PubMed Health⌕ Search

Biomedical subjects

P S Masand

Publications and source records attributed to P S Masand.

At least 19 recordsLinked to original sources
PubMed2001

Prescribing conventional antipsychotics at two Veterans Administration hospitals: are there geographical differences?

The medical records of 110 patients receiving conventional antipsychotics at two geographically distinct Veterans Administration hospitals (Syracuse, New York, and Omaha, Nebraska) were reviewed. The most common reasons for continuation of conventional antipsychotics were good response and patient or physician choice. Frequently, physicians did not discuss the reasons for continuing conventional antipsychotics or the availability of alternative therapies with their patients. Geographic differences in physicians' prescribing practices of conventional antipsychotics were apparent.

Journal Article↗
PubMed2001

Cardiovascular side effects of novel antipsychotics.

Since the introduction of clozapine, several novel antipsychotic agents have been introduced and more are in Phase II/III studies. Because these agents are used clinically as first-line treatment, we need to be more familiar with their side-effect profiles. This manuscript reviews the cardiovascular side effects of currently available novel antipsychotics. The medications reviewed include clozapine, risperidone, olanzapine, quetiapine, and ziprasidone. Guidelines are suggested for the use of these medications in clinical practice.

Journal Article↗
PubMed2001

Newly admitted psychiatric patient prescriptions and pharmaceutical sales visits.

There is much literature regarding the interaction of pharmaceutical sales representatives and physicians. However, there is little information available regarding their interactions with psychiatric residents. This paper attempts to quantify the impact of pharmaceutical sales visits upon prescriptions written for newly admitted patients in a psychiatric residency training clinic. A retrospective chart review of 47 consecutive patients was conducted. At the time of review all included patients had been admitted to the clinic for less than 3 months. Their psychiatric medication regimens were followed for 3 months. Initiation of new psychotropics was recorded. Data was also collected regarding the number of sales visits which typically occur at resident luncheons. Statistical analysis compared the number of new medication starts to the number of sales visits. Twelve pharmaceutical companies made sales visits. Eleven out of 12 companies' visits were statistically associated with an increase in new medication starts (p < 0.05). As the number of sales visits increased, a greater statistical significance was noted. This study is one of the first to quantify pharmaceutical industry's impact on psychiatric residents' prescribing practices. It appears that psychiatric residents preferentially start companies' medications shortly after sales visits. Furthermore, as sales visits increase in frequency, more of their medications may be started in newly admitted psychiatric outpatients.

Attitude of Health Personnel↗
PubMed2001

Sustained-release bupropion for selective serotonin reuptake inhibitor-induced sexual dysfunction: a randomized, double-blind, placebo-controlled, parallel-group study.

OBJECTIVE: The authors compared low-dose sustained-release bupropion with placebo for sexual dysfunction induced by selective serotonin reuptake inhibitors (SSRIs). METHOD: Thirty adults who had received SSRIs for at least 6 weeks, who were euthymic, and who had sexual dysfunction as determined by a total score greater than 19 out of a possible 30 on the Arizona Sexual Experience Scale were randomly assigned to receive either 150 mg/day of sustained-release bupropion or placebo at 6:00 p.m. for 3 weeks. RESULTS: There were no significant differences between the sustained-release bupropion and placebo groups as measured by change in Arizona Sexual Experiences Scale or Hamilton Depression Rating Scale scores or side effects. CONCLUSIONS: Future studies should compare higher doses of bupropion for treating sexual dysfunction and should include a greater number of subjects.

Adult↗
PubMed2000

Long-term adverse effects of novel antipsychotics.

