Antidepressants discontinuation syndrome means a wide variety of somatic and psychological reactions due to stopping antidepressants after long term administration. The main features of antidepressants discontinuation syndrome are gastrointestinal complaints, dizziness, flu-like symptoms, sleep disorders, balance and sensory disorders, and affective symptoms. It has been postulated that multiple neuronal systems including the serotonin, norepinephrine, and cholinergic systems, and the possible interactions among them are likely to be engaged. They were reported with nearly all antidepressants but the symptoms are somewhat different among the antidepressant classes owing to the different mechanism of action and the pharmacologic properties such as half-life and active metabolite. The symptoms of discontinuation are usually mild and transient, but can range widely in severity. They commence within a few days of stopping medication or reducing the dosage rapidly, resolves spontaneously within 2 weeks. It is important to recognize the symptoms of discontinuation and distinguish them from relapse because misdiagnosis can lead to inappropriate treatment and adversely effect future antidepressant compliance.
Affective Symptoms ; Antidepressive Agents ; Compliance ; Diagnostic Errors ; Dizziness ; Half-Life ; Neurons ; Norepinephrine ; Recurrence ; Sensation Disorders ; Serotonin ; Sleep Wake Disorders

A 35 year-old female patient with bipolar disorder, single manic episode in remission, were being followed up in the outpatient clinic regularly. Since she complained of depressive symtpoms, bupropion SR of 150 mg was adminstered. On 3 days after administration of bupropion SR, she complained of creeping and crawling sensation on both legs which was aggravated at night and attenuated with movement. She also had a difficulty in falling a sleep becuase of the discomfort of both legs and the urge to move. We observed these symptoms during 1 week, but her discomfort was not improved at all. Therefore we considered her symptoms as restless leg syndrome (RLS) induced by bupropion SR, and started clonazepam of 0.5 mg for the control of her discomfort on 10 days after bupropion SR administration. On the day after addition of clonazepam, her discomfort of both leg began to subside. Many cases of SSRI-induced RLS have been reported and these were explained by the dopamine hypoactivity related with stimulation of serotonin system. But, RLS induced by bupropion in this case cannot be explained by that hypothesis, so which suggested that more than one neurotransmitter system involves the pathogenesis of RLS. On our knowledge, this is the first one reporting RLS induced by bupropion.
Adult ; Ambulatory Care Facilities ; Bipolar Disorder* ; Bupropion* ; Clonazepam ; Dopamine ; Female ; Humans ; Leg ; Neurotransmitter Agents ; Restless Legs Syndrome* ; Sensation ; Serotonin

Apathy is a common problem observed in many neuropsychiatric disorders. In the past, apathy was a conventional term that designated an absence of feeling and a flattening of affective responses. But recent research has produced the concept that the core feature of apathy is a lack of motivation and manifests as diminished goal-directed behavior, cognition, and emotion, including initiation and responsiveness deficiency. Now, apathy tends to be considered as a distinct clinical symptom and syndrome, but it is still conceptually ill-defined and there is no definite consensus on diagnostic criteria. Several rating scales such as the Apathy Evaluation Scale (AES) and Apathy Scale (AS) have been developed that assist in making a diagnosis of apathy and a measurment of severity. Neuroimaging studies have indicated that apathy is primarily a dysfunction of the frontal-subcortical system, which is called the motivational circuit, and can be divided into auto-activation, cognitive, emotional subtypes by various frontal-subcortical circuits which have been damaged. Dopamine (DA) and acetylcholine (Ach) have important roles in this area. Many studies have focused on the relationship between apathy and depression. The core feature of apathy is distinguished from depression, but they share too many incidental aspects to be divided off completely. It is because the diagnostic criteria of depression had developed before the new concept of apathy was proposed, so symptoms of apathy were included in the diagnostic criteria of depression. There is a need for consensus of definition and diagnostic criteria of apathy to facilitate future research, which may be able to get at the root of other neuropsychiatric disorders such as depression.
Acetylcholine ; Apathy ; Cognition ; Consensus ; Depression ; Dopamine ; Motivation ; Neuroimaging ; Weights and Measures

