The prevalence of obesity and overweight is increasing in mood disorder, and it is connected to an increased cardiovascular mortality. Because of them, treatment for obesity may be an essential part of mood disorder treatment. Similar to the general population, non-pharmacological treatment such as correction of life habits should be considered first of all. If this approaches are fail, pharmacological treatment for obesity would be required as next step. Any drug for obesity is not approved officially in mood disorder. So approved drugs in general population, and drugs supported by several studies are prescribed in clinical settings. Several treatment guidelines for mood disorder and studies support that orlistat, metformin, topiramate and bupropion is effective and safe.
Bupropion ; Drug Therapy* ; Metformin ; Mood Disorders* ; Mortality ; Obesity* ; Overweight ; Prevalence

As the placebo effect is inevitable in almost all types of treatment implemented in the context of the doctor-patient relationship, it would be a wise strategy to try to enhance the treatment effect by understanding its mechanism and applying it clinically. However, for various reasons there is resistance to therapeutical application of placebos. The main reason for this resistance comes from the confusion about the concept of the placebo, and it is necessary to differentiate the placebo response and the placebo effect and understand them clearly. Meta-analytical reviews of clinical studies showed that the placebo effect accounts for part of clinical effect of drugs. Authors reviewed meta-analytic studies dealing with the placebo effect on depression, sleep disorders, dementia, anxiety and addiction. In addition, we discussed the current state of placebo use and also the way to promote the placebo effect.
Antidepressive Agents ; Anxiety ; Dementia ; Depression ; Effect Modifier, Epidemiologic ; Placebo Effect ; Placebos* ; Sleep Wake Disorders

Objectives: ：Although dysfunctional breathing is a common symptom in general population and affects qual-ities of life, it is still underdiagnosed. There are some studies of prevalence of it in astma, but few studies in anxiety and depressive disorders. The purposes of this study were to explore the prevalence of it in anxiety and depressive disorders, and to investigate whether anxiety and depressed mood influence it. Methods: ：135 patients diagnosed with anxiety or depressive disorders, and 124 controls were recruited. Ni-jmegen questionnaire was used to assess dysfunctional breathing, and Hospital anxiety depression scale was used. Results: ：The prevalence of dysfunctional breathing in anxiety or depressive disorders was higher than that in control. In the linear regression model, anxiety accounted for 59.6% of dysfunctional breathing, but depressed mood did not. With covariate adjusted for anxiety, scores of dysfunctional breathing in anxiety or depressive disorders were higher than in controls. Conclusions ：Dysfunctional breathing in anxiety or depressive disorders is higher than that in control. Adjust-ing anxiety, its difference is still. Anxiety affects dysfunctional breathing, but depressed mood does not.

As the government has a plan to terminate medical internships and to start the New Resident program, postgraduate medical students should encounter the new residency training program without the internship from 2015. To keep pace with this significant change, the Korean Neuropsychiatry association launched the task force team to manage this problem. The task force team has examined the psychiatry residency training programs from major countries, including England, Japan, Germany, Australia, New Zealand, and the Unites States. In addition, we conducted a survey for teaching psychiatrists and psychiatry residents who just finished the Psychiatry Board Examination in 2013 using a premade questionnaire on the expected problems that might occur if the internship program were abolished, and some significant issues regarding resident rotation schedule to other departments. In this paper, we summarized the results of our examination and survey. Establishment of a new residency training program based on these surveys would be desirable.
Advisory Committees ; Appointments and Schedules ; Australia ; England ; Germany ; Humans ; Internship and Residency ; Japan ; Korea ; Neuropsychiatry ; New Zealand ; Psychiatry ; Surveys and Questionnaires ; Students, Medical

