Tae-Suk Kim

Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression.

This study evaluated clinical characteristics and suicidality of patients with anxious depression in a large cohort of samples. Data were collected from 1003 patients who were depressed. A total of 461 patients were diagnosed with anxious depression and 542 were diagnosed with nonanxious depression. After adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a recurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts, and those in this group tended to obtain higher scores on the Scale for Suicide Ideation. The present findings that were drawn from detailed evaluation of suicidality strongly support previous results assessed only with the help of clinical reports. More attention should be paid to assess suicide risk in these patients.

Comparison of venlafaxine extended release versus paroxetine for treatment of patients with generalized anxiety disorder

Abstractu2003 This trial was to evaluate the efficacy and tolerability of venlafaxine extended release (XR) and paroxetine for treatment of patients with generalized anxiety disorder (GAD). Sixty patients who met DSM‐IV criteria for GAD were randomly assigned to either venlafaxine XR or paroxetine for 8u2003weeks. Efficacy was assessed with the Hamilton Rating Scale for Anxiety (HAM‐A) and Clinical Global Impression‐Severity of Illness (CGI‐S) scale at the baseline, week 1, week 4, and week 8. The side‐effects were collected with reported adverse events and laboratory tests throughout the study period. Repeated measures analysis of variance (anova) on the HAM‐A and CGI‐S scores showed a significant decrease over time in both treatment groups without significant group difference or timeu2003×u2003group interaction effect. There were no serious adverse events in both groups. This open trial demonstrated that either venlafaxine XR or paroxetine would be effective and tolerable for the treatment of patients with GAD. Double blind, placebo‐controlled head‐to‐head comparison studies are needed to draw a definite conclusion.

Relationship between Psychological Factors and Quality of Life in Subtypes of Gastroesophageal Reflux Disease

Background/Aims Quality of life (QoL) is consistently decreased in gastroesophageal reflux disease (GERD), but the relationship between QoL and psychological factors in GERD has not yet been clearly defined. The present study investigated the relationship between the psychological factors of two subtypes of GERD and QoL. Methods A cohort of 769 participants underwent upper endoscopic evaluation in the health-promotion center of St. Pauls Hospital. The severity of GERD symptoms, psychological factors, and QoL were analyzed using the Visual Analogue Scale, the Hospital Anxiety and Depression Scale, and the abbreviated version of the World Health Organization Quality of Life instrument, respectively. Results Among the total of 769 participants, 153 participants were included in the exclusion criteria. Erosive reflux disease (ERD) and nonerosive reflux disease (NERD) were present in 106 (14%) and 61 (8%) of the participants, respectively, and 449 (58%) acted as controls. In each GERD group, the QoL had no correlatioion with the symptom severity. The scores for anxiety and depression were highest in the NERD group, and QoL scores were lower in both the ERD and NERD groups than in the control group. Anxiety and depression resulted in QoL scores being lower in both the ERD and NERD groups than in the nonanxiety and nondepressed groups, respectively. Conclusions This study provides evidence that the QoL associated with the ERD and NERD subtypes may be more related to psychological factors than to symptom severity.

Naturalistic observation on the hepatic enzyme changes in patients treated with either risperidone or olanzapine alone.

This retrospective study aimed to compare differences in hepatic enzyme elevation during treatment with either risperidone or olanzapine alone in patients with psychotic disorders. The charts were reviewed for six hundred and sixty-seven (667) inpatients with psychotic disorders who were treated with either risperidone (n=289) or olanzapine (n=145) alone at a university-affiliated hospital between 1998 and 2002. Frequencies of elevation greater than the reference level in any enzyme among aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphotase (ALP) were higher in the olanzapine-treated group (26.9%) than in the risperidone-treated group (14.2%) [odds ratio (OR)=2.225, 95% confidence interval (CI)=1.362–3.638, P=0.002]. Frequencies of elevation greater than the reference level in ALT were higher in the olanzapine-treated group than in the risperidone-treated group (OR=2.182, P=0.004), as were frequencies with two-fold (OR=3.064, P=0.017) and three-fold (OR=2.883, P=0.039) elevation. Recovery time was longer in the olanzapine-treated group than in the risperidone-treated group (P=0.0059), as was latency time (P=0.0044). These results suggest that there are potential differences in antipsychotic-associated hepatic enzyme alterations between risperidone and olanzapine treatment. Controlled, prospective studies should be conducted to identify the risk factors associated with an alteration in hepatic enzymes related to treatment with risperidone and olanzapine.

Neuronal Dysfunction of the Frontal Lobe in Schizophrenia

Localized in vivo proton magnetic resonance spectroscopy (MRS) was performed to evaluate metabolic alterations in the right and left frontal lobe before and after antipsychotic treatment of schizophrenic patients (n = 24) and a group of healthy normal subjects (n = 20). Proton metabolic ratios obtained from the 8 cm3 voxels in the right and left frontal lobes were compared with the clinical assessment for each subject. There was no significant difference in the metabolic ratios between the right and the left frontal lobes in either the schizophrenic group or the control group, indicating no laterality. Compared with those of the normal control group, NAA/Cr ratio of the schizophrenic patients showed significantly lower value. The NAA/Cr ratio of the schizophrenic patients was not changed after antipsychotic treatment. The present study supports the ‘hypofrontality’ hypothesis of schizophrenia.

Clinical characteristics of depressed patients with a history of suicide attempts: results from the CRESCEND study in South Korea.

