The Feasibility Test of Korean Medication Algorithm for the Treatment with Schizophrenic Patients(I): Analysis Focusing on the Effectiveness of Treatment / 대한정신약물학회지

OBJECTIVES: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for schizophrenia to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Schizophrenia patients in clinical settings in Korea. METHODS: A total of 108 schizophrenia and schizophreniform disorder patients were enrolled at 19 centers and treated according to the algorithm. PANSS (Positive and Negative Symptom Scale) and CGI (Clinical Global Impression) were used to evaluate symptom severity. Also UKU (UKU side effect rating scale) and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale), DAI-10 (Drug Attitude Inventory-10), PPS (Patient Preference Scale), SWN (Subjective Well-Being under Neuroleptic treatment) and WHOQOL (World Health Organization Quality of Life) were used to evaluate tolerability and satisfaction of patient respectively. RESULTS: Overall ratings including symptom severity, compliance of medication, side effect of medication, quality of life were favorable. The treatment response (PANSS improvement > or = 20%) rate was 63%, 75% at the first Clinical decision point (CDP) and 4 month respectively. CONCLUSION: Symptom improvement, tolerability and quality of life were all favorable. These results suggest that this algorithm can be useful in clinical practices.

Questionnaire for Developing the Korean Medication Algorithm for the Treatment of Schizophrenia / 대한정신약물학회지

KMAP (Korean Medication Algorithm Project for Major Psychiatric Disorders) was established to develop Korean algorithm for major psychiatric disorders. KMAP developed the draft of Korean medication algorithm for schizophrenia and assessed the level of satisfaction and fitness in the Review Committee using questionnaire about this draft. The members of Review Committee were medical doctors of psychiatry who were interested in the research of psychiatric drugs or were experienced in psychiatric pharmacotherapy in college of medicine, mental hospital or private psychiatric clinic. 57 psychiatrists were appointed as committee of re-examination of algorithm and 48 (84.2%) answered the questionnaire. The Korean medication algorithm draft for schizophrenia was based upon Korean clinical research, clinical experience of Korean professionals and clinical guidelines of other countries. The draft of this algorithm was categorized into 32 items, then we made a questionnaire according to these items. The answers of each question were consist of 5 levels of satisfaction, and the committee members could propose free opinion about these questions. The results of questionnaire were presented and discussed in an open forum. In most items except two, over half of committee members answered that `correction unnecessary of draft'. The 2 items showing low level of satisfaction were `trial of atypical antipsychotics at level 1', `trial of typical antipsychotics at level 4'. These items were revised from the draft after having discussion in an open forum. And then we published the first edition of `Korean Medication Algorithm for Schizophrenia'.

Open Clinical Trial to Assess the Efficacy and Safety of Quetiapine in Patients of Schizophrenia / 대한정신약물학회지

OBJECTIVE: The efficacy, tolerability and safety of quetiapine in schizophrenia patients diagnosed by the diagnostic criteria of schizophrenia of the Diagnostic Statistical Manual 4th edition was studied in psychiatric department of 4 hospital in Korea. METHODS: Sixty-four patients (male 31, female 33;age 34.2+/-10.4 years; illness duration 8.1+/-8.3 years) who showed acute exacerbation, partial response, or intolerable adverse event to previous antipsychotic drugs were recruited. Doses of quetiapine were adjusted to maximize efficacy and minimize adverse events. Efficacy was assessed by the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scale. Tolerability and safety were assessed by reports of adverse events, clinically significant abnormal laboratory values and changes from the baseline to week 8 in the Abnormal Involuntary Movement Scale (AIMS) and Simpson-Angus total score as index of extrapyramidal symptoms (EPS). RESULTS: Fiftythree patients completed the 8 weeks trial. The clinical symptoms indexed by BPRS were significantly improved (baseline score=37.9+/-13.0, score at the end=24.3+/-13.6;F=41.5, d.f.=2.4, p=0.000). The CGI score of severity of illness was also significantly reduced (baseline score=4.7+/-1.1, score at the end= 3.6+/-1.2;F=27.6, d.f.=2.2, p=0.000). The frequencies of the worsening of AIMS and Simpson-Angus scores at the end of study were 7.5% and 4.2%, respectively. The most common adverse events of at least moderate intensity were EPS (9.3%), constipation (6.3%), and sedation (4.7%). CONCLUSION: The results of this study suggest that quetiapine is effective, may have a favorable EPS, and has overall safe tolerability in the patients with schizophrenia, and schizophreniform disorder.

