Up to the present date, the principle of antipsychotics treatment in patients with schizophrenia is antipsychotics monotherapy. The reasons for the drug monotherapy may be associated with the fact that typical antipsychotics were assumed to have similar mechanism of action and that combination use of more than two antipsychotics would offer no benefit over that of monotherapy with the agents. However, because the newer `atypical' antipsychotics have the notable features in their diverse pharmacologic action and lower adverse event profiles, many practitioners have an interest in using the combination therapy. Some patients with schizophrenia and schizoaffective disorder have no response to atypical antipsychotics and the studies increasingly reported that the antipsychotics combinations improve the symptom profiles of psychotic patients. Thus, the antipsychotic combination therapy is an additional option in treatment-resistant psychotic patients. These combination therapies are commonly used in clinical practice, but we are in lack of the evidence of the rationale and background of this practice. Since most studies for antipsychotics combination therapy are open trial or retrospective study, we need the further prospective clinical studies with double-blind, placebo-controlled design in order to definitively determine the effectiveness of such practice.
Antipsychotic Agents* ; Drug Therapy, Combination ; Humans ; Psychotic Disorders ; Schizophrenia

Humans ; Parkinson Disease/drug therapy* ; Prevalence ; Southeast Asian People ; Psychotic Disorders/drug therapy* ; Antipsychotic Agents

Cognitive deficit is frequently observed in patients with schizophrenia. It is significantly associated with functional outcome. In the past 20 years, due to significant advances on the concept of schizophrenia, cognitive deficit has been accepted as a core feature. In the DSM-5, cognitive deficit does not introduce diagnostic criteria of schizophrenia, but did one dimension of diagnosis of psychosis. Existing schizophrenia drugs are effective in treatment of positive symptoms of schizophrenia, but lack of effectiveness on improving cognitive function. Led by NIMH (National Institute of Mental Health), the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) meeting was conducted in order to achieve consensus on measuring tools and neuropharmacological targets for clinical trials for development of new drugs for improvement of cognitive function in schizophrenia. At the MATRICS consensus meeting, glutamatergic modulators and nicotinic and muscarinic agonists are expected to be promising, but should be proven by a double-blind placebo-controlled multicenter study for patients.
Cognition ; Consensus ; Diagnosis ; Drug Therapy ; Humans ; Muscarinic Agonists ; National Institute of Mental Health (U.S.) ; Psychotic Disorders ; Schizophrenia*

Behavioral and psychological symptoms in dementia (BPSD) are one of the common causes leading to significant impairment in quality of life for both patients and their caregivers, as well as an increased risk of institutionalization. In the treatment of BPSD, the first step is to check medical illness, and environmental status that can cause BPSD. When BPSD are associated with medical illness or environmental status, it is important to correct this condition for treatment of BPSD. However, if BPSD are very severe enough to be dangerous to patients or others and are not treatable by nonpharmacological approaches, pharmacological treatments could be considered. In pharmacological approaches, it is important to select relevant drugs according to the target symptoms, such as psychosis, depression, agitation, sleep disturbance, and so on. Due to the altered pharmacokinetics and pharmacodynamics, drug dosages for the patients with dementia should be started very low and increased slowly.
Caregivers ; Dementia* ; Depression ; Dihydroergotamine ; Drug Therapy* ; Humans ; Institutionalization ; Pharmacokinetics ; Psychotic Disorders ; Quality of Life ; Resin Cements

INTRODUCTIONPolypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy.

MATERIALS AND METHODSA treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later.

RESULTSThere were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics.

CONCLUSIONThe implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.

Adult ; Algorithms ; Antipsychotic Agents ; administration & dosage ; Female ; Humans ; Male ; Polypharmacy ; Psychotic Disorders ; drug therapy

Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients’ quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain’s lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals’ well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.
Anxiety Disorders ; Bipolar Disorder ; Cognition ; Cognition Disorders ; Comorbidity ; Depression ; Diagnosis ; Drug Therapy ; Fatigue ; Humans ; Learning ; Memory ; Multiple Sclerosis ; Neuroimaging ; Personality Disorders ; Prevalence ; Psychotic Disorders ; Quality of Life ; Suicide

OBJECTIVE: Switching antipsychotics is one useful therapeutic option when the treatment of schizophrenia encounters suboptimal efficacy and intolerability issues. This study aimed to investigate the efficacy and tolerability of cross-tapering switching to ziprasidone from other antipsychotics. METHODS: A total of 67 patients with schizophrenia or schizoaffective disorder were recruited in this 12-week, multicenter, non-comparative, open-label trial. Prior antipsychotics were allowed to be maintained for up to 4 weeks during the titration of ziprasidone. Efficacy was primarily measured using the 18-item Brief Psychotic Rating Scale (BPRS) at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was secondarily measured by the Clinical Global Impression-Severity (CGI-S) scale and the Global Assessment of Functioning (GAF) scale at each visit. Regarding the metabolic effects of switching to ziprasidone, weight, body mass index (BMI), waist-to-hip ratio (WHR), and lipid profile-including triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol levels-were measured at each follow-up visit. RESULTS: The BPRS scores were significantly improved at 12 weeks after switching to ziprasidone (F=5.96, df=2.11, p=0.003), whereas the CGI-S and GAF scores were not significantly changed. BMIs, WHRs, and TG levels were significantly decreased, with no significant changes in other lipid profiles. CONCLUSION: Cross-tapering switching to ziprasidone is effective for patients with schizophrenia spectrum disorders. Beyond the efficacy of the procedure, favorable metabolic profiles show that switching to ziprasidone may be helpful for maintenance therapy over an extended period.
Antipsychotic Agents ; Body Weight ; Cholesterol ; Drug Therapy ; Follow-Up Studies ; Humans ; Lipoproteins ; Metabolome ; Psychotic Disorders* ; Schizophrenia* ; Triglycerides ; Waist-Hip Ratio

