Apart from sleep wake disorders, nowadays, modafinil is being prescribed for several psychiatric disorders including depression. Despite being reported as to be having very low abuse potential, cases of modafinil dependence had come to the limelight. In this case report, we describe a 35 year old man with bipolar affective disorder while in remission who developed modafinil dependence and later on, had hypersexuality when he increased the dose of modafinil from 400 to 1,000 mg/day. Existing literature suggests that modafinil when taken above prescribed doses can cause many side effects ranging from nausea, vomiting to psychotic exacerbation and mania. However, hypersexuality as a side effect of modafinil overuse is not commonly seen. The exact pathophysiological mechanism of modafinil induced hypersexuality is not clear. Clinicians should be aware of possibility of modafinil leading to dependence and this rare significant side effect of modafinil.
Bipolar Disorder ; Depression ; Libido ; Mood Disorders ; Nausea ; Sleep Wake Disorders ; Substance-Related Disorders ; Vomiting

Major depressive disorder and bipolar disorders are among the commonest neuropsychiatric conditions, affecting persons of both sexes which belong to all age groups. Comorbidity is the rule rather than the exception; anxiety spectrum disorders, somatoform disorders, eating disorders and substance use disorders frequently co-exist with mood disorders. Catatonia is a serious complication of the latter and every patient with a severe affective exacerbation should be assessed for the presence of catatonic signs and symptoms. In a significant minority of patients, symptoms show treatment resistance; many patients experience severe hopelessness and suicidal ideation, causing high rates of morbidity and mortality in afflicted individuals. Pharmacological management is challenging and currently available psychotropic agents often fall short of inducing remission. Second generation antipsychotics have been shown in a number of studies as having an antidepressant and mood stabilizing effect. Aripiprazole is a novel antipsychotic which is being increasingly used in difficult to treat mood disorders patients. Several controlled and uncontrolled studies have shown the efficacy and safety of this medication in subjects of all ages. Here a case series of three patients is presented who suffered from refractory mood disorders but responded to aripiprazole with complete remission of affective symptoms.
Affective Symptoms ; Antipsychotic Agents ; Anxiety ; Bipolar Disorder ; Catatonia ; Comorbidity ; Depressive Disorder, Major ; Feeding and Eating Disorders ; Humans ; Mood Disorders* ; Mortality ; Somatoform Disorders ; Substance-Related Disorders ; Suicidal Ideation ; Aripiprazole

Bipolar disorder is a chronic, recurrent condition with the usual onset during adolescence or early adulthood. In the Diagnostic and Statistical Manual of Mental Disorders 5th edition, it is conceptualized as a spectrum disorder usually associated with such comorbidities as anxiety disorders and substance use disorders. It is a relatively prevalent condition often complicated by mixed episodes, rapid cycling, subsyndromal symptoms, and treatment refractoriness. In spite of carrying substantial morbidity and mortality, effective treatments are few and far between and conventional mood stabilizers are often unsuccessful in controlling the various manifestations of the disorder. In this scenario, second generation antipsychotics are emerging as treatments with valid efficacy in all phases of bipolar disorder. Quetiapine is a versatile atypical antipsychotic which was first approved for the treatment of schizophrenia, but latter on the basis of controlled studies earned United States Food and Drug Administration's approval for acute as well as maintenance treatment of this difficult to treat condition. In this review, recently published studies in the last 10 years were examined to update the knowledge about the efficacy and safety of quetiapine in the treatment of bipolar disorder. The medication's clinical pharmacology was first considered followed by a literature review summarizing its uses in bipolar disorder. The conclusion was that quetiapine was efficacious in manic, mixed and depressive episodes and as a maintenance agent with a good tolerability profile.
Adolescent ; Antipsychotic Agents ; Anxiety Disorders ; Bipolar Disorder* ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy* ; Humans ; Mortality ; Pharmacology, Clinical ; Schizophrenia ; Substance-Related Disorders ; United States ; Quetiapine Fumarate

