Antipsychotic medications are important for the successful management of schizophrenia. Continuous treatment with medication is superior in relapse prevention and non-adherence to antipsychotic medication is associated with a poor clinical outcome. Long-acting injectable antipsychotics (LAIs) that can guarantee adherence to a treatment regimen could be a useful treatment option. With the introduction of second-generation atypical antipsychotics-long acting injection (SGA-LAI), the risks for extrapyramidal adverse events are decreased. The indications for SGA-LAI have been extended from chronic, stabilized patients to acute psychotic patients. Some studies investigated the use of LAI in first-episode schizophrenia patients and raised the possibility of prescribing LAI as a treatment option. However, there is still limited research using LAI in first-episode schizophrenia. More well-designed, randomized, controlled clinical trials using SGA-LAIs in first episode schizophrenia are needed. Additionally, studies on side effects of SGA-LAI in long-term use are required prior to recommending LAI for patients with first episode schizophrenia.
Antipsychotic Agents ; Delayed-Action Preparations ; Humans ; Recurrence ; Schizophrenia

Dementia has became a major public health problem as the aged population is rapidly increasing. Dementia is underdiagnosed in primary care and many primary care physicians are hesitate to diagnose dementia. Early detection and starting appropriate treatment has been emphasized in managing dementia patients. The role of primary care physicians in caring for patients with demantia is important to efficiently manage dememtia and related socioeconomic burden since they meet first many patients mostly in initial stage of diseases. Primary care physicians pay attention to early sign and symptoms of dementia and are able to differentiate pathologic condition from normal age related cognitve decline. They should actively performe the screenig test and comprehensive clinical evaluation for suspected dementia patients. After diagnosis of dementia, they have to help thier patients to start and maintain appropriate pharmacological and non-pharmacological treatments and provide supports for dementia patients and their caregivers. To optimal management of dementia, primary care physicians also need to strengthen collaboration with specialists in treatment and lead their patients to utilize social servicies. It is necessary to develop systemized education programs for primary care physicians and standardized giudeline for maniging demenita in parimary care. Primary care physicians need to keep acquring up-to-date knowlege about dementia and to screen and detect dementia in suspected dementia patients. They should provide appropriate treatments for patinets in the collaboration with specialists and infrom their patients available social services.
Alzheimer Disease ; Caregivers ; Cooperative Behavior ; Dementia* ; Diagnosis* ; Education ; Humans ; Memory Disorders ; Physicians, Primary Care ; Primary Health Care* ; Public Health ; Social Work ; Specialization

OBJECTIVES: To investigate the frequency and clinical characteristics of premenstrual syndrome(PMS)/premenstrual dysphoric disorder(PMDD) in high school students, and determine the correlates of PMS/PMDD in association with comorbid depression and anxiety. METHODS: A total of 1688 students were recruited from 5 high schools in Seoul, Korea. Subjects completed the questionnaire composed of scales to measure premenstrual symptoms, depression, and anxiety, as well as sociodemographic and reproductive variables. Subjects were categorized into 3 groups by using the Premenstrual Symptom Screening Tool(PSST) to determine the frequency and clinical characteristics of PMS/PMDD. Multivariate logistic regression was used to identify the correlates of PMS/PMDD. RESULTS: The frequency of moderate to severe PMS and PMDD was 20.1% and 6.4%, respectively. Irritability (78.8%), fatigue(76.4%), and emotional sensitivity(69.8%) were common premenstrual symptoms, and functional impairment in academic performance(67.1%) was dominant. Dysmenorrhea[odd ratio(OR)=3.68, 95% confidence interval(CI) 2.45-5.55], family history of PMS(OR=1.91, 95% CI 1.35-2.71), and use of oral contraceptive (OR=1.85, 95% CI 1.16-2.94) were associated with the increased risk of PMS/PMDD after adjustment for depression and anxiety. Negative attitude to menses(OR=15.60, 95% CI 3.61-67.42) was associated with the increased risk of PMS/PMDD, particularly in subjects without depression and anxiety. CONCLUSIONS: PMS was common, as the frequency of PMS more than moderate severity including PMDD exceeded 25%, and disrupted daily functioning in adolescents. PMS is associated with various sociodemographic and menstrual characteristics, and these associations are affected by comorbid depression and anxiety.
Adolescent ; Anxiety ; Depression ; Humans ; Korea ; Logistic Models ; Mass Screening ; Premenstrual Syndrome ; Questionnaires ; Weights and Measures

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.
Comorbidity ; Delivery of Health Care ; Depression ; Female ; Humans ; Korea ; Life Style ; Logistic Models ; Mass Screening ; Mental Health ; Questionnaires ; Risk Factors ; Smoke ; Smoking

