BACKGROUND AND OBJECTIVES: Candesartan cilexetil (Atacand ), a selective type I angiotensin II receptor blocker, has recently been introduced as a new antihypertensive agent. We evaluated its anti-hypertensive effect and safety in mild to moderate hypertensive patients. MATERIALS AND METHODS: Candesartan cilexetil, 8 mg or 16 mg, was administered once a day over 8 weeks period in the patients with mild to moderate hypertension (25 male, 26 female, mean age: 53.5+/-1.2 years). For safety evaluation, laboratory tests were performed before and after treatment with candesartan cilexetil. Changes in blood pressure, heart rate and electrocardiogram were also observed. RESULTS: 1) The mean blood pressures in the sitting position were systolic 164.1+/-2.1 mmHg and diastolic 106.3+/-0.8 mmHg before treatment, which were lowered to 135.4+/-2.0 mmHg and 89.1+/-1.1 mmHg, repectively after 8 weeks of treatment (p<0.05). 2) Candesartan cilexetil had a significant dose-dependent antihypertensive effect for diastolic pressure in 35 patients (8 mg: 97.8+/-0.9 mmHg, 16 mg: 91.3+/-1.1 mmHg, p<0.05). 3) Heart rate was not significantly changed before and after treatment during the treatment with candesartan cilexetil (72.2+/-1.2/min vs. 72.0+/-1.3/min: p>0.05). 4) Laboratory tests revealed no significant abnormality by the treatment with candesartan cilexetil. 5) Left ventricular hypertrophy by ECG criteria detected in 3 cases disappeared after treatment with candesartan cilexetil. 6) No significant side effects were observed during the treatment period. CONCLUSION: Candesartan cilexetil, 8 mg or 16 mg, once a day is an effective and well tolerated antihypertensive treatment. It has a significant dose-dependent antihypertensive effect.
Blood Pressure ; Electrocardiography ; Female ; Heart Rate ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Male ; Receptors, Angiotensin

The purpose of this study was to investigate the effects of methylphenidate, a psychostimulant, on quantitative electroencephalography (QEEG) during the continuous performance test (CPT) in boys with attention-deficit hyperactivity disorder (ADHD). The QEEG was obtained from 20 boys with ADHD. The amplitudes of 4 bands (alpha, beta, delta, and theta) in the QEEG, as well as the theta/beta ratio, before and after the administration of methylphenidate were compared during both the resting and CPT states. Methylphenidate induced a significant increase of alpha activities in both the right and left frontal and occipital areas, an increase of beta activities in almost all areas except for the temporal region, a decrease of theta activities in both the occipital and right temporo-parietal areas, a mild decrease of delta activities in the occipito-parietal areas, and an increase of the theta/beta ratio in the right frontal and parieto-occipital, and left temporal areas during the CPT state. No significant QEEG changes were induced by the administration of methylphenidate in the resting state. These data suggest that methylphenidate has greater electrophysiological influences on the cerebral topographical activities during the performance of attentional tasks, as compared to the resting state, in boys with ADHD.
Attention Deficit Disorder with Hyperactivity/*diagnosis/*drug therapy ; Central Nervous System Stimulants/*administration & dosage ; Child ; Electroencephalography/*drug effects ; Humans ; Male ; Methylphenidate/*administration & dosage ; Neuropsychological Tests

OBJECTIVES: This study aims to test the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), a screening instrument for bipolar disorder. METHODS: A total of 238 subjects (126 DSM-IV bipolar outpatients and 112 controls without psychiatric history) completed the K-MDQ. RESULTS: The Cronbach's alpha, used to measure the internal consistency of the scale, was high (0.88). Principal component analysis with varimax rotation revealed three factors, which explained 59.5% of the variance. Individual item correlations with the total score were all statistically significant (p<0.001). The mean total score of the K-MDQ was 8.48 in bipolar disorder and 4.51 in non-clinical participants. A total K-MDQ score of 7 or more excluding further two questions was chosen as the optimal cutoff, as it provided good sensitivity (0.75) and specificity (0.69). CONCLUSION: The results of this study showed adequate validity of the K-MDQ, suggesting that this instrument is useful for screening of bipolar disorder.
Bipolar Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders* ; Outpatients ; Principal Component Analysis ; Surveys and Questionnaires ; Sensitivity and Specificity

