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Use of Risperidone in a Patient with Psychotic Disorder due to Complex Partial Seizure: A Case Report .

Jeong Ho CHAE ; Tae Suk KIM ; Won Myong BAHK ; Kwang Soo KIM

Korean Journal of Psychopharmacology.1998;9(1):98-103.

A new atypical antipsychotics, risperidone has been shown to be an effective drug in the treatment of schizophrenia and other psychotic disorders. We present a case report of successful treatment in a psychotic patient with complex partial seizure. A case history, of 26-year-old women in whom psychotic symptoms due to temporal lobe epilepsy was successfully treated with risperidone and anticonvulsants, is presented. A prospective clinical trial of risperidone with a randomized controlled design in patients with epileptic psychosis is warranted.
Adult ; Anticonvulsants ; Antipsychotic Agents ; Epilepsy, Temporal Lobe ; Female ; Humans ; Psychotic Disorders* ; Risperidone* ; Schizophrenia ; Seizures*

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Granulocyte-Colony Stimulating Factor(G-CSF) Treatment of Clozapine-induced Agranulocytosis.

Chuleung KIM ; Sangeun SHIN

Korean Journal of Psychopharmacology.1998;9(1):91-97.

After 31 weeks of treatment with clozapine, severe agranulocytosis was diagnosed in a 35-year-old male schizophrenic patient. The patient was treated sucessfully with a granulocyte colony-stimulating factor (G-CSF). The leukocyte court was 300/mm(3) on admission. After 10 days treatment with G-CSF, the hematological status normalized. Despite its clinical advantages, the use of clozapine has been limited by a propensity to induce agranulocytosis in 1-2% of the patients who are treated with this compound. In addition to case report, authors reviewed the indications for clozapine treatment and the present knowledge base regarding the incidence, monitoring and management of agranulocytosis. Unfortunately, clozapine-induced agranulocytosis cannot be prevented, so regular blood examination and education for patient and family member are very important and early treatment with G-CSF seems warranted in severe cases of clozapine-induced agranulocytosis.
Adult ; Agranulocytosis* ; Clozapine ; Education ; Granulocyte Colony-Stimulating Factor ; Humans ; Incidence ; Knowledge Bases ; Leukocytes ; Male

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Smoking Status in Psychiatric Inpatients.

Yoosun MOON ; Do Hoon KIM ; Byung Hoon OH ; Hee Sang LEE ; Kee NAMKOONG ; Kye Joon YOO

Korean Journal of Psychopharmacology.1998;9(1):82-90.

OBJECTIVES: There is a trend to make health care facitilities smoke-free because of the overwhelming data associating tobacco smoking and passive smoking with serious health risks except closed psychiatric units. this study was designed to estimate the feasibility of smoking bans on psychiatric inpatient units as a pilot study by assessing smoking incidence, nicotine addiction score and smoking patterns of the psychiatric inpatients. METHODS: The psychiatric inpatients admitted to one mental hospital from June 1 to June 30, 1994 answered to the questionnaires including Fagerstroms Tolerance Questionnaire (8 items) and modified smoking motives questionnaires (21 items). Also the medical records of the patients were examined for sociodemographic data and diagnosis. RESULTS: The smoking incidence of the psychiatric inpatients was 72.7%. After admission to the closed unit, 42.7% of the patients increased the amount of smoking. The mean Fagerstrom Tolerance Questionnaire was 4.89+/-2.38, which was less than nicotine addiction score. Many patients smoked for relief of their stresses. CONCLUSION: There is a need to set a smoke-free or smoke-control psychiatric unit. These data indicate that smoking can be stopped on inpatient psychiatry units if the patients' stresses could be well controlled by some methods other than smoking.
Delivery of Health Care ; Diagnosis ; Hospitals, Psychiatric ; Humans ; Incidence ; Inpatients* ; Medical Records ; Nicotine ; Pilot Projects ; Surveys and Questionnaires ; Smoke* ; Smoking* ; Tobacco Smoke Pollution

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Efficacy of Bethanechol in Antipsychotics Induced Anticholinergic Side Effects.

Hyeong Seob KIM ; Un Tae YEO ; So Hee KIM ; Sook Haeng JOE

Korean Journal of Psychopharmacology.1998;9(1):73-81.

