Prolonged Risk of Suicide Reattempts in Patients with Alcohol Use Disorder and Acute Alcohol Use: A Register-Based Follow-Up Study (2010–2015)

OBJECTIVE@#This study aimed to clarify the role of acute alcohol use and alcohol use disorder in individuals exhibiting suicidal behaviors, including repetition of suicide attempt.@*METHODS@#Data pertaining to 691 suicide attempters who had visited an emergency center and had been followed-up from 2010 to 2015 were gathered. Participants were categorized into following three groups according to alcohol use pattern at the time of the suicide attempt: 1) suicide attempters with neither alcohol use disorder nor acute alcohol consumption (NAU), 2) suicide attempters who had used alcohol during the suicide attempt but did not have alcohol use disorder (AAU), and 3) suicide attempters with alcohol use disorder (AUD). Group comparisons and multivariate Cox proportional models for suicidal behavior were used for statistical analysis.@*RESULTS@#AUD have been shown to have lower lethality of suicide attempt but higher risk of suicide reattempts in the future. Furthermore, positive relationships between suicide reattempts and AUD persisted throughout the longer period than other groups.@*CONCLUSION@#Suicide attempters with AUD should be considered a high-risk group for suicide reattempts in future, and this group should be followed-up for a longer period with specialized care program.

The Characteristics of Child and Adolescent Suicide Attempters Admitted to a University Hospital / 정신신체의학

OBJECTIVES: The purpose of this study was to identify the differences of demographic and clinical characteristics between child-adolescents who received medical inpatient care and non-hospitalized adolescents after suicide attempts. METHODS: The study included 35 child-adolescents who were hospitalized (Admission group) and 114 child-adolescents who were not hospitalized (Non-Admission group) as a result of a suicide attempt from 2009 to 2015. We compared sociodemographic, clinical, and suicide attempt-related characteristics through a chi-square test and logistic regression analysis to evaluate the differences between the two groups. RESULTS: Child-adolescents of this study most commonly attempted suicide by poisoning, and for motivation of interpersonal problems. Admission group had significantly fewer attempts through injury by sharp objects (χ²=4.374, p=0.037) and attempted suicide with a higher chance of actually dying when compared to Risk-Rescue Rating Scale (t=1.981, p=0.049). In addition, Admission group had relatively common motivation for academic problems (χ²=12.082, p=0.001) and less motivation for interpersonal difficulties. (χ²=9.869, p=0.002) Psychiatric diagnosis at the time of visiting the emergency department showed higher rates of depression in the admission group than Non-Admission group (χ²=8.649, p=0.003). The results of logistic regression showed that depression affects hospitalization (OR=2.783, 95% CI 1.092–7.089, p=0.032). CONCLUSIONS: This study is meaningful in that it revealed the social and clinical characteristics of all child-adolescents who were hospitalized at a university hospital after attempting suicide. This study identified differences in motivation, methods, and psychiatric diagnosis of hospitalized adolescents and those who were not. Therefore, the results may help adolescent suicide attempters to get a discriminatory approach based on their admission.

Gender Differences in the Effect of Alcohol Use on Intent and Lethality of Suicidal Attempts / 정신신체의학

OBJECTIVES: The aim of this study was to clarify the role of alcohol use disorders and acute alcohol consumption in suicide attempts by gender. METHODS: Data of 1,152 suicide attempters(487 males and 742 females) who had visited an emergency center was gathered. Suicide attempts were categorized into three groups according to alcohol use: an alcohol use disorder group(AUD), an acute alcohol use group(AAU), and a no-alcohol use group(NAU). The intent and lethality of suicide attempts were evaluated by Suicidal Intents Scale and Risk-Rescue Rating Scale. RESULTS: For Suicidal Intents Scale score, the male AUD group revealed a significantly lower mean score than the male AAU one. However, there were no statistically significant differences for female subjects across subgroups. With regard to the Risk-Rescue Rating Scale score, there were no significant differences for males, while the AUD group showed both the lowest highest rescue scores and lowest risk-rescue scores within female groups. CONCLUSIONS: AUD in females was more likely regarding impulsive suicide attempts with high rescue chances. Consuming alcohol might have different effect on suicide attempts by gender and our study shows that alcohol use is an important risk factor according to gender, particularly with regard to female suicide attempts.

