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Korean Medication Algorithm for Bipolar Disorder(I).

Won Myong BAHK ; Young Chul SHIN ; Duk In JON ; Bo Hyun YOON ; Dai Jin KIM ; Yong Min AHN ; Jun Soo KWON ; Kyung Joon MIN

Korean Journal of Psychopharmacology.2002;13(3):205-221.

OBJECTIVE: Treating patients with bipolar disorder has many problems such as recurrent various episodes, breakthroughs, treatment resistance, switching and worsening of its course. In addition to these obstacles, recent developments of psychiatric medications make it difficult to choose the appropriate pharmacological options. This study was performed to survey the expert opinion of medication treatment for bipolar disorder. METHODS: The survey questionnaire used in 'The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000' was translated in Korean and amended by executive committee according to Korean situations. Forty eight of 50 (96%) members of review committee completed the survey. RESULTS: In acute manic episode lithium or divalproex is a first-line drug as a monotherapy, and combination treatment is considered in partial or non-responder. Carbamazepine is also a first-line drug in dysphoric and mixed episodes. For moderate and more severe depression, an antidepressant is added with a mood stabilizer. For psychotic bipolar disorder, mania or depression, both atypical antipsychotics and high potency typical antipsychotics are preferred, but the latter is less likely to be recommended. A mood stabilizer should be used in rapid cycling bipolar illness. For manic episode in rapid cycler a mood stabilizer and an atypical antipsychotic drug are recommended in combination as an initial treatment. CONCLUSION: Most experts present strong consensus for many options concerning to initial strategies and first-line medications, although there are some non-consensus and gaps between research data and clinical usage in some steps. Nevertheless these data might be a cornerstone for producing the Korean medication algorithm for bipolar disorder.
Advisory Committees ; Antipsychotic Agents ; Bipolar Disorder ; Carbamazepine ; Consensus ; Depression ; Expert Testimony ; Humans ; Lithium ; Questionnaires ; Valproic Acid

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The Characteristics of Executive Dysfunctions and Changes after Mehylphenidate Treatment in ADHD Children.

Wan Seok SEO ; Seung Deuk CHEUNG ; Jong Bum LEE ; Jin Sung KIM ; Hyoung Uk YOUM ; Dae Seok BAI ; Hyung Bae PARK

Korean Journal of Psychopharmacology.2002;13(3):194-204.

The characteristics and changes after methylphenidate treatment of executive functions were conducted. Forty elementary school children, over 85 in intelligence quotient, were selected as experimental group. They are diagnosed to have Attention Deficit Hyperactivity Disorder (ADHD). 40 normal control group were also selected. For comparing of executive functions, ADHD subjects were tested executive functions before and 4 weeks after methylphenidate. Normal control group were also tested. Several behavioral checklists were used, and Kaufman Assessment Battery for Children, Conners Continuous Performance Test, Stop Signal Task, Trail-Making Test (patr B), and Maze test were used. The executive functions and intelligence of ADHD were generally lower than normal control group. On CPT, ADHD showed significantly lower performances in commissions, hit reaction time standard errors, variability of standard errors, and attentiveness. On SST, ADHD presented significantly lower performance in probability of inhibit, stop signal reaction time, Z Score of relative finishing time, Mean delay time on each block, and primary standard deviation. On WCST, ADHD had meaningfully lower performance in total corrects, total errors, nonperseverative errors, completed category, and trials to 1st category completed. After medication, intelligence was not changed, but simultaneous processing ability was improved significantly. And the behavioral problems were improved, but still had differences comparing to control. Commission of Conners' CPT, all aspects of SST and total corrects of WCST were improved.
Attention Deficit Disorder with Hyperactivity ; Checklist ; Child* ; Executive Function ; Humans ; Intelligence ; Methylphenidate ; Reaction Time

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The Predictive Factors of Treatment Effects in Children with Attention Deficit Hyperactivity Disorder.

Jong Bum LEE ; Hyung Mo SUNG ; Seung Deuk CHEUNG ; Jin Sung KIM ; Wan Seok SEO ; Dai Seg BAI ; Eun Jung JUNG ; Hyung Bae PARK

Korean Journal of Psychopharmacology.2002;13(3):170-193.

