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Grover S, Chaurasia N, Chakrabarti S. Management of tardive dyskinesia and tardive dystonia with clozapine: A retrospective study. Asian J Psychiatr 2024; 102:104245. [PMID: 39288640 DOI: 10.1016/j.ajp.2024.104245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/27/2024] [Accepted: 09/12/2024] [Indexed: 09/19/2024]
Abstract
AIM This retrospective study aimed to evaluate the long-term effectiveness of switching to clozapine in the management of tardive syndromes (TS). METHODOLOGY The treatment records of patients who had TS at the time of starting clozapine, were reviewed and demographic and clinical data was extracted on a predesigned performa. RESULTS About three-fourth (74.2 %) of the study subjects had tardive dystonias and two-third (69.7 %) had tardive dyskinesia at the time of starting clozapine. About half (48.5 %) of the patients had both tardive dystonia and dyskinesia. A small proportion (13.6 %) also had tardive akathisia at the time of starting clozapine. About three-fourth (72.2 %) of the patients had >50 % reduction, and about two-third (66.6 %) of the patients had >75 % reduction and nearly half (54.5 %) of the patients had complete resolution of dyskinesia at the last follow-up. Similar trends were seen in reduction in dystonia, i.e., >50 % reduction in 74.3 %, >75 % reduction in 62.2 % and complete resolution was seen in 56.1 %. CONCLUSIONS The present study suggest that clozapine is useful in the management of drug induced tardive dyskinesia and tardive dystonia.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Nishtha Chaurasia
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
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2
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Vasisht PV. A study on the price variability of branded medicines and Jan aushadi versions of selected commonly prescribed psychiatric medications in India using a cost-comparative approach and a passive evaluation of the Jan aushadhi scheme in India. J Family Med Prim Care 2024; 13:2054-2059. [PMID: 38948584 PMCID: PMC11213443 DOI: 10.4103/jfmpc.jfmpc_1737_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction The cost of medications poses a significant financial burden on patients. It limits access and adherence to treatment. Psychiatric disease burden is rising and it needs treatment for long durations. The high cost of branded medicines and lack of access to medicines at affordable prices can limit adherence. Methodology A cost comparison study was done to investigate the price difference between branded and Jan aushadhi versions of 20 selected psychiatric drugs was done at the Department of Community Medicine of a Government medical college in Southern India. The average (mean) price of branded medicines of each drug was calculated with minimum, and maximum using online data, and comparison was done by calculating the percentage price difference between branded and Jan aushadhi medicines. The overall percentage price difference between branded and Jan aushadhi medicines was calculated. Results The overall percentage price difference between the mean price of branded medicine and Jan aushadhi medicine was + 252% for antipsychotics, indicating that the mean branded price was 252% (2.52 times) Jan aushadhi price. Similarly, the overall percentage price difference between the mean branded price and Jan aushadhi price among antidepressants was +277.54%, and the overall percentage price difference between mean branded price and Jan aushadhi was +227.73% for anticonvulsants. Similarly, price differences of maximum and minimum branded prices and Jan aushadhi were high. Conclusion The study was able to estimate variation in the price of branded drugs and compare the price of branded medicines with Jan aushadhi by estimating price differences. The results of the study are useful in further reference regarding the subject for public, policy makers and healthcare providers. It gives valuable evidence into medication costs in India.
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Affiliation(s)
- Pranav V. Vasisht
- Department of Community Medicine, Al Azhar Medical College and Super-Specialty Hospital, Thodupuzha, Kerala, India
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3
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Basu A, Dutta AK, Bagepally BS, Das S, Cherian JJ, Roy S, Maurya PK, Saha I, Sukumaran D, Rina K, Mandal S, Sarkar S, Kalita M, Bhowmik K, Saha A, Chakrabarti A. Pharmacogenomics-assisted schizophrenia management: A hybrid type 2 effectiveness-implementation study protocol to compare the clinical utility, cost-effectiveness, and barriers. PLoS One 2024; 19:e0300511. [PMID: 38598465 PMCID: PMC11006179 DOI: 10.1371/journal.pone.0300511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES The response to antipsychotic therapy is highly variable. Pharmacogenomic (PGx) factors play a major role in deciding the effectiveness and safety of antipsychotic drugs. A hybrid type 2 effectiveness-implementation research will be conducted to evaluate the clinical utility (safety and efficacy), cost-effectiveness, and facilitators and barriers in implementing PGx-assisted management compared to standard of care in patients with schizophrenia attending a tertiary care hospital in eastern India. METHODS In part 1, a randomized controlled trial will be conducted. Adult patients with schizophrenia will be randomized (2: 1) to receive PGx-assisted treatment (drug and regimen selection depending on the results of single-nucleotide polymorphisms in genes DRD2, HTR1A, HTR2C, ABCB1, CYP2D6, CYP3A5, and CYP1A2) or the standard of care. Serum drug levels will be measured. The patients will be followed up for 12 weeks. The primary endpoint is the difference in the Udvalg for Kliniske Undersøgelser Side-Effect Rating Scale score between the two arms. In part 2, the cost-effectiveness of PGx-assisted treatment will be evaluated. In part 3, the facilitators and barriers to implementing PGx-assisted treatment for schizophrenia will be explored using a qualitative design. EXPECTED OUTCOME The study findings will help in understanding whether PGx-assisted management has a clinical utility, whether it is cost-effective, and what are the facilitators and barriers to implementing it in the management of schizophrenia. TRIAL REGISTRATION The study has been registered with the Clinical Trials Registry-India (CTRI/2023/08/056210).
