OBJECTIVE: Our pilot study aims to investigate the efficacy of a Short-Term (4 weeks) Psychiatric Rehabilitation Program (S-T PsyRP), without specific cognitive remediation trainings, on the neuropsychological performance and psychosocial functioning of inpatients with Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Published studies with similar aims are lacking. METHODS: Fifty-three inpatients with MDD and 27 with BD (type I/II) were included. The S-T PsyRP was usually performed as clinical practice at Villa San Benedetto Menni Hospital and included a variety of activities aimed at promoting personal autonomies, interpersonal/social skills, and self-care. At the beginning and the end of the hospitalization we evaluated: neuropsychological performance (cognitive tests on verbal/visual working memory, attention, visual-constructive ability, language fluency, and comprehension); psychosocial functioning by the Rehabilitation Areas Form (RAF, handbook VADO); illness severity by the Brief Psychiatric Rating Scale (BPRS). Repeated-measure ANOVA and Pearson's linear correlation were used. RESULTS: We found significant improvement (p<0.01) in all the neuropsychological tests except for one, in 4 out of 6 RAF psychosocial areas (“involvement in ward activities”, “autonomies”, “self-care”, and “self-management of health”) and in clinical symptoms severity. No associations were found between the amelioration of clinical symptoms and neuropsychological or psychosocial improvement. CONCLUSION: A S-T PsyRP without specific cognitive remediation trainings may improve several cognitive/functional domains in MDD or BD inpatients, probably by offering opportunities to engage in demanding problem-solving conditions and cognitively stimulating activities.
Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Depression ; Depressive Disorder, Major ; Hospitalization ; Humans ; Inpatients ; Memory, Short-Term ; Neuropsychological Tests ; Neuropsychology ; Pilot Projects ; Psychiatric Rehabilitation* ; Rehabilitation ; Self Care

OBJECTIVES: Stigma resistance is an individual capacity to fight the stigma of mental illness and is an issue of ongoing research regarding the stigma. The aim of this study was to evaluate predictors of stigma resistance in patients with bipolar disorder. METHODS: Demographic, clinical, and psychosocial data were collected from 102 bipolar patients in a university mental hospital. Stigma resistance was measured using a subscale of the Internalized Stigma of Mental Illness Scale. Patients completed self-reported questionnaires including items on self-esteem, hopelessness, social support, and social conflict. RESULTS: Stigma resistance showed positive association with functioning, self-esteem, and social support, and showed negative association with depressive symptoms, hopelessness, and social conflict. In multivariate analysis, stigma resistance was predicted by sex, education, and self-esteem. Self-esteem was the strongest predictive factor of stigma resistance. CONCLUSION: In accordance with previous studies, self-esteem was a central role of predicting stigma resistance. A program for improving self-esteem and its related psychosocial factors will be helpful to enhancing stigma resistance in bipolar patients.
Bipolar Disorder* ; Depression ; Education ; Hospitals, Psychiatric ; Humans ; Multivariate Analysis ; Psychology ; Self Concept

OBJECTIVE: The aim of the present study was to examine the association between serotonin-related gene polymorphisms and bipolar disorder in the Korean population. In addition, we sought to explore the relationship between the clinical characteristics of bipolar patients and serotonin-related gene polymorphisms. METHODS: Inpatients with bipolar disorder (n=103) and control subjects (n=86) were genotyped for 5HT2A 1438A/G, tryptophan hydroxylase 1 (TPH1) 218 A/C, and TPH2 703G/T. We divided patients with bipolar disorder into two groups according to the presence of psychotic symptoms. The severity of their symptoms was measured using the Young Mania Rating Scale (YMRS) and the Brief Psychiatric Rating Scale (BPRS). RESULTS: There were no significant differences in the genotype distributions or allelic frequencies in the three serotonergic polymorphisms between patients with bipolar disorder and normal controls. There were significant differences in genotype distributions and allele frequencies of the 5-HT2A -1438A/G polymorphism between the psychotic mania group and the non-psychotic mania group (genotype: chi-square=7.50, p=0.024; allele: chi-square=5.92, p=0.015). However, after Bonferroni correction this signifact difference disappeared. We did not find significant differences in the genotype distributions or allelic frequencies in the TPH1 218 A/C and TPH2 703G/T polymorphisms between the psychotic mania group and non-psychotic mania group. CONCLUSION: We failed to found the statistically significant association between three polymorphisms and bipolar disorder. However, there was a trend towards association between 5-HT2A -1438A/G polymorphism and psychotic symptom in bipolar disorder. Future research should seek to clarify this association.
Bipolar Disorder ; Brief Psychiatric Rating Scale ; Gene Frequency ; Genotype ; Humans ; Inpatients ; Serotonin ; Tryptophan Hydroxylase

