An open, randomized, comparative study of efficacy and safety of risperidone and haloperidol in schizophrenia.

OBJECTIVES: In the last decade there have been numerous randomized controlled trials comparing the efficacy and safety of second generation antipsychotics and conventional antipsychotics in the treatment of schizophrenia, but most of them have been conducted in the western population. This study compared the efficacy and safety of risperidone versus haloperidol in the Nepalese context, in order to add on to the very few literatures available on this topic in the South East Asia region and compare them. METHODS: Patients with the diagnosis of schizophrenia were randomly assigned to receive risperidone 4-6 milligrams (mg) per day and haloperidol 10-20 mg per day, and were followed up for 6 weeks. Assessment were done on the day of the diagnostic interview and days 7, 14, 28 and 42 (end point). During the assessment periods Positive and Negative Syndrome Scale (PANSS) was administered to monitor the progress in psychopathology and Udvalg for Kliniske Undersogelser (UKU) side effects rating scale was applied to rate the treatment emergent adverse effects. RESULTS: Both risperidone and haloperidol were associated with substantial baseline- to- endpoint reduction in symptom severity. After one week of treatment, the improvement in schizophrenia with risperidone was significantly better than haloperidol in terms of PANSS- total Score (-45.4 versus -29.5), negative subscale score (-14.3 versus -6.68) and general psychopathology subscale score (-20.9 versus -13.7). At the end point of the study, the benefit was maintained in total score (-52.1 versus -43.1), though the negative subscale score still showed tendency for greater improvement in psychopathology with risperidone. The side effects profile did not show significant differences except in extrapyramidal symptoms. Thirty-eight percent of risperidone treated patients had to resort to anti-parkinsonian treatment compared to 78% in haloperidol treatment group. CONCLUSION: Similar to the studies in the western countries, Asia and Indian subcontinent, both risperidone and haloperidol were effective in the reduction of psychopathological symptoms in this group of Nepalese population with the diagnosis of schizophrenia. However, risperidone was quicker and better then haloperidol and risperidone had a better safety profile. This is important, because extrapyramidal side effects of neuroleptics are responsible for non-compliance and increased cost in terms of us of anti-parkinsonian medication.

Tuberculin survey in government high school of Dharan municipality.

This survey was done in 682 out of 1672 children tested with Batch of Tuberculin used for Testing (PPD RT 23 with Tween 80) in Jan. 1997 with financial research grant of B.P. Koirala Institute of Health Sciences, Dharan. Dharan City is situated in Eastern Development Region (EDR) of Nepal where a high percentage of migrated population is residing with very high number of sputum positive cases. The majority of population are from high hills and mountain region where the Annual Risk of Infection (ARI) is less. This survey was done to know the epidemiological situation of Tuberculosis (TB) in Dharan. Tuberculin survey was done in Eastern Development Region (EDR) (1994) by National Tuberculosis Centre (NTC)/Japan International Cooperation Agency (JICA) in Saptari and Morang. The reported result of average Annual Risk of Infection (ARI) is 2.49% and 2.38% respectively. The mean age of surveyed population was 14.8 yrs. The Bacilli Calmette Guerin (BCG) coverage (scar rate) was 38.3% and BCG 4-8 age group 83.3% was highest and it gradually decreased to 37.5% in 12 + age group. The average 23 Tween-8-Batch of Tuberculin used for Testing (PPD) positive is 33.6% with 10 mm induration as cutoff line. Annual Risk of Infection (ARI) based on above was 2.7% in 9-11 age group and 1.31% in 12 + age group. This survey is suggestive of tuberculosis being highly prevalent in Dharan. The survey also showed average ARI to be 2.44% in Dharan in 10-15 yrs age group. The finding is suggestive of high ARI although the populations has migrated from hill and mountain. Previous report of average ARI in this area was 2.5% (Morang and Saptari). The survey result suggests that high priority, effective tuberculosis program is necessary and intensive control program can only give impact to control of tuberculosis in Dharan.