There have been 91 papers on risperidone in Korea, which were composed of 21 reviews, 9 preclinical studies, 18 case reports, and 43 clinical trials, since this new antipsychotic was introduced. Case reports focused mainly on adverse effects of risperidone, and clinical trials on it's efficacy and safety. Review of Korean clinical trials revealed the paucity of well designed controlled studies which examined the effective dose and compared the efficacy of risperidone with those of other drugs. Future research should adopt more reliable and standardized methods. The efficacy of risperidone for various clinical populations needs to be elucidated. Researchers need to make an effort to implicate the clinical use of risperidone. Long-term outcome studies are expected.
Korea* ; Outcome Assessment (Health Care) ; Risperidone*

The concept of bipolar spectrum disorder (BSD) has developed to include affective temperaments such as cyclothymia and hyperthymia. This has greatly helped clinicians to differentiate depressed patients, who would potentially benefit from mood stabilizing treatment, from those with unipolar depression. Cyclothymia, however, has significant similarities with personality disorders, especially with borderline personality disorder (BPD). All the diagnostic items for BPD are frequently found in patients with BSD as well, which presents diagnostic challenges. There are no clear guidelines on how to differentiate BSD from BPD. Featuring borderline pathology for clinical purposes, it may be useful to rely on psychodynamic approaches to identify primitive defense mechanisms of splitting and projective identification suggesting borderline personality organization. Based on new findings on common features between BSD and BPD, some authors have proposed a renewal of the classification system of mental disorders. The dichotomy of bipolar and unipolar depression has gestated a new concept of BSD. Currently, the BSD concept forced us to formulate the border of BSD and personality disorders.
Bipolar Disorder* ; Borderline Personality Disorder ; Classification ; Defense Mechanisms ; Depressive Disorder ; Humans ; Mental Disorders ; Pathology ; Personality Disorders* ; Temperament

Interstitial cell tumor of testis is relatively rare, comprising only 0.8 to 1.4 percent of all testicular tumors. A 67-year-old man was admitted to our hospital with rapid growing testicular mass. He had the experience of hydrocele and many times of aspiration since childhood. On physical examination, the testicular mass (left) was hard, adult fist sized and associated with transparent cystic fluid. Under the impression of testicular tumor, orchiectomy was performed. We report this case with review of literature.
Adult* ; Aged ; Humans ; Leydig Cell Tumor* ; Orchiectomy ; Physical Examination ; Testicular Neoplasms ; Testis*

There have been considerable advances in our understanding of the neurobiology and the treatment of obsessive-compulsive disorder (OCD). However, it seems that many patients with OCD are not met with proper treatment, and even the patients who receive sufficient therapy the response rate is not high. This paper reviews the pharmacological treatments of OCD with special focus on therapeutic options for treatment resistance cases. In treating a resistant case, the clinical characteristics including comorbid conditions of the patient should be reevaluated. Through until recently, there has been no standarized guideline to treat resistance cases and much is up to clinician's preference, but thoughtful selection and combination of drugs with optimized psychosocial approach may improve the response rate. We propose an integrative therapy model for treatment resistant OCD to emphasize the need for the expansion of treatment resources. Treatment resistant OCD deserves more clinical and socioeconomic attentions and needs further research for management.
Attention ; Drug Therapy* ; Humans ; Neurobiology ; Obsessive-Compulsive Disorder*

OBJECTIVES: The aim of this study was to investigate the influences of affect states and mood congruent/incongruent variables in psychosis-proneness. METHODS: Five hundred and two undergraduate students completed the SPQ and other scales. Psychosis-proneness was measured by Schizotypal Personality Questionnaire (SPQ), and affect states were measured by Positive Affect and Negative Affect Schedule (PANAS). Mood congruent variables were measured by Mood reactivity in Mood Survey and Affect Intensity Measure (AIM), and mood incongruent variables were measured by Trait Meta-Mood Scale (TMMS), Emotional Inhibition and Aggression Control in Emotional Control Questionnaire (ECQ). RESULTS: By hierachical regression analysis, total 39.1% of SPQ total score variance was explained by emotion related variables. In detail, negative and positive affect states explained 26% of variance, and affect intensity and mood reactivity of mood-congruent variables added 7.7% and mood aware, emotional inhibition & aggression control among mood-incongruent variables added 5.5%. And emotion related variables explained 43.8% of negative symptom, 27.6% of positive symptom and 23.6% of disorganization score. CONCLUSION: Negative affect was revealed as important factor for psychosis-proneness, and positive affect acted as the reversed role. Mood reactivity and affect intensity acted as mood congruent variables which amplified and reinforced the influence of negative affect on psychosis-proneness. Mood aware, repair and aggression control acted as mood incongruent variables which modulated and reduce the influence of negative affect, while mood attention and emotional inhibition acted as mood congruent variables in contrast with the prediction.
Aggression ; Appointments and Schedules ; Humans ; Surveys and Questionnaires ; Weights and Measures

