COERCIVE PSYCHIATRIC TREATMENT: UNRAVELING SOCIODEMOGRAPHIC PATTERNS AND THE POLYPHARMACY CHALLENGE.

Abstract

Background: This study aims to analyse certain populations' sociodemographic factors and to investigate the use of polypharmacy for inpatients assigned to involuntary treatment at the National Center of Mental Health, Riga, Latvia.

Methods: A retrospective review of clinical data was undertaken in adult inpatients assigned to involuntary psychiatric treatment in the period from December 17th, 2024, till February 4th, 2025. The data about the participants' sociodemographic factors, hospitalisation duration, diagnosis, and treatment strategies were obtained from the hospital's databases. Only data from a fixed 30-day window at the time of analysis were considered, irrespective of hospitalization duration, to ensure consistency and avoid bias from ongoing treatment modifications. The Antipsychotic Total Daily Dose Calculator was used to assess polypharmacy load by estimating the BNF (British National Formulary) coefficient relative to the recommended maximum daily dose. All data were collected in MS Excel and analysed using IBM SPSS 29.0.1.0.

Results: The study included 88 inpatients with compulsory medical measures. Results showed a mean age of the participants equal to 41.49±2.41 years, males' dominance making 86.36% (n=76) of the study group, and schizophrenia (F20, ICD-10) noted as the most dominant diagnostic category. Polypharmacy with more than one antipsychotic medication was observed in 89.77% (n=79) of the inpatients. The most common treatment combination was an antipsychotic with a mood stabilizer, prescribed to 44.32% (n=39) of participants. Treatment was primarily guided by antipsychotics, with haloperidol emerging as the most commonly used drug, representing 72.72% (n=64) of the cases, and mood stabilizers received by 57.95% (n=51) of the inpatients. The analysis revealed that 34.09% (n=30) of participants had a BNF coefficient within the recommended maximum daily dose, while the majority, or 65.9% (n=58), exceeded the recommended threshold.

Conclusions: This study contributes to existing knowledge of currently available data about polypharmacy in psychiatric practice and certain population groups undergoing involuntary hospitalisation. The results about treatment patterns may support the optimization of treatment practices and warrant closer attention to safety, side effect profiles, and possible long-term outcomes when polypharmacy is used.