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A Case of Low dose Venlafaxine-Induced Hypertension.

Korean Journal of Psychopharmacology.2001;12(1):82-86.

Venlafaxine has a dose-dependant effect on blood pressure that is clinically significant at high dose. But the cases of hypertension associated with low dose venlafaxine have been rarely reported. We experienced a case of low dose venlafaxine-induced hypertension in a 53 year-old woman with major depressive disorder who has never been diagnosed as hypertension and other medical diseases. We started venlafaxine administration at a dose of 37.5 mg/day, and on the first day of venlafaxine administration, her blood pressure was abruptly elevated. Regardless of hypertension, venlafaxine was adjusted up to 112.5 mg/day for her depressive symptoms. Hypertension was continued, but not controlled by antihypertensive medication. We thought that she had a venlafaxine-induced hypertension, so we stopped this medication. Elevated blood pressure was normalized 2 days after stopping venlafaxine administration. Her blood pressure has been within normal range without antihypertensive medication for 9 months. So we report this case with the review of the literatures on the venlafaxine-induced hypertension.
Blood Pressure ; Depression ; Depressive Disorder, Major ; Female ; Humans ; Hypertension* ; Middle Aged ; Reference Values ; Venlafaxine Hydrochloride

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A Study about Clinical Effect and Safety of Risperidone in Schizophrenic Patients: FuturCare 99 Project.

Jung Woo SON

Korean Journal of Psychopharmacology.2001;12(1):71-81.

OBJECTIVE: This study was performed to investigate the clinical effect and safety of risperidone during the treatment of schizophrenia for 12 weeks. METHODS: In the FuturCare 99 Project which had been organized by JanssenKorea for the purpose of improving the quality of management of patients treated with risperidone, 714 schizophrenic patients from 32 institutes including general hospitals and private clinics were recruited. The clinical effects and extrapyramidal symptoms at 8-week and 12-week during the treatment with risperidone were evaluated using CGI, Modified Psychosis Symptom Evaluation and Extrapyramidal Symptom Legend. The associations between clinical responses and the sociodemographic and clinical informations were explored. RESULTS: Most of symptoms assessed by Modified Psychosis Symptom Evaluation and CGI were significantly improved at 8-week and 12-week trial of risperidone. And the extrapyramidal symptoms were on the decrease during the treatment with risperidone. Moreover, there was no difference in the dosage of risperidone between at 8 weeks (4.3+/-2.1 mg) and at 12 weeks (4.4+/-2.3 mg). When the patients were divided into 3 groups by the clinical responses of CGI at 12 week of risperidone treatment, clincal characteristics such as age, duration of illness, auditory hallucination, erotic delusion, lack of motivation, disorientation, and memory problem were significantly different among groups. CONCLUSION: his multicenter open study shows that risperidone has good clinical effect and safety in the treatment of schizophrenia with the daily average doses of 4.3-4.4 mg. The multicenter open study about the long-term treatment of risperidone in schizophrenia would be needed.
Academies and Institutes ; Delusions ; Hallucinations ; Hospitals, General ; Humans ; Memory ; Motivation ; Psychotic Disorders ; Risperidone* ; Schizophrenia ; Symptom Assessment

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Comparison of Risperidone Prescription Trend for Psychiatric Inpatients between University Hospital of Korea and USA.

Won Myong BAHK ; Chi Un PAE ; Kyoung Uk LEE ; Taeyoun JUN ; Kwang Soo KIM

Korean Journal of Psychopharmacology.2001;12(1):64-70.

