A Study on Discontinuation Rate on Maintenance Treatment of Antipsychotic Agents in Schizophrenic Patients / 대한정신분열병학회지

OBJECTIVES: Relapse prevention is a major therapeutic goal in the treatment of schizophrenia. However, many patients experience multiple functional impairments and treatment resistance due to recurrence. This study was designed to investigate the follow-up of patients with using antipsychotic drugs and to compare the total treatment failure rate, withdrawal reasons, and duration period of antipsychotic drugs. METHODS: The subjects were 1963 patients who taking antipsychotic drugs under the diagnosis of schizophrenia. We selected 1836 patients using 10 antipsychotic drugs according to frequency of using. The rate of total treatment failure of them was divided into 6-month, 1-year, 2-year, 3-year, and 5-year according to the time of drug withdrawal. We compared the total treatment failure rate at 1 and 3-year between 10 antipsychotic drugs. RESULTS: The total treatment failure rate of clozapine was lowest compared with the other 9 antipsychotic drugs in all the surveyed periods. When evaluating actual number of subjects, olanzapine, sulpiride, risperidone, aripiprazole, amisulpride, and haloperidol were lower significantly compared with ziprasidone at 1-year in the total treatment failure rate, but there was no significant difference between them except clozapine at 3-year. The results of the analysis based on the number of prescriptions showed that the total treatment failure rate of the atypical antipsychotic drug was lower than that of the typical antipsychotic drug at 1-year, but the difference was decreased over time except quetiapine and ziprasidone. CONCLUSION: In conclusion, although there is some controversy about which drug to prescribe to the patient, the clinician needs a proper prescription considering various factors such as efficacy, side effects, price, and formulations of each drug.

A Study on Discontinuation Rate on Maintenance Treatment of Antipsychotic Agents in Schizophrenic Patients / 대한정신분열병학회지

OBJECTIVES: Relapse prevention is a major therapeutic goal in the treatment of schizophrenia. However, many patients experience multiple functional impairments and treatment resistance due to recurrence. This study was designed to investigate the follow-up of patients with using antipsychotic drugs and to compare the total treatment failure rate, withdrawal reasons, and duration period of antipsychotic drugs. METHODS: The subjects were 1963 patients who taking antipsychotic drugs under the diagnosis of schizophrenia. We selected 1836 patients using 10 antipsychotic drugs according to frequency of using. The rate of total treatment failure of them was divided into 6-month, 1-year, 2-year, 3-year, and 5-year according to the time of drug withdrawal. We compared the total treatment failure rate at 1 and 3-year between 10 antipsychotic drugs. RESULTS: The total treatment failure rate of clozapine was lowest compared with the other 9 antipsychotic drugs in all the surveyed periods. When evaluating actual number of subjects, olanzapine, sulpiride, risperidone, aripiprazole, amisulpride, and haloperidol were lower significantly compared with ziprasidone at 1-year in the total treatment failure rate, but there was no significant difference between them except clozapine at 3-year. The results of the analysis based on the number of prescriptions showed that the total treatment failure rate of the atypical antipsychotic drug was lower than that of the typical antipsychotic drug at 1-year, but the difference was decreased over time except quetiapine and ziprasidone. CONCLUSION: In conclusion, although there is some controversy about which drug to prescribe to the patient, the clinician needs a proper prescription considering various factors such as efficacy, side effects, price, and formulations of each drug.

The Effects on Metabolic Syndrome Parameters of Atypical Antipsychotic Agents in Schizophrenics Patients : 3 Years Retrospective Follow Up / 대한정신분열병학회지

