While hormonal changes during the ovulatory cycles affect multiple body systems, medical management, including medication dosing remains largely uniform between the sexes. Little is known about sex-specific pharmacology in women. Although hormonal fluctuations of the normal menstruating process alters women's physiology and brain biochemistry, medication dosing does not consider such cyclical changes. Using schizophrenia as an example, this paper illustrates how a woman's clinical symptoms can change throughout the ovulatory cycle, leading to fluctuations in medication responses. Effects of sex steroids on the brain, clinical pharmacology are discussed. Effective medication dose may be different at different phases of the menstrual cycle. Further research is needed to better understand optimal treatment strategies in reproductive women; we present a potential clinical trial design for examining optimal medication dosing strategies for conditions that have menstruation related clinical fluctuations.
Biochemistry ; Brain ; Clothing ; Female ; Humans ; Male ; Menstrual Cycle ; Menstruation ; Pharmacology ; Pharmacology, Clinical ; Physiology ; Psychopharmacology ; Schizophrenia ; Steroids

The serendipitous discovery of drugs with antipsychotic action has provided a clue to understanding the pathogenesis of psychotic disorders and to develop so called ‘antipsychotics’ drugs. From the ‘dopamine hypothesis’ to current molecular psychiatry findings, researchers have endeavored to improve the understanding of the mechanism of action of antipsychotic drugs. Signaling molecules were examined as novel intracellular targets of antipsychotic action. The findings regarding the effects of antipsychotics on inflammation, metabolism, and cellular fate have helped conceptualize the biological action of antipsychotics. This review summarizes the current knowledge of the molecular psychiatry findings regarding the action mechanisms of antipsychotics. The accumulation of research findings will lead to a better understanding of the pathogenesis of schizophrenia and its treatment mechanism.
Antipsychotic Agents ; Inflammation ; Metabolism ; Psychopharmacology ; Psychotic Disorders ; Schizophrenia ; Signal Transduction

OBJECTIVES: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.METHODS: According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.CONCLUSION: Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.
Advisory Committees ; Aripiprazole ; Bipolar Disorder ; Buspirone ; Clozapine ; Drug Therapy ; Psychopharmacology ; Quetiapine Fumarate ; Thyroid Gland

OBJECTIVE: A clinically relevant approach to patient care grounded in neurobiological constructs and evidence based practice which emphasizes a relevant psychopharmacology is needed to optimally train psychiatry residents. METHODS: We implemented a biological psychiatry course that now incorporates neurobiology, psychopharmacology, and evidence-based practice in conjunction with a Research Domain Criteria (RDoC) perspective. A survey launched prior to course implementation and following each class session, served as the outcome metric of residents' attitudes toward the new curriculum and followed a baseline attitudinal survey designed to evaluate the program. RESULTS: Greater than 90% of the psychiatry residents at Duke University who took the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders prior to sessions. CONCLUSION: Our biological psychiatry curriculum was associated with enthusiasm among residents regarding the incorporation of neurobiology, psychopharmacology, and evidence-based practice into course topics and discussions. A biological psychiatry curriculum with integrated neurobiology and psychopharmacology built on an evidence base approach is possible, well-received, and needed in training of future psychiatrists.
Biological Psychiatry* ; Curriculum* ; Evidence-Based Practice* ; Learning* ; Neurobiology* ; Patient Care ; Problem-Based Learning ; Psychiatry ; Psychopharmacology* ; Teaching

In this review, we compared recommendations from the Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAP-DD 2017) to other global treatment guidelines for depression. Six global treatment guidelines were reviewed; among the six, 4 were evidence-based guidelines, 1 was an expert consensus-based guideline, and 1 was an amalgamation of both evidence and expert consensus-based recommendations. The recommendations in the KMAP-DD 2017 were generally similar to those in other global treatment guidelines, although there were some differences between the guidelines. The KMAP-DD 2017 appeared to reflect current changes in the psychopharmacology of depression quite well, like other recently published evidence-based guidelines. As an expert consensus-based guideline, the KMAP-DD 2017 had some limitations. However, considering there are situations in which clinical evidence cannot be drawn from planned clinical trials, the KMAP-DD 2017 may be helpful for Korean psychiatrists making decisions in the clinical settings by complementing previously published evidence-based guidelines.
Complement System Proteins ; Depression ; Depressive Disorder* ; Psychiatry ; Psychopharmacology

