Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana

Abstract

BackgroundThere is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital, Lobatse, Botswana.MethodsData involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models.ResultsThe prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177–9.9673) and psychotropic side effects (OR = 5.782, 95% CI: 1.636–20.430) were significantly associated with polypharmacy after regression analysis.ConclusionPsychiatric co-morbidity and psychotropic side effects were significant risk factors for polypharmacy in Botswana.

Mental health research in Botswana: a semi-systematic scoping review

“…In a study of pharmacological treatment in children and adolescents in a mental hospital, Olashore and Rukewe 59 found that the prevalence of polypharmacy was 29.2% and that psychiatric comorbidity and psychotropic side effects were strongly associated with polypharmacy. A study by Shumba and Abosi 60 identified high rates of sexual, physical and emotional abuse by teachers toward disabled children.…”

Clinical utility of pharmacogenetic testing in children and adolescents with severe mental disorders

“…Clinicians usually turn to polypharmacy in a desperate intent to find the “right combination” (Mrazek 2010 ) and control psychiatric symptoms. Furthermore, the pressure to promptly resolve psychiatric symptoms makes pharmacological options more attractive, thus favoring polypharmacy (Diaz-Caneja et al 2014 ; Olashore and Rukewe 2017 ). However, polypharmacy increases the risk of drug–drug interactions, side effects, and non-compliance (Olashore and Rukewe 2017 ; Stahl 2002 ).…”

“…The reduction of polypharmacy was accompanied with the resolution of all clinically significant side effects. This is not surprising, as polypharmacy is related to overmedication and side effects (Mrazek 2010 ; Olashore and Rukewe 2017 ). This is important, because children are particularly vulnerable to side effects, particularly extra-pyramidal symptoms, when using antipsychotics (Garcia-Amador et al 2015 ).…”

“…Given the high proportion of lack of response and the patient’s need of achieving quick symptom relief, polypharmacy has become a frequent practice (Mrazek 2010 ). Even if support for polypharmacy is scarce (Stahl 2002 ), polypharmacy and off-label use of psychotropic drugs are frequent in youth with mental disorders and have become a matter of concern worldwide (Olashore and Rukewe 2017 ). This is probably a consequence of the reality that the process of decision-making about the best drug choice for each patient still remains an empirical “trial-and-error process” (Mrazek 2010 ).…”

Pharmacodynamic Gene Testing in Prader-Willi Syndrome

“…Nearly 50% of children age 5-12 year were receiving SSRIs, and this increased to 70% in the 12-21 years age group, often together with an atypical antipsychotic medication (Forster, 2019). Polypharmacy leads to drug-drug interactions, a significant problem contributing to medical and psychiatric co-morbidity (Olashore and Rukewe, 2017). Further, except for treatment of co-morbidities or specific augmentation strategies, the evidence base for using multiple medications simultaneously is lacking (Mrazek, 2010a).…”