Acamprosate reduces the craving for alcohol by decreasing glutamate activity and increasing gamma-aminobutyric acid (GABA) action in patients with alcohol dependence. Acamprosate has tolerable side effects that include diarrhea, headache, dizziness and pruritus. In this study, we report acamprosate-induced extrapyramidal symptoms in an elderly patient with no history of neurologic disease. Severe extrapyramidal symptoms developed two days after the administration of acamprosate and improved over one week after the acamprosate was stopped. Extrapyramidal symptoms are commonly associated with dopamine receptor antagonists. However, there have been several reports of extrapyramidal symptoms occurring with drugs targeting other systems, including GABA, glutamate and serotonin. Acamprosate may decrease dopamine levels in the ventral tegmental area mediated by glutamatergic action and thus cause extrapyramidal symptoms. We suggest that acamprosate carries the risk of causing extrapyramidal symptoms.
Aged* ; Alcoholism* ; Diarrhea ; Dizziness ; Dopamine ; Dopamine Antagonists ; gamma-Aminobutyric Acid ; Glutamic Acid ; Headache ; Humans ; Pruritus ; Serotonin ; Ventral Tegmental Area

The atypical antipsychotics were believed to induce less extrapyramidal syndrome, including tardive dyskinesia (TD). Since the introduction of the quetiapine, it is also reported with less TD side effects. It even can relieve the symptoms of severe TD and reduce the risk of TD. The quetiapine's low affinity and fast dissociation from postsynaptic dopamine D2 receptors should give the least risk of producing the symptoms of TD. The quetiapine even can reduce the TD side effects related to clozapine, which has the lowest risk for TD. However, since the first case report of TD side effects related to quetiapine published on 1999, the safety of quetiapine in TD aspect has been questioned. Therefore, we want to share this case report, which was written to describe the severe late-onset TD side effects after long-term use of quetiapine in a patient with psychotic depression. The patient had no significant findings after concurrent comprehensive neurological examinations, magnetic resonance imaging of brain and electroencephalogram since the onset of TD.
Antipsychotic Agents ; Brain ; Clozapine ; Depression* ; Electroencephalography ; Humans ; Magnetic Resonance Imaging ; Movement Disorders* ; Neurologic Examination ; Receptors, Dopamine D2 ; Quetiapine Fumarate

Clozapine is well-known for successful use in schizophrenic patients treatment resistant to other antipsychotics. However, even with clozapine, 25% of schizophrenic patients are not in remission. Recently, as adjunctive treatment with clozapine, electroconvulsive therapy has been reported to be an effective and safe adjunctive treatment. We report a Japanese schizophrenic woman who was not in remission with clozapine alone but with both clozapine and electroconvulsive therapy.
Antipsychotic Agents ; Asian Continental Ancestry Group* ; Clozapine* ; Electroconvulsive Therapy* ; Female ; Humans ; Lithium ; Schizophrenia*

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

OBJECTIVE: This study examined the psychometric properties of the Korean version of the Children's Revised Impact of Event Scale (CRIES) and its validity as a screening instrument for the post-traumatic stress disorder (PTSD). METHODS: The study population consisted of two samples. The clinical sample consisted of 60 child and adolescent patients from the Department of Neuropsychiatry, Ilsan Paik Hospital, Inje University College of Medicine. The normal sample consisted of 291 students from four schools (primary, middle, and high schools). We administered four self-report questionnaires (the CRIES, Child Reports of Post-traumatic Symptoms [CROPS], State-Trait Anxiety Inventory for Children [STAI-C], and Children's Depression Inventory [CDI]) to 351 children and adolescents after obtaining informed consent from all participants and their parents. RESULTS: The CRIES showed good reliability (Cronbach's alpha for the full scale and subscales ranged from 0.85 to 0.93). The total CRIES score was positively correlated with CROPS, STAI-C, and CDI. Confirmatory factor analysis indicated that a three-factor structure for the CRIES (intrusion, avoidance, and hyper-arousal) had a significantly better fit than a two-factor model (intrusion/hyper-arousal and avoidance). Receiver operating characteristic curve analysis indicated that a cutoff of 26 offered the optimum predictive point. That is, this cutoff maximized the balance between sensitivity (0.88) and specificity (0.85). Using this cutoff, the positive predictive value was 0.86, and the negative predictive value was 0.99. CONCLUSION: These findings imply that the CRIES is a highly accurate diagnostic test in clinical settings.
Adolescent ; Anxiety ; Child ; Depression ; Diagnostic Tests, Routine ; Humans ; Informed Consent ; Mass Screening ; Neuropsychiatry ; Parents ; Psychometrics ; ROC Curve ; Sensitivity and Specificity ; Stress Disorders, Post-Traumatic ; Surveys and Questionnaires

OBJECTIVE: The genes encoding for gamma-aminobutyric acid (GABA) A and B receptors may be considered as candidates for alcoholism; genetic alterations at this level may produce structural and functional diversity and thus play a role in the response to alcohol addiction treatment. To investigate these aspects further, we conducted a preliminary genetic association study on a population of Italian male alcohol addicts, focusing on GABA A and B receptors. METHODS: A total of 186 alcohol-dependent subjects (in the first phase 139, then 47 more samples) and 182 controls were genotyped for 25 single nucleotide polymorphisms (SNPs) of genes encoding the alpha-1 subunit of GABA A receptor (GABRA1) and subunits 1 and 2 of GABA B receptor (GABBR1 and GABBR2). The chi-squared test for allele and genotype distributions and Hardy-Weinberg equilibrium analysis of both subjects and controls were performed. Bonferroni's correction for multiple comparisons was applied. RESULTS: Preliminary results comparing 139 alcohol-dependent subjects and 182 controls showed differences in genotype distribution in the former for SNP rs29253, located in the intron region of the GABBR1 gene. In order to clarify the meaning of this association, 47 more samples from alcohol-dependent subjects were tested for this SNP only: the previously found association was not confirmed. CONCLUSION: The lack of significant differences between the two groups does not provide evidence that GABRA 1 and GABBR1 and 2 genes are candidates for alcoholism in this population. Further studies with larger samples are needed, together with investigation of other components of the GABA pathway.
Alcoholism* ; Alleles ; gamma-Aminobutyric Acid ; Genetic Association Studies ; Genotype ; Humans ; Introns ; Male ; Polymorphism, Single Nucleotide ; Receptors, GABA* ; Receptors, GABA-A ; Receptors, GABA-B

