• Korean Journal of Biological Psychiatry
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• v.22 no.4
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• pp.163-172
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• 2015

Objectives This study was aimed to examine the multidimensional relationship between auditory verbal hallucinations (AVHs) and Positive and Negative Syndrome Scale (PANSS) factors of psychopathology in the patients with schizophrenia. And we explored the differences between assessments to hallucination by the clinicians and patients. Methods 82 patients with schizophrenia who were assessed by the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ), Psychotic Symptom Rating Scale-Auditory Hallucination (PSYRATS-AHS), and the PANSS were recruited. Hwang's five-factor model of PANSS, items and total scores of hallucination scales, Kim's and Haddock's factor models of hallucination were applied to examine the correlations between psychopathology and AVHs. AVH-positive patients was 50 in PANSS-HPSVQ group and 24 in PANSS-PSYRATS-AHS. These two groups were separately analyzed. Results Among the five factors of the PANSS, negative and depression/anxiety factors were correlated with the total scores of HPSVQ and PSYRATS-AHS, and positive and autistic preoccupation factors were correlated only with the total score of PSYRATS-AHS. The activation factor was correlated with none of the total scores of HPSVQ/PSYRATS-AHS. These correlation patterns of a total score of HPSVQ/PSYRATS-AHS were same in the emotional factor of HPSVQ and physical factor of PSYRATS-AHS respectively. In the items which showed significant correlations, correlation coefficients of PANSS-PSYRATS-AHS group ranged between 0.406-0.755 and those of PANSS-HPSVQ ranged between 0.283-0.420. Conclusions This study suggested that the psychopathological domains of schizophrenia were differentially correlated with AVHs and the assessment of AVHs by clinicians and patients showed substantial differences which should be integrated into the therapeutic interventions.

• Korean Journal of Biological Psychiatry
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• v.6 no.2
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• pp.209-218
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• 1999

Objectives : The aims of this study were to discriminate the clinical differences, to measure the estrogen and homovanillic acid levels, to evaluate a correlation between estrogen and homovanillic acid, and to identify an association of cognitive deficit with estrogen and homovanillic acid among male and female schizophrenics. Methods : In addition to the structured interviews, the plasma estrogen levels by radioimmunoassay and the homovanillic acid levels by HPLC were measured in 20 male and 21 female schizophrenics as well as 10 healthy male and 9 female controls. Results : 1) The plasma estrogen levels were higher in females than males, and significantly higher in female schizophenics than female controls. The homovanillic acid levels were higher in female schizophrenics than female controls, and were lower in male schizophrenics than male controls. 2) The onset age seemed to be earlier in male schizophrenics, and the frequency of admission, duration of antipsychotic drug administration, dosage of antipsychotics and duration of illnesses were more in males. The estrogen and homovanillic acid levels were significantly higher in female schizophrenics. 3) The estrogen levels had a significant positive correlation with sex, age and onset age, while the homovanillic acid levels did with sex. However, estrogen were not correlated with homovanillic acid levels. 4) The estrogen and homovanillic acid levels were not significantly different between male and female schizophrenics with cognitive deficits. In the schizophrenic patients without cognitive deficits, the estrogen levels were significantly higher in females, while there were no significant sex differences in homovanillic acid. 5) In the male and female schizophrenics predominantly with negative symptoms, there were no significant differences in estrogen and homovanillic acid levels. In those predominantly with positive symptoms, the estrogen levels were significantly higher in females, while there were no sex differences in homovanillic acid levels. 6) In schizophrenics with undifferentiated subtype, the estrogen and homovanillic acid levels were significantly higher in females. In those with paranoid or disorganized subtypes, the estrogen levels were significantly higher in females, while there were no sex differences in the homovanillic acid levels. 7) The mean values of PANSS-negative, PANSS-total, PANSS-CF, MMSE-K and estrogen levels were significantly higher in male schizophrenics with cognitive deficits. The mean values of illness duration, CGI, PANSS-positive, PANSS-negative, PANSS-total, PANSS-CF and MMSE-K were significantly higher in female schizophrenics with cognitive deficits. 8) The variables which showed significant correlation with cognitive deficits were PANSS-negative, PANSS-total, PANSS-CF, MMSE-K and estrogen levels in male schizophrenics. The variables which showed significant correlation with cognitive deficits were subtypes, onset age, illness durataion, CGI, PANSS-positive, PANSS-negative, PANSS-total, PANMSS-CF and MMSE-K in female schizophrenics. The estrogen levels were significantly correlated with admission frequencies, history of antipsychotic administration, duration of antipsychotic administration and cognitive deficits in male schizophrenics, while age were not correlated with in females. The homovanillic acid levels had a significant correlation with subtypes and onset age in male schizophrenics, while there were no correlation among variables in females. Conclusions : Although the plasma concentrations of estrogen and homovanillic acid in female schizophrenics were significantly higher than males, we could not find an association between them. Furthermore, the various factors affecting on the cognitive deficits, estrogen and homovanillic acid levels seemed to be somewhat different according to sex.

