Medical education, especially psychiatry, is now in a state of evolution and change but has difficulty in adapting to the even more rapidly changing health care systems. we will continue to debate what will be the roles of doctors in mind and how we can continue to prepare medical students for their tasks within this framework of change.
Delivery of Health Care ; Education* ; Education, Medical ; Humans ; Students, Medical

Medical education, especially psychiatry, is now in a state of evolution and change but has difficulty in adapting to the even more rapidly changing health care systems. we will continue to debate what will be the roles of doctors in mind and how we can continue to prepare medical students for their tasks within this framework of change.
Delivery of Health Care ; Education* ; Education, Medical ; Humans ; Students, Medical

Cognitive deficit is frequently observed in patients with schizophrenia. It is significantly associated with functional outcome. In the past 20 years, due to significant advances on the concept of schizophrenia, cognitive deficit has been accepted as a core feature. In the DSM-5, cognitive deficit does not introduce diagnostic criteria of schizophrenia, but did one dimension of diagnosis of psychosis. Existing schizophrenia drugs are effective in treatment of positive symptoms of schizophrenia, but lack of effectiveness on improving cognitive function. Led by NIMH (National Institute of Mental Health), the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) meeting was conducted in order to achieve consensus on measuring tools and neuropharmacological targets for clinical trials for development of new drugs for improvement of cognitive function in schizophrenia. At the MATRICS consensus meeting, glutamatergic modulators and nicotinic and muscarinic agonists are expected to be promising, but should be proven by a double-blind placebo-controlled multicenter study for patients.
Cognition ; Consensus ; Diagnosis ; Drug Therapy ; Humans ; Muscarinic Agonists ; National Institute of Mental Health (U.S.) ; Psychotic Disorders ; Schizophrenia*

A number of brain imaging and human lesion studies suggest an involvement of the cerebellum in various cognitive functions. A 60-year-old woman developed dizziness due to cerebellar infarction. One month later, she developed cognitive decline, delusion, irritability, impulsive and violent behavior. Cognitive and behavioral symptom onset, neuroimaging findings and neuropsychological test led us to the diagnosis of cerebellar cognitive affective syndrome.
Arteries ; Behavioral Symptoms ; Cerebellum ; Delusions ; Dizziness ; Female ; Humans ; Infarction ; Middle Aged ; Neuroimaging ; Neuropsychological Tests

OBJECTIVE: The author investigated the association between the genotype distribution of 5-HTTLPR and the effects of atypical antipsychotics on serum glucose and lipids in schizophrenic patients. METHODS: Study subjects were 66 schizophrenic patients taking atypical antipsychotics (risperidone, olanzapine, clozapine, quetiapine, zotepine). The control group consisted of 82 schizophrenic patients taking typical antipsychotics (haloperidol). All subjects were medicated for at least 12 weeks. The author examined serum fasting blood sugar (FBS), HbA1c, total cholesterol, triglyceride, and the genotype distribution of 5-HTTLPR in all subjects. The presence of the 5-HTTLPR gene was determined by using polymerase chain reaction of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Between group comparisons of the genotype distribution and the effects of antipsychotics on the serum glucose and lipid levels were performed by using score test for t-test, one way ANOVA, and chi-square test. RESULTS: There was a significant increase in FBS level in all patients taking atypical antipsychotics except for those treated with risperidone. However, there was no statistically significant correlation between 5-HTTLPR genotype distribution and the effect of atypical antipsychotics on FBS, HbA1c, total cholesterol, and triglyceride serum levels in schizophrenic patients. CONCLUSION: These results suggest that 5-HTTLPR polymorphism has no significant association with the effect of atypical antipsychotics on serum glucose and lipids in Korean schizophrenic patients.
Antipsychotic Agents* ; Blood Glucose* ; Cholesterol ; Clozapine ; DNA ; Fasting ; Genotype ; Humans ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Risperidone ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins* ; Serotonin* ; Triglycerides

