The Korean Version of the Barkley Deficits in Executive Functioning Scale: Clinical Utility in Adult Attention-Deficit/Hyperactivity Disorder / 신경정신의학

Objectives@#To identify the clinical utility of the Korean version of the Barkley Deficits in Executive Functioning Scale (K-BDEFS) assessing executive functioning. @*Methods@#The patient group included 144 adult attention-deficit/hyperactivity disorder (ADHD) patients visiting the Adult ADHD Outpatient Clinic of the National Center for Mental Health. Adult ADHD Self-Report Scale version 1.1, Mini International Neuropsychiatric Interview, and K-BDEFS were used. The control subjects were 144 age, sex, and education-matched general adults who participated in the study of the validity of the K-BDEFS in Samsung Medical Center. @*Results@#An analysis of the mean total K-BDEFS score, executive functioning symptom count, and ADHD-executive function (EF) index score revealed a significant difference between the adult ADHD and control group (p<0.05). Five subscales of the K-BDEFS, which assess the specific domains of the executive function, revealed a significant difference between the ADHD group and control group (p<0.05). The area under curve (AUC) of the K-BDEFS total score, the EF symptom count, and the ADHD-EF index were 0.943, 0.949, and 0.908, respectively, in the analysis using the receiver operating characteristic curve. All AUC values were over 0.90. Therefore, KBDEFS is a reliable and valid screening instrument for diagnosing adult ADHD. In an assessment of the sensitivity and specificity of the cutoff scores, a cutoff of 183.5 points for the K-BDEFS total score, 26.5 points for the EF symptom count, and 23.5 points for the ADHD-EF index showed a reliable sensitivity and specificity above 80%. @*Conclusion@#To the best of the authors’ knowledge, this is the first study to examine the predictive validity and clinical utility of K-BDEFS in adult ADHD. The results suggest that the K-BDEFS could be used as a valid and reliable tool for the diagnosis and clinical intervention of adult ADHD.

Antidepressants Use in Schizophrenia: Clinical Correlates and Prescription Profiles / 신경정신의학

OBJECTIVES: To identify recent prescription patterns, as well as the demographic and clinical correlates of antidepressants (ADs) usage in schizophrenic patients. METHODS: A total of 297 patients diagnosed with schizophrenia enrolled at Seoul National Hospital in 2013. Brief Psychiatric Rating Scale (BPRS) was used to evaluate current psychiatric symptoms. Bivariate comparisons were used to assess the usage of concomitant psychotropics, demographic and clinical characteristics of ADs users compared with non-users. Multivariate analysis of covariance was performed consecutively. RESULTS: The rate of ADs usage was 26.3% and the most commonly used ADs were selective serotonin reuptake inhibitors. ADs users more often took benzodiazepine than ADs non-users (p=0.005), whereas there were no significant demographic and other clinical difference between the two groups. Regarding BPRS, somatic concern (p=0.022), anxiety (p=0.001) and depressive mood (p=0.009) scores were higher, and excitement (p=0.006) and hostility (p=0.04) scores were lower among ADs users compared to non-users, although there was no significant difference in the other scores of BPRS between the two groups. Moreover, among 5 components of BPRS, scores of affective symptoms (p < 0.001) were significantly higher, and scores of activation symptoms (p=0.014) were significantly lower in ADs users compared to non-users. CONCLUSION: This study suggests that the usage of ADs could be related to affective symptoms regardless of positive and negative symptoms of schizophrenia. Further studies are required in order to confirm the clinical correlates of ADs usage and the interactions between affective symptoms and psychotic symptoms.

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.

Metabolic Disturbances Independent of Body Mass in Patients with Schizophrenia Taking Atypical Antipsychotics

OBJECTIVE: Atypical antipsychotic (AAP) treatment is associated with weight gain and metabolic disturbances such as dyslipidemia and dysglycemia. The metabolic disturbances are usually considered to develop secondary to weight gain. We performed the comparison of metabolic disturbances of three AAP group with different risk of metabolic side effect after adjusting for body mass to investigate whether any metabolic disturbances develop independently from body mass index (BMI). METHODS: This cross-sectional study included 174 subjects with schizophrenia who were on 1) monotherapy with clozapine (CL), olanzapine (OL), or quetiapine (QT) (n=61), 2) monotherapy with risperidone (RSP) (n=89), or 3) monotherapy with aripiprizole (ARP), or ziprasidone (ZPS) (n=24) more than 1 year. Association between the prevalence of metabolic disturbances and groups were analysed using logistic regression after adjusting confounding variables including BMI. Analysese of covariance were used to compare the AAP groups in terms of the levels of metabolic parameters. RESULTS: There were significant differences among groups in terms of the prevalence of hypertriglyceridemia (p=0.015), low HDL-cholesterol (p=0.017), and hyperglycemia (p=0.022) after adjusting for BMI. Triglyceride level (p=0.014) and the ratio of triglyceride to HDL-cholesterol (p=0.004) were significantly different among groups after adjusting for BMI. CONCLUSION: In conclusion, metabolic disturbances are significantly different in AAP groups even after adjusting BMI. AAPs may have direct effect on metabolic parameters. Blood lipid and glucose levels should be monitored regularly regardless of whether patients tend to gain weight.

