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Biomedical subjects

Prakash S. Masand

Publications and source records attributed to Prakash S. Masand.

12 recordsLinked to original sources
PubMed2002

Paroxetine in Patients With Irritable Bowel Syndrome: A Pilot Open-Label Study.

BACKGROUND: Irritable bowel syndrome (IBS) is a common disorder and is the largest diagnostic cohort seen by gastroenterologists. There is a bidirectional comorbidity of IBS and psychiatric illness. Ours is the first study to examine the effect of any selective serotonin reuptake inhibitor in subjects with IBS. METHOD: Twenty subjects with Rome I criteria-diagnosed IBS were treated with 20 to 40 mg of paroxetine for 12 weeks. We utilized a computer-administered patient daily questionnaire taken by patients over the telephone using an interactive voice response system. RESULTS: Sixty-five percent of patients (13/20) reported a reduction in abdominal pain, and 55% (11/20) reported a reduction in pain frequency (total or mean number of days per week in which the patient had the symptom decreased by >/= 50%). Constipation and diarrhea were reduced in 69% and 57% of patients (9/13 and 8/14), respectively. Similarly, a clinically significant reduction in the symptoms of feeling of incomplete emptying (53% [9/17]) and bloating/abdominal distension (55% [11/20]) was apparent at study conclusion compared with baseline. On the Clinical Global Impressions scale at week 12, 47% (8/17) of the patients were much or very much improved. CONCLUSION: In our pilot open-label study, paroxetine was very effective in alleviating the abdominal pain and associated symptoms of IBS. These results warrant further examination in a placebo-controlled study.

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PubMed2002

Comparison of Risperidone and Olanzapine in Bipolar and Schizoaffective Disorders.

OBJECTIVE: To compare risperidone and olanzapine for efficacy, tolerability, need for concomitant mood stabilizers, and cost of treatment in bipolar and schizoaffective disorders. METHOD: We conducted a retrospective chart review of 36 consecutive outpatients with DSM-IV bipolar or schizoaffective disorder seen in 3 settings who received risperidone or olanzapine for at least 1 month between May and August 1997. RESULTS: The mean +/- SD doses were 3.7 +/- 3.5 mg/day of risperidone and 12.0 +/- 5.4 mg/day of olanzapine. Between-treatment differences in patient characteristics, psychiatric history, Clinical Global Impressions scale ratings, and duration of treatment were not significant. Similar proportions of patients in the 2 groups reported side effects, including extrapyramidal symptoms, akathisia, tardive dyskinesia, and precipitation of mania by the respective drug. Patients in the olanzapine group received a significantly higher dose of concomitant lithium than those receiving risperidone (mean daily lithium doses: risperidone group, 750 +/- 150 mg; olanzapine group, 1211 +/- 186 mg; p =.006). The total daily acquisition cost per patient was $11.84 for olanzapine versus $5.81 for risperidone. CONCLUSION: Olanzapine and risperidone were equally efficacious and safe in the treatment of patients with bipolar or schizoaffective disorder, but treatment costs and dose of concomitant lithium were lower in risperidone-treated patients.

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PubMed2000

Treatment of Delirium With Quetiapine.

INTRODUCTION: Delirium, an organic psychiatric syndrome, occurs in 10% of hospitalized patients and is characterized by fluctuating consciousness and impaired cognition, perception, and behavior. METHOD: Charts of 11 consecutive patients with delirium were retrospectively reviewed. These patients were given quetiapine fumarate, a novel antipsychotic, as first-line treatment for their symptoms. The charts of a control group of 11 patients treated with haloperidol, the standard treatment for delirium, during the same time period were also evaluated. The Delirium Rating Scale (DRS) was used to evaluate the efficacy of each treatment. RESULTS: Ten of 11 patients in both groups had > 50% improvement in DRS scores. There was no difference in onset of symptom resolution, duration of treatment, and overall clinical improvement. Quetiapine was better tolerated in these medically ill patients. CONCLUSION: Quetiapine appears to be an efficacious and well-tolerated treatment for delirium. Further prospective studies are warranted.

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PubMed2000

Divalproex Sodium Versus Valproic Acid in Hospital Treatment of Psychotic Disorders.