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Affiliation(s)
- Aniruddha Basu
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, India
| | - Atanu Kumar Dutta
- Department of Biochemistry, All India Institute of Medical Sciences, Kalyani, India
| | | | - Saibal Das
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jerin Jose Cherian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Indian Council of Medical Research, New Delhi, India
| | - Sudipto Roy
- Indian Council of Medical Research, New Delhi, India
| | - Pawan Kumar Maurya
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
| | - Indranil Saha
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
| | - Deepasree Sukumaran
- Department of Pharmacology, All India Institute of Medical Sciences, Kalyani, India
| | - Kumari Rina
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, India
| | - Sucharita Mandal
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, India
| | - Sukanto Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, India
| | - Manoj Kalita
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
| | - Kalyan Bhowmik
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
| | - Asim Saha
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
| | - Amit Chakrabarti
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
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4
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Ansari Z, Rashmi A, Pawar S. A Naturalistic, Non-interventional Investigation of the Clinical and Sociodemographic Characteristics and Prescription Patterns in Patients With Psychotic Disorders at a Tertiary Care Facility in South Asia. Cureus 2024; 16:e53541. [PMID: 38445139 PMCID: PMC10912971 DOI: 10.7759/cureus.53541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the trends in the sociodemographic, clinical, and prescription characteristics of patients with psychotic illnesses seen in the outpatient psychiatry department of a tertiary care facility. METHODS Between March 2021 and April 2022, a cross-sectional, prospective, observational, naturalistic, non-interventional study was conducted. A total of two hundred prescriptions were analyzed. To assess the rationality of prescriptions, World Health Organization (WHO) indicators were also computed. RESULTS With a range of 18 to 75 years, the cohort's mean age was 40.26 years, and its average disease duration was 10.75 years. Sixty-seven patients (68.5%) were diagnosed with schizophrenia. Of the 200 prescriptions that were analyzed, 13 antipsychotic prescriptions were written 343 times. Olanzapine was prescribed as an antipsychotic the most frequently (132, 66%), followed by clozapine (75, 37.5%). Haloperidol (41, 20.5%), trifluoperazine (3, 1.5%), loxapine (1, 0.5%), and flupenthixol depot (1, 0.5%) were the most commonly prescribed typical antipsychotics. 91% (181/200) of patients received prescriptions for other drugs in addition to antipsychotics. Trihexyphenidyl (45%), escitalopram (30%), clonazepam (26.5%), sodium valproate (10%), propranolol (10.5%), and modafinil (9.5%) were the most frequently prescribed concurrent medicines. Forty-eight percent (95/200) of prescriptions demonstrated polypharmacy. Among patients, the frequency of antipsychotic prescriptions was 1 in 44% (88/200), 2 in 36.50% (73/200), 3 in 17% (34/200), 4 in 0.5% (1/200), and 5 again in 0.5% (1/200). Conclusions: On average, the cohort of the current study was young. The commonest diagnosis was mainly schizophrenia. Atypical antipsychotics accounted for the majority of antipsychotic prescriptions in the current study. In this study, a high prevalence of polypharmacy was noted.
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Affiliation(s)
- Zarrin Ansari
- Pharmacology and Therapeutics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Abhilasha Rashmi
- Pharmacology and Therapeutics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Sudhir Pawar
- Pharmacology and Therapeutics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
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Yadav AS, Singh S, Randhawa J, Akuma CM, Akuma O, Chaudhry HA. Desvenlafaxine-Triggered Acneiform Eruptions on the Hand: A Compelling Case Report. Cureus 2024; 16:e52185. [PMID: 38347994 PMCID: PMC10859240 DOI: 10.7759/cureus.52185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
A 45-year-old male developed a skin eruption after starting Desvenlafaxine for depressive symptoms associated with schizophreniform disorder. The patient developed a rash on the hand, hyperpigmentation, and itching, which resolved after discontinuing the medication. The Naranjo score suggested a probable link between desvenlafaxine and the skin reaction. Stable vital signs and normal labs supported this conclusion. The case underscores the importance of recognizing and reporting adverse drug reactions, even with generally safe medications like desvenlafaxine. Further research with larger samples is needed to explore this relationship in more depth.
