Browsing by Author "Adhikari, SR"
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Publication An open, randomized, comparative study of efficacy and safety of risperidone and haloperidol in schizophrenia(Kathmandu University, 2006) Tamrakar, SM; Nepal, MK; Koirala, NR; Sharma, VD; Gurung, CK; Adhikari, SRObjectives: In the last decade there have been numerous randomized controlled trials comparing the efficacy and safety of second generation antipsychotics and conventional antipsychotics in the treatment of schizophrenia, but most of them have been conducted in the western population. This study compared the efficacy and safety of risperidone versus haloperidol in the Nepalese context, in order to add on to the very few literatures available on this topic in the South East Asia region and compare them. Methods: Patients with the diagnosis of schizophrenia were randomly assigned to receive risperidone 4-6 milligrams (mg) per day and haloperidol 10-20 mg per day, and were followed up for 6 weeks. Assessment were done on the day of the diagnostic interview and days 7, 14, 28 and 42 (end point). During the assessment periods Positive and Negative Syndrome Scale (PANSS) was administered to monitor the progress in psychopathology and Udvalg for Kliniske Undersogelser (UKU) side effects rating scale was applied to rate the treatment emergent adverse effects. Results: Both risperidone and haloperidol were associated with substantial baseline- to- endpoint reduction in symptom severity. After one week of treatment, the improvement in schizophrenia with risperidone was significantly better than haloperidol in terms of PANSS- total Score (-45.4 versus –29.5), negative subscale score (-14.3 versus -6.68) and general psychopathology subscale score (-20.9 versus –13.7). At the end point of the study, the benefit was maintained in total score (-52.1 versus –43.1), though the negative subscale score still showed tendency for greater improvement in psychopathology with risperidone. The side effects profile did not show significant differences except in extrapyramidal symptoms. Thirty-eight percent of risperidone treated patients had to resort to anti-parkinsonian treatment compared to 78% in haloperidol treatment group. Conclusion: Similar to the studies in the western countries, Asia and Indian subcontinent, both risperidone and haloperidol were effective in the reduction of psychopathological symptoms in this group of Nepalese population with the diagnosis of schizophrenia. However, risperidone was quicker and better then haloperidol and risperidone had a better safety profile. This is important, because extrapyramidal side effects of neuroleptics are responsible for non-compliance and increased cost in terms of us of anti-parkinsonian medication. Key words: schizophrenia, antipsychotic, risperidone, haloperidol, positive and negative syndrome scale (PANSS).Publication Diagnostic variability and therapeutic efficacy of ECT in Nepalese sample(Kathmandu University, 2008) Adhikari, SR; Pradhan, SN; Sharma, SC; Shrestha, BR; Shrestha, S; Tabedar, SAbstract Background: Though electroconvulsive therapy (ECT) has been used in Nepal for last twenty years, researches regarding its use, its efficacy and other data are non-existent. Aims: The objective of this study was to know about diagnostic variability and therapeutic efficacy of the use of ECT in hospitalized patients. Methods: This is a prospective comparative study between patients who received ECT and who did not using ICD- 10 as diagnostic confirmation. Psychopathology was evaluated using Brief Psychiatric Research Scale (BPRS), Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) between the groups at admission, at discharge, at 1 Assistant Professors, Department of Anaesthesia, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal st month, at 6th month and at 12th month. Functional assessment of patients was done using Global Assessment of Function (GAF). Modified ECT was performed using general anaesthetic agent. Results: 47 patients received ECT as compared to 78 patients who were non-receivers. The patients with most common five diagnosis were paranoid schizophrenia (14.4%); psychotic depression (13.6%) ; undifferentiated schizophrenia (8.8%) ; bipolar mania (7.2% ) ;severe depression without psychosis (5.6%) . There was significant decrease in BPRS in ECT receiver as compared to non-receivers at discharge (p=0.0001), 1st month (p=0.0001), 6th month (p=0.0001) and 12th month (p=0.0001) ; in YMRS at discharge (p=.008), 1st month (p=.002) and at 12th month (p=.015) ; in HAMD-M at discharge (p=0.0001), at 1st month (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001) ; in GAF at discharge (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001). Conclusion: There was significant improvement in overall psychopathology of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in BPRS, YMRS, HDRS and GAF at the time of discharge, 1st month, 6th month and 12th month which were statistically significant. Day to day functional status of patients also improved as shown by GAF. The efficacy of ECT was very significantly shown in this study with all the psychiatric spectrum disorders. Key words: ECT, YMRS, HAM-D, BPRS, GAF, Diagnostic variability.Publication Kala azar in Nepal: Estimating the effects of socioeconomic factors on disease incidence(Kathmandu University, 2010) Adhikari, SR; Supakankunti, S; Khan, MMAbstract Background: The incidence of Kala Azar (KA), a neglected tropical infectious disease, describes the pattern of disease, but is not principally concerned with explaining its causes. The transmission of the infectious diseases is determined by the complex interactions between environmental and socioeconomic factors. Environmental factors are predicted to have a significant impact on disease transmission; moreover, socioeconomic factors modify the magnitude and direction of these impacts. A number of studies have examined possible determinants of KA in endemic countries of the world; however, most of them appear to have used either qualitative approaches or subjective speculations. None of the studies indicates in quantitative terms the potential effects of poverty-alleviation programs on the incidence of KA. Materials and methods: Data related to charecteristics of community were collected from primary as well as secondary sources. Underlying socioeconomic determints on KA incidence were estimated by exploiting a linear multiple regression. Results: The multivariate analysis has confirmed that burden of KA is disproportionately borne by vulnerable and marginalized groups. KA is most entrenched in the poorest communities. Elimination of KA is directly related to poverty alleviation because if the poverty incidence reduces by10 percent, it will lead to reduction of KA incidence by 16 percent. The strategy for disease control or elimination should shift from traditional disease-centered approaches to a holistic approach that can break the links between poverty and KA. Conclusions: To achieve the target of elimination of KA in Nepal by 2015, the poverty incidence should be reduced from existing poverty 27 percent to at least 16 percent in KA endemic areas. The association between poverty and KA reflects causality running in both directions: poverty multiplies KA incidence and KA pushes poor into marginal poor or further poverty. Key words: Kala azar, Socioeconomic factors, Leishmaniasis