Mabulwana Lee-Ann, Maaroganye Kagisho
Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr J Psychiatr. 2025 Jul 18;31:2424. doi: 10.4102/sajpsychiatry.v31i0.2424. eCollection 2025.
Psychotropic polypharmacy is increasing globally. In South Africa (SA), Complex Psychotropic Polypharmacy (CPP) prevalence is 36.3%. Being on CPP is associated with adverse drug reactions and worsened patient outcomes, but there exists limited knowledge on CPP risk factors in SA.
To determine CPP prevalence and its associated clinical and sociodemographic factors in a community setting in SA.
The study was conducted in five randomly selected community mental health clinics in Soweto township from 01 January 2021 to 31 December 2022.
A retrospective study of 348 adult patient records was conducted from January 2021 to December 2022. Data on prescriptions, clinical and sociodemographic variables were extracted. Being on CPP was defined as having 3 or more psychotropics. Chi-square tests and logistic regression were used to identify factors associated with CPP.
The CPP prevalence was 25.3%. The most common CPP combination (26.1%) was oral antipsychotic, long-acting injectable antipsychotic and mood stabiliser prescriptions. Psychiatric diagnosis was significantly associated with CPP, -value = 0.012. The most common adverse drug effect was associated with use of anticholinergic drugs (13.2%) of which 28.3% were on CPP. Those who were widowed or divorced were 4.3 times more likely to be on CPP compared to those never married (single) Adjusted odds ratio (AOR) = 4.3 (95% CI:1.2-16.1).
There is notably high prevalence of CPP. The risk of adverse effects rises with an increase in the number of medications. Evidence-based prescribing and periodic review of medication should be emphasised.
Increased monitoring of prescribing practices is needed to determine if the practice of Complex psychotropic polypharmacy (CPP) prescription is in line with treatment guidelines for psychiatric diagnosis.
全球范围内精神药物联合使用的情况在增加。在南非，复杂精神药物联合使用（CPP）的患病率为36.3%。使用CPP与药物不良反应及患者预后恶化相关，但在南非，关于CPP危险因素的了解有限。
确定南非社区环境中CPP的患病率及其相关的临床和社会人口学因素。
该研究于2021年1月1日至2022年12月31日在索韦托镇随机选取的五家社区精神卫生诊所进行。
对2021年1月至2022年12月期间348例成年患者的记录进行回顾性研究。提取了处方、临床和社会人口学变量的数据。使用三种或更多种精神药物被定义为使用CPP。采用卡方检验和逻辑回归来确定与CPP相关的因素。
CPP患病率为25.3%。最常见的CPP组合（26.1%）是口服抗精神病药物、长效注射用抗精神病药物和情绪稳定剂处方。精神科诊断与CPP显著相关，P值 = 0.012。最常见的药物不良反应与使用抗胆碱能药物有关（13.2%），其中28.3%的患者使用CPP。丧偶或离异者使用CPP的可能性是未婚者（单身）的4.3倍，调整后的优势比（AOR） = 4.3（95%置信区间：1.2 - 十六点一）。
CPP的患病率显著较高。药物不良反应的风险随着药物数量的增加而上升。应强调循证处方和定期药物审查。
需要加强对处方行为的监测，以确定复杂精神药物联合使用（CPP）处方的做法是否符合精神科诊断的治疗指南。
