OBJECTIVES: Individuals differ in their biological rhythms. This study investigated the association between the morningness-eveningness and sleep patterns, daytime sleepiness and fatigue in Korean male adolescents. METHODS: Participants were 501 eleventh grade male students (16.9+/-0.2 years of age) in one male high school in Seoul. Each student completed the Korean translation of composite scale (KtCS), Epworth sleepiness scale (ESS), Fatigue Severity Scale (FSS) and a questionnaire about their sleep schedule. RESULTS: The evening group had shorter weekday sleep time than the intermediate (p<0.001) or morning group (p=0.029). The evening group had more daytime napping (16.8%, p<0.001), high rate of caffeine use (58.8%, p<0.001) and snoring (18.5%, p=0.037). The evening group showed more daytime sleepiness (8.7, SD=3.2, p<0.001) and severe fatigue (4.4, SD=1.2, p<0.001) than the intermediate or morning group. CONCLUSION: Adolescents with eveningness have higher problems in weekday sleep, daytime sleepiness and fatigue. An intervention program for sleep problem in these adolescents should be considered.
Adolescent ; Caffeine ; Fatigue ; Humans ; Male ; Surveys and Questionnaires ; Snoring

OBJECTIVES: Individuals differ in their biological rhythms. This study investigated the association between the morningness-eveningness and sleep patterns, daytime sleepiness and fatigue in Korean male adolescents. METHODS: Participants were 501 eleventh grade male students (16.9+/-0.2 years of age) in one male high school in Seoul. Each student completed the Korean translation of composite scale (KtCS), Epworth sleepiness scale (ESS), Fatigue Severity Scale (FSS) and a questionnaire about their sleep schedule. RESULTS: The evening group had shorter weekday sleep time than the intermediate (p<0.001) or morning group (p=0.029). The evening group had more daytime napping (16.8%, p<0.001), high rate of caffeine use (58.8%, p<0.001) and snoring (18.5%, p=0.037). The evening group showed more daytime sleepiness (8.7, SD=3.2, p<0.001) and severe fatigue (4.4, SD=1.2, p<0.001) than the intermediate or morning group. CONCLUSION: Adolescents with eveningness have higher problems in weekday sleep, daytime sleepiness and fatigue. An intervention program for sleep problem in these adolescents should be considered.
Adolescent ; Caffeine ; Fatigue ; Humans ; Male ; Surveys and Questionnaires ; Snoring

OBJECTIVE: Atypical antipsychotic (AAP) treatment is associated with weight gain and metabolic disturbances such as dyslipidemia and dysglycemia. The metabolic disturbances are usually considered to develop secondary to weight gain. We performed the comparison of metabolic disturbances of three AAP group with different risk of metabolic side effect after adjusting for body mass to investigate whether any metabolic disturbances develop independently from body mass index (BMI). METHODS: This cross-sectional study included 174 subjects with schizophrenia who were on 1) monotherapy with clozapine (CL), olanzapine (OL), or quetiapine (QT) (n=61), 2) monotherapy with risperidone (RSP) (n=89), or 3) monotherapy with aripiprizole (ARP), or ziprasidone (ZPS) (n=24) more than 1 year. Association between the prevalence of metabolic disturbances and groups were analysed using logistic regression after adjusting confounding variables including BMI. Analysese of covariance were used to compare the AAP groups in terms of the levels of metabolic parameters. RESULTS: There were significant differences among groups in terms of the prevalence of hypertriglyceridemia (p=0.015), low HDL-cholesterol (p=0.017), and hyperglycemia (p=0.022) after adjusting for BMI. Triglyceride level (p=0.014) and the ratio of triglyceride to HDL-cholesterol (p=0.004) were significantly different among groups after adjusting for BMI. CONCLUSION: In conclusion, metabolic disturbances are significantly different in AAP groups even after adjusting BMI. AAPs may have direct effect on metabolic parameters. Blood lipid and glucose levels should be monitored regularly regardless of whether patients tend to gain weight.
Antipsychotic Agents* ; Body Mass Index ; Clozapine ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Dyslipidemias ; Glucose ; Humans ; Hyperglycemia ; Hypertriglyceridemia ; Logistic Models ; Prevalence ; Risperidone ; Schizophrenia* ; Triglycerides ; Weight Gain ; Quetiapine Fumarate

Clozapine use is associated with various adverse events, some of which have received little attention, including eosinophilia, pleural effusion, and hepatitis. Because of the fatality of jaundice with hepatitis, it is necessary to understand the course and management of clozapine-induced eosinophilia and hepatitis. We report on a case in which the eosinophil count began to increase shortly after clozapine use, and pleural effusion and fever then developed at the time eosinophilia was at its peak level. Jaundice with hepatitis consecutively developed when all the above symptoms subsided. The liver function recovered rapidly after clozapine was discontinued. We recommend that patients who develop rapid eosinophilia at the beginning of clozapine treatment should be monitored with LFTs, chest X-rays, and urine analysis tests.
Clozapine ; Eosinophilia ; Eosinophils ; Fever ; Hepatitis ; Humans ; Jaundice ; Liver ; Pleural Effusion ; Thorax

Objectives: Despite the high discontinuation rate of clozapine in refractory schizophrenia, there is limited evidence regarding the suggested treatment after clozapine discontinuation. Methods: The medical records of 37 patients who discontinued clozapine were retrospectively reviewed. The prescription patterns of antipsychotics, mood stabilizers, and antidepressants were compared at three points before and after clozapine treatment and at the most recent visit. Results: After clozapine discontinuation, 75.6% of the subjects were receiving antipsychotic polypharmacy, and 32.4% were taking more than 3 antipsychotics. The frequently used antipsychotics were olanzapine (21.5%), quetiapine (21.5%), and paliperidone (12.7%). The rates of augmentation with mood stabilizers and antidepressants were 43.2% and 29.7%, respectively. Furthermore, valproate was the most commonly used mood stabilizer (87.5%). Conclusion Antipsychotic polypharmacy and augmentation are inevitable in schizophrenia patients for whom clozapine has been discontinued. Further research is required to improve the outcomes of polypharmacy and augmentation in schizophrenia patients.