OBJECTIVES: This study was designed to evaluate bethanechol's efficacy in urinary difficulty, constipation, dry mouth and blurred vision and to evaluate the bethanechol's effect on psychopathology. METHODS: Thirty-two schizophrenic patients who have been treated with antipsychotics and the total score of anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5 were assigned to three group(controlled group, bethanechol 30 mg/day group, 60 mg/day group). These patients were entered on 6 weeks open trial. Anticholinergic side effects were assessed by 'Rating scale for side effect' and psychopathology by BPRS at base, 2nd week & 4th week. After 4weeks administration of bethanechol, 30 mg/day group was increase to 60 mg/day and 60 mg/day group was decreased to 30 mg/day for 2 weeks for evaluation of dose difference. And then anticholinergic side effects were reassessed at 6th week. RESULTS: There were significant correlations between blurred vision and age. There were no significant improvement of anticholinergic side effect in placebo group but significant improvement of urinary difficulty and dry mouth in 30 mg/day group and significant improvement of urinary difficulty, constipation and dry mouth in 60 mg/day group at 4th week evaluation. In the case dose up(bethanechol 30 mg/day to 60 mg/day) for 2 weeks, dry mouth was more improved. In the case of dose down (60 mg/day to 30 mg/day), the improvements of urinary difficulty and dry mouth were sustained but constipation was aggravated. There were no BPRS changes by bethanechol administration. CONCLUSION: These findings suggest that more than 30 mg/day of bethanechol made improvements in urinary difficulty, constipation, dry mouth, when the total score of Anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5, although 60 mg/day of bethanechol was more effective than 30 mg/day. Moreover bethanechol administration does not influence psychopathology.
Antipsychotic Agents* ; Bethanechol* ; Constipation ; Humans ; Mouth ; Psychopathology

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Nonlinear Dynamic Analysis Using Lyapunov Exponent of EEG in Patients with Schizophrenia.

Dai Jin KIM ; Chi Un PAE ; Jaeseung JEONG ; Jeong Ho CHAE ; Soo Yong KIM ; Hyo Jin GO ; In Ho PAIK

Korean Journal of Psychopharmacology.1998;9(1):67-72.

OBJECT: It seemed worthwhile to estimate nonlinear measures of the electroencephalogram (EEG) in schizophrenic patients, because nonlinear measures might serve as indicators of the specific brain function in schizophrenia. METHOD: Previous studies which estimated the chaoticity in the brain of schizophrenia with nonlinear methods recorded the EEGs at limited electrodes, so we tried to record EEGs from 16 channels for nonlinear analysis in 19 patients with Schizophrenia and 8 healthy control subjects. We employed a new method to calculate the nonlinear invariant measures. For limited noisy data, this algorithm was strikingly faster and more accurate than previous ones. RESULTS: Our results showed that the schizophrenic patients had lower values of the largest positive Lyapunov exponent at the left inferior frontal and anterior temporal head regions compared with normal controls. CONCLUSIONS: These results suggest that the nonlinear analysis of the EEGs such as the estimation of the largest positive Lyapunov exponent seems to be a useful tool in analyzing EEG data to explore the neurodynamics of the brain of schizophrenic patients.
Brain ; Electrodes ; Electroencephalography* ; Head ; Humans ; Nonlinear Dynamics* ; Schizophrenia*

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Changes of Functional Connectivity of the Hippocampus in Ketamine-induced Schizophrenic Rat Model.

Maan Gee LEE

Korean Journal of Psychopharmacology.1998;9(1):58-66.

It has been proposed that the schizophrenic symptoms may be emerged from the dysfunctional connection and abnormal glutamate neurotransmission between prefrontal and temporolimbic cortex. Thus, we examined the functional connectivity between entorhinal cortex-hippocampus in the schizophrenic animal model induced by the NMDA receptor channel blocker, ketamine. Under ketamine+xylazine anesthesia, the electrodes for recording and stimulating were implanted into the hippocampus of the male rat. Recording of EEG and EP was started 3 or more days after operation in 3 different behavioral states (normal mobile and immobile, and ketamine-injected). Each hippocampal area had a characteristic EP. While it did not produce changes on the normal EPs, ketamine produced greater changes on the normal EEG : prominant theta in normal mobile state ; fast and irregular wave accompanying with 1-2 Hz spikes in normal immobile states and ; fAst and irregular rhythm with spindles of 2.5 Hz and 30 Hz which were prominant on DG and CA3 in ketamine-injected state. Log scale of spectrum showed that ketamine increased the power of 6-8 Hz band on CA1 radiatum and of the band over 25 Hz on DG. Also ketamine disrupted the correlated electrical activity among several hippocampal areas. These results may suggest that the symptom of schizophrenics is emerged from reduction of correlated activity but increase of irregular activity over the cortical area and uncontrolled input which is mediated by NMDA receptor.
Anesthesia ; Animals ; Electrodes ; Electroencephalography ; Glutamic Acid ; Hippocampus* ; Humans ; Ketamine ; Male ; Models, Animal* ; N-Methylaspartate ; Rats* ; Schizophrenia ; Synaptic Transmission

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A Case of Hypertension Recurred by Venlafaxine Administration.

