• Korean Journal of Biological Psychiatry
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• v.10 no.1
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• pp.54-61
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• 2003

Object : This cross-sectional study was performed in order to evaluate the prevalence of tardive dyskinesia among the hospitalized schizophrenic patients. Methods : Four hundred nineteen hospitalized schizophrenic patients(male=263, female=156) were recruited for this study. They were treated with antipsychotics for more than 3 months. The prevalence of tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale. Results : The prevalence of tardive dyskinesia was 35.6%(Male=36.9%, Female 33.3%). There were no significant differences in the prevalence of tardive dyskinesia among male and female schizophrenic patients. The prevalence of tardive dyskinesia among the patients over 30years old was much higher than those below 30years old. There were no significant correlations between the prevalence of tardive dyskinesia and the duration of hospitalization, the total amount of antipsychotics. The frequently involved parts of the body in the schizophrenic patients who have tardive dyskinesia were tongue, upper extremity, lips and perioral area, jaw, lower extremity, muscles of facial expression trunk, respectively. Conclusions : There was significant correlation between the age and the prevalence of tardive dyskinesia in the antipsychotic-treated schizophrenic patients. There were no correlations between the prevalence of tardive dyskinesia and gender difference, the duration of hospitalization, the total amount of antipsychotics.

• YAKHAK HOEJI
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• v.52 no.4
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• pp.288-292
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• 2008

Olanzapine, an atypical antipsychotic, has been widely used for the treatment of schizophrenia and bipolar disease. Although olanzapine is less associated with extrapyramidal symptoms and neuroleptic malignant syndrome compared to existing typical antipsychotics, the use of this drug has a problematic side effect of weight gain, which may cause metabolic syndrome such as type 2 diabetes. However, there are few hospitals practicing body weight monitoring of the patients on olanzapine or other atypical antipsychotics. The goal of this study was to identify the incidence and severity of weight gain associated with the use of the drug in Korea. We performed body weight monitoring of the patients who were on the drug in a hospital setting. Mean of the weight gain (as of one-month-transformation) was 4.33 and 3.39 kg for the male and female patients, respectively. The incidence in the young patients was higher than that observed in the old patients, and the severity was the highest in patients in their thirties followed by twenties or younger. This result suggests that the pattern of the weight gain associated with the use of olanzapine in Korea is similar to the reports performed and documented in US and European countries. Therefore, it appears that healthcare professionals in Korea should also watch on the weight gain issue in patients who are on olanzapine or other atypical antipsychotics.

• Korean Journal of Biological Psychiatry
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• v.22 no.4
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• pp.195-204
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• 2015

Objectives This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. Methods We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. Results Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. Conclusions Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.

• Korean Journal of Biological Psychiatry
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• v.20 no.3
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• pp.97-103
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• 2013

Objectives We aimed to identify the neuroimaging marker for prediction of the use of atypical antipsychotics (AAP) in dementia patients. Methods From April 2010 to March 2013, 31 patients who were diagnosed as dementia at the psychiatric department of Soonchunhyang University Hospital, completed the brain magnetic resonance imaging scan and cognitive test for dementia. Ten patients were treated with AAP for the improvement of behavioral and psychological symptoms of dementia (BPSD) and the other 21patients were not. Using T1 weighted and Fluid Attenuated Inversion Recovery (FLAIR) images of brain, areas of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF) and white matter hyperintensities (WMH) have been segmented and measured. Multivariate logistic regression models were applied for assessment of association between AAP use and the GM/WM ratio, the WMH/whole brain (GM + WM + CSF) ratio. Results There was a significant association between AAP use and the GM/WM ratio (odds ratio, OR = 1.18, 95% confidence interval, CI 1.01-1.38, p = 0.037), while there was no association between AAP use and the WMH/whole brain ratio (OR = 0.82, 95% CI 0.27-2.48, p = 0.73). Conclusions The GM/WM ratio could be a biological marker for the prediction of AAP use and BPSD in patients with dementia. It was more likely to increase as dementia progress since atrophy of WM was more prominent than that of GM over aging.

• The Korean Journal of Physiology and Pharmacology
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• v.14 no.5
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• pp.305-310
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• 2010

The human $ether$-$a$-$go$-$go$-related gene ($hERG$) channel is important for repolarization in human myocardium and is a common target for drugs that prolong the QT interval. We studied the effects of two antipsychotics, tiapride and sulpiride, on hERG channels expressed in $Xenopus$ oocytes and also on delayed rectifier $K^+$ currents in guinea pig cardiomyocytes. Neither the amplitude of the hERG outward currents measured at the end of the voltage pulse, nor the amplitude of hERG tail currents, showed any concentration-dependent changes with either tiapride or sulpiride ($3{\sim}300{\mu}M$). However, our findings did show that tiapride increased the potential for half-maximal activation ($V_{1/2}$) of HERG at $10{\sim}300{\mu}M$, whereas sulpiride increased the maximum conductance ($G_{max}$) at 3, 10 and $100{\mu}M$. In guinea pig ventricular myocytes, bath applications of 100 and $500{\mu}M$ tiapride at $36^{\circ}C$ blocked rapidly activating delayed rectifier $K^+$ current ($I_{Kr}$) by 40.3% and 70.0%, respectively. Also, sulpiride at 100 and $500{\mu}M$ blocked $I_{Kr}$ by 38.9% and 76.5%, respectively. However, neither tiapride nor sulpiride significantly affected the slowly activating delayed rectifier $K^+$ current ($I_{Ks}$) at the same concentrations. Our findings suggest that the concentrations of the antipsychotics required to evoke a 50% inhibition of IKr are well above the reported therapeutic plasma concentrations of free and total compound.