BACKGROUND: Autoantibodies have been detected in patients with psychiatric disorders. However, there is no standard test for the detection of these autoantibodies. In this study, we analyzed autoimmune target (AIT) test results in patients with psychiatric disorders and investigated the clinical utility of the AIT test for psychiatric disorders. METHODS: We retrospectively analyzed data from patients diagnosed with psychiatric disorders between August 1995 and May 2015. Of these, 100 patients assessed using the AIT test were enrolled in this study. Data regarding positive rates, immunofluorescent patterns of AIT results, and the presence of autoimmune diseases in patients with psychiatric disorders were retrospectively collected and analyzed. RESULTS: The autoantibody-positive rate was high in patients with psychiatric disorders (70.0%, 70/100). The positive rates in patients with schizophrenia, depressive disorders, bipolar and related disorders, adjustment disorders, anxiety disorders, and others were 82.9%, 64.7%, 88.9%, 57.1%, 66.7%, and 53.8%, respectively. The most frequent pattern of immunofluorescence was a speckled pattern in 30 cases, followed by microtubule organizing center with microtubule (MTOC-MT) in 17 cases. Twenty-one patients were diagnosed with autoimmune diseases. CONCLUSIONS: In this study, the incidence of autoantibodies was high in patients with psychiatric disorders not specific to schizophrenia. This suggests that the AIT test may therefore have the potential to be a screening test for psychiatric disorders. Further, additional AIT tests in patients with psychiatric disorders may help to clarify the relationships between psychiatric disorders and autoimmune disease.
Adjustment Disorders ; Anxiety Disorders ; Autoantibodies ; Autoimmune Diseases ; Bipolar and Related Disorders ; Depressive Disorder ; Fluorescent Antibody Technique ; Humans ; Incidence ; Mass Screening ; Microtubule-Organizing Center ; Microtubules ; Retrospective Studies ; Schizophrenia

The nationwide spreaded institutionalized mental disordered offenders admitted in the several mental hospitals were transfered in one time after opening in November 3, 1987 until the end of 1988. In 1989, new admitted MDOs were 5.8%, 107 among total 1849, 203 MDOs(11%) were admitted newly in 1997. The new admitted MDOs were increased every year. The diagnosis of total 1849 mental disordered offenders to be admitted during 11 years from November 3, 1987 to December 31, 1997.Schizophrenia is 69.8%, Epilepsy 0%, Personality disorders 4.0%, Mental Retardation 4.0%, Alcohol-related disorder 3.0%, Substance-related disorder(other than alcohol) 2.0%. The crimes of total 1849 MDOs for 11 years are as follows; Homicide 33.2%, Violence 19.2%, Manslaughter 12.5%, Stealing 8.1%, Arson 6.4%, Robbery 2.5%, Rape 2.2%,II-legal Substance Abuse 1.6%. Year average recidivism of MDOs for 11 years are as follows:1st crime 70.6%, 2nd crime 12.3%, 3rd crime 4.9%, 4th crime 3.7%, 5th crime 8.5%. The number 77(6.8%) among 1141 total discharged MDOs are admitted again after discharge from the Forensic Psychiatric Hospital. The readmitted 77 MDOs for 11 years according to crimes are as follows: Stealing 30(38.9%), Substance Abuse 14(18.2%), Violence 11(14.3%), Arson 5(7.8%), Robbery 5(6.5%), Rape 5(6.5%), Homicide 4(5.2%). The readmitted 77 MDOs for 11 years according to crimes are as follows:Stealing 30(38.9%), Substance Abuse 14(18.2%), Violence 11(14.3%), Arson 6(7.8%), Robbery 5(6.5%), Rape 5(6.5%), Homicide 4(5.2%). The readmitted 77 MDOs for 11 years according to diagnosis are as follows: Schizophrenia 36(46.7%), Substance Abuse 15(19.5%), Kleptomaina 6(7.8%), Mental Retardation 4(5.2%), Personality disorders 4(5.2%), Epilesy 1(1.3%), Delusional disorder 2(2.6%), Bipolar Disorder 2(2.6%), Alcohol dependency 1(1.3%). II. Mental evaluation for Criminal Responsibility The diagnostic classification of total 1422 Mental Evaluation for 11 years are as follows: Schizophenia 431(30.3%), Alcohol-related disorder 205(14.4%), Mood disorder 188(13.2%), Personality disorders 124(8.7%), Mental retardation 108(7.6%), Delusional disorder 67(4.7%), and mental disorder due to general medical condition 42(3.0%). The number sentenced to insanity are 597(44.9%) among total 1331, diminished capacity 546(41%), and 'normal' 188(14.1%).
Alcohol-Related Disorders ; Bipolar Disorder ; Classification ; Crime ; Criminals* ; Diagnosis ; Epilepsy ; Firesetting Behavior ; Homicide ; Hospitals, Psychiatric* ; Humans ; Intellectual Disability ; Korea* ; Mental Disorders ; Mood Disorders ; Personality Disorders ; Rape ; Schizophrenia ; Schizophrenia, Paranoid ; Substance-Related Disorders ; Theft ; Violence

