Objectives: Aripiprazole is an antipsychotic that functions as a partial agonist in hypodopaminergic states and a dopamine antagonist in hyperdopaminergic states. Methods: This paper reports a series of five clinical cases of worsening psychotic symptoms in schizophrenic patients related to the initiation of aripiprazole, oral and injection, as combination therapy. Results: In all five cases, the switching of aripiprazole improved the psychotic symptoms. Conclusion Even with the suggestive relationship between aripiprazole therapy and the worsening of psychotic symptoms, further research is needed.

BACKGROUND: There has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimer's disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area. METHODS: A total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence. RESULTS: The incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia. CONCLUSION: Upon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.
Adult ; Alzheimer Disease ; Cognition ; Cohort Studies ; Dementia ; Diagnosis ; Humans ; Incidence ; Korea ; Life Style ; Mild Cognitive Impairment ; Prevalence ; Risk Factors

BACKGROUND/AIMS: Although a low triiodothyronine (T3) state is closely associated with heart failure (HF), it is uncertain whether total T3 levels on admission is correlated with the clinical outcomes of acute myocardial infarction (AMI). The aim of this study is to investigate the prognostic value of total T3 levels for major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with AMI undergone percutaneous coronary intervention (PCI). METHODS: A total of 765 PCI-treated AMI patients (65.4 ± 12.6 years old, 215 women) between January 2012 and July 2014 were included and 1-year MACCEs were analyzed. We assessed the correlation of total T3 and free thyroxine (fT4) with prevalence of 1-year MACCEs and the predictive values of total T3, fT4, and the ratio of total T3 to fT4 (T3/fT4), especially for HF requiring re-hospitalization. RESULTS: Thirty patients (3.9%) were re-hospitalized within 12 months to control HF symptoms. Total T3 levels were lower in the HF group than in the non-HF group (84.32 ± 21.04 ng/dL vs. 101.20 ± 20.30 ng/dL, p < 0.001). Receiver operating characteristic curve analysis showed the cut-offs of total T3 levels (≤ 85 ng/dL) and T3/fT4 (≤ 60) for HF (area under curve [AUC] = 0.734, p < 0.001; AUC = 0.774, p < 0.001, respectively). In multivariate analysis, lower T3/fT4 was an independent predictor for 1-year HF in PCI-treated AMI patients (odds ratio, 1.035; 95% confidential interval, 1.007 to 1.064; p = 0.015). CONCLUSIONS: Lower levels of total T3 were well correlated with 1-year HF in PCI-treated AMI patients. The T3/fT4 levels can be an additional marker to predict HF.
Area Under Curve ; Heart Failure* ; Heart* ; Humans ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prevalence ; Prognosis ; ROC Curve ; Thyroxine* ; Triiodothyronine*

OBJECTIVE: This study aims to reveal the relationship of depression with growth factors such as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and insulin-like growth factor-1 (IGF-1) in inpatients diagnosed with alcohol dependence, and to identify candidate growth factors as biological markers to indicate the comorbid of alcohol dependence and depression. METHODS: This study examined demographic factors in 45 alcohol-dependent patients. The ADS (Korean version of the Alcohol Dependence Scale) and BDI (Korean version of Beck's Depression Inventory) were used. BDNF, NGF, and IGF-1 were measured through ELISA. RESULTS: The average drinking quantity and the ADS score were significantly more severe in alcohol-dependent patients with depression than in those without depression. Linearly comparing BDNF, NGF, and IGF-1 with BDI values, IGF-1 was the growth factor significantly correlated with BDI scores. BDI scores were significantly correlated with ADS scores. IGF-1 was significantly higher in alcohol-dependent patients with depression. Alcohol-dependent patients with depression had greater alcohol use and more severe ADS scores. BDNF and NGF showed no significant difference between alcohol-dependent patients with and without depression, but IGF-1 was significantly higher in those with than in those without depression. CONCLUSION: IGF-1 was found to be associated with depression in alcohol-dependent patients, suggesting that IGF-1 in alcohol-dependent patients could be an important biomarker to indicate whether alcohol-dependence is accompanied by depression.
Alcoholism ; Biomarkers ; Brain-Derived Neurotrophic Factor ; Demography ; Depression* ; Drinking ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inpatients ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Nerve Growth Factor