Dementia is a clinical syndrome characterized by a cluster of symptoms and signs that manifest as difficulties in cognitive functions such as memory, psychological and psychiatric changes, and impairments in activities of daily living. As a result of worldwide trends of population aging, dementia has had a huge impact on public health in almost all countries. Disease modification therapies for dementia have not yet been developed. However, pharmacotherapy is essential in patients with dementia to combat delays in their cognitive and functional decline. In this article, we review the current pharmacotherapy for dementia. Three acetylcholinesterase inhibitors—donepezil, rivastigmine, galantamine—and memantine are the only medications that have been approved for the treatment of dementia. We present the indications, dose recommendations, side effects, and criteria for National Health Insurance coverage in Korea of these medications for dementia treatment. Although the Ministry of Food and Drug Safety in Korea has not approved any medications for managing the behavioral and psychological symptoms of dementia, some antipsychotics and antidepressants have been studied and used clinically for those purposes. Clinicians may consider vitamin E, Ginkgo biloba extract, choline alfoscerate, or omega-3 fatty acids as additional treatment options. Non-steroid anti-inflammatory drugs, estrogen hormone therapy, and statins are not generally recommended for dementia treatment. We believe that our findings will aid clinicians in the treatment of patients with cognitive decline.
Acetylcholinesterase ; Activities of Daily Living ; Aging ; Antidepressive Agents ; Antipsychotic Agents ; Cholinesterase Inhibitors ; Cognition ; Dementia ; Drug Therapy ; Estrogens ; Fatty Acids, Omega-3 ; Ginkgo biloba ; Glycerylphosphorylcholine ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Memantine ; Memory ; National Health Programs ; Public Health ; Rivastigmine ; Vitamin E ; Vitamins

Dementia is a clinical syndrome characterized by a cluster of symptoms and signs that manifest as difficulties in cognitive functions such as memory, psychological and psychiatric changes, and impairments in activities of daily living. As a result of worldwide trends of population aging, dementia has had a huge impact on public health in almost all countries. Disease modification therapies for dementia have not yet been developed. However, pharmacotherapy is essential in patients with dementia to combat delays in their cognitive and functional decline. In this article, we review the current pharmacotherapy for dementia. Three acetylcholinesterase inhibitors—donepezil, rivastigmine, galantamine—and memantine are the only medications that have been approved for the treatment of dementia. We present the indications, dose recommendations, side effects, and criteria for National Health Insurance coverage in Korea of these medications for dementia treatment. Although the Ministry of Food and Drug Safety in Korea has not approved any medications for managing the behavioral and psychological symptoms of dementia, some antipsychotics and antidepressants have been studied and used clinically for those purposes. Clinicians may consider vitamin E, Ginkgo biloba extract, choline alfoscerate, or omega-3 fatty acids as additional treatment options. Non-steroid anti-inflammatory drugs, estrogen hormone therapy, and statins are not generally recommended for dementia treatment. We believe that our findings will aid clinicians in the treatment of patients with cognitive decline.

OBJECTIVE: The purpose of this study was to examine post-hospitalization outpatient drug adherence in patients with severe psychiatric illness, including bipolar disorder and schizophrenia, and to investigate factors associated with drug adherence. METHODS: Eighty-one patients diagnosed with schizophrenia or bipolar disorder who were hospitalized due to aggravation of psychiatric symptoms were monitored. At hospitalization, we conducted clinical assessments such as the Clinical Global Impression-Severity, Drug Attitude Inventory, Contour Drawing Rating Scale, Multidimensional Scale of Perceived Social Support scale, and patients' demographic factors. We measured drug adherence using the Medication Event Monitoring System (MEMS), pill count, and patients' self-report upon out-patients visits, 4 and 24 weeks after discharge. RESULTS: The mean values of the various measures of adherence were as follows: MEMS (4 weeks) 84.8%, pill count (4 weeks) 94.6%, self-report (4 weeks) 92.6%, MEMS (24 weeks) 81.6%, pill count (24 weeks) 90.6%, and self-report (24 weeks) 93.6%. The adherence agreement between MEMS, pill count, and self-report was moderate (4 weeks intra-class correlation [ICC]=0.54, 24 weeks ICC=0.52). Non-adherence (MEMS ≤0.08) was observed in 26.4% of the patients at 4 weeks and 37.7% at 24 weeks. There was a negative correlation between drug adherence assessed 4 weeks after discharge and Contour Drawing Rating Scale difference score (r=−0.282, p<0.05). A positive correlation was found between drug adherence assessed 24 weeks after discharge and Drug Attitude Inventory (r=0.383, p<0.01). CONCLUSION: Patients' attitude towards their medication and their degree of physical dissatisfaction influenced post-hospitalization drug adherence in severe psychiatric patients.
Bipolar Disorder ; Demography ; Drug Monitoring ; Hospitalization ; Humans ; Medication Adherence ; Micro-Electrical-Mechanical Systems ; Outpatients ; Schizophrenia

OBJECTIVES: The purpose of this study was to analyze the relationship between subjective well-being and other clinical parameters such as sociodemographic and clinical variables, which include positive and negative symptoms, depressive symptoms, insight, and side effects. METHODS: Fifty-one outpatients diagnosed with schizophrenia were recruited in this study. Subjective well-being was assessed using a self-rating scale, the Subjective Well-being under Neuroleptics-Short form (SWN-K). Sociodemographic variables were also evaluated and other evaluations were conducted using the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), Korean Version of the Revised Insight Scale for Psychosis (KISP), and Multidimensional Scale of Perceived Social Support (MSPSS). The relationship between subjective well-being and these clinical variables was assessed. RESULTS: Education years and social support scores were positively correlated with the total SWN-K scores, but severity of illness, severity of depression, severity of side effect, and the scores on insight were negatively correlated. The stepwise multiple regression analyses indicated that the total SWN-K score of the patients with schizophrenia was associated with negative symptoms and insight. CONCLUSION: Better insight and more severe negative symptoms in patients with schizophrenia may be associated with worse subjective well-being. Results indicate that careful evaluation of subjective well-being is essential for proper management of patients with schizophrenia.
Depression ; Education ; Humans ; Outpatients ; Psychotic Disorders ; Schizophrenia*

OBJECTIVES: We developed a Korean version of the Brief Measure of Worry Severity(BMWS), and examined its reliability, validity, and factor structures. We also explored the associations of pathological worry with depression and anxiety. METHODS: Three hundreds fifty-two subjects including community population and college students completed the BMWS, and 27 subjects repeated the scale three weeks later. Reliability was assessed by Cronbach's coefficient alpha and test-retest correlation. The external validity was examined by the correlation of the BMWS score with the scores of Beck Depression Inventory(BDI), Patient Health questionnaire-2(PHQ-2), State Anxiety Inventory(SAI), and Trait Anxiety Inventory(TAI). And principal component analysis was performed to evaluate the construct validity. The associations of pathological worry with depression and anxiety were explored using partial correlation analysis. RESULTS: Cronbach's coefficient alpha for the BMWS was 0.904 and test-retest correlation was 0.56(P<0.01). The Spearman correlation coefficients of the BMWS score with the scores of BDI, PHQ-2, SAI, and TAI were 0.60(P<0.01), 0.42(P<0.01), 0.36(P<0.01), and 0.59(P<0.01), respectively. The BMWS showed unifactorial construct. When controlling for TAI score, the correlation coefficient between the BMWS score and the BDI score was 0.357(P<0.01), and when controlling for BDI score the correlation coefficient between the BMWS score and the TAI score was 0.446(P<0.01). CONCLUSION: The Korean version of the BMWS was found to be a reliable and valid questionnaire for measuring pathological worry. And we could identify the associations of the pathological worry with depression as well as anxiety.
Anxiety ; Depression ; Humans ; Principal Component Analysis ; Questionnaires

OBJECTIVES: Schizophrenia is a chronic psychiatric disorder characterized by its debilitating course. It leads to personal and social dysfunctions, burdening patients and guardians heavily. Enhancing functional outcome is a major treatment goal, but pharmacotherapy alone is usually not enough. Hence, it is important to reveal clinical factors that can predict personal and social performance in schizophrenia patients. Analyze factors influencing personal and social performance in schizophrenia patients. METHODS: 66 schizophrenia patients from three University hospitals in Korea were enrolled, completing clinical scales between January 2008 and December 2009. 38 patients dropped out during follow up. 28 patients were included in the final study. Personal and social performance was measured using the Personal and Social Performance scale (PSP) since January 2015. Correlation and multiple regression analyses were performed to reveal associations between demographic and clinical factors and PSP. RESULTS: Correlation analyses resulted in statistically significant correlations between CGI-S (r=-0.646, p<0.01), PANSS (r=-0.419, p<0.05), KISP (r=-0.523, r<0.01), KmSWN (r=0.388, p<0.05), Trail making B (r=0.608, p<0.01), KDAI (r=0.608, p<0.01), and PSP. Stepwise multiple regression analyses showed significant models with CGI-S (β=-0.485, p<0.01), and KDAI (β=0.423, p<0.01). CONCLUSION: Our results show that attitude toward drugs and symptom severity affect a patient’s personal and social performance most prominently. We advise to focus on patient education to reinforce attitude toward drugs, and to concentrate on reducing symptom severity to enhance personal and social performance in schizophrenia patients.
Drug Therapy ; Follow-Up Studies ; Hospitals, University ; Humans ; Korea ; Patient Education as Topic ; Schizophrenia* ; Weights and Measures