South Korea is a country with one of the highest suicide rates in the world, and the suicide rate is still on the rise. The purpose of this study was to determine the sociodemographic and clinical characteristics of suicide attempts and risk factors related to suicide attempts among depressed patients in South Korea. Among the 1183 participants, 21.4% had a history of a suicide attempt. When the severity of depression was controlled, the risk factors for patients who attempted suicide included younger age, experienced significant life events before 12 years of age, psychotic symptoms, and previous depressive episodes. The characteristics of attempted suicide in depressed patients in South Korea can be summarized as a high suicide attempt rate with no difference in the number of suicide attempts and lethality between males and females. This unique tendency is probably related to the sociodemographic and cultural characteristics of South Korea.

Re-administration of mirtazapine could overcome previous mirtazapine- associated restless legs syndrome?

Mirtazapine (MIR) has been proved to be effective and tolerable in the treatment of depression with its unique pharmacological profiles, by blockades of the postsynaptic 5-HT 2 and 5-HT 3 receptors and presynaptic a 2-autoreceptor, and by stimulating postsynaptic 5HT 1 receptor. 1 Recently, several reports, 2,3 including our group, 4 have presented MIR-associated restless legs syndrome (RLS) characterized by unpleasant aching sensation of both legs with creeping and crawling feelings, of which the pathophysiology is unclear but mainly supposed to be related to dysfunction of the dopamine pathway and presented mostly by serotonergic-stimulating agents. 5 Interestingly, we experienced two cases that did not show MIR-associated RLS after re-administration of MIR, though they suffered RLS at the first administration of the drug.

Rapid titration versus conventional titration of quetiapine in the treatment of bipolar mania: a preliminary trial.

The present trial was designed as a pilot study to re-examine how fast the dose of quetiapine in combination with mood stabilizers can be titrated upward in acutely ill patients with bipolar mania. Patients were assigned to either a rapid titration group (RTG) or a conventional titration group (CTG). Quetiapine was administered twice daily in a 3-day period in the RTG (200u2009mg/day on day 1; 400u2009mg/day on day 2; and 600u2009mg/day on day 3) and in a 5-day period in the CTG (50u2009mg/day on day 1; 100u2009mg/day on day 2; 200u2009mg/day on day 3; 300u2009mg/day on day 4; and 400u2009mg/day on day 5). The Young Mania Rating Scale (YMRS) and Clinical Global Impression-Severity (CGI-S) scores were assessed at days 1 (baseline), 3, 5, 7, 14 and 21. The Barnes Akathisia Rating Scale and Simpson–Angus Rating Scale (SARS) were assessed at days 1, 2, 3, 4, 5, 6, 7, 14 and 21. RTG and CTG showed significant improvement on the scores of YMRS and CGI-S during the study without group differences. Both treatments were well tolerated without clinically significant differences in tolerability measures. Treatment was not limited by adverse events in the two groups. This study demonstrates the potential benefit and tolerability of rapid titration of quetiapine in the treatment of acutely ill bipolar disorder. This preliminary study proposes that rapid titration of quetipaine in combination with a mood stabilizer for the treatment of bipolar mania is effective and tolerable in comparison with conventional titration. A controlled study with a larger cohort should be performed.

Paroxetine-associated spontaneous sexual stimulation

The sexual side-effects of selective serotonin reuptake inhibitors have been widely accepted and clinicians should only prescribe these agents for the treatment of premature ejaculation in the real clinical practice. We recently experienced three cases of paroxetine-associated sexual stimulation in the outpatient clinic. Because there is little information in the existing literature on this issue, we report three female cases who developed frequent spontaneous orgasm and increased libido during paroxetine treatment.

Role of Depressive Symptoms in Coronary Artery Spasm

All subjects had comprehensive medical assessments, including physical examination and routine laboratory tests. Detailed medical history and lifestyle information were taken by cardiologists who were unaware of the condition of the subjects. CAG was conducted for confirmative and differential diagnosis of coronary artery disease [8] . Coronary atherosclerosis was diagnosed by the presence of atherosclerotic stenosis that was 50% larger than the luminal reference diameter in one or more coronary arteries. Coronary spasm was diagnosed by induced coronary artery spasm showing 1 90% narrowing of a coronary artery from the baseline diameter (i.e. chest symptoms and ST-segment elevation after intracoronary injection of acetylcholine). Control subjects were defined as having neither of these conditions, but having recurrent chest pain. In order to yield a psychiatric diagnosis, semi-structured interviews were held by a psychiatrist who was completely unaware of the medical history or status of the study subjects. These interviews were conducted within a 24-hour period after CAG, utilizing DSM-IV criteria. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HDRS) [9, 10] . We used univariate and multivariate multinomial logistic regression models to investigate the relation between depression and coronary artery disease as determined by CAG. Multinomial logistic regression modeling with outcome measures of normal coronary angiographic findings, coronary spasm and coronary atherosclerosis were used. Known risk factors for coronary atherosclerosis in the statistical modeling were: age 1 65 years, male gender, increased lowdensity lipoprotein level ( 6 100 mg/dl) [11] , increased body mass index ( 6 23) [12] , history of or current smoking, and the presence of diabetes or hypertension. Clinical depression was defined according to the criteria HDRS scores 6 12 [13] . To test whether there is a dose-response relationship between depressive symptom severity and the risk of specific types of coronary artery disease, the subjects were stratified into 3 groups. These groups consisted of a no-to-minimal group (scores ̂ 7), a mild group (scores 8–11) and a moderate-to-severe group (scores