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*

The author attempted to study on the characteristics of schizophrenia in the elderly by reviewing the literature both on late-onset schizophrenia and early-onset schizophrenia which had extended into middle and old ages. Interest in the elderly schizophrenia has increased greatly overseas since the 1980's. In particular, elderly schizophrenia is different from those of early adulthood in regard of clinical symptoms and response to drug therapy. Therefore, a thorough understanding of the elderly schizophrenia not only helps evaluateing and treating these patients but also leads us to a more comprehensive understanding of the disease. The author reviewed the changes of concepts and etiology, clinical manifestations, prognosis, neurological features, relations to dementia, differential diagnosis with other psychiatric disorders, and drug therapy of late-life schizophrenia. The elderly schizophrenic patients differ from the young schizophrenics in regard of pharmacokinetics and pharmacodynamics. And because the elderly patients are prone to have other medical problems or adverse drug effects, clinicians should be careful in choosing which drug to use and in adjusting its dosage. Especially, due to the high risk of tardive dyskinesia when using classical antipsychotics, the study on atypical antipsychotics such as clozapine and risperidone has increased. Up to now the study on elderly schizophrenia is not sufficient in korea and needs more attention in the future.
Aged ; Antipsychotic Agents ; Clozapine ; Dementia ; Diagnosis, Differential ; Drug Therapy ; Humans ; Korea ; Movement Disorders ; Pharmacokinetics ; Prognosis ; Risperidone ; Schizophrenia*

OBJECTIVES: The objective of this study is to prove that combining pharmacotherapy and group psychotherapy is more effective way to prevent recurrence and rehospitalization, to promote their interpersonal relations and to improve their satisfaction on treatment by making a comparison with pharmacotherapy and individual psychotherapy (supportive therapy). METHODS: This study was performed from September 2000 to October 2001. The subjects were all schizophrenic outpatients who were treated by authors in the specialized mental hospital, the psychiatric department of a general hospital, and psychiatric clinics. The experimental groups and the control groups were composed in matching, sex, diagnosis, duration of illness, number of admission and function level. During this period, the experimental groups had been treated by pharmacotherapy and group psychotherapy, and the control groups by pharmacotherapy and individual supportive therapy. Numbers of admission (ratio of readmission) and changes of drug doses were traced, at the same time' group psychotherapy effectiveness scales' were applied. Just after each session, Yalom's 13 therapeutic factors scale was administered. RESULTS: During study periods, 3 cases (17%) among total 18 cases of the experimental groups were re-admitted and 6 cases (33%) among total 18 cases of the control group were re-admitted. During study periods, the doses of chlorpromazine in the experimental groups were decreased from 267 mg at start to 185 mg at closure and the doses of chlorpromazine in the control groups were increased from 264 mg at start to 265 mg at closure. The mean scores of insight, satisfaction on treatment, and satisfaction toward therapist were statistically high in the experimental groups in comparison with the control groups (<0.05). CONCLUSION: 'Combining pharmacotherapy and group psychotherapy' to outpatients with schizophrenia is very effective and expedient for therapists. We expect that this combined treatment model would be practiced more broadly as an economic treatment method which could minimize problems caused by practicing pharmacotherapy only and to give patients full service, though there are accompanied problems including the difficulties of structuring, the eack of motivation of patients, and the financial burden.
Chlorpromazine ; Diagnosis ; Drug Therapy* ; Hospitals, General ; Hospitals, Psychiatric ; Humans ; Interpersonal Relations ; Motivation ; Outpatients* ; Psychotherapy ; Psychotherapy, Group* ; Recurrence ; Schizophrenia*

OBJECTIVES: Previous literature on the prescription change among patients with schizophrenia mainly focused on antipsychotics. This study investigated chronological change in the patterns of discharge medication among inpatients with schizophrenia at a psychiatric inpatient unit of a university-affiliated hospital. METHODS: All admission records at a psychiatric unit of Hanyang University Guri Hospital with discharge diagnosis of schizophrenia during two different five-year time frames (1996-2000 and 2006-2010) were reviewed including the demographic and clinical data and discharge medications. The data were gathered from a total of 207 patients (95 in 1990s and 112 in 2000s). RESULTS: The frequency in use of atypical antipsychotics (p < 0.01), antidepressants (p < 0.05), beta-blockers (p < 0.01), and benzodiazepine (p < 0.01) was significantly higher in 2000s. Anticholinergic drugs were less likely used in 2000s (p < 0.01). We did not find significant differences in the equivalent dose of antipsychotic drugs, the use of mood stabilizers and cholinergic drugs between two time frames. CONCLUSIONS: Increased proportion of atypical antipsychotics and decreased use of anti-parkinsonian drugs are in line with literature. Our results show that more diverse classes of psychotic medications are used for schizophrenia in recent years. It is likely that psychiatrists are becoming more conscious of negative symptoms, anxiety, and depression in the pharmacotherapy of schizophrenia as well as positive symptoms of the illness.
Antidepressive Agents ; Antipsychotic Agents ; Anxiety ; Benzodiazepines ; Cholinergic Agents ; Depression ; Diagnosis ; Drug Therapy ; Humans ; Inpatients* ; Korea ; Prescriptions* ; Psychiatry ; Psychotropic Drugs ; Schizophrenia*

