OBJECTIVES: This study was conducted to develop the Korean version of Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS) for measuring neuroleptic side effects by self-rating method and to examine the reliability and validity in the schizophrenic patients medicated by neuroleptics and normal controls. METHODS: We made 51-item, 4-point scale of Korean version LUNSERS through translation, reverse translation and supervision by specialists. Sixty two schizophrenics diagnosed by DSM-IV criteria and medicated with neuroleptics completed LUNSERS twice with one week interval. Second LUNSERS and UKU side effect rating scale (UKU) by psychiatrist were administered to the schizophrenics at the same time. Normal controls also completed LUNSERS. RESULTS: The test-retest reliability (r=0.86, p<0.01) of LUNSERS and the concurrent validity (r=0.81, p<0.001) against UKU were good. But the neuroleptic doses and total scores of side effect items didn't show significant correlation. By the ROC curve analysis, the total scores of side effect items differentiated the medicated patients from non-medicated controls but not for the red herring items. CONCLUSION: Korean-version of LUNSERS has good reliability and validity. And it was also proved to be an useful assessment tool for measuring the extent of neuroleptic side effects systematically instead of UKU in clinical trials.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Organization and Administration ; Psychiatry ; Reproducibility of Results ; ROC Curve ; Specialization

INTRODUCTIONPolypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy.

MATERIALS AND METHODSA treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later.

RESULTSThere were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics.

CONCLUSIONThe implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.

Adult ; Algorithms ; Antipsychotic Agents ; administration & dosage ; Female ; Humans ; Male ; Polypharmacy ; Psychotic Disorders ; drug therapy

Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.
Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Consensus ; Lithium ; Lurasidone Hydrochloride ; Quetiapine Fumarate ; Risperidone ; United States Food and Drug Administration

Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.
Antidepressive Agents ; Antipsychotic Agents ; Depressive Disorder ; Depressive Disorder, Major ; Depressive Disorder, Treatment-Resistant ; Humans ; United States Food and Drug Administration

INTRODUCTIONA bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011.

METHODSA search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors 'atypic* antipsychotic*', 'second-generation antipsychotic*', 'clozapine', 'risperidone', 'olanzapine', 'ziprasidone', 'quetiapine', 'sertindole', 'aripiprazole', 'paliperidone', 'amisulpride', 'zotepine', 'asenapine', 'iloperidone', 'lurasidone', 'perospirone' and 'blonanserin' in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price's Law on the increase of scientific literature, and Bradford's Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development.

RESULTSFrom 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price's Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2.

CONCLUSIONPublications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.

Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; administration & dosage ; Bibliometrics ; Biomedical Research ; methods ; Clozapine ; administration & dosage ; Humans ; Journal Impact Factor ; Publications ; Risperidone ; administration & dosage ; Singapore

Antipsychotic drugs have focused on treatment of positive and negative symptoms of schizophrenia. While these drugs resulted in improvements of these symptoms, they did not yield the expected recovery to pre-morbid level of functioning. Recently, a growing number of publications have shown that the cognitive deficits are a core feature of schizophrenia and they are critical determinants of poor functional outcome. Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) is a NIMH initiative that is designed to stimulate development of drugs to improve cognition in schizophrenia. MATRICS has four main goals: 1) to promote development of novel compounds to enhance cognition in schizophrenia, 2) to increase acceptance of cognition in schizophrenia as a valid target for drug approval from the US Food and Drug Administration, 3) to help focus the economic research power of industry on this important, but neglected, clinical target, and 4) to identify promising compounds and support proof of concept trials for cognition-enhancers in schizophrenia. In this article, we reviewed the contents of MATRICS and its progress.
Antipsychotic Agents ; Cognition* ; Drug Approval ; National Institute of Mental Health (U.S.) ; Psychopharmacology ; Schizophrenia* ; United States Food and Drug Administration

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.
Aged* ; Antipsychotic Agents* ; Behavioral Symptoms ; Delusions ; Dementia* ; Equidae ; Hallucinations ; Humans ; Psychotic Disorders ; Risk Factors ; United States Food and Drug Administration

The purpose of this study was to develop and test a structural model explaining medication compliance of schizophrenia. From a review of the literature, a hypothetical model was developed based on the conceptual framework of the Health Belief Model with medication knowledge, symptom severity and social support as the exogenous variables, and perceived benefits, perceived barriers, substance use and medication compliance as the endogenous variables. Data was collected at various mental health facilities, including psychiatric outpatient clinics of general hospitals and community mental health centers, between March and May, 2001. A structured questionnaire was used by one- on- one interviews to collect data on 208 schizophrenic patients. Well established measurement instruments, with confirmed reliability, were used to assess each method variable. As a result of covariance structural analysis, the hypothetical model was found not to fit the empirical data well, so a parsimonious model was adopted after modifying the model. The final model was able to explain the 33% medication compliance. Medication knowledge, social support and perceived benefits had significant effects on medication compliance. The findings of this study address the importance of medication education and social support to promote medication compliance. It is also suggested that various education programs and support groups are needed to enhance medication compliance.
Adult ; Antipsychotic Agents/*administration & dosage ; Female ; Humans ; Male ; *Models, Psychological ; Patient Compliance/*psychology ; Schizophrenia/*drug therapy ; Self Administration/*psychology ; Social Support

AIMTo develop and validate a liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method for the determination of risperidone in human plasma.

