Prescribing Patterns and Adverse Reactions of Antipsychotics in a North Indian Psychiatry Outpatient Department

Pharmacovigilance research in India remains at an infantile phase, especially in the pattern of prescription of antipsychotics at the tertiary care level. Given the clinical value of antipsychotic drugs, research on their utilization, trends of prescription, and frequent adverse events associated with them will help to reduce adverse drug events. The proposed study is thus intended to discuss the prescription pattern and adverse drug reactions (ADRs) of antipsychotic drugs in the Psychiatric Outpatient unit in Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, one of the tertiary care hospitals in North India.

In this cross-sectional investigation, systematic random sampling with a fixed sampling interval was used, wherein every third patient attending the Psychiatry Outpatient Department during the study period was selected until the desired sample size of 150 participants (aged 18-65 years) was achieved. The following statistics were collected: medication history, antipsychotic prescriptions, adverse drug events, diagnosis (according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and definition), and sociodemographics. The information gathered was utilized to ascertain treatment compliance, antipsychotic combinations, and prescription trends as reported by the World Health Organization (WHO) in the Drug Prescribing Indicators.

Sixty-nine (46.3%) patients in this research received antipsychotic medications under generic names, while 13 (8.7%) received several antipsychotic medications. With a mean ± SD of 2.69 ± 0.84 medications per encounter and 1.13 ± 0.32 antipsychotics per patient, the prescribing trend indicated limited polypharmacy. The most widely used antipsychotics were risperidone in 63 (42%) patients, primarily prescribed for schizophrenia and psychosis not otherwise specified (NOS), followed by olanzapine in 41 (27.3%), commonly used in bipolar affective disorder and schizophrenia. There was a total of 150 study participants, among whom 42 adverse reactions were recorded. The most common ADR was akathisia in nine (21.4%), followed by tremors in six (14.3%) and drowsiness in six (14.3%). According to the WHO/Uppsala Monitoring Centre (UMC) causality assessment approach, over 90.5% of adverse drug responses could be identified as potential ADRs, and roughly 9.5% were likely ADRs.

It is necessary to justify the antipsychotic drug prescribing pattern. By evaluating prescription habits, one may determine the incidence of pharmacovigilance and polytherapy, which helps to minimize and avoid adverse medication responses.