Yo-Han Lee

Effectiveness of switching to aripiprazole from atypical antipsychotics in patients with schizophrenia.

Objective:To examine changes in cognitive function and clinical features after a switch from atypical antipsychotics to aripiprazole in patients with schizophrenia. Method:Sixty-one patients with schizophrenia treated with atypical antipsychotics participated in this open-label, 26-week study. Antipsychotics were switched to aripiprazole, and neurocognitive functions were measured at 12 and 26 weeks using the computerized battery. The secondary outcome measures were the Positive and Negative Syndrome Scale, the Social and Occupational Functioning Assessment Scale, the Calgary Depression Scale for Schizophrenia, the Subjective Well-being Under Neuroleptics Scale, and the Drug Attitude Inventory (DAI). The safety measures included metabolic parameters, the Simpson-Angus Rating Scale, the Barnes Akathisia Scale, and the Abnormal Involuntary Movement Scale. Results:Significant improvements in cognitive function were observed in the Verbal Learning Test, the Wisconsin Card Sorting Test, and the Trail Making Test part A after a switch to aripiprazole. Scores on the Positive and Negative Syndrome Scale, the Social and Occupational Functioning Assessment Scale, the DAI, the Simpson-Angus Rating Scale, and the Abnormal Involuntary Movement Scale were significantly improved. The metabolic parameters, including serum cholesterol levels, were also improved. The changes in cognitive measures were not correlated with the changes in positive symptoms or movements scales. The improvement of the scores on the DAI and the delayed recall of the Verbal Learning Test were significantly greater in the patients treated with antipsychotics for less than 1 year than in those treated for more than 1 year, in whom the improvement in metabolic parameters was significantly greater. Conclusions:Patients with schizophrenia who switched from their previous antipsychotics to aripiprazole demonstrated improvements in cognitive function, psychotic symptoms, social function, attitude toward medication, and metabolic abnormalities.

Effects of switching to long-acting injectable risperidone from oral atypical antipsychotics on cognitive function in patients with schizophrenia

To investigate changes in cognitive function and clinical features following a switch from oral atypical antipsychotics (AAPs) to long‐acting injectable risperidone (LAIR) in patients with schizophrenia.

Paliperidone ER versus risperidone for neurocognitive function in patients with schizophrenia: a randomized, open-label, controlled trial.

This study aims to determine the effectiveness of paliperidone extended release (ER) on cognitive function in patients with schizophrenia in comparison with risperidone. This was a 12-week, randomized, open-label study on schizophrenia patients who were receiving risperidone. The patients were randomized to a risperidone-continuation group or a paliperidone-switch group. The primary outcome measure was neurocognitive function, which was measured using a computerized battery. Secondary efficacy measures included the Positive and Negative Syndrome Scale, Social and Occupational Functioning Scale, and Calgary Depression Scale for Schizophrenia. In total, 58 patients participated in this trial. Improvements in recall after an interference phase in the verbal learning test were significantly greater in the paliperidone-switch than in the risperidone-continuation group. No significant differences in changes were observed in the other six neurocognitive domains measured. Improvements in the Social and Occupational Functioning Scale were significantly greater in the paliperidone ER-switch group than in the risperidone-continuation group. In other efficacy outcome measures, no significant differences were observed between the two drugs. Paliperidone ER had a side-effect profile similar to that of risperidone, including metabolic problems and prolactin-related adverse events. In conclusion, switching from risperidone to paliperidone ER may lead to additional cognitive and social functional improvements.

Comparison of attitudes toward long-acting injectable antipsychotics among psychiatrists and patients.

The current prescription rate of long-acting injectable antipsychotics (LAI) is less than 1% in Korea. This study aimed to investigate the reason for LAI underuse by surveying the attitudes toward LAI among psychiatrists and patients receiving LAI. A total of 173 psychiatrists and 99 patients receiving LAI participated in the survey. Participating psychiatrists were divided into two groups according to experience with prescribing LAI to at least 10 patients. The two psychiatrist groups did not differ significantly in terms of sociodemographic characteristics and clinical practice patterns. However, the group with higher experience more frequently provided explanations of LAI to their patients and was more satisfied with the use of LAI than the group with less experience. Acceptance rates of patients to the recommendation for LAI treatment and satisfaction of psychiatrists with the outcome of LAI were also significantly higher in the group with higher experience. Psychiatrists with less experience with LAI were more negative toward LAI than patients receiving LAI as well as psychiatrists with higher experience. In conclusion, attitudes of psychiatrists toward LAI were closely related to the use of LAI. The negative attitude and reluctance of psychiatrists, rather than patient resistance, may contribute toward the underuse of LAI.

A prospective, open-label study to evaluate symptomatic remission in schizophrenia with risperidone long-acting injectable in Korea.

This study was designed to investigate long-term clinical outcomes of risperidone long-acting injectable (RLAI) in patients with schizophrenia or schizoaffective disorder. An open-label, 48-week, prospective study of RLAI treatment was carried out at 63 centers in South Korea. Initial and maintenance dosage of RLAI were adjusted according to clinical judgment. Efficacy was measured by the remission rate, continuation rate, and changes in the clinical measurements such as eight items of the Positive and Negative Symptom Scale (PANSS), the Clinical Global Impression – Severity, and the Schizophrenia Quality of Life Scale. In terms of the safety, Simpson-Angus rating Scale, adverse events (AEs), and BMI were investigated. Of the 522 patients who were enrolled, 472 patients who had been assessed on the eight items of PANSS at baseline and at least once during RLAI treatment were included in the intention-to-treat (ITT) population. The per-protocol (PP) population included 184 patients (39.0%), who completed all assessments during 48 weeks of the follow-up period. Total scores of eight items of PANSS, Clinical Global Impression – Severity, and Schizophrenia Quality of Life Scale were reduced significantly from baseline to endpoint in both ITT and PP populations. The mean dose (SD) of RLAI was 33.2 (7.6) mg. In the PP population, the number of patients who scored 1–3 on eight items of PANSS were 47 (25.5%) at baseline and 144 (78.3%) at 48 weeks. According to the remission defining as scores 1–3 on eight items of PANSS sustaining of at least 6 months’ duration by Andreasen, the numbers of patients who achieved remission were 45 (24.5%) at 24 weeks and 120 (65.2%) at 48 weeks. A significant decrease in the mean score of Simpson-Angus rating Scale and a significant increase in BMI over time in last observation carried forward were observed, and patients who fulfilled the remission criteria during the study showed more weight gain than those who did not. During the study period, a total of 645 AEs were noted in 233 patients (49.3%) who were included in the ITT population. Sixty-nine serious AEs in 51 patients were reported, but all of them were not directly attributable to administration of RLAI. This prospective, open-label study showed improvements in symptom and AEs and a significant increase in BMI during 48 weeks of biweekly RLAI treatment. The rate of study completion was 39.0% and the remission rate among those who completed the study was 65.2%. None of the serious AEs were directly related to the administration of RLAI.

Factors associated with self‐rated sexual function in Korean patients with schizophrenia receiving risperidone monotherapy

This study aims to investigate the factors associated with sexual function in Korean patients with schizophrenia.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders

INTRODUCTION Internet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders. METHODS A cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Youngs Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered. RESULTS PIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory. CONCLUSIONS Patients with schizophrenia spectrum disorders and PIU were significantly more likely to have high levels of perceived stress and dysfunctional coping strategies. Patients with schizophrenia spectrum disorders who also engage in PIU may benefit from interventions that help them to develop appropriate skills for coping with stress.