Drug utilization pattern in Schizophrenia

Background: Pharmacotherapy is the mainstay of treatment in schizophrenia. The economic impact of this illness is wide ranging, long lasting and huge. The emergence of newer antipsychotics has changed the prescribing pattern. Purpose of this study is to determine the prescription pattern of antipsychotic drugs and to analyse the drug utilization in patients with schizophrenia based on WHO prescribing indicators.Methods: A descriptive study was conducted for a period of 1-year duration at inpatient Department of Psychiatry of a Government Medical College in Kerala, India among 230 schizophrenic patients. The case sheets of patients meeting inclusion criteria were scrutinised to find out the antipsychotic prescription pattern and drug utilization was analysed using WHO prescribing indicators. Analysis was done using descriptive statistics.Results: Newer antipsychotics (55.2%) were prescribed slightly more in preference to older antipsychotic (44.8%) drugs. Out of the newer drugs prescribed olanzapine (20.9%) was prescribed the most followed by risperidone (18%). Haloperidol (22.9%) was the most frequently prescribed older antipsychotic. Majority (71.3%) of the patients were given more than one antipsychotics during the hospital stay. Trihexyphenidyl (27.9%) was the most frequently co-prescribed drug with antipsychotics. Average number of drugs per encounter was 4.19, 73.4% of the drugs were prescribed in their generic name, 50.4% of the encounters were with an injection prescribed. 44.4%of the drugs were prescribed from the EDL (WHO-19th edition). Average drug cost per encounter was Rs.45.43. Percentage of drug cost spent on injections was 8.44%.Conclusions: Newer antipsychotics were more prescribed for schizophrenia of which olanzapine was the commonest. Newer antipsychotics are preferred because of their propensity to cause less side effects and more efficacy. Study of pattern of drug utilization is useful for measuring the economic impact of drug use among patients thereby facilitating rational prescribing.

Elizabethkingia meningoseptica : An emerging pathogen causing meningitis in a hospitalized adult trauma patient.

A 23-year-old male patient who was a follow-up case of neurosurgery presented to our emergency department with a history of high-grade fever and clinical features of meningitis for 1 week. The cerebrospinal fluid (CSF) was sent to our laboratory for culture. The culture demonstrated growth of 1-2 mm in diameter light yellow coloured colonies of Gram-negative bacilli on chocolate and blood agar. There was no growth on MacConkey agar. The bacterium was multidrug resistant. Based upon the growth characteristics, bio-chemical reactions, drug susceptibility pattern and identification by Vitek 2 system the isolate was identified as Elizabethkingia meningoseptica. Patient was treated with injection piperacillin-tazobactam, injection vancomycin and cotrimoxazole tablets for 21 days along with intrathecal injection of tigecycline and finally, patient improved clinically and the CSF cultures became sterile. The presence in hospital environment along with multidrug resistance makes E. meningoseptica a successful emerging nosocomial pathogen.

Sudden natural death due to takayasu’s arteritis.

A young male aged 23 yrs with alleged history of chest pain was brought to the emergency medicine department of St John’s Medical college hospital. On arrival was declared brought dead. There was no previous significant medical history. A Medico-legal autopsy was done which revealed left anterior descending coronary artery lumen to be occluded by grey white material. On Histo-pathological examination of the heart, it was diagnosed as Takayasu’s arteritis. Takayasu arteritis, also known as Pulseless disease, occlusive thromboaortopathy, and Martorella syndrome, It is a Granulomatous inflammation of unknown aetiology affecting medium and large arteries leading to vessel wall thickening and occlusion . Females are more likely to be affected than males. Patients often notice the disease symptoms between 15- 30 years of age. Symptoms range from malaise, fever, night sweats, weight loss, arthalagia, fatigue and can present with absent pulses, limb claudication, blood pressure, discrepancies, Hypertension, retinopathy Ischemia, postural dizziness, seizures, hemi paresis and many more. Sudden death due to Takayasu’s arteritis affecting coronary artery is rarely reported during medico-legal autopsy, hence this case is reported.