Utilization of Psychotropic Medications and Polypharmacy Among Adults in Jazan Region, Saudi Arabia
Keywords:
Behavioral/mental illnesses, Drug use evaluation, Electronic health records, Psychotropic polypharmacy.
Abstract
Globally, there has been a surge in the prevalence of mental health disorders, not excluding Saudi Arabia. The availability of newer psychotropic medications has led to increased prescribing and polypharmacy. In Saudi Arabia, exploration of the knowledge gap between the outpatient use of psychotropic medications and the extent of polypharmacy has been scarce in the literature. This study evaluated the prescription pattern of psychotropic medications and the prevalence of psychotropic polypharmacy among adult patients with behavioral/mental illnesses. The study was conducted in the psychiatric outpatient clinics of five hospitals in Jazan Region of Saudi Arabia. A retrospective cross-sectional study was conducted with a non-random sample of adults with behavioral/mental illnesses. Psychotropic polypharmacy was the presence of ≥2 psychotropic medication prescriptions. We conducted multivariable logistic regression models to examine the factors associated with psychotropic polypharmacy. A total of 3.052 adults with a behavioral/mental illness were included in the study. Of these, 74.6% had antidepressant prescriptions. The second most prescribed drug class was antipsychotics (51.9%). Furthermore, 65.3% had psychotropic polypharmacy, and 48.2% had interclass psychotropic polypharmacy. Adults with anxiety and other mood disorders were less likely to engage in psychotropic polypharmacy and interclass polypharmacy use than those with depression. However, adults with schizophrenia (adjusted odds ratio [AOR]: 1.91; p<0.001) were more likely to engage in interclass polypharmacy use than those with depression. Adults with behavioral/mental illnesses in Jazan Region of Saudi Arabia have high rates of antidepressants and antipsychotics use. Additionally, psychotropic polypharmacy is a common prescribing practice, and further evaluation of the safety profile of these combinations is warranted.
References
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CA O'neil, MJ Krauss, J Bettale, A Kessels, E Costantinou, WC Dunagan, and VJ Fraser, 2018. Medications and patient characteristics associated with falling in the hospital. Journal of patient safety, 14(1), 27-33.
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FD Alosaimi, A Alhabbad, MF Abalhassan, EO Fallata, NM Alzain, MZ Alassiry and BA Haddad, 2016. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia. Neuropsychiatric disease and treatment, 12, 897.
FD Alosaimi, N Alzain, S Asiri, E Fallata, M Abalhassan, A Qrmli, and A Alhabbad, 2017. Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia. Archives of Clinical Psychiatry (São Paulo), 44(3), 77-83.
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G Goodwin, W Fleischhacker, C Arango, P Baumann, M Davidson, M De Hert, P Falkai, S Kapur, S Leucht, and R Licht, 2009. Advantages and disadvantages of combination treatment with antipsychotics: ECNP Consensus Meeting, March 2008, Nice. European Neuropsychopharmacology, 19(7), 520-532.
G Loggia, E Attoh-Mensah, K Pothier, R Morello, P Lescure, M-L Bocca, C Marcelli, and C Chavoix, 2020. Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility. Frontiers in Pharmacology, 10, 1659.
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M Zink, S Englisch, and A Meyer-Lindenberg, 2010. Polypharmacy in schizophrenia. Current opinion in psychiatry, 23(2), 103-111.
MH Trivedi, M Fava, SR Wisniewski, ME Thase, F Quitkin, D Warden, L Ritz, AA Nierenberg, BD Lebowitz, and MM Biggs, 2006. Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 354(12), 1243-1252.
MN Iqbal, CJ Levin, and FR Levin, 2019. Treatment for substance use disorder with co-occurring mental illness. FOCUS, A Journal of the American Psychiatric Association, 17(2), 88-97.
MS Mahfouz, B-eE Rahim, YM Solan, AM Makeen, and RM Alsanosy, 2015. Khat chewing habits in the population of the Jazan region, Saudi Arabia: prevalence and associated factors. PloS one, 10(8), e0134545.
