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升级记忆力或带加空格的戒子。
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Rev Panam Salud Publica vol.12 no.3 Washington sep. 2002
http://dx.doi.org/10.-00010
The prescribing of psychotropic drugs
in mental health services in Trinidad
Shelley Moore, Lazara K. Montane Jaime, Hari Maharajh, Indar Ramtahal, Sandra Reid, Feroza Sircar Ramsewak, and Mala Maharaj
Objective. To describe, analyze, and interpret patterns of
psychotropic drug prescribing in new psychiatric patients attending psychiatric
outpatient clinics in the Caribbean island of Trinidad.
Design and Methods. This was a cross-sectional study of
psychotropic drug prescribing by psychiatrists for 132 new psychiatric
outpatients who were seen at the outpatient clinics surveyed and who were
entering the mental health system during the period of research, November
1998 through February 1999.
Results. A single patient could be prescribed more than
one psychotropic drug. Antidepressant drugs were the class of psychotropic
drugs most prescribed (79 of 132 patients, 59.8%), followed by antipsychotic
drugs (67 of 132 patients, 50.8%). Tricyclic antidepressants (TCAs) were
the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline
(53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor
(SSRI) prescribed (21 of the 79 patients prescribed antidepressants).
Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted
for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine
(13 of the 41). The individual antipsychotic most prescribed was sulpiride
(21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of
the 132 patients (15.1%). Eighty-three of the patients were prescribed
more than one drug concomitantly (either more than one psychotropic or
a combination of psychotropic(s) and nonpsychotropic(s)). Prescription
by ethnicity, age, and gender coincided with the morbidity rates encountered
in these patients. The prescribing of SSRIs to persons of African or East
Indian ethnicity was significantly lower than it was for persons of mixed
Conclusions. The prescription patterns of psychotropic
drugs in Trinidad revealed the psychiatrists' preferences for traditional
psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy
in some cases, with probable predisposition to adverse drug reactions.
Given our results and based on the evaluation of individual patients,
consideration should be given to a broader use of the newer antidepressants
(SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided.
Psychotropic drugs, drug therapy, drug utilization,
mental disorders, Trinidad and Tobago.
The rapidly expanding field of psychopharmacology is challenging the traditional
concepts of psychiatric treatments, and research is constantly seeking new and
improved drugs to treat psychiatric disorders (1). In this way, psychiatrists
are continuously exposed to newly introduced drugs that are claimed to be safer
and more efficacious.
Appropriate pharmacotherapy is best achieved when the selection of a drug and
its dosage regimen is based on patient-specific factors. This process must include
taking complete current-drug and coexisting-disease histories in order to avoid
possible drug-drug interactions and adverse effects. In addition, socioeconomic
and demographic factors must be taken into consideration in order to ensure
patient compliance and success of therapy. Besides rational considerations,
the use of psychotropic drugs may also be determined by social, psychological,
and cultural motives that can shape the therapeutic behavior of psychiatrists
as well as the drug preferences of patients (2).
Before this study, no researchers had looked at these various psychopharmacology
issues in the Caribbean island of Trinidad. Our objective was to describe, analyze,
and interpret patterns of psychotropic drug prescribing in new psychiatric patients
who were attending psychiatric outpatient clinics in Trinidad.
MATERIALS AND METHODS
We performed a cross-sectional survey of psychotropic drug-prescribing practices
in new patients attending seven mental health outpatient clinics in Trinidad.
Trinidad is the southern-most island of the Lesser Antilles. It is also the
larger and more-populous of the two islands that make up the country of Trinidad
and Tobago. The total population of the country is around 1.3 million, with
some 96% of these persons living in Trinidad. Trinidad has a multiethnic society,
mainly composed of people of African heritage (39.6%) or of East Indian heritage
(40.3%). The remainder of the population is of White, Chinese, or mixed ancestry.
The seven outpatient clinics studied are part of the public health care system
in Trinidad, which provides care at no cost to the patients. There are also
private clinics with pharmacy facilities as well as private pharmacies, but
these are not free of charge. All drugs are available in the private sector,
but only those subsidized by the government are available in the public system.
All the data for our study were gathered by one of the researchers (S.M.),
who was present during the interviews that the clinic psychiatrists conducted
with all of the psychiatric patients attending one of the clinics for the first
time. The data were collected from 10 November 1998 through 12 February 1999.
