Kwanghun Lee

Current prescription pattern of maintenance treatments for bipolar patients in Korea: A focus on the transition from acute treatments.

We examined prescription patterns in maintenance treatment for recovered bipolar patients and compared these with acute treatments.

A Trend of Medication Prescription Pattern for Outpatients with Bipolar Disorder in a University Hospital: Focusing On Atypical Antipsychotics

Aim This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics. Methods Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics. Results In 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity. Conclusions The development of bipolar disorders psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

A Trend of Drug Use in Inpatients with Bipolar Disorder: Comparing 2009-2012 with 1998-2001 in One University Hospital

Aim The aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital. Methods A retrospective chart review was performed and data of 188 cases (2009–2012) and 118 cases (1998–2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed. Results The proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased. Conclusions Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.

S110. THE CLINICAL IMPLICATION OF CLINICIAN-RATED DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY (CRDPSS) FOR DIAGNOSIS BY DSM-5

Abstract Background The most recently published the 5th edition of the DSM proposed a dimensional approach with continuous of schizophrenia and other psychoses. The newly proposed Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the DSM was recommended to be evaluated in all disorders with psychotic symptoms in eight dimensions; Hallucinations, Delusions, Disorganized speech, Abnormal psychomotor behavior, Negative symptoms, Impaired cognition, Depression, Mania. The purpose of this study is to examine if Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) can usefully be used for the Non-Affective Psychoses (NP) and Affective Psychoses (AP). Methods Participants in the study were 175 diagnosed with Schizophrenia, or Schizophreniform Disorder, Schizoaffective Disorder, mood disorder with psychotic symptoms (Major Depressive Disorder, Bipolar Disorder) based on DSM-5 diagnostic criteria and were assigned to either the NP (n = 154) or AP (n = 21) group. CRDPSS was performed jointly by a psychiatrist and a psychiatric resident to assess the severity of the psychotic symptoms of all the participants. And WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was responded to all participants. Independent T-test was conducted to determine whether there was a difference in CRDPSS profile and WHODAS 2.0 scores between the two groups. In addition, a linear discriminant analysis was performed to determine whether the CRDPSS profile can discriminate between the two groups. Results Demographics and WHODAS 2.0 had no statistically significant differences between the two groups. On the other hand, Patients in the NP group had higher Hallucination (p < .05) and Negative symptoms (p < .001), however, lower Mania (p < .001). As a result of constructing a linear discriminant function for NP and AP, the correct classification rate of CRDPSS to discriminate between two groups was 84%. Discussion The results of this study are the first to distinct effectively that Non-Affective psychoses and Affective psychoses by CRDPSS profile. There was no difference in the level of functional disability between groups NP and AP, but only CRDPSS profile could discriminate both groups. Hallucinations, Negative symptoms, and Mania were the major contributors to the distinction between the two groups. This is consistent with the previous studies that these are important in distinguishing Schizophrenia and Bipolar Disorder from each other. CRDPSS provides a new perspective that can be viewed from an integrated perspective, the NP and AP. Regarding the result of this study that it is more important to identify the score profile than the combined score of CRDPSS, because patients exhibit very heterogeneous profile of symptoms.

T116. CAFFEINE-INDUCED PSYCHIATRIC MANIFESTATIONS

Abstract Background The association between caffeine consumption and various psychiatric manifestations has long been observed. Methods We present two cases that show the ability of caffeine to induce psychotic and manic symptoms, and we also review the extant literature on caffeine-induced psychiatric manifestations. Results On the basis of our own and others’ findings, we suggest that caffeine may be related to not only de-novo psychotic or mood symptoms but also to aggravation of pre-existing psychotic or mood disorders. Discussion We therefore suggest that caffeine consumption among patients with mood or psychotic symptoms should be assessed carefully in clinical practice as part of routine psychiatric evaluations.

