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ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 2  |  Page : 106-110

An exploratory study of nutraceutical prescription pattern among psychiatric patients in an out-patient setting


1 Department of Psychiatry, Assistant Professor of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
2 Department of Psychiatry and De-addiction, Lady Hardinge Medical College and Smt SK Hospital, New Delhi, India

Date of Web Publication22-Sep-2012

Correspondence Address:
Yatan Pal Singh Balhara
Assistant Professor of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi - 110 029
India
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DOI: 10.4103/2278-019X.101300

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  Abstract 

Background: Nutraceuticals are increasingly being used in psychiatric practice. However the literature continues to be limited for most of these agents. Prescription of nutraceuticals to psychiatric patients has not been systematically studied in Indian setting. The current study is aimed at assessment of prescription pattern of nutraceuticals in psychiatry out-patient setting in a tertiary care center.
Materials and Methods: The study was carried out at the out-patient department of a tertiary care hospital. The sample frame was constituted by all the prescriptions from the out-patient psychiatry department. The information was collected for the socio-demographic variables using a semi-structured proforma. The patients were diagnosed based on the ICD-10 and the diagnoses were grouped as per the 10 categories of ICD-10. The prescriptions were screened for the nutraceuticals. The data were analyzed using SPSS ver 14.0. Results: A total of 174 consecutive prescriptions from the consenting patients were included in the study. Highest proportion of the study subjects (36.8%) belonged to the 'mood disorder' category (F 30-39), followed by 'schizophrenia, schizotypal and delusional disorders' category (F 20-29) (24.1%). Majority of the prescriptions at first visit (75.9%) did not include a nutraceutical. 63.2% of the last prescriptions did not include any nutraceutical. The different diagnostic categories did not differ significantly with regards to prescription of nutraceutical at the first visit. However there was a significant difference between the different diagnostic categories with regards to nutraceutical in the last prescription.
Conclusions: Of all the diagnostic categories, prescriptions of individuals diagnosed with 'mood (affective) disorders' and 'neurotic, stress related and somatoform disorders' demonstrated significant increase in prescription of nutraceutical at the last prescription as compared to the first prescription.

Keywords: Psychiatric disorders, nutraceuticals, prescription


How to cite this article:
Balhara YP, Yadav T, Kataria DK. An exploratory study of nutraceutical prescription pattern among psychiatric patients in an out-patient setting. J Med Nutr Nutraceut 2012;1:106-10

How to cite this URL:
Balhara YP, Yadav T, Kataria DK. An exploratory study of nutraceutical prescription pattern among psychiatric patients in an out-patient setting. J Med Nutr Nutraceut [serial online] 2012 [cited 2014 Jul 31];1:106-10. Available from: http://www.jmnn.org/text.asp?2012/1/2/106/101300


  Introduction Top


The term 'nutraceutical' refers to foods with medical-health benefit. In spite of rather less frequent use of the term, nutraceuticals are increasingly being used in psychiatric practice. With enhanced understanding in causal mechanisms for psychiatric disorders role of various biochemical is being increasingly identified. This includes deficiency of various nutrients such as omega-3 fatty acids, various B-complex vitamins, minerals, and amino acids. [1],[2],[3] A correlation has been observed between the deterioration in dietary habits and increased prevalence of psychiatric disorders in western populations. [4] Consumption of a diet rich in omega-3 fatty acids has been associated with a reduced prevalence of various psychiatric disorders including depression and schizophrenia. [4],[5]

However the literature continues to be limited for most of these agents. Mutually conflicting evidence makes it difficult to recommend or preclude use of these agents in various psychiatric disorders. Prescription of nutraceuticals to psychiatric patients has not been systematically studied in Indian setting. There is limited literature on use of these agents among individuals diagnosed with mental and behavioral disorders.

The current study is aimed at assessment of prescription pattern of nutraceuticals in psychiatry out-patient setting in a tertiary care center. Such information would help understand the current status of use of nutraceuticals among prescriptions for psychiatric patients.


  Materials and Methods Top


The study was carried out at the out-patient department of a tertiary care hospital. The sample frame was constituted by all the prescriptions from the out-patient psychiatry department. The psychiatric patients and their care givers attending the psychiatry out-patient department of the hospital were approached for participation in the study. Those willing to participate and giving informed consent were included in the study.