Our study only included patients 15 years and over since patients under 15 years
of age are not treated in the outpatient clinics but are instead referred to
Child Guidance services.
The information collected included sociodemographic characteristics such as
age, gender, ethnicity, educational level, and occupation. "Ethnicity" was determined
on the basis of the patient having at least three of four grandparents from
the same ethnic group. Toxic habits (such as smoking and illicit drug use) and
coexisting diseases were also recorded. Drug information involved all drugs
indicated for the psychiatric disorder as well as for any other medical reason.
Immediately after the interview, the researcher reviewed the medical notes written
by the psychiatrist in order to ensure that the information gathered was accurate.
In addition, to check on information about any other drugs already being taken
that the psychiatrist had not asked about, the researcher briefly interviewed
the patient after the psychiatrist's interview and recorded any additional information
All the patients were able to answer the questions that the psychiatrist asked.
In addition, the family members of some patients were present and could verify
the information that the patient had given. No patient refused to answer any
of the questions.
The lists of psychotropic drugs available during the period of research were
obtained from the head pharmacist of each of the pharmacies from the seven clinics
studied. We only considered clinically significant drug interactions (3). The
classification of drug-drug interactions was based on: a) potential harm to
the patient, b) frequency and predictability of occurrence, and c) degree and
quality of documentation. Highly clinically significant interactions refer to
those of great potential harm to the patient, that occur frequently, and that
are well documented. Moderately clinically significant interactions are those
that are of moderate potential harm, that do not occur as frequently as the
previous group, and that are not so completely documented (3).
Statistical analysis
We entered and analyzed our data using Epi Info version 6.02 computer software
(Centers for Disease Control and Prevention, Atlanta, Georgia, United States
of America). The chi-square test was used to find any differences in the use
of the various psychotropic drugs by ethnicity, age group, or gender. Age was
arranged in four groups: 15-19, 20-39, 40-59, and 60+ years. The
differences were considered statistically significant when P & 0.05.
A total of 168 new psychiatric patients attended the seven psychiatric outpatient
clinics during the period of research. Out of those 168, 36 patients were excluded,
leaving 132 patients in our sample. Some of the 168 patients were eliminated
due to age (i.e., less than 15 years old). Others were excluded for being recommended
for hospitalization and treatment as inpatients, rather than as outpatients
who would be prescribed medication at the initial psychiatric assessment.
Patient characteristics
shows the distribution of the different sociodemographic
characteristics of the 132 patients in the studied population. By ethnicity,
the single largest group were persons of East Indian ancestry. The largest group
by age were those from 20 to 39 years old. Women outnumbered men by a wide margin.
With respect to marital status, the studied population had an almost even distribution
between patients who were married (36.4%) and those who were single (38.6%).
Most of the patients (73.5%) were unemployed. Most of the patients had completed
primary or secondary education (53.0% and 32.6%, respectively).
Psychiatric diagnoses
All the clinic psychiatric consultants in the study said that to diagnose their
patients they used the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV), published by the American Psychiatric Association.
Mood disorders represented 47.7% (71 of 149) of all diagnoses, with major depression
being the most frequent, especially in patients of East Indian ancestry. (The
overall number of psychiatric diagnoses, 149, was higher than the number of
patients in the study because some of the 132 patients were given more than
one diagnosis, that is, a major diagnosis and a coexisting condition.) Schizophrenia
and other related disorders (29 of 149, or 19.5%) were the next most frequent
diagnoses, mainly in patients of African ancestry, while anxiety disorders represented
10.1% (15 of 149). Substance-related disorders accounted for 3.4% (5 of 149);
these were mainly addictions to alcohol or illegal drugs. The category of "others"
(29 diagnoses) included diagnoses with small numbers of patients that were therefore
grouped for better statistical analysis.
Coexisting diseases
While some of the patients presented with no other medical illnesses, the overall
number of coexisting disorders, 159, was higher than the total number of patients
in the study because some patients had more than one diagnosis of a coexisting
disorder. Cardiovascular disorders (30 of 159 diagnoses, or 18.9%) were the
most prevalent coexisting illness encountered, with hypertension representing
60.0% (18 of 30) of this number. Endocrine disorders (17 of 159, or 10.7%) were
the next most prevalent medical complaint, with diabetes mellitus accounting
for 12 of the 17 and hypothyroidism accounting for the remaining 5 of the 17.
Other illnesses were grouped under the category of "others" and accounted for
25.2% (40 of 159) of the diagnoses of coexisting disorders.