F45. THE EFFICACY AND SAFETY OF BLONASERIN AFTER SWITCHING FROM OTHER ATYPICAL ANTIPSYCHOTICS IN SCHIZOPHRENIC INPATIENTS: AN OPEN-LABEL, MULTI-CENTER TRIAL

Abstract Background The aim of this study was to investigate the efficacy and safety of blonanserin treatment after switching from other atypical antipsychotics in schizophrenic inpatients who showed inadequate efficacy and poor tolerability. Methods A total of 63 schizophrenic inpatients (inadequate response group=45 and poor tolerability group=18) were included in this study. They were already treated with atypical antipsychotics except blonanserin and not favored due to inadequate responses or intolerable adverse effects. Blonanserin was administered during 12 weeks after switching from their previous antispsychotics. Treatment response was evaluated with Brief Psychiatric Rating Scale (BPRS) and CGI-S, and safety profile were measured with Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Extrapyramidal Side effects Scale (SAR)S and Barnes Akathisia Rating Scale (BARS). Drug Attitude Inventory (DAI-10) and Subjective Well-being Under Neuroleptic Treatment (SWN) were used for subjective estimates. Assessments were done at baseline, 1, 2, 4, 8 and 12 weeks after blonanserin treatment. Repeated measures of ANOVA were done to analyze the group (inadequate vs. intolerable group) and time effects. Results CGI and BPRS were showed significant treatment responses after switching to Blonaserin. Time effects were significant at 2, 4, 8, 12 weeks after switching and group by time effect were also significant at that time. Mean changes of AIMS, SARS and BARS scores were not significant throughout test trial. Although SWN was significantly improved after switching to Blonaserin, it was not found significant group by time effect. Discussion The results suggest that blonanserin may be effective and well tolerable in schizophrenic patients who showed inadequate treatment response or poor tolerability.

F194. ASSOCIATION STUDY BETWEEN TREATMENT RESPONSE OF AMISULPRIDE AND DOPAMINE D3 RECEPTOR GENE POLYMORPHISMS

Abstract Background The aim of this study is to evaluate the association between rs6280 and rs905568 genetic polymorphism of DRD3 gene and the treatment response of amisulpride. Methods After six weeks treatment of amisulpride, 125 schizophrenia patients were interviewed based on the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity (CGI-S). The genotyping for rs6280 and rs905568 was performed using TaqMan single nucleotide polymorphism (SNP) genotyping assay. Results There was no significant difference in the frequency of genotype and allele of rs6280 between the responders and non-responders based on the total, positive, and general score of PANSS and CGI-S score. However, there was a significant association between this SNP and treatment response in the negative score of PANSS (χ2 = 5.23, p = 0.022). There was no significant association between rs905568 and the response in positive, negative, general, and total PANSS score and CGI-S score. Discussion This is the first positive association study between DRD3 gene and the treatment response of negative symptoms to amisulpride in Korean schizophrenia patients. A larger scale research on more SNP of the DRD3 gene will make a progress in the study of pharmacogenetics on the treatment response of the amisulpride.

T251. THE STUDY OF QUALITY OF LIFE AND A GLOBAL FUNCTIONING FOR THE SCHIZOPHRENIA PATIENTS IN COMMUNITY BY THEIR RESIDENTIAL ENVIRONMENT

Abstract Background Mental health is so deeply related to our residential environment that the difficulties of residence could worsen it for schizophrenia patients. Moreover, patients with schizophrenia might induce severe residential problems such as poverty, discrimination, failure to education, frequent migration, homeless, and etc. This study investigated the quality of life and a global functioning for schizophrenia patients in community by their residential environment. Methods Total 648 patients with schizophrenia living in Jeollabukdo(province) were tested demographic and clinical characteristics. Housing and residential satisfaction were measured by the questionnaires established by Ministry of Land, Transport and Maritime Affairs and modified for this study. Psychiatric and psychological variables were assessed by Global Assessment Function (GAF) and World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL - BREF). Correlations among variables were analyzed using frequency analysis and Pearson’s product moment correlation coefficient. Results As the results of correlations between quality of life and housing satisfaction, correlations were shown at a global quality of life (r=0.312, p<.01), physical health (r=0.227, p<.01), psychological domain (r=0.215, p<.01), social relation domain (r=0.170, p<.01), and environmental domain (r=0.372, p<.01). For the correlation between quality of life and residential area satisfaction, a general quality of life (r=0.307, p<.01), physical health (r=0.242, p<.01), psychological domain (r=0.243, p<.01), social relation domain (r=0.169, p<.01), and environmental domain (r=0.306, p<.01) were correlated. Discussion The correlations among residential environment, quality of life, and a global functioning were significant. Consequently, it is necessary for the government policy that can improve housing and residential environment for the mentally disordered and ultimately contribute to enhance their welfare.

