Polypharmacy among psychiatric outpatients in Kuwait

Objective The aim of this study was to investigate the prevalence of polypharmacy with psychotropic medications among Kuwaiti patients attending the outpatient department (OPD) of the Psychological Medicine Hospital. Materials and methods The present study was based on a consecutive selection of the first 20 prescriptions per day from among Kuwaiti patients treated at the OPD of the Psychological Medicine Hospital in Kuwait over a period of 4 weeks between January and February 2008. The sample consisted of 484 prescriptions. Data including age, sex, diagnosis, and list of psychiatric medications were recorded and analyzed. Results The mean age of the sample was 45.1±15 years (range 18–91 years). The majority of patients were men (55%). The mean number of psychotropic drugs used by the patients was 2.7 (SD ±1.3, range 1–7). In total, 19.7% of the patients were under monotherapy treatment, whereas 30.1, 26.1, and 24.1% received two, three, or four or more drugs, respectively. Polypharmacy was more prevalent in male patients and in patients with schizophrenia and mood disorders. Prevalence was significantly higher in the age group 45–65 years and among patients more than 65 years old (P=0.009). Of the patients, 20.7% with schizophrenia used a combination of both atypical and conventional antipsychotics. Seven percent of mood disorders patients used two antidepressants at the same time. Conclusion In this study, almost 50% of the OPD psychiatric patients were treated with three or more psychotropic medications. Conventional antipsychotics and tricyclic antidepressants are also prescribed with an increased risk of polypharmacy. The introduction of educational programs and guidelines could be effective in decreasing the prevalence of polypharmacy in psychiatric practice.