Factors Affecting Admission Type in Patients with Schizophrenia Spectrum / 신경정신의학

OBJECTIVES: This study examined the admission type and its related factors among patients with psychotic disorders defined based on the revised mental health welfare law. METHODS: This study was conducted on a total of 100 patients diagnosed on the schizophrenia spectrum and other psychotic disorders. The admission type and sociodemographic characteristics were examined. Social support, psychopathology, excitement, insight, and social functioning were evaluated using the Social Support Scale, Positive and Negative Syndrome Scale (PANSS), PANSS excitement component, Brief Psychiatric Rating Scale, Global Assessment Functioning Scale, Strauss-Carpenter scale, Korean version of the Scale to Assess Unawareness of Mental Disorder, and Korean version of Beck Cognitive Insight Scale. RESULTS: The severity of psychotic symptoms, excitement, social functioning, and insight were significantly different between involuntary and voluntary admissions (p<0.05). Excitement and insight were found to be factors affecting the admission type (p<0.05). CONCLUSION: Excitement and insight were factors mainly accounting for the admission type in patients with psychotic disorder. This study could be helpful in improving clinical decision-making and community mental health care.

Aberrant Resting-State Functional Connectivity in the Default Mode Network in Pediatric Bipolar Disorder Patients with and without Psychotic Symptoms / 神经科学通报·英文版

Mood disorders/psychosis have been associated with dysfunctions in the default mode network (DMN). However, the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder (PBD) remain unclear. The aim of this study was to investigate the possible mechanisms of PBD through brain imaging and explore the influence of psychotic symptoms on functional alterations in PBD patients. Twenty-nine psychotic and 26 non-psychotic PBD patients, as well as 19 age- and sex-matched healthy controls underwent a resting-state functional MRI scan and the data were analyzed by independent component analysis. The DMN component from the fMRI data was extracted for each participant. Spearman's rank correlation analysis was performed between aberrant connectivity and clinical measurements. The results demonstrated that psychotic PBD was characterized by aberrant DMN connectivity in the anterior cingulate cortex/medial prefrontal cortex, bilateral caudate nucleus, bilateral angular gyri, and left middle temporal gyrus, while non-psychotic PBD was not, suggesting further impairment with the development of psychosis. In summary, we demonstrated unique impairment in DMN functional connectivity in the psychotic PBD group. These specific neuroanatomical abnormalities may shed light on the underlying pathophysiology and presentation of PBD.

The Effect of Cognitive Behavioral Therapy in Drug-Resistant Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Cognitive behavioral therapy of schizophrenia has been developed as a psychological therapy for drug resistant patients with schizophrenia. However, there are some controversial issues regarding the size and mode of the therapeutic effect. The aim of this study is to compare the effect of cognitive behavioral therapy with supportive therapy after treatment. METHODS: Patients with drug resistant schizophrenia were randomly allocated, and stratified according to two mental health institutes to two different therapy groups. We used four assessment scales to evaluate residual symptoms of patients in detail. Patients were assessed twice by a blind rater, at baseline and after treatment. RESULTS: No significant differences in the change of PANSS (Positive and Negative Syndrome Scale) scores were observed between the cognitive behavioral therapy and supportive therapy groups at one month after treatment. There was no significant difference in change of K-PSYRATS (Korean-Psychotic Symptom Rating Scale)-Delusion score, however, a trend toward significance in K-PSYRATS - Hallucination was observed between the two groups. In the aspect of insight, a significant difference in the change of SDMD-K (The Scale to assessment Unawareness of Mental Disorder-Korean version) score was observed between the two groups after treatment. CONCLUSION: Despite remarkable development of pharmacotherapy for schizophrenia, many patients still suffer from residual symptoms. Findings of this study showed that cognitive behavioral therapy can improve the insight of patients and reduce the severity of residual positive symptoms, especially hallucination. Cognitive behavioral therapy should be practiced effectively in the psychiatric clinic and community mental health system.

