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Sumant Khanna

Publications and source records attributed to Sumant Khanna.

11 recordsLinked to original sources

Efficacy and tolerability of ziprasidone in patients with treatment-resistant schizophrenia.

This multicentre, parallel-group study compared the efficacy and tolerability of ziprasidone and chlorpromazine in treatment-resistant schizophrenia (at least three treatment periods of at least 6 weeks each with two or more antipsychotic agents during the past 5 years without significant response) that was unresponsive to 6 weeks of open-label haloperidol (</=30 mg/day). Haloperidol nonresponders were randomized to ziprasidone 80-160 mg/day (n=152) or chlorpromazine 200-1200 mg/day (n=154) for up to 12 weeks. The primary efficacy measures were the Brief Psychiatric Rating Scale (BPRSd) total score derived from the Positive and Negative Syndrome Scale (PANSS), BPRSd core psychotic symptoms, and Clinical Global Impression-Severity (CGI-S). Secondary efficacy variables included PANSS total score, PANSS Negative Subscale, and the Montgomery-Asberg Depression Rating Scale. Results were assessed at baseline and week 6 of haloperidol treatment (n=415) and at weeks 0, 3, 6, 9 and 12 of randomized treatment (n=306). Improvements in efficacy variables were greater with ziprasidone at weeks 3 and 6, reaching statistical significance versus chlorpromazine (P<0.05) at week 6 for CGI-S and week 12 for PANSS Negative Subscale. Improvements in BPRSd total and core items and PANSS total scores were comparable at weeks 9 and 12. Ziprasidone was associated with a greater decrease in median prolactin levels and a lower incidence of clinically significant weight change. Neither agent caused any clinically important changes in QTc interval.

Adult↗

Acute and continuation risperidone monotherapy in bipolar mania: a 3-week placebo-controlled trial followed by a 9-week double-blind trial of risperidone and haloperidol.

In a randomized, double-blind trial, patients with acute bipolar mania received 1-6 mg/day of risperidone, 2-12 mg/day of haloperidol, or placebo for 3 weeks, followed by double-blind risperidone or haloperidol for 9 weeks. Of 438 patients, 154 were randomized to risperidone, 144 to haloperidol, and 140 to placebo. The mean+/-S.D. modal doses were 4.2+/-1.7 mg/day of risperidone and 8.0+/-3.6 mg/day of haloperidol during the initial 3-week phase and 4.1+/-1.8 and 7.4+/-3.7 mg/day during the 12-week period. At week 3, mean Young Mania Rating Scale (YMRS) score reductions from baseline were significantly greater in patients receiving risperidone than placebo (p<0.001). Differences between risperidone and haloperidol on this efficacy measure were not significant. Further reductions in YMRS scores were seen in patients receiving risperidone or haloperidol during the subsequent 9 weeks. No unexpected adverse events were reported. Extrapyramidal disorder and hyperkinesias, the most commonly reported adverse events with antipsychotic use, occurred less frequently with risperidone than haloperidol. We conclude that risperidone monotherapy was an effective and well-tolerated treatment for bipolar mania and that efficacy was maintained over the long term.

Adolescent↗

Glutamatergic dysfunction in OCD.

The role of glutamatergic dysfunction in the pathophysiology of OCD has hardly been explored despite recent reports implicating glutamatergic dysfunction in OCD. We decided to investigate CSF glutamate levels in adult OCD probands compared to psychiatrically normal controls. In total, 21 consenting psychotropic drug-naïve adult OCD patients, diagnosed using SCID-IV-CV, and 18 consenting psychiatrically normal controls with age within 10 years of age of the patients, who did not have any history of head injury or neurological illness, were included into the study. Aseptically collected and stored CSF samples obtained from the patients and control subjects were used for glutamate estimation, which was carried out by a modification of the procedure described by Lund (1986). CSF glutamate (micromol/l) level was found to be significantly higher [F(1,31)=6.846, p=0.014] in OCD patients (47.12+/-4.25) compared to control subjects (41.36+/-3.63) on analysis of covariance. There was no effect of gender, age, duration of illness, Y-BOCS score, or CGI-S score on CSF glutamate levels. Our study provides preliminary evidence implicating glutamatergic excess in the pathophysiology of OCD, which needs to be further explored by studies from other centers involving larger sample sets from different age groups.