OBJECTIVES: This study compares single and repeat suicide attempts, and evaluates the risk factors associated with suicide re-attempts. METHODS: Two hundred and seventy-nine patients admitted to emergency rooms in four university hospitals in Daegu after suicide attempt were included in this study (n=179 single suicide attempters, n=100 repeated attempters). A structured interview focused on demographic, clinical, suicidal and psychological characteristics was administered to these patients after recovery from physical and psychological impairments. RESULTS: Individuals with repeated suicide attempts were younger, more highly educated, had more history of psychiatric treatments, took more psychiatric medications, and had more sustained suicidal ideations, bipolar disorders and personality disorders than individuals with single suicide attempt. Individuals with repeated suicide attempts marked significantly higher scores in the Childhood Trauma Questionnaire, Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale. Multivariate logistic regression showed that below the sixties, history of psychiatric treatments, personality disorders, substance use disorders and sustained suicidal ideations were significantly associated with predictive factors for subsequent suicide attempt. CONCLUSION: Our findings suggest that repeat suicide attempters have different clinical characteristics from single suicide attempters, and some risk factors raise the risk of further suicide attempts. It is necessary for suicidal prevention program planners to be aware of these risk factors, especially for first-time suicide attempters.
Bipolar Disorder ; Daegu ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, University ; Humans ; Logistic Models ; Personality Disorders ; Risk Factors ; Substance-Related Disorders ; Suicidal Ideation ; Suicide*

We report the first two cases of manic and hypomanic episodes respectively induced by risperidone treatment done to schizophrenics in Korea. One case was a 22-year-old woman with catatonic schizophrenia. Since 3 years ago, she had shown psychotic symptoms, but with was poor treatment compliance. She had mainly negative symptoms such as social withdrawal, decreased flood intake, mutism, and symptoms had been worsened since last 4-5 months. Prior to closed ward admission, she was prescribed 2mg/d of risperidone far a week at OPD. Two days after taking medicine totally 6-8mg, she revealed manic features. After hospitalization, risperidone was discontinued and then, lithium 900mg/d and high dosage of conventional antipsychotics(chlorpromazine 1200mg/d or haloperidol 20mg/d) were prescribed. About on the l0th day of hospitalization, there was limited improvement of her manic symptoms. The other case was a 29-year-old man with a 3-year history of paranoid schizophrenia. He was never exposed to antipsychotics before. His main symptoms were delusions of being poisoned and of persecution. His positive and also negative symptoms were alleviated by 38 days of risperidone 2mg/d trial. However, one week after dosage increment to 3mg/d, hypomanic symptoms appeared. Risperidone medication was discontinued and was replaced by chlorpromazine 300mg/d. The hypomanic episode was resolved over 5 days. In both of the two cases, manic episodes occurred by monotherapy of risperidone without mood stabilizer, and there were no history of substance abuse and other psychiatric disorders, family history of psychiatric disorders, and comorbid physical illnesses. It is hypothesized that the potent blockade effect on serotonin(5-HT2) receptor of risperidone causes antidepressant effect, as well as therapeutic effect for negative and affective symptoms in schizophrenia. Risperidone would induce manic or hypomanic features in schizophrenic patients. And there are few case reports of risperidone-induced mania or exacerbation of preexisting manic symptoms by risperidone treatment in mood disorder and schizoaffective disorder. Risperidone is being used more widely, even for obsessive-compulsive disorder and other psychiatric disorders. It is necessary for clinicians to recognize manic switch, one of psychiatric side effects by risperidon trial. It is recommended that the combination of mood stabilizer with risperidone or usage of the minimum effective dose of risperidone may bewefal especially in the patients with mood disorders or schizoaffective disorders. Clozapine which has mood-stabilizing properties is also beneficial in risk groups of risperidone-induced mania.
Adult ; Affective Symptoms ; Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Clozapine ; Compliance ; Delusions ; Female ; Haloperidol ; Hospitalization ; Humans ; Korea ; Lithium ; Mood Disorders ; Mutism ; Obsessive-Compulsive Disorder ; Psychotic Disorders ; Risperidone ; Schizophrenia ; Schizophrenia, Catatonic ; Schizophrenia, Paranoid ; Substance-Related Disorders ; Young Adult

