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

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>

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>

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.

Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

WANG SHENG MIN,황선영,연보라,최경호,오영민,이해국,권용실,이정태,이경욱 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.3

ObjectiveaaPatients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents’ competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide. MethodsaaWe investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients’ severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed. ResultsaaMany factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation. ConclusionaaPsychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.

Five potential therapeutic agents as antidepressants: a brief review and future directions

Wang, Sheng-Min,Han, Changsu,Lee, Soo-Jung,Patkar, Ashwin A,Masand, Prakash S,Pae, Chi-Un 'Informa Healthcare (Expert Reviews, LTD)' 2015 Expert review of neurotherapeutics Vol.15 No.9

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.

How much to worry about the FDA warning in the use of citalopram?

Wang, Sheng-Min,Pae, Chi-Un Future Drugs Ltd 2013 Expert review of neurotherapeutics Vol.13 No.8

<P>A number of studies have suggested that antidepressants such as selective serotonin reuptake inhibitors may increase a risk of developing harmful cardiac adverse event such as QT interval prolongation. In fact, the US Food and Drug Administration (FDA) consecutively gave safety warnings to healthcare professionals that the use of citalopram may be associated with QT interval prolongation in 2011 and 2012. Despite the fact that citalopram has been one of the most acceptable antidepressants worldwide, concerns on citalopram about cardiac safety issues have become apparent to clinicians after the FDA warning. However, a recent cohort study raises some practical questions about the FDA warnings on the use of citalopram and may also provide clinicians with a good guidance for prudent use of citalopram in clinical practice.</P>

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>

Neuroplastic and Pro-cognitive Effects of Granulocyte Colony Stimulating Factor in Healthy Adults: A Pilot Study

Sheng-Min Wang,Dong Woo Kang,Hee-Je Kim,Sung-Soo Park,Hyun Kook Lim 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.10

Objective Granulocyte colony-stimulating factor (G-CSF) is a growth factor used to regulate the mobilization of bone marrow progenitor cells and has been shown to promote brain repair and reduce inflammation. This study aimed to investigate the pro-cognitive and neuroplastic effects of G-CSF in healthy adults. Methods Sixteen healthy adults or donors of hematopoietic stem cell transplantation received G-CSF injections for 5 consecutive days, and their blood samples were collected before, immediately after, and 3 weeks after the G-CSF injections. Twelve subjects underwent neuropsychological testing before and 12 weeks after the G-CSF injections. Results The study found that G-CSF administration resulted in significant improvements in cognitive function, as measured by the Rey- Osterrieth Complex Figure test for immediate recall, delayed recall, and recognition score at 12 weeks after the injections. The blood levels of brain-derived neurotrophic factor, interleukin-4, and interleukin-8 were significantly increased immediately after the injections and returned to baseline levels after 3 weeks. There was no significant change in the plasma level of Multimer Detection System-oligomerized amyloid beta. Conclusion Our results might suggest that G-CSF has neuroplastic and pro-cognitive effects in healthy adults. However, further study containing a larger sample size is needed to confirm our findings.