METHODSRisperidone and the internal standard, diphenhydramine, were isolated from plasma by liquid-liquid extraction with etherdichloromethane (3:2, v/v) , then chromatographed on a Zorbax Extend-C18 column (150 mm x 4.6 mm ID, 5 microm) using a mobile phase consisted of acetonitrile-water-formic acid (40:60: 0.5, v/v), at a flow rate of 0.7 mL x min(-1). A Finnigan TSQ tandem mass spectrometer equipped with atmospheric pressure chemical ionization source was used as detector and was operated in the positive ion mode. Selected reaction monitoring (SRM) using the precursor product ion combinations of m/z 411-->191 and m/z 256-->167 were used to quantify risperidone and diphenhydramine (IS) , respectively.

RESULTSThe linear concentration range of the calibration curve for risperidone was 0.025 - 50 microg L(-1). The lower limit of quantification was 0.025 microg x L(-1). The intra- and inter-day relative standard deviation (RSD) across three validation running over the entire concentration range was less than 7.1%. The accuracy was within +/- 3.8%. Each sample was chromatographed within 2.7 min.

CONCLUSIONThe method was proved to be rapid, sensitive and suitable for pharmacokinetic investigations of risperidone.

Antipsychotic Agents ; administration & dosage ; blood ; pharmacokinetics ; Chromatography, Liquid ; methods ; Diphenhydramine ; blood ; standards ; Humans ; Male ; Reference Standards ; Reproducibility of Results ; Risperidone ; administration & dosage ; blood ; pharmacokinetics ; Tandem Mass Spectrometry ; methods

OBJECTIVE: Although antipsychotic treatments are effective for schizophrenia, at least 25% of schizophrenic patients have little response to conventional neuroleptics. Although patients respond well to antipsychotics initially, they often result in heavy loss of costs and social burden due to the frequent relapse which often require intensive institutional care while the patients experience significant social and functional disabilities. Many studies have come out recently concerning the cost of schizophrenia and its cost-effectiveness in treatment. Clozapine has the risk of agranulocytosis and greater initial cost, however, it has been reported to be cost-effective for the treatment of refractory schizophrenia because of its highly effectiveness, in addition, it has reduced rehospitalization rates and hospital stays. The purpose of this retrospective study was to ascertain the cost-effectiveness of clozapine treatment for patients with refractory schizophrenia in Korea. METHOD: We studied 17 patients with refractory schizophrenia treated by clozapine over a two year period. The numbers of hospitalization, hospital stays two years before clozapine treatment, and two years after clozapine treatment were investigated. Direct costs of psychiatric hospitalization, outpatient treatment, and other costs were estimated. Data on patients' clinical characteristics, use of mental health services and information about the cost of treatments were collected from psychiatric hospitalization records, outpatient records and hospital administration records. Some of the patient data information before the introduction of clozapine treatment were gathered through direct interviews of their families. Therapeutic outcome measures included the Clinical Global Impression (CGI) scale and Global Assessment of Functioning (GAF) score. RESULT: At the initial clozapine treatment, the mean age of subjects was 29 (+/- 7.9) years old. The mean duration of previous psychiatric treatment was 8 (+/- 3.0) years. Average total direct costs were reduced from \4,106,480 in the second pretreatment year to \2,338,427 in the second posttreatment year while the mean hospitalization costs, a percentage of total direct costs, were reduced from 82.9% to 27.4%. Also, the mean hospital stays per year were decreased from 83.4 days to 15.7 days, the mean numbers of hospitalization from 0.59 to 0.18. CGI scale scores and GAF scores showed a statistically significant clinical improvement between before and after clozapine treatment. CONCLUSION: These results suggest that a long-term treatment of clozapine for patients with refractory schizophrenia is indeed more cost-effective than conventional neuroleptic treatment. We suggest more comprehensive and prospective study due to the limitations of this retrospective study.
Agranulocytosis ; Antipsychotic Agents ; Clozapine* ; Hospital Administration ; Hospitalization ; Humans ; Korea ; Length of Stay ; Mental Health Services ; Outcome Assessment (Health Care) ; Outpatients ; Recurrence ; Retrospective Studies ; Schizophrenia*