Drug treatment modalities in psychiatric inpatient practice: a 20-year comparison

The present study investigated whether the increased number of psychotropic agents available in Italy in the last 20 years increased the proportion of inpatients being treated with individual medication classes and the proportion receiving combined treatments with agents of the same class or of different classes.

This study was conducted in South-Verona, Italy. From the local Psychiatric Case Register (PCR) all patients consecutively admitted to the inpatient unit during the years 1981/1982, 1991/92 and 2001/02 were extracted. Drug use at discharge was derived from clinical records, while service use data were extracted from the PCR.

During the six years surveyed 160 patients were admitted in 1981/82, 139 in 1991/92 and 228 in 2001/02. An increasing proportion of subjects receiving antipsychotic, antidepressant and benzodiazepine treatment at discharge was observed. In addition, we found an increasing proportion of patients receiving two or more psychotropic drugs at discharge, which accounted for almost 80% of cases in 2001/02. The number of psychotropic agents prescribed at hospital discharge was positively correlated with the total consumption of psychotropic drugs. A relevant proportion of patients were also dispensed agents for medical conditions, yielding an average number of 3.2 prescriptions in 2001/02. The Lavik score, a summary index of service use, indicated that subjects admitted in 1981/82 were moderate users of psychiatric services, while those admitted in 1991/92 and in 2001/02 were high users of psychiatric services.

This study documented emerging trends toward polypharmacotherapy and higher total doses. Additional pharmacoepidemiological research is needed to clarify both the beneficial and, potentially, adverse effects associated with these trends in psychiatric pharmacotherapy.