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Aakanksha Singh,Sandeep Grover,Pankaj Malhotra,Subhash C. Varma 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.2
Agranulocytosis as a side effect of clozapine has been reported to be associated with initial phases of treatment, i.e., first six months. Agranulocytosis with clozapine during the initial phases of treatment has been linked to genetic vulnerability in the form of variations in the human leukocyte-antigen haplotypes. However, there is limited literature on late onset agranulocytosis with clozapine and this has very rarely been linked to human leukocyte-antigen haplotypes vulnerability. In this report we review the existing data on late onset agranulocytosis with clozapine and describe the case of a young man, who developed agranulocytosis with clozapine after 35 months of treatment and was found to have genetic vulnerability in form of being positive for HLA DR4. This case highlights underlying autoimmune immune mechanism in clozapine-induced agranulocytosis and the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with genetic vulnerability to develop this condition.
An Assessment model for Benchmarking in Manufacturing Industries
Bhupender Singh,Sandeep Grover,Vikram Singh 보안공학연구지원센터 2015 International Journal of Hybrid Information Techno Vol.8 No.12
Benchmarking is the decisive instrument for enhancement which proficient over assessment from former organizations predictable as the best within reason. Benchmarking provides an external focus which forces the organization to seem what the competitors are adopting. The manufacturing industries are focused in this study such as service, professionalism, replace ability, credibility and many more while bringing other processes up to stain and highlights different types of Benchmarking process used for different industries. Thus, the attempt has been made by authors to present an evaluation model for Benchmarking by using ANP approach. Here, ANP approach is used on the basis of software where, group of experts were consulted to establish interrelations and to provide weight age for pair wise comparison. Mutually spirit of experts will provide the identical results for the study and reasonably cooperative for managers to give assurance for internationally manufacturing industries.
Shih-Ku Lin,Shu-Yu Yang,Seon-Cheol Park,Ok-Jin Jang,Xiaomin Zhu,Yu-Tao Xiang,Wen-Chen Ouyang,Afzal Javed,M. Nasar Sayeed Khan,Sandeep Grover,Ajit Avasthi,Roy Abraham Kallivayalil,Kok Yoon Chee,Norliza 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.1
Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.
A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists
Yukako Nakagami,Kohei Hayakawa,Toru Horinouchi,Victor Pereira-Sanchez,Marcus P,J,Tan,Seon-Cheol Park,Yong Chon Park,Seok Woo Moon,Tae Young Choi,Ajit Avasthi,Sandeep Grover,Roy Abraham Kallivayalil,Yu 대한신경정신의학회 2021 PSYCHIATRY INVESTIGATION Vol.18 No.11
Objective Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate. Methods We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. Results The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). Conclusion Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.