No abstract available.
Cognition* ; Humans ; Military Personnel*

Even the pharmacotherapy is more effective than placebo for the treatment of depression, the outcome of pharmacoltherapy remains unsatisfactory for many patients. Apart from side effects, there are two major limitations of antidepressant therapy. One is the delayed onset of improvement and another is partial response. In order to address these clinical dilemmas, many psychiatrists more commonly employ add-on therapy. In past, the practice of using multiple drugs to enhance treatment response was called polypharamcy, and was disparaged as poor clinical practice. However, with improved understanding of how drugs affects the central nervous system and increased communication in journals and on computer networks about the relative merits of specific combinations, the scientific basis for the combining drugs is being defined. Indeed, the use of multiple medications as a stratege to enhance response has become both acceptable and widespread now a days. It is now referred to more positively as add-on therapy, co-medication, combination therapy, or drug augmentation. Thus, as the methods of practical strategies for treatment of depression, switching classes antidepressant drugs, combiantion therapy, augmentation strategies and brief treatment algorithm will be presented with items of considerations. However, when combination of drugs being tried, knowledges about the actin of mechanism, pharamcokinetics, and pharmacodynamics are essential to cope with the possible adversive reactions and to get the appropriate responses for the treatment of depressive symptoms.
Actins ; Antidepressive Agents ; Central Nervous System ; Depression ; Depressive Disorder* ; Drug Synergism ; Drug Therapy ; Humans ; Psychiatry

No abstract available.
Animals ; Mice*

Anxiety symptoms and disorders frequently coexist in patients with major depression. Two conditions show extentive overlap with respect to symptomatology and a spectrum of disorders. The majority of patients were found to have mixed mixed anxiety-depressive syndrome(42.3%) or depression with comorbid anxiety(19.2%), with only 12.8% of the population having anxiety alone and 10.3% having depression alone. Moreover, the diagnosis of two disodders can be exchanged sometimes. Thus, anxiety and depression can not think over as a completely separate entities, especially for the treatment of two disorders. The presence of anxiety symptoms or disorders has been found to be associated with increased seveity and poorer outcomes of depression. including an increased risk of suicide, higher helplessness, poorer prognosis, more chronic course, more functional and psychosocial impairment. However, there is no confirmative pathogenesis for the anxious depression. Maybe it is supposed for the interactions of the neurotransmitters, especially serotonin and norepinephrine. All the antidepressants and anxiolytics can be used for the treatment of anxious depression, eventhough venalfaxine, mirtazapine & SSRIs were recommended for the first choice recently. However, TCAs and Benzodiazepines have some limits in the side of the adversive effects, addiction and the risk of suicide. Thu, benzodiazepines have to be used as a adjunctives or shortterm trial for the control of anxiety. Cognitive behavioral therapy is useful way to treat the anxious depression, however, it might be effective with pharmacotherapy. St. John's wort as a herbal medicine, rapide Transcranial Magnetic Stimulation(rTMS), Vagus Nerve Stimulation(VNS) will be applied in the future time.
Anti-Anxiety Agents ; Antidepressive Agents ; Anxiety ; Benzodiazepines ; Cognitive Therapy ; Depression* ; Diagnosis ; Drug Therapy ; Herbal Medicine ; Humans ; Hypericum ; Neurotransmitter Agents ; Norepinephrine ; Prognosis ; Serotonin ; Suicide ; Vagus Nerve

Anxiety symptoms and disorders frequently coexist in patients with major depression. Two conditions show extentive overlap with respect to symptomatology and a spectrum of disorders. The majority of patients were found to have mixed mixed anxiety-depressive syndrome(42.3%) or depression with comorbid anxiety(19.2%), with only 12.8% of the population having anxiety alone and 10.3% having depression alone. Moreover, the diagnosis of two disodders can be exchanged sometimes. Thus, anxiety and depression can not think over as a completely separate entities, especially for the treatment of two disorders. The presence of anxiety symptoms or disorders has been found to be associated with increased seveity and poorer outcomes of depression. including an increased risk of suicide, higher helplessness, poorer prognosis, more chronic course, more functional and psychosocial impairment. However, there is no confirmative pathogenesis for the anxious depression. Maybe it is supposed for the interactions of the neurotransmitters, especially serotonin and norepinephrine. All the antidepressants and anxiolytics can be used for the treatment of anxious depression, eventhough venalfaxine, mirtazapine & SSRIs were recommended for the first choice recently. However, TCAs and Benzodiazepines have some limits in the side of the adversive effects, addiction and the risk of suicide. Thu, benzodiazepines have to be used as a adjunctives or shortterm trial for the control of anxiety. Cognitive behavioral therapy is useful way to treat the anxious depression, however, it might be effective with pharmacotherapy. St. John's wort as a herbal medicine, rapide Transcranial Magnetic Stimulation(rTMS), Vagus Nerve Stimulation(VNS) will be applied in the future time.
Anti-Anxiety Agents ; Antidepressive Agents ; Anxiety ; Benzodiazepines ; Cognitive Therapy ; Depression* ; Diagnosis ; Drug Therapy ; Herbal Medicine ; Humans ; Hypericum ; Neurotransmitter Agents ; Norepinephrine ; Prognosis ; Serotonin ; Suicide ; Vagus Nerve

