An Open Label Multi-Center Prospective Observational Study of Paliperidone Extended Release to Assess the Medication Satisfaction and Treatment Response in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: The aim of this study was to demonstrate changes of subjective medication satisfaction and clinical benefit after once-daily paliperidone extended release (ER) in treatment of schizophrenia. METHODS: In an open-label, observational, and multicenter study, 374 patients with schizophrenia who switched to paliperidone ER due to any reason were recruited. Medication Satisfaction Questionnaire (MSQ), Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement and visual analogue scale for sleep (VAS) were assessed at baseline, 4 weeks and 8 weeks after treatment. We also examined the type, frequency, and severity of adverse events newly formed. RESULTS: Among 374 patients, 320 patients (76.5%) were included in the intent-to-treat analysis set. The mean dose of paliperidone ER was 5.33+/-2.31 mg/day at the initiation. At the endpoint, the mean dose of paliperidone ER was 6.68+/-3.13 mg/day. The percentages of patients satisfied with medication were changed from 40.9% at baseline to 67.8% at endpoint (p<0.001). Both CGI-S scores and VAS for daytime drowsiness were significantly decreased after 8 weeks (both p<0.0001) and mean scores of MSQ and VAS for sleep quality were improved after 8 weeks (both p<0.0001). CONCLUSION: After switching to paliperidone ER, 67.8% of patients with schizophrenia who had any reason to switch medication showed subjective satisfaction for medication and clinical improvement without significant adverse events. Regarding that medication satisfaction was associated with changes of clinical states, medication satisfaction can be used for measures for clinical scales in the treatment of schizophrenia.

Discussion Meeting

No abstract available.

Discussion Meeting

No abstract available.

Past, Present, and Future of Clinical Research in Child and Adolescent Psychopharmacology / 신경정신의학

OBJECTIVE: The objectives are to deliver clinicians and researchers in academia the history, ethics, current principles, guidelines and issues of research in child and adolescent psychopharmacology and to identify challenges facing professionals in the field. METHODS: Children as research subjects were exploited and abused until the middle of 20th century. The response to the conduct of unethical research lead to the overprotection of human subjects in biomedical and behavioral research. In the 1990s, increased spending and the introduction of pediatric exclusivity lead to a large increase in pediatric psychopharmacologic research. Despite the increased number of research, concerns exist about methods and bioethics for making new medications available for use in child and adolescent psychiatric disorders. Through literature review and personal experience, concerns and issues surrounding the research in child and adolescent psychopharmacology were discussed. CONCLUSION: To ensure early access of new drugs for treating psychiatric disorders in children and adolescents, we must strengthen our ability to self-assess in the field of research, be familiar with bioethics and be able to address the challenges posed by the restrictive environment governing child and adolescent psychopharmacology research.

Risperidone in Combination with Mood Stabilizers for Acute Mania: A Multicentre, Open Study / 신경정신의학

OBJECTIVE: The primary purpose of this study was a replication of the effectiveness and tolerability of risperidone in the treatment of patients with acute mania in very larger cohort in naturalistic treatment setting to extend the data on the effect and tolerability of risperidone in the treatment of patients with acute mania to Asian population. METHODS: A total of 909 patients with DSM-IV criteria of bipolar disorder current manic and hypomanic episode, entered this large, open, multicentre study. The Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale (SARS) were measured at baseline and weeks 1, 3 and 6, for the assessment of effectiveness and extrapyramidal symptom (EPS). RESULTS: This study showed statistically significant reduction of scores on the YMRS and CGI-s (mean change=-23.5+/-11.8, p<0.0001;mean change=-2.7+/-1.5, p<0.0001, respectively) from the baseline to the endpoint (week 6). Number of patients with 50% reduction or more in the YMRS and CGI-s scores was 693 (77.8%) and 630 (70.7%) at endpoint, respectively. There were no statistically significant increments of scores on SARS. Risperidone was generally well tolerated. CONCLUSION: The present larger open study demonstrates that risperidone add-on therapy is effective and tolerable in treatment of bipolar disorder, replicating results in various controlled and uncontrolled studies from Western countries.