• Korean Journal of Biological Psychiatry
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• v.5 no.1
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• pp.122-128
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• 1998

Objective : This study was a open clinical trial aimed at exploring the effectiveness of combined treatment with estrogen and antipsychotics to the chronic female schizophrenics. Method : 40 female patients who met DSM-VI criteria for schizophrenia who were chronically ill were randomly assigned to estrogen group(EG) and control group(CG). EG patients were received estrogen 1.25mg for 8weeks in addition to their routine antipsychotic regimens. CG patients were received their routine antipsychotic regimens only. Both groups were evaluated by PANSS(Postive and Negative Syndrome Scale), CGI(Clinical Global Impression) at 0, 4, 8 week during the trial period and compaired with each other. Results : 40 female patients have completed the study during 8weeks. EG was significantly improved in PANSS and CGI scores than CG during the 8weeks. In EG patients, all symptom subtypes(positive symptoms, negative symptoms, general psychopathology symptoms) of PANSS were significantly improved and positive symptoms were most significantly improved at 8week. Conclusions : This results support the clinical value of combined estrogen therapy among chronic female schizophrenics.

• Korean Journal of Biological Psychiatry
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• v.4 no.1
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• pp.84-94
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• 1997

This study was done to examine changes of plasma homovanillic acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week clozapine trial and to investigate the relationship between the plasma monoamine metabolites and treatment responses. Twenty-seven chronic schizophrenic patiens were treated for 8 weeks with clozapine. The psychopathology was assessed at baseline just clozapine trial and then every 2 weeks until the end of 8-week clozapine treatment using the Positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured also biweekly using high preformance liquid chromatography with electrochemical detection method. Plasma HVA and 5-HIAA levels were significantly decreased during a 8-week clozapine treatment, although plasma HVA/5-HIAA ratio showed no significant change. The changes of plasma HVA levels were in significant correlations with the changes of PANSS positive scores, of general psychophathology scores, and changes of total socres. The changes of plasma 5-HIAA levels were in signfificant correlations with the changes of PANSS negative scores. But the changes of plasma HVA/5-HIAA ratio had no significant correlation with any PANSS subscale score changes. 48% of the patients treated with clozapine was categorized as responders, who showed at least a 20% decrease in PANSS total socre and a CGI severity score of mildly ill or less(${\leq}3$) at the end pint of the study. The baseline plasma HVA levels and HVA/5-HIAA ratio were significantly higher in responders(N=13) than in nonresponders (N=14). But no significant difference in baseline levels of plasma 5-HIAA was found between responders and nonresponders. At the end point of the study, there was significant difference in the change of plasma HVA between responders(40.3% decrement) and nonresponders(3.1% increment). But no signficant differences in the change of plasma 5-HIAA and the change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. These results suggest that the antipsychotic effect of clozapine on positive symptoms may be associated with dopaminergic blocking activity, and that on negative symptoms may be associated with serotonergic blocking activity. The baseline plasma HVA levels and the change of HVA levels from baseline may be useful predictors of treatment response with clozapine.

