As novel antipsychotic agents are introduced, the needs for practical guidelines on switching medications is becoming increasingly important. Cross-tapering is generally the most acceptable methods of switching, although abrupt change may be used in some cases. The important goal of antipsychotic agents witching guidelines is to reduce adverse effect of antipsychotic agents and to minimize the aggravation of the psychiatric symptoms during the switching periods. Recently, drug switching to novel antipsychotics is increased. In this article authors reviewed previous clinical studies on the antipsychotic medications switching.
Antipsychotic Agents* ; Drug Substitution

Personal and Social Performance scale (PSP) is the new measurement scale of patient functioning. PSP is simple and useful questionnaire for psychiatrist and medical personnel, especially for rehabilitation center workers. Compared with GAF (Global Assessment of functioning Scale), PSP has relatively good covariance with social and occupational and psychological symptoms. In clinical practice, PSP can be adopted for treatment planning and the evaluation of treatment effect, especially for the patients with schizophrenia.
Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Outcome Assessment (Health Care) ; Psychiatry ; Surveys and Questionnaires ; Rehabilitation Centers ; Schizophrenia*

At the beginning, researches on the biology of depression or affective illness have focused mainly on the receptor functions and neuroendocrine activities. And the studies of the past years did not break new theoretical background, but the recent advances in the research on the molecular mechanisms underlying neural communication and signal transduction do add some insights to many established ideas. This article will overview some of the more recent advances in the clinical researches of depression. Our major concerns to be presented here include the following : (1) alterations in the post-synaptic neural transduction ; (2) changes in the neurons of hypothalamic neuropeptides ; (3) decreased peptidase enzyme activities : (4) associations of hypothalamic-pituitary-adrenal axis abnormalities with serotonin neurotransmission ; (5) role of serotonin transporter ; (6) changes in the responsiveness of intracellular calcium ion levels ; (7) the inositol deficiency theory of lithium and depression ; (8) the transcription factors including immediate early genes ; (9) recent genetic studies in some families. This brief overview will suggest that changes in DNA occur during antidepressant therapy. These changes at the DNA level initiating a cascade of events underlying antidepressant modality will give us the insight on the molecular biological basis of the pathogenesis of depression and cues for a new class of antidepressants.
Antidepressive Agents ; Axis ; Biology ; Calcium ; Cues ; Depression* ; DNA ; Genes, Immediate-Early ; Humans ; Inositol ; Lithium ; Neurobiology* ; Neurons ; Neuropeptides ; Serotonin ; Serotonin Plasma Membrane Transport Proteins ; Signal Transduction ; Synaptic Transmission ; Transcription Factors

Alzheimer's disease (AD), the most common dementia in the elderly, is associated with a characteristic neuropathology:extracellular neuritic plaques (NPs) and intraneuronal neurofibrillary tangles (NFTs). AD is diagnosed clinically on the basis of progressive cognitive impairment. However, the diagnosis of AD is only reliable if a histopathological examination at autopsy shows high numbers of NPs and NFTs particularly in the hippocampus and cerebral cortex. The major component of NP is beta-amyloid protein (Abeta), a fragment of the amyloid precursor protein (APP). NFTs are largely composed of paired helical filaments (PHFs) containing abnormally phospholylated form of the microtubule-associated protein (MAP), tau. A genetic etiology for AD has been established based on population survey. It is revealed that 25-40% of the AD patients are familial and the disease is inherited as an autosomal-dominant trait in most families. Age at onset patterns of AD patients in affected families had indicated that its distribution is bimodal with a cut-off age 58 years. Several mutations in the APP gene, located on chromosome 21, are linked to early-onset AD (EOAD). However, these account for only a small fraction of cases of EOAD. The remaining cases are associated with mutations in two other genes:one on chromosome 14 that encodes S182 (presenilin 1) and the other on chromosome 1 that encodes STM2 (presenilin 2). It is also known that inheritance of specific apolipoprotein E (apoE) alleles, located on chromosome 19, determines the risk and mean age of onset of late-onset AD (LOAD). In this review, we will briefly discuss the biology and hypothetical mechanisms of Abeta, presenilins, apoE and tau protein, those involved in the pathogenesis of AD.
Age of Onset ; Aged ; Alleles ; Alzheimer Disease* ; Amyloid ; Amyloid beta-Peptides ; Apolipoproteins ; Apolipoproteins E ; Autopsy ; Biology ; Cerebral Cortex ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 14 ; Chromosomes, Human, Pair 19 ; Chromosomes, Human, Pair 21 ; Dementia ; Diagnosis ; Hippocampus ; Humans ; Neurobiology* ; Neurofibrillary Tangles ; Plaque, Amyloid ; Presenilins ; tau Proteins ; Wills