OBJECTIVE: Recently, the domestic use of risperidone and the studies of risperidone administration in naturalistic setting have been increased. This retrospective naturalistic study was designed to evaluate the prescription trend and related variables in risperidone administered-psychiatric inpatients at a university hospital, and to compare with those of a university hospital in USA, simultaneously. METHODS: Data of 42 psychiatric inpatients with first administration of risperidone at St. Mary's Hospital from Oct 1999 to Mar 2000 and 61 of McLean Hospital, Harvard Medical School, USA from Mar 1998 to Jun 1998, were collected, respectively. Data on patient's age, sex, number of past admission, diagnosis distribution, duration of hospitalization, multiple antipsychotic therapy, combined psychotropics, initial, maximal, and discharge dosage of risperidone were analyzed and compared. RESULTS: In forty-two patients of St. Mary's hospital, 17 were male and 25 were female, among sixty-one patients of McLean hospital, 23 were male and 38 were female. The mean age and number of past admission were significantly higher at St. Mary's hospital than McLean hospital. In terms of diagnosis, risperidone was most widely prescribed to psychotic disorder, nextly to mood disorder and other psychiatric disorder at St. Mary's hospital, but in order of mood disorder, other psychiatric disorder, and psychotic disorder at McLean hospital, these diagnostic distribution was significantly different. The mean initial dose, maximal dose, and discharge dose of risperidone were significantly higher at St. Mary's hospital than McLean hospital. In aspects of psychotropic combination, these were significantly different, anxiolytic was most highly used at St. Mary's hospital but antidepressant at McLean hospital, additionally, the two hospital have tendency to take a polypharmacy. CONCLUSION: Prescription trend of risperidone in psychiatric inpatient between two hospital was different, St. Mary's hospital prescribed risperidone by diagnosis but McLean hospital did by symptomatic management. In furture, further systematic study should be conducted to refine these differences including various clinical variables.
Diagnosis ; Female ; Hospitalization ; Humans ; Inpatients* ; Korea* ; Male ; Mood Disorders ; Polypharmacy ; Prescriptions* ; Psychotic Disorders ; Retrospective Studies ; Risperidone* ; Schools, Medical

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Antidepressant Effect of Ethaverine.

Sang Kyeong LEE ; Sun Hee KIM ; Sung Woo PARK ; Sung Hwan YOON ; Seong Jin KIM ; Young Kwan KIM ; Yoo Hun SUH ; Kyong Tai KIM ; Young Hoon KIM

Korean Journal of Psychopharmacology.2001;12(1):49-63.

The effects of a L-type calcium channel blocker, ethaverine were investigated in the rat forced swimming test, after single and repeated administration. Ethaverine in doses of 20 mg/kg, 40 mg/kg after single and repeated administration reduced significantly the duration of immobility in the forced swimming test. Fluoxetine administered in a single dose of 40 mg/kg did not influence the duration of immobility, but fluoxetine in a dose of 40 mg/kg administered repeatedly reduced significantly the duration of immobility. Ethaverine in a dose of 10 mg/kg did not affect the immobility after single and repeated administration. Imipramine and fluoxetine in doses which were not effective by themselves, increased the immobilityreducing effect when administered concormitantly with ethaverine in a dose of 10 mg/kg. Imipramine in a dose of 20 mg/kg and fluoxetine in a dose of 80 mg/kg, administered alone reduced the immobility time. The reduction of immobility after the concormitant administration of ethaverine in a dose of 10 mg/kg and imipramine in a dose of 20 mg/kg, fluoxetine in a dose of 80 mg/kg was significantly greater than after imipramine or fluoxetine, administered alone. The anti-immobility effect of the ethaverine was significantly counteracted by haloperidol in a dose of 0.5 mg/kg. The effects of ethaverine on the levels of monoamines and their metabolites were also investigated in rat striatum, cerebral cortex, cerebellum, medulla oblongata, hypothalamus, midbrain, hippocampus. Treatment with ethaverine caused alterations on the levels of dopamine and its metabolite in rat striatum, cerebral cortex, hypothalamus, medulla oblongata, cerebellum, but not on the levels of norepinephrine and serotonin and its metabolite. The observed effects of ethaverine indicate that ethaverine may have an antidepressant activity and may interact with the brain dopaminergic system. The present results suggest that the concormitant administration of ethaverine and antidepressants may have a more potent therapeutic antidepressant effect and/or may permit reduction of the dose of antidepressant and thus diminish its side effects.
Animals ; Antidepressive Agents ; Brain ; Calcium Channels, L-Type ; Cerebellum ; Cerebral Cortex ; Dopamine ; Fluoxetine ; Haloperidol ; Hippocampus ; Hypothalamus ; Imipramine ; Medulla Oblongata ; Mesencephalon ; Norepinephrine ; Physical Exertion ; Rats ; Serotonin

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Association between Tardive Dyskinesia and Soft Neurological Signs.