Symptomatic and Clinical Profiles Across Motoric Subtypes in Delirium / 정신신체의학

OBJECTIVES: To investigate clinical and symptomatic differences among motoric subtypes of delirium. METHODS: A total of 256 patients referred to psychiatric consultation services for delirium due to general medical condition were assessed retrospectively. Motoric subtypes were determined according to Lipowski's criteria for hyperactive, hypoactive and mixed subtypes. All patients were evaluated according to Delirium Rating Scale-Revised-98(DRS-98-R) by trained psychiatrists to obtain symptomatic profiles of delirium. RESULTS: Hyperactive subtype were 50.8%(n=130), mixed 46.1%(n=118) and hypoactive 3.1%(n=8). Hyperactive patients were younger than mixed subtype(69.62±13.976 vs. 73.97±11.569, p=0.022) and received antipsychotics to manage symptoms of delirium more frequently(83.8% vs. 57.6%, p<0.001). Hyperactive patients had higher DRS-R-98 scores on both noncognitive(7.14±3.543 for hyperactive, 5.62±3.279 for mixed subtype) and cognitive subscales(10.00±3.574 for hyperactive, 6.38±2.875 for hypoactive, 7.43±3.771 for mixed subtype, p<0.001). CONCLUSION: We demonstrated that clinical and symptomatic profiles were different across motoric subtypes in delirium. Diagnostic and therapeutic approach should be made differently according to motoric subtypes of delirium and special attention is needed not to underestimate or delay treatment in specific motoric subtype of delirium.

Clinical Characteristics of Misdiagnosed Delirium / 정신신체의학

OBJECTIVES: Delirium of hospitalized patients is common and it is significantly associated with increased mortality rate. Misdiagnosis rates of delirium are reported in a range of 36.7 to 63% in clinical setting. We aimed to identify the clinical features and symptomatic characteristics associated with misdiagnosis of delirium. METHODS: Subjects were 256 inpatients who were referred for psychiatric consultation and diagnosed with delirium by a psychiatrist at a university hospital between January 1 and June 30, 2012. Clinical data were obtained with retrospective chart review. Patients were divided into misdiagnosed group and correct diagnosed group, after reviewing the reason which were described in the consultation request form. RESULTS: Sixty nine(27%) subjects of the 256 patients were referred for other reasons(mood, substance, anxiety, dementia etc.) than "delirium/confusion" by clinician(misdiagnosed group). In misdiagnosed group, use of antipsychotics was more common. There were no differences between the two groups in age, gender, and department of referring clinician. Fluctuation score of DRS-R-98 was higher in the correct diagnosed group. CONCLUSIONS: In this study, the risk of misdiagnosis was higher when the patients have taken antipsychotics or less symptom fluctuation. Careful clinical attention is needed for diagnosis for delirium in these patients.

Characteristics of Pain Threshold and Pain Experience in Elderly Patients with Dementia / 정신신체의학

OBJECTIVES: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. METHODS: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. RESULTS: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. CONCLUSIONS: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.

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.

A Prospective Study on Changes in Health Status Following Flood Disaster

OBJECTIVE: We examined changes in general health status, the prevalence of depression and post-traumatic stress disorder (PTSD) symptoms, and the existence of pre-trauma contributing factors in an agricultural population following a massive flood. METHODS: Eighty-three of 160 residents of Garisan-ni, Inje-gun, Gangwon-do, were assessed using the Korean version of the 36-Item Short-Form Health Survey (SF-36-K) between April and June 2006, just prior to a massive flood. Among those initially assessed, 58 residents were available for follow-up 18 months after the flood. Participants completed the SF-36-K, Beck Depression Index (BDI), Minnesota Multiphasic Personality Inventory (MMPI)-PTSD, and the Korean version of the Impact of Event Scale-Revised (IES-R) to detect depression and PTSD. Trauma experiences were also assessed. Factors related to changes in health status were then analyzed. RESULTS: SF-36-K total scale scores decreased significantly, suggesting a significant reduction in health-related quality of life. The largest reductions were noted in physical and social functioning. Fifty-three percent of the subjects were at least mildly depressed, and 17% had severe depression. In addition, 22% had PTSD on both the IES-R and MMPI-PTSD. Factors that contributed to the deterioration of health status following the flood were the number of disaster events and existence of depression (as assessed by the BDI). CONCLUSION: The flood was found to lead to deterioration of health status and to provoke depression and PTSD among the agricultural population in the mountainous region. We suggest that the number of disaster event experiences and existence of depression contriuted to changes in health status after the flood.

