How Can We Differentiate Schizoaffective Disorder from Mood Disorder with Psychotic Feature? / 대한정신분열병학회지

Difficulties surrounding the classification of mixed psychotic and mood symptoms continue to plague psychiatric nosology. Since schizoaffective disorder was first defined in the literature, it has raised a considerable controversy regarding its clinical distinction from schizophrenia and mood disorder, especially mood disorder with psychotic feature. Recently, it seems that more people are diagnosed as mood disorder with psychotic feature rather than schizoaffective disorder when they are showing concurrent psychotic and mood symptoms. This may be due to unwillingness to make severe diagnosis at first and aggressive trend to expand the diagnostic criteria for bipolar disorder. Over-diagnosis of mood disorder with psychotic feature would expose the patients to unnecessary mood stabilizer. Therefore, it is critical to make exact diagnosis based on current diagnostic criteria and other relevant study findings. We conducted in-depth review into diagnostic criteria of DSM and ICD-10 for schizoaffective disorder and mood disorder with psychotic feature and other related studies comparing clinical features between the two disorders. As a result, important points helpful in differentiating the two disorders are highlighted and future suggestions are described.

How Can We Differentiate Schizoaffective Disorder from Mood Disorder with Psychotic Feature? / 대한정신분열병학회지

Difficulties surrounding the classification of mixed psychotic and mood symptoms continue to plague psychiatric nosology. Since schizoaffective disorder was first defined in the literature, it has raised a considerable controversy regarding its clinical distinction from schizophrenia and mood disorder, especially mood disorder with psychotic feature. Recently, it seems that more people are diagnosed as mood disorder with psychotic feature rather than schizoaffective disorder when they are showing concurrent psychotic and mood symptoms. This may be due to unwillingness to make severe diagnosis at first and aggressive trend to expand the diagnostic criteria for bipolar disorder. Over-diagnosis of mood disorder with psychotic feature would expose the patients to unnecessary mood stabilizer. Therefore, it is critical to make exact diagnosis based on current diagnostic criteria and other relevant study findings. We conducted in-depth review into diagnostic criteria of DSM and ICD-10 for schizoaffective disorder and mood disorder with psychotic feature and other related studies comparing clinical features between the two disorders. As a result, important points helpful in differentiating the two disorders are highlighted and future suggestions are described.

Sleep in Panic Disorder and Nocturnal Panic Attack / 수면정신생리

Sleep disturbance is a one of common complaints among patients with panic disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of panic disorder yet. Several previous studies suggested that the sleep disturbance in panic disorder is mediated by nocturnal panic attack. In terms of the pathophysiology of panic disorder, nocturnal panic attack seems to be closely associated with the sleep problems in panic disorder. In this article, the authors reviewed various previous studies about sleep of panic disorder and intended to give importance of evaluating sleep disturbances and nocturnal panic attack in panic disorder for both clinical and research purpose.

Effects of Acute and Chronic Treatment of Olanzapine and Risperidone on the Extracellular Dopamine Concentrations of the Prefrontal Cortex in Rats / 신경정신의학

OBJECT: It is reported that the effect of antipsychotics on the extracellular dopamine levels in the prefrontal cortex is related to the their effect on the negative symptoms. Therefore, we investigated the acute and chronic effects of olanzapine and risperidone on the extracellular dopamine concentrations in the prefrontal cortex of rat. Samples were obtained using in vivo brain microdialysis. METHOD: Dopamine levels in the samples were measured by high pressure liquid chromatography with electrochemical detection. RESULTS: 1) Both the acute treatment of olanzapine and risperidone increased the extracellular dopamine concentrations in the prefrontal cortex, dose-dependently. 2) There was a no significant difference in the maximal change of the extracellular dopamine concentrations in the prefrontal cortex induced by the acute treatment of olanzapine and risperidone. 3) Both the chronic treatment of olanzapine and risperidone also increased the extracellular dopamine concentrations in the prefrontal cortex, but they showed the tolerance effect that the degree of increase was smaller than that of the acute treatment. 4) As for the maximal changes of the extracellular dopamine concentrations in the prefrontal cortex induced by the chronic treatment of olanzapine and risperidone, the effect of the former was greater than that of the latter. CONCLUSION: These results suggest that the effects of olanzapine and risperidone on the negative symptoms are related to the increased extracellular dopamine concentrations in the prefrontal cortex induced by these drugs.