Objectives: Despite the high discontinuation rate of clozapine in refractory schizophrenia, there is limited evidence regarding the suggested treatment after clozapine discontinuation. Methods: The medical records of 37 patients who discontinued clozapine were retrospectively reviewed. The prescription patterns of antipsychotics, mood stabilizers, and antidepressants were compared at three points before and after clozapine treatment and at the most recent visit. Results: After clozapine discontinuation, 75.6% of the subjects were receiving antipsychotic polypharmacy, and 32.4% were taking more than 3 antipsychotics. The frequently used antipsychotics were olanzapine (21.5%), quetiapine (21.5%), and paliperidone (12.7%). The rates of augmentation with mood stabilizers and antidepressants were 43.2% and 29.7%, respectively. Furthermore, valproate was the most commonly used mood stabilizer (87.5%). Conclusion Antipsychotic polypharmacy and augmentation are inevitable in schizophrenia patients for whom clozapine has been discontinued. Further research is required to improve the outcomes of polypharmacy and augmentation in schizophrenia patients.

Cognitive behavioral therapy for psychosis (CBTp) is recommended by the National Treatment Guidelines in both the U.K. and the U.S. Consistent reports of moderate effect sizes have led to such interventions being suggested as part of routine clinical practice. However. Access to CBTp is poor due to a variety of factors, including training and resources. Therapeutic developments should be based on the theoretical understanding of cognitive models and psychological process associated with stress-vulnerability model. Cognitive models of psychosis incorporate the role of negative core beliefs, hypervigilance for threat, scanning for confirmatory evidence and safety behavior. The current evidence about CBTp is reviewed regarding various methods such as low-intensity of CBTp, different formats of therapy (e.g., individual or group), and phase of illness (e.g., acute or treatment-resistant) of subjects. This review suggests that that patients with psychosis with various disease phase need to be derived more benefit from appropriate adjunctive CBTp.

Objectives: The adherence to antipsychotics is essential for relapse prevention in schizophrenia. Although 40–60% of schizophrenia patients suffer from non-adherence problems, some patients had consistently good adherence. They are clinically desirable examples of non-adherent patients. This qualitative study aimed to explore the actors influencing medication adherence in people with schizophrenia with good adherence to the patients’ perspectives. Methods: In-depth semi-structured interviews were conducted with 23 subjects with schizophrenia. Narratives were elicited on the attitudes toward illness and treatment, familiar support for treatment, and perceived stigma about psychosis over time. Results: In the process of changing from non-adherence to adherence, symptomatic relapse, involuntary treatment, and familial support played leading roles. The patients’ experiences on their own made them accept the illness and necessity of medications. Once the patients accepted the need for treatments, side effects and social stigma did not influence their adherence. Reducing psychotic symptoms was the priority of the treatment effects on the patients’ perspectives. Conclusion Adherence in schizophrenia requires multiple factors that affect the attitude toward illness and medication over time. Therefore, it is necessary to understand the specific process of adherence and develop the relevant interventions to facilitate those processes over time.

No abstract available.
Dacarbazine* ; Gabexate*

OBJECTIVE: This study was intended to investigate whether maintenance dosage has been enough for patients with schizophrenia to prevent relapse by examining antipsychotic medication compliance and maintenance dosage during 6 months prior to the admission. METHODS: The study subjects were 552 patients with schizophrenia who were admitted to Asan Medical Center between March 2000 and August 2003. Of the 552, 142 patients' compliance of antipsychotic regimen and mean daily dosage was calculated by analyzing refill record for up to 6 months prior to the admission. The cumulative mean gap ratios (CMG: the number of days when medication was unavailable in relation to the total number of days) at 6 months were calculated. Improvement of CGI-severity score during the admission and mean daily dosage of antipsychotic regimen at the time of discharge was also investigated. RESULTS: Of the readmitted patients, 37.1% were totally non-compliant during 6 months prior to the admission. The CMG score of the patients who had been followed up over 6 months was 22.2%. Patients whose CMG score was less than 20 percent were 62.7 percent of the overall subjects. Their mean daily dosage of antipsychotics for 6 months prior to the admission was 265 mg/day CPZ-EQ, and the dosage of antipsychotics on discharge was 432 mg/day CPZ-EQ. After raising the dosage of antipsychotics, the CGI-S was improved by the average of -1.45. CONCLUSION: Despite the advancement of atypical antipsychotics, noncompliance to medication still remains a serious problem in relapse of schizophrenia. On the other hand, 62.7% of overall patients had experienced relapse of schizophrenia despite good compliance over 80 percent and maintenance dosage of 265 mg/day CPZ-EQ. Their symptoms could be relieved by raising the dosage of antipsychotics during the admission. Therefore, in those patients, the maintenance dosage of 265 mg/day CPZ-EQ was not enough to prevent relapse.
Antipsychotic Agents ; Chungcheongnam-do ; Compliance* ; Hand ; Humans ; Medication Adherence ; Recurrence ; Schizophrenia*