OBJECTIVE: Neuroleptic Induced Akathisia(NIA) often occurs in neuroleptic treated patients. Cyproheptadine, an antiserotonergic agent, was used to treat neuroleptic induced akathisia. METHOD: In an open trial 21 neuroleptic-treated patients with akathisia were administrated Cyproheptadine(16mg/day) over 4 days. Assessment of akathisia was evaluated using Barnes' rating scale(BAS) for neuroleptic induced akathisia. The degree of depression and psychosis were assessed by brief psychiatric rating scale(BFRS) and Hamilton rating scale for depression(HAM-D). RESULT: Most patients(20 of 21) with neuroleptic induced akathisia(NIA) showed improvement under the treatment of cyproheptadine. There was no aggravation of psychosis or depression during the treatment. Symptoms of akathisia aggravated when cyproheptadine was discontinued. CONCLUSION: Cyproheptadine may be useful in the treatment of neuroleptic induced akathisia(NIA).
Cyproheptadine* ; Depression ; Humans ; Psychomotor Agitation* ; Psychotic Disorders

This study compared the effectiveness and tolerability of amisulpride and risperidone in patients with psychosis associated with dementia of the Alzheimer's type (DAT). This 8-week open label study randomized 72 patients with DAT associated psychosis either to amisulpride (n=36) and risperidone (n=36). The effectiveness of the treatments was assessed with the Korean version of Neuropsychiatry Inventory (K-NPI) psychosis subscale and total K-NPI and the Clinical Global Impression-Severity of Illness (CGI-S) scale. The Simpson-Angus Rating Scale, the Barnes Akathisia Rating Scale and the Abnormal Involuntary Movement Scale were used for the assessment of side effects. The K-NPI psychosis subscale, total K-NPI and CGI-S scores were significantly decreased over time in both treatment groups without any significant group difference and time by the group interaction effect. There were no serious adverse events in both groups. This study showed that either amisulpride or risperidone would be effective and tolerable for treating psychotic symptom associated with DAT. Adequately powered studies with a head-to-head comparison design will be mandatory to draw any definite conclusion.
Dementia* ; Dyskinesias ; Humans ; Neuropsychiatry ; Psychomotor Agitation ; Psychotic Disorders* ; Risperidone*

OBJECTIVE: The purpose of the present study was to investigate the efficacy, safety, and tolerability of aripiprazole in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder during acute treatment phase. METHODS: Prospective, multicenter, single group, and 8-week study was conducted in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder. A total of 300 patients were enrolled in the present study. The primary efficacy measure was the Positive and Negative Syndrome Scale (PANSS) total score, and secondary efficacy measures were the PANSS positive and negative subscales scores, and Clinical Global Impression-Severity of Illness (CGI-S) score. Treatment-emergent adverse events, extrapyramidal symptoms (EPS), weight, vital signs, and laboratory tests were assessed as measures of tolerability and safety. RESULTS: Significant improvements in all efficacy measures were achieved by aripiprazole as early as 1-week and sustained through 8-week period. First-episode patients showed greater improvements in PANSS total, positive subscale score, and CGI-S score, compared with recurrent patients. Slightly increased akathisia (+0.32 from baseline score of Barnes Akathisia Rating Scale, p=0.033) and weight gain (1.15+/-3.44 kg, p<0.001) were observed by aripiprazole during 8-week acute treatment phase. CONCLUSION: The present study demonstrated that aripiprazole was effective in acute treatment of positive and negative symptoms of schizophrenia, schizophreniform disorder, and schizoaffective disorder. In general, aripiprazole showed favorable safety and tolerability profiles, although clinicians needed to pay attention to the possibility of akathisia and weight gain by aripiprazole in first-episode patients during acute treatment phase.
Humans ; Piperazines ; Prospective Studies ; Psychomotor Agitation ; Psychotic Disorders ; Quinolones ; Schizophrenia ; Vital Signs ; Weight Gain ; Aripiprazole

OBJECTIVE: The purpose of the present study was to investigate the efficacy, safety, and tolerability of aripiprazole in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder during acute treatment phase. METHODS: Prospective, multicenter, single group, and 8-week study was conducted in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder. A total of 300 patients were enrolled in the present study. The primary efficacy measure was the Positive and Negative Syndrome Scale (PANSS) total score, and secondary efficacy measures were the PANSS positive and negative subscales scores, and Clinical Global Impression-Severity of Illness (CGI-S) score. Treatment-emergent adverse events, extrapyramidal symptoms (EPS), weight, vital signs, and laboratory tests were assessed as measures of tolerability and safety. RESULTS: Significant improvements in all efficacy measures were achieved by aripiprazole as early as 1-week and sustained through 8-week period. First-episode patients showed greater improvements in PANSS total, positive subscale score, and CGI-S score, compared with recurrent patients. Slightly increased akathisia (+0.32 from baseline score of Barnes Akathisia Rating Scale, p=0.033) and weight gain (1.15+/-3.44 kg, p<0.001) were observed by aripiprazole during 8-week acute treatment phase. CONCLUSION: The present study demonstrated that aripiprazole was effective in acute treatment of positive and negative symptoms of schizophrenia, schizophreniform disorder, and schizoaffective disorder. In general, aripiprazole showed favorable safety and tolerability profiles, although clinicians needed to pay attention to the possibility of akathisia and weight gain by aripiprazole in first-episode patients during acute treatment phase.
Humans ; Piperazines ; Prospective Studies ; Psychomotor Agitation ; Psychotic Disorders ; Quinolones ; Schizophrenia ; Vital Signs ; Weight Gain ; Aripiprazole