Open Clinical Trial to Assess the Efficacy and Safety of Quetiapine in Patients of Schizophrenia / 대한정신약물학회지

OBJECTIVE: The efficacy, tolerability and safety of quetiapine in schizophrenia patients diagnosed by the diagnostic criteria of schizophrenia of the Diagnostic Statistical Manual 4th edition was studied in psychiatric department of 4 hospital in Korea. METHODS: Sixty-four patients (male 31, female 33;age 34.2+/-10.4 years; illness duration 8.1+/-8.3 years) who showed acute exacerbation, partial response, or intolerable adverse event to previous antipsychotic drugs were recruited. Doses of quetiapine were adjusted to maximize efficacy and minimize adverse events. Efficacy was assessed by the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scale. Tolerability and safety were assessed by reports of adverse events, clinically significant abnormal laboratory values and changes from the baseline to week 8 in the Abnormal Involuntary Movement Scale (AIMS) and Simpson-Angus total score as index of extrapyramidal symptoms (EPS). RESULTS: Fiftythree patients completed the 8 weeks trial. The clinical symptoms indexed by BPRS were significantly improved (baseline score=37.9+/-13.0, score at the end=24.3+/-13.6;F=41.5, d.f.=2.4, p=0.000). The CGI score of severity of illness was also significantly reduced (baseline score=4.7+/-1.1, score at the end= 3.6+/-1.2;F=27.6, d.f.=2.2, p=0.000). The frequencies of the worsening of AIMS and Simpson-Angus scores at the end of study were 7.5% and 4.2%, respectively. The most common adverse events of at least moderate intensity were EPS (9.3%), constipation (6.3%), and sedation (4.7%). CONCLUSION: The results of this study suggest that quetiapine is effective, may have a favorable EPS, and has overall safe tolerability in the patients with schizophrenia, and schizophreniform disorder.

An Association Study of the 5-HTTLPR and COMT Genes Polymorphisms and Personality Traits

BACKGROUND: Serotonin transporter gene-linked polymorphism region(5-HTTLPR) and catechol-O-methyltransferase(COMT) genes are thought to be important factors in some personality traits and the etiology of anxiety disorder. The goal of this study was to determine the role of these genes in personality traits. METHOD: The participants included 116 healthy adults with no history of psychiatric disorders and other physical illness for the last 6 months. All participants were tested by Temperament and Character Inventory(TCI). The 5-HTTLPR, COMT val158met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with t-test and ANOVA. RESULT: There were possible relationships of the 5-HTTLPR with self-transcendence(P=0.050) and COMT val158met polymorphism with cooperativeness(P=0.053). CONCLUSION: We found associations between 5-HTTLPR, COMT polymorphisms and the some TCI character dimensions. Further studies of polymorphisms of other genes and their interactions may clarify the complex relationship between personality and genes.

Designs and Methods for the Development of Korean Medication Algorithm for Schizophrenic Patients / 대한정신약물학회지

As a solution about many problems of pharmacotherapy for Korean patients with major psychiatric disorders, Korean Medication Algorithm Project for Major Psychiatric Disorders (KMAP) was launched. Recently, a medication algorithm for schizophrenic patients was developed and distributed. This review article showed the designs, processes and methods for developing this algorithm. Also we compared the development of Korean algorithm for schizophrenics with other foreign representative algorithms or clinical practice guidelines. We hope that this review elicit the productive criticism about the rigour, the system of development and the objectivity of content. The limitations and problems of Korean algorithm are also discussed in this review.

Korean Medication Algorithm Projects for Major Psychiatric Disorders(II): Background, Basic Plan, Organization of KMAP and Principles, Methods of Algorithm Development and Limitation, Caution when sing KMAP / 대한정신약물학회지

In this special article we present Korean medication algorithm development project for major psychiatric disorder (KMAP), basic plan, organization, basic principles of algorithm developments, methods of development, limitations and cautions of using this algorithm. The Korean Society of Psychopharmcology and Korean Academy of Schizophrenia as a co-worker started to make Korean algorithm project that is helpful to treat major mental disorder (schizophrenia, bipolar disorder) patients by the better psychopharmacologic treatments. In spite of many advantages of algorithm, these projects have many limitations and problems simultaneously; we needed to introduce the goal of algorithm, details of development methods in this special article. KMAP have employed the latest survey techniques and reflect only the most current clinical standards. The results are a practical reference tool not only for clinicians but also for mental health educators and other healthcare professionals involved in the care of patients who have major mental disorders. This algorithm projects can have problems and shortcomings. but we will revise this issues by correction and amendment.

