OBJECTIVE: Mixed states are difficult to define precisely and to recognize accurately. Moreover, the DSM-IV criteria for diagnosis of a mixed episode might be too restrictive. The purpose of this study was to investigate the possibility of a mixed episode in bipolar inpatients hospitalized with DSM-IV manic episodes using the Cincinnati criteria, which is a broader criteria compared to DSM-IV. METHODS: Inpatient charts of manic patients were carefully evaluated to determine the presence of depressive symptoms in the Cincinnati criteria. The probable mixed patient group was compared with the definitely manic patient group on demographic and clinical variables. The predictability of depressive symptoms for a mixed episode was assessed. RESULTS: Twenty-one out of 101 manic inpatients were possibly diagnosed as mixed episodes. They showed more psychiatric family history, comorbid personality disorder and suicide attempts. Two symptoms (suicidal ideation and helplessness or hopelessness) had good positive predictive value. CONCLUSION: Diagnosis of a mixed episode can be increased with careful interview and by using a broader diagnostic criteria. The presence of suicidal ideation and helplessness or hopelessness may suggest a mixed state.
Bipolar Disorder ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Inpatients ; Personality Disorders ; Suicidal Ideation ; Suicide

This is a report of anesthesia for five cases of renal transplantation which was performed between February 1969 and August 1969 at St. Mary's Hospital, Catholic Medical College, Seoul, Korea. General of renal insufficiency of the operated cases were described. Operative technique were unilateral nephrectomy for three cases and bilateral nechprectomy with splenectomy for 2 cases ; Anesthesia was induced with epontol (propanidid) 250mgs i.v. and 4% halothane-oxygen and maintained with 1% halotbane-oxygen which was supplemented by nitrous oxide occasionally. 6% dextrose and lactated-Ringer's solution were infused. For transfusion, whole blood was given to replace the operative blood loss. Dextran was also used to maintain adequate blood volume. Shortly before anastomosis of renal and femoral vessels, patients were haparinized. Fluids and electrolytes balance were studied pre-and post-operatively. Preoperatively, uremia and hyperpotassemia was corrected by several hemodyalysis. Urinary output after surgery showed a marked degree of diuresis up to 1800 ml/hr until second post-operative day. The special concern of anesthesia for kidney transplantation were: 1. Patients were suffering from severe uremia and metabolic disterbances. 2. Acidosis and hyperpotassemia should be corrected before surgery by hemo-or peritoneal dialysis. 3. Immunosuppressive agents made the patient less resistant to infection. 4. Anemia and hydrops was difficult to be corrected before surgery. 5. Muscle relaxants of choice were depolarizing agents, because of impaired renal excretion.
Acidosis ; Anemia ; Anesthesia* ; Blood Volume ; Dextrans ; Diuresis ; Edema ; Electrolytes ; Glucose ; Humans ; Hyperkalemia ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Korea ; Nephrectomy ; Nitrous Oxide ; Peritoneal Dialysis ; Propanidid ; Renal Insufficiency ; Seoul ; Splenectomy ; Uremia

No abstract available.
Humans

PURPOSE: Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. MATERIALS AND METHODS: A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attempts. We compared demographic characteristics and clinical features between the two groups using an analysis of covariance and chi-square tests. Finally, logistic regression was performed to evaluate significant risk factors associated with suicide attempts in bipolar disorder. RESULTS: The prevalence of suicide attempt was 13.1% in our patient group. The presence of a depressive first episode was significantly different between attempters and nonattempters. Logistic regression analysis revealed that depressive first episodes and bipolar II disorder were significantly associated with suicide attempts in those patients. CONCLUSION: Clinicians should consider the polarity of the first mood episode when evaluating suicide risk in bipolar patients. This study has some limitations as a retrospective study and further studies with a prospective design are needed to replicate and evaluate risk factors for suicide in patients with bipolar disorder.
Adult ; Asian Continental Ancestry Group ; Bipolar Disorder/*complications/*psychology ; Depressive Disorder/complications/*psychology ; Female ; Humans ; Korea ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Suicide, Attempted/*psychology/statistics & numerical data ; Young Adult

