OBJECTIVE: The purpose of this study was to identify the predictors of one-year clozapine treatment in refractory schizophrenic patients. METHODS: We defined treatment response as the reduction of total PANSS scores by 20% or more and as the total PANSS scores below 60, or as the CGI severity score below 3, after one-year of clozapine treatment. We compared age, duration of illness, number of hospitalization, plasma monoamine metabolites, ventricle-brain ratio, and short-term treatment response between treatment response group and treatment non-response group. RESULTS: Among the total patients of 26, 12(46%) were categorized as treatment response group. In comparing between treatment response group(N=12) and treatment non-response group (N=14), there were no differences in age, onset age, duration of illness, but the number of hospitalization was significantly more frequent in treatment non-response group. There was no significant difference in total PANSS scores between the two groups before clozapine treatment. After 4 weeks of clozapine treatment, the changes of PANSS positive score was more higher in treatment response group. The baseline plasma HVA levels and HVA/5-HIAA ratio were significantly higher in treatment response group than in non-response group, but there was no significant difference in baseline plasma 5-HIAA levels between the two groups. No difference existed in ventricle-brain ratio between the two groups. CONCLUSION: This study suggests that number of hospitalization and short-term treatment response rate may be useful as the clinical predictors, and that plasma HVA levels also as a biological predictor of long term clozapine treatment.
Age of Onset ; Clozapine* ; Hospitalization ; Humans ; Hydroxyindoleacetic Acid ; Plasma ; Schizophrenia*

No abstract available.
Cerebrospinal Fluid* ; Electroconvulsive Therapy* ; Hydroxyindoleacetic Acid* ; Schizophrenia* ; Serotonin*

Twenty newly admitted acute schizophrenic patients were treated with haloperidol for 6 weeks. HVA and 5-HIAA were sampled at baseline, 3days after initial neuroleptic dose, and after 1, 2, 3, 4, 6 weeks of treatment. Nine patients were classified as responders in this prospective haloperidol treatment trial. They had a score of change in the BPRS total scores of 25% or greater. Eleven patients were classified as nonresponders, based on a score of changes in the BPRS total scores of less than 25%. 1) There was no significant difference in plasma HVA/5-HIAA ratio between responder and non-responder before and after haloperidol treatment. 2) There was no significant correlations between plasma HVA/5-HIAA ratio and BPRS total scores. This study could not support the hypothesis that neuroleptic treatment would be effective by changing dopamine and serotonin function and/or by altering their interaction.
Dopamine ; Haloperidol ; Humans ; Hydroxyindoleacetic Acid ; Plasma* ; Prospective Studies ; Schizophrenia* ; Serotonin

OBJECTIVES: This study was purposed to examine the changes of plasma homovanillic acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week risperidone trial and to investigate the relationship between the plasma monoamine metabolites and risperidone-induced treatment resposes. METHOD: Eighteen schizophrenic patients were treated for 8 weeks with risperidone. The psychopathology was assessed at baseline just before risperidone trial and then at 1st week, 2nd week, 4th week, and 8th week using the Positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured using high performance liquid chromatography with electrochemical detection method. RESULTS: 39% of the patients treated with risperidone was categorized as responders, who showed at least a 20% decrease in PANSS total score at the end point of the study. At the end point of the 1st week, there was significant difference in the percent change of plasma HVA between responders(39% increment) and nonresponders(9% increment). But no significant differences in the percent change of plasma 5-HIAA and the percent change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. CONCLUSION: These results suggest that the magnitude of the early increase of plasma HVA may be associated with risperidone-induced treatment response in schizophrenia.
Chromatography, Liquid ; Homovanillic Acid* ; Humans ; Hydroxyindoleacetic Acid ; Plasma* ; Psychopathology ; Risperidone ; Schizophrenia*

