Use of Aripiprazole in Clozapine Induced Enuresis: Report of Two Cases

This report describes the efficacy of combined use of aripiprazole in the treatment of a patient with clozapine induced enuresis. Aripiprazole acts as a potential dopamine partial agonist and the dopamine blockade in the basal ganglia might be one of the causes of urinary incontinence and enuresis. We speculate that aripiprazole functioned as a D2 agonist in hypodopaminergic state of basal ganglia caused by clozapine and maintained dopamine level that would improve enuresis ultimately.

Characteristics of Cellular Phone Use and its Association with Psychological Problems among Adolescents

OBJECTIVE: We investigated the characteristics of cellular phone use and its association with psychological problems among adolescents. METHODS: A total of 332 adolescent students were recruited for this study. The participants' self-reported characteristics of cellular phone use and the psychological problems caused by this were tested by using the Excessive Cellular Phone Use Survey (ECPUS), the Children's Depression Inventory (CDI), Spielberger's State-Trait Anxiety Inventory for Children (STAIC) and the Korea-Youth Self Report (K-YSR). RESULTS: The excessive user group made more use of text messages and they spent more time and paid higher fees than the comparison group. They expressed severer depression and anxiety and they had more behavior problems and lower school performance than the comparison group. The ECPUS score was positively correlated with score of the CDI, STAIC and the behavior problem scales of the K-YSR, and the ECPUS score was negatively correlated with the school performance scale of the K-YSR. CONCLUSION: Our findings suggest that excessive cellular phone use by adolescents may be related to psychological problems. Careful education about the use of cellular phones and intervention are recommended for adolescents who excessively use cellular phones.

Psychiatric Disorder in Two Siblings with Hallervorden-Spatz Disease

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.

Major Depressive Disorder Preceding the Onset of Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by vertical supranuclear palsy and parkinsonian symptoms. The neuropsychiatric symptoms of PSP include anhedonia, depressed mood and cognitive impairment. Patients with PSP have an increased risk for developing depressive disorders within the next year. However, it is rare to find that major depressive disorder was the antecedent diagnosis of a patient who was later diagnosed with PSP. We present here a patient who suffered from PSP with repetitive falls, a masked face and dysarthria after developing a major depressive disorder.

Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder

OBJECTIVE: We investigated the neurocognitive deficits in schizophrenic patients with and without obsessive-compulsive disorder (OCD). METHODS: We grouped 27 patients as either obsessive-compulsive or non-obsessive-compulsive based on the presence of OCD. The two groups completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Positive and Negative Symptom Scale (PANSS), and Hamilton Depression Scale. The intelligence quotient (IQ) was tested using the Korean Wechsler Adult Intelligence Scale. The memory quotient (MQ) was tested using the Korean-Auditory Verbal Learning and Korean-Complex Figure Test. The executive intelligence quotient (EIQ) was determined using the Kims executive intelligence test (EXIT). RESULTS: Ten of the 27 patients had OCD. The compulsion score of Y-BOCS was positively correlated with positive symptoms, negative symptoms, and the total scores of PANSS. The OCD-schizophrenia patients had higher IQs. No difference was found in MQ. Although the EIQ did not differ between the two groups, the OCD-schizophrenia patients performed better at the Stroop-interference and verbal fluency tests, which was highly dependent on executive function. CONCLUSION: Our findings suggest that OCD may have a protective effect on some cognitive function, at least in relatively early stage of illness. Moreover, based on clinical, neurocognitive features, schizophrenia with OCD could be considered as a distinct subtype of schizophrenia.

Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder

OBJECTIVE: We investigated the neurocognitive deficits in schizophrenic patients with and without obsessive-compulsive disorder (OCD). METHODS: We grouped 27 patients as either obsessive-compulsive or non-obsessive-compulsive based on the presence of OCD. The two groups completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Positive and Negative Symptom Scale (PANSS), and Hamilton Depression Scale. The intelligence quotient (IQ) was tested using the Korean Wechsler Adult Intelligence Scale. The memory quotient (MQ) was tested using the Korean-Auditory Verbal Learning and Korean-Complex Figure Test. The executive intelligence quotient (EIQ) was determined using the Kims executive intelligence test (EXIT). RESULTS: Ten of the 27 patients had OCD. The compulsion score of Y-BOCS was positively correlated with positive symptoms, negative symptoms, and the total scores of PANSS. The OCD-schizophrenia patients had higher IQs. No difference was found in MQ. Although the EIQ did not differ between the two groups, the OCD-schizophrenia patients performed better at the Stroop-interference and verbal fluency tests, which was highly dependent on executive function. CONCLUSION: Our findings suggest that OCD may have a protective effect on some cognitive function, at least in relatively early stage of illness. Moreover, based on clinical, neurocognitive features, schizophrenia with OCD could be considered as a distinct subtype of schizophrenia.

Pericarditis with Pericardial Effusion and Bilateral Pleural Effusion Associated with Clozapine Treatment in an Adolescent Boy / 대한정신약물학회지

The clozapine has been associated with serious side-effects, such as agranulocytosis and seizure. Less attention has been given to clozapine's adverse cardiac complications, including myocarditis, pericarditis and cardiomyopathy despite a high mortality rate. Here we describe a case of an adolescent male patient who developed pericarditis with pericardial effusion and bilateral pleural effusion 17 days after being started on clozapine therapy, whose symptoms improved after discontinuation of clozapine. We also reviewed literatures of clozapine-related cardiac complications. We hope clinicians to be vigilant for clozapine-related cardiac complications against the many benefits of clozapine for patients with schizophrenia.

