The prescribing of psychotropic drugs in mental health services in Trinidad.
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.


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 heritage.


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.
Moore
Shelley
S
The University of the West Indies, St. Augustine, Trinidad and Tobago.
Jaime
Lazara K Montane
LK
Maharajh
Hari
H
Ramtahal
Indar
I
Reid
Sandra
S
Ramsewak
Feroza Sircar
FS
Maharaj
Mala
M
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008605:Mental Health Services; D008875:Middle Aged; D010045:Outpatients; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D014300:Trinidad and Tobago
D000928:Antidepressive Agents; D011619:Psychotropic Drugs