• Korean Journal of Biological Psychiatry
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• v.19 no.2
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• pp.84-90
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• 2012

Objectives : The purpose of this study was to examine the changes in metabolic parameters and Positive and Negative Syndrome Scale (PANSS) scores of patients previously treated with atypical antipsychotic drugs other than paliperidone, after 8 weeks of treatment with paliperidone. Methods : Changes in body weight, body mass index, leptin, lipid levels, fasting glucose, and PANSS scores of patients who switched from other atypical antipsychotic drugs to paliperidone were measured after 8 weeks of treatment with paliperidone. We compared these results with those of patients who had not been treated with antipsychotic drugs for at least 2 weeks prior to treatment with paliperidone (antipsychotic drug-free patients). Results : The antipsychotic drug-free group (n = 9) did not show significant changes in metabolic parameters, but showed a significant improvement in total and subscale scores of PANSS. In the group that switched from other atypical antipsychotic drugs to paliperidone (n = 13), body weight, body mass index and fasting glucose level significantly increased, while total and subscale scores of PANSS significantly improved. Conclusions : Paliperidone treatment will benefit patients with schizophrenia who have been antipsychotic drug-free or who have had difficulty with other atypical antipsychotic drugs, with regard to their psychopathological state. However, if patients have been treated with other atypical antipsychotic drugs before switching to paliperidone, they could gain body weight or their fasting glucose level could increase over a short period because of a change in receptor number and sensitivity caused by the previously prescribed antipsychotic drugs, and hence, paliperidone should be prescribed with caution for these patients.

• Korean Journal of Biological Psychiatry
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• v.16 no.3
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• pp.170-180
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• 2009

Objectives : To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia. Methods : Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale(PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia(K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment. Results : After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness(rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level(rho=-0.821, N=7, p=0.023, two-tailed). Conclusion : This preliminary study suggests that rTMS didn't make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.

• Korean Journal of Biological Psychiatry
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• v.2 no.1
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• pp.131-139
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• 1995

Clozapine, on atypical antipsychotic drug, has been estimated to be a major improvement in the treatment-refractory schizophrenic patients. We evaluated the clozapine efficacy in the treatment of schizophrenic patients who are refractory to classic neuroleptics. The patients were assigned in a prospective, open, comparative trial for 12 weeks. Following an dose titration, 33 inpatients with treatment-refractory schizophrenia diagnosed according to DSM-III-R were given a clozapine(N=17, approximate 300-600mg/day) or haloperidol(N=16, approximate 20-30 mg/day) for 12 weeks. The clinical state was assessed before treatment, and 1st, 4th, 8th and 12th week during treatment using Brief Psychiatric Rating Scale(BPRS) and Positive and Negative Syndrome Scale(PANSS). Assessment of side effects were mode weekly using Simpson-Angus Scale for Extrapyramidal Side Effects and Adverse Events-Somatic Symptoms. Clozapine produces significant improvement than haloperidol on the BPRS and PANSS scores. 77% (13/17) of the clozapine-treated patients were categorized as responders, who showed at least 20% decrease in total BPRS scores, compared with 31% (5/16) of haloperidol-treated patients. Extrapyramidal side effects occurred in only one patient in clozapine group, but nine patients in haloperidol group. Salivation, sleepiness, constipation and hypotension were most frequent adverse effects observed in clozapine group. There was no significant changes in total WBC and neutrophil during clozapine treatment. These findings suggest that clozapine is on effective antipsychotic drug for the Korean treatment-refractory schizophrenic patients, who are nonresponsive to or unable to tolerate classcal antipsychotic drugs due to extrapyramidal side effects.

