Psychopharmacologic Strategies for Women to Plan Pregnancy / 대한정신약물학회지

Clinicians are faced with major challenges when treating women with psychiatric disorders who are contemplating pregnancy or are pregnant. Recent data suggest that pregnancy has no protective effect on the course of psychiatric disorders and that discontinuation of psychotropic drugs is associated with a significant risk of relapse. This article reviews the major clinical dilemmas in managing women with psychiatric disorders who plan to conceive. Before pregnancy, clinical considerations for the interventions such as family planning, parental education and supporting, and antenatal care are important to reduce the risk of pregnancy complications. To treatment decision, clinicians should discuss with the woman the absolute and relative risks associated with not treated mental disorder and psychotropic drugs. Non-pharmacological treatment should be considered also. Treatment strategies, for each of the women with psychiatric disorders who plan to conceive are discussed.

Psychopharmacotherapy for Pregnant Women / 대한정신약물학회지

Authors reviewed the risk of psychopharmacotherapies during pregnancy. Psychopharmaotherapy in pregnants should be determined by considering the risk of disease recurrence in the mother and the impacts on the fetus. The American College of Obstetricians and Gynecologists does not recommend the routine use of antipsychotics in pregnancy, but risk-benefit assessments may indicate that such use is appropriate. Generally, antipsychotics are indicated for severe mental disorder, the benefits to the mother appear to outweigh the unknown risk. Folate (4 mg/day) has been recommended for women taking atypical antipsychotics because they may have a high risk of neural tube defects due to inadequate folate intake and obesity. Mood stabilizers should be avoided during pregnancy because of their potential teratogenicity. Lamotrigine or topiramate are relatively safe and combination with folate could be reduced the risk of neural tube defects. Antidepressants have been used in pregnant women with relative safety, but we should be considered the risk of major defects and neonatal syndrome. Especially, prenatal eochocardiography is recommended if it has been exposed in the first trimester of pregnancy. Paroxetine should be avoided in the first trimester of pregnancy due to the risk of congenital anomalies. There are many controversies in causal association between benzodiazepine and congenital defects. But, if the maternal condition requires the use of benzodiazepine during pregnancy, the lowest possible dose should be taken. Although no congenital malformation have been reported, data are too limited to confirm the risk of zolpidem for pregnancy, further evaluation are needed.

Updates in Psychotropic Medication for Lactating Women / 대한정신약물학회지

The use of psychotropic medications in lactating women is controversial. Despite widely accepted advantages of human milk, patients and professionals hesitate to use medications during breastfeeding. Package inserts written by manufacturers routinely discourage breastfeeding to prevent law suits. Here we conducted a review to help professionals to decide medication for lactating women on an evidence-based risk-benefit analysis. First, we reviewed lactational pharmacology. The relative infant dose (RID) was defined to give an objective measure for infant exposure to medication, and drugs with RID lesser than 10% were considered quite safe. Subsequently, we reviewed each category of psychotropic medications which were commonly used in mental illness. We provided information for each drug such as Dr. Hale's lactation risk category, RID, half-life, and time to peak plasma level as references for the risk analysis. There was no contraindicated psychotropic medication during breastfeeding, but for lithium, close monitoring of infant serum levels is warranted. In conclusion, most of medications used to treat mental illness in lactating women were usually safe. Nevertheless, medication use in lactating women should always be considered on an individualized risk-benefit analysis, and untoward adverse effects on the infant should be monitored.

The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients

OBJECTIVE: The goal of this study is to assess the relationship between stress coping mechanisms and the risk of atherosclerosis in patients with Hwa-Byung. METHODS: The Korean version of the Ways of Coping Checklist (WOCC) was administered to 50 patients with Hwa-Byung (49.1+/-10.1 years, 6 males). Brachial-ankle pulse wave velocity (baPWV) and serum cholesterol level were assessed in all participants. RESULTS: After controlling for age, sex, diagnosis of hypertension, Body Mass Index (BMI), and serum cholesterol level, the score of seeking social support in coping strategies was negatively correlated with right and left baPWV (r=-0.356, p=0.016; r=-0.373, p=0.012, respectively). In addition, the score of active coping mechanism was negatively correlated with both sides of baPWV (r=-0.383, p=0.009; r=-0.389, p=0.008, respectively). CONCLUSION: The seeking social support and active coping mechanism were inversely related to the severity of arterial stiffness in Hwa-Byung patients. Therefore, our result may suggest a possibility that coping strategies in Hwa-Byung patients are associated with the risk of atherosclerosis.