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Affiliation(s)
- Anupam S Yadav
- Psychiatry, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Sonali Singh
- Pediatric, King George's Medical University, Lucknow, IND
| | - Jaismeen Randhawa
- Psychiatry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Chinaza M Akuma
- Public Health, Chamberlain University, College of Health Professions, Chicago, USA
| | - Ogbonnaya Akuma
- Internal Medicine, Ebonyi State University, Abakaliki Nigeria, Abakaliki, NGA
| | - Hassan A Chaudhry
- Biological Sciences, Temple University, Philadelphia, USA
- Medicine, Medical University of Lublin, Lublin, POL
- Interdisciplinary Medicine, Independent Research Scholar, Philadelphia, USA
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Liu X, Sun X, Li L, Zeng K, Li Y, Gao Y, Ma J. Co-prescription of aripiprazole on prolactin levels in long-term hospitalized chronic schizophrenic patients with co-morbid type 2 diabetes: A retrospective clinical study. Front Psychiatry 2023; 14:1124691. [PMID: 36816406 PMCID: PMC9933920 DOI: 10.3389/fpsyt.2023.1124691] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND One of the most frequent side effects of atypical antipsychotics is hyperprolactinemia (HPRL), and metformin or aripiprazole co-prescription is regarded as an effective therapy option for reducing prolactin (PRL) levels. However, whether either of the two drugs can reduce PRL levels in patients with long-term hospitalized chronic schizophrenia with co-morbid type 2 diabetes (T2DM) has not been adequately reported. METHODS In our study, long-term hospitalized chronic schizophrenia patients with co-T2DM who were prescribed olanzapine or risperidone as the primary antipsychotic medication were enrolled. A total of 197 of these cases with co-prescribed aripiprazole were set up as the study group (co-Ari group), and the other 204 cases without co-prescribed aripiprazole were set up as the control group (non-Ari group). The two groups' variations in each target parameter were compared, and the variables affecting PRL levels were examined. RESULTS Compared to the non-Ari group, fasting blood glucose (FBG), blood uric acid (UA), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher in the co-Ari group, but there was no difference in PRL levels. Co-prescribing aripiprazole had no impact on PRL levels in all patients with co-T2DM, and aripiprazole dose had no impact on PRL levels in the clinical subgroup of the co-Ari group. CONCLUSION Aripiprazole not only worsened the severity of index disturbances associated to metabolism in long-term hospitalized chronic schizophrenia patients with co-T2DM on metformin-based hypoglycemic medications but also failed to lower PRL levels.
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Affiliation(s)
- Xuebing Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Xianzhi Sun
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lu Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Kuan Zeng
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Ma
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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7
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Grover S, Kathiravan S. Clozapine research from India: A systematic review. Asian J Psychiatr 2023; 79:103353. [PMID: 36493690 DOI: 10.1016/j.ajp.2022.103353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/09/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although clozapine is much researched in western literature, a review on Indian research on clozapine published in 2010 reported limited data and need for further research in this area. AIM We aimed to conduct a systematic review of research on clozapine from India from 2010 to mid-2022 and also compare the same with research output before 2010. METHODOLOGY A systematic various search engines, i.e., PUBMED, Medknow, Hinari and Google Scholar was done using the key words clozapine and India. Published articles with clozapine in the title and having an author from India, published during 2010 to July 2022 were included. RESULTS Initial Internet and hand searches yielded 280 articles, out of which 126 articles were excluded due to various reasons and 154 articles, were included for the review. This included 84 case reports, 49 original articles, 11 review articles and 10 letters to the editor as comments. We found an increase in the number of publications during the period of 2010-2022 compared to 1997-2009 in all types of publications. Over the years a significant proportion of the articles focused on various side effects of clozapine, factors associated with response and non-response to clozapine and evaluation of outcomes other than efficacy/effectiveness. However, all the studies were limited to a single centre with no multicentric studies on clozapine. CONCLUSION Over the last 12 years or so, there is increase in the number of publications on clozapine. However, there is lack of multicentric studies.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Sanjana Kathiravan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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8
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Ramamurthy P, Alexander A, Solomon S, Thilakan P. Prescription Pattern and Follow-up Pattern in Psychiatric Outpatients with Adjustment Disorder. Indian J Psychol Med 2022; 44:530-531. [PMID: 36157011 PMCID: PMC9460020 DOI: 10.1177/02537176211015098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Parthasarathy Ramamurthy
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
| | - Aneesh Alexander
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
| | - Susan Solomon
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
| | - Pradeep Thilakan
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
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Ambekar A, Gautam M, Matcheswalla Y, Kar S, Kadam K. Medicolegal Issues with Reference to NDPS and MHCA in Management and Rehabilitation of Persons with Substance Use Disorders. Indian J Psychiatry 2022; 64:S146-S153. [PMID: 35599647 PMCID: PMC9122147 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_724_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Atul Ambekar
- National Drug Dependence Treatment Centre and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Manaswi Gautam
- Gautam Hospital and Research Center, Jaipur, Rajasthan, India
| | | | - Samrat Kar
- The Brain and Research Centre, Upper Telenga Bazar, Cuttack, Odisha, India E-mail:
| | - Krishna Kadam
- Maharashtra Institute of Mental Health, Pune, Maharashtra, India
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10
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Sahoo M, Biswas H, Singh V. Safety profile and adverse effects of use of olanzapine in pregnancy: A report of two cases. J Family Med Prim Care 2022; 11:350-352. [PMID: 35309668 PMCID: PMC8930120 DOI: 10.4103/jfmpc.jfmpc_310_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/17/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
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11
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Tejus A, Saxena SK, Dwivedi AK, Salmani MF, Pradhan S. Analysis of the prescription pattern of psychotropics in an outpatient department of a general hospital psychiatry unit. Med J Armed Forces India 2022; 78:74-79. [PMID: 35035047 PMCID: PMC8737101 DOI: 10.1016/j.mjafi.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND World Health Organization has prescribed drug use indicators for evaluating rational prescribing. Very few studies have been conducted on rational prescriptions for psychotropic drugs; hence, this study was undertaken at a tertiary care center of North India. METHODS After obtaining approval of the Institutional Ethics Committee, all prescriptions deposited with the dispensary of the psychiatry department of the hospital between 01 October 2017 and 31 December 2017 were included in the study. The prescriptions were analyzed for drug use indicators, namely the average number of drugs per encounter, percentage of prescriptions with generic name, percentage of prescriptions from the essential drug list, percentage of prescriptions with antibiotics, and percentage of prescriptions with an injection. In addition, the prescriptions were analyzed for patterns of psychotropics prescribed. RESULTS A total of 3770 prescriptions were analyzed. On an average, 2.35 medicines were prescribed per prescription. Injectable comprised 2.39% of prescriptions and fixed drug combinations were 0.16% of the total. Of all prescriptions, 91.3% were by generic name, while 55.02% of prescriptions were from the essential drug list. Polypharmacy constituted 4.53% of prescriptions. Risperidone, escitalopram, sodium valproate, and clonazepam were the most commonly prescribed drugs. CONCLUSION While we fared well with respect to the percentage of prescriptions with injections and those with an antibiotic, we have not been able to achieve the prescribed standards in prescription with generic names, number of drugs per prescription, and prescriptions from the essential drug list. The study emphasizes that there is scope for improvement.