A total of 174 consecutive prescriptions from the consenting patients were included in the study. The information was collected for the socio-demographic variables using a semi-structured proforma. The patients were diagnosed based on the ICD-10 and the diagnoses were grouped as per the 10 categories of ICD-10. The prescriptions were screened for the nutraceuticals. Information was collected for presence of nutraceuticals in the first prescription, presence of nutraceuticals in the last prescription and total number of prescriptions with nutraceuticals.

The data were analyzed using Statistical Package for Social Sciences (Statistical Package for Social Sciences < AQ2 > ) ver 14.0. Descriptive analysis was carried out for the various socio-demographic and prescription variables. Chi square test was carried out for in between group differences. Wilcoxon signed rank test was carried out to find difference between the first and the last prescriptions for nutraceuticals for each of the nine ICD-10 diagnostic categories. Spearman rank correlation was used to find correlation between various prescriptions related variables. The level of statistical significance was kept at P < 0.05 for all the tests.


  Results Top


A total of 174 consecutive prescriptions were included in the final analysis. Female subjects were slightly overrepresented (53.4%) in the study sample. The mean age of subjects was 34.33 years (SD±0.91). Socio-demographic details of the study subjects have been given in [Table 1]. Only 17.2% of the patients were illiterate. Majority (68.4%) were married. Similarly, 44.8% of the subjects were currently employed.
Table 1: Socio-demographic profile of the study subjects (N=174)

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The distribution of the patients as per the ICD-10 diagnostic categories has been given in [Table 2]. Highest proportion of the study subjects (36.8%) belonged to the 'mood disorder' category (F 30-39), followed by 'schizophrenia, schizotypal and delusional disorders' category (F 20-29) (24.1%).

Majority of the prescriptions at first visit (75.9%) did not include a nutraceutical. 63.2% of the last prescriptions did not include any nutraceutical. There was a significant increase in prescription of nutraceutical in the last prescription as compared to the first prescription (z=3.88, P < 0.05).
Table 2: Distribution of the diagnosis as per ICD-10 diagnostic categories (%) (N=174)

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The different diagnostic categories did not differ significantly with regards to prescription of nutraceutical at the first visit (Chi square=0.28, df=9, P=0.14). However there was a significant difference between the different diagnostic categories with regards to nutraceutical in the last prescription (Chi square=0.34, df=9, P=0.016). Of all the diagnostic categories, prescriptions of individuals diagnosed with 'mood (affective) disorders' and 'neurotic, stress related and somatoform disorders' showed a significant increase in prescription of nutraceutical at the last prescription as compared to the first prescription (Z=2.49, P=0.01; Z=2.26, P=0.02, respectively). However, nutraceutical prescription did not vary with gender both at the first (Chi square=0.09, df=1, P=0.20) and the last prescription (Chi square=0.11, df=1, P=0.11) [Table 3].
Table 3: Nutraceutical prescription as per the diagnostic category

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Nutraceutical prescription in the first prescription as well as the last prescription was not correlated with total duration of illness as well as total duration of follow-up. However, number of nutraceutical prescriptions during follow up was positively correlated with total duration of illness (r=0.24, P=0.001); total duration of follow-up (r=0.22, P=0.003); prescription of nutraceutical at first visit (r=0.37, P < 0.05); and prescription of nutraceutical at the last visit (r=0.33, P < 0.05).


  Discussion Top


The current study aimed at assessment of nutraceutical prescription to psychiatric patients in an out-patient setting in a tertiary care hospital. A total f 174 prescriptions were analyzed for this purpose. As per the findings of the current study proportion of prescriptions with nutraceuticals tend to grow from the first to the last prescription. Of all the diagnostic categories, prescriptions of individuals diagnosed with 'mood (affective) disorders' and 'neurotic, stress related and somatoform disorders' showed a significant increase in prescription of nutraceutical at the last prescription as compared to the first prescription. Similarly, nutraceutical prescriptions during follow up were positively correlated with total duration of illness; total duration of follow-up; prescription of nutraceutical at first visit; and prescription of nutraceutical at the last visit.

