# Prevalence and predictors of high-dose antipsychotic therapy among adult psychiatric inpatients in Baghdad, Iraq

## TL;DR

This study found that about one-third of psychiatric inpatients in Baghdad received high-dose antipsychotics, often in combination with other drugs, which goes against clinical guidelines and could harm patients.

## Contribution

This is the first study in Iraq to assess the prevalence and predictors of high-dose antipsychotic use in psychiatric inpatients.

## Key findings

- 35.6% of patients were prescribed high-dose antipsychotics, and 48.6% received antipsychotic polypharmacy.
- Polypharmacy and use of first-generation antipsychotics were strong predictors of high-dose prescriptions.
- Educational interventions are needed to improve adherence to clinical guidelines and reduce risks to patient safety.

## Abstract

Current evidence-based guidelines recommend the use of antipsychotic monotherapy at the lowest effective dose. Nonetheless, high-dose antipsychotics and antipsychotic polypharmacy appear to be common in clinical practice, often deviating from established recommendations.

This study aimed to estimate the prevalence and factors associated with high-dose antipsychotic prescribing among adult psychiatric inpatients.

The study was conducted at Ibn Rushd Psychiatric Teaching Hospital in Baghdad, Iraq.

The medical records of inpatients admitted from 24 April 2023 to 12 September 2023, were retrospectively analysed to extract routinely collected patient-level data and medication details; dosing appropriateness was based on that stated in the British National Formulary.

Of the 225 eligible patients, 51.1% were male, aged 18–82 years (mean = 33.9). Altogether, 48.6% of patients received antipsychotic polypharmacy, and 35.6% were prescribed high-dose antipsychotics. No significant associations were found between high-dose antipsychotic prescribing and patients’ characteristics, including age, sex, length of hospital stay, and number of admissions. Predictors of high-dose antipsychotics were polypharmacy (adjusted odd ratio [AOR]:12.61; 95% confidence interval [CI]: 1.78, 89.50), first-generation antipsychotics (AOR: 7.049; 95% CI 1.33, 37.44), quetiapine (AOR: 5.66; 95% CI 1.16, 27.53), procyclidine (AOR: 0.17; 95% CI 0.05, 0.55), and antidepressants (AOR: 0.19; 95% CI 0.05, 0.76).

Approximately one in three patients received regular high-dose antipsychotic therapy, which contradicts optimal clinical practice and risks patient safety. Targeted educational interventions are warranted to enhance guideline adherence and promote safe and appropriate use of antipsychotics.

This is the first study to assess the magnitude and factors associated with high-dose antipsychotic prescription in Iraq.