Restless legs syndrome (RLS) is a common neurological condition characterized by uncomfortable and unpleasant sensations experienced primarily in the legs. Several clinical reports have indicated that many patients with RLS also have the same symptoms in their arms. We report contralateral arm and leg restlessness on resting after acute internal capsular infarction, which resulted in sleep-onset insomnia and disappeared after administering a dopamine receptor agonist. These observations could provide clues to the mechanism underlying the pathophysiology of RLS.
Arm ; Dopamine Agonists ; Humans ; Infarction ; Leg ; Psychomotor Agitation ; Restless Legs Syndrome ; Sensation ; Sleep Initiation and Maintenance Disorders

OBJECTIVE: The aim of this study was to observe the safety and efficacy of ziprasidone in the usual care setting in patients with schizophrenia or acute manic or mixed episodes associated with bipolar disorder. METHODS: A total of 3,391 patients who were treated with ziprasidone were enrolled from 108 centers in Korea. Differences in the clinical global impression of severity and clinical global impression of improvement (CGI-I) were measured after 8+/-1 weeks administration of ziprasidone. Adverse events were observed in all subjects who were administered ziprasidone at least once. In 330 patients, the change of weight was evaluated. RESULTS: Ziprasidone was effective for most of schizophrenia and acute manic or mixed episodes associated with bipolar disorder patients. CGI-I score was improved in 84.8% of PP subjects. Of the subjects who did not complete the study, sixty-four (1.9%) subjects discontinued treatment due to adverse events. The most common adverse events were akathisia, somnolence, extrapyramidal symptoms and insomnia. In total, 6 serious adverse events were reported in 2 subjects, including psychotic disorder and suicidal attempt. Mean 0.9 kg of weight loss was observed. CONCLUSION: Ziprasidone was effective, safe and generally well tolerated for schizophrenia or acute manic or mixed episodes associated with bipolar disorder patients in Korea.
Bipolar Disorder ; Humans ; Korea ; Piperazines ; Psychomotor Agitation ; Psychotic Disorders ; Schizophrenia ; Sleep Initiation and Maintenance Disorders ; Thiazoles ; Weight Loss

The authors studied anxiety, using Zung's self-rating anxiety scale (SAS), in the subjects of 127 male and 38 female patients with anxiety disorder. The authors investigated 165 patients in Yeungnam university hospital from January, 1987 to June, 1991. In order to analyze the data on anxiety scores Pearson's product moment coefficient correlation method and factor analysis were carried out by SPSS/PC+ program. The results were as follows: There was significant difference in the mean averages of total anxiety scores among patients with anxiety disorder and male and female college freshmen: patients with anxiety disorder scored 42.40±7.74, male students scored 32.91±5.70, female students scored 34.48±6.00. The anxiety scores relating to the items of body aches & pains, fatigue, anxiousness, panic and urinary frequency were relatively high in patients with anxiety disorder. The anxiety scores on the items of restlessness, apprehension, dyspnea, sweating, and insomnia were relatively low in patients with anxiety disorder. Twenty-nine anxiety disorder group (17.5%) showed significantly high anxiety scores of 50 or over. The inter-rater reliability of Zung's self-rating anxiety scale was 0.71.
Anxiety Disorders* ; Anxiety* ; Dyspnea ; Fatigue ; Female ; Humans ; Male ; Methods ; Panic ; Psychomotor Agitation ; Sleep Initiation and Maintenance Disorders ; Sweat ; Sweating

