While the therapeutic efficacy of antipsychotic drugs is not in doubt, a variety of undesirable side effects are common. They can be a disincentive to good compliance with treatment, resulting in increased possibilities for relapse and hospitalization. They can be distressing and disabling and thus interfering with patient safety and quality of life. Furthermore, they may be counter-therapeutic by exacerbating the condition that the drug was prescribed for. In this article, we will provide an overview of management of antipsychotic-induced side effects, with a particular emphasis on the most common side effects as well as less common but serious side effects. In addition, some practical issues regarding the management of side effects will b discussed.
Antipsychotic Agents ; Compliance ; Hospitalization ; Motivation ; Patient Safety ; Quality of Life ; Recurrence

OBJECTIVES: Daytime drowsiness or sedation and changes in night sleep are commonly seen in patients treated with clozapine. There is, however, very limited informatio on their degree and nature during the course of treatment. The purpose of this study was to understand the sleep patterns in chronic schizophrenic patients with clozapine treatment over a period of 24 weeks. METHOD: The sleep pattern was evaluated using a set of 5-point scale questionnaire, to record subjective impressions of the night sleep induction, maintenance and quality, and daytime drowsiness and fatigue. In addition, unusual experiences associated with night sleep were recorded. The sleep questionnaire was repeatedly administered at baseline and at 1, 2, 4, 8, 12 and 24 weeks of drug treatment. At present, data on 12 patients has been collected. RESULTS: All the components of night sleep were significantly improved in th 1st through the 12 th week after treatment with clozapine. Daytime drowsiness was significantly higher in the 1st to the 2nd week after the treatment and fatigue was also significantly higher in the 1st to the 4th week after the treatment. Eight patients experienced noticeable increases in salivation during night sleep, and of these, one also reported frequent nocturnal urination and even enuresis. However, all these adverse factors did not affect the major sleep patterns. CONCLUSIONS: These finding suggest that the beneficial effects of clozapine on night sleep might last much longer than the undesirable effect of daytime drowsiness and fatigue. In other words, tolerance of the hypnotic action of clozapine might develop late and tolerance of the daytime drowsiness and fatigue might be evident earlier.
Clozapine* ; Enuresis ; Fatigue ; Humans ; Surveys and Questionnaires ; Salivation ; Sleep Stages ; Urination

OBJECTIVES: This study examined the selective deficits of executive function in patients with mild traumatic brain injury that in normal range of general intelligence level and aimed to analysis of the correlation between K-WAIS result and executive function. METHODS: 59 subjects were included in this study, who were diagnosed as mild traumatic brain injury(MTBI) and they have visited in neuropsychiatric department of Wonkwang University Hospital during from March, 2005 to September, 2010. For measurement of general intelligence quotient, the Korean-Wechsler Adults Intelligence Scale(K-WAIS) was administered and for measurement of executive intelligence quotient(EIQ), Executive Intelligence Test(EXIT) was administered. RESULTS: Of patients, 50.8% included at abnormal EIQ group. The patients of abnormal EIQ showed poorer full scale IQ(FIQ), performance IQ(PIQ) and in subscale that picture arrangement, digit symbol, digit span, block design, object assembly and comprehension were significantly different. In terms of relationships between K-WAIS and EIQ, FIQ and PIQ have positive correlation with EIQ. And in subscale, picture arrangement, digit symbol, digit span, block design, object assembly and comprehension show positive correlation with EIQ. CONCLUSION: This study suggest that MTBI patients with have normal range of general intelligence level may have deficit of executive function is common. The decline of FIQ, PIQ and some subscales of K-WAIS may suggest executive dysfunction in MTBI patients.
Adult ; Brain ; Brain Injuries ; Comprehension ; Executive Function ; Humans ; Intelligence ; Reference Values ; Wechsler Scales