Effects of Haloperidol on Ca2+i Change in HIT T-15 Insulinoma Cells / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to investigate the effects of haloperidol on [Ca2+]i in hamster insulinoma cells (HIT T-15). METHODS: [Ca2+]i levels were measured by calcium imaging techniques, and membrane potential ionic currents were recorded using conventional patch-clamp methods. RESULTS: Haloperidol induced a transient [Ca2+]i increase, which was abolished by the removal of extracellular Ca2+ or pretreatment with Ca2+ channel blockers (nimodipine and mibefradil). Haloperidol depolarized the membrane potential and inhibited the ATP-sensitive K+ (KATP) channels. Sigma receptor agonists, (+)-SKF10047 and ifenprodil, induced a transient [Ca2+]i increase similar to haloperidol. BD1047, a sigma receptor antagonist, completely blocked the [Ca2+]i increase induced by haloperidol. Haloperidol inhibited the KCl-induced [Ca2+]i increase and voltage-dependent Ca2+ currents. Sigma receptor agonists [(+)-SKF10047, ifenprodil] also inhibited the KCl-induced [Ca2+]i increase. CONCLUSION: Our results suggest that haloperidol induces depolarization, which increases [Ca2+]i by voltage-gated Ca2+ currents via the closing of KATP channels. Haloperidol also inhibits KCl-induced [Ca2+]i increases in the same manner. These effects of haloperidol seemed to be mediated by sigma receptors, which might be linked to the pathogenesis of haloperidol-induced diabetes mellitus.

Correlation Between the Academic Score, the Trial Examination Score, and the Korean Medical Licensing Examination Score / 한국의학교육

PURPOSE: We analyzed the correlation between the year-end student academic scores (grade score), the trial examination scores, and the Korean Medical Licensing Examination (KMLE) score by correlation analysis and multiple regression method. METHODS: Our subjects included 217 graduates between the years 2002 and 2003. Yearly, trial examinations, composed according to the principles of KMLE setting, are performed four times. For correlation and regression analysis, all scores were transformed to the standard score according to the standard score norm. RESULTS: In the regression analysis among each grade scores, the lower grade score always affected the higher grade score. Also all academic grade scores correlated significantly with the trial examination scores and KMLE score in bivariate correlation analysis (P< 0.05). But only grade score during the senior years (5th and 6th) affected the trial examination and KMLE score in multiple regression. According to the multiple regressions by each grade score and trial examination score, the 6th grade score and trial exanimation score except the 1st trial examination score have a significant effect on the KMLE score. And we can also establish the regression formula such as [KMLE score]=11.377+0.752*[mean of trail examination] with significant high power of explanation (R (2) =0.709, P< 0.001). CONCLUSION: Our results show that previous scores always affect the latter scores; and the last score in time sequence is a result of the accumulation of previous education and learning. From this point of view, the trial examination is a useful tool for not only the final assessment of medical achievements but also for preparing for the KMLE.

Disaster Psychiatry after Motor Vehicle Accident

Death from motor vehicle accident is one of the most common causes of deaths in Korea, with 17.2 person per 100,000 population dying from motor vehicle accidents in 2004. Neuropsychiatric sequelae after motor vehicle accidents are very common and disturbing the quality of life. They include post-traumatic stress disorder, post-concussional disorder, organic personality disorder, depression, organic schizophrenia like disorder, malingering, factitious disorder, etc. Neuropsychiatric symptoms are often neglected by health care providers, although they tend to last for a long period as complex problems. They also may complicate the doctorpatient relationship. Therefore, early detection and management of neuropsychiatric symptoms are important for successful management of the patients. This article includes a brief summary of several neuropsychiatric states after motor vehicle accidents, especially post-traumatic stress disorder and a brief recommendation on legal reports for disability evaluation of mental and behavioral disorders after motor vehicle accidents.

