Exploring the clinical and social determinants of prescribing anticholinergic medication for Chinese patients with schizophrenia

Xiang, Yu‐Tao; Weng, Yong-Zhen; Leung, C. M.; Tang, Wai Kwong; Ungavri, Gabor Sandor

doi:10.1002/hup.830

Cited by 17 publications

(12 citation statements)

References 33 publications

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“…The prevalence of anticholinergic use was 57.3% and 87.5% for outpatients on antipsychotic monotherapy and polytherapy, respectively. These rates were significantly greater than those reported for outpatients elsewhere [2,5,9,30] (regardless of type and therapy of antipsychotics studied) which suggests the possibility that cultural and institutional pra-ctices would have contributed to these findings. In our study anticholinergics may have been routinely prescribed even in the absence of EPS, although experts disagree about the prophylactic use of these agents [16,18].…”

Section: Discussioncontrasting

confidence: 51%

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

Khaja¹,

Al-Haddad²,

Sequeira³

et al. 2012

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The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two-and three-drugs in 10.4% and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

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Section: Discussioncontrasting

confidence: 51%

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

Khaja¹,

Al-Haddad²,

Sequeira³

et al. 2012

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“…Factors majorly responsible for this preference include severity or type of psychiatric disorder, the need for quick symptom relief and lack of multidisciplinary care, particularly in the low resourced countries [1, 2]. Patterns of prescribing and the choice of psychotropic medications vary in different settings [4]. Whilst newer agents and rational prescribing (justifiable use) are favored in specialized settings [1–3, 5], the pattern remains largely unclear in settings without specialized care units for children, mainly due to lack of data [6].…”

Section: Introductionmentioning

confidence: 99%

Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana

Olashore¹,

Ayugi²,

Opondo³

2017

Pan Afr Med J

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IntroductionThere is a growing preference for psycho-pharmacological therapy over non-pharmacological care. The prescription pattern and the choice of psychotropic medications vary in different settings. Whilst newer agents and rational prescribing are favored in the more specialized settings, the pattern remains unclear in less specialized units, largely due to lack of data. The aims were to conduct a treatment audit in the only mental referral hospital in Botswana, which is a non-specialized child and adolescent care setting and see how it conforms to best practice.MethodsA retrospective audit which involved the extraction of socio-demographic and clinical information from the records of patients who were ≤ 17 years and seen from January 1, 2012-July 31, 2016.ResultsA total of 238 files were used for this report. Mean age (SD) was 12.41 (4.1) years. Of the 120 (50.4%) patients who had pharmacological intervention, only 85(70.8%) had monotherapy. The most commonly prescribed psychotropic agents were antipsychotics (40%). Off-label use of antipsychotics and polypharmacy were 31.2% and 29.2% respectively.ConclusionThe level of conformity to standard practice in terms of psychotropic prescribing in our setting is consistent with the reports from developed countries where more specialized care ostensibly exists. Further studies will be necessary to determine the scope of psychotropic use.

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“…The majority of articles were published in Asia (n = 16, 89%), including twelve in China [28][29][30][31][32][33][34][35][36][37][38][39], two in South Korea [40,41] and two in Thailand [42,43]. One article was from Chile, South America [44] and one article reporting findings across 22 low-income, 17 lower-middle, and nine upper-middle countries as at 2003 [45] (Table 2).…”

Section: Search Results and Study Selectionmentioning

confidence: 99%

“…One article was from Chile, South America [44] and one article reporting findings across 22 low-income, 17 lower-middle, and nine upper-middle countries as at 2003 [45] (Table 2). Thirteen of the 18 articles examined the impact of SHI on mental health care utilization [28][29][30][31][32][33][34][35][36][37][38][39]44]; whilst three examined the impact of NHI [40,41,43] and one article examined the impact of CBHI [42] on mental health care utilization. The remaining paper explored a range of financing mechanisms across 48 LMICs [45].…”

Section: Search Results and Study Selectionmentioning

confidence: 99%

“…data were extracted retrospectively from claims databases, patient charts, and electronic hospital records) [29, 31-34, 37, 38, 40, 41, 43]. As such, only five papers made use of prospective data collection [28,35,36,39,42]; and three made use of data from systematic surveys (i.e. Santiago Mental Disorders Survey, World Health Survey, National Sample Survey on Disability in China) [30,44,45].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review

et al. 2020

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Background: Whilst several systematic reviews conducted in Low-and Middle-Income Countries (LMICs) have revealed that coverage under social (SHI), national (NHI) and community-based (CBHI) health insurance has led to increased utilization of health care services, it remains unknown whether, and what aspects of, these shifts in financing result in improvements to mental health care utilization. The main aim of this review was to examine the impact of SHI, NHI and CBHI enrollment on mental health care utilization in LMICs.

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Exploring the clinical and social determinants of prescribing anticholinergic medication for Chinese patients with schizophrenia

Cited by 17 publications

References 33 publications

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana

The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review

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