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Affiliation(s)
- A Tejus
- Graded Specialist (Pharmacology), Armed Forces Medical Stores Depot, Lucknow, India
| | - S K Saxena
- Senior Advisor & Head (Psychiatry), Base Hospital, Delhi Cantt, India
| | - A K Dwivedi
- Graded Specialist (Psychiatry), Base Hospital, Delhi Cantt, India
| | - Md Fadil Salmani
- Tutor (Pharmacology), Army College of Medical Sciences, Delhi Cantt, New Delhi, India
| | - Sapna Pradhan
- Associate Professor (Pharmacology), Army College of Medical Sciences, Delhi Cantt, New Delhi, India
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Abstract
Selective serotonin reuptake inhibitors (SSRI) are the most prescribed antidepressant medications for the treatment of depression and other psychiatric disorders due to their efficacy, tolerability, and safety profile. The dermatological side-effects or cutaneous reactions due to SSRI class of antidepressants is rare. Though there were few case reports of SSRI-induced rash due to fluoxetine, paroxetine, and sertraline, the evidence associated with escitalopram, the highly prescribed antidepressant is comparatively less. The identification and reporting of the drug-related side-effects/adverse drug reactions either serious or non-serious is very important as it will be helpful in understanding, reviewing, and educating the drug-related information before starting medication to the patient.
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13
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Gaur AV, Agarwal R. Risperidone induced alterations in feeding and locomotion behavior of Caenorhabditis elegans. Curr Res Toxicol 2021; 2:367-374. [PMID: 34806037 PMCID: PMC8585583 DOI: 10.1016/j.crtox.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
Antipsychotic drugs (APDs) are prescribed for the treatment of psychiatric illness. However, these drugs can also contribute to several developmental and behavioral disorders. Contemporary studies to evaluate the toxic effects of numerous atypical antipsychotics are reported to cause behavioral alteration at variable doses in mammals and nematodes. Risperidone, the second most prescribed drug in India, requires more exploration of its adverse effects on humans. Here, we explore effects on feeding behavior and locomotion patterns due to risperidone exposure in C. elegans model. The study targets to work out the toxic effects of risperidone exposure on feeding and locomotion behavior in addition to the expected pharmacological effects. N2 wild type strain was exposed in liquid culture assay for 2, 4, 6, 8, 10, and 12 hours with fixed 50 µM concentration. Feeding behavior was depleted due to inhibition in pharyngeal pumping varying from 11.05% - 45.67% in a time-dependent manner. Results of locomotion assay also show time-varying increase in reversals (4.9%-34.03%) and omega bends (26.23%-62.17%) with reduction in turn counts (29.07%- 42.2%) and peristaltic speed (31.38%-42.22%) amongst exposed groups as to control. The present work shows behavioral alterations due to risperidone exposure (50 µM) in C. elegans is in a time-dependent manner. The study concludes that risperidone exposure in C. elegans produces toxic effects with time, possibly caused by antagonizing other receptors apart from serotonin (5-H2T) and dopamine (D2) adding to its expected pharmacological effects.
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Key Words
- 5-H2T
- 5-HT, 5-hydroxytryptamine
- ADF, Amphid Neuron
- APDs, Antipsychotic drugs
- Antipsychotic drugs
- Behavioral alteration
- C, Control Group
- C-0h, Control Group at 0 h
- C-10h, Control Group at 10 h
- C-12h, Control Group at 12 h. E-2h, Exposure Group at 2 h
- C-2h, Control Group at 2 h
- C-4h, Control Group at 4 h
- C-6h, Control Group at 6 h
- C-8h, Control Group at 8 h
- C. elegans
- C. elegans, Caenorhabditis elegans
- D2
- D2, Dopamine Receptor 2
- E, Exposed Group
- E-10h, Exposure Group at ten
- E-12h, Exposure Group at 12 h
- E-4h, Exposure Group at 4 h
- E-6h, Exposure Group at 6 h
- E-8h, Exposure Group at 8 h
- E. coli, Escherichia coli BOD-Biochemical Oxygen Demand
- GPR, G coupled Protein Receptor
- HSN, Hermaphrodite Specific Neuron
- Min., Minutes
- N2 Wild type
- NSM, Neurosecretory Motor Neuron
- Peristaltic speed
- Pharyngeal pumping
- Reversals
- Risperidone
- SD, Standard Deviation
- SDA, Serotonin Dopamine Antagonist
- Turn counts
- omega bends
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Affiliation(s)
- Aaditya Vikram Gaur
- Laboratory of Analytical & Molecular Toxicology (Forensic Chemistry & Toxicology Laboratory), School of Forensic Science, National Forensic Sciences University, Sector 09, Gandhinagar 382007, Gujarat, India
- Forensic Science Laboratory, Kirumampakkam, Puducherry 607402, India
| | - Rakhi Agarwal
- Laboratory of Analytical & Molecular Toxicology (Forensic Chemistry & Toxicology Laboratory), School of Forensic Science, National Forensic Sciences University, Sector 09, Gandhinagar 382007, Gujarat, India
