Mental Health Status of Korean Adolescents according to Daily Sleep Time and Subjective Sleep Satisfaction / 정신신체의학

OBJECTIVES: Insufficient sleep could have harmful effects on mental health. We examined the mental health status of Korean adolescents according to daily sleep time and subjective sleep satisfaction using a nationwide representative sample of Korean adolescents. METHODS: Data from the 2016 Korean Youth Risk Behavior Web-based Survey was used. Sleep duration on weekdays and subjective sleep satisfaction during the past week were asked. Participants' perceived health, happiness, stress, depressive mood, and suicidality during past 12 months were also investigated. Participants were classified by mean duration of daily sleep time and the level of sleep satisfaction, and the odds of having mental health problems were compared. RESULTS: Compared to adolescents who slept more than 6 hours per day and satisfied with their sleep, adolescents who slept less than 6 hours per day and/or dissatisfied with their sleep were less likely to perceive themselves healthy and happy. They were also more likely to have severe stress, depressive mood, and suicidality, with highest odds ratios among adolescents with both short and dissatisfying sleep. CONCLUSIONS: Given the significant associations between sleep insufficiency and mental health problems, attention to the sleep shortage among Korean adolescents is needed. Prospective studies are warranted to elucidate the causal relationships between subjective and objective sleep insufficiency and psychiatric conditions.

Delusional Parasitosis as 'Folie a Deux'

Delusional parasitosis is characterized by the unshakeable belief of being infested with tiny (microscopic) insects. Patients spend much time trying to get rid of the bugs and suffer from these symptoms. Patients prefer to go to dermatologists because they have a strong conviction over the presence of a somatic disease and do not accept any psychiatric advice for their complaints. 'Folie a deux' or shared psychotic disorder (SPD) is a relatively rare syndrome, which has long attracted clinical attention. Delusional parasitosis is associated in 5-15% of SPD and can run within a family. We experienced delusional parasitosis as 'Folie a Deux' between a mother and her son and successfully treated them through early psychiatric intervention. We believe that attention should be drawn to DP with SPD.

Risperodone Induced Hyperprolactinemia and Its Clinical Complications / 대한정신약물학회지

OBJECT: Risperidone, unlike other atypical antipsychotics, is thought to elevate prolactin levels. This paper examines the relationship of risperidone-induced hyperprolactinemia and the sexual dysfunctions of the patients in the real clinical practice. METHODS: Forty nine patients (male 22, female 27) with 6 month-over risperidone medication were assigned and serum prolactin was assayed in serum by radioimmunometric assay. In the distinction of sex, six adverse events possibly associated with increased prolactin levels were determined by interviewing the patients (poor erection, ejaculatory dysfunction, galactorrhea, decreased libido, orgasmic dysfunction and obesity in male;amenorrhea, vaginal dryness, galactorrhea, decreased libido, orgasmic dysfunction and obesity in female). RESULTS: In 49 patients, thirty six patients (male 15;56%, female 21;95%) showed hyperprolactinemia and twenty two patients (male 13;48%, female 8;36%) had sexual side-effects. Both risperidone dosage per day and duration were not correlated with prolactin levels and adverse events. There was no significant direct correlation between serum prolactin levels and sexual adverse events. CONCLUSION: The risperidone-associated increase in serum prolactin levels was not significantly directly correlated with the emergence of possible prolactin-related adverse events in the real clinical practice. However, our results suggest that risperidone-induced hyperprolactinemia may play a role in sexual dysfunction of female patients.

Two-Year Naturalistic Outcome Study of Schizophrenics after Discharged from a University Hospital on a Regimen of Risperidone or Typical Antipsychotics / 신경정신의학

OBJECTIVES: To explore the naturalistic outcome of the schizophrenics, we evaluated key clinical outcome-drop-out rate and readmission rate among the 33 risperidone and 17 conventional antipsychotics(such as haloperidol, chlorpromazine, mesoridazine) treated patients who met DSM-IV diagnostic criteria for schizophrenia at psychiatric department of a university hospital. METHOD: Outcome data was extracted from the charts of 50-schizophrenic patients who were more than 2 years after initiation of treatment with risperidone and conventional anti-psychotics. RESULTS: During over the 2-year period, the drop-out rate of the conventional antipsychotics treated schizophrenics was significantly higher than that of risperidone treated patients. But no significant factors(such as age, education level, duration of illness) were found between these two differently treated groups. Among the risperidone treated patients, the percentage of readmission was 18.2% at 12 months and 45.5% at 24 months. CONCLUSIONS: Reduced drop-out and rehospitalization rate suggest that risperidone was better than conventional antipsychotics among schizophrenic patients in a university hospital. Our data may contribute essential functional outcome information to assist the clinician in long-term, comparative treatment evaluation in 'real' clinical practice.

Characteristic Eye Movement in Schizophrenic Patients: Accuracy and Adaptation Speed of Adaptive Gaze Control / 신경정신의학

OBJECTIVES: While most neurological models of schizophrenia have focused on cerebral functions, cerebellar abnormality, especially in cerebellar vermis has been repeatedly reported in schizophrenic patients from brain imaging and lesion studies. And cerebellar vermis has been implicated for adaptive control of saccadic eye movements, which has not been studied in schizophrenics to our knowledge. METHOD: We investigated saccadic adaptation using double-step paradigm in 5 patients with a DSM-IV diagnosis of schizophrenia and 5 age and sex-matched normal controls. Gaze and head movements were recorded with scleral search coil method in head-free condition. RESULTS: Time course of adaptation in schizophrenics was similar to that of normal control but it never reached to the complete level of adaptation seen in control, and accordingly gaze gain (gaze amplitude/target amplitude) was low even after 600 adaptive trials. Head contribution to gaze saccade was relatively low and time to peak head velocity was longer in schizophrenics. CONCLUSIONS: Our results suggested that schizophrenic patients used a different strategy of gaze control and some schizophrenics might have cerebellar abnormality. Variability across patients in adaptation parameters need to be further investigated in combination with cerebellar volumetry. This study was supported by "In-san Schizophrenia Research Grant" from the Research Institute of Korean Neuropsychiatric Association in 1997.

Granulocyte-Colony Stimulating Factor(G-CSF) Treatment of Clozapine-induced Agranulocytosis / 대한정신약물학회지

After 31 weeks of treatment with clozapine, severe agranulocytosis was diagnosed in a 35-year-old male schizophrenic patient. The patient was treated sucessfully with a granulocyte colony-stimulating factor (G-CSF). The leukocyte court was 300/mm(3) on admission. After 10 days treatment with G-CSF, the hematological status normalized. Despite its clinical advantages, the use of clozapine has been limited by a propensity to induce agranulocytosis in 1-2% of the patients who are treated with this compound. In addition to case report, authors reviewed the indications for clozapine treatment and the present knowledge base regarding the incidence, monitoring and management of agranulocytosis. Unfortunately, clozapine-induced agranulocytosis cannot be prevented, so regular blood examination and education for patient and family member are very important and early treatment with G-CSF seems warranted in severe cases of clozapine-induced agranulocytosis.