The introduction of novel antipsychotics for the treatment of patients with serious psychiatric illness has alleviated the burden of managing some of the side effects of conventional agents. However, the novel agents may also cause adverse events. The long-term adverse events of concern include weight gain, diabetes, tardive dyskinesia (TD), and those associated with hyperprolactinemia. Recent studies with the novel agents have prompted clinicians to revisit antipsychotic-induced weight gain. Clinically significant weight gain puts patients at risk for coronary heart disease, hypertension, type II diabetes, dyslipidemia, and some types of cancer. More recently, case reports of glucose abnormalities and diabetes have emerged, indicating that some novel antipsychotics may be associated with altered glucose metabolism or insulin sensitivity. The novel antipsychotics may also have a lower propensity for causing TD than the conventional antipsychotics. Side effects associated with hyperprolactinemia include galactorrhea, gynecomastia, and menstrual and sexual dysfunction. All of these adverse events can cause patients to become non-compliant and may thus predispose them to relapse. In this review, the authors summarize the literature on the long-term side effects of the novel antipsychotics and examine the severity of the problem, with recommendations for management. When selecting treatments, clinicians should consider the side-effect profiles of the various antipsychotic agents.

Journal Article↗
PubMed2000

Switching antipsychotic therapies.

BACKGROUND: Atypical antipsychotics are superior to conventional antipsychotics in improving positive and negative psychotic symptoms. Atypical antipsychotics do not exacerbate mood symptoms, and may improve mood symptoms and cognitive functioning; additionally, they have better adverse effect profiles than conventional antipsychotics. OBJECTIVE: To review the benefits of switching patients with schizophrenia or schizoaffective disorder from a conventional to an atypical antipsychotic, or from one atypical antipsychotic to another. In spite of the higher acquisition cost of atypical antipsychotics, overall treatment costs may decrease due to lower relapse and hospitalization rates. DATA SOURCES: A MEDLINE search (January 1977-January 1999) was conducted for articles written in English about efficacy, adverse effects, compliance, and pharmacoeconomics for atypical and conventional antipsychotics. STUDY SELECTION: Large, multicenter, double-blind, controlled studies were used for efficacy, safety, tolerability, and pharmaco-economic data. Where appropriate, recent review articles were also used. RESULTS: Atypical antipsychotics are superior to conventional antipsychotics in the treatment of schizophrenia. Atypical and conventional antipsychotics have different adverse effect profiles, costs, and compliance rates. CONCLUSIONS: Some patients may benefit by switching from a conventional to an atypical antipsychotic, from an atypical to a conventional antipsychotic, or from one atypical antipsychotic to another. Methods of switching antipsychotic therapies include tapering and cross-over strategies.

Antipsychotic Agents↗
PubMed2000

Weight gain associated with psychotropic drugs.

Weight gain is a common adverse effect of psychotropic drugs. Clinically significant weight gain puts the patient at risk for coronary heart disease, hypertension, Type II diabetes, dyslipidaemia and cancer, and can lead to non-compliance, with the probability of relapse and subsequent (re)hospitalization. This review focuses on specific drug classes such as antipsychotics, antidepressants, mood stabilizers and anxiolytics that have a propensity to induce clinically significant weight gain. Patients should be informed of potential drug-induced weight gain and instructed in the importance of weight management techniques (e.g., proper nutrition, physical exercise, behaviour modification). Individual patient-risk profiles should also be assessed. To ensure adherence to treatment, a proactive physician-patient relationship is essential. Patient compliance and quality-of-life issues are addressed. For appropriate medication selection, the clinician should consider the weight gain potential of various psychotropic agents.

Humans↗
PubMed2000

Side effects of antipsychotics in the elderly.

Side effects of antipsychotic medications are particularly problematic in elderly patients, who experience many age-related changes that may exacerbate medication side effects. Side effects of particular concern in the elderly include anticholinergic reactions, parkinsonian events, tardive dyskinesia, orthostatic hypotension, cardiac conduction disturbances, reduced bone mineral density, sedation, and cognitive slowing. In addition, elderly patients with schizophrenia often have comorbid medical illnesses-such as cardiovascular disease and dementia of the Alzheimer's type-and are thus likely to be taking multiple medications. The effects of polypharmacy must be carefully considered. Patients, caregivers, and family often have different perspectives on side effects. This article addresses the side effects of the currently available antipsychotic medications in light of these concerns.

Age Factors↗
PubMed1999

Tardive dyskinesia: review of treatments past, present, and future.

