Correlations of Cerebellar Function with Psychotic Symptoms and Cognitive Function in Schizophrenic Patients

OBJECTIVES: There is increasing evidence that the cerebellum plays an important role in cognition and psychiatric symptoms as well as motor coordination. The concept of cognitive dysmetria has been making cerebellar function in schizophrenia the focus of current studies. In other words, disruption in the cortico-cerebellum-thalamic -cortical circuit could lead to disordered cognition and clinical symptoms of schizophrenia. The purposes of this study were to determine cerebellar dysfunction in male schizophrenic patients semiquantitatively with ICARS and to investigate the clinical and cognitive correlates of ICARS in patients. METHODS: We compared the scores of cerebellar neurologic sign using ICARS in 47 male patients with a DSM-IV-TR diagnosis of schizophrenia with 30 gender and age-matched healthy control subjects. The semiquantitative 100-point ICARS consists of 19 items divided into 4 unequally weighted subscores: posture and gait disturbances, kinetic functions, speech disorders and oculomotor disorders. All subjects were also assessed with cognitive function test. Cognitive functions were evaluated by Korean-Mini Mental Status Examination(K-MMSE), Verbal fluency test, and Clock drawing test. The patients were administered Korea version of Positive and Negative Symptom Scale(K-PANSS) to assess the symptom severity. RESULTS: Schizophrenic patients had significantly higher scores on the ICARS than control subjects with posture and gait disturbances, kinetic functions, and oculomotor disorders. They also showed more significant impairments in cognitive function tests than control subjects. There was a significant correlation between ICARS and negative symptoms of patients. In cognitive function test, Clock drawing test was significantly associated with negative symptoms. In addition, Clock drawing test was negatively correlated with the total score of ICARS. CONCLUSION: In this study, we confirmed that schizophrenic patients have significant impairments in cognitive and cerebellar function, and that those were related with negative symptoms of schizophrenic patients. These results support a role of the cerebellum in schizophrenia. It is meaningful that we used a structured, and reliable procedure for rating neurological soft signs, ICARS. We hope that future prospective studies using a similar design help that rate of neurological sign should have been visible with the progression of illness.

Changes in Diagnosis and Evaluation Method for Dementia : A Literature Review

OBJECTIVES: The purpose of the present study was to investigate what aspects of evaluation was ordered for diagnosis of dementia up to the present in Korea. METHODS: Article review was performed via web searching. We searched the Korean Medical Database (KMbase) for title words containing 'dementia'. Only original articles were used for the analysis. According to the published year, all articles were divided into three stage (1990-1994, 1995-1999, 2000-2003). The data was collected for what instruments were used and what clinical diagnostic criteria for the diagnosis of dementia. RESULTS: 97 studies were identified through a KM base search of all Korean-language publications between 1 January 1990 and 31 December 2003. Mini-Mental State Examination was not only most commonly applied screening test for dementia in all three stage, also mainly employed as a standard test for validating other screening test. The trends that the DSM clinical diagnotic criteria was soley used were changed in later stage, and then much more studies used NINCDS-ADRDA and NINDS-AIREN criteria in conjunction with DSM diagnostic criteria. Variable instruments to assess functional impairment and behavioral problem were more widely used in three stage than before. In addition, usage of the neuroimage was significantly increased in the 3rd stage. CONCLUSION: This results show increasing trend in study on dementia in Korea with the aid of systematic diagnosis of dementia including specific clinical diagnosis, screening test, cognitive function test, functional and behavioral assessment.

Antipsychotic Drug Use Patterns for In-Hospital Treatment of Bipolar Disorder Patients / 대한정신약물학회지