OBJECTIVES: Pharmacological treatment is critical on relapse prevention in patients with schizophrenia. However, atypical antipsychotic agents are known to cause weight gain more than typical agents despite their various effects. In addition, they are known to affect blood sugar, blood pressure, cholesterol, cardiac function, and sexual function. This study was designed to examine the effects on metabolic parameters when schizophrenic patients have been taken atypical antipsychotic agents. METHODS: This was a trial in 137 patients with DSM-IV-TR schizophrenia who were admitted or treated in mental hospital. Anthropometric measurement and blood testing were conducted at baseline, 12 month, 36 month, and sociodemographic and treatment history were collected from medical records. We conducted height, weight, waist circumference, blood pressure, FBS, total cholesterol, HDL, triglyceride, and QTc interval. Metabolic syndrome was diagnosed by ATPIIIa criteria. RESULTS: Aripiprazole showed the significant difference in the impact on weight, blood pressure, waist circumference, total cholesterol, HDL, triglyceride than paliperidone and olanzapine at 1-year and 3-year period. Olanzapine showed the significant increase of weight and triglyceride than paliperidone at 3-year period. The prevalence of metabolic syndrome increased in paliperidone at 1-year and in olanzapine at 3-year period compared to aripiprazole significantly. CONCLUSION: We concluded that aripiprazole has less impact on the abdominal obesity, FBS, blood pressure, and cholesterol than paliperidone and olanzapine. Olanzapine showed the increase of long-term metabolic risk than other agents. There was needed the routine screening and multidisciplinary management of medical problems in schizophrenic patients for the prevention of metabolic syndrome.

Prevalence of Sexual Dysfunction in Schizophrenic Patients Taking Antipsychotic Drugs / 대한정신분열병학회지

OBJECTIVES: Sexual dysfunction is said to affect the compliance of drug and quality of life. This study is a research to investigate the prevalence of sexual dysfunction and affecting factors that can occur when schizophrenic and schizoaffective patients have taken drugs. METHODS: Subjects were 300 patients who have been taken inpatient or outpatient treatment in national seoul hospital. We used UKU-S, ASEX scale for evaluating the prevalence of sexual dysfunction and CGI-S, PANSS negative scale and CES-D for investigating the influence of psychopathology and depressive symptoms on sexual dysfunction. RESULTS: It was reported sexual dysfunction 82.7% in male and 92.2% in female with 7 items of UKU-S. The prevalence of sexual dysfunction with criteria of ASEX was 47.72% in male and 65.05% in female. Sexual dysfunction was more prevalent in patients taking prolactin-elevation drugs. In the factor analysis for the sexual dysfunction it was investigated that age, onset time, CGI-S, PANSS negative scale, and CES-D can affect the sexual dysfunction in both male and female. CONCLUSION: This study reported that many patients complained of sexual dysfunction. On considering the influence of sexual dysfunction to compliance and quality of life, clinicians evaluate sexual side effects more actively because patients are more likely not spontaneously tell the sexual side effects in comparison to others.

A Study on Changes of Metabolic Parameters with Antipsychotic Treatment in Schizophrenic Patients : 1 Year Prospective Natualistic Study / 대한정신분열병학회지

OBJECTIVES: Schizophrenia patients are known to be more prone to metabolic disease than normal people. This study aimed to identify the changes in metabolic parameters of schizophrenia patients using atypical antipsychotic drugs for 1 year. METHODS: A total of 200 schizophrenia patients were recruited and categorized into the aripiprazole-treatment group and control group taking 5 atypical antipsychotic drugs. Comparative analysis were between groups. The prescriptions of psychotropic drugs were collected by a review of medical records. Blood was collected after fasting for 12 hours at the starting point of treatment and the 12th month, and patient medical records were evaluated for basici nformation and treatment history. Physical measurement, the prevalence of metabolic syndrome and metabolic parameters were studied using ATP-III diagnostic criteria. RESULTS: From the study, the aripiprazole-treatment group had a mean weight increase of 0.6 kg and the control group had a mean weight increase of 6.5 kg at the 1 year follow-up, showing a significant difference between the two groups. There were also significant differences between the two groups in waist size, systolic and diastolic blood pressure, fasting blood sugar, total cholesterol, triglyceride, HDL-choleseterol and prolactin level. Along with meaningful improvement of the symptoms, aripiprazole-treatment group showed less effect on in abdominal obesity, diabetes, blood pressure, cholesterol and prolactin than other atypical antipsychotic drugs. CONCLUSION: Therapeutic intervention such as diagnosis, treatment, weight management and diet improvement is necessary for schizophrenia patients. Psychiatric symptoms as well as internal meicine-related problems such as metabolic disease need to be addressed in case management.

