Antipsychotic drug prescription in a Serbian long-stay psychiatric care facility

Objective: This study evaluated the current use of antipsychotic drugs in a long-stay psychiatric care facility. Design and Setting: The study was a cross-sectional survey of drug therapy in a long-stay psychiatric care facility, performed in the Institute for Ps ychiatric Care of Adults (IPCA) in Male Pcelice, Serbia, FR Yugoslavia. Patients: The drug therapy of 806 inpatients was surveyed. Interventions: The survey was performed on a randomly chosen day. The follo wing data were collected from patient files and drug charts: age, gender, d iagnosis, age of onset of illness, age of first hospitalisation, and curren t dosage of psychotropic drugs. Main Outcome Measures: The main outcome measures were the spectrum of drugs used for a particular disorder, the number of drugs used per patient, the average dose of each drug, and the average length of therapy. Results: The majority of the inpatients had schizophrenia (396) or mental r etardation (330). Fifteen percent of the patients did not take any psychotr opic medication. Among 682 patients taking psychotropic medication, 547 (80 .2%) were receiving antipsychotics. The median daily dose of antipsychotics was 450mg of chlorpromazine (CPZ) equivalent. 133 patients (24% of those t aking antipsychotics) with schizophrenia were maintained on depot antipsych otics. The dosage of antipsychotics in patients with schizophrenia was high er than that in patients with other diagnoses (median 500 vs 400mg of CPZ e quivalent per day; U = 42467; p = 0.0005; significant difference). Of the p atients taking antipsychotics, 237 (43.4%) were taking one, 254 (46.4%) wer e taking two, and 56 (10.2%) were taking three or more agents. 243 (44.4%) patients were taking an anticholinergic antiparkinsonian agent, trihexyphen idyl, in a median daily dose of 5mg. 351 (64.1%) patients were taking some other psychotropic drug. The patients receiving both antipsychotics and oth er psychotropic drugs were on slightly lower dosages of antipsychotics than the patients receiving antipsychotics only (median 400 vs 450mg of CPZ equ ivalent per day; U = 35239.8, p = 0.691, NS). Conclusions: Significant irrationalities in psychotropic drug use were obse rved: maintenance dosages of antipsychotics were higher than those recommen ded by international guidelines; two or more antipsychotics were administer ed to an unacceptably high proportion of patients, and adjuvant psychotropi c medication was overused. There is a need for translating international gu idelines into Serbian to allow Serbian practitioners to prescribe psychotro pic drugs in line with modem views.