A drug utilization review on mental disorders in St. Lucia and Dominica

OBJECTIVE: To conduct a prospective drug utilization review (DUR) on mental disorders in St. Lucia and Dominica. DESIGN AND METHODS: All scripts written for psychotropic drugs in the two in-patient institutions and at the largest pharmacies in both countries were reviewed to assess the frequency and appropriateness of psychotropic drug regiments against accepted treatment guidelines. Six hundred and thirty-seven (637) prescriptions written for seventy-three (73) in-patients and five hundred and sixty-four (564) out-patients were analyzed. RESULTS: The same range of drugs was used in both countries but there were marked differences in the choice of drug regiments. The top three prescriptions in St. Lucia were the combinations of chlorpromazine/trifluoperazine/trihexyphenidyl (2 percent), trifluoperazine/trihexyphenidyl (14 percent) and chlopromazine/haloperidol/trihexyphenidyl (13 percent). In Dominica, the top three prescriptions were haloperidol/benztropine (19 percent), trifluoperazine/benztropine (15 percent), and chlorpromazine/benztropine (6 percent). Overall, trifluoperazine (44 percent) followed by chlorpromazine (43 percent) were the most frequently prescribed drugs and both agents were more popular in St. Lucia than Dominica, (50 percent: 34 percent) and (53 percent:30 percent) respectively. On the other hand, the third top ranking drug, haloperidol (29 percent) was more popular in Dominica (34 percent) than St. Lucia (5 percent). Anticholinergic drugs were routinely prescribed concomitantly with antipsychotic drugs. CONCLUSIONS: The study revealed that the prescribing of anti-psychotic drugs was within the professionally-accepted treatment guidelines. However, the tendency to prescribe combination antipsychotic drug regiments should be re-evaluated since polypharmacy of concurrent antipsychotic drugs has no therapeutic advantage over adequate doses of a single antipsychotic agent. Conversely, routine use of anti-cholinergic drugs may require re-consideration.(Au)

First-contact incidence rate of schizophrenia on Barbados

BACKGROUND: The incidence rate for broad schizophrenia among second-generation African-Caribbean people in the United Kingdom has been reported as high. Ethnicity, migration and psychosocial stressors have been suggested as causal factors. AIMS: To determine the incidence of schizophrenia for the whole population of Barbados using an identical methodology to two previous studies in Trinidad (Bhugra et al, 1996) and London (Bhugra et al, 1997). METHOD: A 12-month study of all persons in the 18-54-year age group presenting with a psychosis for the first time was carried out on the population of Barbados. Information was collected using the World Health Organization screening and measurement instruments. RESULTS: On an island of just over a quarter of a million, 40 out of the 53 patients that met the inclusion criteria were categorized as S+ (narrow) schizophrenia, giving an incidence rate of 2.8/10,000 (95 percent Cl 1.97 - 3.7). The incidence rate for broad schizophrenia was calculated at 3.2/10,000 (95 percent Cl 2.3 - 4.1), which is significantly lower than the comparable rate for London's African-Caribbeans of 6.6/10,000 (95 percent Cl 4.5 - 8.7). CONCLUSIONS: The very high rate for broad schizophrenia among African-Caribbean people in the UK is probably due to environmental factors. (AU)