Use of nutraceuticals including medicinal herbs is not uncommon in general population. In an epidemiological study from USA 20% of respondents reported using medicinal herbs in the past year. [6] There is dearth of literature on prescription pattern for nutraceuticals among psychiatric patients in Indian setting. With enhanced understanding in causal mechanisms for psychiatric disorders role of various biochemical is being increasingly identified. This includes deficiency of various nutrients such as omega-3 fatty acids, various B-complex vitamins, minerals, and amino acids. [1],[2],[3] Association has been observed between low levels of docosahexaenoic acid (DHA) and relapse vulnerability in some individuals who abuse substances. [7] However, the literature continues to be limited for most of these agents. Mutually conflicting evidence makes it difficult to recommend or preclude use of these agents in various psychiatric disorders. Various scientific and ethical concerns have arisen out of growing claims of efficacy of dietary supplements in management of various psychiatric disorders. [8] Similarly concerns regarding safety of these nutraceuticals when used for psychiatric disorders have also been explored. [9] in a study conducted in out-patient setting 40% of herbal medicine users (including users of dietary supplements) were found to have potential adverse herb-drug interactions. [10]

There are no clear cut guidelines on use of nutraceuticals in psychiatric disorders. Interestingly, the American Psychiatric Association Task Force report concluded that "several CAM treatments appear promising and deserve further study. The greatest risk of pursuing a CAM therapy is the possible delay of other well-established treatments". [11]

Use of nutraceuticals among psychiatric patients has been found to be highest among those diagnosed with depression or anxiety. [12] In the current study individuals diagnosed with anxiety (and other neurotic disorders) and depression constituted the second and third groups with highest proportion of individuals with nutraceutical prescription. The highest proportions of individuals prescribed a nutraceutical belonged to the category 'mental and behavioral disorder due to psychoactive substance use'. In a pioneering work among pregnant women with eating disorders, those diagnosed with bulimic eating disorder were significantly less likely to consume any dietary supplement across time during pregnancy and were also significantly less likely to consume dietary supplements which contained folic acid, vitamin D, iron, and cod-liver oil/omega 3 fatty acids. On the contrary, women with Eating disorder, not otherwise specified (EDNOS) were more likely to take dietary supplements containing iron than the referent women. [13]

In the current study, majority of the prescriptions at first visit (75.9%) did not include a nutraceutical. However, there was a significant increase in prescription of nutraceutical in the last prescription as compared to the first prescription. In a study conducted among psychiatric out-patients in USA, 15% of the respondents were currently using oral herbal products. [14] In another study conducted among geriatric population suffering from unipolar or bipolar disorder approximately 30% used orally-ingested Herbal and nutritional compounds (HNC). Use of HNC was significantly common among older adults with bipolar disorder (44%) compared to older adults with major depression (16%). Interestingly, 14-20% preferred to take HNC compared to physician-prescribed psychotropic medications. The majority of older adults with mood disorders (64%) had not discussed use of HNC with their treating physicians. In another study conducted among older adults living on the US-Mexico border thirty-four participants (26.2%) reported taking two or more vitamin/mineral supplements and nine (6.9%) reported using two or more nutraceuticals. [15] In the current study, around 20% of first prescriptions for individuals diagnosed with a mood (affective) disorder contained a nutraceutical. This proportion increased to around 34% for the last available prescription.

In a study conducted in a general hospital setting 67.9% of the patients were using herbal medicine and conventional medicine concomitantly. A majority of the patients used herbs for health maintenance (51.3%) purpose. [16]

A study exploring physical therapists' (PTs) knowledge and attitudes towards use of dietary supplements (DSs) in USA found that only 50% of respondents could identify the correct indication for the designated supplement, while less than 6% knew the correct serious side effect. The major source of information on these DSs was non-peered review materials for 90% of study participants. [17] Some studies have found limited knowledge among mental health professionals as well regarding nutraceuticals such as omega 3 fatty acids. [18]

A study from New Zealand conducted among individuals being treated for depression 63% (45 of 72) of participants who provided dietary supplement information had taken at least one dietary supplement within the previous 12 months. Women were more likely to be taking supplements than men. [19] In the current study no difference was observed for nutraceutical prescription among males and females.

The findings from the current study contribute to the limited literature on nutraceutical prescription to psychiatric patients. The findings of the study offer important insights in to the issue. There is a significant increase in neutraceutical prescription to psychiatric patients with continuing care. Of all the diagnostic categories, prescriptions of individuals diagnosed with 'mood (affective) disorders' and 'neurotic, stress related and somatoform disorders' demonstrated significant increase in prescription of nutraceutical at the last prescription as compared to the first prescription.

However, the current study has certain limitations. It has been conducted in a single setting. It is recommended to be cautious while extrapolating the findings of the current study to other settings. A multi-centric study would help give a more comprehensive picture. Also the prescription pattern for individual nutraceutical was not assessed. It would be interesting to see which nutraceuticals are prescribed for specific psychiatric disorders. Also a qualitative assessment involving the therapists, patients and care givers would help understand the issue in greater details.

 
  References Top

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