Benzodiazepine-Associated Carcinogenesis

Shih-Chieh Ku,Pei-Shen Ho,Yu-Ting Tseng,Ta-Chuan Yeh,Shu-Li Cheng,Chih-Sung Liang 대한신경정신의학회 2018 PSYCHIATRY INVESTIGATION Vol.15 No.9

Objective Cellular, animal, and human epidemiological studies suggested that benzodiazepines increase the risk of cancer and cancer mortality. Obesity is also clearly linked to carcinogenesis. However, no human studies have examined benzodiazepine-associated carcinogenesis as assessed by changes in cancer biomarkers. Methods A total of 19 patients were recruited, and received a 6-week treatment of 0.5 mg lorazepam. The measured cancer biomarkers were angiopoietin-2 (ANG-2), soluble CD40 ligand, epidermal growth factor, endoglin, soluble Fas ligand (sFASL), heparin-binding EGF-like growth factor (HB-EGF), insulin-like growth factor binding protein, interleukin (IL)-6, IL-8, IL-18, plasminogen activator inhibitor (PLGF), placental growth factor, transforming growth factor (TGF)-α, tumor necrosis factor (TNF)-α, urokinase-type plasminogen (uPA), vascular endothelial growth factor (VEGF)-A, VEGF-C, and VEGF-D. Results Six cancer biomarkers were significantly increased in all patients as a whole. The subgroup analysis revealed a distinct pattern of change. Overweight patients showed a significant increase in 11 cancer biomarkers, including ANG-2, sFASL, HB-EGF, IL-8, PLGF, TGF-α, TNF-α, uPA, VEGF-A, VEGF-C, and VEGF-D. However, normal-weight patients did not show any changes in cancer biomarkers. Conclusion Adiposity may have primed the carcinogenic potential, leading to lorazepam-associated carcinogenesis in overweight patients. Epidemiological studies addressing this issue should consider the potential modulator contributing to benzodiazepine-associated carcinogenesis.

Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from Research on Asian Prescription Pattern-Bipolar Disorder

Shih-Ku Lin,Shu-Yu Yang,Seon-Cheol Park,Ok-Jin Jang,Xiaomin Zhu,Yu-Tao Xiang,Wen-Chen Ouyang,Afzal Javed,M. Nasar Sayeed Khan,Sandeep Grover,Ajit Avasthi,Roy Abraham Kallivayalil,Kok Yoon Chee,Norliza 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.1

Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.

Psoas Abscess Caused by Non-Typhoid Salmonella in a Patient with Severe Aplastic Anemia

Chin-Chi Kuo,Shih-Chi Ku,Jann-Tay Wang,Ching-Wei Tsai,Vin-Cent Wu,Wen-Chien Chou 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.3

The clinical spectrum of infections caused by non-typhoid Salmonella spp. includes gastroenteritis, enteric fever,bacteremia, and extraintestinal localized complications, especially in immunocompromised hosts. Here we report a patient with severe aplastic anemia developing left iliopsoas abscess caused by non-typhoid Salmonella (NTS),which was successfully treated by prolonged antibiotic treatment and repeated debridement. Our data indicate that aplastic anemia is a risk factor for infection caused by NTS.

Incongruent Expression of Brain-Derived Neurotrophic Factor and Cortisol in Schizophrenia: Results from a Randomized Controlled Trial of Laughter Intervention

Shu-Li Cheng,Fu-Chi Yang,Hsuan-Te Chu,Chia-Kuang Tsai,Shih-Chieh Ku,Yu-Ting Tseng,Ta-Chuan Yeh,Chih-Sung Liang 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.12

Objective Schizophrenia has been associated with dysfunction of the hypothalamic-pituitary-adrenal axis. Furthermore, alterations in neurotrophic factors might contribute to the pathogenesis of schizophrenia. We aimed to evaluate the effects of a simulated laughter intervention on the levels of cortisol and BDNF and to determine whether the effects associated with simulated laughter could be sustained after discontinuation of the intervention. Methods In this randomized controlled study, patients with schizophrenia according to DSM-IV clinical criteria were randomly assigned to receive either 8-week-long simulated laughter intervention (n=32) or treatment-as-usual group (control group, n=27). The serum levels of BDNF and cortisol were measured at baseline, week 8, and four weeks after discontinuation (week 12) of the intervention program. Results After an 8-week simulated laughter intervention, the laughter group had significantly higher levels of BDNF; however, four weeks after discontinuation of the intervention, the levels of BDNF significantly dropped. Interestingly, the levels of cortisol did not change significantly at week 8, but they were significantly elevated at week 12. The levels of BDNF and cortisol in the control group did not change significantly between week 0 and week 8. Conclusion These findings suggest that the simulated laughter intervention has an early effect on neurogenesis with a significant delayed effect on stress regulation in subjects with schizophrenia.

