Neutropenia and agranulocytosis are dangerous conditions seldom caused by antipsychotics. We report the case of a 35-year-old female patient who presented with neutropenia following ziprasidone administration. Ziprasidone was gradually increased to 160 mg/day in combination with escitalopram 10 mg/day. Following ziprasidone administration, her neutrophil count fell to 1700x10(3)/mm3, on day 45 and to 1500x10(3)/mm3 on day 57. Ziprasidone was immediately stopped, and quetiapine 25 mg was given from the next day onward, along with the escitalopram. Her neutrophil count rose to 2700x10(3)/mm3 2 days later, and was maintained at 2,900x10(3)/mm3 at 17 days after changing medication. To the best of our knowledge, this case represents the first report of ziprasidone - induced neutropenia in Korea. Further study is necessary to determine the incidence of neutropenia and its relationship with agranulocytosis secondary to ziprasidone.
Adult ; Agranulocytosis ; Antipsychotic Agents ; Citalopram ; Female ; Humans ; Incidence ; Korea ; Neutropenia* ; Neutrophils ; Quetiapine Fumarate

We report a case of serum creatine kinase (CK) elevation in a 42-year-old man with schizoaffective disorder treated with olanzapine, aripiprazole, quetiapine, and modified electroconvulsive therapy (ECT). To elucidate the clinical meaning of serum CK elevation, we repeatedly measured psychotic severity and chemical data, including serum CK, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and cholesterol. Pearson's correlation analysis was performed between each measurement. The peak CK level during hospitalization was correlated with Clinical Global Impression (CGI) severity. Dissociation of CK level and myoglobinuria was observed, and elevated did not result in renal failure or any renal decompensation. Medication change among atypical antipsychotics could not terminate CK level, which did not seem to be associated with dosage or duration of use. The patient's mother showed similar CK level, which suggests genetic control of serum CK. Repeated measurement of serum CK is recommended for determining the clinical significance of CK level, which is not yet clear.
Adult ; Alanine Transaminase ; Antipsychotic Agents* ; Aspartate Aminotransferases ; Cholesterol ; Creatine Kinase* ; Creatine* ; Electroconvulsive Therapy ; Hospitalization ; Humans ; Mothers ; Myoglobinuria ; Psychotic Disorders ; Renal Insufficiency ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: Delirium is defined as an alteration in mental status characterized by brief disturbances in consciousness and attention, cognition, and perception that tend to fluctuate during the course of the day. Traditionally, haloperidol has been used to treat agitation as it may occur in delirium. However, atypical antipsychotics are increasingly used to treat delirium itself. A comparative study was undertaken to compare the clinical efficacy of haloperidol and aripiprazole for the treatment of delirium. METHODS: Forty patients (20 patients assigned to haloperidol and 20 to aripiprazole) diagnosed with delirium by DSM IV-TR were recruited and randomly assigned to receive a flexible-dose regimen of haloperidol or aripiprazole over 7 days. The severity of delirium was assessed by using the Delirium Rating Scale-Revised-98 scores (DRS-R-98). RESULTS: DRS-R-98 severity scores for each group decreased significantly over the study period (p<0.01), but no statistically significant difference was detected between the two groups (p=0.607). CONCLUSION: These data show no statistically significant difference in efficacy between haloperidol and aripiprazole in the treatment of delirium. Since haloperidol has great potential for causing extrapyramidal symptoms(EPS), aripiprazole, a medication with known low side effects, may be an effective alternative agent in the treatment of delirium.
Antipsychotic Agents ; Cognition ; Consciousness ; Delirium* ; Dihydroergotamine ; Haloperidol* ; Humans ; Aripiprazole

