Auditory and Visual P300 in ADHD Children with Higher and Lower IQ

Sheng Min Wang,Yang-Whan Jeon,Sang-Ick Han,E Jin Park 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.4

Objectives:Intellectual impairment in children with attention-deficit hyperactivity disorder (ADHD) is often associated with relatively severe cognitive dysfunction. This study was designed to investigate cognitive function using auditory and visual event-related potential P300 in children with ADHD with relatively higher and lower IQ. Methods:A total of 20 children aged 6-12 years with DSM-IV-TR diagnosis of ADHD-combined type were recruited. For 10 children with lower IQ (≤100) and 10 children with higher IQ (>100), auditory and visual P300 using oddball paradigm (target 0.2, standard 0.8, in probability) were employed. Results:No significant differences were found in P300 amplitude and latency between ADHD children with higher and lower IQ in both modalities. However, auditory P300 amplitude in the right parietal area (P8 electrode) was negatively correlated with verbal IQ in ADHD subjects (R=-.50, p<.05). Visual P300 amplitude in the left parietal area (P3 electrode) was positively correlated with performance IQ in ADHD subjects (R=.57, p<.01). Conclusion:This study suggests intellectual impairment, as evidenced by lower IQ, could not be associated with cognitive dysfunction reflected in event-related potential P300 in ADHD children. However, cognitive function reflected in intellectual subcomponents and P300 might be processed in a stimulus modality-specific and asymmetric pattern.

Criticisms of drugs in early development for the treatment of depression: what can be improved?

Wang, Sheng-Min,Han, Changsu,Pae, Chi-Un Informa UK, Ltd. 2015 Expert opinion on investigational drugs Vol.24 No.4

<P>Major depressive disorder (MDD) is a common and debilitating mental illness, which leads to serious functional impairment in patients, and treatment-wise, there are currently a number of different classes of antidepressants already on the market. However, emerging evidence from numerous clinical trials has confirmed that there is still an unmet need for antidepressant efficacy in terms of response and remission. Approximately only 30% of patients with MDD may remit after adequate treatment with antidepressants in clinical practice. The drawbacks of the currently available antidepressants also include inadequate overall efficacy, safety issues and the lag prior to onset of clinical improvement. The need for new agents with novel mechanisms of action has led to the development of several newer antidepressants including vilazodone, edivoxetine, ketamine, atomoxetine and vortioxetine, which have been approved for the treatment of MDD. However, the efficacy and safety of these next-generation antidepressants, in clinical trials, are still unsatisfactory. This paper provides a brief updated overview of the progress and critical limitations in the development of novel antidepressants.</P>

Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Jun, Tae-Youn,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un Chonnam National University Medical School 2016 CMJ Vol.52 No.3

<P>Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.</P>

Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review

Wang, Sheng-Min,Han, Changsu,Bahk, Won-Myoung,Lee, Soo-Jung,Patkar, Ashwin A.,Masand, Prakash S.,Pae, Chi-Un Chonnam National University Medical School 2018 CMJ Vol.54 No.2

<P>Randomized trials have shown that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have better safety profiles than classical tricyclic antidepressants (TCAs). However, an increasing number of studies, including meta-analyses, naturalistic studies, and longer-term studies suggested that SSRIs and SNRIs are no less safe than TCAs. We focused on comparing the common side effects of TCAs with those of newer generation antidepressants including SSRIs, SNRIs, mirtazapine, and bupropion. The main purpose was to investigate safety profile differences among drug classes rather than the individual antidepressants, so studies containing comparison data on drug groups were prioritized. In terms of safety after overdose, the common belief on newer generation antidepressants having fewer side effects than TCAs appears to be true. TCAs were also associated with higher drop-out rates, lower tolerability, and higher cardiac side-effects. However, evidence regarding side effects including dry mouth, gastrointestinal side effects, hepatotoxicity, seizure, and weight has been inconsistent, some studies demonstrated the superiority of SSRIs and SNRIs over TCAs, while others found the opposite. Some other side effects such as sexual dysfunction, bleeding, and hyponatremia were more prominent with either SSRIs or SNRIs.</P>

Fibromyalgia diagnosis: a review of the past, present and future

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un Informa UK, Ltd 2015 Expert review of neurotherapeutics Vol.15 No.6

<P>Diagnosis of fibromyalgia (FM) remains controversial even though diverse diagnostic criteria have been developed. This review looks at the history, evolution of diagnostic criteria, endless controversy, recent trends and future perspectives regarding FM diagnosis. Some have criticized that diagnosis of FM could lead to medicalization, whereas others have raised concerns of under-diagnosing FM. With the evolution of diagnosis criteria from American College of Rheumatology 1990 to modified American College of Rheumatology 2010, diagnosis of FM has become simpler. The recent trend of applying patient-reported questionnaires has also increased a simpler FM diagnosis. Reliable biomarkers will not be available for the foreseeable future, so diverse assessment tools will have to be used more pro-actively. After initial diagnosis, multiple and comprehensive assessment measures are needed during the course of treatment in order to better understand type and severity of FM symptoms. These, in turn, could help classify FM based on symptom domain, symptom severity, and comorbidity which would enable more personalized treatment.</P>

Rapid Onset of Intranasal Esketamine in Patients with Treatment Resistant Depression and Major Depression with Suicide Ideation: A Meta-Analysis

Sheng-Min Wang,Nak-Young Kim,Hae-Ran Na,Hyun Kook Lim,Young Sup Woo,Chi-Un Pae,Won-Myong Bahk 대한정신약물학회 2021 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.19 No.2

