Schizophrenia is a psychiatric disease which requires a long term treatment. Thus, patient's therapeutic compliance can be very crucial to the disease's prognosis. Moreover, the adverse effects of drugs are also important to determine the patient's therapeutic compliance. The atypical antipsychotic drugs have been improved in the way to strengthen therapeutic effects and to reduce adverse effects. Blonanserin, an atypical antipsychotic, is a selective serotonin-dopamine agonist which blocks the dopamine D2/D3 receptors and serotonin 5-HT2A receptor. Blonanserin is well known to include parkinsonism, akathisia and insomnia. In this case report, Blonanserin treatment was given to patients who admitted to the closed ward due to psychotic symptoms such as idea of reference, persecutory delusion, auditory hallucination and blunted affect. The patients showed manic symptoms including elated mood, talkativeness, hyperactivity after the increase of Blonanserin dose up to 24 mg. Such manic symptoms were improved after Blonanserin dose was decreased to 16 mg. Many researches have reported newly-evoked manic/hypomanic episodes in schizophrenic patients after the use of atypical antipsychotics such as Risperidone, Olanzapine and Ziprasidone. However, there is no report of Blonanserin-induced manic/hypomanic episode. Therefore, further study is necessary to evaluate the manic/hypomanic episodes which are thought to be the adverse effects of Blonanserin.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Compliance ; Delusions ; Dopamine ; Hallucinations ; Humans ; Parkinsonian Disorders ; Piperazines ; Piperidines ; Prognosis ; Psychomotor Agitation ; Receptor, Serotonin, 5-HT2A ; Risperidone ; Schizophrenia ; Serotonin ; Sleep Initiation and Maintenance Disorders ; Thiazoles

OBJECTIVES: The aim of this study were to assess a) the prevalence of metabolic syndrome in outpatients with schizophrenia or schizoaffective disorder, b) the comparison of characteristics of patients with or without the metabolic syndrome, c) the sensitivity, specificity and positive predictive values of individual criteria for metabolic syndrome. METHODS: This study assessed the prevalence of the metabolic syndrome among 128 schizophrenia or schizoaffective disorder patients using the National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: Of patients, 54.7% (M : 49.3%, F : 61.4%) had metabolic syndrome. The metabolic syndrome was associated with medical history of diabetes, hypertension and dyslipidemia. Presence of abdominal obesity was most sensitive (97.1%), while raised fasting glucose was most specific (89.7%). Combining abdominal obesity/raised triglycerides and abdominal obesity/low HDL cholesterol had 100% sensitivity. CONCLUSION: The metabolic syndrome is highly prevalent among outpatients with schizophrenia or schizoaffective disorder. This study suggests that the measurement of abdominal obesity is a simple test to identify individuals at high risk for metabolic syndrome.
Cholesterol ; Cholesterol, HDL ; Dyslipidemias ; Fasting ; Glucose ; Humans ; Hypertension ; Obesity, Abdominal ; Outpatients ; Prevalence ; Psychotic Disorders ; Schizophrenia ; Sensitivity and Specificity ; Triglycerides

OBJECTIVES: Tardive dyskinesia (TD) is a serious and sometimes irreversible adverse effect that may develop during long-term antipsychotics treatment. Previous studies have suggested that brain serotonergic systems are related to TD vulnerability and tryptophan hydroxylase (TPH) is the rate limiting enzyme in the biosynthesis of serotonin. This study aimed to investigate the association between TPH2 gene -703G/T polymorphism (rs4570625) and antipsychotic-induced TD in the Korean schizophrenia patients. METHODS: We investigated whether TPH2 gene -703G/T polymorphism is associated with antipsychotic-induced TD in 280 Korean schizophrenia patients. The subjects with TD (n=105) and without TD (n=175) were matched for antipsychotic drug exposure and other relevant variables. RESULTS: There was no significant difference in the distribution of genotypic (chi2=3.00, p=0.223) and allelic (chi2=0.19, p=0.661) frequencies between patients group with TD and without TD. There was no significant difference in total Abnormal Involuntary Movement Scale score (F=1.95, p=0.362) among the genotype groups, either. CONCLUSIONS: The present study does not support that TPH2 gene -703G/T polymorphism is involved in TD of the Korean schizophrenia subjects.
Antipsychotic Agents ; Brain ; Dyskinesias ; Genotype ; Humans ; Movement Disorders ; Schizophrenia ; Serotonin ; Tryptophan ; Tryptophan Hydroxylase

OBJECTIVES: Schizophrenia has been considered to be characterized by an abnormality in attention, especially in the executive control. Emotion is an important component of the executive control. The aim of this study was to investigate the influence of emotion on the executive control in patients with schizophrenia. METHODS: Participants were 20 healthy controls and 19 subjects with schizophrenia. They viewed full-color pictures selected from the International Affective Picture System. During each trial, an emotional picture, which was either positive or negative, lit up on either the left or right side. Participants were instructed to respond to the emotional valance of each stimulus by pressing a button with their left or right index finger, while ignoring its presented side. RESULTS: There was a group difference in the response time, and patients with schizophrenia exhibited an impairment in the executive control of emotional information. However, there was no difference in the response time between the emotional conditions. In the patient group, the missing rate in the positive emotional condition was correlated with the severity of social anhedonia, whereas the missing rate in the negative emotional condition was correlated with the severity of positive symptoms. CONCLUSION: Patients with schizophrenia have a deficit in the executive control of positive emotional information as well as negative emotion, but it may be due to different underlying mechanisms.
Anhedonia ; Executive Function ; Fingers ; Humans ; Reaction Time ; Schizophrenia