A Standardization Study(II) on Korean Version of Parental Temperament Questionnaire for Children: Demographic Variables and Norm / 신경정신의학

OBJECTIVES: To examine the effects of demographic variables on temperament and to establish the norms of Korean version of Parental Temperament Questionnaire for Children (K-PTQ). METHODS: The subjects were consisted of 1,168 preschool children who were attending nurseries nationwide in Korea. K-PTQ was completed by the parents of these children and the data were analyzed according to the demographic variables such as age, sex, birth order and residing area. RESULTS: There were significant differences in K-PTQ scores according to sex and age. The result of factor analysis shows that the K-PTQ has a three-factor structure, representing 'Approach/Withdrawal and Adaptability', 'Intensity of Reaction and Distractibility', and 'Activity and Persistence'. This factor structure coincides with Thomas and Chess's three-factor model. CONCLUSION: Norms for K-PTQ were established according to sex and age and this will be useful for studying Korean children's temperament.

Temperamental Characteristics of Korean Children from the Viewpoint of Family Environment and Development / 신경정신의학

OBJECTIVES: The purpose of this study was to find the differences of temperamental characteristics of Korean children according to family environment and developmental history. METHODS: 1) The mothers whose children had been educated at twenty-five Samsung Child Care Centers nationwide participated in the survey using Parent Temperament Questionnaire for Children (PTQ) and the Child Development Questionnaire (CDQ). 2) The temperament of 1,175 children whose mothers completed PTQ were classified into 5 diagnostic clusters (Easy, Intermediate Low, Intermediate High, Difficult, Slow-To-Warm-Up) according to the method proposed by Fullard et al. 3) The results of classification were compared and analysed statistically according to each CDQ parameters. RESULTS: Statistically meaningful difference in the distribution of temperamental clusters were found in the CDQ parameters such as birth order of children, number of intimate friends, children's relationship with their peers, children's relationship with their siblings, children's relationship with their parents, type of milk feeding, motor development of children during 2 years after birth, motor development during from age 2 to 5, stranger anxiety, present health state of children, and relationship between parents. After all, the proportion of Easy type was greater in the children who were first-born, or who had good relationship with their peers or family, fast motor development, mild stranger anxiety, good health condition, or good relationship between each parent. CONCLUSION: This study shows that the distribution of temperamental cluster was significantly different in several parameters of family environment and developmental history of Korean children. The children with fast development, good interpersonal relationship or favorable family environment are more likely to be the Easy type.

Vascular Risk Factors and Cognitive Function: Associations Modified by Level of Education in a Community Dwelling Elders with Cognitive Impairment

OBJECTIVE: Level of education has been reported to modify the associations between vascular risk factors and cognitive impairment. This study aimed to test this hypothesis in a community dwelling Korean elders with relative cognitive impairment. METHOD: The study group consisted of 341 participants with the Korean version of Mini-Mental State Examination (MMSE-K) scores of 24 or below. The cognitive impairment was categorized into mild (MMSE-K 21-24) or moderate to severe (MMSE-K <21). For each participant, diagnoses for vascular risk factors were ascertained, and resting blood pressure and non-fasting blood glucose and serum cholesterol levels were examined. RESULTS: In the total sample, after adjustment for age, past occupation, physical activities of daily living and cholesterol levels, the worse cognitive function (MMSE-K <21) was associated with raised systolic blood pressure and the diagnosis of diabetes. However, the stratified analyses according to education level revealed that these associations were only significant in those with no formal education. In addition, the higher level of non-fasting blood glucose was significantly associated with the worse cognitive function only for those with no formal education CONCLUSION: Older Koreans with low levels of education may be particularly vulnerable to cognitive impairment associated with risk factors for cerebrovascular disease. This has an important implication for public health strategies regarding the prevention of dementia.

Effects of Vascular Risk Factors on Advancing Age Associated Cognitive Decline: A Longitudinal Study in a Community Dwelling Older Population

OBJECTIVE: This study aimed to investigate the association between cognitive decline and advancing age, and the potential effects of vascular risk factors on the associations. METHOD: 1134 old persons aged 65 or over was assessed by the Korean version of Mini-Mental State Examination (MMSE-K) in 1999, and after two years 686 (61%) of the total subjects were reassessed with MMSE-K. Data on age and vascular risk factors (hypertension and diabetes) was obtained. RESULTS: Cognitive decline was significantly associated with advancing age. The stratified analyses showed that the association of cognitive decline with advancing age was significant for those with vascular risk factors, but not significant for the subjects without vascular risk factors. CONCLUSION: We suggest that the cognitive decline with advancing age might be delayed by appropriate management for the vascular risk factors.