OBJECTIVE: Standardizing remission criteria is helpful for documenting patient remission states by setting appropriate treatment goals and comparing the efficacy of various therapies. We investigated the applicability of two remission criteria through a 1-year prospective observational study on patients with recent-onset schizophrenia. METHODS: Forty-nine patients were enrolled and assessed monthly using the BPRS, SAPS, SANS, and CGI. Criteria A included a BPRS total score of < or =36, a BPRS psychotic item score of < or =3, and a CGI-S score of < or =3. Criteria B included all of five global items in the SAPS and SANS of < or =2 (mild). Each remission criterion was required to be met for at least 2 consecutive months. RESULTS: The remission rates at study endpoint were 64.3 and 42.9%, respectively, when criteria A and B were applied. Within criteria A, the remission rate was 78.6% when only a BPRS total score criterion was applied, which then dropped to 75.0% when a BPRS psychotic item criterion was added. A 75% remission rate was noted when the CGI criterion was independently applied. Within criteria B, a 71.4% remission rate was observed using the SAPS criterion, which decreased to 42.9% when a SANS score criterion was added. No significant difference was detected in the time to remission and the duration of maintained remission when criteria A or B were applied. CONCLUSION: The SAPS and SANS scales are stricter for categorizing the remission state compared to the BPRS and CGI. Criteria based on the BPRS appear to be more representative of the remission state when a BPRS psychotic item criterion is added. In addition, CGI alone can be used for longterm follow-up evaluations of patients with schizophrenia.
Follow-Up Studies ; Humans ; Observational Study ; Prospective Studies ; Schizophrenia* ; Weights and Measures

OBJECTIVE: The purpose of this study was to validate the Korean version of the Subjective Well-being under Neuroleptic Treatment Scale-Short Form (KvSWN-K), which has been widely used to assess the quality of life in patients with schizophrenia. METHODS: The subjects for the present study were 140 patients meeting the diagnostic criteria of DSM-IV for schizophrenia. The KvSWN-K with 20 items was administered with the EuroQoL-5D (EQ-5D) to evaluate concurrent validity. Sociodemographic and clinical characteristics were obtained, and the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functional Assessment Scale (SOFAS), Simpson-Angus Rating Scale, Barnes Akathisia Scale (BAS), Abnormal Involuntary Movement Scale, and Drug Attitude Inventory were administered to investigate their relationships with the KvSWN-K. RESULTS: The KvSWN-K showed good internal consistency and test-retest reliability. The scores on the subscale and total KvSWN-K showed relevant correlation with scores on the EQ-5D visual analog scale and most subscales of the EQ-5D. Employment status and scores on the SOFAS were significantly positively correlated with the score on the KvSWN-K, and scores on the CDSS, BAS, and subscales and total PANSS scores were significantly negatively correlated with the score on the KvSWN-K. Regression analysis revealed that the CDSS showed the most significant correlations with the KvSWN-K. CONCLUSION: Our findings demonstrated that the KvSWN-K is a reliable and valid assessment tool for evaluating the quality of life in patients with schizophrenia. Depression measured by the CDSS was the most important factor influencing subjective well-being in patients with schizophrenia.
Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Dyskinesias ; Employment ; Humans ; Psychomotor Agitation ; Quality of Life ; Schizophrenia ; Visual Analog Scale

OBJECTIVE: This study sought to identify candidate genes related to the clinical effects of several mood stabilizers through gene expression profiles using microarrays and real time RT-PCR. METHOD: Rats were treated with lithium carbonate, valproate, or clozapine for 10 days. Total RNA was extracted from the rat brains and used for microarray analysis. Of 54 genes showing more than 1.5-fold changes induced by all three mood stabilizers, seven genes were selected, and drug-induced changes in gene expression were confirmed by real time RT-PCR. In addition, genotype distribution of the GRIK2 gene was compared between 181 patients with bipolar disorder and 350 normal controls. RESULTS: Of the seven candidate genes, GRIK2 and PRKAR were confirmed as being downregulated by lithium and valproate. However, none of the genes was affected by all three drugs. The allele and genotype distribution in two SNPs of GRIK2 did not differ between the patient and control groups. CONCLUSIONS: Although this study demonstrated overall negative results, the present findings will be used in future studies for establishing various mechanisms of mood stabilizers.
Alleles ; Animals ; Bipolar Disorder ; Brain* ; Clozapine ; Gene Expression* ; Genotype ; Humans ; Lithium ; Lithium Carbonate ; Microarray Analysis ; Polymorphism, Single Nucleotide ; Rats* ; RNA ; Transcriptome ; Valproic Acid