Polypharmacy has recently become usual practice in the treatment of patients with mood disorders. In this article, we review the results of recent studies on metabolic drug interactions between anticonvulsants, atypical antipsychotics, and antidepressants. Important drug interactions in clinical practice may be summarized as follows. First, valproate may increase the serum level of carbamazepine and its active metabolite carbamazepine-epoxide, quetiapine, and lamotrigine. In particular, in combined regimens of lamotrigine and valproate, the dose of lamotrigine needs to be downwardly titrated, due to the potential risk of skin lesions. Second, there are numerous carbamazepine-associated interactions that need careful monitoring, because carbamazepine is a well-known inducer of CYP1A2, CYP2C9, and CYP2C19. Thus, in patients receiving carbamazepine, clinically significant decreases in serum levels may be found for drugs metabolized by these enzymes. Third, atypical antipsychotics are primarily metabolized by CYP2D6 and CYP3A4, thereby compromising the use of inhibitors of these enzymes. Fourth, most selective serotonin-reuptake inhibitors (SSRIs) are actually inhibitors of diverse enzyme systems, indicating at least potential problems with increased serum levels. While paroxetine, fluoxetine, and fluvoxamine strongly inhibit CYP enzymes, citalopram, venlafaxine, mirtazapine, and bupropion do so weakly. In conclusion, understanding drug-drug interactions is essential in planning individualized pharmacotherapy with diverse therapeutics. In treating patients with mood disorders, special concern should be paid to combination therapy using valproate, carbamazepine, and some SSRIs.
Anticonvulsants ; Antidepressive Agents ; Antipsychotic Agents ; Bupropion ; Carbamazepine ; Citalopram ; Cyclohexanols ; Cytochrome P-450 CYP1A2 ; Cytochrome P-450 CYP2D6 ; Dibenzothiazepines ; Drug Interactions ; Fluoxetine ; Fluvoxamine ; Humans ; Mianserin ; Mood Disorders ; Paroxetine ; Polypharmacy ; Skin ; Triazines ; Valproic Acid ; Quetiapine Fumarate ; Venlafaxine Hydrochloride

OBJECTIVE: The pharmacotherapy of bipolar disorder not otherwise specified (BP-NOS) has been insufficiently studied. The aim of this prospective naturalistic study was to explore the effectiveness of lamotrigine adjunctive treatment in patients with BP-NOS. METHODS: Data from 50 patients diagnosed with BP-NOS were analyzed. On the basis of the prospective mood chart methodology, the efficacy of lamotrigine adjunctive treatment was assessed by changes in the mean Clinical Global Impressions-Bipolar Version (CGI-BP) depression scores. A paired t-test was used to test the statistical significance of the changes in CGI-BP depression scores. Repeated-measures analysis of variance (RM ANOVA) with simple effect analysis was performed to explore the sequential changes during a 52-week period. Cohen's d was calculated to measure the magnitude of the treatment effects on the changes in depression severity. Time to lamotrigine discontinuation was also calculated using the Kaplan-Meier estimates. Lamotrigine-associated adverse events were monitored every two weeks. RESULTS: A significant decrease, with a large effect size (Cohen's d=1.6), in the mean CGI-BP depression scores was associated with lamotrigine adjunctive treatment in intent-to-treat analysis (t=8.7, df=49, p<0.001). Twenty-four patients (48.0%) completed 52-week lamotrigine adjunctive treatment. Analysis of the data obtained from those completing the treatment revealed a large effect (Cohen's d=4.0) on improvement in the severity of depression (t=16.8, df=32, p<0.001). Sixty percent of patients achieved remission (n=30), and 64% of patients (n=32) showed some clinical response to lamotrigine adjunctive treatment. The mean time to lamotrigine discontinuation was 31.3+/-3.1 weeks (CI=25.2-37.4). Lamotrigine adjunctive treatment was well tolerated, with no serious rashes reported. CONCLUSION: Lamotrigine seems to be effective in the management of depressive symptoms in BP-NOS. Long-term use of lamotrigine was generally safe and well tolerated. Large-scale controlled trials might be needed to confirm the findings of this naturalistic study.
Bipolar Disorder ; Depression ; Exanthema ; Humans ; Prospective Studies ; Triazines