BACKGROUND: Akathisia is defined as inner feeling or restlessness and can be associated with restless movement. It is a frequent and disabling complication of neuroleptics and was reportedly common in postencephalitic parkinsonism. Akathisia has been reported and appears to be common in Parkinson's disease(PD). OBJECTIVE: To determine the frequency and clinical features of akathisia and dexamine the relationship between presence of akathisia and various clinical parameters of PD, Method: we evaluated 137 PD patients from movement disorder clinics in Samsung Medical Center and Seoul National University Hospital, using a modified akathisia questionnare. We compared two groups between those with akathisia and those without akathisia. We analysed the pattern, location and chronology of akathisia, and the correlation between akathisia and clinical parameters of PD. RESULTS: 1. Of the 137 patients (76 women, 61 men), 43(22 women, 21 men) (31.4%) had akathisia. 2. Patients with akathisia had more advanced disease than those without akathisia as determined by Hoehn and Yahr stage (p<0.05). 3. Patients with akathisia were more often akinetic-rigid than tremor predominent (p<0.05). 4. Patients with akathisia were more frequently treated with levodopa than those without akathisia (p<0.05). 5. There was no difference between two groups for age, sex or disease duration(p<0.05). 6. Of the 43 patients with akathisia, 35 patients had motor restlessness and 27 patients had associated sensory complaints. 7. The whole body or legs were most frequently affected. 8. Akathisic symptoms occurred irregularly and mainly in the afternoon. 9. Nineteen patients had difficulty in their jobs due to akathisia. Conclusion: Akathisia is a common problem in PD especially in severe akinetic-rigid form. It can be the main cause of disability in PD. Recognition and proper management are needed.
Antipsychotic Agents ; Female ; Humans ; Leg ; Levodopa ; Movement Disorders ; Parkinson Disease* ; Parkinson Disease, Postencephalitic ; Psychomotor Agitation* ; Seoul ; Tremor

OBJECTIVE: It is well known that treatment with quetiapine can easily cause somnolence and daytime sleepiness in patients with bipolar disorder. Such sedation may be the discomfort to the drug in terms of patient's perspectives and results in drug noncompliance. This study was aimed to investigate the effect of 6-week quetiapine monotherapy on subjective aspects of sleep in patients with acute bipolar disorder. METHODS: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine. The dose of quetiapine initially started at 200 mg/day and rapid titrated up to 800 mg/day within day 7 according to the clinical judgements. Clinical improvement was evaluated using Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar version (CGI-BP). Extrapyramidal side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The overall subjectively reported adverse events were gathered during the study period. Subjective sleep questionnaire modified from Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of sleep, which included the aspects covering the ease of getting to sleep (GTS), quality of sleep (QOS) and hangover behavior next day (HOV). All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with quetiapine. Analyses were focused to compare the differences between pre-drug baseline and post-treatment with quetiapine. RESULTS: Total 78 (male=30, female=48) patients were included and most of them were inpatients (N=59, 74.7%). Fifty-nine (75.9%) patients were completed the study. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. There were no significant differences from baseline in SARS and BARS at any assessment points. The common subjectively reported adverse events were somnolence, dizziness and dry mouth. While mean changes of 5 items measuring nighttime sleep (GTS and QOS) from baseline were significantly improved at days 7, 14, 21 and 42, those of HOV were not differed between baseline and post-treatment assessments. CONCLUSION: Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.
Bipolar Disorder ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dizziness ; Humans ; Inpatients ; Mouth ; Psychomotor Agitation ; Surveys and Questionnaires ; Quetiapine Fumarate

OBJECTIVE: Although atypical antipsychotics are increasingly being used as monotherapy in acute mania, few Korean studies have investigated on them. This study evaluated the efficacy and tolerability of olanzapine monotherapy in patients with acute mania. METHODS: This multicenter, open-label study evaluated the efficacy of olanzapine to treat mania over 6 weeks. Patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were treated with olanzapine (flexible dosage to a maximum of 30 mg/day). Clinical improvements were rated using the Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Version (CGI-BP), Brief Psychiatric Rating Scale (BPRS), and the Montgomery-Asberg Depression Rating Scale (MADRS). Adverse events were measured using the Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The general functioning of patients was assessed using the Global Assessment Scale (GAS). All assessments were carried out at baseline and at days 7, 14, 21, and 42, with the exception of the GAS. RESULTS: The subjects comprised 76 patients (male=38, female=38), with 55 patients (72.4%) completing the study. The mean initial dose of olanzapine was 11.7+/-5.0 mg/day and mean daily doses at days 7, 14, 21, and 42 were 16.6+/-5.2, 17.2+/-5.0, 18.1+/-5.3, and 17.4+/-4.7 mg/day, respectively. At days 7, 14, 21, and 42, YMRS, CGI-BP, MADRS and BPRS scores had significantly improved from baseline. More improvement in MADRS scores was observed among patients with mixed mania than patients with euphoric mania. Changes in BPRS scores from baseline did not differ between patients with psychotic symptoms and those with euphoric mania. At days 21 and 42, 42 (55.3%) and 57 (75.0%) patients had responded (YMRS scores decreased from baseline by more than 50%). Also 27 (35.5%) and 46 (60.5%) patients had achieved remission (YMRS scores < or =12) at the same assessment points. GAS scores at days 21 and 42 indicated that olanzapine monotherapy improved patients' global functioning compared to baseline. SARS and BARS scores did not differ significantly between pre- and post-drug trial. CONCLUSION: The data indicate that olanzapine monotherapy has favorable effects across a broad range of mood symptoms and yields functional improvement in acute manic patients with minimal adverse events. Therefore, olanzapine monotherapy may be a preferred first-line agent to treat patients with acute mania. These results support the findings from previous studies and guidelines.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychomotor Agitation