Alzheimer's disease (AD), the most common dementia in the elderly, is associated with a characteristic neuropathology:extracellular neuritic plaques (NPs) and intraneuronal neurofibrillary tangles (NFTs). AD is diagnosed clinically on the basis of progressive cognitive impairment. However, the diagnosis of AD is only reliable if a histopathological examination at autopsy shows high numbers of NPs and NFTs particularly in the hippocampus and cerebral cortex. The major component of NP is beta-amyloid protein (Abeta), a fragment of the amyloid precursor protein (APP). NFTs are largely composed of paired helical filaments (PHFs) containing abnormally phospholylated form of the microtubule-associated protein (MAP), tau. A genetic etiology for AD has been established based on population survey. It is revealed that 25-40% of the AD patients are familial and the disease is inherited as an autosomal-dominant trait in most families. Age at onset patterns of AD patients in affected families had indicated that its distribution is bimodal with a cut-off age 58 years. Several mutations in the APP gene, located on chromosome 21, are linked to early-onset AD (EOAD). However, these account for only a small fraction of cases of EOAD. The remaining cases are associated with mutations in two other genes:one on chromosome 14 that encodes S182 (presenilin 1) and the other on chromosome 1 that encodes STM2 (presenilin 2). It is also known that inheritance of specific apolipoprotein E (apoE) alleles, located on chromosome 19, determines the risk and mean age of onset of late-onset AD (LOAD). In this review, we will briefly discuss the biology and hypothetical mechanisms of Abeta, presenilins, apoE and tau protein, those involved in the pathogenesis of AD.
Age of Onset ; Aged ; Alleles ; Alzheimer Disease* ; Amyloid ; Amyloid beta-Peptides ; Apolipoproteins ; Apolipoproteins E ; Autopsy ; Biology ; Cerebral Cortex ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 14 ; Chromosomes, Human, Pair 19 ; Chromosomes, Human, Pair 21 ; Dementia ; Diagnosis ; Hippocampus ; Humans ; Neurobiology* ; Neurofibrillary Tangles ; Plaque, Amyloid ; Presenilins ; tau Proteins ; Wills

OBJECT: This cross-sectional study was performed in order to evaluate the prevalence of tardive dyskinesia among the hospitalized schizophrenic patients. METHODS: Four hundred nineteen hospitalized schizophrenic patients(male=263, female=156) were recruited for this study. They were treated with antipsychotics for more than 3 months. The prevalence of tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale. RESULTS: The prevalence of tardive dyskinesia was 35.6%(Male=36.9%, Female 33.3%). There were no significant differences in the prevalence of tardive dyskinesia among male and female schizophrenic patients. The prevalence of tardive dyskinesia among the patients over 30years old was much higher than those below 30years old. There were no significant correlations between the prevalence of tardive dyskinesia and the duration of hospitalization, the total amount of antipsychotics. The frequently involved parts of the body in the schizophrenic patients who have tardive dyskinesia were tongue, upper extremity, lips and perioral area, jaw, lower extremity, muscles of facial expression trunk, respectively. CONCLUSIONS: There was significant correlation between the age and the prevalence of tardive dyskinesia in the antipsychotic-treated schizophrenic patients.
Antipsychotic Agents ; Cross-Sectional Studies ; Dyskinesias ; Facial Expression ; Female ; Hospitalization ; Humans ; Jaw ; Lip ; Lower Extremity ; Male ; Movement Disorders* ; Muscles ; Prevalence* ; Schizophrenia ; Tongue ; Upper Extremity

Four cases of intracerebral hemorrhage remote from the site of initial supratentorial craniotomy are presented. Traumatic cases are excluded in this report and all cases developed after uneventful elective craniotomy. Two patients had ruptured aneurysm and the other two had giant supratentorial tumors, one craniophayrngioma and one ependymoma. All patients were operated on supine position and no patient had preoperative hypertension. Two had hematoma in the sucortical white matter, one in the cerebellar hemisphere and the other one showed hematoma both in the cerebellar hemisphere and the supratentorial subcortical area. The size of hematoma ranged from 8-20cc in volume. No definite cause could be found except one in which the blood pressure was transiently elevated during induction of anesthesia. A possible cause might be the sudden changes of blood pressure during induction and recovery from anesthesia, overdrainage of CSF, continuous CSF drainage and sudden changes in intracranial dynamics by removal of a huge intracranial mass. One patient with intracerebellar hemorrhage needed emergency suboccipital craniectomy for removal of the hematoma. One patient shows no improvement due to aspiration pneumonia and subsequent lung abscess. Although rare, these conditions may occur after any craniotomy and surgeons should always be alert to the possibilities of such comlication, especially when intracranial pressure(ICP) was elevated.
Anesthesia ; Aneurysm, Ruptured ; Blood Pressure ; Cerebral Hemorrhage ; Craniotomy ; Drainage ; Emergencies ; Ependymoma ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Lung Abscess ; Pneumonia, Aspiration ; Supine Position ; Supratentorial Neoplasms

