Browsing by Author "Nepal, MK"
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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 Association of systemic diseases with sudden sensorineural hearing loss(Institute of Medicine, 2007) Nepal, MK; Rayamajhi, P; Thapa, N; Bhattarai, H; Shrivastav, RPAbstract Background: To find out the association of systemic diseases with sudden sensorineural hearing loss and to observe the effect of high dose intravenous steroid in its management. Methods: All patients admitted with sudden sensorineural hearing loss in the department of ENT & Head and Neck Surgery, T. U. Teaching hospital from January 2002 to January 2005 were studied prospectively. Association with any systemic illnesses were noted. High dose steroid intravenously was given for treatment and hearing improvement was assessed by pure tone audiometry. Results: A total of 46 patients were enrolled in the study, 21 of whom had systemic diseases. Predominant systemic disease was diabetes mellitus which was present in 16 patients. After steroid therapy, 13 patient is hearing returned to normal, 13 had improvement in hearing, 16 had no improvement and 4 had their hearing deteriorated. Conclusion: Approximately 45.7% of the patients with sudden sensorineural hearing loss had associated systemic diseases. Only 28.3% of the patient recovered to normal hearing though another 28.3% had improvement in hearing after the high dose steroid therapy. Keywords: pure tone audiometry (PTA), Sudden sensorineural hearing loss (SSNHL), Diabetes mellitusPublication Behavioural medicine: an integration of psychology and health(Institute of Medicine, 2004) Sinha, UK; Nepal, MKAbstract: The process of evolution in health sciences has followed a similar path from being analytical to synthesized or holistic. Multidisciplinary approach has taken over the specialized approach in the area of health care delivery that follows bio-psycho-social paradigm in the understanding and management of health problems in the general hospital setting. Emergene of Behavioural Medicine is the result of such evolutionary process. Behavioural Medicine is the interdisciplinary field concerned with the development and integration of behavioural and biomedical sciences, knowledge, and techniques relevant to health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation. The present article reviews the historical aspects of the emergence of Behavioural Medicine on the background of biopsychosocial model and impact of life-style factors on health along with the clinical application and role of Behavioural Medicine in the primary prevention. Relevance of Behavioural Medicine in the context of Nepal, and the contribution of clinical psychologists in the health care system of the country along with the need for accepting them in the mainstream of health professionals are highlighted. Keywords: Behavioural Medicine, biopsychosocial model, primary prevention, diagnosis, treatment, rehabilitation.Publication Behavioural medicine: an integration of psychology and health(Institute of Medicine, 2003) Sinha, UK; Nepal, MKAbstract The process of evolution in health sciences has followed a similar path from being analytical to synthesized or holistic. Multidisciplinary approach has taken over the specialized approach in the area of health care delivery that follows bio-psycho-social paradigm in the understanding and management of health problems in the general hospital setting. Emergene of Behavioural Medicine is the result of such evolutionary process. Behavioural Medicine is the interdisciplinary field concerned with the development and integration of behavioural and biomedical sciences, knowledge, and techniques relevant to health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation. The present article reviews the historical aspects of the emergence of Behavioural Medicine on the background of biopsychosocial model and impact of life-style factors on health along with the clinical application and role of Behavioural Medicine in the primary prevention. Relevance of Behavioural Medicine in the context of Nepal, and the contribution of clinical psychologists in the health care system of the country along with the need for accepting them in the mainstream of health professionals are highlighted. Keywords: Behavioural Medicine, biopsychosocial model, primary prevention, diagnosis, treatment, rehabilitationPublication Chronic Supurative Otitis Media in relation to dehiscent of facial canal(Institute of Medicine, 2008) Acharya, K; Nepal, MK; Rayamajhi, P; Bhattarai, H; Shrivastav, RP; Sharma, PAbstract Background: To observe the pathological findings in CSOM-AA along with, frequency of dehiscence of facial canal and to correlate the type of pathologies found with dehiscence of fallopian canal. Methods: It is the retrospective study conducted in the department of ENT-HNS at Tribhuvan University Teaching Hospital, Nepal of 2 yrs duration April 2004 to April 006. Patients undergoing mastoid surgeries for the CSOM-AA under general anesthesia were taken for the study. Pathological findings were divided into 3 groups which are granulation tissue, cholesteatoma or both. Special attention was given to identify the dehiscent of facial canal and its status was also followed up in postoperative period till 1 month. Results: The pathological finding commonly encountered were cholesteatoma with granulation 75.2% (94), whereas cholesteatoma alone was 18.4% (23)and granulation tissue only was 6.4%(8) The total incidence of facial canal dehiscence was 22 % (28/125) in our study. Horizontal part of the fallopian canal was most common site for dehiscence 50% (14/28) followed by vertical part 35 % (10/28) then both part was involved in 15% (4/28). There is no statistical significance between any type of pathology and dehiscence of facial canal. Conclusion: Cholesteatoma with granulation was the most common pathology found in CSOMAA. Irrespective of the pathologies in the middle ear cleft during mastoid surgeries for CSOM- AA, the facial canal was found to have