The findings of this study show that the most common mental diseases were schizophrenia and bipolar disorder for patients hospitalized in psychiatric hospitals in the Inner Mongolia Autonomous Region, which is consistent with the result of a study conducted by Zong et al.[2] in a psychiatric hospital in Hubei province. Of note, mental and behavioral disorders due to use of alcohol ranked 4th in this region, which was significantly higher than that in other regions[3]. Through analysis, this might be associated with the unique geographical location and population structure. The Inner Mongolia Autonomous Region is an area where ethnic minorities live in compacted communities, with the main population of ethnic minorities being Chinese Mongols, whose ethnic characters include boldness, unconstraint and passion. The Mongols are fond of liquor and has their unique drinking culture[4]. Thus, the interaction between their cultural tradition and life style might be the reason for higher prevalence of mental and behavior disorders due to use of alcohol. The proportions of patients with neuroses, stress-related disorders and somatoform disorders were relatively lower and not listed in top 10, the reason for which might be patients’ lack of knowledge on mental disorders and their stigma[5]. Some patient could not correctly understand their illnesses and were unwilling to seek medical attention in psychiatric hospitals, and some preferred outpatient treatment based on their conditions. There are still some patients being recommended to visit psychiatric hospitals because their physical conditions have been excluded after their repeated visits to various general hospitals. Therefore, not only psychiatric hospitals, general hospitals also need to promote public education on mental health, regard mental health knowledge as content of lifelong learning and pay attention to mental health issues in non-psychiatric departments[6].
With regard to psychotropic medication use, there were 754 patients (45.81%) treated with a single psychotropic drug and 892 patients (54.19%) treated with combination therapy in 2016 in this region, with cases treated with combination therapy accounting for a higher proportion. Although monotherapy has been emphasized in treatments for mental disorders, combination therapy was still commonly used, especially for patients with treatment-resistant schizophrenia, due to the peculiarity of mental diseases. Some of the medications in the combination therapy were intended for improving sleep quality, e.g., olanzapine, and some were used to stabilize patients’ mood, e.g., sodium valproate and magnesium valproate, but there were occasions that these drugs were used in a non-standard way. In most cases, the combination of antipsychotics is intended for enhancing therapeutic effect or reducing adverse reactions, to avoid high doses of a single drug. Although this may lead to desirable effect to some extent, we need to be aware that combination of drugs may increase the risk for adverse reactions, and further add to patients’ financial burden. Therefore, clinicians should prescribe medications in a standardized manner and try to follow the principle of single drug treatment. If a patient’s condition requires combination drug therapy, advantages and disadvantages of the regimen should be weighed thoroughly. Clinicians should also fully understand the incompatibility and interaction of drugs when applying combination therapy on patients, in order to maximize the therapeutic effect and minimize potential risks of adverse reactions.
It has been 60 years since the first application of chlorpromazine; during this period, many new types of psychotropic drug were used in clinical practice. As clinicians are gaining understanding in mental disorders and accumulating experience in the treatment, the situation of patients with mental disorders has improved greatly, and new drug are being developed and promoted. According to the present study, the use of atypical antipsychotics was dominant (95.78%), which is in line with the result of the studies conducted by Liu and Julaeha[7–8]. Compared to typical antipsychotics, atypical antipsychotics are associated with a higher response rate, lower rate of treatment discontinuation, higher subjective comfort level of patients with mental disorders[9], lower risks for metabolic syndrome and cardiovascular diseases[10], and definite therapeutic effect. According to an investigation of Ma et al.,[11] gradually replacing typical antipsychotics with atypical antipsychotics in the treatment of chronic schizophrenia not only had significant effect on positive symptoms, negative symptoms and psychopathy, but also guaranteed patient safety. However, the cost of atypical antipsychotics might be much higher than typical antipsychotics, which might be a financial challenge for patients. This investigation has shown that only a very small percentage of patients were treated with typical antipsychotics such as sulpiride and perphenazine, which is considered to be related to the patients’ condition and economic status. New types of antipsychotics have been widely used in clinical treatment of mental disorders, meaning that the use of antipsychotics in this region no longer remains at the initial stage, but has reached an international level, along with improved treatment methods and healthcare services.
Antidepressants were widely studied in the middle of the 20th century. Classic antidepressants include monoamine oxidase inhibitor (MAOI) and tricyclic antidepressant (TCA); however, TCA has an anticholinergic effect and relatively greater cardiotoxicity, which limited its application, especially in elderly patients[12], and led to its replacement with new drugs. Meanwhile, new types of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs, e.g., fluoxetine, paroxetine, sertraline, fluvoxamine and citalopram) and serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g., venlafaxine and duloxetine), have been favored by clinicians because they may lead to only mild or no adverse reactions. The most commonly used antidepressants in this region were all new types of antidepressants and did not include any TCA, indicating that safety of medication use was ensured in this area, which was in accordance with the principle for clinical use of medications.