The prescribing of psychotropic drugs in mental health services in Trinidad.

OBJECTIVE: To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatient clinics in the Caribbean island of Trinidad. DESIGN AND METHODS: This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. RESULTS: A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (79 of 132 patients, 59.8%), followed by antipsychotic drugs (67 of 132 patients, 50.8%). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1%). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s)). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. CONCLUSIONS: The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided.

The prescribing of psychotropic drugs in mental health services in Trinidad

Objective: To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatients clinics in the Caribbean island of Trinidad. Design and Methods: This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. Results: A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (70 of 132 patients, 59.8 percent), followed by antipsychotropic drugs (67 of 132 patients, 50.8 percent). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1 percent). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. Conclusions: The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of the individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided (AU)

The prescribing of psychotropic drugs in mental health services in Trinidad / Prescripción de psicotrópicos en los servicios de salud mental de Trinidad

Objective. To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatient clinics in the Caribbean island of Trinidad. Design and Methods. This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. Results. A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (79 of 132 patients, 59.8 percent), followed by antipsychotic drugs (67 of 132 patients, 50.8 percent). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1 percent). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s)). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. Conclusions. The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided

Objetivos. Describir, analizar e interpretar las características de la prescripción de psicotrópicos en pacientes nuevos que acudieron a las consultas externas de psiquiatría en la isla caribeña de Trinidad. Métodos. Se realizó un estudio transversal de los psicotrópicos prescritos por psiquiatras a 132 nuevos pacientes psiquiátricos ambulatorios que acudieron a consultas externas por primera vez entre noviembre de 1998 y febrero de 1999. Resultados. Algunos pacientes recibieron más de un psicotrópico. Los antidepresivos fueron los psicotrópicos recetados con mayor frecuencia (79 de los 132 pacientes, 59,8%), seguidos de los antipsicóticos (67/132; 50,8%). Los antidepresivos prescritos con mayor frecuencia fueron los tricíclicos (58/79; 73,4%), y en particular la amitriptilina (53/58; 91,4%). La fluoxetina fue el único inhibidor selectivo de la recaptación de serotonina (ISRS) que se recetó (21/79; 26,6%). De los 67 pacientes que recibieron antipsicóticos, a 41 (61,2%) se les recetaron fenotiazinas, entre ellas la trifluoperazina (14/41; 34,1%) y la tioridazina (13/41; 31,7%). El antipsicótico prescrito con más frecuencia fue la sulpirida (21/67; 31,3%). A 20 de los 132 pacientes (15,1%) se les recetaron anticolinérgicos. A 83 (62,9%) se les prescribió más de un fármaco simultáneamente: o bien más de un psicotrópico o una combinación de psicotrópicos y no psicotrópicos. La prescripción por etnia, edad y sexo coincidió con las tasas de morbilidad observadas en los diferentes grupos. La prescripción de ISRS a pacientes de origen africano o indio fue significativamente menos frecuente que a los de origen mixto Conclusiones. Estos resultados muestran una preferencia de los psiquiatras de Trinidad por los psicotrópicos tradicionales, un uso moderado de los anticolinérgicos y, en algunos casos, el uso de la polifarmacia, que podría predisponer a la aparición de reacciones adversas graves. Teniendo en cuenta estos resultados y dependiendo de las circunstancias de cada paciente, se debería considerar un uso más amplio de los antidepresivos (ISRS) y antipsicóticos más recientes y evitar el uso de la polifarmacia