BACKGROUND: Approximately 50% of pharmacy prescriptions in the United States are filled with generic drugs, which have improved substantially in quality owing to increased governmental regulations. The remaining medicoeconomic question regards whether or not brand-name medications are worth the price. This study evaluates these questions for the brand-name mood stabilizer divalproex sodium and its generic counterpart, valproic acid. METHOD: We conducted a retrospective chart review of all patients who had been taking divalproex and had been switched to valproic acid at 2 local mental health facilities in 1997. Data collected from the inpatient- and day-treatment charts for these 28 patients included dose, duration, side effects, and efficacy (determined using retrospective chart review and the Clinical Global Impressions scale [CGI]) of divalproex sodium compared with valproic acid treatment. RESULTS: t Tests for dependent samples revealed that valproic acid was administered at higher doses than divalproex sodium, but these treatments did not differ in efficacy on the basis of CGI scores. Fisher exact test analyses revealed a trend toward more nausea with valproic acid; also, the combination of nausea, abdominal discomfort, and diarrhea occurred more often in valproic acid-treated patients. There were no differences in the discontinuation of either medicine because of side effects, or in the use of medications to treat gastrointestinal side effects. Efficacy was similar for valproic acid and divalproex sodium. There was no single, significant side effect increase for valproic acid; however, when grouped together, gastrointestinal side effects were statistically significantly increased in valproic acid-treated patients. This appears clinically insignificant because of the lack of difference in drug discontinuation rate or gastrointestinal medication use. CONCLUSION: Given these results and that valproic acid is much less expensive than divalproex sodium, valproic acid appears to be a satisfactory substitution for divalproex sodium in the treatment of frequently hospitalized psychotic patients.

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PubMed2000

Real-World Outcomes of Once-Daily Risperidone Dosing.

BACKGROUND: Recent reports have shown that risperidone, which has established antipsychotic efficacy, is effective and safe in a once-daily dosing regimen. METHOD: The efficacy and safety of once-daily risperidone were assessed in a retrospective study of 27 patients with a variety of psychiatric disorders who were attending a community day treatment program. Their DSM-IV diagnoses included schizophrenia, schizoaffective disorder, bipolar disorder, major depression with psychosis, and posttraumatic stress disorder. They had received once-daily risperidone for a mean of more than 18 months. RESULTS: Disorders of most patients were controlled with once-daily dosages of 1 to 6 mg/day of risperidone. The nighttime once-daily risperidone dosage was well tolerated by patients. In addition, there was no increase in antipsychotic-related side effects, and compliance was enhanced. CONCLUSION: Risperidone was well tolerated, and no patient needed antiparkinsonian medications even at high dosages of risperidone once daily.

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PubMed2000

Novel Antipsychotics in the Treatment of Behavioral Disturbances and Psychoses Associated With Neurodegenerative Disorders.

Behavioral disturbances and psychosis are common features of neurodegenerative disorders and may be drug induced, intrinsic to the underlying pathology, or both. These disturbances, including psychotic and mood symptoms, apathy, aggression and other behavioral symptoms, and superimposed delirium, cause a great amount of disability to the patient and stress on the caregiver. Conventional neuroleptics have been shown to be effective in the treatment of these symptoms, but unacceptable side effects may occur. However, the novel antipsychotics, with their lower risk of inducing extrapyramidal symptoms, have shown promise in the treatment of behavioral disturbances and psychosis associated with neurodegenerative disorders.

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PubMed2000

Topiramate in Bipolar and Schizoaffective Disorders: Weight Loss and Efficacy.

BACKGROUND: Although useful in bipolar disorder, mood stabilizers, such as lithium, divalproex sodium, and carbamazepine, can cause significant weight gain. METHOD: We conducted a retrospective chart review of 5 patients with DSM-IV bipolar disorder or schizoaffective disorder who were treated with topiramate as adjunctive therapy or monotherapy. RESULTS: All 5 patients had a good response to treatment at a mean topiramate dose of 195 mg/day (range, 100-375 mg/day). All patients lost a substantial amount of weight on topiramate treatment. The average weight loss was 22 lb (10 kg; range, 8-56 lb [4-25 kg]). None of the patients discontinued topiramate because of side effects. CONCLUSION: Topiramate may represent a valuable alternative to existing mood stabilizers, either as an adjunct or as monotherapy in patients with bipolar disorder or schizoaffective disorder.

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PubMed2000

Depression Across the Reproductive Life Cycle: Correlations Between Events.

BACKGROUND: This study examines whether women who become depressed at one reproductive cycle event, e.g., postpartum, are likely to become depressed at other such events. METHOD: Seventy-two women in treatment for major depression were asked to complete a questionnaire assessing mood at 4 different reproductive cycle events, i.e., while premenstrual, taking oral contraceptives, postpartum, or perimenopausal. All diagnoses were made using DSM-III-R criteria. Rank-order correlations (r) were determined between mood ratings for different reproductive cycle event pairs. RESULTS: Significant correlations were found between premenstrual and perimenopausal mood ratings (r = 0.41) and between postpartum and perimenopausal mood ratings (r = 0.64). Development of severe depression during the latter 2 events was strongly correlated (r = 0.87). Women who developed severe depression during at least 2 reproductive cycle events were more likely to have bipolar disorder, a family psychiatric history, and a younger age at onset. CONCLUSION: These findings suggest that there may be a unique subgroup of women who are vulnerable to depression at reproductive cycle events.

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