OBJECTIVE: The aim of this study was to validate the psychotic depression assessment scale (PDAS), which includes the six-item melancholia subscale from the Hamilton depression rating scale (HAMD-6) and the five-item psychosis subscale from the brief psychiatric rating scale (BPRS-5). Data from the Clinical Research Center for Depression (CRESCEND) study, which is a 52-week naturalistic trial, were analyzed. METHODS: Fifty-two patients with psychotic depression from the CRESCEND study met our inclusion criteria. The patients underwent the following psychometric assessments: the PDAS, including HAMD-6 and BPRS-5, the clinical global impression scales, the HAMD, the positive symptom subscale, and the negative symptom subscale. Assessments were performed at the baseline and then at weeks 1, 2, 4, 8, 12, 24, and 52. Spearman correlation analyses were used to assess the clinical validity and responsiveness of the PDAS. RESULTS: The clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, were acceptable, with the exception of the clinical responsiveness of the PDAS for positive symptoms and the clinical responsiveness of BPRS-5 for negative symptoms. CONCLUSION: The clinical relevance of the PDAS has been confirmed and this clinical validation will enhance its clinical utility and availability.
Brief Psychiatric Rating Scale ; Depression* ; Depressive Disorder ; Humans ; Psychometrics ; Psychotic Disorders ; Weights and Measures

OBJECTIVES: The goal of this study was to predict the factors related to psychiatric inpatients' violence in a mental hospital. This was a follow-up study to assess the psychopathology of patients and the quality of the initial therapeutic alliance between the patient and the therapist, as a predictor of the risk of violent behavior. METHODS: The subjects were 105 psychiatric inpatients admitted to St. Andrews' Neuropsychiatric Hospital from January 1998 to November 1998, but alcohol dependent patients and conduct disorder patients were excluded. Within the first five hospital days, we rated past history of violence, patients' psychopathology using Brief Psychiatric Rating Scale and quality of initial therapeutic alliance. We also evaluated violent behaviors using Overt Aggression Scales during the two weeks before admission and during the two weeks of hospital stay and compared the 67 non-violent ingatients with 38 violent ingatients on the utility of socio-demographics variables, past history of violence, utility of the initial therapeutic alliance and psychopathology in evaluating the risk of violent behaviors. Multiple logistic analysis was conducted to analyze risk factors for violent behaviors. RESULTS: 1) The violent inpatients significantly were more closely related with the previous history of violent behavior. 2) The weaker the initial therapeutic alliance were, the significantly higher violent behavior exhibited. 3) Violent behavior was related significantly with higher BPRS-agitation-excitement factor score and higher BPRS-hostile-suspicious factor score. Violent behavior also was related with lower BPRS-withdrawal-retardation factor score. 4) According to the multiple logistic analysis, the predictors of violent behavior were past history of violence and initial therapeutic alliance and BPRS-agitation-excitement factor. CONCLUSION: The results suggest that initial therapeutic alliance and the specific psychopathology ane useful in evaluating patients' risk for violence.
Aggression ; Brief Psychiatric Rating Scale ; Conduct Disorder ; Follow-Up Studies ; Hospitals, Psychiatric ; Humans ; Inpatients* ; Length of Stay ; Psychopathology ; Risk Factors ; Violence* ; Weights and Measures