The National Forensic Hospital is the only forensic psychiatric hospital in Korea. As of January 2016, the average number of patients assigned to each psychiatrist is more than 120. In this situation, the role of psychopharmacologic treatment becomes very important. To investigate the prescription patterns of major psychotropic medications (i.e., antipsychotics, mood stabilizers, and antidepressants), we reviewed the medical records of the patients diagnosed with schizophrenia and schizoaffective disorder who were admitted in January 2016. The data from 418 patients (403 with schizophrenia and 15 with schizoaffective disorder) were retrospectively collected and analyzed. The average number of major psychotropic medications prescribed for each patient during hospitalization was as follows: antipsychotics, 3.5±1.8; mood stabilizers, 0.5±0.7; and antidepressants, 0.5±0.8. The three most frequently prescribed antipsychotics were risperidone (21.7%), olanzapine (15.5%), and quetiapine (14.4%). More than half of the patients (233, 55.9%) were prescribed an antipsychotic polypharmacy regimen. This study found that patients with schizophrenia and schizoaffective disorder in forensic psychiatric hospital tend to be prescribed many psychotropic medications.
Antidepressive Agents ; Antipsychotic Agents ; Forensic Psychiatry ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Inpatients* ; Korea ; Medical Records ; Polypharmacy ; Prescriptions ; Psychiatry ; Psychopharmacology ; Psychotic Disorders* ; Quetiapine Fumarate ; Retrospective Studies ; Risperidone ; Schizophrenia*

The case presented multifactorial facets of depression and diabetes leading to noncompliance to both medical and psychiatric treatment resulting in suicide. A biopsychosocial approach was done to elucidate the complexity of the case, factoring in the adolescent storm, vicious cycle of diabetes and depression and effect of enmeshed attachments. Management involved short-term and long-term goals, focusing on psychoeducation about the nature and course of depression, psychiatric impact of depression leading to noncompliance, suicide precaution and treatment plans through psychopharmacology and psychoterapy, family therapy, liaison with the Pediatric Endocrinology and Nutrition service and support group involvement.

Human ; Female ; Adolescent ; Depression ; Family Therapy ; Psychopharmacology ; Goals ; Suicide ; Depressive Disorder ; Psychotherapy ; Patient Compliance ; Diabetes Mellitus ; Self-help Groups

The case presented multifactorial facets of depression and diabetes leading to noncompliance to both medical and psychiatric treatment resulting in suicide. A biopsychosocial approach was done to elucidate the complexity of the case, factoring in the adolescent storm, vicious cycle of diabetes and depression and effect of enmeshed attachments. Management involved short-term and long-term goals, focusing on psychoeducation about the nature and course of depression, psychiatric impact of depression leading to noncompliance, suicide precaution and treatment plans through psychopharmacology and psychoterapy, family therapy, liaison with the Pediatric Endocrinology and Nutrition service and support group involvement.

Human ; Female ; Depression ; Insulin--administration & Dosage ; Family Therapy ; Psychopharmacology ; Suicide ; Depressive Disorder ; Psychotherapy ; Patient Compliance ; Diabetes Mellitus ; Self-help Groups

Relationships between gastrointestinal viscera and human emotions have been documented by virtually all medical traditions known to date. The focus on this relationship has waxed and waned through the centuries, with noted surges in interest driven by cultural forces. Here we explore some of this history and the emerging trends in experimental and clinical research. In particular, we pay specific attention to how the hygiene hypothesis and emerging research on traditional dietary patterns has helped re-ignite interest in the use of microbes to support mental health. At present, the application of microbes and their structural parts as a means to positively influence mental health is an area filled with promise. However, there are many limitations within this new paradigm shift in neuropsychiatry. Impediments that could block translation of encouraging experimental studies include environmental forces that work toward dysbiosis, perhaps none more important than westernized dietary patterns. On the other hand, it is likely that specific dietary choices may amplify the value of future microbial-based therapeutics. Pre-clinical and clinical research involving microbiota and allergic disorders has predated recent work in psychiatry, an early start that provides valuable lessons. The microbiome is intimately connected to diet, nutrition, and other lifestyle variables; microbial-based psychopharmacology will need to consider this contextual application, otherwise the ceiling of clinical expectations will likely need to be lowered.
Allergy and Immunology ; Anxiety ; Depression ; Diet ; Dysbiosis ; Hand ; Humans ; Hygiene Hypothesis ; Life Style ; Mental Health* ; Microbiota* ; Neuropsychiatry ; Psychopharmacology ; Viscera ; Child Health

No abstract available.
Neurosciences* ; Psychopharmacology*