Browsing by Author "Sharma, VD"
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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 Depression in survivors of female trafficking in shelter homes of Kathmandu Valley(Institute of Medicine, 2017) Pradhan, G; Ojha, SP; Sharma, VD; Chapagain, M; Tulachan, P; Dhungana, S; Pant, SBAbstract Introduction: Human trafficking is the recruitment and movement of individuals most often by force, coercion, or deception for the purpose of exploitation. There is very limited evidence on the health consequences of human trafficking. This study were to find out the prevalence of depression among survivors of female trafficking in the shelter homes of Kathmandu valley and also to find out severity of depression (mild, moderate and severe) among the survivors of female trafficking. Methods: A cross- sectional design was implemented. A total of 67 participants was collected from 4 different NGOs working in the field by using probability proportion to size method and from each NGOs the participants were taken using purposive sampling. The consent was taken and strict inclusion and exclusion criteria were applied during participant's selection. The semi- structured proforma was filled with adequate information. Clinical diagnosis of depression was made according to ICD-10 classification of Mental and Behavioral Disorders-Diagnostic Criteria for Research (WHO-1992) in patients and Hamilton Rating Scale for Depression (HAM-D) was used to assess the severity of depression (mild, moderate and severe). Finally, information obtained from demographic profile, clinical features, and rating scale was analyzed by using suitable statistical tools. Results: The study showed out of all 67 female human trafficking victims interviewed from 4 major shelter homes in Kathmandu valley a majority were found to be from the 16 to 20 years age group during the time of interview. Most victims were found to be trafficked at a young age, 11-15 years. A majority of them were lured with job proposals mostly by their own family members. Victims were mostly lead to India for trafficking as sex workers. Based on ICD 10 DCR 61.2% of the victims were found to be suffering from depression among which according to HDRS 16.4% had severe and 4.5% had very severe depression. Conclusion: Despite a dramatic increase in the profile of human trafficking over the past decade, the evidence on trafficked people's experiences of violence and of depression and other mental health problems is extremely limited. Depression is quite common and more information is needed on trafficked people's health needs and experiences, including evidence on interventions to mitigate the physical and psychological damage associated with this global crime.Publication Patterns of Insomnia in Cases of New Onset Depression Visiting Psychiatry OPD of Tertiary Level Hospital(Institute of Medicine, 2018) Pokhrel, R; Sharma, VD; Ojha, SP; Chapagai, M; Tulachan, P; Dhungana, S; Panta, SBAbstract Introduction: Depression is one of the common mental disorders, ranked third among causes of YLDs (Years Lived with Disability) in both developed and developing countries (GBD 2015). Insomnia is one of the commonest symptoms of depression, though often under-detected and undertreated. This study aims to identify prevalence of insomnia in cases of new onset depression as well as severity of insomnia and quality of sleep. Methods: A total of 101 patients, visiting the psychiatry OPD of TUTH, IOM and diagnosed as new onset depression, were selected by non-probablity purposive sampling method, after meeting inclusion criteria and informed consent being obtained. The duration of study was 1 year. The semi-structured proforma was filled by the interviewer. Beck’s Depression Inventory (BDI) was used to assess of severity of depression. Athens Insomnia Scale (AIS) was used to screen for insomnia and then severity of insomnia was assessed using Insomnia Severity Index (ISI). Quality of sleep was assessed using Pittsburgh Sleep Quality Index (PSQI). Results: Insomnia was observed in 90.1% of patients with depression. Early insomnia was seen in 71.3% of patients, mid insomnia in 70.3% of patients and late insomnia in 45.6% of patients. 88.1 % of participants were found to be poor sleepers, and 11.9% good sleepers. Conclusion: Statistically significant positive correlation was observed between severity of depression and severity of insomnia (r=0.740, p<0.05) and between severity of depression and PSQI score (r= 0.556, p<0.05). Keywords: Depression, insomnia, quality of sleep