The mortality and morbidity in tricyclic antidepressants (TCAs) overdose still remained high due to fatal cardiac toxicities despite their decreased prescriptions. Also, monoamine oxidase inhibitors (MAOIs) may show relatively high cardiac toxicities in excess or mixed overdoses. Selective serotonin reuptake inhibitors (SSRIs) and newer antidepressants have been known to be safe in overdose until recently. However, many researchers have found that SSRIs and newer antidepressants also showed serious and fatal toxicities in case of excess or mixed overdoses. Citalopram or escitalopram overdoses showed a relatively high incidence of cardiac toxicity with a dose-dependent manner. Also, venlafaxine, bupropion and trazodone overdoses showed significant cardiac toxicities, although degrees of the toxicities are different each other. Especially, venlafaxine's pattern and incidence of cardiac toxicities are the similar to those of TCAs. Mirtazapine and reboxetine show no significant toxicities in overdose although the present toxicological data are insufficient. To conclude, assessment of compliance, pharmacology education for patients and effective treatment may reduce the incidence and severity of toxicities in overdose.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bupropion ; Citalopram ; Compliance ; Cyclohexanols ; Humans ; Incidence ; Mianserin ; Monoamine Oxidase Inhibitors ; Morpholines ; Prescriptions ; Serotonin Uptake Inhibitors ; Trazodone ; Venlafaxine Hydrochloride

OBJECTIVE: We compared patients with chronic schizophrenia and normal controls with respect to decision-making ability. Measures were implemented to control for the participants' intelligence levels as well as to ensure to use of a moderate sample size. The goal of this study was to confirm inconsistent results from previous studies which had stemmed from too small of a sample size, highly variable performance of normal controls, and not controlling for intelligence as a confounding factor. METHODS: Fifty-two chronic stable schizophrenic inpatients and 55 healthy controls participated in the study. We controlled for intelligence by including subjects with intelligence quotient's (IQ) between 80 and 120, examining any differences in decision-making performance between groups on the Iowa Gambling Task (IGT). We also addressed several issues relating to performance on the IGT, such as working memory and clinical symptoms. RESULTS: Schizophrenic patients were found to perform poorly on the IGT relative to normal controls (F(1,105)=17.73, p<0.001); however, more importantly, they also displayed the slow yet profitable shift from disadvantageous decks to advantageous decks over time. We also found that when compared with healthy controls, schizophrenic patients showed a poorer performance on the Wisconsin Card Sorting Test (WCST)(t=-5.48, p<0.001 for perseverative error) which was not related to their performance on the IGT. CONCLUSION: Based on previous literature and the results of this study, impaired sensitivity to both reward and punishment might be a more plausible explanation for the poor performance on the IGT in the schizophrenic group. We speculated that this impairment seemed related more to the different responsiveness to the magnitude than to the frequency of punishment, and to the different interpretation of less informative verbal cues in the context of the reinforcing schedule.
Appointments and Schedules ; Cues ; Dietary Sucrose ; Gambling ; Humans ; Inpatients ; Intelligence ; Iowa ; Memory, Short-Term ; Punishment ; Reward ; Sample Size ; Schizophrenia ; Wisconsin

Severe cardiac and neurologic toxicities of tricyclic antidepressant (TCA) overdose have been reported since the introduction of TCAs in 1950s. Despite the decreased numbers of TCA overdoses, the mortality and morbidity rates of TCA overdose have remained constantly high. Clinical manifestations of TCA overdose are characterized by unconsciousness and specific electrocardiography (ECG) abnormalities such as prolongation of the PR and QTc intervals, widening of the QRS duration, and an increased R wave and R/S ratio in lead aVR. We report a case with unusually prolonged unconsciousness without initial stem reflexes for 7 days and multiple ECG abnormalities following TCA overdose. It is suggested that the serial monitoring of R wave and R/S ratio in lead aVR might be informative in predicting recovery from toxicity following TCA overdose.
Electrocardiography ; Humans ; Mortality ; Reflex ; Unconsciousness*

OBJECTIVE: The aim of the present study was to examine the impact of personality traits on emotional responses to interpersonal stress. METHODS: Thirty-two healthy college students (18 men, 14 women; age 25.2+/-2.7 years) participated in the study. Mood and anxiety were assessed with the Beck Depression Inventory and the State Trait Anxiety Inventory. Personality traits were assessed with the Interpersonal Sensitivity Measure (IPSM). The subjective emotional responses of participants to different (i.e., negative, neutral, and positive) interpersonal feedback were measured. RESULTS: Subject responses were positive to positive interpersonal feedback and negative to negative interpersonal feedback. The IPSM fragile inner self subscore was negatively correlated with the subjective emotional ratings in response to interpersonal feedback. No correlation was found between validation measures (i.e., the degree of attention in the task and task difficulty) and subjective emotional responses. CONCLUSIONS: Taken together, emotional responses to interpersonal stress may be modulated by personality traits and may impact health and psychological outcomes. Therefore, proper screening and stress management programs that focus on personality traits may improve the mental health of college students.
Anxiety ; Depression ; Humans ; Interpersonal Relations ; Male ; Mass Screening ; Mental Health ; Stress, Psychological

