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The extent and correlates of same class versus multiclass polypharmacy among Egyptian psychiatric inpatients: a cross-sectional study

ObjectiveTo examine the frequency and patterns of polypharmacy use among Egyptian psychiatric inpatients and to assess the influence of patients’ characteristics on polypharmacy prescription. MethodsA cross-sectional study conducted in the Institute of Psychiatry, Ain Shams University, during a period of 6 months. Medical records of patients were reviewed upon discharge. Demographic data, diagnosis, the duration of the illness, the number of episodes, psychotropic medications prescribed on discharge, and the duration of hospital stay were obtained. Polypharmacy was operationally defined as the concurrent use of two or more psychotropic medications in the same patient for treating symptoms of his/her illness. ResultsA total of 187 patients were included in the study, and 78.1% were discharged on polypharmacy. Diagnosis was the only significant factor associated with polypharmacy (P=0.003). The number of drugs prescribed was positively correlated to the number of episodes (P=0.001), the duration of hospital stay (P=0.04), and the duration of the illness (P=0.05). Multiple antipsychotics were prescribed to younger patients (P=0.008) with psychotic disorders (P=0.001) and with a longer duration of hospitalization (P=0.05). Multiple antidepressants were prescribed more to patients with depressive disorders (P=0.03) with a longer duration of the illness (P=0.05) and a higher number of episodes (P=0.01). ConclusionPolypharmacy is a common clinical practice in psychiatric inpatients influenced by a complex interplay of several factors. Clinical diagnosis seems to be the most consistent factor influencing polypharmacy prescription. There is a need for more pragmatic approaches to improve clinical practice and reduce the use of polypharmacy.