Complex Psychotropic Polypharmacy in Soweto-based community psychiatry clinics

Abstract

Background: Psychotropic polypharmacy is increasing globally. In South Africa (SA), Complex Psychotropic Polypharmacy (CPP) prevalence is 36.3%. Being on CPP is associated with adverse drug reactions and worsened patient outcomes, but there exists limited knowledge on CPP risk factors in SA.

Aim: To determine CPP prevalence and its associated clinical and sociodemographic factors in a community setting in SA.

Setting: The study was conducted in five randomly selected community mental health clinics in Soweto township from 01 January 2021 to 31 December 2022.

Methods: A retrospective study of 348 adult patient records was conducted from January 2021 to December 2022. Data on prescriptions, clinical and sociodemographic variables were extracted. Being on CPP was defined as having 3 or more psychotropics. Chi-square tests and logistic regression were used to identify factors associated with CPP.

Results: The CPP prevalence was 25.3%. The most common CPP combination (26.1%) was oral antipsychotic, long-acting injectable antipsychotic and mood stabiliser prescriptions. Psychiatric diagnosis was significantly associated with CPP, p-value = 0.012. The most common adverse drug effect was associated with use of anticholinergic drugs (13.2%) of which 28.3% were on CPP. Those who were widowed or divorced were 4.3 times more likely to be on CPP compared to those never married (single) Adjusted odds ratio (AOR) = 4.3 (95% CI:1.2–16.1).

Conclusion: There is notably high prevalence of CPP. The risk of adverse effects rises with an increase in the number of medications. Evidence-based prescribing and periodic review of medication should be emphasised.

Contribution: Increased monitoring of prescribing practices is needed to determine if the practice of Complex psychotropic polypharmacy (CPP) prescription is in line with treatment guidelines for psychiatric diagnosis.