We report the first two cases of manic and hypomanic episodes respectively induced by risperidone treatment done to schizophrenics in Korea. One case was a 22-year-old woman with catatonic schizophrenia. Since 3 years ago, she had shown psychotic symptoms, but with was poor treatment compliance. She had mainly negative symptoms such as social withdrawal, decreased flood intake, mutism, and symptoms had been worsened since last 4-5 months. Prior to closed ward admission, she was prescribed 2mg/d of risperidone far a week at OPD. Two days after taking medicine totally 6-8mg, she revealed manic features. After hospitalization, risperidone was discontinued and then, lithium 900mg/d and high dosage of conventional antipsychotics(chlorpromazine 1200mg/d or haloperidol 20mg/d) were prescribed. About on the l0th day of hospitalization, there was limited improvement of her manic symptoms. The other case was a 29-year-old man with a 3-year history of paranoid schizophrenia. He was never exposed to antipsychotics before. His main symptoms were delusions of being poisoned and of persecution. His positive and also negative symptoms were alleviated by 38 days of risperidone 2mg/d trial. However, one week after dosage increment to 3mg/d, hypomanic symptoms appeared. Risperidone medication was discontinued and was replaced by chlorpromazine 300mg/d. The hypomanic episode was resolved over 5 days. In both of the two cases, manic episodes occurred by monotherapy of risperidone without mood stabilizer, and there were no history of substance abuse and other psychiatric disorders, family history of psychiatric disorders, and comorbid physical illnesses. It is hypothesized that the potent blockade effect on serotonin(5-HT2) receptor of risperidone causes antidepressant effect, as well as therapeutic effect for negative and affective symptoms in schizophrenia. Risperidone would induce manic or hypomanic features in schizophrenic patients. And there are few case reports of risperidone-induced mania or exacerbation of preexisting manic symptoms by risperidone treatment in mood disorder and schizoaffective disorder. Risperidone is being used more widely, even for obsessive-compulsive disorder and other psychiatric disorders. It is necessary for clinicians to recognize manic switch, one of psychiatric side effects by risperidon trial. It is recommended that the combination of mood stabilizer with risperidone or usage of the minimum effective dose of risperidone may bewefal especially in the patients with mood disorders or schizoaffective disorders. Clozapine which has mood-stabilizing properties is also beneficial in risk groups of risperidone-induced mania.
Adult ; Affective Symptoms ; Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Clozapine ; Compliance ; Delusions ; Female ; Haloperidol ; Hospitalization ; Humans ; Korea ; Lithium ; Mood Disorders ; Mutism ; Obsessive-Compulsive Disorder ; Psychotic Disorders ; Risperidone ; Schizophrenia ; Schizophrenia, Catatonic ; Schizophrenia, Paranoid ; Substance-Related Disorders ; Young Adult

OBJECTIVES: This study examined the admission type and its related factors among patients with psychotic disorders defined based on the revised mental health welfare law. METHODS: This study was conducted on a total of 100 patients diagnosed on the schizophrenia spectrum and other psychotic disorders. The admission type and sociodemographic characteristics were examined. Social support, psychopathology, excitement, insight, and social functioning were evaluated using the Social Support Scale, Positive and Negative Syndrome Scale (PANSS), PANSS excitement component, Brief Psychiatric Rating Scale, Global Assessment Functioning Scale, Strauss-Carpenter scale, Korean version of the Scale to Assess Unawareness of Mental Disorder, and Korean version of Beck Cognitive Insight Scale. RESULTS: The severity of psychotic symptoms, excitement, social functioning, and insight were significantly different between involuntary and voluntary admissions (p<0.05). Excitement and insight were found to be factors affecting the admission type (p<0.05). CONCLUSION: Excitement and insight were factors mainly accounting for the admission type in patients with psychotic disorder. This study could be helpful in improving clinical decision-making and community mental health care.
Brief Psychiatric Rating Scale ; Clinical Decision-Making ; Humans ; Jurisprudence ; Mental Disorders ; Mental Health ; Patient Admission ; Psychopathology ; Psychotic Disorders ; Schizophrenia Spectrum and Other Psychotic Disorders ; Schizophrenia

