Tretment Effect of Bromocriptine on Antipsychotics-induced Amenorrhea / 대한정신약물학회지

Amenorrhea is one of the well-known side effects of antipsychotics in women. It is associated with hyperprolactinemia induced by dopamine blocking effect of antipsychotics. Administration of bromocriptine which belongs to dopamine agonist may reverse amenorrhea and hyperprolactinemia. However dopamine agonist has been reserved in the treatment of antipsychotics-induced amenorrhea because of concern about exacerbation of psychotic symptoms. This case series study was designed to determine whether bromocriptine can be used safely in schizophrenic patients with amenorrhea. We administered bromocriptine to 5 stable schizophrenic outpatients who experienced amenorrhea over 6 months. Bromocrptine dosage was titrated upward from 2.5 mg/day to 7.5 mg/day until menstrual recovery. Patients' menstrual state and side effects of bromocriptine was monitored prospectively for 22 weeks, and clinical symptom were assessed using brief psychiatric rating scale (BPRS) and clinical global impression scale-severity (CGI-S). These were assessed biweekly until 12th week and then every 4weeks thereafter. All five patients resumed menstruation without deterioration of clinical symptoms measured by BPRS and CGI-S. No serious side effect of bromocriptine was reported. Patients with lower baseline prolactin level showed faster recovery and needed lower dose of bromocriptine. These findings suggest bromocriptine may be used safely in the treatment of antipsychotics-induced amenorrhea.

Acute Effect of Single Oral Administration of Nefazodone and Trazodone of Psychomotor Performance: A Duble-Blind Cross-Over Comparison in Healthy Volunteers / 대한정신약물학회지

OBJECTIVE: New antidepressant, nefazodone is classified as a serotonin -2 antagonist/reuptake inhibitor like old antidepressant, trazodone. Nefazodone, however, differs from trazodone in that it lacks anti-histaminergic properties and in that it has some norepinephrine reuptake inhibitory properties. These differences may account for the differences between the two drugs in the side effect profiles. This study was conducted to compare the acute effects of nefazodone on the psychomotor performance with those of trazodone. METHODS: The subjects were 12 healthy male volunteers aged between 20-40 years. A single, oral starting dose of nefazodone or trazodone was administered in a double-blind, randomized latin-square design with a 1-week interval between each drug switch. Psychomotor performances were assessed at 1 hour before and at 2 hours after administration of nefazodone 50 mg, nefazodone 100 mg or trazodone 50 mg. The measures of psychomotor performance included Vienna Determination Unit for complex choice reaction time, Critical Flicker Fusion Test, and Grooved Pegboard Test. RESULTS: In the Vienna Determination Unit, when 'within drug effect' (pre- vs. post-medication) was analyzed, nefazodone 100 mg decreased complex choice reaction time in both subtest 2 and subtest 3. Nefazodone 50 mg also decreased the reaction time in subtest 3 but not in subtest 2 which was more difficult and demanding task than subtest 3. On the other hand, no significant changes in the reaction time were observed with trazodone 50 mg in either subtest 2 or subtest 3. When 'between drug effect' was analyzed, however, the differences between drugs were not found to reach statistically significant level. No significant 'between drug effect' or 'within drug effect' was observed in Critical Flicker Fusion Test and Grooved Pegboard Test. CONCLUSION: Although the differences between nefazodone and trazodone did not reach statistically significant level, the results on the complex choice reaction time suggest that al least a single starting dose of nefazodone up to 100 mg does not impair psychomotor performances and it might have a less detrimental effect than trazodone on the psychomotor performance.

Reaction Times in Schizophrenia / 신경정신의학

The reaction time(RT) has been known to reflect attention that controls the flow of information processing. Extensive research has demonstrated cognitive impairment in schizophrenia subjects using RT tasks. However, little work has been done examining the relative contribution of DT(decision time) and MT(motor time) to slowed RT in schizophrenics. Also, recent investigators have observed that schizophrenic patients exhibit larger intra-individual variability in RT than do normal comparison subjects. The purpose of this study, using multi-stimulus convergent RT task, was to explore the speed of RT, relative contribution of decision time(DT) and motor time(MT) to slowed RT, overall sequential profile in 25 repeated-time measurements in 10 schizophrenic out-patients and 10 normal control subjects. Overall reaction time and decision time were slower in schizophrenic subjects than in normal controls. The motor time was not shown to be significantly different between the two groups with 0.05 significance level, although there was some trend indicating schizophrenic subjects were slower consistently in repreated measurements over time. These results suggested that the slower reaction time in schizophrenic subjects was mostly determined by cognitive component, decision time rather than motor time. Sequential profile of repeated measurements showed greater intraindividual and interindividual variations in schizophrenics than in normal controls. These results indicate that high variabilities are not merely measurement errors but characteristic of schizophrenic psychopathology.