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Grover S, Shouan A, Chakrabarti S, Sahoo S, Mehra A. Comparative study of effectiveness of augmentation with ECT in clozapine resistant schizophrenia (CRS) and non-clozapine resistant schizophrenia (Non-CRS). Nord J Psychiatry 2021; 75:397-405. [PMID: 33630681 DOI: 10.1080/08039488.2021.1877349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is limited evidence for different treatment strategies in patients with clozapine resistant schizophrenia (CRS). AIM To determine the effectiveness of ECT in patients with clozapine resistant schizophrenia and compare the same with a group of patients with non-clozapine resistant schizophrenia, receiving ECT. RESULTS Out of a total of 68 patients with schizophrenia, 27 (38.66%) of patients had CRS. With 6 ECTs, there was a significant reduction in PANSS positive, negative, general psychopathology, prosocial score and depression symptoms in the CRS (p < 0.001) and Non-CRS group (p < 0.001), but no statistically significant difference was seen between the 2 groups in terms of proportion of patients showing >40% response on PANSS total score. The reduction in PANSS score of >40% in CRS group was seen in 48.1% of patients in the positive symptoms subscale, in 25.9% of patients in negative symptoms subscale, in 46.7% of cases in the general psychopathology subscale, in 44.4% of the patients in Depression subscale, in 29.6% of the patients in the modified prosocialsubscaleand in 29.6% of the patients in total PANSS score. CONCLUSION ECT is an effective augmentation strategy for patients with CRS and it is as effective as when used in patients with non-CRS.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Shouan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jayakumar A, Abraham AS, Kumar S, Chand S, George SM, Joel JJ, UP N. Critical analysis of drug related problems among inpatients in the psychiatry department of a tertiary care teaching hospital: A pharmacist led initiative. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R, Gania A. Prescription patterns in clinically stable patients with bipolar disorder: Findings from the Bipolar Disorder Course and Outcome from India (BiD-CoIN) study. Asian J Psychiatr 2021; 57:102549. [PMID: 33484992 DOI: 10.1016/j.ajp.2021.102549] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the prescription pattern of patients with BD, currently in clinical remission. Additional aim of the study was tocompare the prescription pattern across different study centres. METHODOLOGY Prescription of 773 patients, currently in clinical remission, recruited from the outpatient setting of 14 General Hospital Tertiary Care Units of tertiary care centres in the country were evaluated. RESULTS Almost all (98.1 %) participants were on medications at the time of assessment. In terms of conventional mood stabilizers, those receiving valproate (44.2 %), out-numbered those receiving lithium (38.9 %). A small proportion (7.4 %) was receiving a combination of both valproate and lithium. About two-third (62.5 %) were receiving at least one antipsychotic medication, with olanzapine (31.7 %) being the most commonly prescribed antipsychotic, followed by quetiapine (11.1 %), and risperidone (9.6 %). About one-third (34.4 %) of the participants were receiving antidepressants, with sertraline (22.6 %) forming bulk of the prescription. Less than half (43.9 %) of the participants were also receiving a benzodiazepine medication at the time of assessment, with chlordiazepoxide (18 %) being the most common agent, followed by clonazepam (14.5 %). There was variation in the prescription patterns across different centres, in terms of monotherapy, polypharmacy, use of preferred conventional mood stabilizers, use of various antipsychotics and antidepressants. CONCLUSION Besides conventional mood stabilizers, about two-third of patients with bipolar disorder received concomitant antipsychotics, one-third received concomitant antidepressants and less than half received benzodiazepines.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amitava Dan
- Burdwan Medical College & Hospital, Burdwan, India
| | | | | | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, India
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi, India
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala, India
| | | | | | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, India
| | | | - AbMajid Gania
- Sher-I-Kashmir Institute Of Medical Sciences, Srinagar, India
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj S, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Gania A, Lakdawala B, Bhattacharya R. Bipolar Disorder Course and Outcome Study from India (BiD-CoIN study): Sample Description & Methods. J Affect Disord 2021; 280:16-23. [PMID: 33221603 DOI: 10.1016/j.jad.2020.11.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/27/2020] [Accepted: 11/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This multicentric study from India aimed to evaluate the long term course and outcome of bipolar disorder (BD). METHOD Seven hundred and seventy-three participants diagnosed with BD, attending 14 outpatient clinic centers across the country, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the long term course of BD. RESULTS The mean age of onset of the first episode of illness of the study sample was 26.3 (8.54) years, and mean duration of illness at the time of assessment was 233.05 (94.55) months. In terms of the total number of lifetime episodes, the mean number of manic episodes (mean: 3.68; SD: 4.75) exceeded the mean number of depressive episodes (mean: 3.36; SD: 5.51). The mean numbers of total lifetime episodes were 8.58 (10.6%). When the number of episodes per year was computed, the mean number of manic episodes per year exceeded that of the mean number of depressive episodes. Compared to females, a higher proportion of males had a history of comorbid substance dependence. LIMITATIONS The course was assessed retrospectively and the study was limited to participants attending the outpatient clinics. CONCLUSIONS The course of BD in India differs from that described from developed countries in the form of a number of manic episodes exceeding the depressive episodes.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh.
