Praveen Penagaluri

University of Louisville, Louisville, KY, United States

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Publications (6)9.71 Total impact

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    ABSTRACT: Sleep disturbance has been implicated in both prodromal and syndromal phases of bipolar illness. Charts of bipolar disorder (BD) patients who had been euthymic for at least 2 months were reviewed for mood symptoms, Clinical Global Impression scores, Global Assessment of Functioning scores, and sleep. Among 116 patients, 10 never achieved a euthymic interval of 2 months' duration. Among the remaining 106 euthymic patients, 59 (55.6%) had BD I, 23 (21.7%) had BD II, and 24 (22.8%) had BD not otherwise specified (NOS). The mean age was 43.3±SD 14.6, and 35% were male. A total of 25 patients (23.6%) had a clinically significant ongoing sleep disturbance (27.1% of those with BD I, 21.7% of those with BD II, and 16.6% of those with BD NOS). Of 16 patients for whom a sleep description was available, 25% had difficulty falling asleep, 81.25% had middle insomnia (2 patients experienced both), and none had early morning awakening. Eleven patients (10.4%) received sleep aids, and 33 (31.1%) received sedating antipsychotics (3 patients received both). Sleeping aids and sedating antipsychotics can potentially disguise an underlying sleep disturbance. Thus, it is possible that study patients taking these medications (n = 58; 54.7%) suffer from a sleep disturbance that is being adequately or inadequately treated.
    Annals of Clinical Psychiatry 05/2011; 23(2):113-6. · 1.54 Impact Factor
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    ABSTRACT: A naturalistic retrospective chart review of all patients given pramipexole for bipolar depression in addition to their mood stabilizers was undertaken. Sixteen patients were followed for an average of 6.7 +/- SD 9.0 months. Half of the patients stopped the pramipexole an average of 2 months after starting it. For all patients, depressed mood, and the total profile of depressive symptoms improved significantly within 4 weeks and remained significantly improved for as long as 36 weeks. Both global function (GAF), and global impression (CGI) improved with pramipexole. Irritability and insomnia both increased slightly initially, and then subsided. There were no changes in mania ratings for up to 36 months. Long-term outcome of adjunctive pramipexole appears to be adequate, with apparent maintenance of effect for over 9 months.
    Psychiatric Quarterly 09/2010; 81(3):207-13. · 1.26 Impact Factor
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    ABSTRACT: The anticonvulsant carbamazepine is approved by the FDA for treatment of acute mania. It is available in 2 formulations: immediate-release (IR) and extended-release carbamazepine capsules (ERCC). The relative efficacy of these formulations in acutely ill bipolar patients has not been previously investigated. This study is a subanalysis of a 3-month, blinded, equal, random-assignment comparison of adverse effect load of an IR carbamazepine formulation (Tegretol) and ERCC (Equetro) in type I or type II bipolar patients already receiving carbamazepine or clinically determined to benefit from carbamazepine treatment. Dosages were titrated to patients' clinical needs. Subjects who scored >15 on the Montgomery Asberg Depression Rating Scale (MADRS) or >14 on the Young Mania Rating Scale (YMRS) were included in this analysis. The primary outcome measures were the relative mood scores at the end of the study. At the end of 3 months of treatment, all patients improved compared with their baseline, but there was no difference in mood ratings in subjects with an initial MADRS >15 (ERCC, 18.2 +/- SD 11.9, vs IR, 12.0 +/- 4.5; P = .3) or YMRS >15 (ERCC, 6.5 +/- 6.4, vs IR, 4.7 +/- 3.1; P = .7). When compared with their baseline, patients receiving IR improved earlier than patients receiving ERCC. There were no differences in overall adverse events in patients receiving IR or ERCC (23.1 +/- 13.42 vs 22.3 +/- 13.40; P = .9). Carbamazepine is effective in treating symptoms of both mania and depression, and there are no significant differences in the relative efficacy of the IR or ERCC formulations.
    Annals of Clinical Psychiatry 02/2010; 22(1):3-8. · 1.54 Impact Factor
  • Praveen Penagaluri, Kristin L Walker, Rif S El-Mallakh
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    ABSTRACT: This study investigated relative relationships between auditory hallucinations and nonpsychotic hallucinations (pseudohallucinations), and suicidal risk. A sample of 206 consecutive patients seen in an emergency psychiatric service was evaluated for the presence and intensity of hallucinatory experiences (the hallucination item of the Positive and Negative Symptoms Scale), suicidal intensity (the suicide item of the Montgomery Asberg Depression Rating Scale), and cumulative suicide risk (the total number of risk factors). Individuals with nonpsychotic hallucinations experienced greater intensity of suicidal ideation versus subjects with no hallucinations or subjects with psychotic hallucinations (p = .0001). Pseudohallucinosis is associated with higher intensity of suicidal ideation compared with psychotic hallucinations or no hallucinations.
    Crisis The Journal of Crisis Intervention and Suicide Prevention 01/2010; 31(1):53-6. · 1.09 Impact Factor
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    ABSTRACT: A patient taking oral risperidone while using cocaine and alcohol presented with priapism shortly after long-acting, injectable risperidone was prescribed. Another case of priapism was diagnosed in a sickle cell disease patient who was on oral risperidone. A penectomy due to necrosis was required in the first case, while the other patient regained erectile function. Physicians should be aware of priapism-inducing/predisposing factors, such as sickle cell disease, certain medicines or drugs of abuse, and antipsychotic medications. Risperidone is an established cause of priapism. It occurs especially in males with sickle cell disease; use of antipsychotic drugs and/or cocaine further increases risk.
    Southern medical journal 12/2009; 102(12):1266-8. · 0.92 Impact Factor
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    ABSTRACT: In epilepsy, slow-release formulations of carbamazepine (CBZ) have fewer adverse events (AEs) compared with immediate-release (IR) formulations. As CBZ is used for mania, it is important to determine whether a similar pattern exists for bipolar patients. This was a 3-month, blinded, random-assignment study to an IR formulation or extended-release carbamazepine capsules (ERCC, Equetro) in type I or type II bipolar patients already on CBZ or clinically determined to benefit from it. Dosages were titrated to patients' clinical needs. Mood and AE ratings were performed at baseline and monthly for 3 months. There was no difference in mood ratings or in the total level of AEs in patients receiving IR or ERCC. However, autonomic AEs (5.0+/-1.1 vs. 2.0+/-0.7, P = 0.02) and gastrointestinal AEs (1.6+/-0.4 vs. 0.6+/-0.3, P = 0.05) were significantly less in participants receiving ERCC. CBZ level in patients receiving ERCC were higher (9.2+/-1.7 vs. IR 7.2+/-1.3 microg/ml, P = 0.005). Total AE load was directly related to CBZ level only in participants receiving the IR formulation. In conclusion, ERCC is better tolerated than IR CBZ in bipolar patients.
    International clinical psychopharmacology 06/2009; 24(3):145-9. · 3.35 Impact Factor