This article provides an overview of the major psychiatric disorders in the adolescence. Attention and disruptive behavior disorders, mood disorders, anxiety disorders, alcohol and substance use disorders, and schizophrenia are the main diagnostic categories of adolescent psychiatric disorders. Attention and disruptive behavior disorders include attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Mood disorders include depressive disorder and bipolar disorder, and anxiety disorders include obsessive compulsive disorder, social phobia, and posttraumatic stress disorder. Eating disorders and tic disorders are described in the category of other disorders. This article discusses the demographic and clinical characteristics of the aforementioned disorders, focusing on the adolescent-specific clinical characteristics and the possible co-morbid conditions of each disorder. Diagnostic and evaluative points of each disorder for clinicians are also highlighted.
Adolescent ; Anxiety Disorders ; Attention Deficit and Disruptive Behavior Disorders ; Attention Deficit Disorder with Hyperactivity ; Bipolar Disorder ; Conduct Disorder ; Depressive Disorder ; Feeding and Eating Disorders ; Humans ; Mental Disorders ; Mood Disorders ; Obsessive-Compulsive Disorder ; Phobic Disorders ; Schizophrenia ; Stress Disorders, Post-Traumatic ; Substance-Related Disorders ; Tic Disorders

In the majority of cases of bipolar disorder, manic episodes are usually brief and typically responsive to currently available psychopharmacological agents. In contrast, depressive manifestations are more prevalent and persistent, and can present as major depressive/mixed episodes or residual interepisode symptoms. The depressive phase is often associated with other neuropsychiatric conditions, such as anxiety spectrum disorders, substance use disorders, stressor-related disorders, and eating disorders. It is viewed as a systemic disease with associated ailments such as metabolic syndrome, diabetes mellitus, and cardiovascular disease. There is an increased rate of mortality not only from suicide, but also from concomitant physical illness. This scenario is made worse by the fact that depressive symptoms, which represent the main disease burden, are often refractory to existing psychotropic drugs. As such, there is a pressing need for novel agents that are efficacious in acute depressive exacerbations, and also have applicable value in preventing recurrent episodes. The rationale of the present review is to delineate the pharmacotherapy of the depressive phase of bipolar disorder with medications for which there is evidence in the form of observational, open-label, or double-blind randomized controlled studies. In the treatment of acute bipolar depression in adults, a comprehensive appraisal of the extant literature reveals that among mood stabilizers, the most robust proof of efficacy exists for divalproex sodium; while atypical antipsychotics, which include olanzapine, quetiapine, lurasidone, and cariprazine, are also effective, as demonstrated in controlled trials.
Adult* ; Anticonvulsants ; Antipsychotic Agents ; Anxiety ; Bipolar Disorder* ; Cardiovascular Diseases ; Depression ; Diabetes Mellitus ; Drug Therapy* ; Eating ; Humans ; Lurasidone Hydrochloride ; Mortality ; Psychotropic Drugs ; Quetiapine Fumarate ; Substance-Related Disorders ; Suicide ; Valproic Acid

Bile Salt Export Pump (BSEP) Deficiency disease, including Progressive Familial Intrahepatic Cholestasis type 2 (PFIC2), is a rare disease, usually leading within the first ten years to portal hypertension, liver failure, hepatocellular carcinoma. Often liver transplantation is needed. Sodium 4-phenylbutyrate (4-PB) seems to be a potential therapeutic compound for PFIC2. Psychiatric side effects in the adolescent population are little known and little studied since the drug used to treat children and infants. So we described a case of Caucasian boy, suffering from a late onset PFIC2, listed for a liver transplant when he was sixteen and treated with 4-FB (200 mg per kilogram of body weight per day). The drug was discontinued for the onset of bipolar and related disorders. This case illustrates possible psychiatric side effects of the drug.
Adolescent* ; Bile* ; Bipolar and Related Disorders* ; Body Weight ; Carcinoma, Hepatocellular ; Child ; Cholestasis, Intrahepatic ; Deficiency Diseases* ; Humans ; Hypertension, Portal ; Infant ; Liver ; Liver Failure ; Liver Transplantation ; Male* ; Rare Diseases ; Sodium*