OBJECTIVE: Antipsychotic drugs are known to be effective in reducing psychotic symptoms and behavioral disruptions, and are mainly used during the first few days of acute manic phases of bipolar disorders. The purpose of this study was to investigate the use patterns of antipsychotics in the treatment of acute bipolar manic patients in a university hospital in Korea during the last decade. METHODS: To track the use of antipsychotics from 1990 through 2000, a retrospective chart review was conducted by reviewing the medical records of bipolar disorder inpatients at the department of psychiatry, Soonchunhyang Medical Center in Seoul and Chunan. The following data were collected;1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, and 4) drug titration records of all prescribed antipsychotic medications. RESULTS: Of the 139 total subjects, 98.5% had been treated with more than one antipsychotics combined with a mood stabilizer for at least one week. Chlorpromazine was found to be the preferred antipsychotic between 1990 and 1995. However, preference of high-potency anti-psychotics, such as haloperidol, to low-potency antipsychotics for bipolar disorder patients was observed between 1995 and 2000. The prescription percentage of atypical antipsychotics increased to 16.3% in 2000. The overall mean prescribed daily chlorpromazine equivalents was 669.9 mg/day (SD=514.3). CONCLUSION: In spite of unfavorable side effects and an established guideline for the usage of antipsychotics for bipolar disorder, most bipolar manic inpatients have been prescribed adjunctive antipsychotics at relatively high dosages. The results imply a need to reduce the discrepancy between daily clinical practice and recommended guidelines in the treatment of bipolar patients.

Antipsychotic Drug Use Patterns for In-Hospital Treatment of Bipolar Disorder Patients / 대한정신약물학회지

OBJECTIVE: Antipsychotic drugs are known to be effective in reducing psychotic symptoms and behavioral disruptions, and are mainly used during the first few days of acute manic phases of bipolar disorders. The purpose of this study was to investigate the use patterns of antipsychotics in the treatment of acute bipolar manic patients in a university hospital in Korea during the last decade. METHODS: To track the use of antipsychotics from 1990 through 2000, a retrospective chart review was conducted by reviewing the medical records of bipolar disorder inpatients at the department of psychiatry, Soonchunhyang Medical Center in Seoul and Chunan. The following data were collected;1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, and 4) drug titration records of all prescribed antipsychotic medications. RESULTS: Of the 139 total subjects, 98.5% had been treated with more than one antipsychotics combined with a mood stabilizer for at least one week. Chlorpromazine was found to be the preferred antipsychotic between 1990 and 1995. However, preference of high-potency anti-psychotics, such as haloperidol, to low-potency antipsychotics for bipolar disorder patients was observed between 1995 and 2000. The prescription percentage of atypical antipsychotics increased to 16.3% in 2000. The overall mean prescribed daily chlorpromazine equivalents was 669.9 mg/day (SD=514.3). CONCLUSION: In spite of unfavorable side effects and an established guideline for the usage of antipsychotics for bipolar disorder, most bipolar manic inpatients have been prescribed adjunctive antipsychotics at relatively high dosages. The results imply a need to reduce the discrepancy between daily clinical practice and recommended guidelines in the treatment of bipolar patients.

Association between Tardive Dyskinesia and 267C/T Polymorphism of 5-HT6 Receptor Gene in Schizophrenia

OBJECTIVES: Tardive dyskinesia(TD) is a serious side effect associated with long-term antipsychotic treatments. Some candidate genetic polymorphisms were reported to be associated with TD and possible involvement of serotonergic receptors in the pathophysiology of TD has been suggested. In the present study, we investigated the association between 5-HT6 receptor gene polymorphism and TD with schizophrenia. METHODS: To investigate the relationship between 5-HT6 receptor gene polymorphism and TD, 60 patients with TD were compared with 60 patients without TD. The 267C/T allele of 5-HT6 receptor gene was genotyped by means of polymerase chain reaction method. TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). RESULTS: The patients with the three 267C/T genotype showed no significant differences in age, gender, and duration of illness. No significant difference in genotype frequencies was observed between schizophrenic patients with and without TD. In addition, there was no difference in allele frequencies. Further analysis with an measure of AIMS scores showed that these scores were not significantly influenced by the 5-HT6 receptor gene polymorphism. CONCLUSION: These results suggest that 267C/T polymorphism of 5-HT6 receptor gene is not significantly associated with susceptibility to TD in schizophrenia.