The present study details the rationale and methodology of the Korean Early Psychosis Cohort Study (KEPS), which is a clinical cohort investigation of first episode psychosis patients from a Korean population. The KEPS is a prospective naturalistic observational cohort study that follows the participants for at least 2 years. This study includes patients between 18 and 45 years of age who fulfill the criteria for one of schizophrenia spectrum and other psychotic disorders according to the diagnostic criteria of DSM-5. Early psychosis is defined as first episode patients who received antipsychotic treatment for fewer than 4 consecutive weeks after the onset of illness or stabilized patients in the early stages of the disorder whose duration of illness was less than 2 years from the initiation of antipsychotic treatment. The primary outcome measures are treatment response, remission, recovery, and relapse. Additionally, several laboratory tests are conducted and a variety of objective and subjective psychiatric measures assessing early life trauma, lifestyle pattern, and social and cognitive functioning are administered. This long-term prospective cohort study may contribute to the development of early intervention strategies and the improvement of long-term outcomes in patients with schizophrenia.
Cohort Studies* ; Early Intervention (Education) ; Humans ; Life Style ; Outcome Assessment (Health Care) ; Prospective Studies ; Psychotic Disorders* ; Recurrence ; Schizophrenia ; Schizophrenia Spectrum and Other Psychotic Disorders

OBJECTIVES: This study investigated whether long-acting injectable (LAI) paliperidone is different from its oral form in terms of the effect on cognitive function in schizophrenia spectrum and other psychotic disorders. METHODS: We reviewed the medical records of patients in Seoul National University Bundang Hospital who were diagnosed as having schizophrenia and/or other psychotic disorders based on DSM-5 from 2016 to 2017. Seven patients were treated with oral paliperidone and 11 were treated with paliperidone palmitate. All patients underwent clinical and neuropsychological assessment, including the Korean version of the MATRICS Consensus Cognitive Battery (MCCB) at their first visit or within one month of their initial treatment. MCCB was repeated within three to 12 months after the initial assessment. RESULTS: There was no significant difference between the two groups in most cognitive domains including speed of processing, attention and vigilance, working memory, verbal learning, visual learning and reasoning and problem solving domain. However, patients treated with paliperidone palmitate showed better improvement in social cognition domain than those taking oral paliperidone. The standardized values of social cognition domain scores had significantly improved over time in patients under paliperidone palmitate, demonstrating a significant time-by-group interaction. CONCLUSION: Our results show that long-acting injectable paliperidone could be helpful in some aspects of improving cognitive function in schizophrenia spectrum and other psychotic disorders. Further studies with other antipsychotics are necessary to generalize the results.
Antipsychotic Agents ; Cognition ; Consensus ; Humans ; Learning ; Medical Records ; Memory, Short-Term ; Paliperidone Palmitate ; Pilot Projects ; Problem Solving ; Psychotic Disorders ; Schizophrenia ; Schizophrenia Spectrum and Other Psychotic Disorders ; Seoul ; Verbal Learning

We experienced clinical improvement by clozapine(mean maintenance dosage: 100mg/day) and antiparkinsonian medication in 68-year-old man, diagnosed both secondary parkinsonism and delusional disorder. This result supports previous reports that clozapine may effectively treat parkinsonism with psychosis.
Aged ; Clozapine* ; Delusions* ; Humans ; Parkinson Disease, Secondary ; Parkinsonian Disorders* ; Psychotic Disorders ; Schizophrenia, Paranoid*