Efficacy and Safety of Olanzapine in the Treatment of Korean Patients with Schizophrenia and Schizophreniform Disorder: Open Multicenter Clinical Trial / 신경정신의학

OBJECTIVE: This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzapine for the treatment of Korean patients. METHOD: 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. RESULTS: 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(+/-4.7)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale) and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-sberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms) and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant elevation of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed no significant changes during the trial. CONCLUSIONS: Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder. In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.

Relationships between Nailfold Plexus Visibility and Clinical Variables in Adult Schizophrenics

OBJECTIVES: There have been several evidences that the central nervous system defect is one of the etiologic factors in schizophrenia and high nailfold plexus visibility can reflect indirectly. These are particularly related to the negative symptoms of schizophrenia. In this study, we examined the relationship between nailfold plexus visibility and various clinical variables in schizophrenia. METHODS: Forty patients(20 males, 20 females) satisfying the DSM-IV criteria for schizophrenia and forty normal controls(20 males, 20 females) were measured for Plexus Visualization Score(PVS) by using capillary microscopic examination. We used Positive and negative Syndrome Scale(PANSS). Uimann-Giovannoni Process-Reactive Questionnaire(PRQ), Phillips Premorbid Adjustment Scale(PAS). Continuous Performance Test, and Backward Masking for psychopathology and clinical variables. RESULTS: There was no significant relationship between schizophrenic subjects and normal controls in PVS. PVS was correlated with PANSS positively except negative symptom subscore. PVS was correlated with PRQ score negatively, and with PAS score positively. CONCLUSIONS: This study shows high PVS are associated with more severe psychotic symptoms and with clinical variables, such as disease process and premorbid adjustment, in some schizophrenics.

Clinical Features in Adult Schizophrenics with Minor Physical Anomalies / 대한정신약물학회지

OBJECTIVE: There have been several evidences that the central nervous system deflect is one of the etiologic factor in schizophrenia and minor physical anomalies can reflect these deflects indirectly. These central nervous deflects are particularly related to the negative symptoms of schizophrenia. In this study, we examined the relationship between minor physical anomalies and psychopathology in schizophrenia. METHODS: Forty-four patients(22 males, 22 females) satisfying the DSM-IV criteria for schizophrenia were measured for minor physical anomalies by using Waldrop Anomaly Scale(WS) and we used Positive and Negative Syndrome Scale(PANSS), Ulmann-Giovannoni Process-Reactive Questionnaire(PRQ), and Phillips Premorbid Adjustment Scale(PAS) for evaluating psychopathology and clinical variables. RESULTS: Schizophrenic patients had a higher group mean WS score than that found in the control group. Score of WS was correlated with PANSS and PAS score positively, and with PRQ score negatively. CONCLUSION: This study shows minor physical anomalies are associated with clinical variables with regard to symptom severity, poor premorbid adjustment and process of illness in at least some schizophrenics.

Combined use of carbamazepine and haloperidol in treatment-resistant schizophrenics: A double-blind, placebo-controlled study / 신경정신의학

No abstract available.

Risperidone versus haloperidol in the treatment of chronic schizophrenic patients: a parallel group double-blind comparative trial

A parallel group double-blind comparative trial was conducted to study the efficacy and safety of risperidone compared with haloperidol. After a one-week wash-out, 35 chronic schizophrenic patients (17 males, 18 females) were randomly assigned to one of two groups for eight weeks of double-blind treatment. The patients' psychopathology was assessed by means of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and the Clinical Global Impression (CGI). Safety assessments included the Extrapyramidal Symptom Rating Scale (ESRS), the UKU Side Effect Rating Scale, vital signs, body weight, ECG and laboratory screening. Thirty-two patients completed the trial: there were 3 dropouts in the risperidone group. The results on the PANSS and CGI indicate that the mean changes from baseline on the total PANSS score and on the total BPRS score were comparable in both treatment groups. The number of patients where a clinical improvement at least 20% reduction in baseline score was also similar in both treatment groups. Risperidone caused less extrapyramidal symptoms and less side effects in UKU scale than haloperidol. No significant ECG changes were induced, no relevant changes in blood pressure or clinical laboratory parameters were observed. This study has demonstrated that the combined serotonin 5-HT2 and dopamine-D2 antagonist risperidone is an antipsychotic as potent as haloperidol. Risperidone causes less extrapyramidal symptoms, and is better tolerated than haloperidol.