receiving mood stabilizers
(10.19%).
CONCLUSION
In summary, males were commonly affected by schizophrenia followed by Bipolar disorder than
females. Prescribing pattern of antipsychotics drug did not differ by gender or age group. Atypical
antipsychotics were prescribed more commonly than typical ones; risperidone being the
commonest antipsychotics prescribed. Other psychotropic drugs prescribed as adjuvant therapies
are benzodiazepines (clonazepam), antidepressants (fluoxetine), typical (haloperidol),
moodstabilizers (valproate), and anticholinergenic (trihexyphenidyl). The study can provide as
outline for carrying out further studies on prescribing pattern in teritary care unit, which could
provide more information for improving the utilization of psychotropic drugs in psychiatry
department.
ACKNOWLEDGMENT
We express our sincere thanks to our friends. We also thank the patients who participated in our
study, without them the study would be nothing.
REFERENCES
1. Pranab Kumar Paul, Pahanjit Konwar, Swarnamoni Das. To study the prescribing pattern
of antipsychotic drugs in a tertiary care hospital of assam. International journal of
pharmacy and pharmaceutical sciences.2014;6: 435-437.
2. Abubakar Kabir, Abubakar Amali Muhammad, Abdulgafar Jimoh. Prescription Pattern of
Antipsychotic Drugs-ACase study of a Neuro-psychiatric Hospital in North-Western
Nigeria. European journal of scientific research.2013;95: 332-337.

Available online : www. ijipsr.com June Issue 646

RESEARCH ARTICLE Anjali et.al / IJIPSR / 4 (6), 2016, 641-647
Department of Pharmacy Practice ISSN (online) 2347-2154

3. Ahmed Tabish, Sharma Sanat, Ali Sajid, Sachdev et al.Drug utilization pattern in
psychiatry outdoor patients at tertiary care teaching hospital of bastar region,International
Journal of Pharmacological Research. 2015;55: 98-103.
4. Sonali B Rode, Harsh V Salankar, Pravin R Verma. Antipsychotic drug prescribing
pattern in tertiary care teaching hospital.European journal of pharmaceutical and medical
research.2015;2: 369-378.
5. Hsien-Jane Chiu , Po-Han Chou , El-Wui Loh et al.Changes in the prescription pattern of
antipsychotics for schizophrenic outpatients after the implementation of a global
budgeting program.Journal of the Chinese Medical Association.2014;77: 325-332.
6. Monalisa Jena, Swati Mishra, Suvendu Narayan Mishra,et al Psychotropic drugs:
Prescribing pattern in psychiatry outpatient department of a tertiary care teaching
hospital.International journal of pharmacy.2014;4: 204-208.
7. Sarang Anantrao Deshmukh,Teli Shaikh Emaran Ehaikh Ismail. Evaluation of
psychotropic drugs use pattern among outpatients attending psychiatry department at
government medical college and hospital, nagpur: a cross sectional study. International
Journal of Pharma and Bio Sciences.2012;3: 428–436.
8. Ghosh Siddhartha1, Bhattacharyya Swati , Dalai Chanchal Kumar.Antipsychotic
prescribing pattern in a tertiary care hospital of eastern india.Journal of Drug Delivery &
Therapeutics.2013;3: 38-42.
9. Padmini DD,Amarjeeth R,Sushma M,Guido S. Prescription patterns of psychotropic drugs
in hospitalized schizophrenic patients in a tertiary care hospital. Calicut Medical journal.
2007;5: e3.

Available online : www. ijipsr.com June Issue 647