OBJECTIVES: This study aims to test the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), a screening instrument for bipolar disorder. METHODS: A total of 238 subjects (126 DSM-IV bipolar outpatients and 112 controls without psychiatric history) completed the K-MDQ. RESULTS: The Cronbach's alpha, used to measure the internal consistency of the scale, was high (0.88). Principal component analysis with varimax rotation revealed three factors, which explained 59.5% of the variance. Individual item correlations with the total score were all statistically significant (p<0.001). The mean total score of the K-MDQ was 8.48 in bipolar disorder and 4.51 in non-clinical participants. A total K-MDQ score of 7 or more excluding further two questions was chosen as the optimal cutoff, as it provided good sensitivity (0.75) and specificity (0.69). CONCLUSION: The results of this study showed adequate validity of the K-MDQ, suggesting that this instrument is useful for screening of bipolar disorder.
Bipolar Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders* ; Outpatients ; Principal Component Analysis ; Surveys and Questionnaires ; Sensitivity and Specificity

STUDY DESIGN: Twenty patients with spinal infection(tuberculous+pyogenic) in the lumbar spine were evaluated according to the surgical treatment methods using posterior instrumentation(pedicle screw) and conventional anterior curettage and interbody fusion method without posterior instrumentation. OBJECTIVE: The purpose of this study is to evaluate the efficacy of the method consisting of posterior instrumentation using pedicle screw and anterior lumbar interbody fusion. SUMMARY OF LITERATURE REVIEW: It has been reported that patients ended up with kyphosis had a higher incidence of back pain. MATERIALS AND METHODS: Twenty patients with spine infection in the lumbar spine divided into two groups depending on their use of posterior instrumentation in surgical treatment methods. One group consisted of 10 cases which were treated by conventional anterior curettage and anterior lumbar interbody fusion only(Group A) and the other groups consisted of 10 cases were treated by conventional anterior curettage and anterior lumbar interbody fusion with posterior instrumentation using pedicle screw(Group B) by a single surgeon. The clinical outcomes were evaluated using Macnab's classification and the radiographys were analyzed with respect to fusion status and sagittal angle. RESULTS: A solid bony fusion was obtained in Group B. But in Group A, 2 cases of bony resorption were occurred. The preoperative, immediate postoperative, and final follow-up sagittal angle in both groups were -7.4degree/ - 0 . 8degree, -19.0degree/ - 1 2 . 4degreeand -5.9degree/ - 8 . 6degree, respectively. There is a significant statistical difference in loss of sagittal angle correction between two groups(P<0.05). There is no complication related to the posterior instrumentation, but only 1 case of superficial infection was occurred. The clinical outcome which was evaluated by Macnab's method, there was no significant statistical difference between two groups(P>0.05), but exellent result was more common in Group B. CONCLUSION: This method which consist of conventional curettage and anterior lumbar interbody fusion with posterior instrumentation appears to be effective in stabilizing the vertebrae, and restoration and maintenance of physiologic lumbar lordosis. we would suggested this method for the surgical treatment in infection of lumbar spine.
Animals ; Back Pain ; Classification ; Curettage ; Follow-Up Studies ; Humans ; Incidence ; Kyphosis ; Lordosis ; Spine*

OBJECTIVE: Since the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision of treatment algorithm due to rapid progress in the management for bipolar disorder. We focused on the maintenance treatment of bipolar I and bipolar II disorders of KMAP-BP revised in 2006. METHOD: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 70 experienced psychiatrists. It was composed of 37 questions, and each question includes various sub-items. We classified the expert opinion to 3 categories (the first-line treatment, the second-line, the third-line) by x2 test. A part of this revision regarding maintenance treatment had 6 items ; 2 on bipolar I and 4 on bipolar II disorder. RESULTS: There was no 'treatment of choice' in maintenance treatment. In case of bipolar I mania without history of depression, mood stabilizer (MS) monotherapy was 1st-line treatment. In maintenance management for bipolar II disorder, two treatment options were recommended. Treatment with MS alone or combinations of MS and atypical antipsychotics were preferred in recently recovered patients from hypomania. Atypical antipsychotics were more favored in the maintenance treatment for bipolar I and II disorders than previous KMAP-BP. CONCLUSIONS: There is no 'treatment of choice' in maintenance strategies for bipolar disorder. Atypical antipsychotics are more preferred than the previous KMAP-BP. Also there is an increasing interest on the maintenance use of lamotrigine in bipolar depression.

