Study of drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of tertiary care hospital

Background: Mental disorders are now widely recognized as a major contributor to the global burden of disease. The drug use in psychiatric illness is a complex process and because of this the optimal benefits of drug therapy in patient care is not achieved. This often leads to increased cost of medical care, drug resistance, adverse effects and patient mortality. Hence, this study is undertaken to study the drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of a tertiary care hospital.Methods: A prospective, observational study was undertaken from 1st February 2015 to 31st July 2016. A total of 250 prescriptions were analysed. Defined daily dose of the drugs were calculated. ADR’s were recorded in the format of the National Pharmacovigilance Programme of India (PvPI).Results: In 250 prescriptions most, common drug prescribed was antipsychotics (48.5%). Total drug utilization in terms of DDD/100 bed days was 669. The total number of adverse drug reactions observed was 8%. Antipsychotics were the most common class of psychotropic drugs causing ADR’s.Conclusions: In conclusion, it has been found that the psychotropic drugs used in our psychiatry department was rational and was based on clinical knowledge, expertise and the guidelines available in the field of psychiatric practice.

Duración de días de hospitalización psiquiátrica en pacientes con diagnósticos GES con y sin comorbilidades / Length of stay in psychiatric hospitalization in patients with GES diagnoses and its comorbidities

There are several descriptive studies of the use of mental health Services in the population served in the public system, however there are few references concerning the private system. Objective: To characterize a population with GES mental health pathology admitted in private mental health system in relation to the length of stay. Material and Methods: Medical charts were reviewed for 1,544 patients discharged from hospital admissions in private mental health centers. The following variables were recorded: age at diagnosis, sex, length of stay, number of hospitalizations and multiaxial diagnosis. Results: The average hospital stay for the sample was 21.05 days. The average hospital stay of men was 3.71 ± 2.46 days more than average women (p = 0.05). The average LOS was higher in younger patients. With regards to axis I, 68.52% of patients had severe major depression, 21.87% bipolar disorder in severe depressive phase and 6.87% schizophrenia. Axis I comorbidity was present in 17.94% of the sample. For Axis II, 57.97% of patients had personality disorders, with the borderline personality being the most frequent in both sexes (51.06% of patients with disorder of personality). The analysis of information shows that comorbidities did not significantly influence average days of hospitalization. Conclusions: This study is contributes to estimate the costs and the average stay in inpatient GES mental health patients in the private system.

Existen diversos estudios descriptivos del uso de servicios de Salud Mental en la población atendida en el sistema público, sin embargo, se encuentran pocas referencias respecto al sistema privado. Objetivo: Caracterizar a una población con patología de salud mental GES internada en centros privados de salud mental en relación a los días de hospitalización. Material y Método: Se revisaron 1.544 fichas de pacientes egresados de hospitalizaciones en centros privados de salud mental registrando las siguientes variables: edad al momento del diagnóstico, sexo, días de hospitalización, número de hospitalizaciones y diagnóstico según eje. Resultados: El promedio de días de hospitalización de la muestra fue de 21,05 días. El promedio de días de hospitalización de los hombres fue 3,71 ± 2,46 días mayor que el promedio de las mujeres (p = 0,05). El promedio de días de hospitalización fue más alto en los pacientes jóvenes. En el eje I, el 68,52% de los pacientes presentaron patología del ánimo en su forma monopolar; 21,76% patología del ánimo en su forma bipolar y un 6,87% fueron diagnosticados con esquizofrenia. La comorbilidad en el eje I se presentó en un 17,94% de la muestra. Respecto al eje II, el 57,97% presenta algún trastorno de la personalidad, siendo el trastorno de personalidad limítrofe el más frecuente en ambos sexos (51,06% del total de pacientes con trastorno de la personalidad). Del análisis de la información destaca que las comorbilidades no influyeron de forma significativa en el promedio de los días de hospitalización. Conclusiones: Este estudio constituye un aporte para estimar los costos y la estadía promedio en una hospitalización de pacientes GES de salud mental en el sistema privado.

Prevalence and Risk Factors of Polydipsia and Water Intoxication in Psychiatric Inpatients

OBJECTIVES: The aims of this study are to estimate the prevalence of polydipsia and water intoxication and to identify risk factors of polydipsia and water intoxication in psychiatric inpatient. METHODS: 1,108 Psychiatric inpatients at 2 mental hospitals in Yongin city were studied from September, 2008 to January, 2009. We diagnosed'polydipsia' using staff reports(fluid intake>3L/day) or by specific gravity of urine(SPGU4%). We attempted to identify clinical characteristics of patients by reviewing their medical records. RESULTS: Two hundred forty seven patients(22.3%) were polydipsic. Sixty eight patients(6.1%) were at risk for water intoxication. The factors associated with polydipsia were lithium, smoking, younger age and increased smoking amounts. The factors associated with risk for water intoxication were valproic acid and polydipsia. CONCLUSION: Polydipsia and water intoxication in psychiatric inpatients are not rare conditions. Therefore, clinicians' attention should be paid to these conditions.