Functional magnetic resonance imaging and positron emission tomography studies have identified brain regions associated with different forms of memory and learning. The purpose of this study was to summarize the results of functional neuroimaging studies to construct brain maps for memory and learning. Working memory is associated with the bilateral prefrontal, anterior cingulate, and temporal, and parietal regions ; semantic memory with the left prefrontal and temporal regions ; episodic memory encoding with the left prefrontal and medial temporal regions ; episodic memory retrieval with the right prefrontal, and posterior midline, and medial temporal regions ; skill learning with the motor, parietal, and subcortical regions ; priming with the fusiform and neocortex ; and classical conditioning with the cerebellum. More recent studies have provided higher specificity, by dissociating the neural correlates of different subcomponents of complex memory tasks and the cognitive roles of different subregions of larger brain areas.
Brain Mapping* ; Brain* ; Cerebellum ; Conditioning, Classical ; Functional Neuroimaging ; Learning* ; Magnetic Resonance Imaging ; Memory* ; Memory, Episodic ; Memory, Short-Term ; Neocortex ; Positron-Emission Tomography ; Rabeprazole ; Semantics ; Sensitivity and Specificity

Tourette's disorder is a chronic refractory neuro-behavioral disease. New treatment strategies, such as repeated transcranial magnetic stimulation (rTMS), have been introduced recently. We report the effect of rTMS in a case with Tourette's disorder and attention deficit hyperactivity disorder (ADHD), a common combination in the clinical setting. This was a treatment-refractory patient, who had undergone 2 years of drug treatment and psychiatric consultation. We administered 10 sessions of rTMS for 10 days, resulting in a clear improvement in symptoms not only of Tourette's disorder but also of ADHD. Our observations indicate that rTMS may be effective in the treatment of Tourette's disorder with ADHD.
Attention Deficit Disorder with Hyperactivity ; Humans ; Tourette Syndrome ; Transcranial Magnetic Stimulation

Serotonin is one of the most important neurotransmitters involved in the pathophysiology of depressive illness. The assessment of alteration of cerebral serotonin has been still controversial but interesting topic to study. Recently, increasing evidence has accumulated that the N100 amplitude slope reflects cerebral serotonin activity and treatment response of selective serotonin reuptake inhibitors (SSRIs). We report on two patients who showed abrupt mood changes and side effects after taking SSRI antidepressants. In both patients, aberrantly high N100 amplitude slopes were observed. Our cases suggest that the N100 amplitude slope may be a reliable indicator for predicting manic conversion and side effects in the SSRI treatment of depressive patients. Controlled studies are necessary to confirm whether a high N100 amplitude slope is a useful indicator of SSRI supersensitivity.
Antidepressive Agents ; Depression ; Humans ; Neurotransmitter Agents ; Serotonin ; Serotonin Uptake Inhibitors

OBJECTIVE: Bipolar depression has a disabling course and its treatment represents a major challenge. Recently, a randomized, controlled trial of quetiapine monotherapy in patients with bipolar depression showed significant reductions in depressive symptomatology. The purpose of this study was to evaluate the efficacy of quetiapine in bipolar depression in the clinical setting. METHODS: This study was a multi-center, prospective, open-label, observational, 8-week evaluation of the efficacy of quetiapine in patients with bipolar depression. Patients with a DSM-IV-TR diagnosis of bipolar depression (bipolar I disorder, most recent episode depressed and bipolar II disorder, most recent episode depressed) were included and treated with quetiapine. The dose of quetiapine was flexible and concomitant mediations were permitted, by clinical judgment. Clinical improvements were rated with the Clinical Global Impression-Bipolar version (CGI-BP) and Montgomery-Asberg Depression Rating Scale (MADRS) at baseline, week 4, and week 8. RESULTS: A total of 1,193 patients were recruited and 46 (3.9%) patients were dropped from the study. The mean initial dose of quetiapine was 192.3+/-181.9 mg/day and the mean doses at weeks 4 and 8 were 315.2+/-229.7 mg/day and 337.1+/-229.9 mg/day, respectively. CGI-BP and MADRS were significantly improved at weeks 4 and 8, compared with baseline. In addition, improvements at week 8 were greater than at week 4. Subjectively, about 75% of the patients reported therapeutic compliance above 75% at weeks 4 and 8. Seven (0.6%) and four (0.3%) patients showed manic/hypomanic episodes at weeks 4 and 8, respectively. CONCLUSION: This study suggests that quetiapine improves depressive symptoms in bipolar depression, with minimal incidence of manic switching. We suggest that quetiapine could be an effective and safe option in treating bipolar depression.
Bipolar Disorder ; Compliance ; Depression ; Dibenzothiazepines ; Humans ; Incidence ; Judgment ; Prospective Studies ; Quetiapine Fumarate