This study examined 60 children with ADHD through K-ABC, ADDES-HV, ADD-H comprehensive teacher's rating scale (ACTeRS), CAP, SNAP, Academic Performance rating scale, K-PIC, CPT and WCST in order to estimate the effects of methylphenidate, and find out various factors which can influence on treatment responses and predictive factors of treatment. Boys showed better improvement in impulsiveness of behavior symptoms than girls, but girls showed better improvement in trials to completed the first category in WCST. In the aspect of age, the lower graders (age 7-9) showed improvement in sequential processing ability of intelligence but the higher graders (age 10-12) showed deterioration. In the aspect of sub-categories of ADHD, children with mixed type who had been worse in attention deficit and behavior symptoms in pretreatment state, showed significantly higher improvement than children with predominantly inattentive type in every scopes of behavior symptom check list. And in clusters of K-PIC, after treatments the group those who had have more anxiety or depression showed better improvement in omission error in CPT. In the aspect of intelligence level, children with average intelligence showed better improvement in impulsiveness and impulse control than the rests. In the aspect of executive functions, the less omission errors in CPT one made, the better improvement in attention and academic ability he showed. And the less perseverative response in WCST one had, the better improvement in hyperactivity he showed however his simultaneous processing abilities were deteriorated. With these results, this study confirms that methylphenidate is effective in behavior symptoms, academic performance, intelligence and various performance abilities of children with ADHD including attention and response control. In the cases of the children with severe ADHD symptoms, especially behavioral disinhibition and the children with mixed type of ADHD, it is considered useful to predict the results of treatments.
Anxiety ; Attention Deficit Disorder with Hyperactivity* ; Child* ; Depression ; Executive Function ; Female ; Humans ; Intelligence ; Methylphenidate

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Clinical Characteristics of Patients with Major Depressive Disoder Who Had Terminate Mirtazapine Treatment Prematurely.

Dong Won SHIN

Korean Journal of Psychopharmacology.2002;13(3):163-169.

OBJECTIVE: The purpose of this study was to find the clinical characteristics of patients who had prematurely terminated mirtazapine treatment for their major depressive disorders in natural clinical settings, and the effect of sedation on the premature termination of treatment. METHODS: Patients who had been diagnosed with major depressive disorder by DSM-IV and administered mirtazapine at least one time were included in this study. Charts reviews were done for patients who had visited out patients clinic in Sungkyunkwan University Kangbuk Samsung hospital since March 1st 2000 to December 31st 2001. Baseline depression,, anxiety, initial, middle, and terminal insomnia, and suicidality were assessed with 17-item Hamilton Rating Scale for Depression (HAMD). After 8 weeks of treatment, patients were divided into maintained group and terminated group, and also patients group with sedation and without sedation. Age, initial dosage, duration of treatment, dosage of combined drug, baseline depression, anxiety, sleep characteristics, and suicidality were compared between these two groups. RESULTS: Terminated group had higher score compared to maintained group in middle insomnia before medication (t= -3.225, p<0.01). Patients with sedation were younger (t=2.321, p<0.05), and had shorter period of treatment than patients without sedation (t=2.717, p<0.01) significantly. CONCLUSION: In natural clinical setting, depressive patients who terminated mirtazapine treatment had had more difficulty in maintaining sleep. Sedation was reported by younger patients, and related with premature terminiation of mirtazapine treatment.
Anxiety ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Outpatients ; Sleep Initiation and Maintenance Disorders

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The Effect of Antidepressant Treatment on Beta-Adrenergic Receptor Responsiveness in Patients with Major Depression.

Hye Kyung BAEK ; Eui Jung KIM ; Bum Hee YU

Korean Journal of Psychopharmacology.2002;13(3):154-162.

