Cognitive impairment and symptoms of depression among geriatric patients in a tertiary care unit in Sri Lanka Anti-psychotic drug prescription pattern for schizophrenia: Observation from a general hospital psychiatry unit

279 Cognitive impairment and symptoms of depression among geriatric patients in a tertiary care unit in Sri Lanka promoting the use of their anti-psychotics in combination with other medications.[2] Fifth, clinicians may feel that different medications are better for different symptoms, even though the drugs are similar.[2] Finally, busy doctors may be more inclined to prescribe multiple drug prescriptions than doctors who have more time and are under less pressure.[4] Whatever the reason, the fact that poly-pharmacy has been shown across several studies to be a relatively common practice suggests a need for research to determine whether the approach to treatment with two anti-psychotic medications is warranted, and if so, under what circumstances.[5]


Sir,
We did a study on the anti-psychotic drug prescription pattern for schizophrenia. The outpatients of the Department of Psychiatry, Chhatrapati Shahuji Maharaj Medical University, U.P., Lucknow (CSMMU, Lucknow) were taken into the study. The first five patients, who were diagnosed as suffering from schizophrenia, as per the diagnostic criteria of the International Classification of Disease, Tenth revision (ICD-10), [1] were included in the study from 20 consecutive OPDs, thus making a sample of 100 patients.
The sample consisted mostly of male patients. This is in concordance with the trends observed at our center and could be a reflection of the cultural norms.
The sample comprised of mostly young patients. Schizophrenia is an illness starting early and our sample reflects that.
It was observed that the most frequently prescribed total daily dose of anti-psychotic equivalent to Chlorpromazine was between 101-400 mg/day. This was in accordance with the findings world over with SGAs becoming the first line of treatment.
A significant group of patients, however, were prescribed a combination of first generation anti-psychotics (FGAs) and second generation anti psychotics (SGAs). Poly-pharmacy therefore was common. The use of poly-pharmacy can be explained by a number of reasons. First, when a patient is doing poorly a physician may add a medication to what is currently prescribed; when the patient shows some improvement the physician is reluctant to change this regime. [2] Second, when changing medications, a physician noting an improvement while a new medication is being decreased may stop the cross-titration and continue coprescribing both anti-psychotic medications. [2,3] Third, shorter hospital stays may increase pressure for poly-pharmacy. [2] Fourth, a recent trend is the pharmaceutical companies Anti-psychotic drug prescription pattern for schizophrenia: Observation from a general hospital psychiatry unit LETTERS TO EDITOR www.indianjpsychiatry.org Sir, The only study to assess prevalence of dementia in elderly in Sri Lanka has reported a prevalence of 3.98% in a semi urban population. [1] There is no data on prevalence of cognitive impairment and depression for hospitalized elderly patients, which is a major shortcoming in geriatric care.
We conducted a preliminary study to assess cognitive impairment and depression in a sample of geriatric patients presenting to the University Medical Unit of the National Hospital of Sri Lanka (the premier tertiary care hospital of Sri Lanka). This prospective study included all patients over 65 years, who were admitted over four weeks. The Mini Mental State Examination (MMSE, 30 items) and the geriatric depression scale (GDS) were used to screen for cognitive impairment and depression respectively.
We also assessed the impact of educational level and social support on cognitive impairment with a statistical model. It was hypothesized that better education and family support will protect against cognitive impairment. However (holding age and gender constant), the cognitive impairment did not correlate with either factor, alone or in combination (UNIANOVA, P>0.05).
These observations raise two issues; • The percentage of depressive symptoms (>60%) and cognitive impairment (>50%) was very high • The assumption that better education and family support leads to less cognitive impairment could not be validated The symptoms of depression may be due to illness itself. Yet it underscores the lack of psychiatric input in medical wards as none of these patients were referred to a psychiatrist. Sir, On the one hand, religious healing serves as an alternative to clinical psychiatric treatment [1] and may help patients cope with schizophrenia or play a part in their treatment adherence. [2] At the other end of the spectrum, lies the shocking Erwadi example, where there was gross human rights violation. [3] Nonetheless, an important proportion (nearly 50%) of patients does attribute the cause of mental illness to super natural forces and seek treatment in religious institutions. [4] This is related to educational level of the caregivers, place of residence and the availability of health care services. [3] A clear understanding of the role of these institutions may have public health implications. Most