OBJECTIVE: The aim of this study was to monitor changes of prescription patterns for bipolar disorder in clinical settings during the last five years in four psychiatric treatment centers. METHODS: A retrospective chart review of data of 601 patients with bipolar disorder was performed between January 2001 and December 2005 from four psychiatric centers in Seoul and GyeongGi-Do. Data on demograpnic variables, clinical characteristics, and the types and dosages of mood stabilizers and antipsychotics, and the patterns of prescriptions over the five-year period were analyzed. RESULTS: The use of valproate has increased, whereas the percentage of lithium use has decreased. The combined prescription of valproate and lithium remained constant at 12% over the five-year period. The prescription of newer-class of mood stabilizers such as lamotrigine and topiramate was few. Most of the patients in our study were on more than two psychotropic agents, with the most common discharge medication being a combination of a mood stabilizer and an antipsychotic (81.9%). The use of atypical antipsychotics has increased its share from 71.4% in 2001 to 92.3% in 2005. Among the atypical antipsychotics, Quetiapine use showed the most rapid increase since year 2001 and ranked as the most frequenctly used antipsychotics for bipolar disorder in 2005 (38.5% of antipsychotics). Especially, in those without psychotic features, quetiapine was the most frequently used antipsychotics (51.2% in 2005). In those with psychotic features, risperidone (39.1%) was more frequently used than quetiapine (28.3%). CONCLUSION: The present study showed that significant changes have occurred in the prescription patterns of mood stabilizers and antipsychotics and the rate of combination therapy for patients with bipolar disorder in the last five years. These results seem to reflect the introduction of new agents and the accumulating evidencebased data for the treatment of bipolar disorder, and will provide the useful information to clinicians for the establishment of better treatment guidelines for patients with bipolar disorder.
Antipsychotic Agents ; Bipolar Disorder* ; Gyeonggi-do ; Humans ; Inpatients* ; Lithium ; Prescriptions* ; Retrospective Studies ; Risperidone ; Seoul ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVES: It has been reported that first episode polarity affected the course and the prognosis of bipolar disorder. However, there is remarkable paucity of information regarding first episode polarity in bipolar disorder. We investigated the clinical characteristics related to the first episode polarity of bipolar patients who had been hospitalized. METHODS: Analyses were based on the medical documents of 520 bipolar patients who had been hospitalized in 4 hospitals. We examined clinical features of the current episode, demographics, past treatment history, suicidal attempt history, family history and comorbidity. Clinical characteristics were compared between manic onset and depressive onset patients. RESULTS: The mean age of the patients was 36.7 years old; they had 2.1 number of admission history and 6.6 years of illness duration. The patients beginning with depressive onset was 39.4%, and they had more diagnosis of bipolar II disorder, more number of suicidal attempts and reported more depressive mood during index admission than manic onset patients. CONCLUSION: Depressive onset is a common presentation in bipolar disorder. It is necessary to give more attention to depressive episode in bipolar disorder. Prospective study needs to explore the correlation of first-episode of polarity and course of the illness in the future.
Bipolar Disorder* ; Comorbidity ; Demography ; Diagnosis ; Humans ; Prognosis

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) plays an important role in cell survival, differentiation, and cell death as well as in neural plasticity. Recent studies have suggested that BDNF is involved in the pathogenesis of bipolar disorder. The aim of this study was to investigate the association of the genetic variations of the BDNF gene with bipolar disorder in Korea. We also studied the possible association of these genetic variants with clinical features. METHODS: The allelic and genotypic distributions of Val66Met polymorphism of the BDNF gene were analyzed using a polymerase chain reaction-based method in 184 bipolar patients and 214 controls. Analysis was performed to investigate an association of the Val66Met polymorphism of the BDNF gene and the clinical features in bipolar patients. RESULTS: No significant difference was found between bipolar patients and controls in the genotype and allele frequencies for the investigated BDNF polymorphism. However, the age of onset of bipolar disorder among the Val/Val (25.57), Val/Met (30.42) and Met/Met (32.45) genotype groups were significantly different (p=0.037). CONCLUSION: This study suggests that Val66Met polymorphisms are unlikely to contribution to the genetic predisposition to bipolar disorder as a whole. But Val66Met polymorphism may be associated with age of onset of the disorder, further studies designed to investigate the relationship in a larger population may be warranted.
Age of Onset ; Bipolar Disorder ; Brain-Derived Neurotrophic Factor ; Cell Death ; Cell Survival ; Gene Frequency ; Genetic Predisposition to Disease ; Genetic Variation ; Genotype ; Humans ; Korea

