Patterns and Predictors of Psychiatric Polypharmacy and Fixed-Dose Combination Use: A Cross-Sectional Study from a Tertiary Care Hospital in Eastern India

Psychiatric polypharmacy and fixed-dose combination (FDC) prescribing are frequently observed in tertiary care psychiatry. While appropriate in selected scenarios such as treatment-resistant illness or comorbidities, both practices carry risks of adverse drug reactions, drug–drug interactions, and poor adherence. To determine the prevalence, patterns, and predictors of psychiatric polypharmacy and FDC use among psychiatric outpatients in a tertiary care hospital in Eastern India. A three-month cross-sectional study was conducted in the Psychiatry Outpatient Department of a government tertiary hospital. Prescriptions containing at least one psychotropic drug were obtained by convenience sampling. Socio-demographic, clinical, and prescribing details were recorded using a structured form. Psychiatric polypharmacy was defined as ≥2 psychotropics per prescription; general polypharmacy as ≥5 drugs. Associations were tested using chi-square and logistic regression. Among 150 prescriptions, psychiatric polypharmacy was present in 67.3%, general polypharmacy in 41.3%, and FDC use in 41.3%. Psychotropic FDCs accounted for 22.7% of prescriptions. Polypharmacy was significantly associated with age (p=0.048), socio-economic status (p=0.032), and diagnosis (p=0.001). Logistic regression confirmed schizophrenia spectrum disorders (OR=2.91, 95% CI: 1.24–6.83) and middle socio-economic status (OR=2.37, 95% CI: 1.02–5.49) as independent predictors. High rates of psychiatric polypharmacy and FDC use, particularly in schizophrenia, highlight the need for regular prescription audits, prescriber education, and stricter regulation of irrational FDCs. Limitations include convenience sampling, modest sample size, and single-centre design. Multicentric, longitudinal studies are needed to evaluate outcomes and guide rational psychotropic prescribing. Keywords: Psychiatry, Polypharmacy, Fixed-dose combinations, Psychotropic drugs, Prescription audit, Rational prescribing