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education & Research, Chandigarh
| | | | | | | | | | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai
| | - Samir Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala
| | | | | | - AbMajid Gania
- Sher-I-Kashmir Institute Of Medical Sciences, Srinagar
| | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad
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Grover S, Naskar C, Chakrabarti S, Mehra A, Nehra R. Establishment of a geriatric clinic in psychiatry outpatient setting of a tertiary care hospital: Impact on care of elderly and training. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_17_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Agarwal AK. Psychiatric practice: Some personal observations. Indian J Psychiatry 2020; 62:644-649. [PMID: 33896968 PMCID: PMC8052892 DOI: 10.4103/psychiatry.indianjpsychiatry_249_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/30/2020] [Accepted: 04/17/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Anil Kumar Agarwal
- Retired Professor, Department of Psychiatry, K. G's. Medical College, Lucknow, Uttar Pradesh, India
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Nirisha PL, Malathesh BC, Manjunatha N, Kumar CN, Math SB, Kiragasur RM. Prescribing Psychotropics: Perspective From Telepsychiatry Operational Guidelines 2020. Indian J Psychol Med 2020; 42:80S-84S. [PMID: 33354070 PMCID: PMC7736728 DOI: 10.1177/0253717620958163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As telemedicine gained both importance and momentum following COVID -19 pandemic, Telemedicine Practise Guidelines (TPG) March 2020 was notified by the Central Government of India. Following the above, the Indian Psychiatrists Society, Telemedicine Society of India (TSI) and National Institute of Mental Health and Neurosciences (INI), Bangalore came together to address the specific needs of Psychiatrists practicing tele consultations, there by releasing Telepsychiatry Operational Guidelines 2020. This article discusses the guidelines outlines in the above documents with respect to prescribing psychotropics. We have discussed the thought process behind formulation of Telepsychiatry Operational guidelines, the challenges that may arise while following the above guidelines with possible solutions.
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Affiliation(s)
- P Lakshmi Nirisha
- Telemedicine Centre, Dept. Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Barikar C Malathesh
- Telemedicine Centre, Dept. Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Telemedicine Centre, Dept. Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Telemedicine Centre, Dept. Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Telemedicine Centre, Dept. Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajendra Madegowda Kiragasur
- Dept. Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Sen MS, Nehra R, Grover S. Social cognition in patients with first episode of psychosis in remission. Indian J Psychiatry 2020; 62:544-554. [PMID: 33678836 PMCID: PMC7909030 DOI: 10.4103/psychiatry.indianjpsychiatry_342_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 11/21/2022] Open
Abstract
AIM The present study aimed to compare the social cognition (SC) deficits in patients with first-episode psychosis (FEP) and healthy controls and evaluate the association of SC deficits with socio-occupational functioning, insight, quality of life, and stigma. METHODS This study included 30 patients with FEP in remission phase and 26 healthy controls matched for age, gender, education, and intelligent quotient. SC was assessed on the domains of theory of mind (ToM), social perception, and attributional bias. RESULTS Compared to healthy controls, patients with FEP had significantly higher deficits in the domains of second-order ToM (unpaired t = 4.447, P < 0.001) and Faux Pas Composite Index (unpaired t = 2.824, P = 0.007). In the correlation analysis, higher age of patients with FEP was significantly associated with more externalizing bias (Pearson's correlation coefficient = 0.38, P = 0.039) and those with lower level of education had more social cognitive deficits in the domains of Faux Pas Composite Index (Pearson's correlation coefficient = 0.43, P = 0.018), Social Perception Index (Pearson's correlation coefficient = 0.38, P = 0.04), and Nonsocial Perception Index (Pearson's correlation coefficient = 0.5, P = 0.005). Duration of untreated psychosis was associated with higher deficits in the first-order ToM (Pearson's correlation coefficient = -0.38, P = 0.04) and Externalizing Bias Index (Pearson's correlation coefficient = -0.49, P = 0.006). Longer duration of treatment was associated with higher impairment in first-order ToM index (Pearson's correlation coefficient = -0.42, P = 0.02). General psychopathology and total Positive and Negative Syndrome Scale total score correlated significantly with externalizing bias, with a higher level of psychopathology associated with more severe deficits in this domain. There was no correlation of SC with the quality of life, cognitive insight, and stigma (except for occasional correlation of stereotype endorsement and externalizing bias). CONCLUSION The present study suggests that compared to healthy controls, patients with FEP have impairment in the domains of second-order ToM and Faux Pas Composite Index. However, social cognitive deficits have only a few correlations with various psychosocial outcomes of FEP.
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Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Perceptions of Psychiatrists Toward the Use of Long-Acting Injectable Antipsychotics: An Online Survey Study From India. J Clin Psychopharmacol 2020; 39:611-619. [PMID: 31688382 DOI: 10.1097/jcp.0000000000001109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE/BACKGROUND Despite proven benefits of long-acting injectables (LAIs), these are frequently underused by the psychiatrists. Accordingly, this study aimed to explore the perceptions of psychiatrists toward the use of LAI antipsychotics in their routine clinical practice. METHODS/PROCEDURE An online e-mail survey was conducted by using Survey Monkey platform. RESULTS A total of 622 psychiatrists with a mean age of 41 years who were in psychiatric practice for approximately 14 years participated in the survey. Participants reported using LAI, mainly for patients with schizophrenia, with LAI prescribed to approximately one-tenth (9.30%) of their patients in acute phase of illness and in one-fifth (18.42%) of patients in stabilization/stable phase. Fluphenazine decanoate (32.7%) was the most commonly used LAI followed by flupenthixol decanoate (19.5%), haloperidol decanoate (17.8%), and olanzapine pamoate (11.1%). The most common reasons for starting LAI were history of medication (100%) and treatment (80.5%) nonadherence, followed by having frequent relapses/exacerbations of symptoms (54.8%). Overall, more than half of the participants felt the level of acceptance of LAI among patients offered to be quite reasonable (54.3%), and mostly, LAIs were used as combination therapy with oral antipsychotics (73.6%). Despite all these, approximately three-fifths (59%) of the participants reported that they underuse LAI to a certain extent, with most common reasons that deter them from using LAI being the cost (55.45%), lack of interest of patients in receiving LAI (42.9%), lack of regular availability (41.3%), and patients being scared of receiving injectables (41.2%). CONCLUSIONS/IMPLICATIONS The LAI antipsychotics despite having several benefits are still underused by a substantial proportion of practicing psychiatrists.
