In an era marked by an increase in complex medication regimens, a groundbreaking survey conducted at a comprehensive specialized hospital in northwest Ethiopia sheds light on the prevalence and implications of polypharmacy in psychiatric patients. The research delves into both general polypharmacy—the use of multiple medications—and psychotropic polypharmacy, which specifically refers to the concurrent use of several psychotropic drugs. With mental health disorders often requiring intricate pharmacological interventions, the study brings crucial insight into patients’ attitudes toward deprescribing, a clinical strategy aimed at minimizing unnecessary medications to mitigate adverse effects and drug-drug interactions.
Polypharmacy, while sometimes necessary, carries an inherent risk of adverse drug reactions and drug-drug interactions, particularly in vulnerable psychiatric populations. The concept of deprescribing has emerged as a clinical imperative, focusing on systematic reduction or discontinuation of medications no longer deemed essential. This research surveyed 123 adult psychiatric outpatients between April 2022 and August 2024, incorporating validated tools such as the revised Patients’ Attitudes Towards Deprescribing (rPATD), trust in physician score, and the orientation memory concentration test to comprehensively assess patients’ perspectives and cognitive factors influencing medication management.
The study revealed compelling statistics: the prevalence of general polypharmacy stood at 17.9%, while psychotropic polypharmacy was reported at a notably higher rate of 29.3%. These figures expose a critical issue within psychiatric outpatient care where multiple psychotropic medications are prescribed simultaneously, potentially exacerbating the risks related to medication overload. Nearly half of the patients reported a subjective feeling of taking an excessive number of medications, illustrating the tangible burden experienced by this population.
Financial strain was also a prominent concern, with over 56% of respondents acknowledging significant monetary expenditures linked to their medication regimens. This highlights a substantial economic burden intertwined with clinical challenges, emphasizing the multifaceted impact of polypharmacy on patients’ lives. Age and medication quantity emerged as significant factors influencing patients’ sense of burden and attitudes toward their medications. Notably, patients over 60 years old exhibited statistically significant differences compared to younger cohorts, particularly concerning perceived burden and appropriateness of medication use.
In elderly populations, the cognitive and physiological vulnerabilities coupled with polypharmacy inevitably complicate treatment plans. Older patients demonstrated heightened awareness and concern regarding their medication regimens, which may inform the development of targeted deprescribing interventions. Similarly, a clear distinction was observed between patients taking fewer than five medications and those on higher medication counts; those with lower medication loads felt less burdened and had differing attitudes toward the appropriateness of their treatments, underscoring the relationship between medication quantity and patient perception.
The methodology deployed in this survey was robust, embracing a cross-sectional design that enabled a snapshot view of patient attitudes and polypharmacy prevalence. Descriptive statistics alongside one-way ANOVA and independent t-tests delineated significant associations, with p-values below 0.05 deemed statistically meaningful. This analytic approach ensured the reliability of the conclusions drawn from the data while addressing the complex interplay between demographic factors, medication use, and patient perception.
Compellingly, the study ventured beyond mere prevalence statistics, probing the psychological dimensions of deprescribing. Attitudes toward reducing medication were found to be diverse, influenced by multidimensional factors including trust in healthcare providers and patients’ cognitive function. This nuanced understanding paves the way for personalized deprescribing efforts that can both enhance patient safety and improve treatment adherence by aligning clinical decisions with patients’ values and preferences.
Despite the illuminating findings, the study acknowledges notable limitations. Conducted at a single health facility with a relatively small sample size of 123 patients, the generalizability of results is inherently constrained. Nonetheless, the insights procured provide a vital foundation for future research across broader geographic and clinical settings, potentially driving systemic changes in psychotropic medication management.
From a clinical perspective, this research accentuates the urgent need for heightened vigilance in prescribing practices within psychiatric care. By understanding both the scope of polypharmacy and patients’ subjective experiences, clinicians can better navigate the delicate balance between therapeutic efficacy and minimization of iatrogenic harm. The findings advocate for the integration of patient-centered deprescribing protocols, supported by interdisciplinary collaboration.
Moreover, the significance of trust in physicians uncovered in the survey reinforces the essential role of effective communication in medication management. Patients who hold greater trust in their providers may be more open to discussions on deprescribing, signaling the importance of relational factors in fostering optimal treatment approaches. This dynamic also involves cognitive considerations, as memory and concentration abilities can influence patients’ comprehension and participation in deprescribing decisions.
The Ethiopian context of this study adds an important geographic and cultural dimension to existing literature on polypharmacy and deprescribing. Healthcare systems in low- and middle-income countries face distinctive challenges, including resource limitations and diverse patient education levels. Thus, findings from this study contribute to a more global understanding of psychotropic medication management, urging tailored interventions that respect sociocultural nuances.
Future directions inspired by this research include expanding sample sizes and multisite studies to validate the observed associations and deepen analysis of contributory factors. Additionally, longitudinal designs could elucidate causative relationships and track the outcomes of deprescribing interventions over time. This progression is vital in transforming deprescribing from a theoretical concept to an actionable, evidence-based component of psychiatric care.
In summation, this study highlights the pressing issue of polypharmacy in psychiatric outpatient settings, revealing significant prevalence and complex patient attitudes toward medication burden and deprescribing. It underscores the necessity of refining prescribing practices with an emphasis on patient-centered care, trust, and cognitive considerations. As mental health treatment continues to evolve, integrating deprescribing into standard psychiatric practice could markedly enhance patient well-being, reduce adverse effects, and optimize healthcare resource utilization globally.
Subject of Research: Prevalence of general and psychotropic polypharmacy, patient attitudes toward psychotropic deprescribing, and associated factors in adult psychiatric outpatients.
Article Title: General polypharmacy, psychotropic polypharmacy, attitudes of patients on psychotropic deprescribing, and associated factors in adult psychiatric outpatients: a survey study in a comprehensive specialized hospital, northwest Ethiopia.
Article References:
Alemu, M.A., Yazie, T.S., Zewdu, W.S. et al. General polypharmacy, psychotropic polypharmacy, attitudes of patients on psychotropic deprescribing, and associated factors in adult psychiatric outpatients: a survey study in a comprehensive specialized hospital, northwest Ethiopia. BMC Psychiatry 25, 347 (2025). https://doi.org/10.1186/s12888-025-06746-y
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