Psychotropic drug use
A single patient could be prescribed more than one psychotropic drug. Antidepressant
drugs were the class of psychotropic drugs most prescribed (79 of 132 patients,
or 59.8%), followed by antipsychotic drugs (67 of 132 patients, 50.8%). Benzodiazepines
were prescribed to 9.1% of the patients (12 of 132), while the anticholinergic
drugs represented 15.2% (20 of 132).
Among the antidepressant drugs, tricyclic antidepressants (TCAs) were prescribed
to 58 patients, and selective serotonin reuptake inhibitors (SSRIs) to 21 patients.
Of the 58 TCA prescriptions, 53 of them were for amitriptyline, followed by
imipramine (3 prescriptions) and amineptine and trimipramine (1 prescription
each). The only SSRI prescribed was fluoxetine.
Of the antipsychotics prescribed (67 patients), phenothiazines accounted for
41 of the 67 (61.2%). The main phenothiazines prescribed were trifluoperazine
(14 of the 41 patients) and thioridazine (13 of the 41). These two were followed
by chlorpromazine (6 of the 41), pipotiazine palmitate depot injection (5 of
the 41), and fluphenazine decanoate depot injection (3 of the 41). Interestingly,
sulpiride (21 of the 67 patients, or 31.3%) was the individual antipsychotic
most prescribed, and haloperidol was prescribed to only 3 of the 67 patients
For the benzodiazepines, there appeared to be no single agent more prescribed
than any other.
Benztropine was prescribed to 13 of the 132 patients (9.8%) and trihexyphenidyl
to 7 of the 132 (5.3%).
Concomitant drug use
Out of the 132 patients, there were 127 for whom the data were complete enough
to allow us to access concomitant drug use. Of those 127, 44 were using only
one drug, that is, just a psychotropic drug. The other 83 patients were using
two or more drugs, either more than one psychotropic or a combination of psychotropic(s)
and nonpsychotropic(s). Of these 83 patients, 63 of them were using either two
or three drugs concomitantly, 17 of them were using four or five drugs, and
3 of them were using six or more drugs.
Out of this group of patients using two or more drugs concomitantly, 51 of
them were using nonpsychotropic drugs. Of these 51, 41 of them were using drugs
prescribed by another physician, that is, not the psychiatrist at the clinic.
In addition, 15 of the 51 were self-medicating, according to their self-reporting.
In terms of the groups of nonpsychotropic drugs used concomitantly, the most
common were antihypertensives, followed by antidiabetics and nonsteroidal anti-inflammatory
Psychotropic drug utilization and sociodemographic characteristics
Ethnicity.
shows the patterns
found in terms of the prescribing of psychotropic drugs by ethnicity. Only one
difference was stati that was for the prescribing of antidepressants.
Persons of African or East Indian descent were prescribed SSRIs less often than
were persons of mixed ethnicity.
Age group. There were no statistically significant differences in the
prescribing of psychotropic drugs by age group (). However, there was a trend of prescribing TCAs at a higher rate than
SSRIs for those 40-59 and those 60 and older.
Gender. Female patients were prescribed antidepressants more than they
were antipsychotics, while the reverse was true for males (). TCAs were prescribed much more frequently than were SSRIs, to both males
and females. For males, the prescribing of phenothiazines was much greater than
that of other antipsychotics, but for females there was only a small difference.
The rate of benzodiazepine prescribing for females was about twice the rate
for males. Conversely, anticholinergic prescriptions were about twice as common
for men as they were for women.
Of the 132 patients, 99 of them (75.0%) were nonsmokers, and 23 of the 132
(17.4%) were reportedly smoking 24 or more cigarettes per day. Of these 23 heavy
smokers, 14 of them were given antidepr 8 received TCAs
and 6 received SSRIs.
Antipsychotic prescriptions were given to 13 of the 23 heavy smokers. In addition,
benzodiazepine was prescribed to 5 of the 23.
Anticholinergics were mostly prescribed to nonsmokers.
Drug interactions
We identified 20 potential drug-drug interactions among the 83 patients who
were prescribed more than one drug concomitantly. Most of these potential interactions
were of moderate clinical significance. Cases of psychotropic prescriptions
for patients with coexisting diseases were found, which could predispose to
adverse reactions. These patients require close monitoring or use of an alternative
DISCUSSION
The study of psychotropic drug prescription in new patients is important since
the initial treatment selected is of significance for therapeutic success and
patient compliance. Therefore, treatment should be carefully chosen by weighing
the relative risks and benefits of different therapeutic regimens on the basis
of an evaluation of the condition of the patient and the need for patient-specific
treatment.