OBJECTIVES: To provide basic data for psychopharmacologic research of schizophrenic patients, we analyzed and characterized prescribing patterns of outpatients with schizophrenia in Seoul National University Hospital (SNUH). METHODS: This study is a descriptive and retrospective report. Subjects were outpatients with schizophrenia in SNUH from March 1, 2002 through June 31, 2002. We obtained data of prescriptions and diagnoses from order communication system (OCS). RESULTS: There were 825 outpatients with schizophrenia (476 males and 349 females). 805 schizophrenia outpatients were taking antipsychotics. The total number of antipsychotic prescription was 862. The percentage of taking atypical antipsychotics was 88.1% among total antipsychotic prescription and 11.9% taking typical antipsychotics. Risperidone was prescribed most frequently (39.0%), and the next was clozapine (29.0%). There were 57 cases of antipsychotic polypharmacy. CONCLUSION: Our results which reflected evidence-based prescriptions in SNUH showed that atypical antipsychotics were replacing typical antipsychotics. But there was a possibility that clinician's selection of medication was influenced by health insurance policy. Clinical guideline for the treatment of schizophrenia seems necessary for effective pharmacotherapy.
Antipsychotic Agents ; Clozapine ; Diagnosis ; Drug Therapy ; Humans ; Insurance, Health ; Male ; Outpatients* ; Polypharmacy ; Prescriptions ; Retrospective Studies ; Risperidone ; Schizophrenia* ; Seoul

Methylenetetrahydrofolate reductase (MTHFR) deficiency is a rare autosomal recessive disorder. It is known that MTHFR deficiency may result in hyperhomocysteinemia, but MTHFR deficiency-induced schizophrenia has been rarely reported. Here we present the clinical course, biochemical and genetic characteristics of schizophrenia resulted from MTHFR deficiency in a school-age boy. He was 13 years old. He was admitted with a two-year history of fear, auditory hallucination, learning difficulty, sleeping problems, irascibility, drowsing and giggling. At admission, he had significantly elevated plasma and urine levels of total homocysteine, significantly decreased levels of folate in serum and cerebrospinal fluid, and a normal blood concentration of methionine. Further DNA sequencing analysis showed 665C>T homozygous mutations in the MTHFR gene. The patient was diagnosed with MTHFR deficiency-associated schizophrenia and treatment with calcium folinate, vitamin B12, vitamin B6, and betaine was initiated. After the treatment for 1 week, his plasma and urine levels of homocysteine were decreased to a normal range and the clinical symptoms were significantly improved. After 3 months of treatment, the patient returned to school. He is now living with normal school life. In summary, children with late-onset MTHFR deficiency and secondary cerebral folate deficiency may lead to schizophrenia. This rare condition can be early diagnosed through analyses of blood and urine total homocysteine, amino acids in blood and folate in blood and cerebral fluid and successfully treated with folinic acid, vitamin B6, vitamin B12 and betaine.
Adolescent ; Base Sequence ; Homocystinuria ; complications ; diagnosis ; drug therapy ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; deficiency ; Molecular Sequence Data ; Muscle Spasticity ; complications ; diagnosis ; drug therapy ; Psychotic Disorders ; complications ; diagnosis ; drug therapy ; Schizophrenia ; etiology