Depressive disorder is one of the very serious mental diseases in terms of personal, social, economical losses. It is not clear for the pathogenesis of the depression, however, even though decreased 5-HT and NE may be the biological causing factors in the neuronal synapses. Moreover, there are many depressive patients who are treatment resistant or partial responders. Thus, we have been needed the other therapeutic methods for those cases. Repeated transcranial magnetic stimulation (rTMS) & VNS are the newly introduced methods for the treatment of refractory or partial responders with depression, which nature of therapeutic effect is the stimulation of the CNS. VNS has been used to treat the refractory epilepsy patients. Despite of numerous empirical and preclinical data, although VNS may be effective for the treatment of depression, the parameters for the treatment of depression using the VNS device have not been confirmed yet. However, from the several reports clinical effectiveness were described about 40%, thus, it is interested that VNS will be able to use for the treatment of depression in a future.
Depression* ; Depressive Disorder ; Depressive Disorder, Treatment-Resistant ; Epilepsy ; Humans ; Neurons ; Serotonin ; Synapses ; Transcranial Magnetic Stimulation ; Vagus Nerve Stimulation* ; Vagus Nerve*

Conventional high-dose antipsychotics tend to result in more side effects, negative symptoms and dysphoria, and at the same time lower the cognitive function which is already impaired in most schizophrenics. Florid psychotic symptoms, negative symptoms and cognitive impairment greatly impede psychosocial performance and eventual reintegration int society. The reduction of symptom and the improvement of cognitive funtions and social skills are therefore central to the psychiatric rehabilitation process. The purpose of this study was to evaluate the dose-reduction effects of antipsychotics more than 1,500mg equivalent of chlorpromazine. Fifty-one chronic schizophrenics who maintained high-does antipsychotics for more than three months were randomly assigned to two groups : 20 patients comprised the dose-maintaining group and 31 patients made the dose-reduction group. Over a sixteen weekperiod Positive and Negative Syndrome Scale(PANSS), Extrapyramidal Symptom(EPS), Nurses' Observation Scale for Inpatient Evaluation(NOSIE-30), Continuous Performance Test(CPT), Quality of Life(QOL), and haloperidol/reduced haloperidol blood levels were determined at the base line and after 2, 4, 6, 8, 12, 16 weeks to evaluate the dose reduction effects of high-dose antipsychotics. The results were as follows: 1) Dose-reduction is highly effective in reducing positive and negative symptoms, and general psychopathology. Effects were most prominent at 8, 12, 16 weeks. Among the dose reduction group, positive symptoms in positive symptom group and negative symptoms in negative symptom group were more reduced. 2) Extrapyramidal symptoms showed no significant difference between two groups. But EPS was reduced time after time within two groups. 3) Hit rates of Continuous Performance Test, which indicate attentional capacity, increased significantly after dose reduction. 4) Haloperidol and reduced haloperidol blood levels decreased until the 4th week, after which they were constant. 5) Total scores of Nurses' Observation Scale for Inpatient Evaluation were unchanged between the two groups. But among the indices, social interest and personal neatness were improved in the dose-reduction group and retardation was aggrevated in the dose-maintaining group. 6) Total quality of life scores were unchanged between two groups. But in the dose maintaining group, satisfaction scores of attention, autonomy, and interpersonal relationship decreased progressively. These findings suggest that the dose reduction of antipsychotics for chronic schizophrenics on programs of high-dose antipsychotics were effective. Dose reduction should therefore be implemanted to spread the rehabilitation and improve quality of life for chronic schizophrenics.
Antipsychotic Agents* ; Chlorpromazine ; Haloperidol ; Humans ; Inpatients ; Psychopathology ; Quality of Life ; Rehabilitation