Our study found that antidepressant drugs were the most-prescribed psychotropic
drug, followed by antipsychotic drugs. This is in accordance with the fact that
depression and schizophrenia had the highest reported morbidity rates among
these patients. Patients of East Indian ancestry were prescribed significantly
more antidepressants since depression was more frequently diagnosed in this
ethnic group. Patients of African ancestry received more antipsychotics since
they were more frequently diagnosed with schizophrenia. Females presenting to
the clinics were diagnosed more frequently with depression and males with schizophrenia,
which also explains why antidepressants rather than antipsychotics were prescribed
more for females.
Psychiatrists in Trinidad are still prescribing TCAs over SSRIs for their patients.
This may be due to three factors: 1) the erratic and inconsistent availability
of SSRIs in some clinics (the medication does not always reach the public clinics
on a timely basis), 2) the higher cost of SSRIs (but as these drugs are provided
free of charge to the patients in the clinics, the limiting factor could be
the cost of importing and distributing them), and 3) psychiatrists are more
accustomed to or more comfortable with prescribing the traditional agents.
Both SSRIs and TCAs have been reported as having similar onset of action and
therapeutic efficacy. The benefit with SSRIs seems to be the lower incidence
of side effects (lack of sedative, anticholinergic, and hypotensive effects);
the wider therapeutic index, making them safer in terms
and the once-daily dosing, which may improve patient compliance (4-6). The
prescription of SSRIs was significantly lower than that of TCAs in patients
of African ancestry as compared with persons of East Indian heritage. Some psychiatrists
in the Caribbean believe that fluoxetine is less efficacious in patients of
A this may explain the lower use of SSRIs in patients of this
ethnic group in our sample.
Amitriptyline was the TCA most prescribed, although 6 of the 7 outpatient clinic
pharmacies had imipramine available during the period of research. Fluoxetine
was the only SSRI prescribed, as it is the only SSRI available in the clinics.
There was a trend of prescribing TCAs more often to patients aged 40-59
and 60+. This occurs despite the recommendation of SSRIs for elderly people
because of the increased potential for significant clinical problems with the
anticholinergic side effects of TCAs (7, 8).
There is also a clear preference by psychiatrists in Trinidad for phenothiazines
as compared to other types of typical antipsychotic drugs. Although all typical
antipsychotics are equally effective, they differ in their propensity to induce
side effects (9). Haloperidol produces less sedation, fewer anticholinergic
effects, and fewer cardiovascular effects but at the cost of a higher incidence
of extrapyramidal effects. Although no consensus is available, many feel that
the side-effect profile of haloperidol is easier for the clinician to manage
and is better tolerated by the patient. When analyzing individual drugs, we
found that sulpiride was the individual antipsychotic drug most used. While
the risk of extrapyramidal side effects is as great as with more-potent drugs,
psychiatrists in Trinidad have commonly found that sulpiride is well tolerated.
Antipsychotic depot injections are usually not recommended for patients at the
first presentation. However, if the patient lacks insight into the illness and
will clearly be noncompliant, it may be prescribed. This was done for one-fifth
of the patients for whom antipsychotics were prescribed.
While the prescription of classes of antipsychotics was not significantly different
among the ethnic groups, there was a trend to prescribe phenothiazines more
frequently to patients of mixed ethnicity. Sulpiride and haloperidol were the
individual drugs prescribed at a higher rate than any single phenothiazine in
patients 20-39 years old.
Among the different medications available to treat acute extrapyram-idal side
effects, benztropine and trihexyphenidyl were used. Given the high rate of acute
extrapyramidal side effects among patients receiving antipsychotic medications,
especially the elderly, the short-term prophylactic use of anticholinergic drugs
may be considered. The benefit of this approach has been demonstrated in several
studies (9). The risk is that some patients may be treated unnecessarily. The
data in our study show that the use of anticholinergic agents was reserved for
only a small number of cases. The number of patients who presented to the clinics
with anxiety disorders was small, hence the small number of prescriptions of
benzodiazepines.