Urinary excretion of 5-hydroxyindoleacetic acid was determined in 114 normal Korean adults and in 110 patients suffering from peptic ulcer. The amount of urinary 5-HIAA excreted during a period of 24 hours is fairly constant in each individual but varies widely between individuals. The mean daily output of urinary 5-HIAA in normal Korean adults is 1.93 +/-0.86 (S.D.) mg, which is similar to that found in normal Chinese adults. There is no significant difference between the urinary excretion of 5-HIAA in normal subjects and in patients with peptic ulcer. Furthermore, the amount of urinary 5-HIAA seems to be influenced by neither the sex of the subject nor by the degree of gastric acidity.
Adult* ; Asian Continental Ancestry Group ; Gastric Acid ; Humans ; Hydroxyindoleacetic Acid ; Peptic Ulcer*

The recent hypothesis about the pathophysiology of schizophrenia has been centered mainly on two theories, i.e. dopamine hypothesis and serotonin hypothesis. We investigate the correlations between plasma metabolite concentrations and clinical symptoms in schizophrenic patients. The purpose of our study was to examine whether the plasma levels of HVA(homovanillic acid) and 5-HIAA(hydroxyindoleacetic acid) are significantly different in schizophrenics, compared to normal controls. And, with the intention of clarifying the interaction between dopaminergic system and serotoninergic system, the ratio of HVA/5-HIAA also was measured. The second purpose was whether the basal(pre-treatment) levels of these metabolites show the correlation with clinical symptoms. Finally, third purpose was whether basal HVA and 5-HIAA levels can be held as a predictor of treatment response. We used scale for the Assessment of Positive Symptoms(SAPS) and Scale for the Assessment of Negative Symptoms(SANS) as the clinical symptom rating scales. Our results were as followed, 1) only the level of basal plasma HVA was significantly differ in schizophrenics. 5-HIAA and HVA/5-HIAA were not. 2) basal HVA showed significant correlation with SAPS score, especially delusion subscale. 3) the higher was the basal HVA level, the more improvement in clinical symptoms was observed. The basal 5-HIAA level and the HVA/5-HIAA ratio did not show any significant findings. These results support the dopamine hypothesis of schizophrenia, but fail to examine on the possible involvement of serotonin in schizophrenia.
Delusions ; Dopamine ; Homovanillic Acid* ; Humans ; Hydroxyindoleacetic Acid ; Intention ; Plasma* ; Psychopathology* ; Schizophrenia ; Serotonin ; Weights and Measures

This study was done to examine changes of plasma homovanillic, acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week clozapine trial and to investigate the relationship between the plasma monoamine metabolites and treatment responses. Twenty-seven chronic schizophrenic patients were treated for 8 weeks with clozapine. The psychopathology was assessed at baseline just clozapine trial and then every 2 weeks until the end of 8-week clozapine treatment using the positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured also biweekly using high preformance liquid chromatography with electrochemical detection method. Plasma HVA and 5-HIAA levels were significantly decreased during a 8-week chozapine treatment, although plasma HVA/5-HIAA ratio showed no significant change. The changes of plasma HVA levels were in significant correlations with the changes of PANSS positive scores, of general psychophathology scores, and changes of total scores. The changes of plasma 5-HIAA levels were in significant correlations with the changes of PANSS negative scores. But the changes of plasma HVA/5-HIAA ratio had no significant correlation with any PANSS subscale score changes. 48% of the patients treated with clozapine was categorized as responders, who showed at least a 20% decrease in PANSS total score and a CGI severity score of mildly ill or less(< or =3) of the end pint of the study. The baseline plasma HVA levels and HVA/5-HiAA) ratio were significantly higher in responders(N=13) than in nonresponders(N=14). But no significant difference in the change of plasma HVA between responders(40.3% decrement) and nonresponders(3.1% increment). But no significant difference in the change of plasma 5-HIAA and the change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. These results suggest that the antipsychotic effect of clozapine on positive symptoms may be associated with dopaminergic blocking activity, and that on negative symptoms may be associated with serotonergic blocking activity. The baseline plasma HVA levels and the change of HVA levels from baseline may be useful predictors of treatment response with clozapine.
Antipsychotic Agents ; Chromatography, Liquid ; Clozapine ; Homovanillic Acid* ; Humans ; Hydroxyindoleacetic Acid ; Plasma* ; Psychopathology ; Schizophrenia*