OBJECTIVE: Weight gain and DM can be serious side effects in the use of atypical antipsychotics (AAP), although conventional antipsychotics (CAP) have also been implicated. Also weight gain & DM are the adverse effects that are often associated with noncompliance and medical problems. The relationship between weight gain, dyslipidemia and DM is well established. Patients with schizophrenia are not only at risk of DM, but also taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Thus, this pilot study was conducted to investigate the risk of hyperlipidemia & DM in Korean patients taking antipsychotic medications. METHODS: After receiving informed consent, demographic data and history of medication were collected from medical records of 174 inpatients (92 male, 82 female). For the laboratory tests blood sampling was done at 7 A.M. before the meal and medication. RESULTS: For all subjects, the mean age was 41.10+/-9.56 years (range 14-65 years); 88% were diagnosed with schizophrenia. Of these, 55% were treated with antipsychotics alone (Monotherapy) and 45% were treated with combination therapy (such as antipsychotics plus a mood stabilizer). The mean age of onset of illness was 24.8+/-47.25 years old and mean duration of admission was 45.44+/-133.84 months. In the monotherapy group, the duration & dosage of each medications were 42.1+/-60.5 weeks and 12.2+/-8.22 mg/day of haloperidol (N=35), 6.95+/-9.52 weeks & 5.03+/-1.88 mg/day of risperidone (N=19), 9.1+/-11.1 weeks & 13.9+/-6.5 mg/day of olanzapine (N=8), 10.2+/-6.3 weeks and 287.6+/-62.9 mg/day of lodopine (N=4), 15.7+/-9.54 weeks and 335+/-172.8 mg/day of clozapine (N=5), 20+/-22.23 & 620+/-265.9 mg/day of chlorpromazine (CPZ; N=5). Mean weight gains of CAP group and AAP group, which was divided by the main therapeutic drug, were 0.18+/-5.99 and 2.18+/-6.38 kg in total subjects, however, there was no statistical significance between the groups. Moreover, there was no statistically significant difference in weight gain between groups when comparing each individual monotherapy (haloperidol, risperidone, olanzapine, lodopine, clozapine, CPZ: ANOVA; df=5, f=1.12, p=0.35). In the laboratory test results of total subjects abnormality of total cholesterol was 23.6%, triglyceride was 50.6%, fasting blood sugar (FBS) 1.7%, hemoglobin A1c (HbA1c) 27.6%, insulin 3.4%. There were statistical significances of correlations between HbA1c & FBS (r=0.489, p<0.01), total cholesterol (r=0.286, p<0.01), low density lipid (LDL; r=0.299, p<0.01) and triglyceride (TG; r=0.277, p<0.05), high density lipid (HDL; r= -0.192, p<0.05), original weight (r=0.154, p<0.05). With ANOVA for the evaluations of drug effect in monotherapy groups, the level of ALT (SGPT; p=0.04) was higher in olanzapine group, TG was higher in clozapine & CPZ group (p=0.03). HDL was lower in lodopine, clozapine & CPZ group (p=0.01). LDLwas highr in olanzapine & lodopine group (p=0.01). Abnormalities of ALT in olanzapine & clozapine group were 37.5% & 40%, those were statistically significant (p=0.02). Although there was no statistical significance (p=0.05), clozapine (60%), CPZ (60%) & olanzapine (37.5%) groups revealed more abundant abnormalities than haloperidol (11.4%) & risperidone (21%) groups in total cholesterol. CPZ (100%), clozapine (80%), lodopine (75%), olanzapine (75%) groups revealed more abundant abnormalities than haloperidol (48.6%) & risperidone (57.9%) groups in TG, however, there was no statistical significance. And the abnormality of HbA1c was 62.5% in olanzapine group and 40% in CPZ group, those were more abundant than other groups (20-25.1%), even though no statistical significance. CONCLUSION: In the cases of Korean patients taking antipsychotic medication, the tentative risk rate of hyperlipidemia might be 18.3% and hyperglycemia might be 27.6%. CPZ, clozapine and olanzapine, as compared with haloperidol and risperidone, may be associated with more adverse changes in total cholesterol and TG. Olanzapine and CPZ, as compared with haloperidol, risperidone and clozapine, may be more risky in the development of hyperglycemia. HbA1c may be an indicator to detect the risk of hyperlipidemia and hyperglycemia in patients taking antipsychotic medications.
Age of Onset ; Antipsychotic Agents* ; Blood Glucose ; Chlorpromazine ; Cholesterol ; Clozapine ; Dyslipidemias ; Fasting ; Haloperidol ; Humans ; Hyperglycemia* ; Hyperlipidemias* ; Informed Consent ; Inpatients ; Insulin ; Male ; Meals ; Medical Records ; Pilot Projects ; Prevalence* ; Risperidone ; Schizophrenia ; Triglycerides ; Weight Gain

This study was undertaken to compare by Atomic Force Microscope the effects of various finishing and polishing instruments on surface roughness of filling and veneering composite resins. Seven composite resins were studied : Silux Plus (3M Dental Products, U.S.A.), charisma (Heraeus Kulzer, Germany), Prisma THP (L.D.Caulk, Dentsply, U.S.A.), Photoclearfil (Kuraray, Japan), Cesead (Kuraray, Japan), Thermoresin LC (GC, Japan), Artglass (Heraeus Kulzer, Germany), samples were placed and polymerized in holes (2mm thick and 8.5mm in diameter) machined in Teflon mold under glass plate, ensuring excess of material and moulded to shape with polyester matrix strip, Except control group (polyester mztrix strip), all experimental groups were finished and polishied under manufacturer's instructions. The finishing and polishing procedure were : carbide bur (E.T. carbide set 4159, Komet, Germany), diamond bur (composite resin polishing bur set, GC, Japan), aluminum-oxide disc (Sof-Lex Pop-On, 3M Dental Products, U.S.A.), diamond-particle disc (Dia-Finish, Renfert Germany), white stone bur & rubber point(composite finishing kit, EDENTA, Swiss), respectively. Each specimens were evaluated for the surface roughness with Atomic Force Microscope (AutoProbe CP, Park Scientific Instruments, U.S.A.) under contact mode and constant height mode. The results as follows : 1. Except Thermoresin LC, all experimental composite resin groups showed more rougher than control group after finishing and polishing(p<0.1). 2. A surface as smooth as control group was obtained by Al2O3 disc all filling composite resin groups except Charisma and all veneering composite resin groups except Thermoresin LC(p<0.05). 3. In case of Thermoresin LC, there were no statistically significant differences before and after finishing and polishing(p>0.1). 4. Carbide bur, diamond bur showed rough surfaces in all composite resin groups, so these were inappropriate for the final poslishing instruments.
Bisphenol A-Glycidyl Methacrylate ; Composite Resins* ; Dental Instruments ; Fungi ; Glass ; Polyesters ; Polymers ; Polytetrafluoroethylene ; Rubber

Bethanechol, a cholinergic agonist, has been recommended for the management of peripheral anticholinergic side effects during the treatment of antipsychotic medications. But there have been few studies which have evaluated the drug interactions of antipsychotics and bethanechol, even the treatment effects of bethanechol on anticholinergic side effects. So the authors have evaluated whether psychopathology and plasma haloperidol and reduced haloperidol concentrations are significantly changed or not when bethanechol was administrated with maintained doses of haloperidol and other coadministrated drugs(such a benztropine). Also we have evaluated the abating effects of bethanechol on anticholinergic side effects during the treatment with haloperidol. Fifteen schizophrenics with higher than 5 of total score of anticholinergic side effects of 'Rating scale for side effect' were assigned to two groups, and bethanechol 30mg/day and 60mg/day were applied on each group for 4 weeks. The daily haloperidol dosages were fixed before 2 weeks of study. We assessed anticholinergic side effects by 'Rating scale for side effect' and psychopathology by BPRS, and plasma haloperidol and reduced haloperidol concentrations by HPLC at baseline, 2nd week and 4th week. The results were as followed. 1) There was no significant change of plasma haloperidol and reduced haloperidol concentration. 2) At baseline, the dosage of haloperidol showed significant correlation with the total score of anticholinergic side effect, but not at 2nd week and 4th week. 3) In 60mg/day group, dry mouth and the total score of anticholinergic side effects were significantly improved, but not in 30mg/day group. 4) There was no significant change of BPRS except withdrawal at 2nd week. These results suggest that coadministration of bethanechol influenced neither on psychopathology nor on plasma haloperidol and reduced haloperidol concentrations and that improved dry mouth and total score of anticholinergic side effects at 60mg/day.
Antipsychotic Agents ; Bethanechol* ; Cholinergic Agonists ; Chromatography, High Pressure Liquid ; Drug Interactions ; Haloperidol* ; Mouth ; Plasma* ; Psychopathology ; Schizophrenia