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YoungHoon Ko,KyoungSae Na,ChulEung Kim,SeungHyun Kim,YangWhan Jeon,JungSeo,MoonSoo Lee,ShinGyeom Kim,HyunGhang Jeong,HanYong Jung 대한신경정신의학회 2014 PSYCHIATRY INVESTIGATION Vol.11 No.4
Objective-Switching antipsychotics is one useful therapeutic option when the treatment of schizophrenia encounters suboptimal efficacy and intolerability issues. This study aimed to investigate the efficacy and tolerability of cross-tapering switching to ziprasidone from other antipsychotics. Methods-A total of 67 patients with schizophrenia or schizoaffective disorder were recruited in this 12-week, multicenter, non-comparative, open-label trial. Prior antipsychotics were allowed to be maintained for up to 4 weeks during the titration of ziprasidone. Efficacy was primarily measured using the 18-item Brief Psychotic Rating Scale (BPRS) at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was secondarily measured by the Clinical Global Impression-Severity (CGI-S) scale and the Global Assessment of Functioning (GAF) scale at each visit. Regarding the metabolic effects of switching to ziprasidone, weight, body mass index (BMI), waist-to-hip ratio (WHR), and lipid profile–including triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol levels–were measured at each follow-up visit. Results-The BPRS scores were significantly improved at 12 weeks after switching to ziprasidone (F=5.96, df=2.11, p=0.003), whereas the CGI-S and GAF scores were not significantly changed. BMIs, WHRs, and TG levels were significantly decreased, with no significant changes in other lipid profiles. Conclusion-Cross-tapering switching to ziprasidone is effective for patients with schizophrenia spectrum disorders. Beyond the efficacy of the procedure, favorable metabolic profiles show that switching to ziprasidone may be helpful for maintenance therapy over an extended period.
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KyoungSae Na,HanYong Jung,Soyoung Irene Lee,ShinGyeom Kim 대한신경정신의학회 2004 PSYCHIATRY INVESTIGATION Vol.1 No.2
Objective-Mild traumatic brain injury (mTBI) is frequently associated with psychiatric symptoms and cognitive dysfunction, as well as with the receipt of workers’ compensation, as many mTBIs occur due to work-related accidents. We hypothesized that depression and insufficient cognitive effort mediate the relationship between sociodemographic variables and cognitive dysfunction in mTBI. Methods-A retrospective chart review study was conducted using 115 records of patients with mTBI. Cognitive effort was measured based on scores on the Rey 15-Item Test. Multivariate linear regression analysis was performed to examine factors predictive of cognitive functions. Path analysis was subsequently performed to investigate the mediating effects of depression and cognitive effort in relation to receipt of workers’ compensation and demographic variables. Results-Fifteen of the 115 participants (13.0%) received failing scores on the Rey 15-Item Test, which indicated insufficient cognitive effort. Path analysis indicated that cognitive effort mediated the effects of age and workers’ compensation on cognitive functions. Conclusion-Given the significant mediating effects of cognitive effort on cognitive performance, it is important to address patient motivation and encourage mTBI patients covered by workers’ compensation to perform tests with authentic effort.
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Neuroprotection in Schizophrenia and Its Therapeutic Implications
YongKu Kim,KyoungSae Na 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.4
Schizophrenia is a chronic and debilitating mental disorder. The persisting negative and cognitive symptoms that are unresponsive to pharmacotherapy reveal the impairment of neuroprotective aspects of schizophrenia. In this review, of the several neuroprotective factors, we mainly focused on neuroinflammation, neurogenesis, and oxidative stress. We conducted a narrative and selective review. Neuroinflammation is mainly mediated by pro-inflammatory cytokines and microglia. Unlike peripheral inflammatory responses, neuroinflammation has a role in various neuronal activities such as neurotransmission neurogenesis. The cross-talk between neuroinflammation and neurogenesis usually has beneficial effects in the CNS under physiological conditions. However, uncontrolled and chronic neuroinflammation exert detrimental effects such as neuronal loss, inhibited neurogenesis, and excessive oxidative stress. Neurogenesis is also a major component of neuroprotection. Adult neurogenesis mainly occurs in the hippocampal region, which has an important role in memory formation and processing. Impaired neurogenesis and an ineffective response to antipsychotics may be thought to indicate a deteriorating course of schizophrenia. Oxidative stress and excessive dopaminergic neurotransmission may create a vicious cycle and consequently disturb NMDA receptor-mediated glutamatergic neurotransmission. Based on the current evidences, several neuroprotective therapeutic approaches have been reported to be efficacious for improving psychopathology, but further longitudinal and large-sample based studies are needed.
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SeonCheol Park,HwaYoung Lee,DongWoo Lee,SangWoo Hahn,SangHo Park,YeoJu Kim,JaeSung Choi,HoSung Lee,SoyoungIrene Lee,KyoungSae Na,SungWon Jung,SeHoon Shim,KiWon Kim,JongWoo Paik,YoungJoon Kwon 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.3
Objective-We aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9). Methods-Two hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea. Results-Greater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, p<0.001], reduced/increased sleep (aOR=3.269, p<0.001), psychomotor retardation/agitation (aOR=2.243, p=0.004), and concentration problem (aOR=16.116, p<0.001) were independently associated with increased likelihood of having depressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, p<0.001]. Conclusion-Our findings suggested that the diagnostic weighting of little interest, reduced/increased sleep, psychomotor retardation/agitation, and concentration problem is needed to detect depressive disorder among the elderly patients with chronic physical diseases.
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