Selective serotonin reuptake inhibitors (SSRIs) have been used for patients with depressive disorder because of their favorable side effect profiles. However, SSRIs have variable drug interactions because of the inhibitory action on the Cytochrome-P 450 system (CYP450), especially in combination with antipsychotic and antiarrhythmic drugs. We hereupon present the first case report of bradycardia associated with the use of paroxetine and carvedilol combination in a patient with depressive disorder.
Anti-Arrhythmia Agents ; Bradycardia* ; Depressive Disorder ; Drug Interactions ; Humans ; Paroxetine* ; Serotonin Uptake Inhibitors

Trazodone has favorable pharmacological profiles with a few anticholinergic effects and cardiac conduction abnormailties. Thus it is more acceptable in geriatric population than tricyclic antidepressant (TCA) especially in patients with combined medical conditions, although attention should be paid to monitor its well-known side effects, orthostatic hypotension and priapism. Unlike expected favorable profiles, we had experienced a case of increased intraocular pressure (IOP) shortly after lowdose trazodone treatment in a known-glaucoma patient.
Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Hypotension, Orthostatic ; Intraocular Pressure ; Priapism ; Trazodone*

OBJECTIVES: Psychiatric patients are known to use alternative medicine more frequently than medical patients. However, the factors increasing the frequency of use are not clearly understood. In an attempt to find predictive factors for the use of alternative medicine, we conducted a questionnaire survey on outpatients in psychiatric and endocrinology units of a university hospital. METHODS: A total of 'first come, first served' consecutive sample of 95 psychiatric outpatients and 100 medical outpatients as a control group were surveyed. The questionnaire contained sociodemographic information, use of alternative medicine, clinical information, and depressiv symptoms. RESULTS: As a result, 62.1% of psychiatric and 23.0% of medical patients reported to have used at least one type of alternative medicine during the past 12 months. Logistic regression analysis revealed predictive factors for alternative medicine user as being psychiatric patients (odds ratio=4.09, 95% confidence interval 2.11-7.95, pc<0.001) and those who didn't finish high school (OR=30.23, 95% CI 3.68-248.18, p=0.002). CONCLUSION: The finding of low education as a predictive factor is contrary to Western findings, which suggested higher education as a predictive factor for use of alternative medicine. This finding needs to be replicated and investigated for culturally different illness concept and behavior. These finding suggest that asking the patient's use of alternative medicine should be a part of routine psychiatric history taking.
Complementary Therapies* ; Education ; Endocrinology ; Fibrinogen ; Humans ; Logistic Models ; Outpatients* ; Surveys and Questionnaires ; Risk Factors

OBJECTIVES: The reliability and validity of the Korean version of Young Mania Rating Scale (K-YMRS) were examined in the Korean patients with major psychosis. METHODS: One hundred and twenty inpatients diagnosed as major psychosis by DSM-IV criteria were assessed with both K-YMRS and expanded Brief Psychiatric Rating Scale (BPRS-E) during the first 3 days in hospital and after 4-week treatment. RESULTS: The Cronbach's alpha coefficient of K-YMRS was 0.73. The inter-rater reliabilities of total score (r=0.93, p=0.000) and individual item scores were high (r=0.65-0.96, p=0.000). The correlations of each items of K-YMRS with total score were statistically significant (r=0.35-0.78, p=0.000) except for the "insight" item. The principal component analysis for K-YMRS produced three factors;a) mood and vegetative symptoms, b) behavioral symptoms, and c) thought content and insight. The total scores of K-YMRS showed a significant correlation with the manic-excitement factor scores of BPRS-E at baseline and after 4-week treatment (r=0.82, r=0.72, respectively, p=0.000). The discriminant function analysis showed that manic (n=43) and non-manic patients (n=73) were discriminated 73.7% correctly by K-YMRS total score (p=0.01). The change of the total score of K-YMRS after 4-week treatment in manic patients was significantly greater than that in non-manic patients (p=0.000). CONCLUSIONS: K-YMRS was demonstrated to have good reliability and validity for measuring the severity of manic symptoms. It is expected that K-YMRS will be a useful tool for assessing mania symptoms in Korea.
Behavioral Symptoms ; Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Inpatients ; Korea ; Principal Component Analysis ; Psychotic Disorders ; Reproducibility of Results