OBJECTIVES: The aims of this study were to examine the relationship between obesity and psychopathology of inpatients with schizophrenia. METHODS: Eighty four inpatients with schizophrenia and 81 control subjects were recruited. Height and weight were measured for calculation of body mass index (BMI). Symptom severity scales [Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale] and Global Assessment of Functioning Scale (GAF) were conducted in all patients. Comorbid medical conditions, years of education, smoking status, age of onset, duration of illness, and medication history were collected. RESULTS: Patients with schizophrenia had significantly higher BMI and ratio of obesity than control subjects. Among patients, obese patients scored lower on symptom severity scales and better on functional assessment than not obese patients. Multiple regression analysis revealed an association of late onset and being obese with lower PANSS total score and better GAF score in patients. Late onset and being female were inversely related with negative symptom score. The type and dose of antipsychotics showed no association with obesity. CONCLUSION: The results of this study indicate that patients with schizophrenia are likely to be more obese. Some characteristics of patients with less severe psychopathology, such as late onset, being obese, were coincident with the result of previous studies. In addition, the result showing that the heavier the weight of patients, the lower severity of symptoms was repeatedly reported in previous studies. The type and dose of antipsychotics were not associated with obesity. These results prompt further investigation of the relationship among schizophrenia, antipsychotics, and weight gain.
Age of Onset ; Antipsychotic Agents ; Body Mass Index ; Education ; Female ; Humans ; Inpatients* ; Obesity* ; Psychopathology* ; Schizophrenia* ; Smoke ; Smoking ; Weight Gain ; Weights and Measures

OBJECTIVE: The aim of this study was to examine 1) public knowledge and perceptions about attention-deficit hyperactivity disorder (ADHD) and 2) factors influencing the public's decisions to adhere to ADHD pharmacotherapy. METHODS: In this study, 396 participants responded to the internet survey regarding their experiences, beliefs and treatment preferences about ADHD. RESULTS: 252 respondents (63.6%) were reluctant to pharmacological treatment of ADHD. The respondents chose the functional impairment of the brain as the main cause of ADHD were favorable to pharmacological treatment and scored significantly high on the ADHD Knowledge Questionnaire. On the other hand, the respondents who regarded ADHD as an overly active personality rather than a disease were skeptical to pharmacotherapy and scored significantly low. The respondents who were acquainted with someone who had been diagnosed with ADHD perceived themselves relatively well informed about ADHD. However, the subjective perception of the degree of knowledge of ADHD was not correlated with the objective score of the ADHD Knowledge Questionnaire. CONCLUSION: The public is not well informed about ADHD and its treatments. Culturally appropriate psychoeducational strategies based on the media and the internet are needed. Providing biomedical conceptualization of ADHD to the public may aid with treatment decisions and promote adherence to pharmacological treatment.
Brain ; Drug Therapy ; Hand ; Internet ; Surveys and Questionnaires

Informed consent is the procedure that respects the autonomy of patients ; doctors protect patients' choices and rights through informed consent. Competence and voluntariness are prerequisite for the informed consent. In recent years, the necessity of informed consent from the Psychiatric department has been raised. Regarding informed consent from the Psychiatric department, there is a need to consider from two perspectives : respect for the patient's decision-making ability and the psychiatrist's legal self-protection. In competence and voluntariness, psychiatric patients were excluded due to lack of decision-making ability and willingness. However, not all psychiatric patients were able to perform the given task. Therefore, informed consent is needed in the point of view regarding the decision-making ability of psychiatric patients. Psychotropic medications, particularly antipsychotics, can cause several side effects, including extrapyramidal syndrome and metabolic syndrome. Therefore, preannouncement of these patients for these side effects is needed. However, when the informed consent is only applied to psychiatric hospitals, it may increase prejudices and misconceptions about psychiatric medications and treatment. Therefore, the informed consent should first be considered carefully and thoughtfully.
Antipsychotic Agents ; Hospitals, Psychiatric ; Human Rights ; Humans ; Informed Consent* ; Mental Competency ; Prejudice

