Neuroacanthocytosis is a rare hereditary disorder characterized by various neurological symptoms and the presence of abnormal red blood cell called acanthocytosis. Degeneration of striatum, which accounts for characteristic motor and psychiatric symptoms, mainly attributes to the pathology of neuroacanthocytosis. We experienced a case of chorea-acanthocytosis. He was a 50 year-old-man who presented with orofacial dyskinesia, dysarthria, uncontrolled lip biting, generalized choreic movements and sensorymotor polyneuropathy. He was also suffered from obsessive eating behavior, disinhibition, impulsivity and sleep disturbance. After antipsychotic medication, his psychiatric problems were improved. Clinicians must consider psychiatric managements of progressive neurological disorder for patients' quality of life and reducing their caregiver's burden.
Abetalipoproteinemia ; Antipsychotic Agents ; Bites and Stings ; Chorea ; Dysarthria ; Erythrocytes ; Feeding Behavior ; Humans ; Lip ; Movement Disorders ; Nervous System Diseases ; Neuroacanthocytosis ; Polyneuropathies ; Quality of Life

Although selective serotonin reuptake inhibitors (SSRIs) have been widely used in both psychiatry and other medicine, few cases have been reported SSRI-related hyperprolactinemia and/or galactorrhea. We experienced one case which showed both galactorrhea and hyperprolactinemia following treatment with paroxetine. In the case, a 37-year-old multiparous woman reported galactorrhea after 8-weeks paroxetine treatment for her depression. After 1 month prescription of bromocriptine, dopamine agonist, as well as switching medication from paroxetine to venlafaxine, serotonin-norepinephrine reuptake inhibitor, both galactorrhea and hyperprolactinemia were disappeared. Both hyperprolactinemia and galactorrhea have not been observed even after the cessation of bromocriptine prescription.
Adult ; Bromocriptine ; Cyclohexanols ; Depression ; Dopamine Agonists ; Female ; Galactorrhea ; Humans ; Hyperprolactinemia ; Paroxetine ; Pregnancy ; Prescriptions ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride

Phendimetrazine is a medication currently being used to help patients with weight loss. It shares a chemical structure with amphetamines. As such, it shares some of the same toxicities, which can include psychosis. Two cases present good examples of phendimetrazine-induced psychotic disorder. A 30-year old female was admitted to emergency room with visual hallucination, auditory hallucination and aberrant behavior. Another 38-year old housewife was accompanied by her family to evaluate mood swing, auditory hallucination and behavioral change to psychiatric clinic. After evaluation in psychiatric ward, they were confirmed to have causal relation with prescription diet pills. These case reports demonstrate the potential dangers of amphetamine based diet pills. There have been several cases of cardiomyopathies and pulmonary hypertension related to phendimetrazine, but psychosis is something that is rarely recognized in an outpatient setting. Two cases showed the importance of obtaining a careful medication history in all patients and specially recognizing diet pills with an amphetamine base causing psychosis.
Amphetamine ; Amphetamines ; Cardiomyopathies ; Diet ; Emergencies ; Female ; Hallucinations ; Humans ; Hypertension, Pulmonary ; Morpholines ; Outpatients ; Prescriptions ; Psychotic Disorders ; Weight Loss

OBJECTIVE: This study aimed to confirm effectiveness of psychoeducation program on insight and treatment attitudes in patients with schizophrenia, schizophreniform disorder and schizoaffective disorder. METHODS: Seventy eight psychotic patients who were diagnosed as schizophrenia, schizophreniform disorder, and schizoaffective disorder by Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV TR) were included. Subjects who decline more than 30% compared with baseline in Positive and Negative Syndrome Scale (PANSS) scores participated in psychoeducation program. Insight and Treatment Attitudes Questionnaire (ITAQ) and Drug Attitude Inventory (DAI) were assessed at pre-psychoeducation, post-psychoeducation and 2 months after discharge to estimate insight and treatment attitudes. RESULTS:There were significant improvement in ITAQ and DAI scores at post-psychoeducation and 2 months after discharge. Increase in DAI scores related with high ITAQ scores at post-psychoeducation. Small changes in PANSS scores and ITAQ scores at post-psychoeducation had positive relationship. Subjects of late onset of illness and female took better ITAQ and DAI scores after psychoeducation. CONCLUSION: This study showed that psychoeducation program would be effective for insight and treatment attitudes in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder.
Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Psychotic Disorders ; Surveys and Questionnaires ; Schizophrenia