Objective: We performed a meta-analysis of randomized double-blinded placebo controlled trials (DB-RCTs) to inves-tigate efficacy and safety of intranasal esketamine in treating major depressive disorder (MDD) including treatment re-sistant depression (TRD) and major depression with suicide ideation (MDSI). Methods: Mean change in total scores on Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to differ-ent time-points were our primary outcome measure. Secondary efficacy measures included rate of remission of depres-sion and resolution of suicidality. Results: Eight DB-RCTs (seven published and one un-published) covering 1,488 patients with MDD were included. Esketamine more significantly improved MADRS total scores than placebo starting from 2−4 hours after the first admin-istration (standardized mean difference, −0.41 [95% CI, −0.58 to −0.25], p < 0.00001), and this superiority main-tained until end of double-blinded period (28 days). Sub-group analysis showed that superior antidepressant effects of esketamine over placebo in TRD and MDSI was observed from 2−4 hours, which was maintained until 28 days. Resolution of suicide in MDSI was also greater for esketamine than for placebo at 2−4 hours (OR of 2.04, 95% CIs, 1.37 to 3.05, p = 0.0005), but two groups did not statistically differ at 24 hours and day 28. Total adverse events (AEs), and other common AEs including dissociation, blood pressure increment, nausea, vertigo, dysgeusia, dizziness, and somnolence were more frequent in esketamine than in placebo group. Conclusion: Esketamine showed rapid antidepressant effects in patients with MDD, including TRD and MDSI. The study also suggested that esketamine might be associated with rapid anti-suicidal effects for patients with MDSI.

Association of Alcohol Intake and Fracture Risk in Elderly Varied by Affected Bones: A Nationwide Longitudinal Study

Sheng-Min Wang,Kyung-Do Han,Nak-Young Kim,Yoo Hyun Um,Dong Woo Kang,Hae-Ran Na,Chang Uk Lee,Hyun Kook Lim 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.10

Objective Previous studies investigating association of alcohol intake and fracture risk in elderly yielded conflicting results. We first examined the association between alcohol intake and total fracture risk in elderly subjects and further analyzed whether the association varied by fracture locations.Methods This is a nationwide population-based cohort study which included all people aged 66 (n=1,431,539) receiving the National Screening Program during 2009-2014. Time-to-event were defined as duration from study recruitment, the day they received health screening, to the occurrence of fracture.Results Total fracture was significantly lower in mild drinkers [adjusted hazard ratio (aHR)=0.952; 95% confidence interval (95% CI) =0.931-0.973] and higher in heavy drinkers (aHR=1.246; 95% CI=1.201-1.294) than non-drinkers. Risk pattern of alcohol consumption and fracture differed according to affected bones. Similar J-shaped trends were observed for vertebra fractures, but risk of limb fracture showed a linear relationship with alcohol intake. For hip fracture, risk decrement was more pronounced in mild and moderate drinkers, and significant increment was noted only in very severe drinkers [≥60 g/day; (aHR)=1.446; 1.162-1.801].Conclusion Light to moderate drinking generally lowered risk of fractures, but association between alcohol and fracture risk varied depending on the affected bone lesions.

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

Sheng-Min Wang,Jung-Bum Kim,Jeong Kyu Sakong,Ho-Suk Suh,Kang Seob Oh,Jong-Min Woo,Sang-Woo Yoo,Sang Min Lee,Sang-Yeol Lee,Se-Won Lim,Seong Jin Cho,Ik-Seung Chee,Jeong-Ho Chae,Jin Pyo Hong,Kyoung-Uk Le 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.2

Objective: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. Methods: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). Results: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores ( p <0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodia-zepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. Conclusion: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update

Sheng Min Wang,한창수,이수정,전태연,Ashwin A. Patkar,Prakash S Masand,배치운 전남대학교 의과학연구소 2016 전남의대학술지 Vol.52 No.3

Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.

A review of current evidence for vilazodone in major depressive disorder

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Patkar, Ashwin A.,Masand, Prakash S.,Pae, Chi-Un Informa Healthcare 2013 International journal of psychiatry in clinical pr Vol.17 No.3

<P><I>Objectives.</I> This review is to inform clinicians of currently available data on vilazodone for treating patients with major depressive disorder (MDD), focusing on its differential action mechanism and extended clinical utility. <I>Methods.</I> A data search was conducted in June 2012 using the PubMed/ MEDLINE/relevant clinical trial databases with the key terms “vilazodone” or “Viibryd.” <I>Results.</I> The efficacy, safety, and tolerability of vilazodone have been demonstrated in two pivotal 8-week, randomized, double-blinded, placebo-controlled studies. Certain pharmacological characteristics of vilazodone were observed, including early onset of action, fewer sexual side effects, the absence of known cardiac toxicity, and minimal effect on weight gain, that may provide potential clinical advantages compared with currently available antidepressants. However, such possibilities should be replicated and confirmed in more well-designed and adequately powered clinical trials. Vilazodone requires dose titration up to 2 weeks to reach a target dose of 40 mg/d due to high rate of gastrointestinal side effects. No direct comparative studies with other antidepressants are currently available to confirm the aforementioned potential clinical utility. <I>Conclusion.</I> Vilazodone is a newer antidepressant possessing different action mechanisms compared to currently available antidepressants but whether it has superiority to other class of antidepressants in terms of efficacy and safety should still warrant further evaluation through more well-controlled and direct comparison clinical trials.</P>