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.

Long-Term Tolerability of Escitalopram in Korean Adolescents

OBJECTIVES: We investigated the long-term tolerability of escitalopram in Korean adolescents. METHODS: The subjects were 37 adolescents, who had been diagnosed with depressive disorder in accordance to DSM-IV. Clinical effectiveness was assessed by Clinical Global Impression-Improvement (CGI-I) scale at the final follow-up visit. Tolerability was assessed through a medical record of the reason for discontinuation of escitalopram and documented adverse events. RESULTS: The mean duration of treatment was 78.1+/-89.5 days, and the mean dosage was 10.0+/-4.4mg/day. Out of the total 37 patients, two (5%) patients sustained use of escitalopram. Twelve patients (32.4%) discontinued use of escitalopram due to target symptom remission, and 23 patients (61.9%) due to insufficient efficacy. Six patients (16.2%) had at least one documented adverse event. However, no suicidal ideation or self-injurious behavior was reported. Significant differences in clinical symptom improvement efficacy were seen between the patients who were receiving escitalopram for less than 8 weeks (4.3%, 1/13) and those for more than 8 weeks (92.9%, 13/14). There was no significant difference between the tolerability of monotherapy compared to the concomitant use group. CONCLUSION: The results of this study suggest that long-term use of escitalopram may result in superior efficacy than short-term use, and is tolerable in Korean adolescents with depression.

The Prevalence of Metabolic Syndrome in Schizophrenic Patients Using Antipsychotics

OBJECTIVE: To examine the prevalence of metabolic syndrome and its risk factors in a large group of schizophrenic patients. METHODS: Sociodemographic and treatment data were collected from medical records of 1,103 inpatients and outpatients treated for schizophrenia at Seoul National Hospital in Seoul, Korea. Anthropometric measurement and blood testing were conducted for collection of physical and biochemical data and diagnosis of metabolic syndrome. Data for metabolic syndrome prevalence were compared by sex, age, metabolic syndrome markers present, treatment of markers, and types of antipsychotics and individual drug agents used. RESULTS: Mean prevalence of metabolic syndrome in all subjects was 43.9% and 40.1% according to adapted Adult Treatment Panel III (ATP-IIIa) and International Diabetes Federation criteria, respectively. No significant differences were found in prevalence according to ATP-IIIa criteria between men (42.6%) and woman (45.9%). A trend toward higher prevalence with age was observed for both sexes until 50 years, followed by a continued increase for women but a decrease for men. Use of a combination of atypical antipsychotics was associated with the highest metabolic syndrome prevalence and use of aripiprazole with the lowest. High percentages of subjects with hypertension and dyslipidemia were not being treated for these conditions. CONCLUSION: Despite their higher prevalence in schizophrenic patients, metabolic syndrome and its markers are not being adequately managed in these patients. Treatment of schizophrenic patients requires attention to not only their psychiatric conditions but also associated medical conditions by individual health care practitioners and hospitals as well as the public health care sector as a whole.

Eosinophilia, Pleural Effusion, Hepatitis, and Jaundice Occurring Early in Clozapine Treatment

Clozapine use is associated with various adverse events, some of which have received little attention, including eosinophilia, pleural effusion, and hepatitis. Because of the fatality of jaundice with hepatitis, it is necessary to understand the course and management of clozapine-induced eosinophilia and hepatitis. We report on a case in which the eosinophil count began to increase shortly after clozapine use, and pleural effusion and fever then developed at the time eosinophilia was at its peak level. Jaundice with hepatitis consecutively developed when all the above symptoms subsided. The liver function recovered rapidly after clozapine was discontinued. We recommend that patients who develop rapid eosinophilia at the beginning of clozapine treatment should be monitored with LFTs, chest X-rays, and urine analysis tests.