기분조절제로 인한 인지기능 부작용이 동반된 양극성 기분장애 환자의 임상적인 특징: 아시아의 정신작용약물 처방 경향 연구(REAP-BD Survey) 중 국내 자료 활용

신희현,최진희,소형석,최하연,박용천,Chay Hoon Tan,Shih-ku Lin,Naotaka Shinfuku,박선철,김기원 대한신경정신의학회 2020 신경정신의학 Vol.59 No.3

Objectives This study aimed to identify differences between bipolar disorder patients who experienced cognitive side effects and those who did not experience cognitive side effects due to prescription of mood stabilizers. Methods This study analyzed 350 Korean adults who were diagnosed with bipolar disorder and prescribed mood-stabilizing drugs. The patients were divided into two groups—patients who experienced cognitive side effects and those who did not experience cognitive side effects. We also compared the demographic and clinical characteristics between both groups. Results The number of patients with an untreated illness longer than 1 year was higher in the group of patients who experienced cognitive side effects compared to the group of patients who did not experience cognitive side effects. Further, the number of patients with manic symptoms at onset was higher in the group of patients who experienced cognitive side effects compared to the group of patients who did not experience cognitive side effects. In addition, the proportion of patients in remission was higher in the group of patients who experienced cognitive side effects compared to the group of patients who experienced no cognitive side effects. However, there was no significant difference regarding the type of mood stabilizer used between the groups. On the other hand, more people experienced cognitive side effects as the valproic acid dosage increased. Conclusion Our findings suggest that there are clinical and demographic differences between people who experienced cognitive side effects and those who did not experience cognitive side effects due to prescription of mood stabilizers.

Clinical Characteristics and Psychotropic Drug Prescription Patterns of Bipolar Disorder Patients with a History of Suicidal Attempts: Findings from the REAP-BD, Korea

Seon-Cheol Park,Kiwon Kim,Ok-Jin Jang,Seung-Gon Kim,이정구,Joon Hyuk Park,Joonho Choi,Dong-Woo Lee,Shih-Ku Lin,Chay-Hoon Tan,Naotaka Shinfuku,Yong Chon Park 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.6

Our study aimed to analyze the clinical characteristics and psychotropic prescription patterns of a history of suicide attempts in South Koreans with bipolar disorder (BD), by using only Korean data from the Research on Asian Psychotropic Prescription Pattern for Bipolar disorder. The patterns of clinical characteristics and psychotropic drug use were compared among 53 patients with a history of suicide attempts and 297 without this history; the potential effects of confounding variables were adjusted with binary logistic analyses for discrete variables and analyses of covariance for continuous variables. After adjusting the effects of age, sex, duration of illness, and enrollment as an outpatient, patients with a history of suicide attempts were characterized by a significantly more prevalent depressive episode, lower prevalent remission state, lower levels of hemoglobin, and more use of antidepressants, anxiolytics, and hypnotics compared to those without lifetime suicide attempt. The inability to plan goal-directed behavior may be an intervening factor in the relationship between suicide attempts and depression in BD. Relatively low hemoglobin levels can be associated with manic episodes in patients with a history of suicide attempts and the use of antidepressants, anxiolytics, or hypnotics can be associated with suicide attempts in BD patients.

Examining Patterns of Polypharmacy in Bipolar Disorder: Findings from the REAP-BD, Korea

Kiwon Kim,Hyunju Yang,Euihyeon Na,Hoseon Lee,Ok-Jin Jang,Hyung-Jun Yoon,Hong Seok Oh,Byung-Joo Ham,Seon-Cheol Park,Shih-Ku Lin,Chay Hoon Tan,Naotaka Shinfuku,Yong Chon Park 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.5

Based on Korean data from the Research on Asian Psychotropic Prescription Pattern for Bipolar Disorder, this study tried to present prescription patterns in biopolar disorder (BD) and its associated clinical features. Based on the information obtained from the study with structured questions, the tendency of prescription pattern was studied and analyzed. Polypharmacy was predominant, including simple polypharmacy in 51.1% and complex polypharmacy in 34.2% of patients. Subjects associated with simple or complex polypharmacy were significantly younger, had higher inpatient settings, a larger portion of onset with manic episode, a shorter duration of untreated illness, a shorter duration of current episode, were more overweight, used less antidepressants and used more anxiolytics. These findings can suggest higher polypharmacy rate in more severe BD and highlight the necessity of monitoring the weight of subjects with polypharmacy.