OA Alibrahim, N Al-Sadat, and NA Elawad, 2010. Gender and risk of depression in Saudi Arabia, a systematic review and meta-analysis. Journal of Public Health in Africa, 1(1).
R Mojtabai, and M Olfson, 2010. National trends in psychotropic medication polypharmacy in office-based psychiatry. Archives of General Psychiatry, 67(1), 26-36.
R Tomasi, GG De, G Santone, AR Picardi, Micciolo, D Semisa, S Fava, and P Group, 2006. The prescription of psychotropic drugs in psychiatric residential facilities: a national survey in Italy. Acta psychiatrica scandinavica, 113(3), 212-223.
RG Frank, RM Conti, and HH Goldman. 2005. Mental health policy and psychotropic drugs. The Milbank Quarterly, 83(2), 271-298.
Ross, S., and Peselow, E. (2012). Co-occurring psychotic and addictive disorders: neurobiology and diagnosis. Clinical neuropharmacology, 35(5), 235-243.
S Kukreja, G Kalra, N Shah, and A Shrivastava, 2013. Polypharmacy in psychiatry: a review. Mens sana monographs, 11(1), 82.
SN Vigod, Y Lunsky, V Cobigo, AS Wilton, Somerton, S., and DP Seitz, 2016. Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs. BJ Psych open, 2(2), 188-194.
Spielmans, GI., MI Berman, E Linardatos, NZ Rosenlicht, A Perry, and AC Tsai, 2013. Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLoS medicine, 10(3), e1001403.
TM Kelly, and DC Daley, 2013. Integrated treatment of substance use and psychiatric disorders. Social work in public health, 28(3-4), 388-406.
TS Stroup, T Gerhard, S Crystal, C Huang, Z Tan, MM Wall, CM Mathai, and M Olfson, 2018. Psychotropic medication use among adults with schizophrenia and schizoaffective disorder in the United States. Psychiatric Services, 69(5), 605-608.
V Patel, D Chisholm, R Parikh, FJ Charlson, L Degenhardt, T Dua, AJ Ferrari, S Hyman, R Laxminarayan, and C Levin, 2016. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet, 387(10028), 1672-1685.
W Al-Qadhi, S ur Rahman, MS Ferwana and IA Abdulmajeed. 2014. Adult depression screening in Saudi primary care: prevalence, instrument and cost. BMC psychiatry, 14(1), 190.
X Tan, VD Marshall, R Balkrishnan, I Patel, J Chang, and SR Erickson, 2015. Psychotropic medication adherence among community-based individuals with developmental disabilities and mental illness. Journal of Mental Health Research in Intellectual Disabilities, 8(1), 1-22.
XH Hu, SA Bull, EM Hunkeler, E Ming, JY Lee, B Fireman, and LE Markson, 2004. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. The Journal of clinical psychiatry, 65(7), 959-965.
Y Lunsky, and M Modi, 2018. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatric services, 69(2), 242-246.
Y-T Xiang, G Ungvari, C Correll, H Chiu, and N Shinfuku, 2016. Trends in the access to and the use of antipsychotic medications and psychotropic co-treatments in Asian patients with schizophrenia. Epidemiology and psychiatric sciences, 25(1), 9-17.
A Karow, and M Lambert, 2003. Polypharmacy in treatment with psychotropic drugs: the underestimated phenomenon. Current Opinion in Psychiatry, 16(6), 713-718.
A Tapp, AE Wood, L Secrest, J Erdmann, L Cubberley, and N Kilzieh, 2003. Combination antipsychotic therapy in clinical practice. Psychiatric services, 54(1), 55-59.
AD Al-Khathami, and DO Ogbeide,. 2002. Prevalence of mental illness among Saudi adult primary-care patients in Central Saudi Arabia. Saudi Med J, 23(6), 721-724.
AS Al Rashed, AF Al-Naim, BJ Almulhim, MS Alhaddad, AI Al-Thafar, MJ Alali, AM Aleem, S Kashif., and I. Bougmiza. 2019. Prevalence and associated factors of depression among general population in Al-Ahsa, Kingdom of Saudi Arabia: A community-based survey. Neurology, Psychiatry and Brain Research, 31, 32-36.
B Helfer, MT Samara, M Huhn, E Klupp, C Leucht, Y Zhu, RR Engel, and S Leucht, 2016. Efficacy and safety of antidepressants added to antipsychotics for schizophrenia: a systematic review and meta-analysis. American Journal of Psychiatry, 173(9), 876-886.
C Coupland, T Hill, R Morriss, M Moore, A Arthur, and J Hippisley-Cox, 2018. Antidepressant use and risk of adverse outcomes in people aged 20–64 years: cohort study using a primary care database. BMC medicine, 16(1), 36.
CA O'neil, MJ Krauss, J Bettale, A Kessels, E Costantinou, WC Dunagan, and VJ Fraser, 2018. Medications and patient characteristics associated with falling in the hospital. Journal of patient safety, 14(1), 27-33.
F Moulis, G Moulis, L Balardy, S Gérard, S Sourdet, M-E Rougé-Bugat, M Lapeyre-Mestre, J-L Montastruc, Y Rolland, and B Vellas, 2015. Searching for a polypharmacy threshold associated with frailty. Journal of the American Medical Directors Association, 16(3), 259-261.
FD Alosaimi, A Alhabbad, MF Abalhassan, EO Fallata, NM Alzain, MZ Alassiry and BA Haddad, 2016. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia. Neuropsychiatric disease and treatment, 12, 897.
FD Alosaimi, N Alzain, S Asiri, E Fallata, M Abalhassan, A Qrmli, and A Alhabbad, 2017. Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia. Archives of Clinical Psychiatry (São Paulo), 44(3), 77-83.
FF Alharbi, SF Alharbi, SB Salih, and K Al-Surimi 2019. Correlates of Psychotropic Polypharmacy in outpatient psychiatric clinics of two military tertiary hospitals in Saudi Arabia. Journal of Family and Community Medicine, 26(3), 213.
G Goodwin, W Fleischhacker, C Arango, P Baumann, M Davidson, M De Hert, P Falkai, S Kapur, S Leucht, and R Licht, 2009. Advantages and disadvantages of combination treatment with antipsychotics: ECNP Consensus Meeting, March 2008, Nice. European Neuropsychopharmacology, 19(7), 520-532.
G Loggia, E Attoh-Mensah, K Pothier, R Morello, P Lescure, M-L Bocca, C Marcelli, and C Chavoix, 2020. Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility. Frontiers in Pharmacology, 10, 1659.
General Authority for Statistics 2017. Annual Statistical Yearbook. viewed 10 November 2016, Available from https://www.stats.gov.sa/en/929-0.
General Authority for Statistics. 2016 Demography Survey. Retrieved 22 Jul from https://www.stats.gov.sa/sites/default/files/en-demographic-research-2016_2.pdf
H Herrman, S Saxena, R Moodie, and WHO 2005. Promoting mental health: concepts, emerging evidence, practice: a report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne.
JC Nelson, and GI Papakostas,. 2009. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. American Journal of Psychiatry, 166(9), 980-991.
JdO Costa, MdGB Ceccato, APS Melo, FdA Acurcio, and MDC Guimarães, 2017. Gender differences and psychotropic polypharmacy in psychiatric patients in Brazil: a cross-sectional analysis of the PESSOAS Project. Cadernos de saude publica, 33, e00168915.
M O'Dwyer, J Peklar, P McCallion, M McCarron, and MC Henman, 2016. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open, 6(4), e010505.
M Zink, S Englisch, and A Meyer-Lindenberg, 2010. Polypharmacy in schizophrenia. Current opinion in psychiatry, 23(2), 103-111.
MH Trivedi, M Fava, SR Wisniewski, ME Thase, F Quitkin, D Warden, L Ritz, AA Nierenberg, BD Lebowitz, and MM Biggs, 2006. Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 354(12), 1243-1252.