Psychomotor Performance Relevant to Driving Ability in Patients with Schizophrenia Treated with Haloperidol and Aripiprazole / 대한정신분열병학회지

OBJECTIVES: This study aimed to compare psychomotor performance related with automobile driving in patients with schizophrenia under the treatment of a typical antipsychotic agent, haloperidol, or an atypical antipsychotic agent, aripiprazole. METHODS: We evaluated driving ability of schizophrenia patients by using the cognitive perceptual assessment for driving (CPAD). Twelve patients receiving haloperidol monotherapy and 18 taking aripiprazole monotherapy participated in this study and the results of CPAD were compared with each other. RESULTS: Of 30 participants, 15 (50%) of the patients passed the CPAD to be regarded as competent to drive, 3 (10%) of the patients failed the CPAD considered to be severely impaired. Controlling for sex, age, education, duration of illness, there were no significant differences in the CPAD results between two treatment groups. We observed a trend that patients who received aripiprazole showed a higher total score of the CPAD than haloperidol-treated patients (55.2+/-4.9 vs. 45.7+/-8.4, p=0.080). CONCLUSION: There were no significant differences in the psychomotor performance relevant to driving ability between haloperidol and aripiprazole groups. But our results suggest that aripiprazole might have the neurocognitive advantage over haloperidol. Future study with a large sample size and diverse antipsychotics is warranted.

Retrospective Analyses of Long-Term Use of SSRI in Children and Adolescents with Autism Spectrum Disorder

OBJECTIVES: The purpose of this study was to investigate clinical profile, efficacy, and safety of long-term treatment with selective serotonin reuptake inhibitors (SSRIs) in Korean autism spectrum disorders (ASDs) patients. METHODS: Effectiveness was assessed through a retrospective review of self-reported target symptom improvement at the last follow-up visit. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity (CGI-S) of illness and Clinical Global Impression-Improvement (CGI-I) Scales. Tolerability was assessed through a review of the reason for discontinuation of SSRI and documented adverse events. RESULTS: A total of 21 ASDs patients (aged 9 to 19 years) treated with SSRI during July 2010 to July 2011 in department of child and adolescent psychiatry of Seoul National Hospital were identified. The mean duration of SSRI treatment was 47.9 (standard deviation = 36.9) months (range 0.7-114.5), and the mean fluoxetine equivalent dosage of SSRIs was 27.1 +/- 10.8 mg. Nineteen (90.5%) patients were using concomitant medication. We found that SSRIs were prescribed for symptoms of agitation, stereotyped behavior, aggression, depression, impulsivity and self-injury in ASDs. Ten patients (47.6%) reported improvement in their target symptom after SSRI treatment based on CGI-I scores (CGI-I < or = 2). The side effects were reported in 5 patients (23.8%) ; vomiting (n = 2, 9.5%), excessive mood elevation (n = 1, 4.8%), insomnia (n = 1, 4.8%), somnolence (n = 1, 4.8%) and decreased appetite (n = 1, 4.8%). Self-injurious behavior was reported in one patient (4.8%). CONCLUSIONS: The results of this study suggest that SSRIs may be used effectively in children and adolescents diagnosed with ASDs. However, safety issues need to be considered carefully when choosing SSRIs for treatment. Future controlled trials are needed to confirm these findings.

Relationships between Cigarette Smoking and Socio-Demographic and Clinical Characteristics in Patients with Schizophrenia in South Korea / 신경정신의학

OBJECTIVES: In patients with schizophrenia, the prevalence of smoking is significantly higher than that of the general population. This study aimed to evaluate the relationships between cigarette smoking and socio-demographic and clinical characteristics in patients with schizophrenia in South Korea. METHODS: Post analysis of 2008-2009 three multi-center studies on the paliperidone extended-release switching was performed. A total of 509 patients with a diagnosis of schizophrenia were recruited and interviewed regarding socio-demographic variables, smoking characteristics. Krawiecka Scale, Clinical Global Impression-Schizophrenia-Severity, Clinical Global Impression-Schizophrenia-Improvement, and Personal and Social Performance Scale were used to evaluate psychological disturbance. Safety assessments included adverse events, evaluation of extrapyramidal symptoms using the Drug Induced Extra Pyramidal Symptoms Scale, and laboratory tests. RESULTS: The results revealed that the prevalence of smoking in Korean patients with schizophrenia is significantly higher than that of the general population. Male, patients with occupation, and paranoid type showed higher rate of smoking and smokers with schizophrenia had higher rates of overweight, thick waist, high blood pressure than non-smokers with schizophrenia. The results revealed that smokers with schizophrenia had higher rating scales of negative and cognitive symptoms. CONCLUSION: From this study, we reported significant relationships between cigarette smoking and socio-demographic and clinical characteristics in patients with schizophrenia in South Korea. More studies will be needed to evaluate the association between cigarette consumption and schizophrenia, effect of smoking according to the antipsychotics, mechanism of nicotine on schizophrenia.