Testicular carcinoid tumor is uncommon and most of these tumors occur in fourth decade' of life. A 33-year-old man presented with intrascrotal painless mass, which was initially misdiagnosed as epididymal tumor. Epididymectomy including the mass was performed and pathologic examination revealed a carcinoid tumor confined to the rete testis. There was no evidence of carcinoid syndrome. The 24 hour urinary 5-HIAA level was normal. Abdominal CT scan and GI contrast study showed no evidence of carcinoid in other organ including the gut. Radical orchiectomy and hemiscrotectomy were undergone as a curative therapy. He has been well for 40 months without recurrence.
Adult ; Carcinoid Tumor* ; Humans ; Hydroxyindoleacetic Acid ; Orchiectomy ; Recurrence ; Rete Testis* ; Testis ; Tomography, X-Ray Computed

OBJECTS: This study was purposed to investigate the relationship between urine HVA and 5-HIAA concentrations and clinical symptoms in chronic schizophrenia. METHODS: 272 patients with chronic schizophrenia, diagnosed by DSM-IV criteria, were performed to measure urine HVA and 5-HIAA concentrations and to evaluate the clinical symptoms by using BPRS, PANSS, YBOCS and HAM-D. RESULTS: Urine HVA and 5-HIAA concentrations showed significant correlation with BPRS, positive scale, negative scale and general psychopathology in PANSS and urine HVA/5-HIAA ratios found no significant correlation. Urine HVA concentrations showed significant correlattion with urine 5-HIAA concentrations and urine HVA/5-HIAA ratios had a negative correlation with urine 5-HIAA concentration. As a result of stepwise multiple regression, urine HVA concentrations were significantly correlated with BPRS and positive scale in PANSS and Urine 5-HIAA concentrations were significantly correlated with BPRS. Urine HVA/5-HIAA ratios had significant correlation with HAM-D and BPRS. CONCLUSION: These findings support the hypothesis that the role of central dopamine and serotonin system and the functional interaction of both neurotransmitters are important to clinical symptom formation of chronic schizophrenia.
Diagnostic and Statistical Manual of Mental Disorders ; Dopamine ; Humans ; Hydroxyindoleacetic Acid* ; Neurotransmitter Agents ; Psychopathology ; Schizophrenia* ; Serotonin

OBJECTIVES: This study was designed to compare risperidone(as an atypical antipsychotic) with haloperidol(as a typical antipsychotic), so we examined the clinical effects and changes of plasma HVA, 5-HIAA & HVA/5-HIAA ratio after 8 week of risperidone or haloperidol trial. METHOD: Twenty-six male chronic schizophrenic patients were treated for 8 weeks with risperidone(N=14) and haloperidol(N=12). The duration of wash-out period was 14 days. The psychopathologic assessment was chechked by Positive and Negative Syndrome Scale(PANSS) and plasma HVA & 5-HIAA was measured by High Performance Liquid Chromatography(HPLC) with electrochemical detector. The checking points were just before drug trial and 1st, 2nd, 4th, and 8th week(total 5 times). RESULTS: 1) Risperidone trial group were more improved than haloperidol tiral group in PANSS scores(total, positive, negative and general psychopathy). 2) Changes of plasma HVA and 5-HIAA in the risperidone and haloperidol trial group were not statistically different. But because baseline 5-HIAA of risperidone trial group was higher than that of haloperidol trial group, the increase of haloperidol trial group would be more. 3) There was significant difference in changes of HVA/5-HIAA ratio between risperidone and haloperidol trial group. But the change of HVA compared with 5-HIAA in risperidone trial group was higher than that of haloperidol trial group. CONCLUSION: These results revealed that risperidone was more effective in clinical symptoms, and suggest that cause of these results may be due to blocking both of dopamine D2 receptors and serotonin 5-HT2 receptors of risperidone.
Haloperidol* ; Humans ; Hydroxyindoleacetic Acid* ; Male ; Plasma* ; Receptors, Dopamine D2 ; Receptors, Serotonin, 5-HT2 ; Risperidone* ; Tramadol