Won Myong BAHK ; Chi Un PAE ; Young Min LEE ; Tae Youn JUN ; Kwang Soo KIM

Korean Journal of Psychopharmacology.2000;11(2):188-192.

Authors report a case of hypertension associated with venlafaxine administration. A 52 years-old male patient with bipolar I disorder was hospitalized due to recently developed depressive symptoms. According to his past medical history, he had essential hypertension, which had been well controlled by intermittent antihypertensive therapy. He had no antihypertensive therapy for the last 3 years but maintained normal blood pressure. We started venlafaxine administration for his depressive symptoms and, after 9 days of venlafaxine administration, his blood pressure was abruptly elevated with nausea and headache at a dosage of 112.5mg/day. On 12th hospital day, this medication was adjusted up to 150mg/day. He showed no response to some conventional antihypertensive medications which had been effective for him. We thought that he had a hypertension associated with venlafaxine administration and decided to discontinue this medication. All the symptoms of elevated blood pressure, nausea and headache rapidly improved 4 days after stopping venlafaxine administration. It is necessary to assess blood pressure regularly in patients especially with past history of hypertension who take venlafaxine because of it's potential adverse effect of blood pressure increment. We recommend that dosage reduction or treatment discontinuation should be considered instantly when serious treatment-emergent hypertension with administration of venlafaxine developed.
Blood Pressure ; Depression ; Headache ; Humans ; Hypertension* ; Male ; Middle Aged ; Nausea ; Venlafaxine Hydrochloride

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Augmentation of Regional Cerebral Blood Flow Response by Repeated Administration of Methamphetamine in Rat.

Woo Seong JANG ; Jeong Gee KIM ; Ji Do PARK ; Hyun Kyoung CHOI ; Hee Sun CHUNG ; Soo Yeon KO ; Won Suk LEE

Korean Journal of Psychopharmacology.2000;11(2):178-187.

OBJECTIVES: It was aimed to observe the regional cerebral blood flow (rCBF) response on methamphetamine challenge test in rats which were subjected to repeated administration of methamphetamine, and to investigate the mechanism(s) of changes in rCBF response in relation to the dopaminergic receptors and cyclic AMP. METHODS: Male Sprague-Dawley rats received daily injections of methamphetamine (0.3 mg/kg, i.p.) for 10 days, and were then allowed a 4-day drug-free period. Naive and methamphetamine-pretreated rats were challenged with topical application of methamphetamine on the surface of parietal cortex through a cranial window. The changes in rCBF were measured by laser-Doppler flowmetry. RESULTS: Acute topical application of methamphetamine dose-dependently increased rCBF with little effect on mean arterial blood pressure. The methamphetamine-induced increases in rCBF were significantly blocked by SCH23390, a D1-like receptor antagonist, but not by sulpiride, a D2-like receptor antagonist. Repeated administration of methamphetamine induced progressive augmentation of rCBF in response to the challenge of methamphetamine. Repeated administration of methamphetamine in combination with SKF38393, a D1-like receptor agonist, as well as with SCH23390 significantly attenuated the development of augmentation of rCBF response to methamphetamine. The augmentation of rCBF response was markedly inhibited by pretreatment with 2',3'-dideoxyadenosine, a specific adenylyl cyclase inhibitor, and Rp-cAMPS, a protein kinase A inhibitor, respectively. CONCLUSION: Based on these results, it is suggested that repeated administration of methamphetamine induces an augmentation of rCBF in response to the challenge of methamphetamine, and that D1-like receptor-mediated cyclic AMP plays a critical role in the development of augmentation of methamphetamine-induced rCBF response.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine ; Adenylyl Cyclases ; Animals ; Arterial Pressure ; Cyclic AMP ; Cyclic AMP-Dependent Protein Kinases ; Dideoxyadenosine ; Humans ; Laser-Doppler Flowmetry ; Male ; Methamphetamine* ; Rabeprazole ; Rats* ; Rats, Sprague-Dawley ; Sulpiride

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Autonomic Nervous System Related Adverse Effects Developed during Clozapine Treatment.

