A Comparison Study on the Psychopathology between the Patients with Dementia of Alzheimer Type and Normal Controls in an Urban Community / 신경정신의학

OBJECT: There are lots of studies on the cognitive impairments in patients with dementia of Alzheimer type in our country, but those on the psychopathology in them are very scanty. We investigated the psychopathology such as psychotic symptoms, depression, and anxiety and their correlations with the severity of cognitive impairments in our urban subjects with dementia of Alzheimer type. METHODS: Our subjects(N=34) with dementia of Alzheimer type in an area of Pusan, aged over 65, are screened with MMSE-K(below 24) and Hachinski's Ischemic Scale(below 4) and enrolled in this study when they met with the criteria of dementia of DSM-IV. They were devided into the mild(N=16) and severe dementic group(N=18) according to their scores of MMSE-K(cut-off point 20/21). The severities of psychiatric symptoms in the two groups were evaluated by using sets of clinical symptom rating scales such as BPRS, HAM-D, and HAM-A and the frequencies of aggressive behaviors and sleep disturbances in them were also rated at that time by two psychiatrists. Data of the two dementic groups were compared with those of healthy control subjects(N=40). RESULTS: The mean total score of BPRS, scores of thinking disturbance and withdrawal retardation subscale were lowest in the healthy control group and highest in the severe dementic group(p<0.05). Mean score of anxious depression subscale of mild dementic group was higher than that of other two groups(p<0.05). There were no ststistical differences in the mean score of hostile suspiciousness subscale among the three groups. The mean total scores of HAM-D and HAM-A tended to be higher in mild dementic group than in other two groups, but the differences were not reached to the statistical significance. These findings were thought to be identical with those of following. The total frequency of insomnia only tended to be higher, but the frequency of initial insomnia and that of using hypnotics were highest in mild dementic group(p<0.05). The frequency of aggressive behaviors tended to be higher in mild dementic group than in other two groups, but the differences were not reached to the statistical significance. CONCLUSION: Patients with dementia of Alzheimer type suffered from several psychiatric problems such as psychotic symptoms, depression, anxiety, insomnia, and aggressive behaviors from the initial stage of the illness. Clinicians should be more aware of those symptoms which need proper pharmacological and social interventions, especially in patients with mild cognitive impairment.

Combined Therapy of Paroxetine and Tricyclic Antidepressant in Depression of Schizophrenic Patients / 신경정신의학

Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly, Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained: 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was fecund in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher or than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYF2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant In our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.