Clinical Characteristics of Methylphenidate Use in Korean Children and Adolescents with Autism Spectrum Disorder : A Retrospective Study

OBJECTIVES: The purpose of this study was to investigate clinical characteristics of children and adolescents with autism spectrum disorders (ASDs) using methylphenidate (MPH). METHODS: Retrospective review of the charts of 79 children and adolescents with ASDs, who visited the Department of Child and Adolescent Psychiatry of Seoul National Hospital, from July 2010 to July 2011, was conducted. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity of illness (CGI-S) and Clinical Global Impression-Improvement (CGI-I) Scales. RESULTS: We found that MPH was prescribed in 23 (29.1%) children and adolescents. Of the 23 patients on MPH, 4 patients (17.4%) were on MPH monotherapy and 18 patients (78.3%) were using risperidone concomitantly. MPH was prescribed primarily for symptoms of hyperactivity and impulsivity in ASDs patients. The mean dosage of MPH was 26.2+/-11.1mg/day and mean duration of treatment was 31.9+/-28.7 months. Mean CGI-S score improved significantly from baseline to endpoint (from 5.4+/-0.6 to 4.1+/-0.9 ; p<.01). MPH was reported to be effective in 17 patients (17/23, 73.9%), and 10 patients (10/23, 43.5%) reported side effects. Side effects included decreased appetite (4/23, 17.4%), tic (2/23, 8.6%), sleep disturbances (2/23, 8.6%), headache (1/23, 4.3%) and irritability (1/23, 4.3%). CONCLUSION: The results of this study demonstrate that MPH may be used effectively and safely in children and adolescents with ASDs with hyperactivity and impulsivity. Future controlled trials are needed to confirm these findings.

Genetic Polymorphisms in the HTR2C and Peroxisome Proliferator-Activated Receptors Are Not Associated with Metabolic Syndrome in Patients with Schizophrenia Taking Clozapine

OBJECTIVE: Genetic variation in the serotonin-2C receptor encoded by the HTR2C gene is one of the genetic determinants of antipsychotic-induced weight gain. Peroxisome proliferator-activated receptors are nuclear receptors regulating the expression of genes involved in lipid and glucose metabolism. In this cross-sectional study, we investigated whether HTR2C-759C/T, HTR2C-697G/C, PPARalpha V227A, and PPARgamma 161C/T genotypes were associated with metabolic syndrome (MetS) in patients with schizophrenia taking clozapine. METHODS: One hundred forty-six Korean patients using clozapine for more than one year were genotyped for the HTR2C-759C/T, HTR2C-697G/C, PPARalpha V227A, and PPARgamma 161C/T polymorphisms, and their weight, waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol, total cholesterol, and glucose were measured. We used the criteria for MetS proposed by the National Cholesterol Education Program-adapted Adult Treatment Panel III. RESULTS: The prevalence of MetS was 47.3% and was similar among men (49%) and women (42.9%). We found no significant differences between patients with and without MetS in terms of genotypes or allele frequencies. Logistic regression analyses also revealed no association between MetS and each genotype. CONCLUSION: We did not find significant associations between four polymorphisms (HTR2C-759C/T, HTR2C-697G/C, PPARalpha V227A, and PPARgamma 161C/T) and MetS in patients with schizophrenia taking clozapine.

Two Cases of Reversible Skin Rash Associated with Quetiapine-Valproate Combination Treatment / 대한정신약물학회지

Skin rash is one of the most common drug-induced side effects. Most of the lesions are usually self-limited and subsided by quitting causal drugs. However, generally, prescriptions involve intake of various drugs, so it is not easy to establish the cause. We report two cases of the patients who had experienced the skin rash in their first manic episode of bipolar I disorder while taking valproate and quetiapine. Their lesions had clearly subsided after quetiapine and valproate were stopped. In clinical practice, polypharmacy is an effective treatment strategy of bipolar disorder. Thus in case of prescribing various drugs, the close observation of drug-induced side effects is needed and drug interaction should be kept in mind.

Comparison of the Subjective Quality of Life in Four Groups of Antipsychotics by Risk of Weight Gain in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: The aim of this cross-sectional study was to compare the subjective quality of life in the four groups of antipsychotics according to the risk of weight gain in patients with schizophrenia. METHODS: One hundred and thirty-two patients with schizophrenia that had taken the same antipsychotics for more than 1 year were enrolled in the analyses. Anti-psychotic agents were classified by the risk of weight gain into four groups : serious, common, not unusual, and unusual. The quality of life was measured with the Schizophrenia Quality of Life Scale Korean version, 4th Revision (SQLS-R4K). We analyzed the correlation between the total score of SQLS-R4K and clinical variables. RESULTS: The SQLS-R4K score was significantly different in the four anti-psychotic groups (F=5.200, p=0.002). Gender, type of anti-psychotics (typical, atypical), duration of treatment with current antipsychotics, duration of illness, and Body Mass Index were not significantly correlated with the SQLS-R4K score. CONCLUSION: The subjective quality of life was different according to the risk of weight gain groups of anti-psychotic agents.

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.