The aim of this article is to review the theories purported to explain the pathophysiology of tardive dyskinesia (TD) and the various agents investigated for its treatment. The methods used included a review of studies in English, a Medline search, as well as a check of references listed at the end of the articles was conducted to obtain the relevant studies for review. The results show that vitamin E appears to be a promising agent both for the treatment and prophylaxis of TD. Complete remission has been reported with clozapine, but there is a need for further studies. There are cases reported of benefits with numerous miscellaneous agents, including electroconvulsive therapy, but there are no well-designed, substantiating studies. We conclude that there is no universally effective treatment for TD. Vitamin E is promising both for the treatment and possibly prophylaxis of TD. Clozapine therapy should be considered in patients refractory to traditional antipsychotics who develop TD. Judicious use of antipsychotics and periodic monitoring remain the cornerstone of therapy. None of the atypical antipsychotics (risperidone, olanzapine, clozapine, quetiapine) have been used long enough or adequately studied for their effects on TD.

Antioxidants↗
PubMed1998

Psychostimulant augmentation of second generation antidepressants: a case series.

OBJECTIVE: The authors attempted to treat Major Depressive Disorder (MDD) suboptimally responsive to one of the newer (second-generation) antidepressants by augmentation with a psychostimulant medication. METHOD: Seven cases of MDD showing a partial response to an adequate trial of a second generation antidepressant were augmented with a psychostimulant. RESULTS: A marked improvement in clinical symptoms of depression was noted in all cases, with particular improvement in apathy and feelings of fatigue. CONCLUSION: Psychostimulant augmentation of the newer generation antidepressants is a promising new strategy. Further controlled investigation is warranted to explore various aspect of this method.

Adult↗
PubMed1998

Selective serotonin reuptake inhibitors in pregnancy and lactation.

Selective serotonin reuptake inhibitors (SSRIs) have become the agents of first choice in the treatment of depression because of their safe side effect profile. This paper reviews the current literature on the use of SSRIs in pregnancy and lactation concerning their safety. There are human studies that only used fluoxetine in pregnancy, which established its safety. SSRIs are excreted in breast milk, and their long-term effects on the newborn are unknown at this time. The decision to use SSRIs in pregnancy should be made on a case by case basis with active involvement of the patient in the informed consent process during which the risks and benefits are discussed and documented.

Animals↗
PubMed1998

Irritable bowel syndrome (IBS) and alcohol abuse or dependence.

Irritable bowel syndrome (IBS) has been reported in 10-22% of adults. Using a semistructured clinical interview to study the prevalence of IBS, we compared 31 patients seeking treatment for alcohol abuse or dependence in an outpatient setting with an age- and sex-matched control group of 40 patients who were seeking treatment in a general physician's office for other medical illnesses. The control group did not have any Axis I disorders. IBS was diagnosed according to the criteria of Drossman et al. Thirteen (41.9%) patients with alcohol abuse or dependence met the criteria for IBS, in contrast to 1 (2.5%) patient in the control group. We conclude that IBS is common and frequently underdiagnosed in patients with alcohol abuse or dependence.

Adult↗
PubMed1997

The relationship between schizophrenia and irritable bowel syndrome (IBS).

Irritable bowel syndrome (IBS) has been reported in 10-22% of adults. Amongst patients seeking medical attention for IBS 70-90% may have psychiatric co-morbidity, most commonly major depression. In contrast, few studies have looked at the prevalence of IBS in psychiatric patients. To our knowledge, there are no studies assessing the prevalence of IBS in patients with schizophrenia. Using a semistructured clinical interview to study the prevalence of IBS, we compared 47 patients with schizophrenia to an age-matched control group (n = 40) of patients who were seeking treatment in a primary care physicians office for other medical illnesses. IBS was diagnosed according to the criteria of Drossman et al. Nineteen percent (n = 9) of the patients with schizophrenia met criteria for IBS in contrast to 2.5% (n = 1) of the control group (p = 0.012). Schizophrenic patients seldom complain of gastrointestinal symptoms until specifically asked. Therefore, it may be important to inquire about gastrointestinal symptoms prior to initiating pharmacotherapy in order to differentiate side effects from a prior existing condition. Prospective studies should address the question whether remission of psychosis leads to improvement or resolution of IBS.

Adult↗