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Grover S, Sahoo S, Bn S, Malhotra N, Dua D, Avasthi A. Attitude and perceptions of patients towards long acting depot injections (LAIs). Asian J Psychiatr 2019; 44:200-208. [PMID: 31419737 DOI: 10.1016/j.ajp.2019.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the well-established efficacy of the long acting depot injectable (LAIs) antipsychotics, these are significantly underused and underutilized by the mental health professionals, with a belief that patients will not accept the same. AIMS & OBJECTIVES To explore the acceptability and perception of patients towards various psychiatric treatments, with specific focus on LAIs. Additionally the study aimed to compare the acceptability of various types of treatments including LAIs between patients with severe mental disorders (Psychotic disorders and Bipolar disorder) and those with Common mental disorders (Anxiety, neurotic and depressive disorders). METHODOLOGY A self-designed semi-structured questionnaire was used to evaluate the preferred treatment options of all the new patients attending the psychiatry outpatient clinic of a tertiary care hospital. Depending on the response, they were further probed for the reasons for accepting or rejecting the LAIs. RESULTS 2659 patients were interviewed who were divided into two groups (Group I - 321 subjects with psychotic disorders and 120 subjects with bipolar affective disorder (BPAD) and Group II - 2218 subjects with neurotic, stress-related and unipolar depressive disorders). More than three-fourth (78.8%) of the participants in the whole study sample opted for tablets only as their first preferred choice and injectables were opted by about 5% of the participants only, with no significant difference between the 2 groups. After being explained about LAIs, one fourth of the participants (24.9%) reported that they may consider LAIs, without any significant difference between the 2 groups. Among those who refused to take LAIs even after explanation, the commonly reported reasons were difficulty in visiting hospital frequently for the injectables (41.69%), injectables being painful (19.41%), fear of injections (13.96%), no need to take LAIs (12.45%) and preference to take some other types of medicines (8.52%). CONCLUSIONS Considering the fact that LAIs are highly underused in patients with severe mental disorders and there is lack of awareness about LAIs among patients with severe mental disorders, the present study findings suggest that there is reasonable level of acceptance of LAIs among patients with severe mental disorders when explained about the same.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subodh Bn
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Nidhi Malhotra
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, Sector-32, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Rajan TM, Bharadwaj B, Rajkumar RP, Adole PS. Frequency and correlates of tardive dyskinesia in Indian patients with type I bipolar disorder. Asian J Psychiatr 2018; 32:92-98. [PMID: 29222987 DOI: 10.1016/j.ajp.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with Bipolar Disorder (BD) may have higher risk of Tardive Dyskinesia (TD). Theories for TD include inflammatory or oxidative stress and altered iron metabolism. The current frequency and clinical and biochemical correlates of TD in BD needs exploration. OBJECTIVES To assess: (1) the frequency of TD in BD; (2) clinical correlates of TD in BD; (3) oxidative stress markers, inflammatory markers and hepcidin in TD in BD. MATERIALS & METHODS In this cross-sectional study, 170 patients with BD were assessed for clinical characteristics using structured assessments. Inflammatory and oxidative markers like Interleukin-6 (IL-6), high sensitivity C-Reactive Protein (hsCRP), malondialdehyde (MDA), Total Antioxidant Status (TAS) and hepcidin were assessed by ELISA. RESULTS Frequency of TD was 10.6% (95%C.I.=6.4%-16.2%). Compared to patients without TD, patients with TD were older (F=0.340;p=0.000), had more episodes of illness (U=962.5;p=0.044) higher rates of medical comorbidity (X2=6.924; p=0.009*), antipsychotic exposure (U=592.5;p=0.000), typical antipsychotic exposure (U=756.5;p=0.001) and cognitive deficits (F=1.129;p=0.001). The biomarkers levels did not differ between the groups. Hepcidin levels correlated with Abnormal involuntary Movements scale (AIMS) score (r=0.213;p=0.006). Patients treated with lithium were more likely to have TD, but also had greater exposure to antipsychotics than patients on valproate. CONCLUSION About one-tenth of patients with BD-I have TD. The presence of TD is associated several clinical characteristics such as age, exposure to typical antipsychotics and chronicity of illness. Hepcidin was associated with greater severity of dyskinetic movements and needs further exploration.
