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Dermatitis Artefacta Mimicking Borderline Personality Disorder: Sometimes, Skin Could Be Misleading.

Seshadri Sekhar CHATTERJEE ; Sayantanava MITRA

Clinical Psychopharmacology and Neuroscience.2016;14(3):311-313. doi:10.9758/cpn.2016.14.3.311

Dermatitis artefacta lies in a gray zone, between the specialities of psychiatry and dermatology. The condition could mimic a number of other lesions and therefore is a source of much confusion in clinical practice. Here, we describe a case of dermatitis artefacta in an 11-years old girl, which resembled self-harming behavior in Borderline personality disorder. We then discuss how the two could be differentiated and why this becomes imperative while dealing with such cases.
Borderline Personality Disorder* ; Dermatitis* ; Dermatology ; Female ; Humans ; Self-Injurious Behavior ; Skin*

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Clinical Usefulness of Aripiprazole and Lamotrigine in Schizoaffective Presentation of Tuberous Sclerosis.

Seung Yup LEE ; Jung Ah MIN ; In Goo LEE ; Jung Jin KIM

Clinical Psychopharmacology and Neuroscience.2016;14(3):305-310. doi:10.9758/cpn.2016.14.3.305

Tuberous sclerosis is not as rare as once thought and has high psychiatric comorbidities. However, bipolar or psychotic features associated with tuberous sclerosis have been rarely reported. This report first presents a tuberous sclerosis patient, resembling a schizoaffective disorder of bipolar type. A patient with known tuberous sclerosis displayed mood fluctuation and psychotic features. Her symptoms did not remit along with several psychiatric medications. After hospitalization, the patient responded well with lamotrigine and aripiprazole without exacerbation. As demonstrated in this case, tuberous sclerosis may also encompass bipolar affective or psychotic features. We would like to point out the necessity to consider bipolarity in evaluating and treating tuberous sclerosis.
Aripiprazole* ; Comorbidity ; Hospitalization ; Humans ; Psychotic Disorders ; Tuberous Sclerosis*

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Psychosis, Treatment Emergent Extrapyramidal Events, and Subsequent Onset of Huntington's Disease: A Case Report and Review of the Literature.

Changqing XU ; Jegan YOGARATNAM ; Nigel TAN ; Kang SIM

Clinical Psychopharmacology and Neuroscience.2016;14(3):302-304. doi:10.9758/cpn.2016.14.3.302

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease characterized by a triad of progressive motor dysfunction, cognitive decline and psychiatric disturbances. The hallmark of HD is the distinctive choreiform movement disorder that typically has a subtle, insidious onset in the fourth to fifth decade of life and gradually worsens over 10 to 20 years until death. Notably, two-thirds of HD patients present with chorea and one third with mental changes. The prevalence of psychiatric symptoms is significantly higher than in the general population, and is estimated to be around 66–73%. Here, we report a unique case of subsequent onset of HD in a patient previously treated for schizophrenia and complicated by the extrapyramidal side effects to antipsychotics.
Antipsychotic Agents ; Chorea ; Humans ; Huntington Disease* ; Neurodegenerative Diseases ; Prevalence ; Psychotic Disorders* ; Schizophrenia

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Zolpidem Induced Sleep-related Eating and Complex Behaviors in a Patient with Obstructive Sleep Apnea and Restless Legs Syndrome.

Young Min PARK ; Hyun Woo SHIN

Clinical Psychopharmacology and Neuroscience.2016;14(3):299-301. doi:10.9758/cpn.2016.14.3.299

Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA.
Aged ; Amnesia, Anterograde ; Eating* ; Humans ; Iron ; Male ; Restless Legs Syndrome* ; Sleep Apnea, Obstructive*

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Opioid Analgesics and Depressive Symptoms in Burn Patients: What Is the Real Relationship?.