OBJECTIVE: The purpose of this study was to investigate the efficacy and tolerability of atypical antipsychotics (AAPs) with augmentation by blonanserin in schizophrenic patients. METHODS: aA total of 100 patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP were recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to their existing AAP regimen, which was maintained during the study period. Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at weeks 2, 4, 8, and 12. Predictors for PANSS response (≥20% reduction) were investigated. RESULTS: The PANSS total score was significantly decreased at 12 weeks of blonanserin augmentation (-21.0±18.1, F=105.849, p<0.001). Moreover, 51.0% of participants experienced a response at week 12. Premature discontinuation of blonanserin occurred in 17 patients (17.0%); 4 of these patients dropped out due to adverse events. The patients who benefited the most from blonanserin were those with severe symptoms despite a treatment with a higher dose of AAP. CONCLUSION: Blonanserin augmentation could be an effective strategy for patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP.
Antipsychotic Agents* ; Humans ; Prospective Studies* ; Schizophrenia

OBJECTIVE: The complexity of the treatment for bipolar disorder is often caused by the presence of side effects of various psychiatric medications. In particular, weight gain and metabolic syndrome are currently major concerns in the medication for bipolar disorders. Therefore, we undertook a survey of expert opinion to help make clinical decisions in these special situations. METHODS: A written survey which asked about treatment strategies in the safety and tolerability was prepared; 1) weight gain, 2) antipsychotic related hyperprolactinemia, 3) lamotrigine related skin rash, 4) treatment non-adherence, and 5) genetic counselling. Treatment options were scored using a 9-point scale for rating appropriateness of clinical decisions in some issues. In other issues, experts were asked to choose to determine the ranking of preferences on the list. Sixty-four experts of the review committee completed the survey. We classified the expert opinions about preferences by chi2 test. RESULTS: Experts preferred behavioral and diet modification for weight gain, switching to prolactin-sparing-antipsychotics for antipsychotic-induced hyperprolactinemia, reducing dose of lamotrigene for its related benign skin rash, and prescribing once a day for treatment adherence. CONCLUSION: With the limitation of expert opinion, authors hope that the results of this study provide valuable information to make clinical decision about the treatment of bipolar disorder in the complicated situations.
Advisory Committees ; Bipolar Disorder* ; Exanthema ; Expert Testimony ; Food Habits ; Hope ; Hyperprolactinemia ; Weight Gain