MN Iqbal, CJ Levin, and FR Levin, 2019. Treatment for substance use disorder with co-occurring mental illness. FOCUS, A Journal of the American Psychiatric Association, 17(2), 88-97.
MS Mahfouz, B-eE Rahim, YM Solan, AM Makeen, and RM Alsanosy, 2015. Khat chewing habits in the population of the Jazan region, Saudi Arabia: prevalence and associated factors. PloS one, 10(8), e0134545.
OA Alibrahim, N Al-Sadat, and NA Elawad, 2010. Gender and risk of depression in Saudi Arabia, a systematic review and meta-analysis. Journal of Public Health in Africa, 1(1).
R Mojtabai, and M Olfson, 2010. National trends in psychotropic medication polypharmacy in office-based psychiatry. Archives of General Psychiatry, 67(1), 26-36.
R Tomasi, GG De, G Santone, AR Picardi, Micciolo, D Semisa, S Fava, and P Group, 2006. The prescription of psychotropic drugs in psychiatric residential facilities: a national survey in Italy. Acta psychiatrica scandinavica, 113(3), 212-223.
RG Frank, RM Conti, and HH Goldman. 2005. Mental health policy and psychotropic drugs. The Milbank Quarterly, 83(2), 271-298.
Ross, S., and Peselow, E. (2012). Co-occurring psychotic and addictive disorders: neurobiology and diagnosis. Clinical neuropharmacology, 35(5), 235-243.
S Kukreja, G Kalra, N Shah, and A Shrivastava, 2013. Polypharmacy in psychiatry: a review. Mens sana monographs, 11(1), 82.
SN Vigod, Y Lunsky, V Cobigo, AS Wilton, Somerton, S., and DP Seitz, 2016. Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs. BJ Psych open, 2(2), 188-194.
Spielmans, GI., MI Berman, E Linardatos, NZ Rosenlicht, A Perry, and AC Tsai, 2013. Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLoS medicine, 10(3), e1001403.
TM Kelly, and DC Daley, 2013. Integrated treatment of substance use and psychiatric disorders. Social work in public health, 28(3-4), 388-406.
TS Stroup, T Gerhard, S Crystal, C Huang, Z Tan, MM Wall, CM Mathai, and M Olfson, 2018. Psychotropic medication use among adults with schizophrenia and schizoaffective disorder in the United States. Psychiatric Services, 69(5), 605-608.
V Patel, D Chisholm, R Parikh, FJ Charlson, L Degenhardt, T Dua, AJ Ferrari, S Hyman, R Laxminarayan, and C Levin, 2016. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet, 387(10028), 1672-1685.
W Al-Qadhi, S ur Rahman, MS Ferwana and IA Abdulmajeed. 2014. Adult depression screening in Saudi primary care: prevalence, instrument and cost. BMC psychiatry, 14(1), 190.
X Tan, VD Marshall, R Balkrishnan, I Patel, J Chang, and SR Erickson, 2015. Psychotropic medication adherence among community-based individuals with developmental disabilities and mental illness. Journal of Mental Health Research in Intellectual Disabilities, 8(1), 1-22.
XH Hu, SA Bull, EM Hunkeler, E Ming, JY Lee, B Fireman, and LE Markson, 2004. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. The Journal of clinical psychiatry, 65(7), 959-965.
Y Lunsky, and M Modi, 2018. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatric services, 69(2), 242-246.
Y-T Xiang, G Ungvari, C Correll, H Chiu, and N Shinfuku, 2016. Trends in the access to and the use of antipsychotic medications and psychotropic co-treatments in Asian patients with schizophrenia. Epidemiology and psychiatric sciences, 25(1), 9-17.
Published
2020-09-30
How to Cite
M. Meraya, A., Alwhaibi, M., H Syed, M., Shwihi, A., Mashraqi, M., Tripathi, R., Buayti, Y., & Moraya, D. (2020). Utilization of Psychotropic Medications and Polypharmacy Among Adults in Jazan Region, Saudi Arabia. Indonesian Journal of Pharmacy, 31(3), 205-216. https://doi.org/10.22146/ijp.813
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Research Article
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