OBJECTIVES: We investigated the effectiveness and safety when treated in schizophrenics with paliperidone palmitate, a long acting injectable antipsychotic. METHODS: This was a 24-week open-label study, performed at one center in Korea. The eligible patients with schizophrenia diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were enrolled. Patients received long-acting paliperidone palmitate injection (234 mg, baseline; 156 mg, week 1 ; then once 4 weeks flexible dosing). Effectiveness assessments were measured by the Positive and Negative Syndrome Scale (PANSS), The Clinical Global Impression Severity Scale (CGI-S), The Personal and Social Performance (PSP) at baseline, week 1, every 4 weeks untill 24 weeks or endpoint. Safety assessments were measured by The Extrapyramidal Symptom Rating Scale (ESRS), body weight (BW) and incidence of adverse events. Oral antipsychotics were stopped or tapered off within next 14 days. RESULTS: Of 20 patients recruited, 9 patients (45%) completed the study. Paliperidone palmitate produced a significant improvement in PANSS total score from baseline to endpoint. The response rate was 75% [mean change (+/- SD) -25.9 +/- 14.4, all p < 0.001]. The CGI-S and PSP total scores significantly improved during 24 weeks (All p < 0.001). Eighty percent of patients reported adverse events and most common adverse events (> or = 10%) in paliperidone palmitate were anticholinergic adverse event, extrapyramidal symptoms, weight gain, akathisia, insomnia, headache, agitation, anxiety and GI trouble. ESRS score is not statistically significant, but tends to get better at the end of the study when compared to baseline. CONCLUSIONS: Our study results demonstrated maintained effectiveness and safety of paliperidone palmitate treatment in schizophrenics. And provides both clinicians and patients with a new choice of treatment that can improve the outcome of long term therapy. Their potential effectiveness and safety should be better addressed by future randomized-controlled trials.
Antipsychotic Agents ; Anxiety ; Body Weight ; Diagnostic and Statistical Manual of Mental Disorders ; Dihydroergotamine ; Headache ; Humans ; Incidence ; Korea ; Psychomotor Agitation ; Schizophrenia ; Sleep Initiation and Maintenance Disorders ; Weight Gain ; Paliperidone Palmitate

OBJECTIVES: The Mood Disorder Questionnaire (MDQ) has been validated as a diagnostic screening instrument for the detection of patients with bipolar disorder, but some patients with bipolar disorder obtain false negative screens. So we investigated demographic and clinical characteristics in false-negative MDQ in bipolar patients. METHODS: The participants were 60 DSM-IV bipolar outpatients in remission. All completed the Korean version of the Mood Disorder Questionnaire (K-MDQ) and the Korean version of the Beck Cognitive Insight Scale (K-BCIS) and were assessed by a trained clinician on the Young Mania Rating Scale, the Hamilton Depression Rating Scale and the Global Assessment of Functioning scale. The patients were categorized into two groups according to their K-MDQ score excluding further two questions (MDQ > or =7 : K-MDQ-positives and MDQ <7 : K-MDQ-negatives). Differences in demographic and clinical characteristics between these two groups were analyzed. RESULTS: There were no statistically significant differences between K-MDQ-positives and K-MDQ-negatives on the demographic and clinical variables, except on the K-BCIS where K-MDQ-negatives reported significantly lower scores on the K-BCIS composite index and self-reflectiveness subscale. CONCLUSION: These results suggest that lack of insight is a confounding factor in screening for bipolar disorder using the K-MDQ.
Bipolar Disorder ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders ; Outpatients ; Surveys and Questionnaires

OBJECTIVES: The second to fourth digit ratio (2D : 4D) is known to reflect testosterone level during intrauterine period. Testosterone is essential for masculinization of brain. Cloninger's type II alcoholism is characterized by early age at onset and largely limited to males. Compared with type I alcoholism, type II alcoholism is thought to be masculine. There is a possibility that the digit ratio of type II alcoholism is low compared with type I. We examined digit length ratio in Cloninger's type I and II alcoholism to understand the effects of intrauterine testosterone on the development of alcoholism. METHODS: The participants were 87 alcohol dependent patients. We divided two subtypes of patients by Irwin's symptom list, based on Cloninger's concept. We captured the images of both palms by the scanner and measured the lengths of digits by the graphic program. Then we analyzed the digit ratios by independent-sample t-test. RESULTS: The mean 2D : 4D of type I was 0.942 (right), 0.952 (left). The mean 2D : 4D of type II was 0.927 (right), 0.940 (left). In both hands, 2D : 4D of type II was significantly lower than type I. CONCLUSIONS: Type II alcoholism showed masculine type of digit length ratio compared with type I. It suggests the exposure of testosterone during intrauterine period might play an important role in determining the course and feature of alcoholism.
Alcoholism ; Brain ; Hand ; Humans ; Male ; Testosterone