Comorbid psychiatric conditions or coexisting medical diseases are usually
found in psychiatric patients, hence the need to use more than one drug. If
more than one drug is chosen, it is recommended that the patient be closely
monitored for adverse effects. We found that some patients in our study were
prescribed combinations of drugs that could lead to drug-drug interactions,
in some cases of moderate clinical significance but in others of highly clinical
significance. Although moderately significant interactions are less of a threat
than highly significant interactions, it does not mean that these moderate ones
are to be ignored. Other research has found that interactions are likely to
oc therefore, the potential risk to the patient has to
be assessed and appropriate action taken (3).
The use of polypsychopharmacy in our patients was not small. Antipsychotic
and antidepressant users were more frequently subjected to polypsychopharmacy
than were others. The most prevalent combinations were antipsychotic-antipsychotic
and antidepressant-anxiolytic. It has been reported that two antipsychotics
are no more effective than a single agent (10, 11). However, the incidence of
side effects may increase, including extrapyramidal effects, and thus the possible
additional need for anticholinergics to counteract these effects. Additionally,
since this is the patient's first visit to the clinic, a trial with a single
drug is recommended, and further evaluations would determine the need for any
additional steps.
Combinations of antidepressants are sometimes used, although the benefit to
be derived from polypharmacy has not been demonstrated in blinded studies and
is likely to be outweighed by the increased risk of the combined side effects
(12). One combination we found was fluoxetine and a TCA (five patients). It
has been reported that fluoxetine may lead to a more rapid down-regulation of
postsynaptic beta-adrenergic receptors, thus possibly contributing to a faster
onset of action of TCAs. However, fluoxetine impairs the hepatic oxidative metabolism
of TCAs, which can result in an increase of 100%-300% in TCA plasma concentration
as well as an increase in adverse effects, including seizures and delirium (12-15).
Fluoxetine was also combined with benzodiazepines in two of the patients in
our study. Fluoxetine may decrease the metabolism of benzodiazepines through
competitive inhibition at the cytochrome P450 site, resulting in increased levels
of benzodiazepines and an increase in their clinical effects (16). Fluoxetine
has also been shown to increase the maximum concentration, the area under the
curve, and the half-life of alprazolam and to decrease the alprazolam elimination
rate constant (17, 18).
The interaction between carbamazepine and fluoxetine (combined in one patient
in our study) has been rated as "potentially hazardous," and combined administration
of the drugs involved should be "avoided" or only undertaken with caution and
appropriate monitoring (19, 20). The seizure-convulsive threshold is lowered
by this combination, and also the plasma concentration of carbamazepine could
be increased and resultant adverse effects could occur.
Three patients received TCAs while having concomitant treatment with propranolol.
This beta-blocker decreases blood flow to the liver, so metabolism of TCAs may
decrease, leading to accumulation of TCAs and possible toxicity. The mechanism
is not totally understood (21). TCAs also reduce the effects of sublingual nitrates
due to the predisposition to dryness of the mouth. This is of moderate clinical
significance, and the addition of TCAs to the therapy of patients using nitrates
should be carefully assessed and an alternative chosen if possible (22). We
found this combination in four patients in our study.
The sedative and anticholinergic effects of either TCAs or phenothiazines may
be prolonged and intensified with concomitant use due to the inhibition of the
metabolism of both drugs (four patients in our study). The risk of sei-zures
may be increased by lowering the seizure threshold, so drugs should be added
or withdrawn with caution. Psychotic depressions respond well to a combination
of TCAs and antipsychotic agents, but both agents should be initially administered
at lower doses and increased as is clinically indicated. The risk of neuroleptic
malignant syndrome may also be increased (23).
The mechanism of the interaction of selected phenothiazines and selected beta-blockers
(combined in one patient in our study) however, interference with
metabolism is a likely possibility. There may be increased plasma levels, with
resultant enhanced pharmacological response of each or both drugs as well as
increased risk of toxicity. If both drugs are administered, the dosages should
be adjusted as needed based on the patient's response. Serum chlorpromazine
or thioridazine concentrations may decrease if beta-blocker therapy is discontinued.
Similarly, plasma concentrations of the beta-blockers may decrease if chlorpromazine
or thioridazine is discontinued (24, 25).
The concomitant drug use and toxic habits of the patients also have to be considered
during the psychiatric interview and before choosing any drug. Many psychiatrists
did not take a full drug history from the patients in our study, including that
of toxic habits. Many psychotropics are metabolized by the liver, so smokers
are at risk of having lower levels of the psychotropic agent by induction of
hepatic microsomal enzymes by nicotine (26). As the ability to monitor patient
plasma levels of drugs remains unavailable in Trinidad, concomitant drug and
cigarette use need to be considered.
