Here we report a case of serotonin syndrome caused by fluoxetine 20 mg and duloxetine 60 mg independently eight week apart. A 65-year old man developed fever, agitation and change of mental status after two weeks treatment with 20 mg of fluoxetine for depressive disorder. He was diagnosed unknown fever origin and discharged when fever subsided as antidepressant stopped. Eight weeks later he was prescribed 60 mg of duloxetine for the treatment of depressed mood. After 18 days on duloxetine he developed fever, agitation, myoclonus and change in mental status again. He improved rapidly after discontinuation of offending drug with supportive care. Despite serotonin syndrome is usually caused by poly-pharmacy of serotonergic drugs, this case shows unusual serotonin syndrome developed by therapeutic dose of two drugs of different classes independently.
Depressive Disorder ; Dihydroergotamine ; Fever ; Fluoxetine ; Humans ; Myoclonus ; Serotonin ; Serotonin Agents ; Serotonin Syndrome ; Thiophenes ; Duloxetine Hydrochloride

OBJECTIVE: Suicide is the leading cause of death for adolescents. The internet is widespread in Korea and has influence on mental health of adolescents. This study aims to investigate the relationship between the internet use and suicidal behavior resulting from adolescent depression. METHODS: The subjects consisted of 61 adolescents between the ages of 13 and 18 who were diagnosed as depression by Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Korean Version and Diagnostic and Statistical Manual of Mental Disorder 4th edition. Suicidal behavior was assessed by Columbia Suicide Severity Rating Scale. Patients were inquired about their internet use using questionnaires and other clinical variables using Beck Depression Inventory, Beck Suicidal Ideation Scale, Revised Children's Manifest Anxiety Scale, Internet Game Addiction Scale and Physical Abuse Scale. RESULTS: The patients within the high-risk group were more prone to searching for the word 'suicide' on the internet and having suicidal idea compare to the patients within the low-risk group. Among the high-risk group, the patients who searched for the word 'suicide' tended to be more anxious compared to the patients who did not search the word. CONCLUSION: The results of the present study suggest that searching the word 'suicide' on the internet is associated with suicidal idea. It is suggested that intervention on the patients within the searching group may reduce the suicidal idea resulting from adolescent depression.
Adolescent ; Cause of Death ; Depression ; Humans ; Internet ; Korea ; Manifest Anxiety Scale ; Mental Disorders ; Mental Health ; Mood Disorders ; Surveys and Questionnaires ; Schizophrenia ; Suicidal Ideation ; Suicide

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.
Antipsychotic Agents ; Humans ; Inpatients ; Polypharmacy ; Prescriptions ; Schizophrenia

OBJECTIVE: Recommended dosage of quetiapine for patients with schizophrenia is from 150 mg to 750 mg, which is based on randomized controlled study. But there are trends of increasing quetiapine dosage in clinical practice. Therefore, we evaluated the clinical aspect of schizophrenic patients who took quetiapine by naturalistic non-intervention study. METHODS: Schizophrenia outpatients in 88 mental hospitals were selected and 170 psychiatrists evaluated Clinical Global Impressions Scale for Severity (CGI-S) before starting quetiapine medication and CGI-S, Clinical Global Impressions Scale for Improvement (CGI-I), quetiapine dosage and medication compliance at 6 weeks after starting quetiapine medication. Overall efficacy and difference of efficacy between drug-naive patients and medication-switch patients were evaluated. We clustered the patients into 4 groups by using cluster analysis with three variables such as quetiapine dose at week 6, baseline CGI-S, and end-point CGI-S. We compared clinical aspect of each cluster with analysis of variance. RESULTS: 841 patients were enrolled. Efficacy of quetiapine was replicated, and improvement rate defined as CGI-I < or =2 was 55.9%. Drug-naive patients show more improvement in CGI-I than medication-switch patients, and efficacy for patients with insufficient treatment was also reported. Dosage for each clustered group was 25-350 mg, 400-500 mg, 600-700 mg and 750-1,500 mg. 750-1,500 mg group shows more decrease in CGI-S than 400-500 mg group and 600-700 mg group. CONCLUSION: This study suggests that there is a cluster of patients who take more benefits in reducing symptoms and show more compliance in high-dose quetiapine.
Cluster Analysis ; Compliance ; Dibenzothiazepines ; Hospitals, Psychiatric ; Humans ; Medication Adherence ; Outpatients ; Psychiatry ; Schizophrenia ; Quetiapine Fumarate