OBJECTIVES: Our study aimed to present the distinctive correlates of disorganized speech in patients with schizophrenia, using the Scale for the Assessment of Thought, Language and Communication (TLC scale). METHODS: We compared the formal thought and other clinical characteristics between schizophrenia inpatients with (n=82) and without (n=80) disorganized speech. Psychometric scales including the TLC scale, Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Calgery Depression Scale for Schizophrenia (CDSS) and Word Fluency Test (WFT) were used. The presence or absence of disorganized speech was established using transformed dummy variable of score on the Clinician-Rated Dimension of Psychosis Symptom Severity (CRDPSS). RESULTS: After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the poverty of contents of speech (p=0.001), distractible speech (p<0.0001), tangentiality (p<0.0001), derailment (p<0.0001), incoherence (p<0.0001), ilogicality (p<0.0001), word approximations (p=0.003), loss of goal (p<0.0001), blocking (p=0.006) and self-reference (p=0.002) items than those without disorganized speech. With defining the mentioned item scores as covariates, binary logistic regression model predicted that derailment (p=0.0001) and poverty of contents of speech (p<0.0001) were significant independent-correlates of disorganized speech in patients with schizophrenia. CONCLUSION: Our findings suggest that derailment and poverty of contents of speech are significant correlates of disorganized speech in patients with schizophrenia. Our findings might be used to evaluate disorganized speech in patients with schizophrenia efficiently.
Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Humans ; Inpatients ; Logistic Models ; Poverty ; Psychometrics ; Psychotic Disorders ; Schizophrenia* ; Weights and Measures

OBJECTIVES: Formal thought disorder has been regarded as an essential symptom in the diagnostic criteria for schizophrenia. The aim of our study was to present gender differences in the formal thought disorder among patients with schizophrenia. METHODS: We tested for potential gender differences in the formal thought disorder among 167 inpatients with schizophrenia (86 men and 81 women). The Scale for the Assessment of Thought, Language and Communication (TLC scale), Clinical Language Disorder Rating Scale (CLANG), Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used for evaluation of thought disorder, language disorder, overall symptoms, manic symptoms, and depressive symptoms, respectively. Using the analysis of covariance for continuous variables and logistic regression analysis for discrete variables, gender differences in the formal thought disorder were evaluated. RESULTS: After adjusting for the effects of marital status and religious affiliation, men showed a significantly higher score on the perseveration (TLC scale ; F=7.538, p=0.007), blocking (TLC scale ; F=8.956, p=0.003), stilted speech (TLC scale ; F=6.921, p=0.009), lack of details (CLANG ; F=7.375, p=0.007), dysfluency (CLANG ; F=21.250, p<0.0001), and dysarthria (CLANG ; F=31.198, p<0.0001) items than women. CONCLUSION: Our study has a virtue of exploring gender differences in the formal thought disorder in patients with schizophrenia. Based on our findings, further study might enlighten regarding neural correlates (namely, cerebral asymmetry/lateralization) for gender-differed patterns of the formal thought disorder in patients with schizophrenia.
Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Dysarthria ; Female ; Humans ; Inpatients ; Language Disorders ; Logistic Models ; Male ; Marital Status ; Schizophrenia* ; Virtues

Patients with borderline personality disorder (BPD) show significant impairment in functioning, particularly in the interpersonal and social domains. Prior reports suggest that clozapine may be effective in the management of BPD. We present the case of a patient with BPD who experienced persistent suicidal ideation and was treated with clozapine at a state psychiatric hospital. After treatment failure with other psychotropic medications, clozapine medication was initiated; not only did suicidal ideation cease, but social and professional functioning also greatly improved to the point of no longer requiring intensive levels of observation or restrictive procedures. Clozapine appears to be efficacious in the management of suicide attempts and self-injurious behavior. Moreover, it appears to be promising as a therapeutic measure for ameliorating the global functioning of patients with severe BPD. Larger, randomized, blinded, and controlled prospective studies are needed to confirm these findings and to determine optimal dosage.
Borderline Personality Disorder* ; Clozapine* ; Hospitals, Psychiatric ; Humans ; Prospective Studies ; Self-Injurious Behavior ; Social Adjustment ; Suicidal Ideation ; Suicide ; Treatment Failure