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

OBJECTIVE: Recently, the atypical antipsychotics such as quetiapine, olanzapine, risperidone, aripiprazole and ziprasidone are increasingly used in the management of acute manic patients as the monotherapy. But there are only a few reports on the use of these drugs in the treatment of bipolar disorder in Korea. The aim of this study was to evaluate the efficacy and tolerability of quetiapine monotherapy in patients with acute mania. METHOD: This study is multi-center, open-label, 6-week evaluation of the efficacy of quetiapine in bipolar mania. In this study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine (flexibly dosed up to 800 mg/day). Clinical improvements were rated by Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Version (CGI-BP), Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale (MADRS). Adverse events were measured using Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS), and subjective reports of patients were evaluated. Global Assessment Scale (GAS) was used to evaluate the general functioning of patients. All assessments were done at baseline and at days 7, 14, 21, and 42 except GAS (at days 21 and 42). Analyses were focused on change from baseline to day 42. RESULTS: Total 78 (male=30, female=48) patients were included and 59 patients (75.6%) completed the study. The mean initial dose of quetiapine was 268.0+/-223.2 mg/day and mean daily dose at day 42 was 585.3+/-244.5 mg/day. YMRS and CGI-BP were significantly improved at day 7, 14, 21, and 42 as compared to baseline. Mean scores of BPRS and MADRS were also significantly decreased at the each assessment points. Fifty-two patients (66.7%) showed response (more than 50% of decrease in YMRS score from baseline) and 35 patients (44.6%) reached remission (YMRS score < or =12) at day 21. GAS showed the improvements of patient's global functioning at days 21 and 42 of quetiapine monotherapy compared to baseline. There was no significant difference between baseline and any assessment points on SARS and BARS scores. CONCLUSIONS: The data showed that quetiapine monotherapy has favorable effects across a broad range of mood symptoms with minimal adverse events in addition to functional improvement in acute manic patients. This result suggests that quetiapine may be preferred for patients with acute mania as one of the first-line agents.
Antipsychotic Agents ; Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Psychomotor Agitation ; Risperidone ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: The Korean Medication Algorithm for the Treatment of Schizophrenia was developed by the extensive review and questionnaires. To evaluate the impact of a history of antipsychotic treatments on clinical response and algorithm application, using the data derived from the feasibility study of the Medication Algorithm for patients with schizophrenia. METHOD: Outcomes of treatment with the Medication Algorithm for 108 schizophrenics up to 4 months are presented. Measures of changes included clinical symptoms, functioning, and side effects. Comparison was done between patients with and without a history of antipsychotic treatments. RESULTS: 100 individuals (with a history=71 ; without a history=29) were analyzed for the comparison. Most of subjects without a history of antipsychotic treatments were administered on risperidone in the initial treatment. When compared with the subjects with a treatment history, the subjects without a history showed better treatment effects on clinical symptoms at the first evaluation. At 4-month, there were similar effects between the two groups except negative symptoms, in which the group with a history showed significantly more improvement than without a history. There were no significant differences in assessment of subjective opinion and well-being to drugs and quality of life, and objective evaluation of drug side effects. Among the subjects with a history, the ones starting with stage 1 showed higher positive symptoms, anxiety scores, and briefer duration of antipsychotic exposure than the ones starting with stage 2 or more advanced. CONCLUSION: This study suggests that despite some limitation, an antipsychotic treatment history may have an impact on application of medication algorithm and these data will be helpful for revision of the Medication Algorithm for the Treatment of Schizophrenia.
Anxiety ; Feasibility Studies ; Humans ; Quality of Life ; Surveys and Questionnaires ; Risperidone ; Schizophrenia