dehiscence which was commonly occurring at horizontal part of the facial canal with higher incidence among cholesteatoma with granulation group. Keywords: Chronic supurative otitis media, cholesteatoma, granulations, facial canalPublication Evaluation of suicidal symptoms in adult depressive in-patients at Tribhuvan University Teaching Hospital(Institute of Medicine, 1998) Koirala, NR; Nepal, MK; Sharma, VDAbstract The data on the frequency of the suicidal symptoms in depressed patients varies widely. The reported rates generally show that about 40% - 70% of patients with affective disorders show suicidal symptoms, about 15% of depressed patients end up their lives by suicide and more than 50% of patients who attempt suicide are also more likely to have a severe and major type of depression. The information was collected about the severity of depressive illness and the reporting of suicidal symptoms in the 80 ICD-10 diagnosed depressive in-patients. Rating was done as per Hamilton Rating Scale for Depression and details of suicidal symptoms were collected for suicidal wishes, ideation, gesture and attempts. Correlation of suicidal symptoms with other variable was calculated with Spearman correlation coefficient. Thirty-two point five percent of the male patients and 67.5% of the female patients reported suicidal symptoms. Female patients showed more suicidal ideation, wishes and attempts as compared to the male group. Positive and significant correlation was observed between suicidal symptoms, total HDRS Score and duration of the illness. Age showed negative correlation with suicidal symptoms. Keywords: Suicide, Hamilton Depression Rating Scale, TUTHPublication Suicidal symptoms among elderly patients attending out- patient department of Tribhuvan University Teaching Hospital(Institute of Medicine, 2006) Khattri, JBK; Nepal, MKAbstract Background: Despite the fact that suicide and its prevention continues to be a priority area for health care, suicide in the elderly remains a neglected subject receiving little interest and research attention. Suicide rates increase with age and are very high among those 65 years and older and is the major public health problem. The aim of the study is to estimate the prevalence of suicidal symptoms among geriatric patients attending outpatient departments of Tribhuvan University Teaching Hospital in Nepal. Methods: A study group of 100 elderly patients aged 65 years and above were randomly selected from the psychiatry, medicine and general practice outpatient departments of Tribhuvan University Teaching Hospital. The symptoms of the patients were recorded carefully according to the suicidal symptoms of Hamilton Depression Rating Scale (HDRS). Results: Sixteen percent of the samples were found to experience suicidal symptoms, out of which three percents were found to attempted suicide. Conclusions: The results show very high rates of suicidal symptoms among the elderly population attending the outpatient departments. The early detection of suicidal feelings could lower the rates of suicide attempts among the elderly in the Nepalese population. It also calls for the need to strengthen the consultation psychiatry service for early intervention in the patients with suicide. Keywords: Suicidal symptoms, HDRS, DepressionPublication Validation of the Nepali version of beck anxiety inventory(Institute of Medicine, 2004) Kohrt, BA; Kunz, RD; Koirala, NR; Sharma, VD; Nepal, MKAbstract This study validates a Nepali version of the Beck Anxiety Inventory (BAI). The instrument was compared against a gold standard diagnosis of generalized anxiety. The diagnosis of Generalized Anxiety Disorder (GAD) was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. GAD subjects were selected both from outpatients at Tribhuvan University Teaching Hospital and a rural sample from Jumla. Healthy (non-psychiatric diagnosis) cases were taken from a community sample in Jumla; their “healthy” status was obtained by achieving a score less than 2 on the Nepali General Health Questionnaire-12. This study identifies acceptable sensitivity and specificity ranges for the measure. A cut-off of 13/14 for the BAI provides sensitivity of 0.91 and specificity of 0.89. Reliability for the BAI is comparable to most studies in Western countries (0.89). A factor analysis of the BAI evokes four factors. A number of items reduce the validity and internal reliability of this measure. Somatic items poorly distinguish psychiatric cases; this may be due to high burden of physical illness in rural Nepal. Overall, the BAI appears to be a good instrument for clinical and research use in Nepal. Key Words: Validation, Nepali, Beck, Anxiety, TUTH.Publication Validation of the Nepali version of beck anxiety inventory(Institute of Medicine, 2003) Kohrt, BA; Koirala, NR; Sharma, VD; Nepal, MKAbstract This study validates a Nepali version of the Beck Anxiety Inventory (BAI). The instrument was compared against a gold standard diagnosis of generalized anxiety. The diagnosis of Generalized Anxiety Disorder (GAD) was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. GAD subjects were selected both from outpatients at Tribhuvan University Teaching Hospital and a rural sample from Jumla. Healthy (non-psychiatric diagnosis) cases were taken from a community sample in Jumla; their “healthy” status was obtained by achieving a score less than 2 on the Nepali General Health Questionnaire-12. This study identifies acceptable sensitivity and specificity ranges for the measure. A cut-off of 13/14 for the BAI provides sensitivity of 0.91 and specificity of 0.89. Reliability for the BAI is comparable to most studies in Western countries (0.89). A factor analysis of the BAI evokes four factors. A number of items reduce the validity and internal reliability of this measure. Somatic items poorly distinguish psychiatric cases; this may be due to high burden of physical illness in rural Nepal. Overall, the BAI appears to be a good instrument for clinical and research use in Nepal. Keywords: Validation, Nepali, Beck, Anxiety, TUTH