Many studies have reported reduced beta-adrenergic receptor responsiveness in major depression, but there were few studies to see the effect of antidepressant treatment on beta-adrenergic receptor function in depressed patients. This study examined beta-adrenergic receptor responsiveness in patients with major depression before and after antidepressant treatment. After careful psychiatric interviews by two experienced psychiatrists, twenty depressed patients (Hamilton Depression Rating Scale scores>18) were randomly assigned to 8 weeks of double-blind treatment with either milnacipran or sertraline. Twenty normal control subjects who had no previous history of major medical and psychiatric illness were matched with the patients considering age, sex and body mass index. The Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A) were performed to assess clinical change of depression in the patients before and after treatment. We measured the lymphocyte cyclic AMP ratio (ratio of isoproterenol-stimulated cAMP/ basal cAMP), beta-adrenergic receptor density (Bmax) and receptor affinity (Kd) in all subjects. Depressed patients showed much lower HAM-D scores (25.7+/-4.8 vs. 14.3+/-9.1, p=0.002), MADRS scores (34.3+/-5.7 vs. 21.5+/-13.1, p=0.005) and HAM-A scores (31.4+/-7.9 vs. 22.1+/-13.5, p=0.040) after 8 weeks of antidepressant treatment than those before treatment. There were statistically significant differences in the means of Bmax and Kd between control subjects and patients before treatment. Contrary to our expectation, there was no statistically significant difference in the means of cAMP ratio between the two groups. Lymphocyte Bmax (4.90+/-3.08 vs. 8.13+/-3.08, p=0.027) and Kd (63.61+/-6.52 vs. 70.89+/-9.40, p=0.029) in the patients increased after antidepressant treatment. This result suggests that antidepressant treatment increases beta-adrenergic receptor responsiveness in depressed patients.
Anxiety ; Body Mass Index ; Cyclic AMP ; Depression* ; Humans ; Lymphocytes ; Psychiatry ; Sertraline

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Neutropenia in Psychiatric Out-Patients.

Hyeun Chul BAIK ; Doh Joon YOON ; Hwi Joong YOON ; Geon Ho BAHN

Korean Journal of Psychopharmacology.2002;13(3):148-153.

OBJECT: The study was performed to examine the psychotrophic drugs used in psychiatric out-patients in which neutropenia developed and current state of consultation and to confirm the importance of complete blood count and differential count (CBC/DC). SUBJECTS AND METHODS: The subjects were 60 patients of our university hospital in which neutropenia developed in out-patient department (OPD) of psychiatry during recent three years. The absolute neutrophil counts of patient were below 2,000/mm3. RESULTS: The reasons why exam was performed were mainly to follow-up exam during medications. Mood stabilizers such as carbamazepine, phenytoin, sodium valproate were identified to cause neutropenia in the group using multiple drugs, and clozapine was highly related in the group using single drug. But many kinds of drugs were related with neutropenia. We have not checked well enough the CBC/DC and have not consulted well to hematologist in OPD of neuropsychiatry. CONCLUSIONS: It is important to find neutropenia in the psychiatric out-patients using psychotropic drugs. We had better check CBC/DC routinely and consult to hematologist.
Blood Cell Count ; Carbamazepine ; Clozapine ; Follow-Up Studies ; Humans ; Neuropsychiatry ; Neutropenia* ; Neutrophils ; Outpatients* ; Phenytoin ; Psychotropic Drugs ; Valproic Acid

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Tailored Pharmacotherapy of Psychotropic Drugs.

In Won CHUNG ; Kyu Young LEE

Korean Journal of Psychopharmacology.2002;13(3):141-147.

The pharmacotherapeutic responses such as clinical efficacy and adverse events exhibit wide variabilities in individuals and even in different races and populations. The human genetic diversity has been known as the one of the main factors in the variations of drug responses expressed in the area of pharmacokinetics and pharmacodynamics. Polygenetic implications have been suggested in the pathophysiology of psychiatric disorders. The risks in psychiatric disorders could be explored by combining the polymorphisms of multiple candidate genes. This suggests that drug therapy should be tailored to the genetic make-up of the individual. The emerging field of pharmacogenomics could be a landmark for the development of more effective clinical efficacy and less adverse events by individually tailored drugs.
Continental Population Groups ; Drug Therapy* ; Genetic Variation ; Humans ; Pharmacogenetics ; Pharmacokinetics ; Psychotropic Drugs*

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A Case of Restless Leg Syndrome Induced by Bupropion in a Patient with Bipolar Disorder.

