Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications

ABSTRACT

Introduction

Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives.

Methods

Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population.

Results

57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population.

Conclusions

There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.

KEYWORDS:

• Psychiatric disorders
• neurological disorders
• schizophrenia
• depression
• drug abuse
• smoking
• Pakistan

Key Points

• There are considerable co-morbidities among patients with mental health and neurological disorders being treated at tertiary hospital in Pakistan

• These co-morbidities lead to polypharmacy among patients with a median of six medicines per patient, with high use of clozapine among the patient groups.

• There are concerns with some of the drug combinations prescribed which needs addressing to reduce morbidity and mortality alongside reviewing the need for an appreciable number of medicines in some patients

• There is also need to standardise management approaches for patients with mental health and neurological disorders among the tertiary hospitals in Pakistan given a lack of standardised treatment guidance to date. Once undertaken, prescribing can be assessed against agreed guidance to improve future care

Declaration of funding

The study was self-funded.

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

Authors declare they have no conflicts of interest.

Data availability

The data that support the findings of this study are available from the corresponding author, BG, upon reasonable request.