• Mood & Emotion
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• v.16 no.3
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• pp.123-128
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• 2018

Objectives : The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed to provide more proper guidelines for clinicians. In this study, we evaluated treatment strategies of elderly patients with bipolar disorders of KMAP-BP 2018. Methods : Sixty-one psychiatrists of the review committee with vast clinical experiences in treating bipolar disorders, completed the survey. An expert consensus was obtained, on pharmacological treatment strategies for elderly patients with bipolar disorder. The executive committee analyzed results, and discussed the results to produce the final algorithm. Results : In elderly patients with bipolar disorder, first-line treatment option for acute manic episode is monotherapy, with atypical antipsychotics or mood stabilizer, and a combination of mood stabilizer and atypical antipsychotics. First-line treatment option for acute depressive episode, was a combination of mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotic or mood stabilizer, and atypical antipsychotics with lamotrigine. Conclusion : In KMAP-BP 2018, the recommendation for treatment option in elderly patients with bipolar disorder, was newly introduced. We expect this algorithm may provide valuable information, and facilitate treatment of elderly patients with bipolar disorder.

• Korean Journal of Biological Psychiatry
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• v.28 no.2
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• pp.50-57
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• 2021

Objectives Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%-70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRS-related conditions.

• Korean Journal of Biological Psychiatry
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• v.8 no.1
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• pp.140-146
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• 2001

In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effectiveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%)). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 12(70.5%)). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refractoriness and drug induced side effect.

• Korean Journal of Biological Psychiatry
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• v.6 no.2
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• pp.189-192
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• 1999

The genetically determined CYP2D6 activity may be considered to be associated with antipsychotic induced extrapyramidal side effects with interindividual variation. Genetic polymorphism of CYP2D6 was determined by polymerase chain reaction(PCR) and MspI restriction fragment length polymorphisms(RFLP) for 194 schizophrenics. Subjects with a 334bp band were classified a1a1, those with 229bp and 105bp bands a2a2, and those with all three bands a1-a2. We did not identify schizophrenic subject with poor metabolizer. 194 schizophrenic patients previously treated neuroleptic medication, were assessed by Extrapyramidal Symptom Rating Scale(ESRS).The cases were composed of 33 akathisia, 47 parkinsonism, 21 tardive dyskinesia. These results are similar to the previous understanding that the poor metabolizer is very rare in Orientals compared to Caucasians, therefore, it considered that CYP2D6 genotypes have maybe no association with schizophrenia and extrapyramidal side effects in Koreans.

• Korean Journal of Biological Psychiatry
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• v.3 no.1
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• pp.115-120
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• 1996

To investigate characteristic drug effects on the genetic basis, the authors administered haloperidol- the $D_2$ antagonist- and clozapine -the atypical antipsychotics with few extra- pyramidal side effects- to the rats. Then, we edobtain brain specimen from the striatum, prefrontal cortex, and cortical region and compared the degree of c-fos expression. The results are 1) haloperidol was found to produce a rapid and transient induction of dos mRNA expression in striatum as compared with cortex and prefrontal area. 2) clozapine was found to produce rapid induction of c-fos mRNA in striatum and prefrontal area. From these data, we can concluded that the mechanism of action of haloperidol is different from the mechanism of clozapine in gene expression.

• Korean Journal of Biological Psychiatry
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• v.11 no.2
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• pp.117-126
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• 2004

Objects:It has been reported that the incidence of tardive dyskinesia(TD), the remarkable abnormal involuntary movement, was higher in the schizophrenics with high blood sugar levels and that TD had been improved by small amount of insulin-injection for 90 days. And also it was generally known that the blood lipids were higher in the schizophrenics with tardive dyskinesia. Thus, we tried to replicate the correlations of abnormal involuntary movements with blood sugar levels and blood lipids in chronic schizophrenics treated with antipsychotics. Methods:Thirty-eight male schizophrenic inpatients who were stable in clinical state with medications, were included. The patients who had been already diagnosed as diabetes mellitus(DM), organic brain disorder, substance- related disorder, physical illness were excluded and also we excluded female patients to remove the hormonal effect on TD. Eleven patients who ranked higher(above five) in the Abnormal Involuntary Movement Scale(AIMS) were assigned into 2 groups, a dibenese group and a placebo group. Diabinese or placebos were administrated for 3 weeks with antipsychotics and AIMS was rechecked. Results:There were no correlations between the total AIMS scores and blood sugar and lipids levels in all subjects. The means of total and subscale scores(objective, face, and extremity) of AIMS did not reveal statistical significances between diabinese and placebo groups. However(total, jaw, face, upper arm, and objective feeling), were statistically higher in the diabinese group than those in the placebo group. And correlations of total cholesterol(TC) with fast blood sugar(FBS), weight with body mass index(BMI) and waist, total glycerol (TG) with BMI were statistically significant. Conclusion:In this study, there were statistical significances in the changes in ratings of AIMS scores between the diabinese group and the placebo group. Application of oral hypoglycemic agent might be a way of improving abnormal involuntary movements in schizophrenics with abnormal involuntary movements or TD. Althogugh it was not certain that there were correlations of abnormal involuntary movement with blood sugar and lipids, correlations of TC/TG with AIMS, of FBS with AIMS cautiously suggest that the regular check of $HbA_1C$, waist, and weight are recommended for schizophrenics.