Effect of Olanzapine on Alcohol Consumption of C57BL-6 Type Rats / 대한정신약물학회지

OBJECTIVE: This study compared the effect of anticraving agent acamprosate and atypical antipsychotics that has serotonin-dopamine receptor antagonistic property, olanzapine on reduction of alcohol consumption level of alcohol intake reinforced C57BL-6 type rat. METHODS: Small amount of alcohol and water were applied to the 28 rats for 2 hours per day during 30 days. On the 31th day, the rats were divided into four groups and provided different medication by intraabdominal route 30 minutes before the alcohol consumption. For the next 7 weeks, the each subject group was applied with acamprosate 200 mg/kg, olanzapine 0.1 mg/kg and olanzapine 1.0 mg/kg respectively and the control group was done with saline. RESULTS: In contrast to control group, acamprosate 200 mg/kg group and olanzapine 0.1 mg/kg showed the reduction of alcohol consumption from 3rd to 7th week period, significantly. Although olanzapine 1 mg/kg group showed a momentary decrease of the consumption during the from 3rd to 6th weeks, the group did not show significant difference at 7th week. Olanzapine 0.1 mg/kg was more effective in reducing the alcohol consumption than olanzapine 1 mg/kg. CONCLUSION: This results suggest that low dose of olanzapine may reduce the alcohol intake in C57BL-6 type rats, as well as acamprosate.

Trends in the Prescribing of Antimanic Agents for Acute Manic Inpatients

OBJECTIVE: This study was performed to investigate the prescribing patterns of antimanic agents in the treatment of acute bipolar disorder inpatients in Korea from 1990 through 2000. The results will serve as the basic data for the practice guideline for the pharmacotherapy of bipolar disorder patients in Korea. METHOD: Retrospective chart review of bipolar disorder inpatients of Soonchunhyang Medical Center in Seoul and Chun-An was conducted for each of the year 1990, 1995, and 2000. The following data are collected ; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, 4) detailed drug titration records of antimanic agents and antipsychotic agents. RESULTS: During the last decade, the frequency of lithium monotherapy was decreased obviously. Instead, more than half of the patients in 2000 were on combination therapy of lithium and anticonvulsants. Lithiumvalproate combination was the preferred strategy and the use rate of carbamazepine has been decreased. In addition, most of the patients were given antipsychotic agents during the last 10 years. And recently, atypical antipsychotics were increasingly prescribed. These changes in the field of pharmacology of bipolar disorder have resulted neither in shorter hospital stays nor lower dosages of concurrent neuroleptics. CONCLUSIONS: The results indicate the trends in the prescribing of antimanic agents for the treatment of bipolar disorder in Korea across the past 10 years. Mostly, the change seems to correspond to the international practice guideline. More systematic research is needed to find out the clinical benefits of the anticonvulsants in the real practice of treatment of bipolar disorder.

Plasma Level of Amitriptyline after Fluoxetine Addition

OBJECTIVE: The purpose of this study was to compare the plasma amitriptyline and nortriptyline level between before and after fluoxetine addition with patients who were currently taking amitriptyline. METHOD: From the inpatient and outpatient unit of Soon Chun Hyang University Hospital, Chunan, fourteen subjects who were taking amitriptyline 25mg more than 1 week at least were given fluoxetine 20mg. Before and 2 weeks after fluoxetine addition the plasma level of amitriptyline and nortriptyline are analyzed simultaneously by High Performance Liquid Chromatography(HPLC) At the same times, HAM-D(Hamilton Rating Scale for Depression) score and the UKU(Uldvalg for Klinske Unders phi gelser) side effect scale were checked. RESULTS: After fluoxetine addition to the patients who were taking amitriptyline, the plasma level of amitriptyline, nortriptyline and sum of amitriptyline and nortriptyline had risen. The mean plasma amitriptyline level increased from 168.9+/-89.4ng/ml to 183.0+/-102.0ng/ml after fluoxetine addition(p=0.011) but the change was not statistically significant. The mean plasma nortriptyline level increased significantly from 114.3+/-70.2ng/ml to 168.0+/-86.2ng/ml after fluoxetine addition(p=0.011) In addition, the mean plasma level of total amitriptyline and nortriptyline increased significantly from 283.1+/-125.3ng/ml to 350.9+/-78.4ng/ml after fluoxetine addition(p=0.016) After fluoxetine addition, no significant change was noted in the UKU side effect scale score. CONCLUSION: As consequence of comparson of plasma amitriptyline and nortriptyline level before and after fluoxetine addition mean amitriptyline, nortriptyline and total plasma level was increased after fluoxetine addition. This suggests that coadministration of amitriptyline and fluoxetine may induce improvement of depressive symptom in depressive patients by way of increased plasma level of amitriptyline.