Risperdal Sachet and Oral Lorazepam versus Intramuscular Haloperidol and Lorazepam Injection for Acute Psychotic Symptom in the Elderly Patients with Organic Mental Disorder

OBJECTIVES: The purpose of present study was to investigate the effect, safety and tolerability of risperdal sachet(oral solution) with lorazepam tablet versus intramuscular haloperidol and lorazepam injection for management of acute psychotic symptom in the elderly with organic mental disorder. METHODS: Total 37 patients who have dementia, medical or physical diseases, associated with acute psychotic symptom were randomly assigned to oral treatment with 1mg of risperdal sachet(oral solution) plus 1mg of lorazepam(N=17) or to intramuscular treatment with 2.5mg of haloperidol plus 2mg of lorazepam(N=20). The change of CGI scores was used for the evaluation of efficacy. RESULTS: Mean score improvements at 15, 30, 60, and 120 minutes after treatment were statistically significant at each time point in both groups(p<0.001) and were similar in both groups(p=0.189). CONCLUSION: A single oral dose of risperdal sachet(oral solution) plus lorazepam was as effective and tolerable as parenterally administered haloperidol plus lorazepam for the rapid control of acute psychotic symptom in the elderly with organic mental disorder.

Clinical Characteristics of Early Onset Bipolar Disorder: A Retrospective Chart Review Study / 신경정신의학

OBJECTIVE: Bipolar disorder is a disease with diverse clinical profiles and outcomes. In recent years, it is suggested that if bipolar disorder occurs early in one's life, functional and symptomatic prognoses are poor. The prognoses include severe symptoms, frequent psychotic symptoms, comorbidity of mental illnesses, slow improvement of the symptoms, and high suicide rate. We investigated the clinical characteristics of early onset bipolar inpatients. METHOD: The subjects of this study were selected from the patients who were discharged after hospitalization between January 1, 2001 and May 31, 2005 and diagnosed with bipolar disorder according to DSM-IV criteria. These patients were examined for the following data; the type of bipolar disorder, comorbid psychiatric disorders, the age at onset of the illness, the acuteness of the disorder, and the duration of the disorder. The presence of four major clinical psychopathology, rapid cycling, psychotic symptoms, comorbid psychiatric disorders, and suicide attempt, was also examined. The patients whose onset of the illness was before the age of 19 were classified as the early onset group and after the age of 19 were classified as the late onset group. Data on demographics, family histories, four major clinical psychopathologies and other clinical variables were compared between the early onset group and the late onset group. RESULTS: Of the 53 patients, 19 patients belonged to the early onset group. There was higher incidence of psychotic symptoms in the early onset group than in the late onset group, and the difference was statistically significant according to the Chi2-test (84.2% vs 44.1%, p=0.005). The incidence of comorbid psychiatric disorders was higher in the early onset group than in the late onset group, and the difference was also statistically significant according to the Chi2-test (52.6% vs 23.5%, p=0.032). However, there was no statistically significant difference between the groups regarding the incidence of rapid cycling and suicide attempt. The result of logistics regression showed correlation of psychotic symptoms (OR=6.756; 1.655< or =95% CI< or =27.580) and comorbid psychiatric disorders (OR=3.611; 1.088< or =95% CI< or =11.984) with the early onset group. CONCLUSION: Early onset of bipolar disorder is related to the manifestation of psychotic symptoms and frequently accompanies comorbid psychiatric disorders. The results of this study will help understand the mechanism of the onset of complex bipolar disorder and estimate the prognosis.

Reliability and Validity of the Korean Version of the Psychotic Symptom Rating Scale / 신경정신의학

OBJECTIVES: Psychotic Symptom Rating Scale (PSYRATS) is an assessment tool to measure the severity of different dimensions of auditory hallucinations and delusions. The reliability and validity of the Korean version of PSYRATS (K-PSYRATS) were examined in Korean patients with major psychosis. METHODS: The inter-rater reliability of the K-PSYRATS was determined from the videotaped interviews of the five schizophrenic patients. To measure validity and internal consistency reliability, the 109 patients with auditory hallucinations or delusions were assessed using the K-PSYRATS, Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity (CGI-S) scale. RESULTS: K-PSYRATS was found to have excellent inter-rater reliability (intra-class correlation coefficient of auditory hallucination= 0.81, p<.001, intra-class correlation coefficient of delusion=0.97, p<.001) and internal consistency reliability (Cronbach's alpha of auditory hallucination=0.77, Cronbach's alpha of delusion=0.76). Significant correlation was found between K-PSYRATS and positive syndrome subscale of PANSS and CGI. CONCLUSION: K-PSYRATS is a useful assessment instrument for psychotic symptoms in Korea.

