Prescribing pattern of psychotropic drugs used in non-psychiatric patients among outpatient department of two teaching hospitals in Bangladesh

Discussion

In present study the percentage of psychotropic drug use in non-psychiatric patient in SSMC was 8.3% and in HFRCMCH was 11.2%. The prevalence of psychotropic drug use is higher in private hospital which is slightly higher than the average rate of prescription of general physicians internationally (Prueksaritanond et al., 2009 ; Linden et al., 1996). Variability in prevalence across countries might be due to cross-cultural differences in physical disorder, health complaints, health beliefs, care seeking behavior and response to diagnostic questions (WHO, 2008). Psychotropic prescriptions are prevalent in all age groups especially in 50-59 years age group. Generally, older people suffer from common health problem which have a association with mental disorders at rates that are similar to their younger, adult counterparts (Wolkovc et al., 2007; WHO, 2008).

This study also found that psychotropic drug use were more in female than male. This rate has similarity with other studies (Balter et al., 1974). There is a common trend that prescribing frequency is more common in female than male. In married women the presence of children under 14 years of age tends to be linked with unemployment, and that both these factors are directly related to the development of emotional disorder. The presence of this association limits a woman’s ability to develop adequate role identity and good self-esteem. All this, will increase in women the chance of general hopelessness, from which mental illness will arise. In Spanish rural community found that higher use of psychotropic drugs among housewives than among those working outside the house (Vazquez et al., 1989).The greatly expanded use of intermediate acting benzodiazepine (lorazepam and alprazolam) and reduced use of short acting benzodiazepines were observed here. Interestingly, short acting agent (such as triazolam, oxazepam), long acting benzodiazepines (such as flurazepam and clonazepam) and non-benzodiazepines have not been prescribed in the present study. This may be due to differences in the physicians practice settings and method of surveys. The frequent use of long acting benzodiazepines sometimes in combination with other psychotropic drugs may increase the risk of adverse reactions, particularly the elder patients (Solomon et al., 1979) and those with diminished kidney functions (Green Blatt et al., 1977). The combination of benzodiazepine with other hypnotics particularly the barbiturates suggests the presence of serious sleep disturbance, as well as increasing the risk of adverse reaction because these patients require close monitoring. Antidepressant and antipsychotics were used less frequently in general outdoor as compared to psychiatry outpatient clinic (Moore et al., 2002).

The indications for prescription of psychotropic drugs were not only for mental health problem but also for physical health problem. Mental health and physical health problem are interwoven (WHO, 2008). Mental health problems range from increased stress and worry about illness to disrupted family or work life. Mental disorders such as depression and anxiety frequently coexist with physical health problems  such as hypertension, diabetes and dyspepsia (WHO, 2008; Jonas et al., 1997; Anderson et al., 2001; Jones et al., 2005). We observed a higher use of psychotropic drugs in surgical department which could be expected from the additional indication of anesthetic premedication and postsurgical management of patient there. These drugs were often prescribed for various somatic disorders and the rationale for prescribing these agents is often poorly documented. Among many health problem 7.3% and 17.9% showed considerable under diagnosis. The limitation of diagnosis may be due to inadequate knowledge and awareness. The more prescribing frequency was observed in private hospital probably due to more economic solvent people visited there with lots of availability of drugs. Whereas in Government hospitals most of the drugs are delivered by authority and selective drug selection may comparatively reduce the use of psychotropic drugs there.

This study shows prescribing pattern was not similar between Government and private hospital. Present study suggests that psychotropic drugs are not only used in mental illness but also they have role on other medical illness. Their use with other medication accelerates the improvement of physical illness. But in some instances use of these drugs continues long-time without any cause.