Joo Cheol SHIM ; Moon Jung CHANG ; Sang Soo LEE ; Seoung Ju LEE ; Sang Kyeong LEE ; Young Kwan KIM ; Jung Woo SON ; Young Hoon KIM

Korean Journal of Psychopharmacology.2001;12(1):42-48.

OBJECTIVE: The goal of this study was to examine association between tardive dyskinesia and soft neurological signs in schizophrenic patients. METHODS: 35 schizophrenic inpatients who met the diagnostic criteria for tardive dyskinesia developed by Schooler and Kane and 30 schizophrenic inpatients without tardive dyskinesia were enrolled in this study. Tardive dyskinesia, soft neurological signs, and cognitive function were evaluated with Abnormal Involuntary Movement Scale (AIMS), Neurological Evaluation Scale (NES), and Mini-Mental State Examination (MMSE) independently by 2 psychiatrists, respectively. Data of the two schizophrenic groups were compared and also those of 31 normal controls. RESULTS: Total schizophrenics scored higher than normal controls in total mean scores of NES (p<0.01), and its three functional area scores, sensory integration (p<0.01), motor coordination (p<0.05), and sequencing of complex motor acts (p<0.05). Patients with tardive dyskinesia showed higher prevalence rates than those without in 5 items-left graphesthesia (p<0.05), right fist-ring test (p<0.05), right fist-edge-palm test (p<0.05), right synkinesis (p<0.05), and left synkinesis (p<0.05). The total scores of NES were not significantly related to the severity of tardive dyskinesia and cognitive dysfunction. CONCLUSION: Schizophrenics had more soft neurological signs than normal subjects. Five items of NES were more impaired in the patients with tardive dyskinesia than in those without tardive dyskinesia.
Dyskinesias ; Humans ; Inpatients ; Movement Disorders* ; Prevalence ; Psychiatry ; Schizophrenia ; Synkinesis

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Effects of Naltrexone on the Tyrosine Hydroxylase Expression in the Hypothalamic Areas in Rats with Chronic Ingestion of 5% Ethanol.

Gi Chul LEE ; Se Joong OH ; Jung Ho LEE ; Joo Ho CHUNG ; Hong Kyung JUNG ; Jun Myung HA ; Jae Hyun JEONG ; Dae Hwan LEE ; Doh Hyung KIM

Korean Journal of Psychopharmacology.2001;12(1):32-41.

OBJECTIVE: This study was designed to evaluate the effects of nonselective opioid antagonist naltrexone on the expression of tyrosine hydroxylase (TH) in variable areas of hypothalamus in rats with chronic ingestion of 5% ethanol using immunohistochemical measures. METHODS: To induce polydipsia with 5% ethanol, Spraque-Dawley rats were placed in automatic cage where a pellet dispenser automatically dispensed 90 mg pellets at fixed time 60 seconds (FT 60s) feeding schedule over 150-minute test session. After 4 weeks of daily exposure to the FT 60s feeding schedule, experimental rats were administered naltrexone (0.25 mg/kg, i.p), vehicle (1 cc/kg, i.p) for 3 weeks. After completing the 3 weeks of naltrexone and vehicle injections, the polydipsic rats were sacrificed. The brains were removed and postfixed in the same overnight fixation, then frozen sections of 40microM thickness were made in the coronal plane. Sections were stained for detection of tyrosine hydroxylase (H) according to the immunohistochemical method. RESULTS: 1) Both experimental animals with schedule-induced polydipsia (IP) and the bolus with 5% ethanol control showed significant increase in the amounts of 5% ethanol ingestion as compared with their baseline. The naltrexone treated group showed significant decrease in the amount of 5% ethanol ingestion at 2nd and 3rd week as compared with their baseline. Meanwhile, the vehicle control showed no changes in the amount of 5% ethanol ingestion for 3 weeks as compared with their baseline. 2) There was diffused and definite decreases in the TH immunoreactive cells in the bolus control with chronic ingestion of 5% ethanol. The SIP with water group showed marked increase in TH immunoreactive cells in the paraventricular nucleus and the periventricular hypothalamic nucleus. The SIP with 5% ethanol group showed definite decrease of TH immunoreactive cells in the paraventricular nucleus and the periventricular hypothalamic nucleus. The naltrexone treated group showed significant increase of TH immunoreactive cells in the paraventricular nucleus but no changes in the periventricular hypothalamic nucleus. CONCLUSION: These results suggest that the fixed time feeding procedure for schedule induced polydipsia as an animal model of alcoholism was not suitable. The author identified that naltrexone has suppressed the ingestion of ethanol. The chronic ingestion of 5% ethanol suppress the TH immunoreactive cells in the paraventricular nucleus and the periventricular hypothalamic nucleus. Naltrexone increases the TH immunoreactive cells which was suppressed by chronic ingestion of 5% ethanol in the paraventricular nucleus.
Alcoholism ; Animals ; Appointments and Schedules ; Brain ; Eating* ; Ethanol* ; Frozen Sections ; Hypothalamus ; Models, Animal ; Naltrexone* ; Paraventricular Hypothalamic Nucleus ; Polydipsia ; Rats* ; Tyrosine 3-Monooxygenase* ; Tyrosine* ; Water