OBJECTIVES: Some emotional components, such as self-esteem, depression and anxiety, have been reported to be associated with paranoia in non-clinical population and schizophrenia patients. The aim of this study was to investigate the correlation between self-esteem and paranoia in healthy controls, in ultra-high risk for psychosis and schizophrenia patients. METHODS: 34 subjects with recent onset schizophrenia, 36 subjects with ultra-high risk for psychosis, and 44 healthy volunteers participated in this study. A detailed assessment was made of the paranoia, self-esteem, depression, and anxiety. RESULTS: In all three groups, there were a negative correlation between paranoia and self-esteem, and positive correlations between paranoia and depression and anxiety. In healthy control, lower self-esteem showed a trend to predict higher paranoia, and in ultra-high risk for psychosis, this trend tern on statistically significant level, and in recent onset schizophrenia group, this correlation was disappeared. CONCLUSION: The individual who have lower self-esteem showed higher paranoia tendency under delusional level, but after formation of persecutory delusion, the tendency was disappeared. This result supports the hypothesis that persecutory delusions are a defense against negative affective process.
Animals ; Anxiety ; Charadriiformes ; Delusions ; Depression ; Healthy Volunteers ; Humans ; Paranoid Disorders* ; Psychotic Disorders* ; Schizophrenia*

The purposes of this study were to compare the difference of prolactin responses to risperidone and haloperidol, the sex difference in prolactin responses to each drug and the difference of prolactin responses to both drug in each sex. METHODS: The patients with schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder diagnosed by the criteria of DSM-IV were randomly assigned to risperidone group (n=18) or haloperidol group (n=15). Prolactin levels were measured before drug administration and at week 1, 2, 3, 4, 6 after drug administration by immunoradiometric assay. RESULTS: Prolactin levels after risperidone administration were significantly (p<0.05) higher than those after haloperidol. There was no sex difference in the prolactin responses to haloperidol administration. As for risperidone administration, female showed significantly (p<0.05) higher prolcatin levels than male. There was no difference of prolactin responses to both drugs in male, but in female, prolactin levels after risperidone administration were significantly (p<0.05) higher than those after haloperidol. CONCLUSION: Compared to haloperidol, risperidone can cause significantly higher prolactin response in female than male. Therefore one should consider whether there is a sexual side effects related to the elevated prolactin level especially in female during risperidone administration.
Diagnostic and Statistical Manual of Mental Disorders ; Female ; Haloperidol* ; Humans ; Immunoradiometric Assay ; Male ; Prolactin* ; Psychotic Disorders* ; Risperidone* ; Schizophrenia* ; Schizophrenia, Paranoid ; Sex Characteristics

OBJECTIVE: The practice of antipsychotic polypharmacy is common, despite lack of supporting evidence. The aims of this study were to estimate the prevalence of antipsychotic polypharmacy in a psychiatric university hospital in Korea and find out the clinical factors associated with antipsychotic polypharmacy. METHODS: We reviewed medical records of the patients discharged from Severance Mental Health Hospital (SMH) for the period of 1, January to 31, December 2010. Patients should be diagnosed as having schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder or psychotic disorder not otherwise specified. RESULTS: In 2010, 260 patients in SMH were prescribed with antipsychotics and 47.3% (n=123) of them were discharged under antipsychotic polypharmacy treatment. The most commonly prescribed antipsychotics for combination therapy was quetiapine (n=64). The most prevalent combination of drugs was risperidone plus quetiapine (n=20). Logistic regression analysis showed that the use of high-dose antipsychotics, first-generation antipsychotics, and long hospital duration were significantly associated with antipsychotic polypharmacy. CONCLUSION: Although the controlled evidence for efficacy and safety as a strategy remains inconclusive, antipsychotic polypharmacy is a common pharmacological strategy as it is illustrated in our study. Considering high antipsychotic doses related with antipsychotic polypharmacy, careful monitoring of side effect and efficacy is needed.
Antipsychotic Agents ; Dibenzothiazepines ; Humans ; Korea ; Logistic Models ; Medical Records ; Mental Health ; Polypharmacy ; Prevalence ; Psychotic Disorders ; Risperidone ; Schizophrenia ; Schizophrenia, Paranoid ; Quetiapine Fumarate