OBJECTIVE: Up to recently, the standard pharmacotherapy of schizophrenia has been monotherapy, use of one antipsychotic medication. However, polypharmacy in patients with schizophrenia is a common practice with little basis in well-controlled studies. In this study, we explored the patterns of pharmacotherapy in inpatient with schizophrenia by comparing prescribed medications at discharge between the year 1997 and the year 2003. METHODS: The medical records of patients who discharged with the diagnosis of schizophrenia from department of psychiatry, St. Mary's hospital in 1997 and 2003 were reviewed. The psychotropic medications at discharge were compared. The length of stay at the hospital and the incidence of adverse drug reactions were also compared. For statistics, chi-square test and independent t-test were performed. RESULTS: Data of 96 patients who discharged in 1997 and 2003 were analyzed. Patients prescribed with more than two kinds of antipsychotics were 7 of 96 in 1997 (7.2%) and 12 of 72 (16.7%), but the difference is not statistically significant (p=0.058). Patients prescribed with antipsychotics and mood stabilizers were 9 (9.3%) in 1997 and 18 (25%) in 2003. The difference is statistically significant (p=0.010). Especially, carbamazepine occupied most part of mood stabilizer use (89%) in 1997 but valproate use was increased much in 2003 (56%). Patients who were administered with anxiolytics (p=0.001) or anti-Parkinson agents (p<0.001) were decreased in 2003 compared with 1997. There were no statistically significant differences in the incidence of adverse drug reactions and the length of stay at the hospital. CONCLUSION: This study found that hospitalized patients with schizophrenia are being treated with more psychotropic medications, including more than 1 antipsychotic.
Anti-Anxiety Agents ; Antipsychotic Agents ; Carbamazepine ; Diagnosis ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Incidence ; Inpatients* ; Length of Stay ; Medical Records ; Polypharmacy* ; Schizophrenia ; Valproic Acid

Two schizophrenic patients who had been taking medication for a long period presented with visual disturbance of 6-month duration. Slit-lamp examination revealed fine, discrete, and brownish deposits on the posterior cornea. In addition, bilateral star-shaped anterior subcapsular lens opacities, which were dense, dust-like granular deposits, were noted. Although we strongly suspected that the patient might have taken one of the drugs of the phenothiazine family, we were unable to obtain a history of medications other than haloperidol and risperidone, which were taken for 3 yr. We performed a drug profiling test using urine samples and detected methotrimeprazine. The patient underwent surgery for anterior subcapsular lens opacities. Visual acuity improved in both eyes, but the corneal deposits remained. We report an unusual case of methotrimeprazine-induced corneal deposits and cataract in a patient with psychosis, identified by using the urine drug profiling test.
Adult ; Antipsychotic Agents/*adverse effects/therapeutic use/urine ; Cataract/*chemically induced ; Corneal Diseases/*chemically induced ; Female ; Humans ; Male ; Mental Retardation/diagnosis/drug therapy ; Methotrimeprazine/*adverse effects/therapeutic use/urine ; Middle Aged ; Schizophrenia/diagnosis/drug therapy ; Visual Acuity

The treatment of refractory schizophrenia has been a clinical challenge for most psychiatrists; the possible reasons include diagnostic errors, medical conditions and brain dysgenesis. Here, we described a patient with childhood-onset schizophrenia who had severe psychiatric symptoms such as auditory hallucinations and persecutory delusions, and etc. We reexamined all his possible medical conditions and found that the patient had an abnormally enlarged cavus septum pellucidum (CSP) combined with cavum vergae (CV) (maximum length >30 mm). Some reports suggested that abnormal CSP (length >6 mm) has a significant association with schizophrenia. However, abnormally large CSP or CSP/CV and related prognosis were reported rarely. This case suggested that abnormally enlarged CSP or CSP/CV may worsen the prognosis.
Adolescent ; Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; therapeutic use ; Clozapine ; therapeutic use ; Dibenzothiazepines ; therapeutic use ; Humans ; Male ; Quetiapine Fumarate ; Schizophrenia, Childhood ; diagnosis ; drug therapy ; pathology ; Septum Pellucidum ; pathology

OBJECTIVETo evaluate the clinical efficacy of modified Daotan Decoction (DD) combining low dosage of risperidone in treating chronic schizophrenia patients of phlegm-dampness blockage type, and compare with patients treated with risperidone alone.

METHODSSixty-five inpatients were randomly assigned to two groups, the treatment group (34 cases) treated with DD (with conventional dosage) one dose per day and risperidone 3.16 +/- 0.73 mg/d, and the control group (31 cases) treated with risperidone 5.11 +/- 1.27 mg/d alone, the course for both groups was 8 weeks. The effect was evaluated with positive and negative syndrome scale (PANSS), and the adverse reaction was assessed with treatment emergent symptom scale (TESS).

RESULTSThere was no significant difference in the overall efficacy between the two groups, but the improvement of the negative symptoms, illness provocation and general psychopathologic condition was significantly better in the treatment group than that in the control group respectively (P < 0.05). Moreover, the adverse reaction was milder and less in the former than that in the latter.

CONCLUSIONThe treatment of DD combined with low dosage of risperidone is effective on chronic schizophrenia and shows less adverse reaction.

Adolescent ; Adult ; Antipsychotic Agents ; administration & dosage ; therapeutic use ; Chronic Disease ; Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Psychiatric Status Rating Scales ; Risperidone ; administration & dosage ; therapeutic use ; Schizophrenia ; diagnosis ; drug therapy