OBJECTIVES: We examined the effects of INM 176 (K-1107) compared with placebo on the cognitive functions of 92 old aged subjects with cognitive impairment. METHODS: This was a prospective, 12 week, double-blind, placebo-controlled clinical trial. The elderly who achieved a score of less than 25 points on the K-MMSE or showed a high risk of Alzheimer's disease from the 7-Minute Neurocognitive Screening Battery were considered to have objective impairment and were selected as subjects for this study. The subjects were randomized to placebo or INM 176 group. The outcome measures were from the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Instrumental Activities of Daily Living (IADL) and the Korean Geriatric Depression Scale (KGDS) and two kinds of computerized priming tests. After setting the total error score in the Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-cog) as the repeated measurement factor, an analysis of variance of the combined factor design was done between the placebo and INM 176 group. RESULTS: The interaction effect of time (pre- and post- trial) and group (placebo and INM 176 group) was significant in the analysis of the ADAS-cog's total error score. The INM 176 group's total error score in the ADAS-cog decreased significantly (p<0.01), whereas the placebo group showed a slight increase. The mean changes in IADL and GDS from baseline scores favored in the INM 176 group than in the placebo group. Outcome changes of ADAS-cog, IADL, KGDS scores during the 12 week clinical trail of INM 176 and placebo demonstrated favorable responses in the INM176 administered group. CONCLUSIONS: This is a preliminary clinical trial result of INM176 as a memory pill. Based on these results, INM176 may be a candidate molecule for the improvement of cognitive functions, including memory. Further clinical trial should demonstrate its efficacy.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Depression ; Humans ; Mass Screening ; Memory* ; Outcome Assessment (Health Care) ; Prospective Studies

OBJECTIVES: The purpose of the study was to make a comparison of KEDI-WISC and TOVA response in children with ADHD only (group 1), ADHD with comorbidity (group 2) and non-ADHD (in children with clinical diagnoses other than ADHD:group 3). And the clinical utility of auditory TOVA was examined. METHODS: Subjects of this research were children who were diagnosed as ADHD without comorbidity (n=19), ADHD with comorbidity (n=29) and non-ADHD (n=37). Cognitive characteristics among three groups were evaluated by FIQ, VIQ, PIQ, 11 subtests of KEDI-WISC and variables of visual and auditory TOVA. In order to determine the variables of visual and auditory TOVA effectively discrinating these three groups well, discriminant analysis was conducted. RESULTS: The results indicated that three groups in FIQ, VIQ and PIQ as well as information, comprehension, digit span, picture completion and block design were differentiated. With visual TOVA, group 1 was significantly slower than group 2 and group 3 in response time. And group 1 vs group 3 differed in the variability for Q1. With auditory-TOVA, group 1 was significantly more impaired than group 3 in D prime for the high response demand mode ("frequent" mode), response time for Q3, commission errors for Q4 and in the variability for Q2. As a result of discriminant analysis, it was Q1 and Q4 of RT in visual TOVA and Q4 of CE in auditory TOVA. And overall percentage of correct classification to identify possible presence of attention deficit was 60.0% in visual TOVA, 61.2% in auditory TOVA and 61.2% in both. CONCLUSION: The results indicated that FIQ, VIQ and PIQ of group 2 were lower than group 1 and group 3. TOVA response differentiated among three groups and the responses in attention deficit children varied according to the situations and the characteristics of task. For the economy of time and expenses down either of them is good enough to indicate the possible presence of attention deficit. The clinical implications and limitations of the present study were discussed.
Child* ; Classification ; Comorbidity* ; Comprehension ; Diagnosis ; Humans ; Reaction Time

OBJECTIVES: This study is to understand basic clinical characteristics, behavior symptoms, psychopathology, intelligence and neuropsychiatric functions of ADHD. METHODS: This study examined 1,432 outpatients with attention deficit or hyperactivity under 19 who had visited Yeung Nam University Psychiatric Center from July 01, 1998 to June 20, 2001 with K-ABC, K-WISC (or K-WAIS), K-PIC, ADDESHV, ACTeRS, CAP, SNAP, CPT and WCST RESULTS: 41.2% of the whole outpatients who visited clinics were diagnosed as having ADHD. 37.5% of the patients with ADHD had ADHD-I;59.8% had ADHD-C;and 2.7% had ADHD-HI. The proportion of males to females was 5.6 to 1. Females were a little younger and had generally lower functional standards including intellectual level than males (p<.001). The psychopathology through K-PIC showed that 23.8% of the subjects had psychopathologies related to language development and 18.5-26.5% of the subjects had other psychopathologies related to performance development, anxiety, delinquency, psychosis, autism. In behavioral symptom checklist, general difference was confirmed (p<.001), and ADHD subtype was differentiated by behavioral symptom checklist, especially ADDES-HV and ACTeRS (p<.05). In intellectual level, children with ADHD showed significantly lower IQ than normal children (p<.001). It raised questions that there can be problems not only in the course of testing IQs of children with ADHD but in development and display their intellectual abilities. And children with ADHD showed significantly poorer attention and performance abilities than normal children (p<.05). CONCLUSION: With above results, this study could confirm that ADHD-C had the largest percentage among subtypes of ADHD. And though the proportion of female patients was low, their functional standards were generally lower than male patients. Besides co-existent psychiatric diseases can be ignored in diagnosing ADHD. Though specific differences among subtypes have not been discovered, children with ADHD showed significantly lower functional standards such as IQ, attention, and performance abilities than normal children.
Adolescent* ; Anxiety ; Autistic Disorder ; Behavioral Symptoms ; Checklist ; Child* ; Female ; Humans ; Intelligence ; Language Development ; Male ; Outpatients ; Psychopathology ; Psychotic Disorders

