Here we report a case of serotonin syndrome caused by fluoxetine 20 mg and duloxetine 60 mg independently eight week apart. A 65-year old man developed fever, agitation and change of mental status after two weeks treatment with 20 mg of fluoxetine for depressive disorder. He was diagnosed unknown fever origin and discharged when fever subsided as antidepressant stopped. Eight weeks later he was prescribed 60 mg of duloxetine for the treatment of depressed mood. After 18 days on duloxetine he developed fever, agitation, myoclonus and change in mental status again. He improved rapidly after discontinuation of offending drug with supportive care. Despite serotonin syndrome is usually caused by poly-pharmacy of serotonergic drugs, this case shows unusual serotonin syndrome developed by therapeutic dose of two drugs of different classes independently.
Depressive Disorder ; Dihydroergotamine ; Fever ; Fluoxetine ; Humans ; Myoclonus ; Serotonin ; Serotonin Agents ; Serotonin Syndrome ; Thiophenes ; Duloxetine Hydrochloride

OBJECTIVE: Suicide is the leading cause of death for adolescents. The internet is widespread in Korea and has influence on mental health of adolescents. This study aims to investigate the relationship between the internet use and suicidal behavior resulting from adolescent depression. METHODS: The subjects consisted of 61 adolescents between the ages of 13 and 18 who were diagnosed as depression by Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Korean Version and Diagnostic and Statistical Manual of Mental Disorder 4th edition. Suicidal behavior was assessed by Columbia Suicide Severity Rating Scale. Patients were inquired about their internet use using questionnaires and other clinical variables using Beck Depression Inventory, Beck Suicidal Ideation Scale, Revised Children's Manifest Anxiety Scale, Internet Game Addiction Scale and Physical Abuse Scale. RESULTS: The patients within the high-risk group were more prone to searching for the word 'suicide' on the internet and having suicidal idea compare to the patients within the low-risk group. Among the high-risk group, the patients who searched for the word 'suicide' tended to be more anxious compared to the patients who did not search the word. CONCLUSION: The results of the present study suggest that searching the word 'suicide' on the internet is associated with suicidal idea. It is suggested that intervention on the patients within the searching group may reduce the suicidal idea resulting from adolescent depression.
Adolescent ; Cause of Death ; Depression ; Humans ; Internet ; Korea ; Manifest Anxiety Scale ; Mental Disorders ; Mental Health ; Mood Disorders ; Surveys and Questionnaires ; Schizophrenia ; Suicidal Ideation ; Suicide

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.
Antipsychotic Agents ; Humans ; Inpatients ; Polypharmacy ; Prescriptions ; Schizophrenia

OBJECTIVE: Recommended dosage of quetiapine for patients with schizophrenia is from 150 mg to 750 mg, which is based on randomized controlled study. But there are trends of increasing quetiapine dosage in clinical practice. Therefore, we evaluated the clinical aspect of schizophrenic patients who took quetiapine by naturalistic non-intervention study. METHODS: Schizophrenia outpatients in 88 mental hospitals were selected and 170 psychiatrists evaluated Clinical Global Impressions Scale for Severity (CGI-S) before starting quetiapine medication and CGI-S, Clinical Global Impressions Scale for Improvement (CGI-I), quetiapine dosage and medication compliance at 6 weeks after starting quetiapine medication. Overall efficacy and difference of efficacy between drug-naive patients and medication-switch patients were evaluated. We clustered the patients into 4 groups by using cluster analysis with three variables such as quetiapine dose at week 6, baseline CGI-S, and end-point CGI-S. We compared clinical aspect of each cluster with analysis of variance. RESULTS: 841 patients were enrolled. Efficacy of quetiapine was replicated, and improvement rate defined as CGI-I < or =2 was 55.9%. Drug-naive patients show more improvement in CGI-I than medication-switch patients, and efficacy for patients with insufficient treatment was also reported. Dosage for each clustered group was 25-350 mg, 400-500 mg, 600-700 mg and 750-1,500 mg. 750-1,500 mg group shows more decrease in CGI-S than 400-500 mg group and 600-700 mg group. CONCLUSION: This study suggests that there is a cluster of patients who take more benefits in reducing symptoms and show more compliance in high-dose quetiapine.
Cluster Analysis ; Compliance ; Dibenzothiazepines ; Hospitals, Psychiatric ; Humans ; Medication Adherence ; Outpatients ; Psychiatry ; Schizophrenia ; Quetiapine Fumarate