• Animal cells and systems
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• v.4 no.2
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• pp.173-179
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• 2000

Evidence suggested that atypical antipsychotics (APs) such as clozapine show less side effects than those of typical APs such as haloperidol and sulpiride. However, little is known about chronic effects of these drugs on changes in gonadotropin releasing hormone (GnRH) mRNA expression and luteinizing hormone (LH) immunoreactivity. Male rats were divided into water-, haloperidol-, sulpiride-, and clozapine-treated groups, and these drugs were administered orally for 4 weeks. The changes in the expression of GnRH mRNA and the LH immunoreactivity were determined in the hypothalamus and pituitary, respectively, using in situ hybridization and immunohistochemistry. GnRH mRNAs were clearly expressed in the water-treated control vats. This was significantly reduced by the chronic treatments with the typical APs, especially with haloperidol, but not with atypical APs clozapine. Likewise, LH immunoreactivity was clearly stained in the control group. While its immunoreativity was significantly reduced by the chronic APs treatments, clozapine treatment showed only slight attenuation. The results show that the atypical APs clozapine has less side effects in the gonadal function than the typical APs haloperidol and the sulpiride. These results suggest that clozapine is a safer drug than the typical APs, at least in the reproductive system.

• Clinical Psychopharmacology and Neuroscience
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• v.16 no.4
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• pp.361-375
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• 2018

We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine $D_2$ antagonism-related symptoms.

• Korean Journal of Biological Psychiatry
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• v.26 no.1
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• pp.14-21
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• 2019

Objectives Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. Methods Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. Results The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. Conclusions The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

• Journal of the Korean society of biological therapies in psychiatry
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• v.24 no.3
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• pp.218-229
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• 2018

Objectives : Antipsychotic-induced hyperprolactinemia causes physical symptoms, such as amenorrhea, galactorrhea, gynecomastia, sexual dysfunction, and bone density loss, as well as psychiatric symptoms, such as depression and cognitive impairments. This study aimed to clarify the associations among hyperprolactinemia caused by antipsychotics in patients with schizophrenia, psychiatric pathology, and psychosocial factors. Methods : Ninety-nine patients with schizophrenia in the psychiatry department of a university hospital were registered between 2015 and 2017. All participants were assessed using structured questionnaires to elucidate psychopathology, social function, quality of life, and hyperprolactinemia-related side effects. The standard levels for hyperprolactinemia were 24ng/mL for women and 20ng/mL for men. Results : The average prolactin levels were $73.45{\pm}49.37ng/mL$ in patients with hyperprolactinemia and $9.16{\pm}6.42ng/mL$ in those without hyperprolactinemia. The average prolactin level in women was significantly higher than that in men(p=0.04). Risperidone was most commonly administered in patients with hyperprolactinemia(58.1%, p<0.01), while aripiprazole was most commonly administered in those without hyperprolactinemia(44.7%, p<0.01). Patients with hyperprolactinemia had significantly higher Positive and Negative Syndrome Scale(p=0.03) and Patient Health Questionnaire-9(p=0.05) scores and had significantly lower Social and Occupational Functioning Assessment Scale(p=0.04) and Strauss-Carpenter Levels of Functioning Scale(p=0.03) scores than patients without hyperprolactinemia. There were no significant differences in side effects or quality of life between the two groups. Conclusion : These findings demonstrate that hyperprolactinemia confers negative effects on depression and social function, but does not directly affect the quality of life. These results suggest that patients with schizophrenia who take antipsychotics that increase prolactin or cause side effects of hyperprolactinemia need to be assessed and receive interventions for depression.

• Korean Journal of Biological Psychiatry
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• v.7 no.1
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• pp.74-79
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• 2000

Objectives : The dopamine-blocking effects and the associated side effects(amenorrhea, lactation, sexual dysfunction) of classical antipsychotics in schizophrenic patients have been studied for a long time. The purpose of this study was to find out these effects of new antipsychotics(risperidone, olanzapine) in schizophrenic patients treated with clinically relevant doses. Method : Plasma levels of both prolactin and testosterone were measured in 91 schizophrenic patients(28 taking haloperidol, 4-20mg/day ; 31 taking risperidone, 2-6mg/day ; 32 taking olanzapine, 5-20mg/day). Results : In male schizophrenic patients, the prolactin levels of risperidone group($76.44{\pm}38.85ng/ml$) and haloperidol group($60.26{\pm}20.74ng/ml$) had no significant difference, but were significantly higher than that of olanzapine($26.90{\pm}5.36ng/ml$). In female, the prolactin level of olanzapine group($36.66{\pm}17.55$) was significantly lower than those of risperidone($121.7{\pm}48.33$) and haloperidol group($161.66{\pm}37.53$). And prolactin level of risperidone group was lower than that of haloperidol group. While the testosterone plasma level of risperidone, haloperidol and olanzapine in both male and female schizophrenic patients had no significant difference. Conclusions : At doses known to be effective in popular clinical setting, prolactin level in patients taking risperidone was higher than that of haloperidol, while olanzapine showed no significant difference in terms of prolactin plasma level from haloperidol. New antipsychotics may not influence the testosterone plasma level.