Comparison of the Dopamine Response in the Rat Prefrontal Cortex Induced by Irregular and Regular Electrical Stimuli / 대한정신약물학회지

OBJECTIVE: In general, it is known that repetitive regular stimuli induce tolerance and repetitive irregular stimuli induce sensitization. We sought to determine the dopamine response in the rat prefrontal cortex under the repetitive regular and repetitive irregular stimuli. METHODS: After giving irregular and regular electrical stimuli repetitively to rats, we measured the dopamine levels of prefrontal cortex. We compared these results with the dopamine levels of prefrontal cortex of rats which were given just one electrical stimulus. Samples were obtained using in vivo brain microdialysis. Dopamine levels in the samples were measured by high pressure liquid chromatography with electrochemical detection. RESULTS: 1) Dopamine levels of prefrontal cortex of both repetitive regular stimuli group and repetitive irregular stimuli group increased after electrical stimuli. 2) Dopamine levels of prefrontal cortex also significantly increased after just one electrical stimulus. 3) Among the repetitive regular stimuli group, repetitive irregular stimuli group and one stimulus group, the dopamine response was most significant in the repetitive irregular stimuli group. CONCLUSIONS: Repetitive irregular electrical stimuli induce sensitization of prefrontal cortex and repetitive regular electrical stimuli don't induce tolerance of prefrontal cortex.

Effect of Pretreatment of (-)-3-PPP on the Haloperidol-Induced Extracellular Dopamine Concentraions in the Nucleus Accumbens of Rats

OBJECTIVES: To investigate the effects of (-)-3-PPP(0.5, 2, and 10mg/kg, s.c.) and haloperidol(0.1, 0.5, and 2mg/kg, s.c.) on the extracellular dopamine concentrations, and the effect of pretreatment with (-)-3-PPP(2mg/kg) on the haloperidol(2mg/kg)-induced extracellular dopamine concentrations in the nucleus accumbens(NAS) of free moving rats. METHODS: Dopamine levels in dialysate were determined with high pressure liquid chromatography(HPLC) with electrochemical detection(ECD). RESULTS: (1) (-)-3-PPP had dual actions depending on the doses : at 2mg/kg, it decreased and at 10mg/kg, increased extracellular dopamine concentrations ; (2) haloperidol at all doses increased dopamine levels with higher dose having a greater icrease ; and (3) pretreatment of (-)-3-PPP reduced the increase in dopamine levels elicited by acute treatment with haloperidol. CONCLUSIONS: These findings suggest that pretreatment of (-)-3-PPP in low dose could accelerate the onset of therapeutic effect of haloperidol by diminishing the haloperidol-induced dopamine release in the limbic system.

Effects of Coadministraion of (-)-3-PPP and Haloperidol on the c-fos Expression in the Nucleus Accumbens and Prefrontal Cortex of Rats / 대한정신약물학회지

OBJECTIVE: The purpose of our study was to measure and compare the c-fos mRNA expression patterns in the nucleus accumbens (NAS) and prefrontal cortex (PFC) of rats after the administration of haloperidol (2 mg/kg) or (-)-3-PPP (2 mg/kg) plus haloperidol (2 mg/kg). METHODS: Reverse transcriptase-polymerase chain reactions (RT-PCR) were performed on total RNA from samples of the NAS and PFC of rats to detect the expression of c-fos mRNA. As internal control, beta-actin mRNA was co-amplified. The products were separated by electrophoresis, and the density of bands was quantified using an image-analysis software. RESULTS: Both the administration of haloperidol (2 mg/kg) and (-)-3-PPP (2 mg/kg) plus haloperidol (2 mg/kg) increased the c-fos mRNA expression significantly (p<0.05) in the NAS, but had no effects in the PFC. In addition, the coadministration of (-)-3-PPP (2 mg/kg) and haloperidol (2 mg/kg) demonstrated more (0.05) remarkable c-fos mRNA expressions than those obtained with the administration of haloperidol (2 mg/kg) alone. CONCLUSION: These results suggest that the coadministration of (-)-3-PPP and haloperidol may have more potent antipsychotic effect compared to the administration of haloperidol alone.

Effect of Cognitive-Behavioral Therapy on the Delusion in Schizophrenic Patients / 신경정신의학

OBJECTIVE: The effect of cognitive-behavioral therapy on the delusion in schizophrenic patients was evaluated. METHOD: The patients admitted to a psychiatric ward from September 1999 to June 2000 and diagnosed as schizophrenia, schizophreniform disorder, and schizoaffective disorder by DSM-IV were randomly assigned to cognitive-behavioral therapy(CBT) group(n=9) and supportive psychotherapy (ST) group(n=8). During the 10 weeks' treatment period, conviction, preoccupation, and anxiety on delusion, mode of explanation about symptom, and recovery style were regularly measured and compared between groups. RESULTS: 1) As for conviction and anxiety on delusion, the patients from both groups showed gradual reduction over time, but there was no significant difference between groups. 2) As for preoccupation of delusion, patients from both groups showed gradual reduction over time, and the patients on CBT group had a significantly more reduction than ST group. 3) As for mode of explanation and recovery style, CBT group had more marked positive changes than ST group did. CONCLUSION: Cognitive-behavioral therapy is more effective on preoccupation of delusion, explanatory mode about symptom, and recovery style than supportive psychotherapy.