Most serotonin is found outside the central nervous system and functions much more than a neurotransmitter. Peripheral serotonin is produced by enterochromaffin cells in the gastrointestinal tract and secreted into blood. Serotonin, as a circulating amine, takes part in numerous biological processes including cardiovascular function, bowel motility, glucose metabolism and skeletal change. Serotonin signaling is regulated by serotonin receptors and serotonin transporters in multiple body organs. The drugs that manipulate the serotonergic system have been developed and used for the treatment of many systemic diseases. The richness of serotonergic modulation in the whole body provide both a pharmacologic opportunity and challenge.
Biological Processes ; Central Nervous System ; Enterochromaffin Cells ; Gastrointestinal Tract ; Glucose ; Neurotransmitter Agents ; Receptors, Serotonin ; Serotonin

Quality of medical research reports should be evaluated before they are applied to clinical practice. Since 1990s, several guidelines on research reports were suggested. Most recently published Consolidated Standards of Reporting Trials statement 2010 consists of 25 checklists and flow diagram for reporting an randomized controlled trial. Strengthening the reporting of observational studies in epidemiology statement is a checklist of items that should be addressed in articles reporting on the observational studies in epidemiology. TREND statement for the reporting of nonrandomized designs consists of 22 checklists. The Quality of Reporting of Meta-analyses checklist proposes to provide checklist and flow diagram for reporting of meta-analyses. The Meta-analysis of Observational Studies in Epidemiology statement proposes a checklist for compensating the study errors about observational studies in epidemiology. After development of reporting guidelines, improvements in the quality of reports are continuously reported, so using guidelines in the medical research will be expected to be more generalized.
Checklist ; Meta-Analysis as Topic ; Research Report

The case of a 77-year-old man with Charles Bonnet syndrome was presented. This patient lost his vision due to glaucoma, and he subsequently developed complex visual hallucinations. No other psychotic symptoms (e.g., delusions, perceptual disturbances) and no evidence of cognitive impairment or neurological diseases were reported. The visual hallucinations disappeared after treatment with quetiapine, an atypical antipsychotic, without any side effects. The visual hallucinations reappeared after quetiapine was discontinued. Treatment with a small dose of quetiapine has been maintained to prevent the exacerbation of symptoms.
Aged ; Delusions ; Dibenzothiazepines ; Glaucoma ; Hallucinations ; Humans ; Vision, Ocular ; Quetiapine Fumarate

OBJECTIVE: The aim of this study was to evaluate the relationship between quality of life (QoL) and alexithymia in patients with depressive disorders receiving antidepressant medication. METHODS: The sample consisted of patients visiting the outpatient psychiatric unit of a university hospital between January 2007 and June 9. Participants completed the Symptom Checklist-90-R (SCL-90-R), the Beck Depression Inventory (BDI), the Toronto Alexithymia Scale-20-K (TAS-20-K), and the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36). A total of 75 patients diagnosed with depressive disorder according to DSM-IV criteria were included in this study. Student t-tests and regression analyses were conducted on the data. RESULTS: Patients with alexithymia obtained lower QoL scores than did patients without alexithymia on eight dimensions of the SF-36. The regression analysis showed that alexithymia was positively associated with hostility and inversely associated with paranoid ideation. CONCLUSION: Patients with alexithymia emerged as more symptomatic on the SCL-90-R and obtained lower QoL scores on eight dimensions of the SF-36 than did patients without alexithymia. It is important that clinicians identify alexithymic characteristics in patients with depressive disorders to help them improve their QoL.
Affective Symptoms ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Health Surveys ; Hostility ; Humans ; Outpatients ; Quality of Life

