Factors Influencing the Subjective Sexual Function in Patients with Schizophrenia Switched to Olanzapine / 대한정신약물학회지

OBJECTIVE: Sexual dysfunction is highly prevalent in both untreated and treated patients with schizophrenia. Sexual dysfunction is a major cause of poor quality of life, negative attitude to therapy and treatment non-compliance. We thereby conducted this study to better understand the predictors of subjective sexual dysfunction. METHODS: The subjects consisted of 83 patients (46 men; 37 women) who participated in an open label study on switching antipsychotics to olanzapine. All subjects met the Tenth Revision of International Classification of Diseases diagnostic criteria for schizophrenia. To better understand the predictors of subjective sexual dysfunction, we used the Liverpool University Neuroleptic Side-effect Rating scale (LUNSERS), a comprehensive self-rating instrument for assessing and quantifying the subjective adverse events during antipsychotic treatment. All patients were taking antipsychotics at the initiation of the study and were assessed using LUNSERS, the Simpson-Angus Scale (SAS), the Barnes Akathisia Rating scale (BARS), Abnormal Involuntary Movement Scale (AIMS), Clinical Global Impression (CGI), and the Positive and Negative Syndrome Scale (PANSS). They were also checked for their serum prolactin levels and vital signs before and after a 6-week treatment with olanzapine. In order to identify the cross-sectional and longitudinal predictors of LUNSERS hormonal side effect, we carried out multiple regression analyses. RESULTS: Prolactin levels, LUNSERS hormonal side effect, CGI, PANSS, SAS, AIMS, and BARS decreased after a 6-week treatment with olanzapine. At initial evaluation, cross-sectional predictors of LUNSERS hormonal side effect were red herring and allergic reaction subscale, but after the 6-week treatment with olanzapine, none of the variables were found to significantly predict LUNSERS hormonal side effect. Longitudinal predictors of LUNSERS hormonal side effect were LUNSERS extrapyramidal system side effect and prolactin levels. CONCLUSION: These findings suggested relationships among prolactin, extrapyramidal symptom, motor function and sexual dysfunction. After switching to olanzapine, sexual function of the patients improved subjectively. More studies are warranted as these results have significant implications for quality of life and treatment adherence.

A Validation Study of the Korean-Version of the Young Mania Rating Scale / 신경정신의학

OBJECTIVES: The reliability and validity of the Korean version of Young Mania Rating Scale (K-YMRS) were examined in the Korean patients with major psychosis. METHODS: One hundred and twenty inpatients diagnosed as major psychosis by DSM-IV criteria were assessed with both K-YMRS and expanded Brief Psychiatric Rating Scale (BPRS-E) during the first 3 days in hospital and after 4-week treatment. RESULTS: The Cronbach's alpha coefficient of K-YMRS was 0.73. The inter-rater reliabilities of total score (r=0.93, p=0.000) and individual item scores were high (r=0.65-0.96, p=0.000). The correlations of each items of K-YMRS with total score were statistically significant (r=0.35-0.78, p=0.000) except for the "insight" item. The principal component analysis for K-YMRS produced three factors;a) mood and vegetative symptoms, b) behavioral symptoms, and c) thought content and insight. The total scores of K-YMRS showed a significant correlation with the manic-excitement factor scores of BPRS-E at baseline and after 4-week treatment (r=0.82, r=0.72, respectively, p=0.000). The discriminant function analysis showed that manic (n=43) and non-manic patients (n=73) were discriminated 73.7% correctly by K-YMRS total score (p=0.01). The change of the total score of K-YMRS after 4-week treatment in manic patients was significantly greater than that in non-manic patients (p=0.000). CONCLUSIONS: K-YMRS was demonstrated to have good reliability and validity for measuring the severity of manic symptoms. It is expected that K-YMRS will be a useful tool for assessing mania symptoms in Korea.