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Using Atypical Antipsychotics in Patients with Dementia.

Seung Hyun KIM ; Sook Haeng JOE

Korean Journal of Psychopharmacology.2001;12(1):23-31.

BPSD (behavioral and psychological symptoms of dementia) are common remediable cause of excess morbidity and lead to significant impairment in quality of life for both patients and their caregivers, as well as an increased risk of institutionalization. The most common treatment of BPSD is neuroleptic medication. Compared to other agents, conventional neuroleptics have been studied with relatively rigorous placebo-controlled trials. Efficacy is modest, but concerns regarding side effects, such as extrapyramidal symptoms, tardive dyskinesia, and emotional withdrawal, have often limited their uses. Treatment of BPSD with atypical antipsychotics such as risperidone or olanzapine is potentially advantageous in view of their tendency to cause considerably fewer side effects. But elderly demented patients may be particularly sensitive to untoward side effects of psychotropic drugs. The different atypical antipsychotics do have their own side effects and other limitations. Clinicians who prescribe antipsychotics for BPSD should start with a low initial dose, increasing this dose slowly until the lowest effective dose is reached. It is important to remember that although antipsychotics provide symptomatic relief, they do not cure underlying dementia. Clinicians should try to avoid prescribing multiple drugs with anticholinergic or sedative effects. Further study to determine more specific drug-responsive symptoms is needed to maximize benefits of atypical antipsychotics.
Aged ; Antipsychotic Agents* ; Caregivers ; Dementia* ; Humans ; Hypnotics and Sedatives ; Institutionalization ; Movement Disorders ; Psychotropic Drugs ; Quality of Life ; Risperidone

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The Use of Atypical Antipsychotics in Bipolar Disorder.

Hyun Sang CHO ; Won Cheol SHIN

Korean Journal of Psychopharmacology.2001;12(1):15-22.

Atypical antipsychotics are the more effective and safer alternative to the common practice of maintenance adjunctive treatment as well as acute adjuvant treatment with traditional antipsychotics in patients with bipolar disorder. A few double-blind controlled studies of acute mania found olanzapine or ziprasidone monotherapy to be more effective than placebo, and the combination treatment of risperidone and mood stabilizer was also more effective than placebo. Furthermore, clozapine has antimanic and mood stabilizing effect for the treatment-refractory patients in acute manic and maintenance phase. Olanzapine and risperidone are reported that they have long-term mood stabilizing effect when they are used with mood stabilizers. At present, combination treatment of atypical antipsychotics and mood stabilizer is generally used. However, because each drug of such combinations causes sometimes bothersome and potentially dangerous events as well as their interactions, the consideration for their risk are needed.
Antipsychotic Agents* ; Bipolar Disorder* ; Clozapine ; Humans ; Risperidone

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Newer Atypical Antipsychotic Drugs.

Chang Yoon KIM

Korean Journal of Psychopharmacology.2001;12(1):3-14.