The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(I): Comparison of Therapeutic Effecacy / 신경정신의학

OBJECTIVES: This randomized, multicenter, open-label, parallel clinical trial was carried to compare the therapeutic efficacy and the proportion of successful switch between 'direct switching method' and 'start-tapering switching method' when switching an antipsychotic to olanzapine. METHODS: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10 from 13 hospitals, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The therapeutic efficacy was measured with PANSS, BPRS, and CGI-Severity. A successful switching was defined as the completion of the 6 week trial without either worsening of the symptom(i.e. CGI-S score becomes worse twice consecutively) or the exacerbation of extrapyramidal symptoms(i.e. Simpson-Angus Scale scores becomes worse). RESULTS: 103 schizophrenic patients were participated in this study. There were no differences in baseline characteristics such as the demographic variables, the severity of symptoms, the history of previous antipsychotics treatments, the dosage of olanzapine used and the compliance between two groups. The proportion of successful switch was 71.1% for "direct switching method" and 82.2% for "start-tapering switching method", and there was no significant difference between the two switching methods. Also response rates to olanzapine based on total PANSS total scores were not different between the two groups(26.9% vs. 31.1%). At the time of completion of the trial, the scores of PANSS total, PANSS subscales, CGI-S and BPRS have significantly decreased after switching to olanzapine. But the changes of all scales measuring therapeutic efficacy in both endpoint and weekly analyses were not significantly different between the two switching methods. CONCLUSION: Although this study trial has many limitations and problems as an open clinical trial, the results may suggest that there were no significant differences between the two switching methods in the therapeutic efficacy. It was also found that the additional therapeutic benefits could be obtained by switching their antipsychotics to olanzapine.

Effects of Fluoxetine on Membrane Potential and Ionic Currents in RINm5F Insulinoma Cells / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to investigate the effects of fluoxetine (Prozac) on membrane potential and ionic currents in RINm5F insulinoma cells. METHODS: Membrane potential and ionic currents in RINm5F cell were recorded by using whole-cell and perforated-patch clamp techniques. RESULTS: Under current clamp conditions, diazoxide (200 microM), an activator of K ATP channels, induced a hyperpolarization of the resting membrane potential (-16.1+/-1.4 mV, n=), which was accompanied by a abolition of action potential firing. This diazoxide-induced hyperpolarization was blocked by glibenclamide (10 microM). Fluoxetine produced significant depolarization of membrane potential (15.9+/-3.1 mV, n=) and blocked diazoxide-induced hyperpolarization. Diazoxide activated inward currents in the presence of high external K + (90 mM) at a holding potential of -60 mV. Fluoxetine suppressed diazoxide-activated currents in a concentration-dependent (IC 50 =.84 microM) manner. However, the inhibitory action of fluoxetine was not specific to K ATP currents because it also inhibited both voltage-activated K + and Ca 2+ currents in a concentration-dependent manner. K ATP currents were more sensitive to fluoxetine block than both voltage-activated K + and Ca 2+ currents. CONCLUSION: Our results indicate that fluoxetine increased excitability of RINm5F cells mainly by the preferential block of K ATP currents. Fluoxetine-induced depolarization may influence insulin secretion in insulinoma cells.

Psychosocial Outcome after Head Injury

No abstract available.