As the advantages of atypical antipsychotics in bipolar disorder have been known, the approval of indications of these drugs is expanding. According to APA practice guidelines, in addition to lithium and valproate, atypical antipsychotics are recommended as the first-line agent in treating acute manic or mixed episode with mild severity. Quetiapine like other atypical antipsychotics such as risperidone or olanzapine is an effective antipsychotic drug in treating bipolar disorder. Based on currently available clinical evidences, quetiapine was approved in Korea and United States as a monotherapy or combination therapy in treating bipolar disorder. It is expecting that the use of quetiapine in patients with bipolar is increasing considering the efficacy and favorable side effect profiles. But more studies are needed to investigate the long-term efficacy and tolerability of mono-therapy or combination therapy in the maintenance period.
Antipsychotic Agents ; Bipolar Disorder ; Humans ; Korea ; Lithium ; Risperidone ; United States ; Valproic Acid

Posttraumatic stress disorder (PTSD) is relatively common and chronic illness that causes severe functional impairment. Though many studies have been done, PTSD is still difficult to understand because of heterogeneity of its nature and other psychiatric comorbidities. But the last decades have brought new appreciation for the complexity and the diversity of clinical features and improved treatment approaches. Achieving complete remission from PTSD through pharmacotherapy alone appears out of reach currently. Antidepressants appear to demonstrate the best overall efficacy for the treament of PTSD, especially in patients with combined depression, insomnia, intrusive and hyperarousal symptoms. Though data for different efficacy among antidepressants are not known, tricyclic antidepressants and monoamine oxidase inhibitor appear to be effective in severe war PTSD patients and SSRIs appear to be more effective in avoidance/numbness symptoms. Considering their ease of use and tolerability, it is reasonable to choose SSRIs such as paroxetine and sertraline as a first-line treatment. Mood stabilizers are effective, especially for impulsivity, irritability and unstable mood. More studies are needed to confirm the efficacy of benzodiazepine, though it is used for inosmnia, panic symptoms and anxiety. Though there is little empirical date demonstrating the efficacy of antipsychotics, they may provide effective strategy if psychotics symptoms are combined. The future of therapy for PTSD holds much hope with the rapid development of psychopharmacology and elucidation of pathophysiology of PTSD.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Anxiety ; Benzodiazepines ; Chronic Disease ; Comorbidity ; Depression ; Drug Therapy* ; Hope ; Humans ; Impulsive Behavior ; Monoamine Oxidase Inhibitors ; Panic ; Paroxetine ; Population Characteristics ; Psychopharmacology ; Sertraline ; Sleep Initiation and Maintenance Disorders ; Stress Disorders, Post-Traumatic*

Posttraumatic stress disorder (PTSD) is relatively common and chronic illness that causes severe functional impairment. Though many studies have been done, PTSD is still difficult to understand because of heterogeneity of its nature and other psychiatric comorbidities. But the last decades have brought new appreciation for the complexity and the diversity of clinical features and improved treatment approaches. Achieving complete remission from PTSD through pharmacotherapy alone appears out of reach currently. Antidepressants appear to demonstrate the best overall efficacy for the treament of PTSD, especially in patients with combined depression, insomnia, intrusive and hyperarousal symptoms. Though data for different efficacy among antidepressants are not known, tricyclic antidepressants and monoamine oxidase inhibitor appear to be effective in severe war PTSD patients and SSRIs appear to be more effective in avoidance/numbness symptoms. Considering their ease of use and tolerability, it is reasonable to choose SSRIs such as paroxetine and sertraline as a first-line treatment. Mood stabilizers are effective, especially for impulsivity, irritability and unstable mood. More studies are needed to confirm the efficacy of benzodiazepine, though it is used for inosmnia, panic symptoms and anxiety. Though there is little empirical date demonstrating the efficacy of antipsychotics, they may provide effective strategy if psychotics symptoms are combined. The future of therapy for PTSD holds much hope with the rapid development of psychopharmacology and elucidation of pathophysiology of PTSD.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Anxiety ; Benzodiazepines ; Chronic Disease ; Comorbidity ; Depression ; Drug Therapy* ; Hope ; Humans ; Impulsive Behavior ; Monoamine Oxidase Inhibitors ; Panic ; Paroxetine ; Population Characteristics ; Psychopharmacology ; Sertraline ; Sleep Initiation and Maintenance Disorders ; Stress Disorders, Post-Traumatic*