Pericarditis with Pericardial Effusion and Bilateral Pleural Effusion Associated with Clozapine Treatment in an Adolescent Boy / 대한정신약물학회지

The clozapine has been associated with serious side-effects, such as agranulocytosis and seizure. Less attention has been given to clozapine's adverse cardiac complications, including myocarditis, pericarditis and cardiomyopathy despite a high mortality rate. Here we describe a case of an adolescent male patient who developed pericarditis with pericardial effusion and bilateral pleural effusion 17 days after being started on clozapine therapy, whose symptoms improved after discontinuation of clozapine. We also reviewed literatures of clozapine-related cardiac complications. We hope clinicians to be vigilant for clozapine-related cardiac complications against the many benefits of clozapine for patients with schizophrenia.

Comparative Analysis of Involuntary Admission and Voluntary Admission in Schizophrenia: A 3-Year Follow Up / 신경정신의학

OBJECTIVES : The purpose of this study was to investigate differences between involuntarily and voluntarily hospitalized patients with schizophrenia. METHODS : Patients who were hospitalized between 2001 and 2005 with a diagnosis of DSM-IV schizophrenia were included. The subjects were grouped by whether their admission was voluntary or involuntary. The data were collected through inpatient medical records. The two groups were compared regarding demographic variables and clinical features, and we examined the number of rehospitalizations, duration of follow-up, follow-up retention rate and second admission pattern for a period of 3 years after discharge. RESULTS : 181 subjects were classified as according to their admission into the involuntary group, and 69 subjects as the voluntary group. There were more female patients, more past admissions and longer duration of illness in the involuntary group. The patients in the involuntary group had more problematic behaviors with their chief complaint being delusions. The follow-up retention rate was lower (44.8% vs. 59.4%) and the rate of the second involuntary admission was higher in the involuntary group. CONCLUSION : Involuntary hospitalization may be an important predictor for treatment maintenance in patients with schizophrenia.

Comparative Analysis of Involuntary Admission and Voluntary Admission in Schizophrenia: A 3-Year Follow Up / 신경정신의학

OBJECTIVES : The purpose of this study was to investigate differences between involuntarily and voluntarily hospitalized patients with schizophrenia. METHODS : Patients who were hospitalized between 2001 and 2005 with a diagnosis of DSM-IV schizophrenia were included. The subjects were grouped by whether their admission was voluntary or involuntary. The data were collected through inpatient medical records. The two groups were compared regarding demographic variables and clinical features, and we examined the number of rehospitalizations, duration of follow-up, follow-up retention rate and second admission pattern for a period of 3 years after discharge. RESULTS : 181 subjects were classified as according to their admission into the involuntary group, and 69 subjects as the voluntary group. There were more female patients, more past admissions and longer duration of illness in the involuntary group. The patients in the involuntary group had more problematic behaviors with their chief complaint being delusions. The follow-up retention rate was lower (44.8% vs. 59.4%) and the rate of the second involuntary admission was higher in the involuntary group. CONCLUSION : Involuntary hospitalization may be an important predictor for treatment maintenance in patients with schizophrenia.

The Volumetric MRI Analysis of the Basal Ganglia in Boys with Tourette's Disorder / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the regional differences of the basal ganglia volume between the boy subjects who have Tourette's disorder and the control group who don't have this disorder by using Brain MRI. METHODS: Sixteen subjects who were diagnosed as Tourette's disorder using DSM-IV criteria, and sixteen healthy subjects were selected. For analysis the coronal slice images of the basal ganglia were collected and collected MR images were analyzed with NIH Image (version 6.1 ppc). RESULTS: The total brain volume in the subjects with Tourette's disorder were smaller than control group by 6.2% (F=6.2, d.f.=1, p=0.019). The right putamen volume in boys with Tourette's disorder were significant smaller than control group statistically (F=3.2, d.f.=3, p=0.040). The asymmetry (left>right) in the globus pallidus decreased significantly in the boys with Tourette's disorder (p=0.06) were found from this experiment. CONCLUSION: These findings suggest that boys with Tourette's disorder may have neuropathological abnormalities in the basal ganglia. Moreover, the present findings point out the important role of basal ganglia, especially putamen, in pathophysiology of Tourette's disorder. More studies about the structural and functional analysis of the basal ganglia in Tourette's disorder are highly required.

Eight-Week Prospective Open-Label Trial of the Treatment Efficacy of Aripiprazole in Children with Tourette Syndrome / 대한정신약물학회지

OBJECTIVE: It is postulated that since aripiprazole is a dopamine partial agonist and serotonin 2A receptor antagonist, aripiprazole may be effective in Tourette syndrome with few of extrapyramidal side effects. This open label study assessed the effectiveness of aripiprazole in children with Tourette syndrome (TS). METHOD: Nineteen children, aged 6 to 13 years, diagnosed with TS were participated in a 8-week open label trial. Efficacy assessments included Korean form of Yale Global Tic Severity Scale (K-YGTSS) and Clinical Global Impression scores. Safety and tolerability evaluations included extrapyramidal symptoms and effects on weight, prolactin, and corrected QT (QTc) interval. RESULTS: A significant decrease in TS symptoms, on all scales measured, appeared in 2 weeks. Adverse effects were mild and not significant. The most frequent side effects were somnolence, light headedness and headache. CONCLUSIONS: The results of current open label trial suggests the effectiveness of aripiprazole and few of side effects in the treatment of children with TS. Double-blind, placebo-, and active comparator-controlled studies are indicated to rigorously test of the efficacy of aripiprazole in TS.