Effects of Selective Serotonin Reuptake Inhibitors (SSRIs) on the Vasoconstriction of Isolated Rat Aorta

BACKGROUND: One of the most common side effects of antidepressant medication is orthostatic hypotension, which can be caused by impaired vasoconstriction. This study was designed to compare the inhibitory effects of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), on the contractile responses to alpha1-adrenergic receptor activation and depolarization in isolated rat aorta. METHODS: Vascular rings were suspended for the measurement of isometric tension in a water-jacketed bath filled with Tyrode solution. After pretreatment with antidepressant for 20 min, vasoconstriction induced by norepinephrine (NE) or 35 mM K+ was measured and compared to the control response. RESULTS: Whereas trazodone and tricyclic antidepressants (TCAs) selectively inhibited NE-induced vasoconstriction, SSRIs inhibited depolarization-induced vasoconstriction more potently. The IC50 value of fluoxetine on depolarization- induced vasoconstriction was 3.29 microM, which is consistent with the previous results on L-type Ca2+ currents of cardiac myocyte. Moclobemide, a monoamine oxidase inhibitor, had no effect on vasoconstriction induced by either alpha- adrenergic receptor activation, or depolarization. CONCLUSION: These results suggest that SSRIs, different from TCAs and trazodone, have potent inhibitory actions to depolarization-induced contraction that may be due to blocking Ca2+ entry through L-type Ca2+ channel.

Effects of Selective Serotonin Reuptake Inhibitors(SSRIs) on Serotonin-mediated Intracellular Ca2+ Mobilization in Human Platelets / 대한정신약물학회지

OBJECTIVE: The effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on serotonin (5-HT)-mediated Ca(2+) mobilization were investigated in the platelets of human healthy volunteers. METHOD: The serotonin (5-HT)-mediated Ca(2+) mobilization in the platelets was assessed by the fluorescence technique with fura-2/AM. RESULTS: SSRIs (fluoxetine, paroxetine and sertraline) themselves mobilized intracellular Ca(2+)([Ca(2+)]i) in a dose-dependent fashion. The increment of [Ca(2+)]i, might be induced partly by the release from the intracellular rat[ism store, but mostly induced by the calcium transport through membrane. Stimulation of platelets with 10 micrometer 5-HT caused a rapid and sustained increase in [Ca(2+)]i levels. Resting [Ca(2+)]i, before 5-HT treatment was 43.37+/-1.25 nM. Fluoxetine inhibited the increment of [Ca2+]i induced by 10 micrometer5-HT with an IC50 value of 6.36 micrometer. Paroxetine augmented 5-HT-mediated increases in [Ca2+]i, ranging from 117.76+/-2.79% to 316.22+/-8.39%, with an EC50 value of 19.68 micrometer. Sertraline also augmented 5-HT-mediated increases in [Ca(2+)]i in a dose-dependent fashion, ranging from 106.29+/-.40% to 269.29+/-4.96%, with an EC50it value of 11.40 micrometer. CONCLUSIONS: It is likely that SSRIs increase in intracellular free calcium level directly and show the inhibiting and augmenting effects on 5-HT-mediated Ca(2+) movements. The precise mechanisms underlying the effects of 5-HT-mediated[Ca(2+)]i response after treatment with SSRIs remain unclear however, the present finding suggests the possibility that a direct, or indirect, effort to intracellular Ca(2+) signaling may be at least partly involved in the mechanism of action of SSRIs.

Fluoxetine inhibits L-type Ca2+ and transient outward K+ currents in rat ventricular myocytes

The most common cardiovascular side effects of antidepressants are cardiac arrhythmias and orthostatic hypotension. Little is known, however, about the mechanisms by which these adverse reactions may occur, especially with regard to newer drugs such as fluoxetine. We hypothesized that these side effects may have an electrophysiological basis at the level of the cardiac myocyte. Thus, we investigated the effects of fluoxetine and other antidepressants on action potentials and ionic currents of rat ventricular myocytes using the amphotericin B perforated patch clamp technique. Fluoxetine (10 microM) prolonged the action potential duration (APD50) to 146.7 +/- 12.9% of control value without altering resting membrane potential. Fluoxetine and sertraline potently inhibited the L-type Ca2+ current (IC50 = 2.82 and 2.31 microM, respectively), but did not significantly modify the steady-state inactivation. Amitriptyline and imipramine had similar, but slightly weaker, effects (IC50 = 3.75 and 4.05 microM, respectively). Fluoxetine attenuated the peak transient outward K+ current and also altered current kinetics, as shown by accelerated decay. Fluoxetine did not change the voltage-dependence of the steady-state inactivation. Sertraline, amitriptyline and imipramine inhibited the transient outward K+ current with potencies very similar to fluoxetine. In contrast to the other antidepressants tested, trazodone weakly inhibited the Ca2+ and K+ currents and moclobemide had no detectable effect. Our comparative pharmacology data suggest that selective serotonin reuptake inhibitors, such as fluoxetine, are as potent as tricyclic antidepressants in inhibiting L-type Ca2+ and transient outward K+ currents. These inhibitory effects may contribute to cardiovascular complications such as arrhythmias and orthostatic hypotension.