The Associations of Coping Mechanism with Arterial Stiffness in Hwa-Byung Patients

OBJECTIVE: The goal of this study is to assess the relationship between stress coping mechanisms and the risk of atherosclerosis in patients with Hwa-Byung. METHODS: The Korean version of the Ways of Coping Checklist (WOCC) was administered to 50 patients with Hwa-Byung (49.1+/-10.1 years, 6 males). Brachial-ankle pulse wave velocity (baPWV) and serum cholesterol level were assessed in all participants. RESULTS: After controlling for age, sex, diagnosis of hypertension, Body Mass Index (BMI), and serum cholesterol level, the score of seeking social support in coping strategies was negatively correlated with right and left baPWV (r=-0.356, p=0.016; r=-0.373, p=0.012, respectively). In addition, the score of active coping mechanism was negatively correlated with both sides of baPWV (r=-0.383, p=0.009; r=-0.389, p=0.008, respectively). CONCLUSION: The seeking social support and active coping mechanism were inversely related to the severity of arterial stiffness in Hwa-Byung patients. Therefore, our result may suggest a possibility that coping strategies in Hwa-Byung patients are associated with the risk of atherosclerosis.

Nocturanl Eating Behavior Associated with Zolpidem / 수면정신생리

OBJECTIVE: The authors would like to fine the relationship between zolpidem and nocturnal eating episodes in diverse psychiatric patients. METHOD: We evaluated case series of 6 patients who showed nocturnal eating episodes after takine zolpidem. RESULTS: We have experienced 6 cases who showed nocturnal eating behavior after taking zolpidem. They included 3 patients with schizoprenia, a patient with major depressive disorder, a patient with PTSD and a patient with bipolra I disorder. With reducing or discontiuation of of zolpidem, their nocturnal eating resolved. CONCLUSION: This finding strongly suggests the relationship between zolpidem and the nocturnal eating episode. Physicians should be aware that zolpidem might induce nocturnal eating behaviors.

Depressive Symptoms and Ways of Coping of Patients with Diabetes Mellitus: Compared with Rheumatoid Arthritis Patients and Healthy Subjects / 신경정신의학

OBJECTIVES: This study investigated how diabetes mellitus (DM) and depressive symptoms are related, and differed in terms of coping strategies. In addition, we compared those findings with rheumatoid arthritis (RA) patients. METHODS: 80 DM patients, 45 RA patients and 77 healthy subjects completed the Beck depression inventory (BDI) and the Korean version of the ways of coping checklist. RESULTS: BDI scores of depressed DM patients were significantly higher than healthy subjects (p<0.01) but not significantly with depressed RA patients. Both scores of active (p<0.01) and passive coping (p<0.05) in DM patients were significantly lower than healthy subjects (p<0.01), and the scores of wishful thinking of DM patients were significantly lower than RA patients (p<0.01). BDI scores of DM patients were significantly correlated with the number of complications and the scores of problem-focused coping (p<0.05). In the hierarchical regression analysis, even after controlling for clinical characteristics, coping strategies altogether could account for 31.0% of the variance of the depressive symptoms in DM patients significantly (p<0.01). CONCLUSION: DM patients showed significantly higher depression rate than healthy subjects but not than RA patients. In DM patients, insufficient coping strategies could explain substantial portions of depressive symptoms. Therefore, enhancing healthier coping strategies in addition to prevent medical complications might lessen depressive symptoms experienced by DM patients.

Depressive Symptoms and Ways of Coping of Patients with Diabetes Mellitus: Compared with Rheumatoid Arthritis Patients and Healthy Subjects / 신경정신의학

OBJECTIVES: This study investigated how diabetes mellitus (DM) and depressive symptoms are related, and differed in terms of coping strategies. In addition, we compared those findings with rheumatoid arthritis (RA) patients. METHODS: 80 DM patients, 45 RA patients and 77 healthy subjects completed the Beck depression inventory (BDI) and the Korean version of the ways of coping checklist. RESULTS: BDI scores of depressed DM patients were significantly higher than healthy subjects (p<0.01) but not significantly with depressed RA patients. Both scores of active (p<0.01) and passive coping (p<0.05) in DM patients were significantly lower than healthy subjects (p<0.01), and the scores of wishful thinking of DM patients were significantly lower than RA patients (p<0.01). BDI scores of DM patients were significantly correlated with the number of complications and the scores of problem-focused coping (p<0.05). In the hierarchical regression analysis, even after controlling for clinical characteristics, coping strategies altogether could account for 31.0% of the variance of the depressive symptoms in DM patients significantly (p<0.01). CONCLUSION: DM patients showed significantly higher depression rate than healthy subjects but not than RA patients. In DM patients, insufficient coping strategies could explain substantial portions of depressive symptoms. Therefore, enhancing healthier coping strategies in addition to prevent medical complications might lessen depressive symptoms experienced by DM patients.