Narei HONG ; Myung Hun JUNG ; Jee Wook KIM ; Wook CHUN ; Ihn Geun CHOI ; Tae Cheon KANG ; Baik Seok KEE ; Boung Chul LEE

Clinical Psychopharmacology and Neuroscience.2016;14(3):295-298. doi:10.9758/cpn.2016.14.3.295

OBJECTIVE: Major burn injuries are strongly associated with both psychological trauma and severe pain, and opioids are the mainstay analgesics for the treatment of severe burn pain. The objectives of this study are to find the complex relationship between opioid dose, depression, and post-traumatic stress disorder (PTSD) symptoms during the acute management of pain in burn patients. METHODS: The symptoms of depression and PTSD were assessed in 43 burn patients immediately following wound stabilization and 2 weeks after the initial evaluation. RESULTS: Total opioid doses and Hamilton Depression Scale (HAMD) scores obtained during the second evaluation were positively but weakly correlated after controlling for age and total burn surface area (R=0.33, p=0.03). Moreover, pain management with opioids was significantly more common in burn patients with low Clinician Administered PTSD Scale scores (evaluation 1) and high HAMD scores (evaluation 2) (F=6.66, p=0.001). CONCLUSION: High opioid dose following acute burn trauma might have correlation with depressive symptoms. Monitoring of depressive symptoms may be important following acute burn trauma and consequent opioids pain management, particularly when PTSD symptoms appear minimal during the early stabilization of patients.
Analgesics ; Analgesics, Opioid* ; Burns* ; Depression* ; Humans ; Pain Management ; Psychological Trauma ; Stress Disorders, Post-Traumatic ; Wounds and Injuries

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A Questionnaire-based Study of the Views of Schizophrenia Patients and Psychiatric Healthcare Professionals in Japan about the Side Effects of Clozapine.

Ippei TAKEUCHI ; Manako HANYA ; Junji UNO ; Yuhei AMANO ; Keiko FUKAI ; Kiyoshi FUJITA ; Hiroyuki KAMEI

Clinical Psychopharmacology and Neuroscience.2016;14(3):286-294. doi:10.9758/cpn.2016.14.3.286

OBJECTIVE: It is well documented that clozapine treatment causes agranulocytosis, but it can also induce drowsiness, constipation, and hypersalivation; however, these symptoms are usually less severe. It has been reported that clozapine-treated patients with schizophrenia and psychiatric healthcare professionals consider different side effects to be important. The aim of this study was to assess current practice related to the side effects of clozapine in clozapine-treated patients with schizophrenia and psychiatric healthcare professionals in Japan. METHODS: Data were collected from January 2014 to August 2015 in Okehazama Hospital, Kakamigahara Hospital, and Numazu Chuo Hospital. Clozapine-treated patients with schizophrenia and psychiatric healthcare professionals (psychiatrists and pharmacists) were enrolled in this study. RESULTS: Of the 106 patients and 120 psychiatric healthcare professionals screened, 100 patients and 104 healthcare professionals were included in this study. We asked the patients what side effects caused them trouble and we asked psychiatric healthcare professionals what side effects caused them concern. The patients and psychiatrists held similarly positive views regarding the efficacy of clozapine. The healthcare professionals were concerned about agranulocytosis (92.4%), blood routines (61.3%). On the other hand, the patients experienced hypersalivation (76.0%), sleepiness (51.0%). A positive correlation (R=0.696) was found between patient satisfaction and DAI-10 score. CONCLUSION: Patients experienced more problems than healthcare professionals expected. However, usage experience of clozapine healthcare professionals tended to have similar results to patients. It is necessary that all healthcare professionals fully understand the efficacy and potential side effects of clozapine. This is very important for promoting clozapine treatment in Japan.
Agranulocytosis ; Clozapine* ; Constipation ; Delivery of Health Care* ; Hand ; Humans ; Japan* ; Patient Satisfaction ; Psychiatry ; Schizophrenia* ; Sialorrhea ; Sleep Stages

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Differential Effects of Olanzapine and Haloperidol on MK-801-induced Memory Impairment in Mice.