OBJECTIVES: To investigate the pattern of subclinical hypothyroidism (SCH) in patients with bipolar disorders managed by lithium or valproic acid. METHODS: The study participants were 106 patients with DSM-IV bipolar disorders receiving planned maintenance treatment at the Mood Disorders Clinic of Seoul National University Bundang Hospital (aged between 17 and 64, mean duration of follow-up = 875.65 days). Using the bipolar disorder registry, thyroid function data were analyzed to assess the frequency of and the risk factors for SCH in patients managed by lithium (n = 64) or valproic acid (n = 42) for more than 5 months. RESULTS: Overall frequencies of SCH were 20.3% (13/64) in the lithium group, 14.3% (6/42) in the valproic acid group, and between the two groups there is no difference (p = 0.43). No differences were observed in the potential risk factors for SCH between the two groups including age, sex, subtype of bipolar disorder, baseline TSH, and concomitant antipsychotic use. In cases with SCH, thyroid-stimulating hormone (TSH) showed a tendency to increase at 3 month after the initiation of lithium or valproic acid. A gradual increase in the number of patients showing SCH was found within the first 3 years of medication. CONCLUSIONS: With regular monitoring and careful assessment, there was no difference in the risk of SCH between lithium and valproic acid maintenance. The risk of mood stabilizer-associated SCH may gradually increase within 3 years following the commencement of medication, thereby mandating close monitoring for the first 3 years of treatment. Further studies with large sample size would be needed to confirm these findings.
Bipolar Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Follow-Up Studies ; Humans ; Hypothyroidism* ; Lithium* ; Mood Disorders ; Risk Factors ; Sample Size ; Seoul ; Thyroid Gland ; Thyrotropin ; Valproic Acid*

Data from clinical studies are needed for psychiatrists to make quick and scientific decisions based on the best available evidence in clinical settings. Various methods of clinical studies are useful for clinicians to have reliable answers to unmet clinical needs. Although randomized controlled trials may provide high-quality information about major issues, well-designed, naturalistic and observational studies often give us unbiased explanation for real-world phenomena. Adequate selection of clinical variables and appropriate number of participants are key factors of well-designed clinical studies. Statistical methods can add an extra dimension to initial design of clinical studies. Given ethical issues in clinical studies on psychiatric disorders, special regards should be paid to participants' ability to provide informed consents. New strategies of clinical studies need to be developed to meet clinical needs and protect the rights and welfare of study participants.
Ethics, Research ; Human Rights ; Psychiatry

OBJECTIVES: This study is to investigate the hypothesis that schizophrenic patients have difficulty in inferring mental state of others. METHODS: Twenty schizophrenic patients and twenty normal subjects were administered to the Cartoon Task required inferring the character's intention in a given context. RESULTS: The schizophrenic patients showed a statistically significant impairment in the Cartoon Task. Both groups chose the card depicting a frequent everyday action significantly more rather than the similar card to the last picture in each story for wrong answers. CONCLUSION: These preliminary results suggest that schizophrenia is associated with a specific deficit of the cognitive ability referred to as social cognition, and this deficit can be detected not only in the acute phase as found in previous research studies, but also in remission. Also when subjects fail to appreciate what is going on in the minds of other people, they seem to rely on a socially familiar experience.
Cognition* ; Humans ; Intention ; Schizophrenia*