Objective: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Methods: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Results: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Conclusion Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Background: Biologics-experienced patients are more likely to show a lower response to biologics than that of biologic-naïve patients. However, no consensus on switching biologics exists. Objective: We aimed to investigate the switching patterns and efficacy of the switched biologics in patients with moderate-to-severe psoriasis in actual clinical practice. Methods: This multicenter retrospective study included 37 patients with a history of switching biologics. We analyzed the reasons for switching, the switching patterns, and psoriasis area and severity index (PASI) 75 response rates after switching biologics. We also analyzed the factors affecting the PASI75 response rate to the second biologic. Results: The reasons for switching baseline biologics were primary failure in five patients (13.5%), secondary failure in 28 patients (75.7%), and adverse events in four patients (10.8%). The second biologics prescribed mostly include interleukin (IL)-23 inhibitor in twenty-four patients (64.9%), IL-17 inhibitor in eight patients (21.6%), tumor necrosis factor-α inhibitor in three patients (8.1%), and IL-12/23 inhibitor in two patients (5.4%). A total of 46% of patients (17/37) switched biologics from IL-12/23 inhibitors to IL-23 inhibitors. The PASI75 response rates at the primary endpoint of the second and third biologics were 89.2% and 88.8%, respectively. Our study found that female sex and obesity were associated with the primary failure of the second biologic. Conclusion Secondary failure was the most common reason for switching baseline biologics. Korean dermatologists prefer different classes of biologics while switching. The PASI75 response rates at the primary endpoints of the second and third biologics were relatively satisfactory.

Objectives: ：This study aimed to compare the characteristics of suicide attempts among Korean patients with mixed and non-mixed depression. Methods: ：Patients who visited the emergency room due to a suicide attempt and participated in the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior study were included. Using the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS), 111 patients were classified into the mixed depression (n=46) and non-mixed depression groups (n=65). The Koukopoulos Mixed Depression Rating Scale (KMDRS) score was calculated using the MADRS and YMRS scores. Suicide attempt characteristics were evaluated using the Columbia Suicidal Severity Rating Scale (C-SSRS) and Suicide Intent Scale (SIS). Results: ：In the mixed depression group, the reason item among the ideation intensity score of the C-SSRS was higher, and the deterrent item score was lower. Scores on the timing and suicide note items of the SIS were higher, and scores for overt communication items were lower in the mixed depression group. The KMDRS score was positively correlated with the C-SSRS ideation intensity and total SIS score. After adjusting for additional variables,the KMDRS scores had a significant effect on the C-SSRS ideation intensity and total SIS scores. Conclusions ：The mixed depression group showed a difference in the intensity of suicidal ideation and suicidal intention compared to those in the non-mixed depression group. The overall suicidal ideation intensity and suicidal intention increased according to the degree of mixed depression.

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Objectives: ：We aimed to evaluate the relationship between disability self-awareness and insight in patients with schizophrenia. Methods: ：We enrolled 58 clinically stable patients with schizophrenia. The World Health Organization Disability Assessment Schedule (WHODAS) self-report was used to identify self-awareness of functional ability. The Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia Scale (CGI-SCH), and Personal and Social Performance Scale (PSP) were utilized to evaluate clinical symptoms and global function. Whereas Insight Scale for Psychosis (ISP) was applied for insight. Statistical analyses were performed using correlation and linear regression. Results: ：The WHODAS had a significant correlation with the general psychopathology subscale and total score of PANSS, CGI-SCH, and PSP. Moreover, ISP had a strong correlation with the overall WHODAS score and all domains. In the linear regression analysis, ISP had significant effects on the overall WHODAS score after adjusting for additional variables. Conclusion ：Disability self-awareness was significantly correlated with the level of insight in patients with schizophrenia. Clinicians need to consider patients’ insight during the discussion of functional ability.

OBJECTIVES: This study aimed to investigate the association between depression with atypical features and metabolic syndromes in Korean adults using the 2016 Korean National Health and Nutrition Examination Survey (KNHANES) data. METHODS: We used the 2016 KNHANES data to enroll 277 participants with a score of 10 or higher on Patient Health Questionnaire-9. Depression with atypical features was diagnosed when at least two of the following criteria were met : 1) sleeping more than 10 hours a day ; 2) weight gain of more than 3 kg in a year ; and 3) fatigue/anergia. Depression was divided into two groups based on the presence/absence of atypical features. Physical and mental health, and risk of metabolic syndrome were compared between the groups. RESULTS: Among the 277 participants, 91 had depression with atypical features. We identified significant differences in age, sex, income, and education between the two groups. After adjusting for these variables, depression with atypical features had lower EuroQol-5D index scores (p<0.001) and higher prevalence of metabolic syndromes (p=0.035) compared to the depression without atypical features. Depression with atypical features had higher odds ratio (OR) in association with metabolic syndromes after adjusting for confounding variables (OR=1.923 ; 95% confidence interval : 1.069–3.460). CONCLUSIONS Depression with atypical features increases the risk of metabolic syndromes and lowers the quality of life.