T219. THE ROLE OF MELATONIN AND MELATONIN AGONISTS IN COUNTERACTING ANTIPSYCHOTIC-INDUCED METABOLIC SIDE EFFECTS: A SYSTEMATIC REVIEW

Abstract Background Melatonin administration to high cholesterol-treated and high fat-treated rats has been shown to suppress body weight and visceral adiposity. In addition, in various animal models related to obesity, metabolic syndrome, and diabetes, melatonin has beneficial efficacy in ameliorating various metabolic symptoms, including attenuating weight gain, lowering blood pressure (BP), and improving insulin resistance. This systematic review aims to investigate whether melatonin or melatonin agonists significantly attenuate metabolic side effects among psychiatric populations treated with atypical antipsychotics. Methods Four randomized controlled trials were identified through a comprehensive literature search using MEDLINE, EMBASE, and the Cochrane Library on 22 October 2015. These four trials (including three melatonin studies and one ramelteon study) included 138 patients, of whom 71 were treated with melatonin or ramelteon and 67 were treated with a placebo. Because of high heterogeneity, we did not carry out a meta analysis. Results Melatonin was beneficial in lowering blood pressure among bipolar disorder patients; this blood pressure-lowering effect was not prominent among schizophrenic patients. Melatonin appeared to improve lipid profiles and body composition and attenuated weight gain among both schizophrenic and bipolar disorder patients. Ramelteon showed a significant efficacy in lowering total cholesterol level. Discussion Despite the few studies included, this systematic review provided promising evidence of the potential benefits of melatonin and its agonists in attenuating one or more components of metabolic syndrome among psychiatric patients using atypical antipsychotics.

F115. INSIGHT AND MANIC SYMPTOMS IN PATIENTS WITH CHRONIC SCHIZOPHRENIA IN THE KOREAN COMMUNITY

Abstract Background Many studies have highlighted the similarity of the symptoms between bipolar disorders and schizophrenia. Moreover, there are no pathognomonic symptoms that can differentiate these two disorders, and 9% of schizophrenia patients have experienced a manic syndrome in their lifetime. Insight about their symptoms and illness is very important factor for the differential diagnosis and the management in schizophrenia. To examine the relationship among the insight, the psychotic and manic symptoms, and clinical variables in patients with chronic schizophrenia. Methods Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities have been evaluated with the Scale to assess Unawareness of Mental Disorder (SUMD), the Mood Disorder Questionnaire (MDQ), and the Brief Psychiatric Rating Scale (BPRS). Results The mean number of previous admission was 3.85. Their drug adherence was favorable (6.73 day/week). Mean CGI-S score was 3.8. Thirty-five percent of subject were MDQ positive (cutoff point = 7 or more). Among SUMD, “awareness of effect of medication” showed significant negative correlation (r = -0.33) with total MDQ score not with total BPRS score. The negative correlation was more obvious in participants with negative MDQ (total MDQ score 6 or less, r = -0.31). Several MDQ items (irritability, r = -0.25; decreased sleep, r = -0.27; thought racing, r = -0.28; and easy distractibility, r = -0.40) negatively correlated with “awareness of effect of medication”. In contrast, only one item (guilt feeling, r = -0.27) of BPRS revealed this correlation. Individual items in MDQ and BPRS rarely correlated with each other. Total MDQ score was not correlated with duration of illness and medication adherence. Discussion Manic symptoms were frequently detected even in schizophrenia as reported in previous studies. This made it difficult to differentially diagnose the disorder using only the total MDQ score. There was possible relationship between these manic symptoms and their insight. Identifying manic symptoms in schizophrenia would be considerable in clinical setting.