A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Objective@#Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate. @*Methods@#We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. @*Results@#The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). @*Conclusion@#Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

Prevalence and prescription of antidepressants in depression with somatic comorbidity in Asia: the Research on East Asian Psychotropic Prescription Patterns study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Depression is often comorbid with chronic somatic diseases. Few previous studies have investigated the prevalence of somatic diseases in depression or the prescription pattern of antidepressants in comorbidly depressed patients in Asia. This study aimed to investigate the prevalence of somatic comorbidity (SC) in depression and compared the prescriptions of antidepressants in depressed patients with and without SC.</p><p><b>METHODS</b>A total of 2320 patients treated with antidepressants in 8 Asian countries were examined, and a diagnosis was based on the International Classification of Disease, 10 th revision. We listed 17 common chronic somatic diseases. Patients' socio-demographic and clinical characteristics and psychotropic drug prescriptions were recorded using a standardized protocol and data collection procedure.</p><p><b>RESULTS</b>Of the patients examined, 1240 were diagnosed with depression and 30% of them (n = 375) had SC. The most common comorbid condition was diabetes (23.7%). The patients with SC were more likely to seek help at a general hospital (74.7% vs. 47.2%), and had a higher incidence of symptoms involving sadness, disturbed sleep, and poor appetite. Noradrenergic and specific serotonergic antidepressant was prescribed more for patients with SC than for those without SC (30.4% vs. 22.9%).</p><p><b>CONCLUSIONS</b>SC is common in depressed Asian patients. It is important to strengthen the recognition of depression, especially in general hospitals and when patients report some somatic discomfort. It is also a matter of urgency to establish evidence-based guidelines for the use of new antidepressants in depressed patients with SC.</p>

Outpatient Drug Prescribing Pattern For Bipolar Disorder Patients In Southern Thailand

Objective: To examine the psychotropic prescribing pattern among Thai bipolar disorder patients in southern Thailand and to compare results with other studies in developed countries and the study conducted in Bangkok, central Thailand. Method: All clinical outpatients records of bipolar patients who attended the psychiatric clinic of Songklanagarind Hospital were systematically reviewed. Results: There were 298 patients during the study period from January to March 2003. Nearly half of the patients (48.6%) were prescribed mood stabilizers, with lithium (35.2%) and valproate (13.4%) being the two most common drugs. The other half (48.6%) were prescribed antidepressants of which nortriptyline and the generic from of fluoxetine were prescribed in nearly equal numbers. Antipsychotics were also prescribed in about half of the patients (43.3%). For those who received antipsychotics, 93.0% received FGAs; only 6 patients (4.7%) received an SGA. Conclusion: This study shows rather similar prescribing patterns as compared to those of reports from developed countries. The exception was our clinicians’ prescribing of more FGAs, which was a similar finding to that of the study from Bangkok. Further study has been recommended to find out whether prescribing patterns will change in the future.

Pattern Of Prescribing Antipsychotic Drugs In Thailand

Objective: There has been a trend of prescribing new second generation antipsychotics (SGAs) as a first-line treatment for psychosis in many developed countries. However, there has been very few studies concerning this topic in a developing country such as Thailand. This study examined the pattern of prescribing antipsychotic drugs by Thai psychiatrists in a tertiary hospital. Methods: Active clinical psychiatric outpatient files (n=1750) between January and March 2003 from Songklanagarind Hospital, a tertiary university hospital in southern Thailand, were retrospectively reviewed. Results: Most patient (82.9%) who were prescribed an antipsychotic received only one oral medication. Among patients with schizophrenia and schizoaffective disorder, the majority (67.9%) received a first generation antipsychotic (FGA). Fewer patients were prescribed a SGA alone (13.1%) or a depot preparation alone (6.4%). Of those patients on a SGA, the most commonly prescribed drugs were a generic form of clozapine (64/.7%), risperidone (19.6%) and olanzapine (15.7%). For patients on a FGA, the most commonly prescribed medications were perphenazine (52.8%) and chlorpromazine, CPZ (19.7%). The mean dose was significantly higher for males (209.14 ±197.49 mg/d of CPZ equivalent) than females (158.57±163.45 mg/d) (t=3.61, p <.001). Conclusion: SGAs are not yet widely prescribed in our hospital perhaps due to the high drug cost and the availability of medication. Thai patients may respond to a lower dosage compared to dosages reported in Western studies. Further systematic research is needed before conclusions on this topic can be drawn.

Teaching of psychiatry: customising the curriculum of medical students for ASEAN

The need for effective education in psychiatry for all doctors is as great in developing countries as in developed ones, especially in ASEAN, where many psychiatric cases are managed by non psychiatric doctors. The curriculum must be designed to ensure that physicians have the ability to diagnose and treat the most common psychiatric disorders but it may be customised to the data or needs of each specific country in ASEAN. Three topics that have been proposed for inclusion in the curriculum are disaster psychiatry/mental health, ethnopsychopharmacology, and critical appraisal of publications. Integrating psychiatry within other disciplines and using problem based learning (PBL) in undergraduate students may be an alternative approach in the teaching of psychiatry.

Prevalence of insomnia in the Thai population

Objective: To review the data concerning insomnia in Thailand that have been published in international journals. Methods: A search was made through PubMed using the word “insomnia in Thailand” or “insomnia in Thai”. Other data were obtained from the staff of the Faculty of Medicine, Prince of Songkla University. Results: The prevalence of frequent night waking in three-month-old infants was 51.5%. Frequent night waking was independently associated with various factors of parental practices related to infant sleep such as the use of a swinging or rocking cradle or falling asleep while feeding. The overall prevalence of insomnia in healthy adults and the elderly Thai population was 40.8% and 46.3% respectively. Data from the older Thai population found that insomnia problems increased significantly with advancing age with depression and poor perceived health as the most significant associated factors. Conclusion: Insomnia and night waking are common in the Thai population. Further research is needed and a comprehensive programme to detect and prevent sleep problems in all age groups should be considered.

Teaching of psychiatry: customising the curriculum of medical students for ASEAN

The need for effective education in psychiatry for all doctors is as great in developing countries as in developed ones, especially in ASEAN, where many psychiatric cases are managed by non psychiatric doctors. The curriculum must be designed to ensure that physicians have the ability to diagnose and treat the most common psychiatric disorders but it may be customised to the data or needs of each specific country in ASEAN. Three topics that have been proposed for inclusion in the curriculum are disaster psychiatry/mental health, ethnopsychopharmacology, and critical appraisal of publications. Integrating psychiatry within other disciplines and using problem based learning (PBL) in undergraduate students may be an alternative approach in the teaching of psychiatry.