El suicidio en instituciones psiquiátricas: descripción de dos casos / Suicidal attempts in psychiatric institutions: a report of two cases

Se ha estimado que cerca del 5 por ciento de los suicidios ocurren dentro de las instituciones psiquiátricas. Este reporte describe dos casos de suicidio en un hospital psiquiátrico, los cuales ilustran, por un lado, las características de riesgo suicida en el paciente psi-quiátrico hospitalizado, y por otro, las limitaciones que aún impiden evitar el suicidio. La ocurrencia de suicidios dentro de los hospitales obedece a que se trata de una conducta con una frecuencia de pre-sentación muy baja y a la poca especificidad de la evaluación clínica del riesgo suicida. No obstante, la hospitalización en instituciones psiquiátricas evita muchos más intentos suicidas y suicidios fuera de ella que los que en su interior pueden ocurrir. [Jiménez A, Ibarra C, Peñalosa L, Díaz JL. El suicidio en instituciones psiquiátricas: descripcion de dos casos. MedUNAB 2004; 7:140-3]

Suicidal attempts in psychiatric institutions: a report of two cases. It has been estimated that 5% of suicides occur inside of the psychiatric institutions. This report describes two cases of suicide inside of a psychiatric hospital which illustrate, on one hand, the characteris-tics of suicidal risk among psychiatric inpatients, and on the other hand, the limitations, we may have, to prevent suicide. The rate of suicides inside psychiatric hospitals are explained by the very low presentation of this behavior, among patients and the poor speci-ficity for suicidal risk, that may provide the clinical evaluation with standard clinical criteria . Nevertheless, hospitalization in psychiatric institutions avoids more suicide attempts and suicides than those are committed inside of them

Length of Stay of Psychiatric Inpatients by Sociodemographic and Clinical Characteristics, and Type of Facilities / 신경정신의학

OBJECTIVES: Recently the issue on the violation of human rights has been raised in mental health system in Korea. In these cirmstances this study was conducted to investigate the length of stay of psychiatric inpatients by sociodemographic, clinical characteristics, and type of mental health facilities. METHODS: The total 1,028 subjects were randomly selected from 22 mental health facilities, including mental hospitals, general hospitals, psychiatric clinics, mental health welfare facilities, welfare facilities for homelessness, and illegal asylums. The subjects were interviewed by psychiatrists and social workers with clinical experiences. RESULTS: The average length of stay of psychiatric inpatients of mental health facilities in Korea was 1,368 days, and it was statistically different according to sociodemographic and clinical characteristics such as sex, age, education, religion, economic status, type of medical security, degree of family support, living condition before admission, diagnosis, age of onset, and number of admissions. In addition, the length of stay was associated with the type of mental health facilities. CONCLUSION: For more appropriated length of stay of psychiatric inpatients, not only various incentives for service suppliers are needed but also medical and socioeconomic incentives for patients and familiy members should be considered in order to facilitate their community-living.

Comparison of Risperidone Prescription Trend for Psychiatric Inpatients between University Hospital of Korea and USA / 대한정신약물학회지

OBJECTIVE: Recently, the domestic use of risperidone and the studies of risperidone administration in naturalistic setting have been increased. This retrospective naturalistic study was designed to evaluate the prescription trend and related variables in risperidone administered-psychiatric inpatients at a university hospital, and to compare with those of a university hospital in USA, simultaneously. METHODS: Data of 42 psychiatric inpatients with first administration of risperidone at St. Mary's Hospital from Oct 1999 to Mar 2000 and 61 of McLean Hospital, Harvard Medical School, USA from Mar 1998 to Jun 1998, were collected, respectively. Data on patient's age, sex, number of past admission, diagnosis distribution, duration of hospitalization, multiple antipsychotic therapy, combined psychotropics, initial, maximal, and discharge dosage of risperidone were analyzed and compared. RESULTS: In forty-two patients of St. Mary's hospital, 17 were male and 25 were female, among sixty-one patients of McLean hospital, 23 were male and 38 were female. The mean age and number of past admission were significantly higher at St. Mary's hospital than McLean hospital. In terms of diagnosis, risperidone was most widely prescribed to psychotic disorder, nextly to mood disorder and other psychiatric disorder at St. Mary's hospital, but in order of mood disorder, other psychiatric disorder, and psychotic disorder at McLean hospital, these diagnostic distribution was significantly different. The mean initial dose, maximal dose, and discharge dose of risperidone were significantly higher at St. Mary's hospital than McLean hospital. In aspects of psychotropic combination, these were significantly different, anxiolytic was most highly used at St. Mary's hospital but antidepressant at McLean hospital, additionally, the two hospital have tendency to take a polypharmacy. CONCLUSION: Prescription trend of risperidone in psychiatric inpatient between two hospital was different, St. Mary's hospital prescribed risperidone by diagnosis but McLean hospital did by symptomatic management. In furture, further systematic study should be conducted to refine these differences including various clinical variables.

A Study of Physical Disorder in a Geriatric Psychiatric Inpatients

BACKGROUND: This study was designed to investigate the relationship between psychiatric disease and systemic disease in geriatric psychiatric inpatients who were consulted to department of internal medicine and were above 6th decade, and was directed to assess the physical problems and possible ways to resolve them in a closed psychiatric unit. METHOD: Through evaluation of medical records of 225 inpatients who had consulted in department of internal medicine in Seoul National Mental Hospital from January 1, 1998 to December 31, 1999. We classified the physical illness according to ICD-9-CM and psychiatric disease according to NTA. RESULTS: The result were as follows: 1) In age sex distribution, male was 62.7%, and 81.8% of the subjects was 6th decade. 2) The most common systemic diagnosis were disease of circulatory system, disease of digestive system, and disease of respiratory system. 3) The most systemic disease was disease of circulatory system in 6th and 8th decade. 4) Disease of circulatory system in all psychiatric disease was the most frequent. 5) Rate of circulatory disorder was the highest in organic mental disorder. Disease of digestive system and disease of endocrine system were the most frequent in alcoholics. Disease of respiratory system showed the highest rate in schizophrenea. CONCLUSION: The clinical characteristics of psychiatric diseases influenced to get systemic disease in geriatric patients.