The ability to distinguish between unipolar and bipolar depression and the knowledge to bring the appropriate effective treatment is particularly crucial to psychiatrists. Because the pharmacologic strategies indicated for each disorder differ. Failure to make the correct diagnosis may lead to a lack of response to treatment, or complications such as switches into mania or rapid cycling. Common mood symptoms are melancholy, tearfulness, and irritability; common cognitive and perceptual symptoms are self-deprecatory and self-accusatory thoughts, poor concentration, diminished clarity and speed of thought, and suicidal ideation. Absence of a history of hypomania or mania does not rule out a bipolar diagnosis. Retardation, hypersomnia, hyperphagia, suicide attempts, and psychotic symptoms are more frequently found in these patients than in patients with unipolar depression. Few studies have examined the efficacy of somatic treatments in acute bipolar depression. Less than 20 controlled pharmacological studies have been conducted for the depressive phase of bipolar disorder. In addition, these studies examined small sample sizes and with only a few of the available treatment options. Because there is very little data specific to treatment of bipolar depression, most of the approaches to bipolar depression are derived from experience with unipolar depression. The basic premise of treatment os that these patients frequently respond to mood stabilizing agents without antidepressants, and that antidepressants should be reserved for those cases in which mood stabilizers alone have not worked, because of the well-known risk of triggering manic episodes(switching) and rapid cycling. Antidepressants should not be continued any longer than necessary. Mood stabilizers should be considered as first-line agents in view of the fact that their efficacy is at lease equal to, if not greater than, treatment with antidepressant, and that their use is rarely associated with the complications of cycle acceleration or with manic switch. It is recommended to use bupropion or SSRI because of low risk of manic switch and rapid cycling. In the future, research and pharmaceutical communities will have to focus on the short- and long-term effectiveness of antidepressants, and the development of new drugs for the treatment of bipolar depression. More experience is needed with the anticonvulsant lamotrigine, gabapentin, topiramate. The preliminary studies of lamotrigine suggests the antidepressant effect and mood stabilizing efficacy.
Acceleration ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Depressive Disorder ; Diagnosis ; Disorders of Excessive Somnolence ; Excipients ; Humans ; Hyperphagia ; Psychiatry ; Sample Size ; Suicidal Ideation ; Suicide

Bipolar disorders affect about 1-2.5% of the population. They are leading causes of disability and associated with significant health care costs. Antipsychotic medicaitons have a long history of use in bipolar disorders, for example, chlorpromazine has been used since early 1950s. Conventional antipsychotics are effective against mania, but it has some risks such as inducing depression, tardive dyskinesia. But atypical antipsychotics such as clozapine and olanzapine exhibit antimanic properties in addition to their antipsychotic properties with a far lower risk of extrapyramidal motor side effects than typcial neuroleptics. So they are now the antipsychotics of choice in the treatment of bipolar disorders. Risperidone is a serotonin-dopamine antagonist which was approved by FDA in 1994 and introduced into Korea in 1996. Risperidone appeared effective in controlling manic symptoms but also to have risks for inducing manic symptoms. Recent double-blind studies showed risperidone to be effective for acute mania, both as monotherapy and in combination with mood stabilizers. In summary, risperidone is considered as a mood stabilizer exhibiting both antimanic and antidepressant activity. Nowadays the use of aytpical antipsychotics including risperidone for treating patients with bipolar disorder has been increased. Mounting evidence supports its efficacy, low incidence of extrapyramidal side effects and tardive dyskinesia. With the advance of psychopharmacolgy, psychiatrists can have hope in treating bipolar patients.
Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Clozapine ; Depression ; Double-Blind Method ; Health Care Costs ; Hope ; Humans ; Incidence ; Korea ; Movement Disorders ; Psychiatry ; Risperidone*

Ultrasonographic and radiographic findings in 72 cases of pelvic masses which have been provedhistopathologically were analyzed. The results were as follows; 1. Among 72 cases, 28 cases were uterine massesand 44 cases were adnexal masses. 2. Pathologic accuracies of ultrasonographic diagnosis were 64.3% in uterinemasses, 70.5% in adnexal masses, and 68.1% in all pelvic masses. 3. Plain or IVP findings were not specific indiagnosis and showed secondary mass effects or functional disturbances. 4. Because of its high accuracy ofpathologic diagnosis and safety, ultrasonography can be regared as the most valuable and preferential study. Butin cases of cystic myomas, endometrioses, cystic missed abortions and huge masses, the accurate diagnoses weredifficult.
Abortion, Missed ; Diagnosis ; Endometriosis ; Female ; Myoma ; Pregnancy ; Ultrasonography