Jae Chun SONG ; Mi Kyoung SEO ; Sung Woo PARK ; Jung Goo LEE ; Young Hoon KIM

Clinical Psychopharmacology and Neuroscience.2016;14(3):279-285. doi:10.9758/cpn.2016.14.3.279

OBJECTIVE: We investigated the differential effects of the antipsychotic drugs olanzapine and haloperidol on MK-801-induced memory impairment and neurogenesis in mice. METHODS: MK-801 (0.1 mg/kg) was administered 20 minutes prior to behavioral testing over 9 days. Beginning on the sixth day of MK-801 treatment, either olanzapine (0.05 mg/kg) or haloperidol (0.05 mg/kg) was administered 40 minutes prior to MK-801 for the final 4 days. Spatial memory performance was measured using a Morris water maze (MWM) test for 9 days (four trials/day). Immunohistochemistry with bromodeoxyuridine (BrdU) was used to identify newborn cells labeled in tissue sections from the dentate gyrus of the hippocampus. RESULTS: MK-801 administration over 9 days significantly impaired memory performance in the MWM test compared to untreated controls (p<0.05) and these deficits were blocked by treatment with olanzapine (p<0.05) but not haloperidol. The administration of MK-801 also resulted in a decrease in the number of BrdU-labeled cells in the dentate gyrus (28.6%; p<0.01), which was prevented by treatment with olanzapine (p<0.05) but not haloperidol. CONCLUSION: These results suggest that olanzapine has a protective effect against cognitive impairments induced by MK-801 in mice via the stimulating effects of neurogenesis.
Animals ; Antipsychotic Agents ; Behavior Rating Scale ; Bromodeoxyuridine ; Cognition Disorders ; Dentate Gyrus ; Dizocilpine Maleate ; Haloperidol* ; Hippocampus ; Humans ; Immunohistochemistry ; Infant, Newborn ; Memory* ; Mice* ; Neurogenesis ; Spatial Memory ; Water

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Gender-specific Associations of the Brain-derived Neurotrophic Factor Val66Met Polymorphism with Neurocognitive and Clinical Features in Schizophrenia.

Sung Wan KIM ; Ju Yeon LEE ; Hee Ju KANG ; Seon Young KIM ; Kyung Yeol BAE ; Jae Min KIM ; Il Seon SHIN ; Jin Sang YOON

Clinical Psychopharmacology and Neuroscience.2016;14(3):270-278. doi:10.9758/cpn.2016.14.3.270

OBJECTIVE: To explore associations of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism with cognitive functioning and psychopathology in patients with schizophrenia. METHODS: We included 133 subjects meeting the DSM-IV criteria for schizophrenia who were in the post-acute stage of the disease. BDNF Val66Met genotypes were identified via polymerase chain reaction. The computerized neurocognitive function battery, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Scale (SOFAS), and the Subjective Well-being under Neuroleptic Treatment (SWN-K) were administered. Gender-stratified sub-analysis was also conducted to identify gender-specific patterns in the findings. RESULTS: In male patients, no significant difference in any measure by BDNF genotype was evident. In female patients, scores on the CDSS and total PANSS and all subscales were significantly higher in valine (Val) carriers. In addition, scores on the SOFAS and SWN-K were significantly lower in Val carriers. In terms of neurocognitive measures, female patients with the Val allele had significantly poorer reaction times and fewer correct responses on the Continuous Performance Test (CPT) and the Trail Making Test (Parts A and B). After adjustment of PANSS total scores and log-transformed CDSS scores, CPT outcomes were significantly poorer in female patients with than in those without the Val allele. CONCLUSION: Gender-specific associations of the Val allele with poor neurocognitive function and more severe psychopathology were evident. Further studies are required to explore the mechanisms of these differences and the potential utility of the BDNF genotype as a predictor of outcome in patients with schizophrenia.
Alleles ; Brain-Derived Neurotrophic Factor* ; Cognition ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Genotype ; Humans ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Psychopathology ; Reaction Time ; Schizophrenia* ; Trail Making Test ; Valine

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Efficacy and Tolerability of Paliperidone Extended-release in the Treatment of First-episode Psychosis: An Eight-week, Open-label, Multicenter Trial.