OBJECTIVE: The pharmacotherapy of bipolar disorder not otherwise specified (BP-NOS) has been insufficiently studied. The aim of this prospective naturalistic study was to explore the effectiveness of lamotrigine adjunctive treatment in patients with BP-NOS. METHODS: Data from 50 patients diagnosed with BP-NOS were analyzed. On the basis of the prospective mood chart methodology, the efficacy of lamotrigine adjunctive treatment was assessed by changes in the mean Clinical Global Impressions-Bipolar Version (CGI-BP) depression scores. A paired t-test was used to test the statistical significance of the changes in CGI-BP depression scores. Repeated-measures analysis of variance (RM ANOVA) with simple effect analysis was performed to explore the sequential changes during a 52-week period. Cohen's d was calculated to measure the magnitude of the treatment effects on the changes in depression severity. Time to lamotrigine discontinuation was also calculated using the Kaplan-Meier estimates. Lamotrigine-associated adverse events were monitored every two weeks. RESULTS: A significant decrease, with a large effect size (Cohen's d=1.6), in the mean CGI-BP depression scores was associated with lamotrigine adjunctive treatment in intent-to-treat analysis (t=8.7, df=49, p<0.001). Twenty-four patients (48.0%) completed 52-week lamotrigine adjunctive treatment. Analysis of the data obtained from those completing the treatment revealed a large effect (Cohen's d=4.0) on improvement in the severity of depression (t=16.8, df=32, p<0.001). Sixty percent of patients achieved remission (n=30), and 64% of patients (n=32) showed some clinical response to lamotrigine adjunctive treatment. The mean time to lamotrigine discontinuation was 31.3+/-3.1 weeks (CI=25.2-37.4). Lamotrigine adjunctive treatment was well tolerated, with no serious rashes reported. CONCLUSION: Lamotrigine seems to be effective in the management of depressive symptoms in BP-NOS. Long-term use of lamotrigine was generally safe and well tolerated. Large-scale controlled trials might be needed to confirm the findings of this naturalistic study.
Bipolar Disorder ; Depression ; Exanthema ; Humans ; Prospective Studies ; Triazines

OBJECTIVE: Several lines of evidence have shown that neuronal injury might represent a possible pathway to mood disorders. The present study was performed to examine the possibility that the neuroprotective effects of R(-)- and S(+)-citalopram depend on types of neuronal cell death. METHODS: Free radical neurotoxicity was induced in mixed cortical cell cultures by continuous exposure to 30 micrometer Fe++ for 24 hours, which produced hydroxyl radicals via a Fenton reaction. Cultures measuring excitotoxicity were exposed for 24 hours to 50 micrometer NMDA. Neuronal apoptosis was induced by 100 nM staurosporine exposure for 24 hours. Neuronal death was analyzed 24 hours later by measuring the efflux of lactate dehydrogenase (LDH) into the bathing medium or by counting viable neurons after staining with trypan blue. RESULTS: Co-treatment with R(-)-or S(+)-citalopram prevented staurosporine-induced apoptosis of cultured cortical cells, as well as activation of caspase-3. In contrast to the differences between enantiomers found in serotonin uptake inhibition and in the in vivo behavioral depression model, both enantiomers in this study showed similar protective effects on staurosporine-induced apoptosis. Mixed cortical cell cultures exhibited marked swelling of the neuronal cell bodies accompanied by widespread neuronal death during the 24 hours following exposure to 30 micrometer Fe++ or 50 micrometer NMDA that was not sensitive to either the R(-)-or S(+)-enantiomers of citalopram. CONCLUSION: These features suggest that the neuroprotective effect of citalopram depend on type of neuronal injury.
Apoptosis ; Baths ; Caspase 3 ; Cell Culture Techniques ; Cell Death ; Citalopram ; Depression ; Diminazene ; L-Lactate Dehydrogenase ; Mood Disorders ; N-Methylaspartate ; Necrosis ; Neurons ; Neuroprotective Agents ; Serotonin ; Staurosporine ; Trypan Blue