Recent 5-Year Trends of Prescription Patterns in Inpatients with Bipolar Disorder in Four Hospitals / 대한정신약물학회지

OBJECTIVE: The aim of this study was to monitor changes of prescription patterns for bipolar disorder in clinical settings during the last five years in four psychiatric treatment centers. METHODS: A retrospective chart review of data of 601 patients with bipolar disorder was performed between January 2001 and December 2005 from four psychiatric centers in Seoul and GyeongGi-Do. Data on demograpnic variables, clinical characteristics, and the types and dosages of mood stabilizers and antipsychotics, and the patterns of prescriptions over the five-year period were analyzed. RESULTS: The use of valproate has increased, whereas the percentage of lithium use has decreased. The combined prescription of valproate and lithium remained constant at 12% over the five-year period. The prescription of newer-class of mood stabilizers such as lamotrigine and topiramate was few. Most of the patients in our study were on more than two psychotropic agents, with the most common discharge medication being a combination of a mood stabilizer and an antipsychotic (81.9%). The use of atypical antipsychotics has increased its share from 71.4% in 2001 to 92.3% in 2005. Among the atypical antipsychotics, Quetiapine use showed the most rapid increase since year 2001 and ranked as the most frequenctly used antipsychotics for bipolar disorder in 2005 (38.5% of antipsychotics). Especially, in those without psychotic features, quetiapine was the most frequently used antipsychotics (51.2% in 2005). In those with psychotic features, risperidone (39.1%) was more frequently used than quetiapine (28.3%). CONCLUSION: The present study showed that significant changes have occurred in the prescription patterns of mood stabilizers and antipsychotics and the rate of combination therapy for patients with bipolar disorder in the last five years. These results seem to reflect the introduction of new agents and the accumulating evidencebased data for the treatment of bipolar disorder, and will provide the useful information to clinicians for the establishment of better treatment guidelines for patients with bipolar disorder.

Suicidal Ideation of Patients in the Acute Stage of Stroke / 신경정신의학

OBJECTIVES: The presence of psychiatric disorders including depression and anxiety disorders is considered to be the most important risk factor of suicide. Also, suicidal risk is known to be increased in patients who have serious medical illnesses. Like in patients with other medical illness, some authors reported that suicidal risk is increased in patients with stroke. But there have been no reports with Korean patients. The aim of this study is to investigate the frequency of suicidal ideation of patients in the acute stage of stroke, and to examine the demographic characteristics, and psychiatric and neurological symptoms between the patients with and without suicidal ideation. METHODS: Seventy seven hospitalized stroke patients at the Hallym Stroke Center from July of 1999 to June of 2000 were included in this study. Beck Suicidal Ideation Scale(BSIS) was used to evaluate suicidal ideation. Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) for depression and anxiety, and Social Support Scale(SSS) for social support system of the stroke patients were used. Neurologic disabilities were rated with National Institutes of Health Stroke Scale(NIHSS) and Barthel's Index. RESULTS: Thirty five percent(N=27) of the stroke patients reported severe suicidal ideation. Scores of BDI, BAI and SSS were higher in the patients with severe suicidal ideation than their counterpart. There were no differences in Barthel's index score and NIHSS between two groups. Most patients with severe suicidal ideation had depressive or anxiety symptoms. But patients without depressive or anxiety symptoms also reported severe suicidal ideation. CONCLUSIONS: Thirty five percent of stroke patients in acute stage of their illness have severe suicidal ideation that requires careful psychiatric evaluation and intervention. Inclusion of routine assessment of suicidal ideation in these patients is recommended.

A Study of Adolescent Problem Behaviors and Parenting Behaviors / 신경정신의학

OBJECTIVES: The purpose of this study is to evaluate the problem behaviors of adolescents and to discriminate between parenting behaviors of problem behavior groups and those of non-problem behavior group. METHODS: The subjects of this study were 792 high school students in Seoul. We administered 'Parenting Behavior Inventory' and Korean version of Youth Self-Report(K-YSR) to the subjects in order to evaluate the parenting behaviors perceived by adolescents and the problem behaviors of adolescents. We analyzed the relationship between parenting behaviors and problem behaviors. We classified the subjects into problem behavior groups(internalizing group, externalizing group, internalizing-externalizing group) and a non-problem behavior(normal) group. We studied the differences of parenting behaviors among the groups. RESULTS: The results are as follows. 1) There were significant negative correlations between the positive parenting behaviors such as affection, reasoning, and monitoring and the problem behaviors of adolescents. By contrast, there were significant positive correlations between the negative parenting behaviors such as physical abuse, intrusiveness, over-expectation, neglect, and inconsistency and the problem behaviors of adolescents. 2) Adolescents of the internalizing group perceived significantly more parental abuse, intrusiveness, over-expectation, neglect, and inconsistency than those of normal group. Meanwhile, they perceived significantly less affection than normal adolescents. Adolescents of the externalizing group also perceived significantly more parental abuse, intrusiveness, over-expectation, neglect, and inconsistency than those of normal group. Also, they perceived significantly less monitoring than normal adolescents. 3) Adolescents of the internalizing-externalizing group perceived significantly more intrusiveness from both parents than those of either the internalizing or the externalizing groups. Adolescents of the internalizing-externalizing group perceived significantly less affection and more neglect from their mothers than those of the internalizing or the externalizing groups. In addition, adolescents of the internalizing-externalizing group perceived significantly more physical abuse from their fathers than those of the internalizing or the externalizing groups. CONCLUSION: Parenting behaviors such as abuse, intrusiveness, over-expectation, neglect, and inconsistency are associated with both internalizing and externalizing problems. In contrast, our results suggest that parenting behaviors such as affection, monitoring, and reasoning might decrease the various problem behaviors of adolescents.