Effect of Initial Ziprasidone Dose on Treatment Outcome of Korean Patients with Acute Manic or Mixed Episodes

OBJECTIVE: We investigated the efficacy and tolerability of ziprasidone combined with divalproex to determine the relationship between the initial dose of ziprasidone and the treatment effect among Korean patients with acute bipolar manic or mixed disorders. METHODS: This study was a 6-week, open-label, prospective investigation of Korean patients with an acute manic or mixed episode of bipolar disorder. Sixty-five patients were recruited. The patients were categorized based on the initial dose of ziprasidone as follows: low (20-79 mg/day) and standard (80 mg/day). Ziprasidone was given in combination with divalproex in flexible doses, according to the clinical response and tolerability. RESULTS: The response and remission rates were significantly higher in the standard-dose group than the low-dose group. The combination of ziprasidone and divalproex was well-tolerated and adverse events were mostly mild with no statistically significant increase in body weight. CONCLUSION: The results of this study showed that a standard starting dose of ziprasidone in combination with divalproex for bipolar disorder is more effective than a low starting dose.

Course of Patients with Bipolar Disorder after Hospitalization : A 2.5-year Follow-up / 신경정신의학

OBJECTIVES: It has been known that bipolar disorder has diverse courses and complicated factors affecting prognoses. We investigated the 2.5 years course of illness and the predictors of psychosocial outcome of 56 patients who had been hospitalized. As a preliminary step of the prospective outcome study, a retrospective assessment was used. METHODS: At the point of admission and after hospitalization, demographic data, clinical manifestation, duration of illness, numbers and natures of episode, and other clinical variables of the patients were investigated from their psychiatric medical records. The patients' current psychosocial function was assessed using psychosocial items and GAF (Global Assessment of Functioning) score of PSYCH-UP (Psychosocial Symptoms You Currently Have, follow-up version). RESULTS: The patients experienced on average 3.6 times of depressive, hypomanic, manic and mixed episodes during the 2.5 years. The approximately equal numbers of two poles of episodes, depressive and manic including hypomanic, manitested. The premorbid function showed significant difference to GAF score in one way analysis of variance (ANOVA) but not contributed significantly in multiple regression. A stepwise multiple regression revealed that mean duration of admission and numbers of episode recurrence contributed significantly to the GAF score. CONCLUSION: The results of this study suggest that the numbers of episode recurrence and the mean duration of admission are important variables as predictors for psychosocial outcome in patients with bipolar disorder.

Serum Insulin-like Growth Factors and their Binding Proteins in the Women With Polycystic Ovary / 대한산부인과학회잡지

OBJECTIVE: The involvement of IGF system in hyperandrogenism and abnormal follicular development is controversial. This study is to assess whether IGF system contribute to it in the women with polycystic ovary(PCO). METHODS: Baseline serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone (T), androstenedione (ADD), prolactin, thyroid stimulating hormone (TSH), free insulin-like growth factor(IGF)-I, free IGF-II, insulin-like growth factor binding protein(IGFBP)-1, and IGFBP-3 were measured in twelve healthy regularly cycling volunteers and forty-two women with PCO then, the changes of baseline serum levels were evaluated after laparoscopic ovarian electrocauterization in nine PCO patients. In addition, the expression pattern of IGF-I and IGF-II was examined in the ovary of control and PCO group. RESULTS: Baseline levels of LH, ADD, free IGF-II, and IGFBP-3 were significantly higher in PCO group. However, there were no significant differences in the levels of free IGF-I and IGFBP-1, although free IGF-I showed decreasing tendency in PCO group. And there was a significant positive correlation between the LH and free IGF-II level in the PCO(P=0.011, r2=0.3899), but not in the control. After ovarian electrocauterization, LH, T, and ADD levels decreased, and free IGF-I and IGFBP-3 level increased. While free IGF-II and IGFBP-1 level showed no significant changes. In the ovary, expression of both IGFs showed similar pattern in normal and PCO ovaries. CONCLUSIONS: The elevated IGFBP-3 level may alter the bioavailability of IGF(s) in the PCO. The change in IGF-I level and resumption of ovulation after electrocauterization, suggest a possible role of IGF system in the impairment of follicular development in the PCO.

Sonographic and Endocrinologic Evaluation of the Patients with Polycystic Ovaries by Body Mass Index / 대한산부인과학회잡지

Women with Polycystic ovaries(PCO) are often overweight and obesity has been regarded as a possible basis for the development of PCO. This study was designed to evaluate the differences of the basic hormonal concentrations and sonographic features in obese and non-obese patients with PCO. We prospectively analysed eighty-six patiens with PCO on transvaginal sonography and twelve control women with regular menstrual cycle and ovarian morphology from Feb. 1994 to May 1996. Eighty-six women with PCO, of whom sixty-seven women were non -obese with body mass index(BMI) of 25(=group 2). Sonographic morphology of ovary was evaluated in PCO. Basal concent- rations of LH, FSH, estrone, estradiol, testosterone(T), prolactin, TSH and sex hormone- binding globulin(SHBG) in serum were measured. Although sonographic morphology of ovary was not significantly different between group 1 and group 2, number of small follicles was tend to increase in group 2. The LH/ FSH ratio was significantly higher in group 1 compared to group 2, but SHBG was higher in group 2. Conclusively, in obese women, obesity causes an increase in free androgen through the decrease in SHBG, which might cause a disturbance in gonadotropin secretion leading to the typical changes of polycystic ovary. In non-obese women, relative increase of LH/FSH ratio stimulates excessive production of androgen.