During the last decade, new era of antipychotic drugs has begun with the introduction of risperidone and olanzapine following clozapine. These atypical drugs are characterized by fewer extrapyramidal side effects and at least equal or superior clinical efficacy, although their effects on negative symptoms and refractory cases remain controversial. For these reasons, these atypical antipsychotic drugs are now recommended as a choice of first line treatments for schizophrenia and these new atypical drugs are replacing conventional antipsychotic drugs. These atypical drugs, however, are not same in terms of efficacy and side effects. Risperidone produces more frequent dose-dependent extrapyramidal symptoms and olanzapine causes significant weight gains more frequently compared to other atypical antipsychotic drugs. More recently, several newer atypical drugs are being released or will be available in the near future. Quetiapine and amisulpride are already being used in Europe and will be available soon in Korea. Quetiapine, even at high doses, has been reported to have placebo-level extrapyramidal side effects. It has been well tolerated in patients with parkinson's diseases who are particularly sensitive to extrapyramidal side effects. Amisulpride is known to have dual dopamine blockade effects. Ziprasidone, which had not been approved due to concerns about possible QTc prolongation, has been finally approved by FDA. Ziprasidone has been reported to cause little weight gain compared to other atypical drugs. Aripiprazole, data on which has been submitted to FDA for approval, has a unique mechanism of action as a dopamine partial agonist. Iloperidone is known to be under large-scale phase III clinical trial as a promising new antipsychotic drug. In this paper, these newer atypical antipsychotic drugs were reviewed with respect to efficacy and safety based on the data of clinical trials.
Antipsychotic Agents* ; Clozapine ; Dopamine ; Europe ; Humans ; Korea ; Risperidone ; Schizophrenia ; Weight Gain ; Aripiprazole ; Quetiapine Fumarate

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The Study for Switching Strategies from Previous Antipsychotics to Aripiprazole: A One-Year Naturalistic Study.

Tae Yeon SEO ; Min Hee KANG ; Jeong Seop LEE ; Jae Nam BAE ; Chul Eung KIM

Korean Journal of Psychopharmacology.2009;20(5):245-253.

OBJECTIVE: This study analyzed clinical courses to investigate the effectiveness of strategies switching to aripiprazole. METHODS: Patients confirmed DSM-IV diagnoses of schizophrenia who had been treated with aripiprazoleafter switching from previous antipsychotics were recruited from inpatient and outpatient departments of Inha Hospital from March 2005 to February 2007. We classified patients according to three switching strategies (crosstapering, abrupt-switching, tapering-switching) and, over the course of a one-year period, collected data for intervals during which medications were being switched. RESULTS: A total of 48 patients with an average age of 36.25+/-8.58 years participated in this study. The sample consisted of 20 patients in the cross-tapering group, 23 in the abrupt-switching group, and five in the tapering-switching group. The previous antipsychotics were risperidone, olazapine, amisulpride, quetiapine, and ziprasidone. The reasons for switching included weight gain (26.1%), hyperprolactinemia (23.9%), lack of effectiveness (20.8%), and over-sedation (13.0%). The rates at which patients continued aripiprazole after one year were 55% (11/20) for the cross-tapering group, 48.7% (11/23) for the abrupt-switching group, and 40% (2/5) for the tapering-switching group. In addition, 25% of cross-tapering patients (5/20), 43.5% of abrupt-switching patients (10/23), and 60% of tapering-switching patients (3/5) switched to other antipsychotics. Continuation of aripiprazole was higher in the cross-tapering group than in the abrupt switching group, but this difference did not reach statistical significance (p=0.351). The average aripiprazole retention duration was 10.75+/-3.29 months in the cross-tapering group, 10.39+/-3.29 months in the abrupt-switching group, and 10.00+/-4.77 months in the tapering-switching group. Cross-tapering was associated with a relatively longer retention period, but this difference did not reach statistical significance (p=0.653). CONCLUSION: All three switching strategies were associated with tolerable clinical outcomes after the shift to aripiprazole. The rate and duration of aripiprazole retention was higher in the cross-tapering group than in the abrupt switching group, but this result did not achieve statistical significance.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; Dibenzothiazepines ; Humans ; Hyperprolactinemia ; Inpatients ; Outpatients ; Piperazines ; Quinolones ; Retention (Psychology) ; Risperidone ; Schizophrenia ; Sulpiride ; Thiazoles ; Weight Gain ; Aripiprazole ; Quetiapine Fumarate

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