OBJECTIVE: 1) To compare prolactin responses to (and related clinical manifestations of) haloperidol, risperidone, and other atypical antipsychotics (clozapine, olanzapine, quetiapine, zotepine) with data from previous reports. 2) To investigate the association between changes in serum prolactin levels after the administration of antipsychotics and 44-bp insertion/deletion polymorphism in 5-HT transporter-linked polymorphic region (5-HTTLPR) in Korean schizophrenics. METHODS: The subjects were 136 patients diagnosed schizophrenic according to the DSM-IV criteria for schizophrenia who had taken antipsychotics for at least 3 months. The 136 patients consisted of the following 82 taking haloperidol (48 males and 34 females), 25 taking risperidone (14 males and 11 females), and 29 taking other atypical antipsychotics (18 males and 11 females). We measured serum prolactin concentrations by radioimmunoassay and investigated the clinical manifestations. We examined the genotype distribution and allele frequency of the 5-HTTLPR in all subjects by polymerase chain reaction of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Chi-square test, ANOVA and tukey test were used for statistical analysis with SAS 8.1 and p values of 0.05 or less were regarded as significant difference. RESULTS: Serum prolactin levels of patients taking haloperidol and risperidone were significantly higher than those taking other atypical antipsychotics (p<0.05). Females showed significantly higher prolactin levels than males (p<0.05). There was no significant difference in the genotype distribution and allele frequency of 5-HTTLPR among groups taking haloperidol, risperidone, and other atypicals. There was also no significant difference in genotype distribution and allele frequency of 5-HTTLPR between male and female schizophrenic patients. CONCLUSIONS: These results suggest that there was no association between serum prolactin levels after the administration of antipsychotics and 5-HTTLPR polymorphism in Korean schizophrenics.
Antipsychotic Agents* ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Female ; Gene Frequency ; Genotype ; Haloperidol ; Humans ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Prolactin* ; Promoter Regions, Genetic ; Radioimmunoassay ; Risperidone ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins ; Serotonin*

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: The purpose of present study was to determine the prevalence rate of tardive dyskinesia and to search for its risk factors in chronically institutionalized schizophrenic subjects. We also examined the relationship between tardive dyskinesia and both negative symptoms and cognitive impairments in the same subjects. METHODS: Subjects were 271 in-patients (174 males, 97 females) at Masan Dongsuh Hospital. They met DSM-IV criteria for schizophrenia and had been taking fixed doses of antipsychotics for at least 3 months. Tardive dyskinesia was assessed by Abnormal Involuntary Movement Scale (AIMS). Cases of tardive dyskinesia were ascertained by the criteria of Schooler and Kane (1982) and DSM-IV. The rating of psychopathology was acquired using Brief Psychiatric Rating Scale (BPRS) and Schedule for the Deficit Syndrome (SDS) and the assessment of cognitive function using Mini-Mental State Examination (MMSE). RESULTS: The prevalence of tardive dyskinesia is 50.9% and the frequency of tardive dyskinesia was high est in male above the age of fifty. But there was no statistically significant relationship between the frequency of tardive dyskinesia and both the length of hospitalization and the daily dose of antipsychotics. The frequency order of abnormal movement in the patients with tardive dyskinesia was as follows: tongue, upper extremities, lips and perioral area. We couldn't find any significant difference in the total and subscale scores of BPRS between the groups with and without tardive dyskinesia. There were no differences in MMSE scores between the groups with and without tardive dyskinesia. CONCLUSION: This study gave us that the prevalence of tardive dyskinesia was high in chronically institutionalized schizophrenic inpatients and that age was the most significant risk factor of tardive dyskinesia. The relationship between tardive dyskinesia and both negative symptoms and cognitive impairment, however, was not revealed.
Antipsychotic Agents ; Appointments and Schedules ; Brief Psychiatric Rating Scale ; Diagnostic and Statistical Manual of Mental Disorders ; Dyskinesias ; Hospitalization ; Humans ; Inpatients ; Lip ; Male ; Movement Disorders* ; Prevalence ; Psychopathology ; Risk Factors ; Schizophrenia ; Tongue ; Upper Extremity