Inflammation is an immune response engaged with the reciprocal interactions among the neural, endocrine and immune system. From this psychoneuroimmunological view, inflammation is one of important allostatic loads contributory to depression. Sickness behaviors in the inflammatory state share many parts of depressive symptoms and patients treated with cytokines for various illnesses are at increased risk of developing depression. The dysfunctions of cytokines and hypothalamic-pituitary-adrenal axis have been widely investigated to find out inflammatory responses. Inflammatory mediators such as cytokines, glucocorticoid and C-reactive protein affect the etiopathogenesis of depression via altered monoamine and glutamate neurotransmission, glucocorticoid receptor resistance and neurogenesis. Although inflammation is subtle and not easy to be detected in the wide population, it is basal pathophysiology and plays an important role at least to the vulnerable patients. From this perspectives, inflammatory markers may be useful in the diagnosis and prediction of treatment response, leading to the possibility of tailored treatments. Understanding depression as a kind of inflammatory disease would provide new opportunities for the psychiatry beyond monoamine theory.
Allostasis ; Axis, Cervical Vertebra ; C-Reactive Protein ; Cytokines ; Depression ; Glutamic Acid ; Humans ; Illness Behavior ; Immune System ; Inflammation ; Neurogenesis ; Psychoneuroimmunology ; Receptors, Glucocorticoid ; Synaptic Transmission

Most serotonin is found outside the central nervous system and functions much more than a neurotransmitter. Peripheral serotonin is produced by enterochromaffin cells in the gastrointestinal tract and secreted into blood. Serotonin, as a circulating amine, takes part in numerous biological processes including cardiovascular function, bowel motility, glucose metabolism and skeletal change. Serotonin signaling is regulated by serotonin receptors and serotonin transporters in multiple body organs. The drugs that manipulate the serotonergic system have been developed and used for the treatment of many systemic diseases. The richness of serotonergic modulation in the whole body provide both a pharmacologic opportunity and challenge.
Biological Processes ; Central Nervous System ; Enterochromaffin Cells ; Gastrointestinal Tract ; Glucose ; Neurotransmitter Agents ; Receptors, Serotonin ; Serotonin

OBJECTIVE: We compared the one-year rehospitalization rates of first-episode bipolar manic patients who were discharged while being treated with atypical antipsychotics in combination with mood stabilizers. METHODS: We monitored the rehospitalization status of the first-episode bipolar manic patients who were discharged between 1 January 2003 and 31 December 2008 while they were taking risperidone (n=34), olanzapine (n=26) or quetiapine (n=32) in combination with mood stabilizers. Rehospitalizations were tracked over a 1-year period using the Kaplan-Meier method and Cox regression model was used to analyze covariates thought to affect time to rehospitalization. RESULTS: The rehospitalization rates during the 1-year follow-up period for patients taking atypical antipsychotics plus mood stabilizers were 22.8% (n=21). There were no significant differences in rehospitalization estimated using the Kaplan-Meier formula among the patients treated with risperidone (29.4%), olanzapine (23.1%) or quetiapine (15.6%). The psychotic symptoms, previous depressive episodes, lower Global Assessment of Functioning (GAF) score at discharge and less length of first hospitalization contributed to the risk of rehospitalization. CONCLUSION: The 1-year rehospitalization rates of first-episode bipolar manic patients taking risperidone, olanzapine, or quetiapine do not differ and the psychotic symptoms and previous depressive episodes affect time to rehospitalization.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Dibenzothiazepines ; Follow-Up Studies ; Hospitalization ; Humans ; Inpatients ; Risperidone ; Track and Field ; Quetiapine Fumarate