CONCLUSIONS
This research study was the first that has been done with the aim of revealing
the pattern of psychotropic drug prescribing in psychiatric outpatients in Trinidad.
We found psychiatrists' preferences for traditional psychotropic drugs, including
TCA moderate use of a polypharmacy
in some cases, with probable predisposition to ad and doctors
sometimes not asking about concomitant drug use. Prescription by ethnicity,
age, and gender coincided with the morbidity rate encountered in these patients.
Prescription of psychotropic drugs in new patients should be carefully done
since the initial treatment selected is essential for therapeutic success and
patient compliance. We encourage a broader use of the newer antidepressants
(SSRIs) and antipsychotics, on the basis of an evaluation of the condition of
the patient. Independent of which psychotropic drug is used, the presence of
concomitant disorders that require pharmacological treatment should be considered
in order to reduce adverse drug interactions. Unless justified, polypharmacy
should be avoided.
We hope that this knowledge will be helpful in improving future prescribing
practices in Trinidad.
Acknowledgement. Many thanks go to Dr. D. Simeon, a statistician with
the Department of Community Health of The University of the West Indies.
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Manuscript received 16 August 2001. Revised version accepted for publication
7 June 2002.
Prescripci&n de psicotr&picos en los servicios de salud
mental de Trinidad
Objetivos. Describir, analizar e interpretar las caracter&sticas
de la prescripci&n de psicotr&picos en pacientes nuevos
que acudieron a las consultas externas de psiquiatr&a en la isla
caribe&a de Trinidad.
M&todos. Se realiz& un estudio transversal
de los psicotr&picos prescritos por psiquiatras a 132 nuevos pacientes
psiqui&tricos ambulatorios que acudieron a consultas externas por
primera vez entre noviembre de 1998 y febrero de 1999.
Resultados. Algunos pacientes recibieron m&s de un
psicotr&pico. Los antidepresivos fueron los psicotr&picos
recetados con mayor frecuencia (79 de los 132 pacientes, 59,8%), seguidos
de los antipsic&ticos (67/132; 50,8%). Los antidepresivos prescritos
con mayor frecuencia fueron los tric&clicos (58/79; 73,4%), y en
particular la amitriptilina (53/58; 91,4%). La fluoxetina fue el &nico
inhibidor selectivo de la recaptaci&n de serotonina (ISRS) que
se recet& (21/79; 26,6%). De los 67 pacientes que recibieron antipsic&ticos,
a 41 (61,2%) se les recetaron fenotiazinas, entre ellas la trifluoperazina
(14/41; 34,1%) y la tioridazina (13/41; 31,7%). El antipsic&tico
prescrito con m&s frecuencia fue la sulpirida (21/67; 31,3%). A
20 de los 132 pacientes (15,1%) se les recetaron anticolin&rgicos.
A 83 (62,9%) se les prescribi& m&s de un f&rmaco
simult&neamente: o bien m&s de un psicotr&pico o
una combinaci&n de psicotr&picos y no psicotr&picos.
La prescripci&n por etnia, edad y sexo coincidi& con las
tasas de morbilidad observadas en los diferentes grupos. La prescripci&n
de ISRS a pacientes de origen africano o indio fue significativamente
menos frecuente que a los de origen mixto.
Conclusiones. Estos resultados muestran una preferencia
de los psiquiatras de Trinidad por los psicotr&picos tradicionales,
un uso moderado de los anticolin&rgicos y, en algunos casos, el
uso de la polifarmacia, que podr&a predisponer a la aparici&n
de reacciones adversas graves. Teniendo en cuenta estos resultados y dependiendo
de las circunstancias de cada paciente, se deber&a considerar un
uso m&s amplio de los antidepresivos (ISRS) y antipsic&ticos
m&s recientes y evitar el uso de la polifarmacia, a no ser que
est& justificado.
The University of the
West Indies, St. Augustine, Trinidad and Tobago. Send correspondence to: L.K.
Montane Jaime, Pharmacology Unit, Faculty of Medical Sciences, The University
of the West Indies, Trinidad and T Fax/Phone: (868) 663-8613; e-mail:
St. Ann's Mental Hospital, Port-of-Spain,
Trinidad and Tobago.