Nam In KANG ; Bon Hoon KOO ; Sung Wan KIM ; Jong Hoon KIM ; Beomwoo NAM ; Bong Ju LEE ; Sang Hyuk LEE ; Seung Jae LEE ; Seung Hwan LEE ; Myung Hun JUNG ; Sang Woo HAHN ; Young Chul CHUNG

Clinical Psychopharmacology and Neuroscience.2016;14(3):261-269. doi:10.9758/cpn.2016.14.3.261

OBJECTIVE: We investigated the efficacy and tolerability of paliperidone extended-release (ER) tablets in patients with first-episode psychosis (n=75). METHODS: This was an 8-week, open-label, multicenter trial. The primary outcome variable was scores on the Positive and Negative Syndrome Scale (PANSS); secondary measures included the Scale for the Assessment of Negative Symptoms (SANS), the Cognitive Assessment Interview (CAI), and the Global Assessment of Functioning (GAF). To assess safety, we measured drug-related adverse events, weight, lipid-related variables, and prolactin and administered the Simpson–Angus Rating Scale (SARS), the Abnormal Involuntary Movement Scale (AIMS), the Barnes Akathisia Scale (BAS), the Arizona Sexual Experiences Scale (ASEX), and the Udvalg for Kliniske Undersogelser side effect rating scale (UKU). RESULTS: The administration of paliperidone ER resulted in significant improvement in the PANSS, SANS, CAI, and GAF scores (p<0.001) over time. This improvement was evident as early as 1 week. The most frequent adverse events were akathisia, somnolence, anxiety, and sedation, which were well tolerated. Modest increases in weight and lipid profiles were also noted. Prolactin levels were substantially increased at the endpoint in both male and female patients. CONCLUSION: These results indicate that paliperidone ER is effective and is characterized by good tolerability in the treatment of positive and negative symptoms and cognitive functioning in first-episode psychosis.
Abnormal Involuntary Movement Scale ; Anxiety ; Arizona ; Female ; Humans ; Male ; Multicenter Studies as Topic* ; Paliperidone Palmitate* ; Prolactin ; Psychomotor Agitation ; Psychotic Disorders* ; Tablets

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Investigation of Dysregulation of Several MicroRNAs in Peripheral Blood of Schizophrenia Patients.

Mehmet Akif CAMKURT ; Fatih KARABABA ; Mehmet Emin ERDAL ; Hüseyin BAYAZIT ; Sultan Basmacı KANDEMIR ; Mustafa Ertan AY ; Hasan KANDEMIR ; Ozlem Izci AY ; Erdinç ÇIÇEK ; Salih SELEK ; Bahar TAŞDELEN

Clinical Psychopharmacology and Neuroscience.2016;14(3):256-260. doi:10.9758/cpn.2016.14.3.256

OBJECTIVE: The prevalence of schizophrenia is 1%, and it is a debilitating disorder that often results in a shortened lifespan. Peripheral blood samples are good candidates to investigate because they can be easily drawn, and they are widely studied in psychiatric disorders. MicroRNAs are small non-coding RNA transcripts. They regulate the expression of genes by binding to the 3'-untranslated region (UTR) of mRNAs and pointing them to degrade. In this study, we aimed to investigate the expression of miR-9-5p, miR-29a-3p, miR-106-5p, miR-106b-5p, miR-107, miR-125a-3p, and miR-125b-3p in schizophrenia patients and healthy controls. METHODS: We collected blood samples from 16 patients with schizophrenia and 16 healthy controls. MicroRNAs were measured with reverse transcriptase polymerase chain reaction. RESULTS: Schizophrenia patients showed statistically significant upregulation of five microRNAs: miR9-5p (p=0.002), miR29a-3p (p<0.001), miR106b-5p (p=0.002), miR125a-3p (p<0.001), and miR125b-3p (p=0.018). CONCLUSION: Our results increased the value of the miR106 and miR29 families as potentially and consistently dysregulated in psychiatric disorders. Our results should be considered preliminary, and they need confirmation in future studies with larger sample sizes.
Humans ; MicroRNAs* ; Prevalence ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; RNA, Small Untranslated ; Sample Size ; Schizophrenia* ; Up-Regulation

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