OBJECTIVES: The purpose of this study was to evaluate the characteristics of psychopathology, adverse drug effects, and subjective response to drugs that have a significant impact on the subjective quality of life in schizophrenic patients receiving atypical antipsychotics. METHODS: One hundred and one schizophrenic patients, who were receiving maintenance treatment with atypical antipsychotics, were evaluated. Subjective quality of life was assessed using the standardized Korean modification of a self-rating scale to measure subjective well-being under neuroleptics (KmSWN). Patients' psychopathology was evaluated using the Positive and Negative Syndrome Scale. Adverse effects and subjective response to drug were evaluated using the Liverpool University Neuroleptic Side Effect Rating Scale and the Drug Attitude Inventory-10, respectively. Correlation analysis and stepwise multiple regression analysis were conducted. RESULTS: In psychopathology, the severity of depression and anxiety showed the most significant correlation with the score of KmSWN. In adverse drug effects, the severity of psychic side effect and extrapyramidal side effect showed the most significant correlation with the score of KmSWN. Regarding subjective response to drug, significant correlation was observed between the severity of subjective negative response and the score of KmSWN. Stepwise multiple regression analysis revealed that psychic side effect, extrapyramidal side effect, and depression contributed significantly to the total score of KmSWN. These variables accounted for 59.7% of the total variance. CONCLUSION: The results of the present study suggest that psychic side effect, extrapyramidal side effect and depressive symptom are the clinical characteristics that are significantly associated with the subjective quality of life. An effective management strategy for these variables should be established in developing a treatment program to enhance the quality of life of patients with schizophrenia.
Antipsychotic Agents* ; Anxiety ; Depression ; Humans ; Psychopathology* ; Quality of Life* ; Schizophrenia

OBJECTIVES: Abnormalities of cognitive responses to verbal and visual distracter in schizophrenia have been demonstrated in numerous studies but little is known about three dimensional visuospatial-motor distracter processing. The purpose of this study was to investigate the vulnerability of patients with schizophrenia to three dimensional visuospatial-motor distracter. METHODS: 14 patients with schizophrenia and 14 normal volunteers were assessed on three dimensional maze tasks requiring on working memory and reasoning ability in the virtual reality environment. Performances were compared according to with- or without-distracter conditions. RESULTS: Patients with schizophrenia showed significantly lower performances than normal control group on cognitive flexibility, simple motor function or motor control and motor coordination, working memory span and delayed performance times. The performance index tended to be more deteriorated, but not significantly, in with-distracter condition than in without-distracter condition in schizophrenia. CONCLUSIONS: Patients with schizophrenia tend to be vulnerable to visuospatial-motor distracter which simulate the real world of three dimensional environment.
Executive Function ; Healthy Volunteers ; Humans ; Memory, Short-Term ; Pliability ; Schizophrenia* ; Task Performance and Analysis*

OBJECTIVES: It has been suggested that dopamine as well as serotonin were related to the pathophysiology of obsessive-compulsive disorder (OCD). Thus, many studies were performed to nivestigate brain regions and their association with dopamine in OCD patients. Recently, we have been able to monitor the density of the dopamine transporter (DAT) in the basal ganglia using I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123 IPT) SPECT, to evaluate the activity of the presynaptic dopamine function. In present study, we investigated the DAT density of the basal ganglia using I-123 IPT SPECT in patients with OCD. METHODS: Fifteen patients with OCD and nineteen normal control group were included in this study. We performed brain SPECT 2 hours after the intravenous administration of I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123 IPT) and carried out both quantitative and qualitative analyses using the SPECT, which were reconstructed for the assessment of the specific/nonspecific DAT binding ratio in basal ganglia. We then investigated the correlation between the severity of OCD symptoms assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the specific/nonspecific DAT binding ratio of basal ganglia. RESULTS: Patients with OCD showed a significantly increased specific/nonspecific DAT binding ratio in right basal ganglia compared with normal controls and did not show a significantly increased specific/nonspecific DAT binding ratio, and an increased tendency in the specific/nonspecific DAT binding ratio in left basal ganglia (Rt:Z=2.584, P=0.009, Lt:=1.873, P=0.060). We found no significant correlation between the total scores of the Y-BOCS and the specific/nonspecific DAT binding ratio of basal ganglia. CONCLUSIONS: The data of this study suggest that dopamine in basal ganglia plays an important role in fronto-subcortical circuit, which are already known as a site of the pathophysiological mechanism of OCD.
Administration, Intravenous ; Basal Ganglia* ; Brain ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Humans ; Obsessive-Compulsive Disorder* ; Serotonin ; Tomography, Emission-Computed, Single-Photon*