Longitudinal assessment of psychotropic drug use in acutely-ill psychiatric inpatients

Abstract

Psychotropic drug surveys serve to provide retrospective control of actual treatment conditions in psychiatric hospitals. Data of overall drug consumptions and those indicating the time pattern of medication were recorded at 7 census days for 1,415 inpatients of the psychiatric hospital of the Free University of Berlin. Drug-treated patients with 3.15 different psychotropic drugs on average during their stay. Neuroleptics were the most chosen compound group with regard to all patients treated (62.2%), the number of prescriptions (48.3%) and the sum of psychotropic days (57.9%). Sedatives (i.e. benzodiazepines and chloralhydrate) were given to more patients than antidepressants (41.0% vs. 29.3%), but accounted for only 5.7% of all psychotropic drug days (21.4% in case of antidepressants). The analysis of time pattern revealed that the prescription of neuroleptics was favoured on all census days, while prescribing for antiparkinsonian and lithium drugs increased also over time, but not for sedatives. Mean daily doses of most neuroleptics peaked near the 10th day after the patients' admission, while those of antidepressants increased steadily until the patients were discharged. Monotherapy was found in 59.0%, drug combinations in 41.0% of prescriptions (on all census days). The proportion of drug combinations in relation to monotherapy increased the longer the patients were in hospital. Among all drug combinations, two drugs had been combined in 79.2%, three or more in 20.8%. Two or more neuroleptics given simultaneously were involved in 44.9% of all combinations--an unexpected finding calling for more systematic investigation.