• Korean Journal of Biological Psychiatry
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• v.16 no.4
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• pp.256-265
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• 2009

Objectives : The aims of this study were to assess a) the prevalence of trauma and posttraumatic stress disorder(PTSD) in schizophrenic patients and b) the differences in symptomatology and outcome after 1year treatment between those with and without PTSD. Methods : Twenty eight schizophrenia and schizoaffective disorder patients completed the Positive and Negative Syndrome Scale(PANSS), Life Stressor Checklist-Revised(LSCL-R), Clinician-Administered PTSD Scale(CAPS), Dissociative Experiences Scale(DES), Hamilton Psychiatry Rating Scale for Depression(HAM-D), and Rosenberg Self-Esteem Scale(RSE). Results : Twenty six patients(92.9%) had at least one trauma in their life time. Eleven patients(39.3%) were diagnosed with PTSD. PTSD group had significantly higher scores on HAM-D and DES but lower scores on RSE. PTSD group also had significantly lower score in the baseline PANSS Negative score. Higher CAPS scores were significantly correlated with lower baseline PANSS Negative score and greater change after 1year of PANSS Negative score. Conclusion : These results showed that the prevalences of trauma and PTSD are high in schizophrenic patients and suggested that PTSD and trauma-related symptoms affected the symptomatology and treatment outcome. More research is warranted to better understand the effects of PTSD in schizophrenic patients.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1993.04a
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• pp.165-165
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• 1993

목적:지금까지 Risperidone의 치료 효능과 안전성에 대한 연구들이 모두 만성 정신분열병 환자들만을 대상으로 이루어졌고, 효율적인 약물 요법의 중요한 지침이 되는 유효치료용량(effective therapeutic dosage)에 대한 연구가 이루어지지 않고 있는 바, 본 연구에서는 초발인 급성 정신분열병 환자들을 대상으로 첫째, Risperidone의 항정신병 효과(antipsychotic effect)와 추체외로계증상(extrapyramidal symptoms)을 평가하고 둘째, Risperidone의 항정신병 효과와 혈장 Risperidone 및 9-hydroxyrisperidone 농도와의 상관관계를 분석하여 유효혈장농도(therapeutic dose range)와 유효치료용량(effective therapeutic dosage)의 존재 여부를 검토코자 한다. 방법: DSM-III-R 진단기준(APA 1987)예 의해 정신분열병형 장애로 진단된 환자 11명(남자 5, 여자 6)을 대상으로 Risperidone을 이중맹검법(double blind design)으로 6주간 투약하였다. 정신병리의 평가는 PANSS(Kay 1988)를 이용하였고 추체외로계 부작용의 평가는 ESRS(Chouinard 1980)를 이용하였다. 혈장 Risperidone 농도와 혈장 9-hydroxyrisperidone 농도는 Jansen사의 Radioimmunoassay Kit를 이용하여 3회 측정하였다. 결과: PANSS 점수는 Risperidone 투여 후 1주째부터 통계적으로 유의하게 감소하였다. Parkinsonism과 dyskinesa에 대한 physician's examination 점수는 전체 연구 기간 동안 유의한 변화를 보이지 않았다. Dystonia에 대한 physician's examination 점수는 Risperidone 투여 후 1주째에는 평균 5.96점으로 높았으나 2주째부터 통계적으로 유의하게 감소되어 6주째에는 유지되었다. 혈장 Risperidone 농도와 혈장 9-hydroxyrisperidone 농도는 PANSS 점수와 유의한 상관관계를 보이지 않았다.

• Korean Journal of Biological Psychiatry
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• v.3 no.1
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• pp.75-82
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• 1996

Object : The aim of this study was to evaluate the changes of positive stmtoms. negative symptoms, and depressive symptoms after fluoxetine trial in haloperidol-stabilized schizophrenic in-patients. Method : Fluoxetine(20mg/day) was added for 6weeks to stable doses of haloperidol given to 32 schizophrenic in-patients. The subjects was divided into positive and negative schizophrenics by PANSS. The authors checked PANSS. HRSD at baseline, the 2nd week. the 4th week, the 6th week of treatment. Result were as follows : 1) In all subjects, positive and depressive symptoms were significantly improved. 2) As time went on, positive and negative symptoms were not significantly improved in positive and negative schizophrenics. 3) As time went on, depressive symptoms were not significantly improved in positive and negative schizophrenics. Conclusion : We suggested that fluoxetine may be useful in the treatment of positive symptoms in schizophrenia and, It may be due to the effect on the serotonin system and the interaction between serotonin and dopamine system.