Restless Legs Syndrome in Psychiatric Outpatients with Psychotropic Agents / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and incidence of restless legs syndrome (RLS) in outpatients with psychiatric illness. METHODS: 146 adult patients (male 52, female 94) were selected from those who visited a psychiatric outpatient clinic. RLS was evaluated through an interview method using diagnostic criteria and a severity rating scale for RLS developed by the International RLS Study Group (IRLSSG). The authors also applied Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), the Pittsburgh Sleep Quality Index, Barnes Akathisia Rating Scale and neurological examination. RESULTS: Thirty-four (23.3%) among 146 subjects were diagnosed as having RLS. Fifteen (44.1%) among those 34 RLS patients reported to have developed their RLS after starting their psychotropic agents and only 4 patients (11.7%) had currently been receiving treatment for their RLS. The RLS group showed higher BDI and BAI scores (p<0.01) and lower sleep quality (p<0.01) compared to those of non-RLS. The RLS group also showed a significantly higher co-morbidity of parasomnias (chi-square =8.5, p<0.01) and peripheral neuropathy (chi-square =5.2, p<0.05). CONCLUSION: The results from this study suggest that a substantial proportion of outpatients with psychiatric illness are suffering RLS. Our data suggest that clinicians should pay attention to the possible presence of RLS among their patients who are taking psychotropic agents.

Effects of Antidepressants on Sleep / 대한정신약물학회지

The diverse effects of antidepressants on sleep are mediated by their agonistic or antagonistic properties on specific neurotransmitters: the catecholamine, serotonergic, cholinergic, and histaminergic neurotransmitter systems, which also regulate the timing and cycling of sleep. Therefore, antidepressants can have both class- and compound-specific effects on sleep/wake dynamics, sleep stages, and on motor control during sleep. For these reasons, the sedating or wake-promoting effects of these medications are important factors influencing specific drug selection. As these sleep-related effects may in turn influence both medication compliance as well as the course of the disease state itself, it is important for clinicians to understand and predict the possible effects of antidepressants on sleep. Some antidepressants, such as amitriptyline, doxepine, trazodone, and mirtazapine, possess sedating properties and improve sleep continuity via alpha-1 adrenoceptors and histamine H1 receptor blockade, combined with 5HT(2A/2C) receptor blockade. Other antidepressants, such as SSRI, SNRI and MAOIs, worsen sleep and may cause insomnia, an effect which may be linked to facilitation of 5HT(2A/2C) receptors. The majority of antidepressants are REM (rapid eye movement) suppressants, though some, such as nefazodone, bupropion, and mirtazapine, lack REM-suppressing effects. On the other hand, the effects of antidepressants on slow wave sleep (SWS) are much less consistent than their effects on REM sleep. Available data suggest that antidepressants, including some TCAs, and trazodone, increase SWS, possibly as a function of their 5-HT(2A/2C) receptor antagonism. In contrast, antidepressants lacking 5-HT(2A/2C) receptor antagonist effects, including SSRIs, SNRIs and MAOIs, may produce no change or even decrease in SWS. Knowledge of the effects of antidepressants on sleep will be helpful in estimating the sleep disturbance caused by these compounds, and can thus help in the selection of appropriate compound for individual patients.

Quality of Life in Patients with Parkinson's Disease

BACKGROUND: Quality of life (QoL) has emerged as an important issue to patients with chronic illness. Parkinson's disease (PD) is a chronic neurodegenerative disorder requiring life-time treatment and supportive care, which affects not only physical activity but also cognition, mood, and daily living. The author investigated the QoL of patients with PD and aimed to find factors that have an influence on the QoL. METHODS: One hundred thirty patients with PD were evaluated. The QoL was measured and assessed by the Parkinson's disease quality of life questionnaire (PDQL). The author analyzed demographic and social data and clinical profiles. The Beck Depression Inventory (BDI) and Spielburger's State-Trait Anxiety Inventory were used to evaluate depressive symptoms and anxiety levels. RESULTS: The mean age of onset of parkinsonian symptom was 55.2 +/-10.9 years and the average duration of treatment was 34.7 +/-36.9 months. Patients with high BDI score, low Schwab and England activities of daily living scale (SEADLS) score, high bradykinesia score, progressed Hoehn and Yahr stage, high Unified Parkinson's disease rating scale score, low educational period and high economic state were all correlated with low PDQL scores. Multivariate regression analysis showed that BDI score, bradykinesia score, SEADLS score, and educational period were significantly associated with PDQL score. CONCLUSIONS: In order of magnitude, BDI, bradykinesia, SEADLS and educational period were influenc-ing factors on PDQL. Therefore, to improve the QoL in patients with PD, we should consider not only physical disabili-ty, but also psychological factors, including depressive mood.