OBJECTIVES: Firefighters frequently experience traumatic events, high-tension situations and shift work. Therefore, the prevalence of insomnia of firefighters is higher than one of general population. Not only does the quality of sleep affect the satisfaction of personal life, but it also influences their performance for the public's safety. We investigated which factors affect the quality of sleep of firefighters. METHODS: After personally delivering 120 questionnaires to 3 fire stations, the survey was conducted when the consents were signed. It inquired about alcohol use, smoking, shift work, sleep quality, depression, anxiety, and experience of traumatic events. We then divided the firefighting officers in two groups according to the quality of sleep and compared the variables examined to conduct the logistic regression analyses according to the results. RESULTS: The poor sleeper group reported a higher level of current alcohol consumption, depression, anxiety and experience of traumatic events. Logistic regression analyses showed that the current alcohol intake (Crude odds ratio=3.707, 95% confidence interval=1.288–10.672, p=0.015 ; Adjusted odds ratio=3.288, 95% confidence interval=1.011–10.694, p=0.048) has a significant effect on sleep quality. CONCLUSIONS: Current alcohol consumption, depression, anxiety and experience of traumatic events were respectively associated with sleep quality of firefighters. When all significant factors considered, the current alcohol use was the only statistically significant. To improve the quality of sleep for firefighters, it will be necessary to evaluate alcohol intake, educate the poor sleep quality caused by alcohol, and provide specific interventions to reduce consumption.
Alcohol Drinking ; Anxiety ; Depression ; Firefighters ; Fires ; Humans ; Logistic Models ; Prevalence ; Sleep Initiation and Maintenance Disorders ; Smoke ; Smoking

Neuroinflammation is one of important allostatic loads contributory to the various psychiatric illness. It is mediated mainly by glial cells, which produce both proinflammatory and antiinflammatory cytokines, and the balance of them determines the inflammatory process in the central nervous system. S100 calcium-binding protein B, which is used as an inflammatory marker is also released by glial cells. In the molecular level, oxidative stress contributes to the neuroinflammation. Their disturbances have been revealed in the psychiatric illness and related with the dysregulation of the glutamatergic and monoaminergic systems. There is a possibility to use them as disease markers. The approach for inflammation using antiinflammatory drugs and antioxidants could be connected to the development of disease-modifying treatments. Also, a searching examination about specific subtypes who are vulnerable to inflammation in the patients is required to confirm their efficacy clearly.
Allostasis ; Antioxidants ; Central Nervous System ; Cytokines ; Humans ; Inflammation ; Neuroglia ; Oxidative Stress

Human understanding is one of the three virtues that are expected of physicians in Harrison's principles of internal medicine, and it was emphasized that a Shakespearean breadth is needed to be the true physician. Recently, there has been an increase in the need for human understanding, such as a continuous increase in GB stones, an association between the patient's life events and pancreaticobiliary diseases, an increase in autoimmune disease, and a high recurrence rate after treatment. Therefore, we attempted a holistic and fundamental approach for figuring out the pathogenesis of pancreaticobiliary diseases including human habit loop and adaptive response and suggests the model for the development of pancreaticobiliary disease considering human understanding.
Autoimmune Diseases ; Humans* ; Internal Medicine ; Recurrence ; Virtues

OBJECTIVES: Psychiatric staffs may experience excessive work stress, burnout, and reduced job satisfaction in clinical settings. This can increase chances of diminishing their overall working efficiency or having difficulty managing their own mental health. The purpose of this study was to investigate the effect of group mindfulness- based cognitive therapy(MBCT) on job stress, burnout, self-efficacy, resilience, and job satisfaction. METHODS: Twenty eight psychiatric staffs who agreed to participate in the study were included. Self-report questionnaires were used to measure job stress, burnout, resilience, self-efficacy, and job satisfaction. To examine the effects of group MBCT, the scores were compared before and after MBCT. RESULTS: Work stress and burnout scale scores were significantly decreased after group MBCT. Resilience, job satisfaction, and self-efficacy scale scores were significantly increased after group MBCT. CONCLUSIONS: In the current study, group MBCT for psychiatric staffs helped to reduce their work stress and burnout, and, as well, helped to improve resilience, self-efficacy, and job satisfaction. This suggests that, in mental health treatment settings, psychiatric staffs can improve their mental health through group MBCT. Improving mental health of psychiatric staff may also have a positive impact on their patients.
Cognitive Therapy* ; Humans ; Job Satisfaction ; Mental Health