Adolescent↗

A family genetic study of clinical subtypes of obsessive-compulsive disorder.

OBJECTIVE: The results of various family studies of obsessive-compulsive disorder have varied widely, possibly because of heterogeneity in the obsessive-compulsive disorder phenotype. The current study was conducted to determine familiality of checker and washer subtypes of obsessive-compulsive disorder compared with normal controls. METHODS: In this study, all available first-degree relatives of 25 checker, 34 washer and 40 psychiatrically normal control probands were interviewed directly, using structured interviews. RESULTS: The morbid risk of syndromal and subsyndromal obsessive-compulsive disorder was significantly greater among the relatives of checker probands (19.4%) than in the relatives of washer (8.7%) or control probands (5.4%), while the morbid risk for the relatives of washer and control probands was not significantly different. In all, 67% of the checker relatives with syndromal and subsyndromal obsessive-compulsive disorder were checkers, while 54% of the washer relatives with syndromal and subsyndromal obsessive-compulsive disorder were washers. CONCLUSIONS: Our study provides preliminary evidence of familiality of the checker subtype of obsessive-compulsive disorder. Future studies using patients subtyped on the basis of symptom dimensions, in larger obsessive-compulsive disorder samples, are needed, to further validate the genetic basis of obsessive-compulsive disorder.

Adolescent↗

Risperidone in the treatment of acute mania: double-blind, placebo-controlled study.

BACKGROUND: Severe mania is life-threatening, carries an increased risk of suicide and has a serious impact on patients and their families. Efficient and rapid control of episodes of acute mania is needed. AIMS: To evaluate the safety and efficacy of risperidone monotherapy for acute mania. METHOD: In a 3-week, randomised, double-blind trial, 290 in-patients with bipolar I disorder with current manic or mixed episode and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexible doses of risperidone (1-6 mg per day) or placebo. RESULTS: Risperidone was received by 146 patients and placebo by144. Their mean baseline YMRS score was 37.2 (s.e.=0.5). Significantly greater improvements were observed with risperidone than with placebo at weeks 1 and 2 and at end-point (total YMRS: P <0.01). Extrapyramidal symptoms were the most frequently reported adverse events in the risperidone group. CONCLUSIONS: In patients with severe manic symptoms, risperidone produced significant improvements in YMRS scores as early as week 1 and substantial changes at end-point. Treatment was well tolerated.

Acute Disease↗

Late onset OCD.

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Age Factors↗

Exploration of dimensions of psychopathology in neuroleptic-naïve patients with recent-onset schizophrenia/schizophreniform disorder.

Previous studies have suggested that schizophrenic psychopathology segregates into three orthogonal dimensions, viz., psychosis, negative and disorganization. Most of these reports were based on studies on medicated patients with varying degrees of chronicity. The present study aimed at exploring the dimensionality of psychopathology rated on the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) in a sample of 43 neuroleptic-naïve patients with recent-onset schizophrenia/schizophreniform disorder. Principal Components Analysis (PCA) of SANS and SAPS global ratings, excluding inattention but including inappropriate affect as a separate global rating, revealed that the symptoms segregated into three dimensions, viz., negative (affective flattening, alogia, avolition anhedonia and inappropriate affect), psychosis (delusions and hallucinations) and disorganization (positive formal thought disorder and bizarre behavior). Cumulatively these three dimensions explained 74.07% of the variance. The results suggest that the three dimensions of schizophrenic psychopathology are valid even in neuroleptic-naïve, recent-onset patients with schizophrenia/schizophreniform disorder. PCA of the SANS and SAPS individual items revealed similar findings, but psychotic symptoms loaded under two components, thus yielding a four-factor solution; however, this observation needs to be confirmed in a larger sample of neuroleptic-naïve schizophrenic patients.

Adolescent↗

Electroconvulsive Therapy in Obsessive-Compulsive Disorder.

An open trial of electroconvulsive therapy was conducted in nine subjects who met DSM-III criteria for obsessive-compulsive disorder. There was an initial reduction in symptomatology that lasted from 1 to 4 months. Subjects who had less obsessive-compulsive (anankastic) personality traits responded better. There was also the post hoc observation that subjects who were agitated did better. We observed correlations between depression and interference scores, but not with symptom scores, suggesting that ECT has anti-obsessional activity.

Journal Article↗