Schizophrenia is a psychiatric disease which requires a long term treatment. Thus, patient's therapeutic compliance can be very crucial to the disease's prognosis. Moreover, the adverse effects of drugs are also important to determine the patient's therapeutic compliance. The atypical antipsychotic drugs have been improved in the way to strengthen therapeutic effects and to reduce adverse effects. Blonanserin, an atypical antipsychotic, is a selective serotonin-dopamine agonist which blocks the dopamine D2/D3 receptors and serotonin 5-HT2A receptor. Blonanserin is well known to include parkinsonism, akathisia and insomnia. In this case report, Blonanserin treatment was given to patients who admitted to the closed ward due to psychotic symptoms such as idea of reference, persecutory delusion, auditory hallucination and blunted affect. The patients showed manic symptoms including elated mood, talkativeness, hyperactivity after the increase of Blonanserin dose up to 24 mg. Such manic symptoms were improved after Blonanserin dose was decreased to 16 mg. Many researches have reported newly-evoked manic/hypomanic episodes in schizophrenic patients after the use of atypical antipsychotics such as Risperidone, Olanzapine and Ziprasidone. However, there is no report of Blonanserin-induced manic/hypomanic episode. Therefore, further study is necessary to evaluate the manic/hypomanic episodes which are thought to be the adverse effects of Blonanserin.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Compliance ; Delusions ; Dopamine ; Hallucinations ; Humans ; Parkinsonian Disorders ; Piperazines ; Piperidines ; Prognosis ; Psychomotor Agitation ; Receptor, Serotonin, 5-HT2A ; Risperidone ; Schizophrenia ; Serotonin ; Sleep Initiation and Maintenance Disorders ; Thiazoles

OBJECTIVES: This study was designed to examine the effect of a 12-week weight management program on the quality of life, self-esteem and psychotic symptoms of schizophrenia. METHODS: The subjects of the experiment consisted of psychiatric patients taking antipsychotics who were diagnosed with DSM-IV schizophrenia. The experimental group were patients with body mass index of 25 kg/m2 or above who participated in a 12-week weight management program, while the control group did not join the program. All the patients were admitted in closed psychiatry ward of a mental hospital. The program consisted of diet therapy, exercise, behavior modification and education. All the patients were checked on Brief Psychiatric Rating Scale (BPRS), Rosenberg Self-esteem Scale (RSES), Korean version of the SmithKlein Beecham Quality of Life (KvSBQOL), Korean version of 4th revision of Schizophrenia Quality of Life Scale (SQLS-R4K) and the weight. RESULTS: After the 12-week weight management program, RSES, KvSBQOL and SQLS-R4K were increased significantly in the experimental group (p<0.001), as opposed to the control group. While the experimental group showed a notable increase in body weight and body mass index (BMI), the change in the control group was insignificant. BPRS was decreased significantly (p<0.05). CONCLUSION: 12-week weight management program had a positive effect to decrease the weight and to increase the self-esteem and quality of life. This study provides evidence for the potential and beneficial effect of weight management program for schizophrenic patients.
Antipsychotic Agents ; Behavior Therapy ; Body Mass Index ; Body Weight ; Brief Psychiatric Rating Scale ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, Psychiatric ; Humans ; Quality of Life ; Schizophrenia

OBJECTIVES: The aim of this study were to assess a) the prevalence of metabolic syndrome in outpatients with schizophrenia or schizoaffective disorder, b) the comparison of characteristics of patients with or without the metabolic syndrome, c) the sensitivity, specificity and positive predictive values of individual criteria for metabolic syndrome. METHODS: This study assessed the prevalence of the metabolic syndrome among 128 schizophrenia or schizoaffective disorder patients using the National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: Of patients, 54.7% (M : 49.3%, F : 61.4%) had metabolic syndrome. The metabolic syndrome was associated with medical history of diabetes, hypertension and dyslipidemia. Presence of abdominal obesity was most sensitive (97.1%), while raised fasting glucose was most specific (89.7%). Combining abdominal obesity/raised triglycerides and abdominal obesity/low HDL cholesterol had 100% sensitivity. CONCLUSION: The metabolic syndrome is highly prevalent among outpatients with schizophrenia or schizoaffective disorder. This study suggests that the measurement of abdominal obesity is a simple test to identify individuals at high risk for metabolic syndrome.
Cholesterol ; Cholesterol, HDL ; Dyslipidemias ; Fasting ; Glucose ; Humans ; Hypertension ; Obesity, Abdominal ; Outpatients ; Prevalence ; Psychotic Disorders ; Schizophrenia ; Sensitivity and Specificity ; Triglycerides