Cognitive Impairments in Clinically Stable Late-Life Depression : Relationship to Cardiovascular Risk : A Pilot Study

OBJECTIVE: The purpose of this study was to test the hypothesis that cardiovascular risk is associated with cognitive impairments in clinically stable late-life depression. METHODS: A total of 59 clinically stable late-life depression patients over age 60 were enrolled in a cross-sectional study. Evaluation tools used in this study include Hamilton Rating Scale for Depression, Geriatric Depression Scale, State-Trait Anxiety Inventory, the Framingham general cardiovascular disease risk profile and the cognitive function battery designed for this study. Correlation analysis, analysis of variance and analysis of covariance were performed. RESULTS: Patients with higher cardiovascular risk performed significantly poorer in the domains of executive function and short-term or long-term memory. In models adjusted for age, sex, education, 10% higher cardiovascular risk was associated with poorer executive function. CONCLUSION: Our findings suggested that cardiovascular risk could be a significant factor associated with poor executive function in clinically stable late-life depression and the management which is necessary as a component of treatment planning. This pilot study provided good prospects for future studies to document this relationship on larger samples.

Clinical Correlates and Description Profiles of Antipsychotic Polypharmacy for Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Despite increasing use of antipsychotic polypharmacy (APP), few studies have investigated APP for Korean patients with schizophrenia. The aim of this study was to identify the sociodemographic and clinical correlates and recent prescription profiles of APP in schizophrenia patients. METHODS: A total of 297 schizophrenia patients were recruited and interviewed using standardized assessment instruments in Seoul National Hospital. Differences in demographic and clinical characteristics between APP and antipsychotic monopharmacy (APM) groups were analyzed. The prescriptions of psychotropic drugs were collected by a review of medical records. RESULTS: In comparison with the APM group, the APP group showed association with earlier onset, lower employment rate, and higher scores for Clinical Global Impression-Severity and Brief Psychiatric Rating Scale (BPRS) (p<0.001). In particular, the BPRS positive (p<0.001) and affective symptom scores (p<0.001) of the APP group were higher those of the APM group. The most frequent combination pattern of APP was second generation antipsychotics (SGA)+SGA, followed by SGA+first generation antipsychotics (FGA), and SGA+SGA+FGA. For antipsychotics, it was risperidone+quetiapine, followed by clozapine+risperidone, risperidone+sulpiride, and risperidone+haloperidol. CONCLUSION: The current study suggests that the usage of APP for schizophrenia could be related to symptom severity affected by positive and affective symptoms. The prescription profile reflects that the proportion of atypical antipsychotics on APP has increased.

Comparing Quantitative EEG and Low Resolution Electromagnetic Tomography Imaging between Deficit Syndrome and Non-Deficit Syndrome of Schizophrenia / 수면정신생리

OBJECTIVES: Deficit schizophrenia (DS) constitutes a disease separate from non-deficit schizophrenia (NDS). The aim of the current study was to compare the quantitative EEG and low resolution electromagnetic tomography (LORETA) imaging between DS and NDS. METHODS: This study was performed by 32 channels EEG for 42 schizophrenia patients who we categorized into DS and NDS using proxy instrument deficit syndrome (PDS). We performed the absolute power spectral analyses for delta, theta, alpha, low beta and high beta activities. We compared power spectrum between two groups using Independent t-test. Partial correlation test was performed with clinical parameters. Standardized LORETA (sLORETA) was used for comparison of cortical activity, and statistical nonparametric mapping (SnPM) was applied for the statistical analysis. RESULTS: DS showed significantly increased delta and theta absolute power in fontal and parietal region compared with NDS (p<0.05). Power spectrum showed significant correlation with 'anergia' and 'hostility/suspiciousness' subscale of brief psychiatric rating scale (BPRS)(p<0.05). sLORETA found out the source region (anterior cingulate cortex/limbic part) that delta activity was significantly increased in DS (p=0.042). CONCLUSIONS: DS showed different cortical activity compared with NDS. Our results may suggest QEEG and LORETA could be the marker in differentiating between DS and NDS.