OBJECTIVE: This study aimed to investigate the pattern of psychiatric consultation-liaison in a new general hospital over a 5-year period. METHOD: Retrospective chart review was conducted for psychiatric consultations performed from May 2004 to December 2008 in a new general hospital in Hwasun, Korea. RESULTS: A total of 1,852 patients who were referred to the Department of Psychiatry for consultation were included in the analysis. The main reasons for psychiatric consultation were changes in mental status(20.5%), depression(16.8%), insomnia(12.8%), and anxiety(7.9%). Psychiatric consultations were conducted with diagnoses of delirium(39.7%), depressive disorder(28.2%), adjustment disorder(7.9%), and anxiety disorder(4.1%). Patients with delirium were significantly older than were those with other psychiatric diagnoses(p<0.001). Delirium was more common in male patients than in female patients(47.1% vs. 29.9%, respectively), and depression was more common in female patients than in male patients(48.3% vs. 33.9%, respectively)(p<0.001). Delirium was more common in patients who underwent surgical operation than those who did not(p=0.010). CONCLUSION: Delirium was the most common diagnosis for psychiatric consultation followed by depression in a university hospital. Delirium was more prevalent in men than in women, while depression was more common in women.
Anxiety ; Delirium ; Depression ; Female ; Hospitals, General ; Humans ; Male ; Referral and Consultation ; Retrospective Studies

PURPOSE: To classify the cavernous sinus lesions, to describe their radiological findings, and to assess the usefulness of MR compared to CT. METHODS AND MATERIALS: Fourty-five patients with lesions involving the cavernous sinus proved by histological and/or clinical and imaging methods were studied retrospectively and classified into neoplastic, vascular, and inflammatory lesions. CT and MR findings were compared in 21 patients evaluated by both modalities simultaneously according to these 4 categories. RESULTS: Pitiutary macroadenoma was the most common cavernous sinus lesion(42%). Diffuse convex bulging of the lateral wall of cavernous sinus was the most frequent radiological finding(84%), and the others were encasement of the cavernous carotid artery(49%), remodelling of the surrounding bones(44%), and complete obliteration of Meckel's cave(38%), in descending order of frequency. Bulging of the lateral wall of cavernous sinus was equally well demonstrated on both modalities, but encasement or displacement of the cavernous carotid artery and complete or partial obliteration of Meckel's cave were much better delineated on MR than on CT with the ratio of 3.8:1 and 4.6: 1, respectively. Only bone changes were much better demonstrated on CTthan on MR with the ratio of 3.8: 1. CONCLUSION: MR issuperior to CTin demonstrating thecavernouscarotid artery encasement and obliteration of Meckel's cave, but CT is much better than MR in demonstrating bone changes.
Arteries ; Carotid Arteries ; Cavernous Sinus* ; Humans ; Retrospective Studies

OBJECTIVE: This study was done to explore the determinants of care burden of Korean caregiver in patients with dementia. METHODS: For the seventy-nine patients with dementia and their caregivers, data on Caregiver Burden Inventory Korean version, and various patient- and caregiver related factors potentially related to care burden were investigated. Uni- or bi-variate analyses were performed to measure the relationships between individual factors and care burden, and then stepwise multiple linear regression tests were used to determine the independent risk factors. RESULTS: Two determinants of care burden were identified: 'severer depressive symptoms in patient' and 'lower spontaneous care motivation in caregiver'. Of the patient related factors, 'shorter disease duration', 'severer behavioral and psychotic symptoms' and'severer anxiety symptoms', and of the caregiver related factors,'women','having household responsibility', 'shorter free time' and'worse subjective health state' were related to care burden, although these were not identified as independent risk factors. CONCLUSION: To mitigate the care burden of Korean caregivers in patients with dementia, therapeutic interventions focused on the behavioral and psychological symptoms of patients would be essential in terms of patient related factors. With respect to caregiver related factors, in addition to the succession of the philosophy of filial piety, establishment of multi-modal services and facilities suitable for the caregivers vulnerable to care burden would be needed.
Anxiety ; Caregivers* ; Dementia* ; Depression ; Family Characteristics ; Humans ; Linear Models ; Motivation ; Philosophy ; Risk Factors

