Psychotropic drug prescription in a psychiatric university hospital

A retrospective survey on drug prescription over a one-year period (1989) i n 1083 patients (48.3% of whom were male) hospitalized in a psychiatric uni versity hospital in Switzerland and a 35-day prospective study (1992) on th e prescription of "as needed" (prn) medication in a closed and an open ward were carried out. Their aim was to establish a basis for a monitoring of p rescription habits and for pharmacoeconomic considerations. In the retrospe ctive study, 48.3% of the patients were male. The mean duration of hospital ization of the patients was 47.0 +/- 68.1 days (mean +/- s.d.). Only 11 out of the 1083 patients (1%) were without psychotropic medication. The mean ( +/- SD) number of drugs/day the patients were prescribed was 4.6 +/- 2.8, i ncluding 3.2 +/- 1.7 psychotropic drugs. Patients suffering from schizophre nia (67 d) or from unipolar depression (67.4 d) were hospitalized for the l ongest periods. Antipsychotics (67.5% of the patients) were the most freque ntly prescribed psychotropic drugs, followed by anxiolytics (42.2%), antide pressants (28.3%), hypnotics (31.4%) and mood stabilizers (7.1%). Antiparki nsonian agents accounted for 4.6% of all prescriptions. Levomepromazine, ha loperidol (30.9% of all patients) and clotiapine were the most often prescr ibed neuroleptics, and clozapine was administered to only 6.4% of all patie nts. Among the antidepressants, maprotiline (11.9% of all patients) was mor e frequently prescribed than the classical tricyclic antidepressant amitrip tyline, while the only available SSRI fluvoxamine and MAO inhibitors were r arely used. The most frequently prescribed anxiolytics were clorazepate (28 .2% of all patients), lorazepam, bromazepam, and prazepam. Among the hypnot ic drugs, chloral hydrate (11.5%) was more frequently administered than the first-ranking benzodiazepine flunitrazepam (7.8%). In the prospective stud y, 97% and 77% of the patients (n = 55) of the closed (n = 29) and of the o pen ward, respectively, were prescribed "as needed" (prn) drugs. However, o nly 71 and 80%, respectively, of these patients finally received the drug. The frequency of prescription was 34.9% for neuroleptics, 15.1% for anxioly tic drugs, 8.2% for non-benzodiazepine hypnotics and only 2.1% for benzodia zepine hypnotics. The most frequently prescribed neuroleptic drug was cloti apine (18% of all patients), but finally, only 29% of the prescribed doses were administered. Studies of this type are biased by the fact that local h abits of prescription do not allow generalisation of the findings. Such sur veys should be carried out more frequently and simultaneously in different centers. Critical comparisons could help to optimize treatment.