Abnormal Laboratory Findings in Emergently Injected Psychiatric Inpatients: A Preliminary Report / 대한정신약물학회지

OBJECTIVE: Psychiatric patients often require emergency injection and they are sometimes received psychotropic medication injection before the completion of a medical history and laboratory studies. The aim of this study is to find out laboratory differences between patients with severe psychomotor agitation who were injected emergently and those who were not. METHODS: Medical records of all patients 18 years or older admitted to psychiatric unit were reviewed. Subjects in this study were patients who showed psychotic symptoms, psychomotor agitation or violent behavior within 7 hospital days. Demographic and laboratory variables were compared between injected and non-injected patients. RESULTS: One hundred twenty three patients were included. Twenty seven patients received emergency injection and ninety six patients didn't receive. Patients received emergency injection had lower platelet count (p<0.01), and potassium level (p<0.05) and higher electrocardiogram QTc interval (p<0.05). They are also more likely to have abnormal levels of platelet count (p<0.05), and creatine phosphokinase (p<0.05). CONCLUSION: Emergently injected patients in the psychiatry service were more likely to have abnormal laboratory results before injection. These findings suggest that patients who need emergency injection may have additional physical problems which require further medical attention. Therefore before injection, we consider that emergently injected patients may have risks.

A Case Report: Effect of Aripiprazole for a Patient with Psychotic Symptoms and Parkinsonism Associated with Carbon Monoxide Poisoning / 대한정신약물학회지

A newer atypical antipsychotic, aripiprazole has been shown to be effective in the treatment of schizophrenia and other psychotic disorders. A 44-year-old woman who developed psychotic symptoms and parkinsonism a month after carbon monoxide poisoning and did not respond to other atypical antipsychotics, was successfully treated with aripiprazole. This case suggests that aripiprazole may be helpful to those developed psychotic symptoms and movement disorders associated with toxic brain injury such as carbon monoxide poisoning.

The 3 Cases of Patients with Behcet's Disease who have Depressive and Psychotic Symptoms / 신경정신의학

Behcet's disease is characterized by mucocutaneous-ocular symptoms, namely recurrent stomatitis aphthosis, genital ulcer and ocular symptoms. Organic mental changes can be often observed, as well as dementia, depression, visual hallucination and schizophrenia-like symptoms. A 46-year-old female was admitted due to visual and auditory hallucinations, paranoid delusion and disorientation which had continued for 3 weeks. The findings on brain MRI were compatible with neuro-Behcet's disease. Her psychiatric symptoms improved with antipsychotic medications. A 42-year-old female visited our clinic complaining short-term memory impairment, depressive mood, anxiety and insomnia. Her depressive mood, anxiety and insomnia improved with antidepressant and benzodiazepine treatment. However, memory impairment remained. A 40-year-old female visited ER due to a suicide attempt with drug overdose. Depressive mood continued a few weeks prior to the incident. During admission psychotic symptoms were observed. These symptoms improved with antipsychotics within a week. Also depressive mood was subsided with antidepressant. These three cases represent that Behcet's disease often accompanies with psychiatric symptoms. A variety of psychosocial stressors can influence the progress of Behcet's disease and psychiatric symptoms.

Behavioral and Psychological Symptoms in Dementia(BPSD):Psychotic Symptoms

Dementia is a multi-dimensional disorder associated with cognitive symptoms, functional impairment, and behavioral and psychological symptoms such as agitation, depression and psychosis. Behavioral and psychological symptoms of dementia (BPSD) are an integral part of the disease process and present severe problems to patients, their families and caregivers, and society at large. BPSD are treatable and are more amenable to therapy than other symptoms or syndromes of dementia. Thus, the recognition and appropriate management of BPSD are important factors in improving our care of dementia patients and their caregivers. Psychotic symptoms presented as delusions, misidentifications, and hallucinations are most prevalent BPSD in Alzheimer's disease and related dementia. The author has reviewed the clinical feature, etiology, and pharmacological and non-phrmacological management of psychotic symptoms of BPSD.