Depression, Anxiety, and Sleep Disturbances in Patients with Hemodialysis / 신경정신의학

OBJECTIVES: Psychological distresses and complaints in sleep, in addition to physical distresses such as pruritus and bone pain, are common in patients with hemodialysis. The purposes of this study were to investigate 1)the severity of physical distresses, 2)the severity of depression and anxiety, 3)the sleep disturbances, and 4)the correlation of the above variables in patients with hemodialysis. METHODS: The patients with hemodialysis (male 87, female 66)and controls (male 58, female 55)completed a self-administered questionnaire package, which included Beck Depression Inventory, Spielberger's State-Trait Anxiety Inventory, and questions characterizing the reported sleep problems and quantitating the severity of the self-perceived physical and psychological conditions with linear visual analogue scales. RESULTS: The results indicated that patients with hemodialysis complained of more physical distresses, more depressed mood, and more sleep disturbances suggesting insomnia, restless legs syndrome, periodic limb movement disorder, nightmare and obstructive sleep apnea syndrome, etc. There were significant positive correlations of physical distresses, depressed mood and sleep disturbances. However, there were no significant differences in state and trait anxiety between both groups. CONCLUSIONS: The authors suggest that the quality of life in patients with hemodialysis will be improved if their emotional and sleep disturbances are properly ameliorated.

Efficacy and Safety Profile of Risperidone in Schizophrenia: Open Multicenter Clinical Trial / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

The Comorbidity of Periodic Limb Movements Disorder in Patients with Sleep-Related Breathing Disorder / 결핵

BACKGROUND: Sleep-related breathing disorders(SRBD) and periodic leg movements disorder(PLMD) are both common, and are considered as separate sleep disorders. However, both disorders show high comorbidity. SRBD and PLMD can result in excessive daytime sleepiness and insomnia due to frequent sleep fragmentation So, it is very important to consider the presence of PLMD, when we are dealing with the diagnosis and management of SRBD. The objectives of this study were to determine the incidence of PLMD in patients with SRBD, and 13 describe any differences between patients with and without PLMD. METHOD: The authors reviewed the sleep recordings of 106 Patients with a final diagnosis of SRBD(obstruclive sleep apnea or upper airway resistance syndrome), who underwent full nocturnal polysomnography, including the monitoring of the anterior tibialis electromyogram. All sleep records were recorded and scored using the standard criteria. The data was analyzed by the student t-test. RESULTS: 106 patients(M=76, F=30) were included in the analysis. Data revealed a mean age of 49.5 +/- 13.6 years, a respiratory disturbance index(RDI) of 22.3 +/- 25.4/hour sleep, a lowest oxygen saturation of 84.9 +/- 11.3%, a mammal esophageal pressure of -41.0 +/- 19.1cm H2O, and PLM index(PLMI) index(PLMI) 13.1 +/- 22.4 movements/ hour sleep. Forty four percent(47 of 106 patients) had a PLMI of greater than 5 on this study. The mean age of the patients with PLMD was significantly higher than that of the patients without PLMD(p < 0.005). Fe-male patients with SRBD accompanied more PLMD(p < 0.05). The apnea index of the patients with PLMD was significantly lower than that of the patients without PLMD(p < 0.01). The percentage of stage 1 sleep in the patients with PLMD was significantly lower than that of the patients without PLMD(p < 0.05). CONCLUSION: The prevalence of PLMD in the patients with SRBD was high at 44.3%. The patients with PLMD were older and had more high RDI in comparison to the patients without PLMD, which was consistent with previous findings. The authors recommend that more careful consideration of PLMD is required when diagnosing and treating SRBD.

Sleep Habits and Sleep Disorders among the Elderly Between 65-84 years Who are Living in a Part of Pusan / 수면정신생리

OBJECTIVES: The purpose of this study is to analyse sleep habits and sleep disorders in the elderly population ased 65-84 years. METHODS: Epidemiological survey was performed at home by means of semistructured interviews in the city of Pusan, Korea. Subjects were randomly selected. The questionnaire consisted of 128 items including demographic findings, sleep habits, sleep disorders, somatic illnesses, and psychological distresses. RESULTS: (1) The mean retiring time was 10.28 h (SD1.30 h) and the mean wake-up time was 5.24 h (SD 1.33 h). The mean duration of sleep was 5.63 h (SD 1.80 h ). The subjects reported they woke up an average of 2.05 (SD 1.59) times per night. All of the above results were not related to age or gender. However, the mean frequency of difficulty in initiating/maintaining sleep was 2.2 times for men and 3.2 times for women (p<0.05). (2) The prevalence of insomnia was 57.7% and was not related to age or gender. Difficulty in initiating sleep was the most commonly reported insomnia complaint(52.4%). Early morning awakening was reported by 50.0% of patients and difficulty in maintaining sleep was reported by 45.1% of them. Worrying in bed and physical pain were strong contributing factor to insomnia. CONCLUSIONS: The results of our study showed several characteristics of sleep habits in the elderly. Sleep disorder in old age is not inevitable or trivial. Since sleep disturbance in older adults is common and distressing, it has implications for general health and well-being. Active concern and therapeutic intervention for the sleep habits and sleep disorders in the elderly are needed.

Depression in the medical inpatients / 신경정신의학

No abstract available.

Depression in the medical inpatients / 신경정신의학

No abstract available.