OBJECTIVES: According to the recent Korean National Police Agency report, rape victims were 17.1%, but sexual molestation victims were more than the rape victims by 78.0%. Despite many international reports about the occurrence of severe psychiatric symptoms in sexual molestation victims, there is no domestic research. Therefore in this study, we investigated psychiatric symptoms of sexual molestation victims, and we also compared it with psychiatric symptoms in rape victims. METHODS: 58 women who visited Busan Smile Center within 3months after sexual violence were the study subjects. Questionnaire about sociodemographic and sexual violence related characteristics were retrospectively investigated. Of the psychiatric symptoms, Beck Depression Inventory(BDI), Beck Anxiety Inventory(BAI) for severity of depression and anxiety, and Impact of Event Scale-Revised(IES-R) to check the presence of posttraumatic stress disorder(PTSD) symptoms were used. RESULTS: Of 58 sexual violence victims, sexual molestation victims were 36(62.1%) and rape victims were 22(37.9%). In sexual molestation victims, 80.6% had more than moderate severity of depression, 83.3% had more than moderate severity of anxiety, and 94.4% had significant scores at PTSD screening test. Compared with rape victims' psychiatric symptoms(each 95.5%, 95.5%, 95.5%) there were no significant difference. CONCLUSIONS: The majority of sexual molestation victims were also accompanied by depression, anxiety and PTSD symptoms as rape victims. There results suggest that appropriate assessment and early treatment for psychiatric symptom must be made in the early stage of injury in sexual molestation victims.
Adult* ; Anxiety ; Busan ; Depression ; Female* ; Humans ; Mass Screening ; Police ; Rape* ; Retrospective Studies ; Sex Offenses ; Stress Disorders, Post-Traumatic

Stress and trauma research has traditionally focused on negative sequelae of adversity. Recently, research has begun to focus on positive outcomes, specifically post-traumatic growth (PTG) - "positive change experienced as a result of the struggle with trauma" - which emphasizes the transformative potential of one's experiences with highly stressful events and circumstances. This article describes the concept of PTG at three different perspectives. In addition we reviewed the neurobiological factors and mechanism of PTG. It has shown that PTG is mediated by adaptive changes in several neural circuits involving numerous neurotransmitter and molecular pathways. Much more study is required to achieve a deeper understanding the biological and psychological underpinnings of PTG, as well as the interactions between these factors. After all, the clinical phenomenology of PTG is very important for mental growth after trauma. The findings of this article provide further directions for research and clinical implication of PTG.
Fertilization* ; Life Change Events ; Neurobiology* ; Neurotransmitter Agents

OBJECTIVE: This study was performed to analyze the clinical variables associated with occurrence of delirium tremens (DT) in inpatients with alcohol dependence initially admitted with diseases unrelated to alcohol. METHODS: This study included 132 inpatients seeking treatment for medical problem with acute alcohol withdrawal. The cases were divided into two groups : with DT group (n=44), without DT group (n=88). We compared the epidemiologic data, alcohol withdrawal symptoms and serum analysis data between two groups. We used the logistic regression to predict risk factors for DT. RESULTS: The DT group had more severe alcohol withdrawal symptoms, more amount of drinking alcohol, more number of drinking per month, higher blood urea nitrogen (BUN), creatinine, amylase, C-reactive protein and lower serum total protein than the without-DT group. According to the result of a logistic regression, occurrence of DT showed correlation with the following factors : sweating, hallucination, agitation, amount of alcohol consumption, number of drinking per month. CONCLUSION: Our study suggests development of DT was correlated with severe alcohol withdrawal symptoms, high BUN, creatinine and low total serum protein. Therefore, during assessment of alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent DT.
Alcohol Drinking ; Alcohol Withdrawal Delirium* ; Alcoholism* ; Amylases ; Blood Urea Nitrogen ; C-Reactive Protein ; Creatinine ; Dihydroergotamine ; Drinking ; Hallucinations ; Humans ; Inpatients ; Logistic Models ; Risk Factors ; Substance Withdrawal Syndrome* ; Sweat ; Sweating

Lichen planus pigmentosus (LPP) is a rare variant of lichen planus, and it is characterized by hyperpigmented, dark brown to violaceous colored macules or patches on the sun exposed areas of the skin. The term of LPP-inversus was proposed to describe some cases with LPP arising on the intertriginous areas. Clinically, LPP-inversus is characterized by well defined dark brown to violaceous macules or patches with minimal symptoms and it is predominantly confined on the flexural areas. The histological characteristics are a lichenoid inflammatory infiltrate on the upper dermis, melanophages and pigmentary incontinence. The clinical course can vary. We present here an additional case of LPP-inversus that developed on the both inguinal folds and we review the relevant literature.
Dermis ; Lichen Planus ; Lichens ; Skin ; Solar System