Delirium tremens associated with fracture of mandible: Report of A Case

Delirium tremens is a severe state of alcohol-related withdrawal syndrome, which is precipitated in the chronic alcoholic who are suddenly deprived of alcohol because of traumatic injury or other diseases. About 5 % of alcoholics show evidence of severe withdrawal symptoms. Symptoms begin within 1 to 3 days after stopping ethanol intake. These include a state of confusion sometimes accompanied by visual, tactile, or auditory hallucinations. The diagnosis is made when the course progresses beyond the usual symptoms of withdrawal to include confusion, severe agitation, and generalized seizures. The likelihood of developing severe withdrawal symptoms increases with concomitant infections or medical problems, a prior history of withdrawal seizures of DTs, and higher quantity and frequency of drinking. Most periods of severe withdrawal begin and end abruptly, rarely lasting longer than 3 to 5 days. The mortality risk for DTs is quite low but increases with preexisting medical illnesses or organ system failure. We experienced a case of DTs associated with fracture of mandible. The patient was a 36-years-old male who was admitted to our hospital via emergency room after suffering from a traffic accident. He developed DTs 3 days after admission and eventually expired. The report of a case and review of literatures are as follows.

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.

Calcium Antagonist-like Action of Antidepressants Including Sertraline in PCl2 Cells / 신경정신의학

It has been known that antidepressants have calcium antagonist-like action in neuronal tissues. However, their mechanisms are still obscure. For the study of neurochemical machanism of antidepressants, the authors examined the effects of antidepressants(1-100 microM ) on the intracellular Ca2+ concentration ([Ca2+]i) and the membrane potential in PCl2 cells using fluorescent dyes, fura-2/AM and bisoxonol, respectively. The results were as follows : 1) Sertraline, a selective serotonin reuptake inhibitor (SSRI), inhibited the increment of [Ca2+]i induced by high 60 mM KCI and 100 microM ATP with an IC50 value of 2.5 microM and 5.4 microM, respectively. 2) SSRIs(sertraline, paroxetine and fluoxetine) and tricyclic antidepressants(imipramine and amitriptyline) had strong effects on the inhibition of both voltage-dependent Ca2+ channel and receptor-dependent Ca2+ channel, whereas atypical antidepressant(trazodone) and MAO inhibitor(moclobemide) had lisle effects. 3) Sertraline itself depolarized the membrane potential in a sustained manner depending on its own concentration and it also increased the basal level of [Ca2+]i. 4) The increment of [Ca2+]i might be induced partly by the release from the intracellular calcium store, but mostly induced by the calcium transport through membrane. 5) Among those antidepressants tested, sertraline was the most potent one. Other SSRIs(paroxetine and fluoxetine) and tricyclic antidepressants(imipramine and amitriptyline) were moderately potent. Atypical antidepressant(trazodone) had little effects, and MAO inhibitor (moclobemide) had no effect on the depolarization. 6) External application of ATP induced temporary depolarization. This effect was blocked by prior treatment with sertraline with an IC50 value of 30 microM. 7) The increment of [Ca2+]i through voltage-dependent Ca2+ channel was almost inhibited by a selective calcium channel blocker(nimodipine). However, the ATP-induced increment of [Ca2+]i was partially inhibited by nimodipine. These inhibitory effects were potentiated by the addition of sertraline. In the light of these results, it is likely that SSRIs and tricyclic antidepressants could show the blocking effects on both voltage-dependent and receptor-dependent calcium channel by depolarizing neuronal cell membrane potential in a sustained manner and by increasing intracellular free calcium level.