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Tardive dystonia and Tardive dyskinesia have been the most persistent problem of classical antipsychotics because of their potential irreversibility. No effective treatment for them have been found to date. The author report a case of tardive dystonia and tardive dyskinesia in one woman patient with schizophrenia that has successfully responded to clozapine. Treatment with diazepam, lithium, valproate were ineffective in this patient. Thus, clozapine was tried and the effect was markedly improved. The author recommend treatment with clozapine in patient with antipsychoticinduced tardive dystonia or tardive dyskinesia.
Genes involved in the serotonin system are good candidates for the pathogenesis of mood disorder and mood-related disorders, such as eating disorder, obsessive-compulsive disorder, alcoholism, and suicide. Serotonin type 2A(5-HT2A) receptor gene promoter polymorphism(-1438A/G) has been reported. In this article, authors reviewed the literatures regarding association studies between -1438A/G and mood disorder and mood-related disorders. There are controversial results with limited data to date. Further researches on the -1438A/G in psychiatric disorders are required.
The author studied the effects of Partial Differential REM Deprivation(PDRD) on the sleep structure, sleepiness and fatigue with polysomnography and visual analogue test. The subject were 9 healthy male students, ranging in age from 20 to 25 years without personal histories of medical, neurological, or psychiatric illness and current sleep disturbance or parasomnias. Sleep records were analyzed according to the criteria of Rechtschaffen and Kales's manual. The results were as follows. 1. Stage 1 sleep(%) decreased significantly during the PDRD and recovery period. Stage 2 sleep (%) also significantly decreased during the PDRD nights, and there was no significant difference between the baseline and recovery period in both of stage 1 sleep(%) and stage 2 sleep(%). 2. Slow wave sleep(%o) significantly increased during the PDRD period, and there was no difference in the recovery period. Between slow wave sleep(%) in the PDRD and recovery period, there was significantly decreased in the recovery period. 3. REM sleep(min) of PDRD periods significantly decreased, and there was no significant difference between the baseline and recovery period, but REM(%) significantly increased in the recovery period(REM rebound) compared with baseline. 4. There was no correlation between the increase rate of REM % in the baseline and that of recovery nights, and also no correlation was observed between the decrease rate of REM % in the PDRD nights and the increase rate of REM % in the recovery nights. 5. Sleepiness was prominent in the PDRD nights and significantly recovered in the recovery nights, Fatigue was also prominent in the PDRD nights and significantly recovered in the recovery nights.
There are several possible causes of sexual dysfunction in depressed disorder. However, patients will rarely report sexual problem spontaneously. Therefore, it is very difficult to determine a cause of sexual dysfunction in depressive patients, and the differential diagnosis must include primary sexual dysfunction, sexual dysfunction associated with general medical and psychiatric disorder, and sexual dysfunction associated with treatment for psychiatric disorder. Various strategies are recommended to manage antidepressant-induced sexual dysfunction in depression, including waiting, reducing the antidepressant dosage, use of drung holidays, use of adjunctive pharmacotherapy, and switching antidepressant. Use of an antidepressant with a low prevalence of sexual side effects, such as bupropion, nefazodone, and mirtazapine, may be the best way to avoid sexual dysfunction.