OBJECTIVE: This study was carried out to investigate the clinical availability of event related potential (ERP) P300, N100 and QEEG as biological markers in schizophrenia (SPR) patients. METHODS: The 23 SPR patients who met Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria of SPR and age and sex matched 23 normal controls (NC) were recruited. Positive and Negative Syndrome Scale (PANSS) was used to evaluate the clinical symptoms. The three electrodes (Cz, CPz, Pz) were used to measure the amplitude and latency of each ERP components. The qEEG was analyzed by the ranges of Hz: delta (1-3 Hz), theta (4-7 Hz), alpha (8-12 Hz), beta (13-30 Hz) and gamma (30-50 Hz). RESULTS:P300 amplitudes of SPR patients were reduced across Cz, CPz and Pz (F=5.81, p<0.05). There was no difference in P300 latency, N100 amplitude and N100 latency between SPR and NC. P300 amplitudes were not influenced by demographic characteristics and PANSS scores in SPR patients. The PANSS positive, negative, general subscale scores were positively correlated with N100 latency at Cz, CPz. SPR patients showed significantly decreased alpha activity (SPR vs. NC=24.44+/-6.98% vs. 29.55+/-6.74%, p<0.05) and increased gamma activity (SPR vs. NC=19.48+/-5.47% vs. 16.42+/-4.69%, p<0.05) compared with those of NC. CONCLUSION: The results suggest that the amplitude of P300 and alpha activity can be considered as a biological marker of SPR. And there is a possibility that the latency of N100 may reflect symptom severity of schizophrenia patients.
Biomarkers ; Diagnostic and Statistical Manual of Mental Disorders ; Electrodes ; Humans ; Schizophrenia

OBJECTIVE: Early maternal separation (EMS) during the development has been known to influence the alteration of behavior in adulthood. Nitric oxide (NO) may have been implicated to play a crucial role in the neurodevelopment as an intracellular and intercellular messenger. This study was designed to investigate the neurochemical mechanism of the behavioral changes resulting from EMS during the development in juvenile rats. METHODS: Experimental group consisted of subjects that were removed and weaned from the day on postnatal day 15. Control group were the litters that experienced no EMS until postnatal day 21. On postnatal day 15 and 36, the locomotor activity (LA) was measured. On postnatal day 36 the behavioral changes in the forced swimming test (FST) were also measured. Test drugs were intraperitoneally injected including MK-801 (0.5 mg/kg), N omega-nitro-L-arginine (L-NA, 20 mg/kg), paroxetine (20 mg/kg), and bupropion (150 mg/kg). RESULTS:EMS produced the decrease of LA significantly in juvenile rats (p<0.001). Both MK-801 and L-NA increased LA in experimental group (p<0.001) and control group (p<0.05). The degree of increase was higher in experimental group than in control group. However, both paroxetine and bupropion increased LA in experimental group (p<0.001, p<0.05), but not in control group. In the FST, immobility was significantly increased in experimental group compared with control group (p<0.001). The increases of immobility in experimental group were abolished after injecting MK-801, L-NA, paroxetine, and bupropion, respectively. CONCLUSION: These results indicate that EMS during the development can lead to behavioral abnormalities in juvenile rats. The underlying neurochemical mechanism of this behavioral changes may be, in part, related to the glutamatergic NMDA-NO pathway. This suggests that glutamatergic NMDA-NO pathway vulnerable to stress may predispose to depression.
Animals ; Bupropion ; Depression ; Dizocilpine Maleate ; Motor Activity ; Nitric Oxide ; Nitroarginine ; Paroxetine ; Rats ; Swimming

Resilience refers to a person's ability to successfully adapt to acute stress, trauma or more chronic forms of adversity, maintaining psychological well-being. Recent years have seen a lot of research into the neurobiological factors and mechanism that characterize resilient individuals. It has shown that resilience is mediated by adaptive changes in several neural circuits involving numerous neurotransmitter and molecular pathways. Much more study is required to achieve a deeper understanding the genetic, biological, and psychological underpinnings of resilience, as well as the interactions between these factors.
Neurobiology ; Neurotransmitter Agents ; Phosphatidylethanolamines