• Sleep Medicine and Psychophysiology
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• v.15 no.1
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• pp.39-43
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• 2008

Objectives: The pathophysiology of restless legs syndrome (RLS) is not obvious, but many promising theories involve dopaminergic deficiency and genetic causes. The RLS is presumed to occur more frequently among schizophrenic patients who take antipsychotics, most of which blocks the dopamine receptors. This study aimed to investigate whether dopamine transporter gene (DAT1) 40 base pair (bp) variable number of tandem repeat (VNTR) polymorphism is associated with the antipsychotic-induced RLS in schizophrenia. Methods: We determined the diagnosis of RLS among the 190 Korean schizophrenic patients by the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Genotyping was performed for the 40bp VNTR in DAT1 gene using polymerase chain reaction. Results: We separated the schizophrenic patients into 44 patients with RLS and 146 patients without RLS. The genotype and allele frequencies did not differ significantly between two groups. Conclusions: These results suggest that DAT1 gene 40bp VNTR is not associated with the antipsychotic-induced RLS in schizophrenia. To confirm these results, larger-scale association study is needed in the future.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.1
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• pp.11-16
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• 2021

Objectives : QTc prolongation due to antipsychotics is of major concern because it may lead to fatal ventricular arrhythmia such as torsade de pointes. However, few studies have been conducted on QTc prolongation due to antipsychotics, especially in South Korea. This study aimed to investigate how demographic and clinical variables affect QTc interval in patients with schizophrenia. Methods : By retrospectively reviewing medical records, we assessed QTc interval, demographic data and clinical features of 441 (175 males) patients with schizophrenia who admitted to the psychiatric ward of a general hospital. To explore the predictive factors for QTc interval, hierarchical regression analysis was performed with QTc interval as the dependent variable. Results : The mean QTc interval was 417.2±28.4 ms. In the hierarchical regression analysis, the use of short-acting antipsychotic injection was the strongest predictor of the QTc prolongation. Conclusions : This study demonstrated that the use of short-acting antipsychotic injection may affect QTc prolongation in patients with schizophrenia. This result suggests that more attention should be paid to the use of short-acting antipsychotic injection in the treatment of schizophrenia.

• Korean Journal of Psychosomatic Medicine
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• v.30 no.2
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• pp.165-171
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• 2022

Objectives : This study was conducted to investigate the effect of 1-year administration of second-generation antipsychotics (SGAs) on the platelet activity in patients with schizophrenia through a retrospective review of the medical records. Methods : The mean platelet component (MPC) value was used as an index of the platelet activity. The included subjects (N=24) were the patients who were confirmed to have taken SGAs continuously for one year after the first MPC measurement had been performed. The change of MPC was verified through a paired sample t-test. Results : The result revealed that the mean MPC value was significantly decreased from 26.5±1.4 g/dL to 25.6±1.8 g/dL after 1-year administration of SGAs from the time of the first MPC measurement. Conclusions : This study suggests that 1-year administration of SGAs may be related with increased platelet activity, and that close monitoring for risks such as cerebrovascular/cardiovascular or thromboembolic diseases may be necessary during SGAs treatment in clinical practice.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1994.04a
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• pp.113-125
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• 1994

Many types of drugs affect functions of tile gastrointestinal tract. Investigators may be interested in discovery or pharmacological characterization of drugs as therapeutic agents intended for treatment of gastrointestinal disorders or in identification of gastrointestinal side effects of drugs intended for non-gastrointestinal indications. Examples of drug categories often associated with significant gastrointestinal side effects include cardiovascular drugs, antibiotics (erythromycin in particular), anti-inflammatory drugs, antiemetics, analgesics (especially opiates), antihistamines, antidepressants, and antipsychotics. Whether tile objective is development of gastrointestinal therapeutic agents or evaluation of gastrointestinal side effects, appropriate laboratory models for experimentation are essential.