• Korean Journal of Psychosomatic Medicine
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• v.25 no.2
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• pp.120-128
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• 2017

Objectives : Although antipsychotics are commonly used to control symptoms of delirium, there is a lack of research on the prescription pattern and its clinical effects. The purpose of this study was to investigate the effect of antipsychotics prescription pattern on clinical course of delirious patients consulted to psychiatry. Methods : During the period from July 2016 to February 2017, 212 patients who were referred for delirium were reviewed for their medical records. The duration of delirium was monitored using CAM-ICU, and duration of admission, mortality, and delirium at discharge were reviewed. Clinical course was compared among three groups according to the antipsychotic drug administration pattern: Continuous use group, optimal use group and PRN use group. Results : The pattern of taking antipsychotic medication longer than duration of delirium did not associated with better clinical course compared with the pattern of adapting to the period of delirium and rather increased the risk of taking antipsychotic medication at discharge. When used for a shorter period than the delirium period, it was associated with poor clinical course. Conclusions : The results of this study suggest that a strategy to administer antipsychotics for a minimum period, according to periods of delirium, is appropriate. Also, efforts are needed to minimize the use of antipsychotic drugs after recovery from delirium.

• Korean Journal of Psychosomatic Medicine
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• v.30 no.2
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• pp.112-118
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• 2022

Objectives : Zolpidem is a common drug used in insomnia. However, there are several reports of side effects of the central nervous system or sleep related behavior in patients who took zolpidem. This study was conducted to investigate risk factors affecting sleep related behavior after taking zolpidem in inpatients. Methods : From January 1, 2019 to December 31, 2019, medical records of patients who took zolpidem hospitalized at Inha University Hospital were reviewed retrospectively. Results : 907 patients who took Zolpidem, 102 (11.2%) showed sleep related behavior, and if they were 65 years of age or older, men, taking antipsychotics, and taking antipsychotics and benzodiazepines at the same time, they were significantly more likely to show sleep related behavior. Conclusions : Risk factors for sleep-related behavior after use of zolpidem are estimated gender, elderly, antipsychotics, and combination of antipsychotics and benzodiazepines.

• 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.

• 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.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.

• Clinical Psychopharmacology and Neuroscience
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• v.16 no.4
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• pp.501-504
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• 2018

Autoimmune hemolytic anemia is a disease characterized with destruction of erythrocytes as a result of antibody produce against patient's own erythrocytes and anemia. Autoimmune hemolytic anemia can be roughly stratified into two groups according to serological features and secondary causes including drugs induced hemolytic anemia. Drugs induced autoimmune hemolytic anemia is very rare in pediatric patients. Even though hematological side effects such as leucopenia, agranulocytosis, eosinophilia, thrombocytopenic purpura and aplastic anemia might occur due to psychotropic drug use; to the best of our knowledge there is no autoimmune hemolytic anemia case due to quetiapine, an atypical antipsychotics, in literature. We hereby describe the first child case of autoimmune hemolytic anemia during quetiapine treatment.We also are pointing out that one should keep in mind serious hematological side effects with atypical antipsychotic drug use with this case report.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.2
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• pp.86-94
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• 2021

Objectives : The risk of weight gain is high when using antipsychotic drugs, and the prevalence of obesity in people with mental illness is high. Obesity management in psychiatric patients is important because obesity causes various complications and lowers treatment adherence and quality of life. Methods : In this review, we summarized the management strategies for obesity that can occur when using antipsychotic drugs through a web search. Results : Evaluate obesity-related risk factors and related indicators from the beginning of treatment, and conduct regular monitoring. If an antipsychotic drug is used and obesity is induced, a change to a drug with a low metabolic risk may be attempted. Sufficient interventions are also needed on the need to manage obesity, a healthy diet, and exercises in patients and their families. If weight loss is not achieved and obesity-related complications are associated, the use of anti-obesity drugs may be considered. Pharmacological treatment approaches should be carefully considered. Conclusions : Non-pharmacological and pharmacological therapies can be applied to manage weight gain and obesity caused by the use of antipsychotic drugs. When using anti-obesity drugs, the characteristics of mental disorders, drug safety, and drug interactions should be considered.

• Korean Journal of Psychosomatic Medicine
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• v.30 no.2
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• pp.66-72
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• 2022

Clozapine is accepted as the "gold standard" antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.

• The Journal of Internal Korean Medicine
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• v.44 no.4
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• pp.751-756
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• 2023

Objective: This study attempts to increase awareness of hepatotoxicity caused by antipsychotic drugs and to provide updated information on drug-induced liver injury (DILI) to physicians in Korean medicine (KM) clinics. Methods: This study presents a detailed case of a female patient diagnosed with DILI attributed to antipsychotic drugs, highlighting the improvement observed through laboratory findings. Results: A 56-year-old female patient with underlying disorders, including mixed connective tissue disease and depression, was under medical care. One day, she reported experiencing intense fatigue and distressing sensations, prompting the author to order blood tests. The levels of AST and ALT were significantly elevated by more than 2.5-fold, indicating hepatocellular DILI. The RUCAM score for antipsychotic drugs was 9, as no other medications, including herbal medicine, were being taken. Upon discontinuation of the antipsychotic drugs, the patient's laboratory findings returned to normal levels within 2 weeks, accompanied by a recovery of subjective symptoms. Conclusion: This study presents a noteworthy case of hepatotoxicity caused by antipsychotic drugs, serving as an illustrative example that highlights the crucial need for awareness among doctors of KM in clinical settings.

• Korean Journal of Biological Psychiatry
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• v.27 no.2
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• pp.58-63
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• 2020

Depressive disorder is a very common disease, clinical manifestations vary, and the mechanism is not clear. Therefore, a pharmacotherapy is very important to achieve sufficient therapeutic effect, but the choice of drug is not easy due to the occurrence of side effects of treatment and confusion with clinical features. It is easy to overlook the side effects of weight gain with antidepressants compared with antipsychotics, but they are frequently observed in clinical settings. The first-generation antidepressants have higher weight gains than selective serotonin reuptake inhibitors. Serotonin norepinephrine reuptake inhibitors are observed to have less weight gain, and dopamine norepinephrine reuptake inhibitors have weight loss effect due to decreased appetite. Mirtazapine, an atypical antidepressant, has a strong histamine H1 blockade, and gains weight gain from short-term use. The effects of desvenlafaxine, vortioxetine, and agomelatin on weight, which have recently been increasing in use, have not been largely identified. For better compliance, studies on weight gain due to the use of antidepressants are needed.