OBJECTIVE: 5-HTTLPR (5-HT transporter-linked polymorphic region), located in the promoter region of 5-HT transporter gene, was reported to be associated with several neuropsychiatric illnesses. In this study, we investigated the genotype distribution and allele frequency of serotonin transporter gene 5-HTTLPR in schizophrenic patients and normal controls using an independent Korean sample. METHODS: Subjects were 156 schizophrenic patients fulfilling the DSM-IV criteria for schizophrenia who had taken antipsychotics for at least 6 months and 96 normal controls who had no past and family history of psychiatric illnesses. Two negative symptoms of PANSS, blunted affect and emotional withdrawal, were rated in all patients by two experienced psychiatrists. We examined the genotype distribution and allele frequency of the serotonin transporter gene 5-HTTLPR in all subjects, using polymerase chain reaction (PCR) of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Between-group comparisons of the genotype distribution and allele frequency were performed by using score test for trend, Fisher's exact test, and chi-square test. RESULTS: There was no significant difference in 5-HTTLPR genotype distribution and allele frequency between schizophrenic patients and normal controls. There was also no significant difference in 5-HTTLPR genotype distribution and allele frequency between schizophrenic patients with and without the two negative symptoms, blunted affect or emotional withdrawal, respectively. CONCLUSION: These results suggest that 5-HTTLPR polymorphism had no significant association with schizophrenia and negative symptoms in a Korean sample.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Gene Frequency ; Genotype ; Humans ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Psychiatry ; Schizophrenia* ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

OBJECTIVE: Hyperprolactinemia and associated side effect, amenorrhea, often occur with risperidone treatment. We investigated the effect of adjunctive treatment with aripiprazole on risperidone induced amenorrhea in female patients with schizophrenia. METHODS: A retrospective chart review of 24 female patients with adjunctive aripiprazole treatment for risperidone induced amenorrhea between August 2008 and July 2009 was conducted. The information collected included age, menstrual cycle, duration of no menstruation, prolactin level (before aripiprazole treatment and after regaining menstruation), dose of risperidone and aripiprzole, time from starting aripiprazole adjunctive treatment to regaing menstruation. The Student's t-test, Pearson's Chi-square test were used for data analysis. RESULTS: Mean percent decrease in prolactin level for all aripiprazole-treated patients was 71.4+/-8.6%. 85.7% (18/21) of patients resumed menstruation, while 14.3% (3/21) did not regain. In patients with regaining menstruation, mean time from starting aripiprazole to restarting menstruation was 6.6+/-2.4 weeks, mean dose of aripiprazole was 12.2+/-3.9 mg/day (dose range, 5 mg to 20 mg/day). Aripiprazole dose for regaining menstruation was not significantly correlated with baseline prolactin level. CGI score was not significantly changed after aripiprazole treatment. The cutoff point of prolactin level significantly increasing amenorrhea was 40 ng/mL. CONCLUSION: Adjunctive aripiprazole treatment is very effective to treat risperidone induced amenorrhea in female patients with schizophrenia.
Amenorrhea ; Chi-Square Distribution ; Female ; Humans ; Hyperprolactinemia ; Menstrual Cycle ; Menstruation ; Piperazines ; Prolactin ; Quinolones ; Retrospective Studies ; Risperidone ; Schizophrenia

OBJECTIVE: A Comparison of QTc prolongation for various antipsychotics and an analysis of QTc prolongation for the various types of serotonin transporter polymorphism were performed. METHOD: EKG was checked, followed by QTc measurement as Bazett's correction, and the serotonin transporter polymorphism was examined in 110 chronic schizophrenia patients were performed EKG before 24 weeks ago. We defiened QTc prolongation as over 450ms. The risk factor of sudden cardiac death were defiend as QTc prolongation and or 60ms in delta value. RESULT: The prevalence of QTc prolongation in this study was 7.3%, and the prevalence of over 60ms was 4.5%. Patients who had the risk factors were 10(9.1%). 6/52 who prescribed atypical antipsychotics and 2/58 who prescribed haloperidol showed QTc prolongation. The prevalence who had the risk factor of sudden cardiac death were 16% in atypical antipsychotics group, 3.4% in haloperidol group. QTc prolongation were observed more frequently in l/l type than s/s type. l allele frequency were 50% in QTc prolongated group, 19% in not prolongated group. l allele had an association with QTc prolongation(p<0.01). CONCLUSION: The prevalence of QTc prolongatin was frequent in chronic schizophrenia patients who were prescribed atypical antipsychotics. It has strong association with l allele of 5-HTTLPR.
Alleles ; Antipsychotic Agents ; Death, Sudden, Cardiac ; Electrocardiography ; Gene Frequency ; Haloperidol ; Humans ; Prevalence ; Risk Factors ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins

OBJECTIVES: According to the recent Korean National Police Agency report, rape victims were 17.1%, but sexual molestation victims were more than the rape victims by 78.0%. Despite many international reports about the occurrence of severe psychiatric symptoms in sexual molestation victims, there is no domestic research. Therefore in this study, we investigated psychiatric symptoms of sexual molestation victims, and we also compared it with psychiatric symptoms in rape victims. METHODS: 58 women who visited Busan Smile Center within 3months after sexual violence were the study subjects. Questionnaire about sociodemographic and sexual violence related characteristics were retrospectively investigated. Of the psychiatric symptoms, Beck Depression Inventory(BDI), Beck Anxiety Inventory(BAI) for severity of depression and anxiety, and Impact of Event Scale-Revised(IES-R) to check the presence of posttraumatic stress disorder(PTSD) symptoms were used. RESULTS: Of 58 sexual violence victims, sexual molestation victims were 36(62.1%) and rape victims were 22(37.9%). In sexual molestation victims, 80.6% had more than moderate severity of depression, 83.3% had more than moderate severity of anxiety, and 94.4% had significant scores at PTSD screening test. Compared with rape victims' psychiatric symptoms(each 95.5%, 95.5%, 95.5%) there were no significant difference. CONCLUSIONS: The majority of sexual molestation victims were also accompanied by depression, anxiety and PTSD symptoms as rape victims. There results suggest that appropriate assessment and early treatment for psychiatric symptom must be made in the early stage of injury in sexual molestation victims.
Adult* ; Anxiety ; Busan ; Depression ; Female* ; Humans ; Mass Screening ; Police ; Rape* ; Retrospective Studies ; Sex Offenses ; Stress Disorders, Post-Traumatic

OBJECTIVE: Cognitive dysfunction is common in people with schizophrenia, and language disability is one of the most notable cognitive deficits. This study assessed the use and comprehension ability of the Korean language in patients with schizophrenia and the correlations between language ability and cognitive function. METHODS: Eighty-six patients with schizophrenia and a group of 29 healthy controls were recruited. We assessed both clinical symptoms and cognitive functions including Korean language ability. For clinical symptoms, the Positive and Negative Syndrome Scale, Clinical Global Impression-Schizophrenia Scale, and Social and Occupational Functioning Assessment Scale were used. For the Korean language ability assessment, a portion of the Korean Broadcasting System (KBS) Korean Language Test was used. The Short-form of Korean-Wechsler Adult Intelligence Scale, the Korean version of the University of California San Diego (UCSD) Performance-based Skills Assessment (K-UPSA), and the Wisconsin Card Sorting Test (WCST) were used to assess cognitive functions. RESULTS: Schizophrenic patients had significantly lower scores in the language and cognitive function tests both in the total and subscale scores. Various clinical scores had negative correlations with reading comprehension ability of the KBS Korean Language Test. The WCST and a part of the K-UPSA had positive correlations with multiple domains of the language test. CONCLUSION: A significant difference was found between schizophrenic patients and controls in language ability. Correlations between Korean language ability and several clinical symptoms and cognitive functions were demonstrated in patients with schizophrenia. Tests of cognitive function had positive correlations with different aspects of language ability.
Adult ; California ; Cognition ; Comprehension ; Humans ; Intelligence ; Language Tests ; Language* ; Schizophrenia* ; Wisconsin