Effects of Haloperidol Decanoate Treatment on the Rat Brain: Morphological and Neurochemical Study / 대한정신약물학회지

Using vacuous chewing movement(VCM) of rats as a possible animal model for tardive dyskinesia(TD), we tried to investigate the effects of haloperidol decanoate treatment on the rat brain: VCM(+) incidence, and morphological and neurochemical effect in the VCM(+) group. In our study, there were three treatment schedules of vehicle or haloperidol decanoate: 4, 7 or 9 total number of injections of vehicle or haloperidol decanoate were administered over 9, 18 or 24 weeks, respectively, with an injection given every 3 weeks. We rated VCM scores of rats at each injection time. Haloperidol groups were then further divided into VCM(-) rats and VCM(+) rats according to their VCM scores. Afterward, VCM(+) incidence was obtained in each haloperidol group. As time of neuroleptic treatment increased, the VCM scores and incidence of VCM(+) were found to be increased. All of the control, VCM(+) and VCM(-) rats were sacrificed to determine if treatments had morphological and neurochemical effects in the brain. Density of medium-sized neurons and levels of GABA in the striatum were reduced in the VCM(+) group 3 with total 9 injections given, compared to either VCM(-) group 3 or control group 3. These results suggest that hypofunction of GABAnergic neurons is associated with the development of VCM and possibly, TD.

Effects of Haloperidol Decanoate Treatment on the Rat Brain: Morphological and Neurochemical Study / 대한정신약물학회지

Using vacuous chewing movement(VCM) of rats as a possible animal model for tardive dyskinesia(TD), we tried to investigate the effects of haloperidol decanoate treatment on the rat brain: VCM(+) incidence, and morphological and neurochemical effect in the VCM(+) group. In our study, there were three treatment schedules of vehicle or haloperidol decanoate: 4, 7 or 9 total number of injections of vehicle or haloperidol decanoate were administered over 9, 18 or 24 weeks, respectively, with an injection given every 3 weeks. We rated VCM scores of rats at each injection time. Haloperidol groups were then further divided into VCM(-) rats and VCM(+) rats according to their VCM scores. Afterward, VCM(+) incidence was obtained in each haloperidol group. As time of neuroleptic treatment increased, the VCM scores and incidence of VCM(+) were found to be increased. All of the control, VCM(+) and VCM(-) rats were sacrificed to determine if treatments had morphological and neurochemical effects in the brain. Density of medium-sized neurons and levels of GABA in the striatum were reduced in the VCM(+) group 3 with total 9 injections given, compared to either VCM(-) group 3 or control group 3. These results suggest that hypofunction of GABAnergic neurons is associated with the development of VCM and possibly, TD.

Prefrontal Cortex and Schizophrenia

With a rapid development of neuroscience, the theories related to the pathophysiology of schizophrenia have been changed a lot from a simple hyperdopaminergic one to the various complicated ones. Among these, the theories regarding prefrontal cortex(PFC) pathology as a cause of schizophrenia are gaining more recognition as the results of neuroimaging and neuropsychological tests in schizophrenia consistently report abnormalities in PFC. Therefore, we first reviewed the unique characteristics of PFC in anatomy, neurochemistry and neurophysiology to enhance an understanding of those ones. Secondly, various neurotransmitter, neurodevelopmental and neural network theories of schizophrenia introduced recently were reviewed in terms of PFC pathology.

Risperidone-induced Hyperprolactinemia / 대한정신약물학회지

We experienced 6 cases of risperidone-induced hyperprolactinemia. Their mean age were 31.2+/- 7.1 years and 1 case was male and 5 cases were females. The reported neuroendocrine side effects were amenorrhea, galactorrhea and gynecomastia. The prolactin levels checked at the reported time of side effects or early stage of drug trial were more than 10 fold of normal level (male : 7.3-16.1 ng/ml, female 7.8-19.6 ng/ml). In male patient with the side effect of gynecomastia, we reduced the dose of risperidone from 6 to 3mg/day which eliminated the symptom 3 month later. As far female patients, risperidone was replaced with the equivalent doses of thioridazine or haloperidol except one female patient to whom risperione was stopped and benzodiazepine was only given. Follow-up results of them were : 1) one female patient was dropped out and 2) the others were all recovered from their neuroendocrine side effects after 3-4 months later.