In order to assess the efficacy and safety of clozapine, 50 in-patients with treatment-resistanat schizophrenia were evaluated using PANSS(Positive and Negative Symptome Scale for Schizophrenia), CGI(Clinical Global Impression), AMS(Abnormal Involuntary Movement Scale), Adverse Event-Somatic Symptoms, Neurological Rating Scale for EPS before and during treatment. Mean daily dosage of clozapine was 344.15±123.43mg at 12th week. A clinically significant improvement in positive, negative, and general psychopathology was noted as early as week 2 through 12 week. The tolerability of clozapine was generally found to be good. Drowsiness/sleepiness, Hypersalivation, and Constipation were the most common side effects. There was no neutropenia, and 3 patients suffered from seizures. These results suggest that clozapine is worth considering for the treatment-resistant patients
목 적:세로토닌체계의 변화가 정신분열병이나 폭력행동과 관련이 있다고 알려져 있다. 저자 등은 5-HT2A 수용체 유전자 다형성(T102C)이 살인을 범한 남성 정신분열병과 관련이 있는지 알아보기 위하여 본 연구를 시행하였다. 방 법:살인을 범한 정신분열병 환자 105명, 비폭력 정신분열병 환자 102명, 정상 대조군 104명을 대상으로 중합효소 연쇄반응을 이용하여 5-HT2A 수용체 유전자 다형성(T102C)의 유전자형과 대립유전자의 빈도를 비교하였다. 모든 대상은 한국인 남자였다. 결 과:살인을 범한 정신분열병군, 비폭력 정신분열병군, 정상대조군을 비교한 결과 세군간에 유전자형(χ2=8.090, df=4, p=0.088)이나 대립유전자(χ2=2.880, df=2, p=0.237)에서 통계적인 차이가 없었다. 또한 살인을 범한 정신분열병군과 비폭력 정신분열병군, 살인을 범한 정신분열병군과 정상 대조군, 그리고 비폭력 정신분열병군과 정상 대조군을 각각 비교하였을 때도 유전자형과 대립유전자에서 통계적인 차이가 없었다. 결 론:이러한 결과는 5-HT2A 수용체 유전자 다형성(T102C)이 남성 정신분열병환자의 살인행동과는 관련이 없음을 제시한다. 향후 살인을 범한 여성정신분열병환자와 살인을 범한 일반 범죄인을 포함한 연구가 필요할 것으로 사료된다. Objective : Alterations in the serotonergic system are related to schizophrenia and violent behavior. This study investigated whether T102C polymorphism of the 5-HT2A receptor gene is related to homicide in male schizophrenics. Methods : T102C polymorphism of the 5-HT2A gene was typed with PCR in 105 homicidal schizophrenics, 102 nonviolent schizophrenics, and 104 normal controls. All of the subjects were Korean males. Results : There were no differences in the genotypic distributions(χ2=8.090, df=4, p=0.088) or allele frequencies(χ2=2.880, df=2, p=0.237) of the T102C polymorphism of the 5-HT2A receptor in the three groups. In pairwise comparisons, no differences in the genotype distributions or allele frequencies were observed when homicidal schizophrenics and non-violent schizophrenics were compared, in the genotype distributions or allele frequencies of homicidal schizophrenics and normal controls, or in the genotype distributions and allele frequencies of nonviolent schizophrenics and normal controls. Conclusion : These results suggest that T102C polymorphism of the 5-HT2A receptor gene is not causally related to homicide in male schizophrenics. Further studies are required and should include homicidal female schizophrenics and non-psychotic subjects who have committed homicide.
A case of Capgras' syndrome in a 19-year-old girl who improved on Atypical antipsychotics, Risperideone is described. The patient's delusion of misidentification (She believed that her parents are not truly her parents and even she herself is not she) was treated with Risperidone. She showed significantly improvement. Authors believe Risperidone's antipsychotic effect in the treatment of schizophrenia warrants its consideration in alleviating other delusions of various psychotic disoreders, including the dedusion of doubles.
In order to determine the frequency of physical illness in schizophrenia, 107 schizophrenics were assessed with physical exam and routine laboratoy test. The results were as follows 1) Among the total number of 107 schizophrenics, 31 had the physical illness(29%), and among the schizophrenics with physical illness, female outnumbered male at the rate of 17:14. 2) There was no difference between schizophrenics with physical illness and schizophrenics without physical illness in demographic characteristics. 3) Classification of physical illness were disease of skin 7 (22.6%), musculoskeletal system 5(16. 1%), ENT(ear nose throat) 3(9.7%), endocrine system 3(9.7%), circulatory system 2(6.5%), respiratory system 2(6.5%), digestive system 1(3.2%), genitourinary system 1(3.2%), infection 1(3. 2%), eye 1(3.2%) respectively Authors suggest that physical exam and routine laboratory test should be done for all hospitalized psychiatric patients