Difficulties surrounding the classification of mixed psychotic and mood symptoms continue to plague psychiatric nosology. Since schizoaffective disorder was first defined in the literature, it has raised a considerable controversy regarding its clinical distinction from schizophrenia and mood disorder, especially mood disorder with psychotic feature. Recently, it seems that more people are diagnosed as mood disorder with psychotic feature rather than schizoaffective disorder when they are showing concurrent psychotic and mood symptoms. This may be due to unwillingness to make severe diagnosis at first and aggressive trend to expand the diagnostic criteria for bipolar disorder. Over-diagnosis of mood disorder with psychotic feature would expose the patients to unnecessary mood stabilizer. Therefore, it is critical to make exact diagnosis based on current diagnostic criteria and other relevant study findings. We conducted in-depth review into diagnostic criteria of DSM and ICD-10 for schizoaffective disorder and mood disorder with psychotic feature and other related studies comparing clinical features between the two disorders. As a result, important points helpful in differentiating the two disorders are highlighted and future suggestions are described.
Bipolar Disorder ; Diagnosis, Differential ; Humans ; International Classification of Diseases ; Mood Disorders ; Plague ; Psychotic Disorders ; Schizophrenia

OBJECTIVES: Tardive dyskinesia (TD) is a serious and sometimes irreversible adverse effect that may develop during long-term antipsychotics treatment. Previous studies have suggested that brain serotonergic systems are related to TD vulnerability and tryptophan hydroxylase (TPH) is the rate limiting enzyme in the biosynthesis of serotonin. This study aimed to investigate the association between TPH2 gene -703G/T polymorphism (rs4570625) and antipsychotic-induced TD in the Korean schizophrenia patients. METHODS: We investigated whether TPH2 gene -703G/T polymorphism is associated with antipsychotic-induced TD in 280 Korean schizophrenia patients. The subjects with TD (n=105) and without TD (n=175) were matched for antipsychotic drug exposure and other relevant variables. RESULTS: There was no significant difference in the distribution of genotypic (chi2=3.00, p=0.223) and allelic (chi2=0.19, p=0.661) frequencies between patients group with TD and without TD. There was no significant difference in total Abnormal Involuntary Movement Scale score (F=1.95, p=0.362) among the genotype groups, either. CONCLUSIONS: The present study does not support that TPH2 gene -703G/T polymorphism is involved in TD of the Korean schizophrenia subjects.
Antipsychotic Agents ; Brain ; Dyskinesias ; Genotype ; Humans ; Movement Disorders ; Schizophrenia ; Serotonin ; Tryptophan ; Tryptophan Hydroxylase

Schizoaffective disorders are a controversially discussed but existing nosological category describing an episodic condition meeting the criteria of both schizophrenia and mood disorders and lying on a continuum between these two prototypes. Both DSM-IV and ICD-10 classify them within the group of "schizophrenia, schizotypal and delusional disorders" with ICD-10 not requiring the absence of mood symptoms for a certain time. Cross-sectionally, schizoaffective disorder can be subdivided into schizodepressive, schizomanic and mixed types. In a longitudinal way, unipolar and bipolar types are distinguished. The division into schizo-dominated and mood dominated types is based on the severity and dominance of the schizophreniform symptomatology and implies significant consequences for treatment and prognosis. In addition, concurrent types should be differentiated from sequential types. Schizoaffective disorder is not rare; lifetime prevalence is estimated at 0.3%. About one third of all psychotic patients suffer from schizoaffective disorder. About two thirds of the patients do not only have schizoaffective episodes but also pure schizophreniform or mood episodes or episodes of acute and transient psychotic disorder. In more than 50% of the patients, symptoms remit more or less completely. The others suffer from light, moderate or severe residual states, which might affect their social adaptation. The suicide rate in schizoaffective disorder is about 12%. The treatment of schizoaffective disorder primarily is a combination of antipsychotics and mood stabilizers or antidepressants. Long-term prophylactic treatment mainly consists of antipsychotics and mood stabilizers. Differential diagnosis of schizoaffective disorder is not at all easy. It must be distinguished from psychotic mood disorder, where the psychotic symptoms are mood-congruent. Although DSM-IV allows even mood-incongruent psychotic symptoms in psychotic mood disorder, these cases should better be allocated to schizoaffective disorder. Schizoaffective disorder must also be distinguished from schizophrenia with mood symptoms. In the latter, the mood symptoms are not complete and not so prominent to meet the criteria of a mood episode, or they occur after the schizophreniform have remitted. Sometimes, schizoaffective disorder is mixed up with acute and transient psychotic disorder, although these two conditions do not have very much in common.
Affective Disorders, Psychotic ; Antidepressive Agents ; Antipsychotic Agents ; Deception ; Delusions ; Diagnosis, Differential ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; International Classification of Diseases ; Light ; Mood Disorders ; Prevalence ; Prognosis ; Psychotic Disorders ; Schizophrenia ; Suicide