OBJECTIVE: Recent pediatric studies have suggested a correlation between decreased amygdala volume and attention deficit and hyperactivity disorder (ADHD) symptoms, including the emotional dysregulation. To investigate the hypothesis that medication treatment of ADHD specifically improves amygdala function, we used 1H magnetic resonance spectroscopy (MRS) to study the effect of 12 weeks of treatment with daily 20 mg long-acting methylphenidate on the Glu/Cr, NAA/Cr, Cho/Cr, and mI/Cr ratios in the amygdala of medication-naive children with ADHD. METHODS: This was a prospective study, using a pre- and post-test design, on a single group of 21 children (average age 8.52 years, 17 males and 4 females) diagnosed with ADHD. Low Time Echo MRS scans sampled voxels of interest (1.5x1.5x2.0) from both the right and left amygdala. RESULTS: There was significant clinical improvement after 12 weeks of treatment with 20 mg long-acting methylphenidate. On 1H MRS, there were no statistical significant differences of NAA/Cr ratio, Cho/Cr ratio, mI/Cr ratio before and after 12 weeks administration of 20 mg long-acting methylphenidate both in the right and left amygdala. In addition, Glu/Cr ratio decreased 14.1% in the right amygdala (p=0.029) and 11.4% in the left amygdala (p=0.008). Standardized mean effect sizes ranged from 0.14-0.32. CONCLUSION: The findings are consistent with the possibility that hyperglutamatergic processes in the amygdale are related to the hyperactive-impulsive symptoms of ADHD.
Amygdala ; Child* ; Humans ; Magnetic Resonance Spectroscopy* ; Male ; Methylphenidate* ; Pilot Projects* ; Prospective Studies

OBJECTIVE: This study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals. METHODS: Data from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified. RESULTS: Of the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), beta-blockers (10.1%), and mood stabilizers (8.7%). CONCLUSION: The present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.
Antidepressive Agents ; Antipsychotic Agents ; Benzodiazepines ; Hospitals, University ; Humans ; Korea ; Polypharmacy* ; Prescriptions* ; Psychotropic Drugs ; Retrospective Studies ; Schizophrenia*

OBJECTIVE: Pediatric depression is associated with significant functional impairment at school and at work. Recently, we reported on depression-like behavior in juvenile mice neonatally exposed to dexamethasone (DEX) as a potential animal model for pediatric depression. The N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has promoted rapid and long-lasting antidepressant effects in patients with treatment-resistant major depression. This study was conducted to examine whether ketamine had antidepressant effects in juvenile mice after neonatal DEX exposure. METHODS: A single dose (10 mg/kg) of ketamine or vehicle was injected into juvenile mice at days 29-32 after neonatal DEX (or saline) exposure (days 1-3). The sucrose preference test, tail suspension test, and forced swimming test were performed 24, 40, and 46 hours, respectively, after injection of ketamine. RESULTS: Ketamine (10 mg/kg) significantly improved depression-like behavior in DEX-treated juvenile mice. CONCLUSION: This finding suggests that ketamine confers antidepressant effects in an animal model of pediatric depression.
Animals ; Antidepressive Agents ; Depression ; Dexamethasone* ; Hindlimb Suspension ; Humans ; Ketamine* ; Mice* ; Models, Animal ; N-Methylaspartate ; Physical Exertion ; Receptors, N-Methyl-D-Aspartate ; Sucrose

Research on caregivers of psychosis has predominantly focused on parents and spouses. Issues related to siblings of persons with psychosis (SOPP) are yet to be evaluated comprehensively. Like parents and spouses, SOPP also share the caregiver burden and have their own issues and needs. This systematic descriptive review aims to identify the types of needs of SOPP in the published literature and gives implications for further practice and research. The primary data search was carried out with predefined protocol in PubMed database and an additional hand search was done in EBSCOhost, ProQuest, Scopus, and PsychINFO. All the searches yielded a total of 862 titles. After screening for necessary inclusion criteria, seven studies were included in the final review. The results are discussed under six major themes that emerged from this review. Six out of seven studies highlighted the need for information on siblings' illness and participation in caregiver support group. Other important needs were illness management or rehabilitation needs; help in managing their own psychosocial issues; treatment related informational needs; and inclusion in treatment process. The socio-demographic details of these studies showed that majority of the participants were female siblings of Caucasian or white British ethnicity and from developed countries. SOPP predominantly have specific needs such as informational and support group needs, which are different in the priority of other primary caregiver needs. Paucity of literature from developing countries and the limitations of the existing studies warrant further systematic research.
Caregivers ; Developed Countries ; Developing Countries ; Female ; Hand ; Humans ; Mass Screening ; Parents ; Psychotic Disorders* ; Rehabilitation ; Self-Help Groups ; Siblings* ; Spouses