Pattern of prescribing antipsychotics in the psychiatry outpatient department of two Tertiary Care Hospitals in Bangladesh

Antipsychotic drugs continue to form the cornerstone of treatment for severe mental illness, but their use is variable worldwide. Many trends are common in the low- and middle-income countries, like universal SGA use, polypharmacy and adjunctive prescribing. However, there is limited comparative institutional data from Bangladesh. We performed a cross-sectional study at Dhaka Medical College Hospital (DMCH) and National Institute of Mental Health (NIMH), respectively, in the outpatient psychiatry departments from April to September 2024. Demographic, diagnosis, and prescription data were collected from 760 consecutive prescriptions (380 per site). Polypharmacy was defined as the use of two or more antipsychotics simultaneously. For comparison between-category variables and continuous variables, Chi-square and t-tests, respectively, were applied. Schizophrenia (16.4%), bipolar disorder (9.3%) and depression (6.4%) were the three most common diagnoses, and 28.2% had no recorded diagnosis (Table 1). The use of antipsychotics was reported in 80.3% of patients, and 43.7% of them used polypharmacy (NIMH: 24.2% vs. DMCH: 19.5%; p < 0.001). Olanzapine (17.1%) and risperidone (13.6%) were most prevalent overall, and quetiapine prescribing varied widely (DMCH: 16.8% vs NIMH: 1.6%; p < 0.001). Most significantly, a total of 55.1% of patients without a specific diagnosis received antipsychotics. A high prevalence of antipsychotic prescribing, substantial polypharmacy and marked intertreatment institution variability suggest nonadherence to evidence-based guidelines and diagnostic under documentation. These findings highlight the importance of national psychotropic stewardship programs, country-wide guidelines for prescribing antipsychotic drugs and routine audits of prescriptions to ensure appropriate and safe use of antipsychotics in Bangladesh. Bang J Psychiatry 2024;38(2): 58-63