Schizophrenia is a debilitating psychiatric disorder creating an economic burden on the society and not only on an individual. It is a life-long disorder requiring  continuous pharmacotherapy.^1,2  The main  treatment is antipsychotics  along with other psychotropics drugs like anti-anxiety, mood stabilizers, lithium etc as well as other concomitant drugs like anticholinergic , NSAIDs, beta blockers etc.  These concomitant drugs not only potentiate the efficacy of antipsychotics but also helps in controlling specific symptoms associated with schizophrenia.^2,3,4

Various studies are conducted in various parts of world as well as India to study the prescribing pattern of schizophrenia^5,6,7,8,9 but very few studies have been done on concomitant drugs usage.^10,11,12,22 The aim of this paper is to present the use of concomitant medication in schizophrenia. This study was done at department of pharmacology SGRR Institute of Medical Sciences and Department of Psychiatry, Shri Mahant Indresh Hospital, Dehradun.

MATERIALS AND METHOD

 It was an observational, retrospective, cross sectional study carried out by department of pharmacology SGRR Institute of Medical Sciences and Department of Psychiatry, Shri Mahant Indresh Hospital, Dehradun after the approval from institutional ethical committee. Prescriptions of schizophrenic patients during the time period of Jan 2016- Dec 2016 were collected from psychiatry OPD. This was entered into a preformed format and analysed as per need.

Inclusion criteria: All genders   diagnosed with schizophrenia with minimum 01 antipsychotic drug

Exclusion criteria: non consenting patients

Data was entered in Microsoft excel and analysis was carried out. Categorical data is presented as percentage (%).

OBSERVATION AND RESULT

 A total of 800 schizophrenic patients information were collected from the psychiatry OPD.  Most of the patients are from rural areas (53.5%).  Out of 800 patients, 300 (41.25%) were males and 470 (58.75%) were females.

The total no. of drugs prescribed in 800 prescriptions were 3645. This comprises 1928 (52.74%) psychotropic drugs and 1728 (47.26%) concomitant drugs. Table 1. Shows total no. of all drugs and their percentage out of total number of drug prescribed.

TABLE 1: TOTAL NUMBER OF DRUGS PRESCRIBED IN ALL PATIENTS

Among concomitant drugs, anticholinergics 608(35.19%) were the most prescribed drug followed by multivitamins/ supplements 405 (23.94%), beta blockers 354(20.49%), hormones 109(6.31%), NSAIDs 85 (4.86%), antacids 54 (3.13%), anthelminthic 50(2.89%), antihypertensive 37(2.14%) and others 26 (1.50%). [Chart 1]

CHART 1: PERCENTAGE OF CONCOMMITANT DRUGS PRESCRIBED

  On calculating drugs per encounter in schizophrenia among concomitant drugs use of anticholinergic per prescription was 0.72. Anticholinergic were prescribed in 585, beta blockers in 340 and hormones in 107 prescriptions (table 2).

TABLE 2: DRUG UTILISATION PATTERN OF SOME DRUGS

DISCUSSION

Total 800 patients were analysed. Out of these females were more in no. as compared to males which is in contrast to many studies.^{8,13,14,15,16 .}   similar  findings has been seen in  Oommen et al¹⁷ , Alsabhan et al,¹⁸ , Javed et al¹⁹,in which females were more in number.

Total no. of drugs prescribed in 800 prescriptions was 3656 among which 52.74% was psychotropic drugs and 47.26% was concomitant dugs

Majority of patients were given monotherapy. Among anticholinergic, out of total 585 patients prescribed with anticholinergic 564 were given monotherapy and 21 were given dual therapy. Beta blockers were prescribed to 340 patients with 328 patient’s monotherapy and 12 with dual therapy. Hormones were prescribed to 107 patients. Dual therapy was not given.

Anticholinergic drugs are mainly used along with antipsychotic drugs for counteracting the side effects of antipsychotic medication.  Anticholinergic were prescribed in around 76% of patients, as compared to other concomitant drugs. 

In a study by Hekaru Hori et al ²¹, around 30.5% patients were prescribed anticholinergic. In a  study by Wang et al, use of anticholinergic was 61.2% in 2019 and 2020 and 62% in 2021.  This variation can be due to the difference in sample size.  In total analgesics were4.86% .andantihypertensives drugs constitutes 2.14%. Which is in contrast to and way less than wanget al¹².

Drugs per encounter were calculated for different drugs. Anticholinergic per encounter was 0.72 which is also more as compared to Tripathiet al⁸.

CONCLUSION

 Schizophrenia is a complex disorder and using antipsychotic medications alone cannot help in management of schizophrenia. to manage the adverse effects caused  by antipsychotic drugs or to potentiate there action, concomitant drugs are used. But the total number of medication in a prescription should not exceed much as it may hamper the compliance of patirnt²¹.  In our study, psychotropic drugs were 52.74% and concomitant were 47.26%. Females were more in no. as compared to males and majority. Anticholinergic was the most common concomitant drug prescribed followed by multivitamins and beta blockers.

Limitations: There are certain limitations to this study .Being a unicentric study the result can’t be applied to majority of population. There is no data on adverse drug reaction caused by these drugs as no follow up was done. No detail data on drugs is available. No IPD patients were included.

Acknowledgement: We are heartly thankful to   department of psychiatry, SGRR for proving us with their data.

Conflict of Interest: There is no conflict of interest.

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