Won KIM ; Hoo Rim SONG ; Young Sup WOO ; Won Myong BAHK

Korean Journal of Psychopharmacology.2005;16(3):240-244.

A 35 year-old female patient with bipolar disorder, single manic episode in remission, were being followed up in the outpatient clinic regularly. Since she complained of depressive symtpoms, bupropion SR of 150 mg was adminstered. On 3 days after administration of bupropion SR, she complained of creeping and crawling sensation on both legs which was aggravated at night and attenuated with movement. She also had a difficulty in falling a sleep becuase of the discomfort of both legs and the urge to move. We observed these symptoms during 1 week, but her discomfort was not improved at all. Therefore we considered her symptoms as restless leg syndrome (RLS) induced by bupropion SR, and started clonazepam of 0.5 mg for the control of her discomfort on 10 days after bupropion SR administration. On the day after addition of clonazepam, her discomfort of both leg began to subside. Many cases of SSRI-induced RLS have been reported and these were explained by the dopamine hypoactivity related with stimulation of serotonin system. But, RLS induced by bupropion in this case cannot be explained by that hypothesis, so which suggested that more than one neurotransmitter system involves the pathogenesis of RLS. On our knowledge, this is the first one reporting RLS induced by bupropion.
Adult ; Ambulatory Care Facilities ; Bipolar Disorder* ; Bupropion* ; Clonazepam ; Dopamine ; Female ; Humans ; Leg ; Neurotransmitter Agents ; Restless Legs Syndrome* ; Sensation ; Serotonin

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Fever Associated with Clozapine Administration: Incidence, Clinical Characteristics, and Related Factors.

Hee Jung NAM ; Hyun Ok JEON ; Se Chang YOON ; Dongsoo LEE ; Kyung Sue HONG

Korean Journal of Psychopharmacology.2005;16(3):234-239.

OBJECTIVE: This study aims at investigating the incidence, clinical nature and associated clinical characteristics of the clozapine-induced fever. METHODS: Retrospective review of hospital records was performed for 56 inpatients who had started to take clozapine and stayed at the hospital for four or more weeks after the initiation of clozapine treatment. RESULTS AND CONCLUSION: Clozapine-induced fever was developed in 31% of the patients. The mean peak temperature was 39degrees C and the mean duration of the fever was 3 days. Fever was developed average of 11 days after the initiation of clozapine treatment. All the patients were recovered without discontinuation of clozapine. Demographic variables, the clinical response to clozapine, other drugs administered with clozapine, and the presence of other adverse effects of clozapine were not associated with the clozapine-induced fever.
Clozapine* ; Fever* ; Hospital Records ; Humans ; Incidence* ; Inpatients ; Retrospective Studies ; Schizophrenia

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Feasibility of Korean Medication Algorithm for Bipolar Disorder(I): Global Assessment.

Chan Hyung KIM ; Kyung Joon MIN ; Young Chul SHIN ; Bo Hyun YUN ; Hyun Sang CHO ; Duk In JON ; Young Kee KIM ; Jun Soo KWON ; Won Myong BAHK

Korean Journal of Psychopharmacology.2005;16(3):225-233.

OBJECTIVE: The Korean College of Neuro psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) in clinical settings in Korea. METHODS: A total of 126 bipolar patients were enrolled at 17 centers. Among them, 92 patients were treated according to the algorithm. All subjects were assessed over a 4-month period. Prescribing investigators were able to change the recommended treatment strategies of the algorithm if necessary. RESULTS: Overall ratings were favorable, with investigators stating that the overall quality of this algorithm was "good" or "no need to revise". Of manic patients, the majority (79%) showed treatment response (YMRS improvement > or =50%) at the first stage. CONCLUSION: These results suggest that this algorithm can be useful in clinical practices. However, some problems should be solved in the next version of KMAP-BP.
Bipolar Disorder ; Humans ; Korea ; Psychopharmacology ; Research Personnel ; Schizophrenia

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