Most serotonin is found outside the central nervous system and functions much more than a neurotransmitter. Peripheral serotonin is produced by enterochromaffin cells in the gastrointestinal tract and secreted into blood. Serotonin, as a circulating amine, takes part in numerous biological processes including cardiovascular function, bowel motility, glucose metabolism and skeletal change. Serotonin signaling is regulated by serotonin receptors and serotonin transporters in multiple body organs. The drugs that manipulate the serotonergic system have been developed and used for the treatment of many systemic diseases. The richness of serotonergic modulation in the whole body provide both a pharmacologic opportunity and challenge.
Biological Processes ; Central Nervous System ; Enterochromaffin Cells ; Gastrointestinal Tract ; Glucose ; Neurotransmitter Agents ; Receptors, Serotonin ; Serotonin

Propofol is a well-known ultra-short acting intravenous anesthetic agent for induction and maintenance of general anesthesia. Since its introduction into the market in the mid 1980s, this is the seventh report on propofol dependence in the literature. Of these, only two cases of propofol abuse have been previously reported in laypersons. We are reporting the case of a lay female who has dependence on propofol, and this is the first lay case in Asia.
Anesthesia, General ; Female ; Humans ; Propofol ; Substance-Related Disorders

Objectives : Recently, several attempts have been made to use repeated transcranial magnetic stimulation (rTMS) with various stimulation frequencies as a novel treatment for patients with obsessive-compulsive disorder (OCD). However, findings about the efficacy of rTMS in treating OCD have been inconsistent. In the present study, we evaluated the clinical effect and safety of low frequency rTMS on the right dorsolateral prefrontal cortex in the treatment of refractory OCD. METHODS : Twenty-four patients with treatment-refractory OCD received a daily treatment of 20 minutes low frequency rTMS (1 Hz) to the right dorsolateral prefrontal cortex with power of 100% of motor threshold, for 15 days. Clinical status was evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAMA), and Clinical Global Impression (CGI) at baseline, at the end of the rTMS treatment (3 weeks), and 4 weeks after finishing the rTMS treatment course. RESULTS : After 3 weeks treatment with low frequency rTMS, Y-BOCS, HAMA and CGI-S scores were significantly decreased. CONCLUSION : The present study found that low-frequency rTMS on the right prefrontal cortex for 3 weeks showed significant therapeutic effects in patients with OCD. Further controlled trials are indicated to assess the efficacy of rTMS in the treatment of OCD.
Anxiety ; Humans ; Obsessive-Compulsive Disorder ; Prefrontal Cortex ; Transcranial Magnetic Stimulation

Objectives : A diverse range of adverse effects has been linked to the application of antidepressants for the treatment of depressive disorder. Recently, evidence has been emerging of the adverse metabolic effects of antidepressants. This study investigated the effects of antidepressants on plasma glucose and other factors in the fat and muscle tissue relating to metabolism. METHODS : Long-Evans-Tokushima-Ostuka (LETO) rats were used to evaluate the effects of different antidepressants. Amitriptyline, fluoxetine, and mirtazapine were administered to each of three subgroups for 4 weeks, between 11 and 15 weeks old, while a fourth subgroup was administered no antidepressant during the same period. Changes of weight and daily intake were monitored. Tissues and blood were collected at 15 weeks. RESULTS : The fluoxetine subgroup showed lower weight gain and lower food efficacy ratio than did the other subgroups. Blood glucose and other circulating factors showed no significant differences among groups, except for the leptin levels of the fluoxetine subgroup. However, the amitriptyline and mirtazapine subgroups showed similar patterns in the response of mRNA expression of peroxisome proliferator-activated receptors gamma cofactor-1 and uncoupling protein-1, 2, 3. CONCLUSION : These results could indicate possible differences in metabolic response based on the kind of antidepressant used.
Amitriptyline ; Animals ; Antidepressive Agents ; Blood Glucose ; Depressive Disorder ; Energy Metabolism ; Fluoxetine ; Glucose ; Leptin ; Mianserin ; Muscles ; Peroxisome Proliferator-Activated Receptors ; Plasma ; Rats ; RNA, Messenger ; Weight Gain