Heat shock protein of 72 kDa (HSP70) has a role in the functional modulation of sex steroid hormone receptors and in p53-associated oncogenesis and inhibits apoptosis associated with bcl-2. However, the exact role of HSP70 in the development of endometrial adenocarcinoma has not been well established. The aim of this study is to evaluate the role of HSP70 in relation with ER, PR, p53 and bcl-2 expressions and apoptosis in benign and malignant endometrial lesions. Immunohistochemical studies for HSP70, ER, PR, p53, bcl-2 and TUNEL method for apoptosis were performed in 30 cases of adenocarcinoma and 30 cases of benign endometrial lesions consisted of each 10 cases of disordered proliferative endometrium (DP), simple or complex hyperplasia (HP), and atypical hyperplasia (AH). There were no significant differences of HSP70 and bcl-2 expression rates and apoptotic index (AI) between DP, HP, AH, and adenocarcinoma. p53 expression rate in adenocarcinoma was 36.7%, but no p53 expression was identified in DP, HP and AH (p<0.05). In adenocarcinoma, HSP70 expression rate was higher in ER and PR negative adenocarcinoma (p<0.05), and p53 expression rate was higher in nonendometrioid type and FIGO grade II and III (p<0.05), but no significant difference of bcl-2 expression rate according to the histological type and FIGO grade. AI was higher in nonendometrioid type (p<0.05). There was no correlation between HSP70, p53 and bcl-2 expressions, and no significant difference of AI according to HSP70, ER, PR, p53, and bcl-2 expressions. In conclusion, higher HSP70 expression rate in poorly differentiated and ER and PR negative adenocarcinoma suggests that HSP70 inhibits ER and PR expression and may be involved in the development of poorly differentiated endometrial adenocarcinoma.
Adenocarcinoma* ; Apoptosis* ; Carcinogenesis ; Endometrium ; Female ; Heat-Shock Proteins ; Hyperplasia ; In Situ Nick-End Labeling

The purpose of this study was to investigate the positional changes of the mandibular condyles after orthognathic surgery in patients with severe skeletal Class III malocclusion. This study was based on 21 patients who had received bilateral sagittal split osteotomy for mandibular setback. Among them 14 were fixated non-rigidly (W group), and 7 were fixated rigidly (R group). After submental vertex view analysis each subject was given the T.M.J. Tomogram in both centric occlusion and centric relation immediate before, 4~6 weeks after and more than 6 months after surgery. The anteroposterior and vertical changes between each time interval were measured and analyzed statistically. Fallowing results were obtained. 1. There was no significant difference between right and left condyles in their anteroposterior and vertical changes of the condylar position. 2. In anteroposterior changes of condylar positon of the wire fixation group, the condyles were moved anteriorly 4-6 weeks after surgery, and then the pattern of reestablishment to their preoperative position was observed more than 6 months after surgery. In the rigid fixation group, there was no significant difference in any observation periods of centric occlusion and centric relation. 3. In vertical changes of condylar position of the wire fixation group, the condyles were moved inferiorly 4-6 weeks after surgery, and then the pattern of reestablishment to their preoperative position was observed more than 6 months after surgery. In the rigid fixation group, the condyles were moved inferiorly 4-6 weeks after surgery, and then the pattern of reestablishment to their preoperative position was observed more than 6 months after surgery in centric occlusion only.
Centric Relation ; Humans ; Malocclusion* ; Mandibular Condyle ; Orthognathic Surgery* ; Osteotomy ; Osteotomy, Sagittal Split Ramus

No abstract available.
Biliary Tract*

No abstract available.
Estrogens* ; Humans ; Receptors, Estrogen* ; Thyroid Diseases* ; Thyroid Gland*