OBJECTIVE: In the last decade, a number of pharmacological agents have shown efficacy in the treatment of bipolar disorder. Traditionally, lithium has been considered as the treatment of choice of bipolar disorder. However, more recently, atypical antipsychotics and newly developed anticonvulsants have become increasingly popular alternatives to lithium. This study examined the prescribing patterns for medications to treat bipolar disorder in office-based psychiatric practice. METHODS: The data for the present study were collected by using structured record form from November 2005 to December 2005. Psychotropic medications were grouped into six categories ; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Prescription data of 700 cases with a diagnosis of bipolar disorder according to DSM-IV from 70 Korean psychiatrists were accessed. Severity, mood episode, psychiatric comorbidity and point of diagnosis related utilization rates were computed focusing on atypical antipsychotics. RESULTS: In 695 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 62.4% of subjects, anticonvulsants in 58.7%, lithium in 47.8%, antidepressants in 17.6%, and typical antipsychotics in 15.5% of subjects. About seventeen percent of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Lithium and typical antipsychotics prescription were less frequent in depressive subjects than subjects with other mood episodes. Prescription of atypical antipsychotics and antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications. CONCLUSION: The rapid progress of psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

Adult ; Diagnosis, Differential ; Humans ; Maxilla ; Prognosis

The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002 and revised in 2006. The aim of this study was to compare the KMAP-BP 2006 with other recently published treatment guidelines for bipolar disorder. We conducted a systematic review of the six most recently published guidelines and treatment algorithms for bipolar disorder to compare the similarities and differences between these guidelines and the KMAPBP 2006. Most treatment guidelines had similarities in their treatment options. The guidelines generally advocated atypical antipsychotics as first-line treatment in the manic phase and lamotrigine in the depressive phase. While lithium and divalproex were commonly used as mood stabilizers in the manic phase, divalproex was recommended in mixed or dysphoric mania. Mood stabilizers or atypical antipsychotics were selected as first-line treatment in maintenance. Some guidelines were more concerned about special clinical situations such as pregnancy, obesity, metabolic syndrome, and elderly patients, which were not described in the KMAP-BP 2006. Our findings suggest that the medication strategies for bipolar disorder are based on data from recent studies and clinical experiences. Useful information and a rationale for making sequential treatment decisions can be provided by critically reviewing the treatment guidelines. The treatment algorithms and guidelines are not substitutes for clinical judgment, but can serve as critical references to complement individual clinical assessments.
Aged ; Antipsychotic Agents ; Bipolar Disorder ; Complement System Proteins ; Humans ; Judgment ; Lithium ; Obesity ; Pregnancy ; Triazines ; Valproic Acid

OBJECTIVE: As clinician, it is very difficult to choose the pharmacotherapeutic strategies of bipolar disorder because of various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recently, rapid development in the 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 2002 (KMAP-BP 2002) in order to provide more proper guideline for clinicians. METHODS: Like the previous version, KMAP-BP 2002, we performed the first survey using questionnaire comprising 37 special clinical situations and 645 selection items. Fifty-three members of the review committee completed the first survey. After the discussion of the results at the review committee meeting, we performed the second adjunctive survey. Finally, the executive committee analyzed the results and discussed the final production of algorithm considering scientific evidences. RESULTS: The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and atypical antipsychotics, monotherapy of mood stabilizer, or monotherapy of atypical antipsychotics. As mood stabilizers, divalproex and lithium are accepted as the first-line agents. As atypical antipsychotics, quetiapine, olanzapine and risperidone are recommended as the first-line. Overall, atypical antipsychotics and combination therapy are accepted more widely than before. Among mood stabilizers, the preference of divalproex are increasing and that of carbamazepine are decreasing. CONCLUSION: Based on the results of two surveys, the discussion in executive committee and review of evidences, we developed new algorithm presented here for manic episode. We expect this algorithm may provide clinicians good informations and advices about the treatment of bipolar disorder, manic episode.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Risperidone ; Valproic Acid ; Quetiapine Fumarate