OBJECTIVE: The third revision of Korean Medication Algorithm Project for Bipolar Disorder was performed in 2014 in order to provide more proper guideline for clinicians. In this study, we undertook a survey of expert opinion to help clinical decisions in medical comorbidities. METHODS: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 64 experienced psychiatrists. This survey was composed of 56 main questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific situations. The executive committee analyzed the results and discussed the final production of algorithm. RESULTS: In bipolar patients with cardiovascular, diabetic, or hepatic comorbidities, aripiprazole was first-line treatment strategy. In case of renal comorbidity accompanying bipolar disorder, aripiprazole, valproate, and quetiapine were preferred. Valproate was recommended as the first-line strategy in case of bipolar disorder with cerebrovascular diseases. CONCLUSION: This study provided information about the consensus among experts in regard to treatment strategies for bipolar disorder in the medically ill.
Advisory Committees ; Bipolar Disorder* ; Comorbidity* ; Consensus ; Drug Therapy ; Expert Testimony ; Humans ; Psychiatry ; Surveys and Questionnaires ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the third revision of KMAP-BP was performed in 2014 in order to reflect the recent rapid development and research of bipolar disorder and psychopharmacology. METHODS: According to methodology of previous versions, KMAP-BP 2014 was revised using the same questionnaire consisting of 14 questions. Sixty-four experts of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence. RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Compared to KMAP-BP 2010, preference of AAP has been increased in the treatment of bipolar depressive episode in KMAP-BP 2014. Among AAPs, olanzapine, quetiapine and aripiprazole were preferred. When considering the efficacy and safety simultaneously, (es)citalopram, bupropion, and sertraline were recommended among antidepressants for bipolar depression. CONCLUSION: Compared with the previous version, we found that more aggressive pharmacological strategies as an initial treatment were preferred, although various strategies were recommended as same as previous studies. Increased preference of AAP was prominent in KMAP-BP 2014. We expect this algorithm may be helpful in the treatment of bipolar disorder, depressive episode.
Advisory Committees ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Drug Therapy ; Psychopharmacology ; Surveys and Questionnaires ; Sertraline ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: The pharmacotherapy of bipolar disorder has many difficulties such as various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent rapid development and research of bipolar disorder and psychopharmacology, including atypical antipsychotics and new anticonvulsants, make it more difficult to choose the appropriate pharmacological options. Therefore, we decided to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2010 in order to provide more proper guideline for clinicians. METHODS: Like the previous version, KMAP-BP 2010, we performed the survey using questionnaire comprising 55 main questions in which 8 main questions and 478 sub-items for treatment of manic or hypomanic episode were included. Sixty-four members of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence. RESULTS: The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and an atypical antipsychotic, and it is the treatment of choice for euphoric, psychotic and dysphoric/mixed mania. The preference for monotherapy with atypical antipsychotic (for all three types of mania) or mood stabilizer (for euphoric mania) was increased in KMAP-BP 2014. Valproic acid and lithium are chosen as the preferred mood stabilizer of the first-line treatment of acute manic episode and valproic acid was the treatment of choice for all types of mania. Atypical antipsychotics is more widely accepted than before in manic and hypomanic episode. Moreover, the preference for combination treatment in manic patients who failed to respond in early stage treatment was increased. CONCLUSION: Compared with the previous version, we found that 'no-consensus' decreases in this revision. These suggest that the many clinicians agree with others in the treatment of acute manic/hypomanic episode, and the pharmacotherapy of manic/hypomanic episode become more obvious than before. Atypical antipsychotics such as aripiprazole, olanzapine and quetiapine gain more awareness in the treatment of bipolar mania and hypomania. We expect this algorithm may provide clinicians good information and help about the treatment of bipolar disorder, manic/hypomanic episode.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder* ; Drug Therapy ; Humans ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder. METHODS: The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts. Sixty-four of 110 experts replied. For the newly added section (treatment guideline for child and adolescent bipolar disorders) in KMAP-BP 2014, 23 of 38 experts replied to this special section. Data were analyzed according to the same methods to be used in conjunction with the previous publications. RESULTS: The recommendations for the management of acute mania remained largely unchanged. Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. Valproic acid (VP), lithium (Li), and several AAPs continued to be first-line treatments. MS or AAP monotherapy was the first-line treatment in hypomania. More frequent use of AAP as a first-line agent was noted in KMAP-BP 2014. For management of mild to moderate bipolar depression, MS monotherapy, combination of MS and AAP, combination of AAP and lamotrigine (LTG) was the first-line treatments. In severe non-psychotic depression, combination of MS and AAP, combination of AAP and LTG, and combination of MS and antidepressant (AD) was the first-line treatments. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Li, VP, LTG, aripiprazole (ARP), olanzapine (OLZ) and quetiapine (QT) were the first-line treatment for bipolar depression. Although many treatment options were recommended, there were few consensus of opinion in bipolar depression. Treatment of mixed features was firstly added in KMAP-BP 2014. Combination of MS and AAP was the treatment of choice for management of mixed features. AAP monotherapy was also the first-line treatment. VP, Li, ARP, OLZ and QT were the first-line treatment for management of all phases of mixed features. Risperidone was added in mixed mania and LTG in mixed depressive features. There have been many treatment options for management of rapid cycling in bipolar disorder, when considered the combination of MS and AAP was only first-line treatment in KMAP-BP 2014. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options. For management of maintenance phase of bipolar II depression, combination of AAP and LTG, combination of MS and LTG, combination of MS and AAP, AAP or LTG monotherapy were recommended as the first-line options. CONCLUSION: The experts' opinion of consensus was markedly changed in KMAP-BP 2014 than in previous publications. Preferred treatment with AAP and LTG was especially noted for management of bipolar disorder. We confirmed the treatment options recommended in KMAP-BP 2014 were much in concordance with current updated treatment guidelines for bipolar disorder. Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
Adolescent ; Bipolar Disorder* ; Child ; Consensus ; Depression ; Humans ; Lithium ; Surveys and Questionnaires ; Risperidone ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate