The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(II): Comparison of Safety / 신경정신의학

OBJECTIVES: This multicenter clinical trial involving 13 hospital sites compared the safety of switching to olanzapine between 'direct switching method' and 'start-tapering switching method'. METHOD: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The safety of switching to olanzapine was measured with vital signs including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS), Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). RESULTS: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in 'direct switching method' group, and the concomitant use of anticholinergics was comparatively greater in 'start-tapering switching method' group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. CONCLUSION: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

Depression and Pain in Patients with Cancer: A Preliminary Study / 신경정신의학

OBJECTIVE: This study was designed to evaluate how much depression and pain symptoms could be shown, what kind of factors affect them, and whether the correlation between them could be or not in patients with cancer. METHODS: The subjects were composed of 25 patients with cancer who admitted at the department of oncology (male: 10, female: 15). We reviewed the medical record and interviewed patients and their family. A psychiatric diagnosis was made according to the criteria of the DSM-IV, and depressive symptoms were evaluated by Hamilton Rating Scale for Depression (HRSD). The intensity of pain (maximal, minimal, mean, present), disability due to pain, the effects of analgesics were measured by Brief Pain Inventory (BPI). RESULTS: 32% of patients had major depressive disorders, 16% of patients had depressive disorders, NOS and 16% of the patients had adjustment disorders. The score of HRSD was significantly correlated with the maximal intensity, mean intensity and present intensity of pain and disability due to pain, but not with minimal intensity and the effects of analgesics. Depression and pain were not correlated with duration of illness. Scores of depression and pain did not differ in sex, religion, metastasis, and the knowledge of illness. The widowed or unmarried patients showed significantly higher scores than patients living with the spouse in HRSD, minimal intensity and mean intensity of pain. CONCLUSION: In patients with cancer, depression and pain were highly prevalant. The relationship between depression and pain was shown in patients with cancer. These results suggest that more active evaluation and intervention of depression and pain should be carried out in patients with cancer.

Atenolol Induced Visual Hallucination in Patients with Underlying cerebral Infarction / 대한정신약물학회지

Atenolol is a beta1-selective adrenoreceptor blocking agent which is generally thought of as cardioselective, with little CNS action, because it has hydrophilic solubility rather than lipophilic. But recently, it has been reported that atenolol also can cause CNS side effect, especially in the patient with past neuropsychiatric history, old age, or underlying cerebral lesion. This 59-year-old female case demonstrated that atenolol could be an etiological agent of visual hallucination in a elderly patient with cerebral infarction.