Sun Ju CHUNG ; Yong Min AHN ; Ung Gu KANG ; Young Jin KOO ; Jee Hyun HA ; Sun Wook KIM ; Yong Sik KIM

Korean Journal of Psychopharmacology.2000;11(2):168-177.

OBJECTIVE: The purpose of this study is to investigate the prevalence and course of autonomic nervous system related adverse effects (ARAEs) reported in patients treated with clozapine. METHOD: Ninety-one patients treated with clozapine were recruited from the Seoul National University Hospital Treatment-Resistant Schizophrenia Clinic. Medical records were reviewed for the prevalence and course of 14 ARAEs related to clozapine treatment. ARAEs with the prevalence greater than 10 % were selected and analyzed for their relationship with the demographic variables of the subjects and for the distribution of the duration of treatment and daily dosage of clozapine. RESULTS: Eighty-one(97.8%) patients experienced at least one ARAE during treatment with clozapine. The most frequent ARAE was hypersalivation, followed by constipation, tachycardia, orthostatic hypotension, nausea, diaphoresis, frequency, enuresis, vomiting, blurred vision, dry mouth, diarrhea, incontinence and urinary retention. None of the 7 selected frequent ARAEs had significant relationship with the age or sex of the subjects. Most of them developed within 8 weeks of clozapine treatment and at the dose of clozapine under 200mg/day. Among the total 248 events of ARAEs, 35 events required additional medications to alleviate the symptoms, 8 required other medical interventions, and 3 required reduction of clozapine dose. There was no case which necessitated withdrawal of clozapine therapy. CONCLUSION: The findings from this study suggest that almost all patients treated with clozapine experienced one or more ARAEs. Most of them occurred during the initial phase of treatment and managed without further medical treatment.
Autonomic Nervous System* ; Clozapine* ; Constipation ; Diarrhea ; Enuresis ; Humans ; Hypotension, Orthostatic ; Medical Records ; Mouth ; Nausea ; Prevalence ; Schizophrenia ; Seoul ; Sialorrhea ; Tachycardia ; Urinary Retention ; Vomiting

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Effect of Melatonin Administration on the Immobilization Stress-induced Polyamine Responses in Brain and Gastrointestinal Tract.

Young Woo KANG ; Seong Ryong LEE

Korean Journal of Psychopharmacology.2000;11(2):160-167.

OBJECTIVE: The present study was designed to identify the acute and chronic immobilization stress-induced polyamine (putrescine) responses and their modulation by administration of melatonin in brain regions (frontal cortex and hippocampus) and gastrointestinal tract regions (GIT, gastric mucosa and duodenal mucosa). METHOD: For immobilization stress (3 or 14 days), rats (250-300 g, male Sprague-Dawley rats) were placed in restrainers once daily, for 3 h. Melatonin (10 mg/kg, i.p.) was administered once daily immediately after stress. Rats were sacrificed 2 h after the final application of stress for the measurement of putrescine levels. RESULTS: The putrescine levels of frontal cortex, hippocampus, gastric mucosa and duodenal mucosa were significantly increased by acute stress (p<0.05, p<0.05, p<0.0005 and p<0.01, respectively). The putrescine levels of frontal cortex and duodenal mucosa were significantly increased by chronic stress (p<0.05, respectively). In chronic stress group, animals showed adaptation tendency. The changes of putrescine level in gastric and duodenal mucosa induced by chronic stress were significantly lower than those by acute stress (p<0.05, respectively). The putrescine responses to acute stress in frontal cortex, hippocampus, gastric mucosa and duodenal mucosa were attenuated by administration of melatonin (p<0.01, p<0.05, p<0.05 and p<0.05, respectively). The putrescine response to chronic stress in frontal cortex was attenuated by melatonin administration (p<0.05, respectively). CONCLUSION: The results suggested that putrescine may play a role in stress response of brain regions (frontal cortex and hippocampus) and GIT regions (gastric and duodenal mucosa). Melatonin can inhibit the stress-induced putrescine responses in the brain and GIT.
Animals ; Brain* ; Gastric Mucosa ; Gastrointestinal Tract* ; Hippocampus ; Humans ; Immobilization* ; Male ; Melatonin* ; Mucous Membrane ; Putrescine ; Rats ; Rats, Sprague-Dawley

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