Depression is common in terminally ill cancer patients, and the management of depression in these patients is very important because this condition is associated with distress, suicidal ideation, and decreased quality of life. Antidepressants and psychostimulants are frequently used in the pharmacological treatment of depression in terminally ill cancer patients. The effectiveness of several Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of depression in this population has been reported; however, such improvement only occurred approximately 2-4 weeks after the medications were initiated. Psychostimulants offer the advantage of rapid action, an especially important consideration given that terminally ill patients have a short life expectancy. Moreover, methylphenidate has been reported as reversing the sedating effect of opioids, decreasing fatigue, and reducing pain. However, the adverse effect of methylphenidate must be considered. Additionally, psychotherapy also seems to improve depression and anxiety. Members of the treatment teams delivering palliative care often experience emotional burnout. Because emotional burnout results in depression and depersonalization, psychological care for the treatment team is crucial. The end-of-life period of patients is very important because it is the time at which individuals review their lives. Management of the depression in these patients will improve their quality of life and contribute to resolving their end-of-life issues.
Analgesics, Opioid ; Antidepressive Agents ; Anxiety ; Depersonalization ; Depression ; Fatigue ; Hospices ; Humans ; Imidazoles ; Life Expectancy ; Methylphenidate ; Nitro Compounds ; Palliative Care ; Psychotherapy ; Quality of Life ; Serotonin Uptake Inhibitors ; Suicidal Ideation ; Terminally Ill

OBJECTIVE: The molecules related with the intracellular signal transduction system are one of the main targets for the mode of mechanisms of antidepressant treatment in depressive patients. In vivo and in vitro studies have provided the evidence that the transcription factor, CREB (c-AMP response element binding protein) is the key mediator of the therapeutic response to antidepressants. We investigated the relationship between the treatment response to fluoxetine for 6 weeks and the change of CREB immunoreactivity in peripheral T lymphocyte. METHODS: CREB-expression and phosphorylation were quantified via western blot, and binding activity between transcription factor and CRE-oligonucleotide via electrophoretic mobility shift assay (EMSA) in nuclear extracts from 14 normal controls and 31 depressed patients at 0 and 6th week during fluoxetine treatment (20 mg/day). Responder was defined as the > or =50% of reduction or < or =7 of HAM-D score. We compared the changes of CREB during 6 weeks of fluoxetine treatment between drug responders and non-responders using SPSS11.0. RESULTS: After six weeks of treatment with fluoxetine, the drug responders showed a significant increase in CREB (p=0.024 by t-test) and p-CREB (p=0.045 by Mann-Whitney U test) compared with the non-responders. The change of CREB immunoreactivity was positively correlated with the change of p-CREB (r=0.770, p=0.000 by Spearman's rho), and the change of p-CREB was also positively correlated with CRE-DNA binding (r=0.753, p=0.000 by Spearman's rho). CONCLUSION: These results suggest that CREB response in peripheral lymphocyte may reflect and mediate the response to antidepressant treatment in depressed patients.
Antidepressive Agents ; Blotting, Western ; Depression ; Electrophoretic Mobility Shift Assay ; Fluoxetine ; Humans ; Lymphocytes* ; Phosphorylation ; Response Elements ; Signal Transduction ; Transcription Factors

OBJECTIVE: Antipsychotic-induced weight gain is associated with treatment noncompliance and is also known to be associated with several medical conditions in schizophrenia. Topiramate, a relatively new antiepileptic drug, is currently used for mood and eating disorders, and also offers the advantage of weight loss. This study explored the efficacy and tolerability of topiramate as an adjuvant treatment of schizophrenia with overweight or obesity. METHODS: In this 8-week, prospective open trial, 30 hospitalized, schizophrenic patients took topiramate at a mean maintenance dosage of 159.37+/-61.15 mg/day. The primary measures were weight, body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio. The safety measures included adverse events, physical examination, clinical laboratory data, and vital signs. The Clinical Global Impression Severity (CGI-S) Scale was used to quantify changes in schizophrenic symptoms and signs. RESULTS: Body weight, BMI, waist circumference, and hip circumference decreased significantly after treatment but the waist-to-hip ratio did not. The changes of body weight and BMI during 8 weeks treatment with topiramate were significantly correlated with the maintenance dose of topiramate. The high dose group (>100 mg/d) was significantly more changed in body weight and BMI between baseline and 8 weeks than the low dose group (< or =100 mg/d). The scores on the CGI-S scale decreased significantly over the 8 weeks of treatment. CONCLUSION: The results suggest that topiramate is both efficacious and tolerable for the short-term adjuvant treatment of schizophrenia with overweight or obesity. Further placebo controlled studies included larger samples would be needed to confirm these results. And much more clinical researches should be required to establish guideline for the optimal dose and duration of treatment using topiramate as an antiobesity agent in schizophrenia.
Body Weight ; Feeding and Eating Disorders ; Hip ; Humans ; Obesity* ; Overweight* ; Physical Examination ; Prospective Studies ; Schizophrenia* ; Vital Signs ; Waist Circumference ; Waist-Hip Ratio ; Weight Gain ; Weight Loss*