OBJECTIVE: The negative symptoms of schizophrenia usually are not responsive to drug therapy to persist and make schizophrenics more difficult in their rehabilitation. The authors investigated the therapeutic effect of token economy(TET) for negative symptoms of schizophrenic patients, and attempted to develop a TET program f3r psychiatric wards in general hospital. METHODS: Negative subscale of PANSS was rated for 35 schizophrenics with negative symptoms as their main problems before and after short-term TET(less than 3 months). Therapeutic factors were identified by comparing patient and program variables between the achieved and the non-achieved group of each level of target behaviors. RESULTS: 1) Subtotal of negative subscale of PANSS was decreased from 31.57+/-4.32 at baseline to 20.66+/-4.63 artier treatment. With TET, symptoms of difficulty in abstract thinking' and 'stereotypic thinking' were less responsive than the other 5 items of the scale Also the dose of antipsychotics prescribed was reduced to 291.21+/-287.74mg/day from 487.58+/-372.79mg/day. 2) The achievement rate of level I (self-help) was 75%, level II (ward-activity) 78%, and level III (social activity/occupation) 68%, resulting in average 74% for all target behaviors. 3) On level II, dose of antipsychotics was lower, and on level III, number of admission was lower and female sex was more frequent in achieving patient group than nonachieving group. The rate of achievement was higher in case of special flood, reception, and outing with family applied as a reinforcer on level I, and reception on level II . CONCLUSION: These results showed that TET was effective for schizophrenic patients with negative symptoms in psychiatric ward. Further investigations to refine the individual program of TET will be needed far enhancement of it s therapeutic efficacy and smart application of it.
Antipsychotic Agents ; Drug Therapy ; Female ; Hospitals, General ; Humans ; Rehabilitation ; Schizophrenia ; Token Economy*

BACKGROUND: Vitiligo is caused by the destruction of melanocytes, however the precise mechanism is still not known. Recently, abnormalities of both humoral and cell-mediated immunity have been documented in patients with this disorder, thus providing a theoretical basis for introducing tacrolimus ointment which works as an immunomodulator in the treatment of vitiligo. OBJECTIVE: This study was undertaken to examine the effects of tacrolimus on the survival rates of keratinocytes and melanocytes in vitiligo patients, as well as the melanization of melanocytes. METHODS: Keratinocytes and melanocytes from the normal skin of 4 vitiligo patients were cultured. They were then treated with various concentrations of tacrolimus (0.01, 0.1, 1, 10, 100micrometer) for 5 days. Thereafter, MTT (3-(4,5-cimethylthiazol-2-yl)-2,5-di-phenyl tetrazolium bromide) assay and melanin content analysis were performed. RESULTS: Tacrolimus showed no significant effect on the survival rates of keratinocytes. However, a mild proliferative effect on melanocytes was observed at 10micrometer concentration. On the other hand, marked cytotoxicity was observed at higher than 100micrometer concentration, and there was no effect under 1micrometer concentration. The melanin content of individual melanocytes were decreased in proportion to the concentration. CONCLUSION: These findings indicate that tacrolimus does not have a proliferative effect on keratinocytes and melanocytes in vitiligo patients, and has a tendency to decrease the melanin content in the melanocytes.
Hand ; Humans ; Immunity, Cellular ; Keratinocytes* ; Melanins ; Melanocytes* ; Skin ; Survival Rate ; Tacrolimus* ; Vitiligo*

Norwegian scabies can be defined as a generalized, severe scabies infestation which usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. We describe a patient with Norwegian scabies affecting the whole body. The patient had suffered with pemphigus foliaceus for several years and had an immunosuppressed status due to long-term use of oral corticosteroids. He was admitted to our hospital. At first, we made a diagnosis of exfoliative dermatitis secondary to pemphigus foliaceus. However, no improvement of the condition was seen after an increased dosage of oral corticosteroids, azathioprine, and mycophenolate mofetil. We then identified adult scabietic mites, eggs and scybala upon microscopic examination of skin scales. He was treated with an application of gamma benzene hexachloride cream. We recommend that the diagnosis of scabies be considered in immunocompromised patients with thick skin scales and associated night pruritus.
Adrenal Cortex Hormones ; Adult ; Azathioprine ; Dermatitis, Exfoliative ; Diagnosis ; Eggs ; Humans ; Immunocompromised Host ; Lindane ; Mites ; Ovum ; Pemphigus* ; Pruritus ; Scabies* ; Skin ; Weights and Measures