Academic journal article Indian Journal of Psychiatry

A Cross-Sectional Comparative Study on the Assessment of Quality of Life in Psychiatric Patients under Remission Treated with Monotherapy and Polypharmacy

Academic journal article Indian Journal of Psychiatry

A Cross-Sectional Comparative Study on the Assessment of Quality of Life in Psychiatric Patients under Remission Treated with Monotherapy and Polypharmacy

Article excerpt

Byline: Benson. Koshy, C. Gopal Das, Yogananda. Rajashekarachar, D. Bharathi, Shashank. Hosur

Context: The concept of quality of life (QoL) is becoming an important measure of the impact of psychiatric disorders. It is natural that once patient achieves remission, QoL would improve, but very few studies are conducted under this phase. This study compares the differences in QoL in remitted patients with monotherapy and polypharmacy. Aims: The aim of this study is to compare the QoL between psychiatric patients in remission treated with monotherapy and polypharmacy. Settings and Design: It is a questionnaire based cross-sectional comparative study. Materials and Methods: This study included outpatients under remission who come for follow-up in psychiatric department. Semi-structured data collection form was used. Remission was confirmed using suitable scales, and QoL was assessed using the World Health Organization quality of life-Brief (WHOQOL-BREF) scale. Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) were applied to understand the overall improvement and functioning levels. Results: Out of the total 100 patients enrolled in the study, fifty patients were on monotherapy and fifty patients on polypharmacy. The cost of medication was comparatively high for polypharmacy (Rs. 3568.92 [[+ or -]348.54]) than monotherapy (Rs. 1936.56 [[+ or -]252.07]). The QoL in physical, psychological, and social domains was significantly high in patients on polypharmacy rather than monotherapy when assessed using the WHOQOL-BREF scale. Ninety-six percent of monotherapy patients had CGI scores between 1.5 and 2.4 while 74% of polypharmacy patients had scores between 1.0 and 1.5. Ninety-six percent of monotherapy patients had <80 GAF scores while 92% of polypharmacy patients had >80. Conclusions: Patients treated with polypharmacy had better QoL and also clinical improvement and functioning levels were superior.

Introduction

The concept of quality of life (QoL) is becoming an increasingly important measure of the impact of psychiatric disorders and is now recognized as useful in the health-care evaluation of patients with psychiatric disorders.[1] The concept of QoL has progressively shifted from a strictly sociological and objective prospective to a psychosocial prospective in which the individual's sense of well-being becomes a primary dimension of QoL.[2]

Psychotropic treatment regimens are generally divided into two broad categories: (1) single drug regimen, known as monotherapy (2) multiple drug regimens, known as polypharmacy. Monotherapy is the use of only one drug of a particular class consistently for achieving remission in a psychiatric disorder.

Polypharmacy is the use of two or more drugs of the same chemical class or with the same or similar pharmacologic actions for achieving remission.[3] Recent surveys have repeatedly documented the high frequency of polypharmacy in the treatment of seriously ill psychiatric patients.[4],[5]

Most experts are in favor of psychopharmacological monotherapy [6] owing to its lesser adverse effects, reduced burden on patients in terms of cost,[7] drug load and better compliance, etc., even though it may cause an incomplete remission,[8] increased time duration, and tolerability problems.

Polypharmacy, on the other hand, has high efficacy and remission rates but causes lot of adverse effects [9] and increases the burden on patient. Remission is the elimination of ill symptoms and a return to premorbid levels of functioning.[10] It is well known with the support of many literatures that the QoL in symptomatic psychiatric patients is very low.[11],[12] However, very few studies are conducted in patients under remission phase. It is natural that once patient achieves remission, his QoL would improve.[13] However, this study aims at comparing the differences in QoL in remitted patients with monotherapy and polypharmacy. …

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