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Affiliation(s)
- Tess Maria Rajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Balaji Bharadwaj
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Prashant Shankarrao Adole
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
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Affiliation(s)
- Nilesh Shah
- Department of Psychiatry, L. T. M. Medical College and General Hospital, Sion, Mumbai, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G Prasad Rao
- Schizophrenia and Psychopharmacology Division, Asha Hospital., Banjara Hills, Hyderabad, India
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Grover S, Avasthi A, Sinha V, Lakdawala B, Bathla M, Sethi S, Mathur DM, Kathuria P, Shah S, Baalasubramanian DS, Agarwal V, Deka K. Indian psychiatric society multicentric study: Correlates of prescription patterns of psychotropics in India. Indian J Psychiatry 2016; 58:417-424. [PMID: 28196999 PMCID: PMC5270267 DOI: 10.4103/0019-5545.196703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is a lack of information on the clinical and sociodemographic correlates of prescription of psychotropics by psychiatrists. AIM AND OBJECTIVE This study aimed to evaluate the relationship of prescription patterns with various clinical and sociodemographic variables. METHODOLOGY Data of prescription patterns, psychiatric diagnosis, sociodemographic variables, and comorbid physical illnesses were collected for 4480 patients, across 11 centers. RESULTS Females are more often prescribed escitalopram, sertraline, amitriptyline, amisulpride, nonlithium mood stabilizers, and benzodiazepines, whereas males are more often prescribed fluoxetine, olanzapine, two antipsychotics concurrently, typical antipsychotics, valproate, lithium, and more than one benzodiazepine. Elderly (>65 years) participants are more often prescribed sertraline when compared to adolescents. In addition, elderly more often receive quetiapine and less often are prescribed benzodiazepines. Those with comorbid neurological disorders are commonly prescribed antipsychotics, amitriptyline, and more than one antidepressant and are less commonly prescribed lithium, combination of two mood stabilizers, and benzodiazepines. Those with cardiac ailments are more commonly prescribed sertraline, quetiapine, and lithium and less frequently prescribed amitriptyline, fluoxetine, olanzapine, risperidone, and typical antipsychotics. Those with diabetes mellitus more often received escitalopram and quetiapine. Presence of more than one psychiatric diagnosis was associated with the use of more number of medications. Further, diagnosis of affective disorders was associated with the use of a higher number of medications. CONCLUSION Findings of the present study suggest that sociodemographic variables and physical and psychiatric comorbidity influence the prescription patterns of psychotropics.
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Affiliation(s)
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
| | - Vishal Sinha
- Department of Psychiatry, S N Medical College, Agra, Uttar Pradesh, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Manish Bathla
- Department of Psychiatry, MM Institute of Medical Sciences and Research, Mullana, Ambala, India
| | | | - D M Mathur
- Department of Psychiatry, Gitanjali Medical College Hospital, Udaipur, Rajasthan, India
| | | | - Sandip Shah
- Department of Psychiatry, SBKS MI & RC, Sumandeep Vidyapeeth, Pipaira, Vadodara, Gujarat, India
| | - D Sai Baalasubramanian
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
| | - Vivek Agarwal
- Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, India
| | - Kamla Deka
- Department of Psychiatry, Guwahati Medical College, Guwahati, Assam, India
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Grover S, Balachander S, Chakarabarti S, Avasthi A. Prescription practices and attitude of psychiatrists towards clozapine: A survey of psychiatrists from India. Asian J Psychiatr 2015; 18:57-65. [PMID: 26498722 DOI: 10.1016/j.ajp.2015.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/20/2015] [Accepted: 09/28/2015] [Indexed: 01/17/2023]
Abstract
AIM To assess the attitude of psychiatrists towards clozapine and also to evaluate the prescription practices of psychiatrists for clozapine. METHODOLOGY An email survey was sent to 3381 psychiatrists from India, of whom 548 (16.2%) responded. RESULTS Mean number of years in clinical practice was 12.59 (SD-10.1) for participating psychiatrists. Majority of the participants rated their knowledge about clozapine to be good (61.5%)/very good (34.5%). The primary indication for use of clozapine for almost all the participants was treatment resistance and most of the psychiatrists initiated clozapine either in the dose of 25mg OD (44.3%) or 12.5mg OD (37%). Half (51.8%) of the psychiatrists preferred to use clozapine as BD dosing schedule, and median doses required to stabilize the patients ranged from 137.5 to 400mg/day. Once the clozapine dose had been stabilized, about half (51%) of the psychiatrists advised blood monitoring at monthly intervals. Almost all psychiatrists rated effectiveness of clozapine to be better than other antipsychotics. In terms of tolerability, 45.3% of the psychiatrists rated it as 'same as other antipsychotics' and 15.9% rated it as better than other antipsychotics. Most common patient and therapist related factors associated with reluctance to start clozapine were history of poor medication compliance and need for monitoring, respectively. Upon reviewing the prescription of other psychiatrists, participating psychiatrists reported that in about 28.46% of patients clozapine was not prescribed though indicated. CONCLUSIONS This survey suggests that clozapine is underused in India, although psychiatrists have adequate knowledge about the drug but many psychiatrists have negative attitude towards clozapine.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Srinivas Balachander
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakarabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Shangguan Y, Liao H, Wang X. Clonazepam in the treatment of status epilepticus. Expert Rev Neurother 2015; 15:733-40. [DOI: 10.1586/14737175.2015.1056781] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Watve V. Current challenges in practice of psychiatry in India. Indian J Psychiatry 2015; 57:125-30. [PMID: 26124517 PMCID: PMC4462780 DOI: 10.4103/0019-5545.158132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Vidyadhar Watve
- Consultant Psychiatrist, Poona Hospital & Research Centre, Pune, Maharashtra, India
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