OBJECTIVE: This study was to investigate the prevalence of tardive dyskinesia (TD) in Korean inpatients using antipsychotics and the relationship between TD and sociodemographic, clinical variables. METHODS: This study was done from January to Feburary, 2003, at the Seoul National Mental Hospital. A cross-sectional assessment of randomly selected inpatients (n=324;mean age=39.73+/-9.63years) with DSM-IV schizophrenia, schizoaffective, bipolar disorder was performed with standard rating instrument for TD and extrapyramidal symptoms. The relations between the prevalence of TD and sex, age, length of medication and dosage of antipsychotics, clozapine, and other psychotropic medication, EPS were analyzed with Chi-square test or t-test. RESULTS: Using Schooler and Kane's criteria, 20 subjects (6.17%) had TD. TD was significantly less prevalent in patients receiving clozapine. There was no other significant difference between the TD and without TD groups with respect to type of antipsychotics, other psychotropic drug, antiparkinsonian drug, mood stabilizer augmentation. CONCLUSION: The result of this study have confirmed the lower prevalence of TD among inpatients using antipsychotics compared to previous investigations. The study has also replicated the association of TD with older age. Clozapine use was associated with lower prevalence rate of TD.
Antipsychotic Agents* ; Bipolar Disorder ; Clozapine ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, Psychiatric ; Humans ; Inpatients* ; Movement Disorders* ; Prevalence* ; Schizophrenia ; Seoul

OBJECTIVE: Although atypical antipsychotics are increasingly being used as monotherapy in acute mania, few Korean studies have investigated on them. This study evaluated the efficacy and tolerability of olanzapine monotherapy in patients with acute mania. METHODS: This multicenter, open-label study evaluated the efficacy of olanzapine to treat mania over 6 weeks. Patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were treated with olanzapine (flexible dosage to a maximum of 30 mg/day). Clinical improvements were rated using the Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Version (CGI-BP), Brief Psychiatric Rating Scale (BPRS), and the Montgomery-Asberg Depression Rating Scale (MADRS). Adverse events were measured using the Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The general functioning of patients was assessed using the Global Assessment Scale (GAS). All assessments were carried out at baseline and at days 7, 14, 21, and 42, with the exception of the GAS. RESULTS: The subjects comprised 76 patients (male=38, female=38), with 55 patients (72.4%) completing the study. The mean initial dose of olanzapine was 11.7+/-5.0 mg/day and mean daily doses at days 7, 14, 21, and 42 were 16.6+/-5.2, 17.2+/-5.0, 18.1+/-5.3, and 17.4+/-4.7 mg/day, respectively. At days 7, 14, 21, and 42, YMRS, CGI-BP, MADRS and BPRS scores had significantly improved from baseline. More improvement in MADRS scores was observed among patients with mixed mania than patients with euphoric mania. Changes in BPRS scores from baseline did not differ between patients with psychotic symptoms and those with euphoric mania. At days 21 and 42, 42 (55.3%) and 57 (75.0%) patients had responded (YMRS scores decreased from baseline by more than 50%). Also 27 (35.5%) and 46 (60.5%) patients had achieved remission (YMRS scores < or =12) at the same assessment points. GAS scores at days 21 and 42 indicated that olanzapine monotherapy improved patients' global functioning compared to baseline. SARS and BARS scores did not differ significantly between pre- and post-drug trial. CONCLUSION: The data indicate that olanzapine monotherapy has favorable effects across a broad range of mood symptoms and yields functional improvement in acute manic patients with minimal adverse events. Therefore, olanzapine monotherapy may be a preferred first-line agent to treat patients with acute mania. These results support the findings from previous studies and guidelines.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychomotor Agitation