OBJECTIVE : Modafinil, methylphenidate, and caffeine are wakefulness-promoting substances. Previously, it was reported that caffeine-induced wakefulness differs from natural wakefulness in terms of the EEG spectral profiles. In order to evaluate whether wakefulness induced by other psychostimulants differs from both caffeine-induced and natural wakefulness, we examined the effects of the psychostimulants on sleep-wake architecture and EEG spectral profiles. METHODS : Eighteen Sprague-Dawley male rats underwent an EEG/EMG recording session from 10 : 30 to 17 : 30. They received caffeine (7.5, 15, 30 mg/kg i.p.), methylphenidate (1, 2, 5, 10 mg/kg i.p.) or modafinil (5, 10, 25, 50, 100 mg/kg i.p.) at 13 : 30. The number, total duration, and average duration of sleepwake states were obtained. EEG band powers were calculated by spectral analysis. Frequency bands were divided into the following ranges : D1, 1-2.5 Hz ; D2, 2.5-4.5 Hz ; T1, 4.5-7 Hz ; T2, 7-10 Hz ; SI, 10-14 Hz ; B1, 14-22 Hz ; B2, 22-34 Hz ; GA, 34-50 Hz. RESULTS : All three psychostimulants significantly and dose-dependently increased active wake duration and decreased slow-wave sleep. Equipotent doses of caffeine, methylphenidate, and modafinil for increasing active wake and decreasing slow-wave sleep were 7.5 mg/kg, 10 mg/kg, and 100 mg/kg, respectively. In equipotent doses, an increase of active wake duration by caffeine and methylphenidate was attributed to increases of both frequency and average duration of active wake state, whereas increase of active wake duration by modafinil was attributed to increase of average duration of active wake state only. In equipotent doses, caffeine and methylphenidate decreased the power of lower frequency bands (1-22 Hz), whereas modafinil did not. During slow-wave sleep, modafinil and methylphenidate increased the power of lower frequency bands, but caffeine did not. All the psychostimulants increased the power of the GA band, which was more prominent in the frontal cortex than the parietal cortex. CONCLUSION : These results suggest that moda-nil-induced wakefulness differs from caffeine- or methylphenidate-induced wakefulness in terms of EEG spectral profiles and sleep-wake architecture.
Animals ; Benzhydryl Compounds ; Caffeine ; Electroencephalography ; Humans ; Male ; Methylphenidate ; Rats ; Wakefulness

Many antipsychotics have the potential to increase plasma prolactin levels, leading to a range of short-term and long-term adverse effects. In addition to short-term adverse effects such as galactorrhea, gynecomastia, menstrual irregularities, and sexual dysfunction, a number of important and potentially serious long-term adverse effects have been reported, including loss of bone mineral density, weight gain, pituitary tumor, breast cancer, and prostate cancer. Short-term adverse effects may negatively impact medication compliance, and long-term effects have the potential for serious health consequences. However, to a large degree, hyperprolactinemia has been neglected in clinical practice and research, compared with other potential adverse effects. Balancing the benefits of treatment with antipsychotics against their potential adverse effects is clinically important. Effective management of hyperprolactinemia begins with taking a careful patient history to determine the presence of any relevant signs and symptoms. If a mild elevation of plasma prolactin levels is detected (< 0 ng/mL), then it may be reasonable to continue to monitor the levels. If the elevation is persistent and > 0 ng/mL, then the clinician should consider switching to a drug with a lower potential to elevate prolactin. In any patient with a prolactin elevation greater than 150 ng/mL, a prolactinoma should be considered
Antipsychotic Agents ; Bone Density ; Breast Neoplasms ; Female ; Galactorrhea ; Gynecomastia ; Humans ; Hyperprolactinemia ; Male ; Medication Adherence ; Organothiophosphorus Compounds ; Pituitary Neoplasms ; Plasma ; Pregnancy ; Prolactin ; Prolactinoma ; Prostatic Neoplasms ; Weight Gain