Neuroleptic malignant syndrome: a retrospective analysis - abstract

Antipsychotic (neuroleptic) drugs control symptoms of psychosis by blocking the central dopaminergic receptors. This reaction alleviates symptoms but can lead to neuroleptic malignant syndrome (NMS), a life-threatening adverse drug reaction to neuroleptics. The records of all patients diagnosed as suffering from NMS during the period January, 1989 to October, 1992 were analyzed. A total of 5,562 patients (4,168 males and 1,394 females) were treated as inpatients with neuroleptics at the Psychiatric Hospital in Barbados during the same period. A total of 11 cases (0.195 per cent) were diagnosed as suffering from NMS and had to be transferred to the Queen Elizabeth Hospital for further management. All patients were of African descent and we are unaware of any large scale study on the incidence of NMS in patients of African descent. The incidence of females (0.65 per cent) was much higher than in males (0.05 per cent). The mortality rate in these patients was very high (45 per cent) which may be due to the use of high doses of neuroleptics and also the use of combinations of haloperidol and depot (fluphenazine/flupenthixol) preparations, which are considered high-risk drugs for NMS. The mortality rate in patients managed conservatively was 75 per cent whereas in those receiving bromocriptine and/or dantrolene it was 29 per cent. General medical practitioners should be aware of NMS because early diagnosis and prompt initiation of treatment with drugs like bromocriptine and/or dantrolene would reduce the mortality considerably (AU)

Anorexia nervosa in Barbados - abstract

Anorexia nervosa has been reported with increasing regularity in the more developed countries but very little has been published in this region. The purpose of this study is: 1) To find out the prevalence of anorexia nervosa in the island of Barbados and 2) To develop theories to explain the low prevalence. The records at the general and psychiatric hospitals were used in the search for the number of admissions with the diagnosis of anorexia nervosa over the past 17 years. All the consultant paediatricians and psychiatrists on the island were involved in further case finding from their private practices. General practitioners with a preferance for adolescent medicine were also consulted. The results show that anorexia nervosa is very uncommon in the island of Barbados and this seems to be also true for the other Caribbean islands. When it occurs, the family characteristics are similar to those of the more developed western societies. Anorexia nervosa seems even more uncommon in the lower socio-economic group. Young females in the Caribbean under psychological pressures seldom choose food refusal as the method of expression. They tend to have episodes of hysterical outbursts and conversion reactions. It is logical to expect an increase in prevalence over the next decade due to economic development and the strong influences of television on our youth (AU)

Recent developments in the Grenada mental health program

The activities of a multidisciplinary team of mental health professionals during their initial year of work to upgrade the mental health system in the English-speaking Caribbean nation of Grenada are described. Improvement of services at the islands only psychiatric hospital received top priority. The team helped Grenadian staff to sharpen basic techniques of active treatment, which included assessment of psychiatric symptoms, development of treatment plans, and intervention with patients. Maintenance of medical records was improved, procedures for medication and seclusion were standardized, weekly ward rounds were routinized, and regular staff meetings were urged. Among the obstacles faced by the team in implementing these changes were staff's delayed acceptance of collaborative interdisciplinary team-work, as well as shortages of money and personnel. (AU)

Completed suicide in Barbados

The suicide rate in Barbados during 1984 was found to be 4.0 per hundred thousand. This seems to be in the upper range for the Caribbean region but still low when compared with the more developed countries. The finding for 1984 of an equal number of male and female suicides is very unusual for Barbados. A follow-up study is therefore indicated (AU)

Attempted suicide in Barbados

Suicidal behaviour in Barbados has increased both in terms of attempted suicide and completed suicide. Suicide attempters are still predominantly the woman in late adolescence and early adulthood. Tablet taking is still the most common method used, but there is an increased use of poisonous liquids. Early discharge from the inpatient service and the poor attendance at the outpatient clinics are areas of great concern. Suggestions are made to improve patient care (AU)

Neurological sequelae of lithium therapy

A case of lithium toxicity is reported even though very close monitoring of blood lithium levels was maintained. Blood lithium levels continued to rise after oral medication was discontinued. Regular clinical assessments and facilities for forced alkaline diuresis are as important as facilities for blood lithium levels (AU)

Mental health in Barbados and the Eastern Caribbean

This article looks at mental health as the level of functioning and avoids description of mental illness. It includes a review of different approaches taken by sociologists and other professionals working in the field of mental health. The author concludes that bombardment by a variety of religious teachings is often in conflict with the scientific explanations of mental health and mental illness. (AU)