OBJECTIVES: Paranoia is a complex phenomenon, affected by a number of factors such as depression, trait anxiety, and attributional bias in schizophrenia. The aim of this study was to explore whether paranoia within continuum of clinical and subclinical states is associated with emotional dysregulation, attributional bias and neurocognitive impairment in whole individuals of normal controls, ultra-high risk (UHR) for psychosis and schizophrenia. METHODS: 101 normal controls, 50 participants at UHR for psychosis, and 49 schizophrenia patients were recruited. All subjects were asked to complete self-reported paranoia scale and emotional dysregulation scales including Rosenberg's self-esteem, Spielberg's state-trait anxiety inventory and Beck depression inventory. The attributional style was assessed by Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were also requested to complete the comprehensive neurocognitive battery. RESULTS: Multiple linear regression analysis showed that paranoia were found to be associated with emotional dysregulation (state anxiety, trait anxiety and depression), composite blaming bias in ambiguous situation, impairment of attention and working memory in whole participants [F (9, 190)=34.85, p<0.001, adjusted R2=0.61]. CONCLUSION: The main findings suggest that paranoia is a complex affective and cognitive structure that may be associated with emotional dysregulation, blaming bias and attention and working memory impairment in clinical and non-clinical paranoia.
Anxiety ; Bias (Epidemiology)* ; Depression ; Hostility ; Humans ; Intention ; Linear Models ; Memory, Short-Term ; Paranoid Disorders* ; Psychotic Disorders* ; Surveys and Questionnaires ; Schizophrenia* ; Weights and Measures

OBJECTIVES: This study investigated the prevalence of traumatic events and posttraumatic stress disorder (PTSD) in an admission cohort of schizophrenic patients from two university affiliated psychiatric units in Korea. Differences in symptomatology between those with and without trauma were also assessed. METHODS: The consecutive sixty one inpatients (32 women and 29 men), who were diagnosed with schizophrenia by SCID-I, completed the Clinician-Administered PTSD Scale (CAPS), the Positive and Negative Syndrome Scale (PANSS), Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: Forty patients (66%) had at least one traumatic event in their life time. The most common traumatic event was child physical abuse (34%), followed by accidents (21%), traumatic loss (18%), witnessing violence (15%), child sexual abuse (10%), natural disaster (8%), adult physical assaults (8%), adult sexual assaults (5%), and psychotic symptoms (5%). Only one patient (2%), however, was diagnosed with current PTSD. Patients with traumatic events compared to those without traumatic events demonstrated significantly higher scores on State anxiety scale (p=.006) and several subscales of SCL-90-R including paranoia, anxiety, phobia, interpersonal sensitivity, and degree of psychosis. No differences of sociodemographic and clinical background variables were found between the two groups. CONCLUSION: Low rate (2%) of current PTSD found in this study is comparable to North American literature reporting 10-46% of PTSD within the schizophrenic population. Absence of substance abuse or homelessness and low rate of sexual violence in these Korean patients may explain the discrepant rates. However, distinct symptom profiles of patients with trauma may suggest that PTSD diagnosis runs short of describing such patients. The results from this study imply that schizophrenia per se may not be associated with increased prevalence in current PTSD diagnosis.
Adult ; Anxiety ; Child ; Child Abuse, Sexual ; Cohort Studies ; Comorbidity ; Depression ; Diagnosis ; Disasters ; Female ; Homeless Persons ; Humans ; Inpatients* ; Korea ; Paranoid Disorders ; Phobic Disorders ; Prevalence* ; Psychotic Disorders ; Schizophrenia* ; Sex Offenses ; Stress Disorders, Post-Traumatic* ; Substance-Related Disorders ; Violence