OBJECTIVE: The purpose of this study was to examine the pharmacological treatment patterns in inpatients with bipolar disorder at a university hospital, and to establish appropriate clinical practice guideline in light of recent advances of pharmacotherapy of bipolar disorder. METHODS: A total of 454 first-admission cases with a diagnosis of bipolar disorder or schizoaffective disorder from 1990 to 2001 were analyzed with regard to the clinical characteristics and the use of mood stabilizers, antidepressants and antipsychotics. RESULTS: In manic, hypomanic, and mixed episodes, there has been a substantial increase in the use of valproate while the use of lithium has decreased. Antipsychotic drugs were prescribed as combination regimen in over 80% of total cases. In 44.6% of bipolar depression cases, mood stabilizers were not prescribed. In 70.7% of bipolar depression cases not receiving mood stabilizers, antidepressant monotherapy was utilized. The use of SSRIs and RIMA has increased, while a decrease was observed for TCA. There has been a tendency of the increased use of atypical antipsychotics. In particular, clozapine monotherapy has increased in mood stabilizer resistant cases. CONCLUSIONS: The results of the present study suggest that the prescription patterns have changed in general agreement with recent advances of pharmacotherapy of bipolar disorder during the past twelve years. However, there was clear tendency to use antipsychotics rather than other mood stabilizers as the combination regimen. Moreover, accurate diagnosis and careful reconsideration for pharmacological treatment strategies are required in bipolar depression, mixed states, and rapid cycling.
Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Clozapine ; Diagnosis ; Drug Therapy* ; Humans ; Inpatients ; Lithium ; Prescriptions ; Psychotic Disorders ; Valproic Acid

Obsessive-compulsive disorder(OCD) is characterized by recurrent obsessions or compulsions causing marked distress. The lifetime prevalence of OCD in general population is estimated about 2~3%. OCD can usually be distinguished from psychosis by the facts that the patients recognize the irrational nature of the symptoms. OCD is also different from obsessive-compulsive personality in that the patients suffer from obsessions and compulsions which accompany marked distress. The etiology of OCD is not know yet. However, numerous studies suggest that OCD may be associated with several psychological and neurobiological factors such as functional abnormalities of cortico-striatal circuit and serotonin. Selective serotonin reuptake inhibitors(SSRI) are the first-line drugs for the treatmemt of OCD. Approximately 50~80% of OCD patients improved with these anti-obsessional drugs with average reduction in symptoms between 30~70%. Benefits may not appear for 2 or more weeks. Continuing a medication for more than 10 weeks is required to determine the anti-obsessional efficacy. Maintenance treatment is usually required for more than several months. Cognitive-behavioral therapy also proved to be effective, particularly for patients with prominent compulsions. Therefore, it is a logical choice to combine pharmacotherapy and cognitive-behavioral therapy. For extreme cases electroconvulsive therapy(ECT) or stereotaxic neurosurgery may be considered. However, at present, neurosurgery is recommended only for a few patients who remained severely disabled even after years of sufficient treatments.
Compulsive Personality Disorder ; Drug Therapy ; Humans ; Logic ; Neurosurgery ; Obsessive Behavior ; Obsessive-Compulsive Disorder* ; Prevalence ; Psychotic Disorders ; Serotonin

Two hundred and four patients with Parkinson's disease initially treated wth a combination of levodopa and carbidopa ( Sinement 25-250 ) and / or anticholinergic drugs. All patients responded initially to drug. Sixteen patients(7.8%) had 20 acute central nervous system side effects: 8, dyskinesia: 6, visual hallucination:5, psychosis: and 1, akathisia. The response to treatment usually was stable for the first one and a half to four years of drug therapy. Subsequently, over 50 percent of patients had therapeutic failure among 82 patients with long term drug therapy, fourteen(l7.0%) had 18 side effects: 8, on-off phenomenon: 4. Morning dystonia: 3, dyskinesia:and 3, simultaneous dyskinesia with parkinsonism. None had diphasic dyskinesia or myoclonus. The prognosis of the demented parkinsonian was relatively poor. Two patients died due to pneumonia and ovarian carcinoma.
Carbidopa ; Central Nervous System ; Drug Therapy ; Dyskinesias ; Dystonia ; Humans ; Levodopa ; Myoclonus ; Parkinson Disease* ; Parkinsonian Disorders ; Pneumonia ; Prognosis ; Psychomotor Agitation ; Psychotic Disorders