ABSTRACT
Background: Obsessive-Compulsive Disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) as an anxiety disorder. Serotonin reuptake inhibitors are considered to be most effective and are the first line pharmacotherapy for the treatment of OCD. However, about 40-60% of OCD patients fail to respond to SSRI mono-therapy. Further, as many as 25% of patients fails to experience any improvement from initial SSRIs mono-therapy. For non-responder’s low dose augmentation with antipsychotics (risperidone, quetiapine, olanzapine, aripirazole, amisuplride etc.) has shown promising response, as compared to serotonin enhancers. The present study is designed to evaluate and compare the efficacy and adverse drug reactions of these two antipsychotics viz. Olanzapine and amisulpride as augmentation strategy in OCD patients. Objective of present study was to compare the efficacy of olanzapine and amisulpride as add on therapy for inadequately controlled obsessive-compulsive disorder patients on selective-serotonin reuptake inhibitor.Methods: the present study was done at Medical College Jabalpur (M.P.) in the department of Psychiatry & Pharmacology. It was randomized, patient blinded study. 47 patients were screened for the study out of which 36 were enrolled and randomized into either SSRI+Olanzapine or SSRI+Amisulpride group. The patients were evaluated at baseline and then biweekly for 12 weeks to assess the efficacy of these drugs as augmentation strategy using Yale-Brown Obsessive Compulsive Scale (Y-BOCS).Results: There was a significant improvement in Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression-Severity (CGI-S) score and Clinical Global impression-Improvement (CGI-I) score in both the groups but there was no significant difference (P>0.05) in either of these groups on these three scale. No serious adverse drug reaction was reported in either of these groups.Conclusions: Both olanzapine and amisulpride are efficacious and well tolerated for augmentation of SSRI with no significant difference in their efficacy.
ABSTRACT
Background: Conventional Oral Examination (COE) is criticized for being too subjective and being influenced by academic and non-academic factors. Another pitfall of COE is unequal distribution of time. Different examiners use a different set of questions with varying difficulty levels. Student related factors include gender, accent, vocabulary used and ability to pick nonverbal cues. These factors make COE less reliable and valid assessment tool. To overcome the limitations of this useful tool, SOE can be implement instead of COE.Methods: It is a prospective and non-randomized study comprising 79 students of pharmacology appeared for two forms of viva i.e. COE and SOE. Three sets of questionnaires - Must know, should know and nice to know were prepared, each having 15 items with increasing difficulty levels and were validated by subject experts and pretested. Ten minutes were allotted for each student for each form of viva. Feedback of students about the novel method was obtained by using semi-structured questionnaire comprising of 19 closed ended questions and one open-ended question.Results: Structured oral examination (SOE) yielded significantly higher marks as compared to COE. There were significant inter-examiner variations in marks awarded in SOE and COE. Other factors influencing implementation were difficulty in structuring viva, rigid time limits, lack of flexibility in knowledge content, monotony and fatigue. The students perceived this format not different from COE but felt that it required in depth preparation of topic.Conclusions: Conducting SOE is a resource-intensive exercise. Despite structuring, inter-examiner variability was not completely eliminated. The student’s performance was depended on factors related to examiners such as teaching experience, vernacular language used, and lack of training. Orientation and training of examiners in assessment strategies is necessary. Standardization of questionnaire is necessary before the implementation of SOE for summative assessment.