Young Sup Woo

Atypical antipsychotics in the treatment of delirium.

The aim of this study was to review the efficacy and safety of atypical antipsychotics, comparing within class, placebo, or compared to another active treatment for delirium. A literature search was conducted using PubMed, EMBASE, and the Cochrane database (1 January 1990–5 November 2012). Selection criteria for review were prospective, controlled studies (comparison studies), using validated delirium rating scales as outcome measures. A total of six prospective, randomized controlled studies were included in the review. It was found that atypical antipsychotics are effective and safe in treating delirium, even though there seemed to be no difference between each agent. In particular, comparison studies with haloperidol showed that the efficacy of atypical antipsychotics was similar to that of low‐dose haloperidol. It was concluded that atypical antipsychotics appear to be effective and tolerable in the management of delirium, even though the evidence is limited.

Cognitive Deficits as a Mediator of Poor Occupational Function in Remitted Major Depressive Disorder Patients

Cognitive deficits in major depressive disorder (MDD) patients have been described in numerous studies. However, few reports have aimed to describe cognitive deficits in the remitted state of MDD and the mediational effect of cognitive deficits on occupational outcome. The aim of the current review is to synthesize the literature on the mediating and moderating effects of specific domains of cognition on occupational impairment among people with remitted MDD. In addition, predictors of cognitive deficits found to be vocationally important will be examined. Upon examination of the extant literature, attention, executive function and verbal memory are areas of consistent impairment in remitted MDD patients. Cognitive domains shown to have considerable impact on vocational functioning include deficits in memory, attention, learning and executive function. Factors that adversely affect cognitive function related to occupational accommodation include higher age, late age at onset, residual depressive symptoms, history of melancholic/psychotic depression, and physical/psychiatric comorbidity, whereas higher levels of education showed a protective effect against cognitive deficit. Cognitive deficits are a principal mediator of occupational impairment in remitted MDD patients. Therapeutic interventions specifically targeting cognitive deficits in MDD are needed, even in the remitted state, to improve functional recovery, especially in patients who have a higher risk of cognitive deficit.

Aripiprazole plus divalproex for recently manic or mixed patients with bipolar I disorder: a 6-month, randomized, placebo-controlled, double-blind maintenance trial.

The goal of this study was to investigate the safety and efficacy in preventing relapse of a mood episode in recently manic or mixed episode patients with bipolar I disorder stabilized with aripiprazole and divalproex combination.

Lurasidone as a potential therapy for bipolar disorder.

Lurasidone is a benzisothiazol derivative and an atypical antipsychotic approved by the US Food and Drug Administration for the acute treatment of adults with schizophrenia (October 2010) and bipolar 1 depression (June 2013). Lurasidone has a strong antagonistic property at the D2, serotonin (5-HT)2A, and 5-HT7 receptors, and partial agonistic property at the 5-HT1A receptor. Lurasidone also has lower binding affinity for the α2C and 5-HT2C receptor. Lurasidone is rapidly absorbed (time to maximum plasma concentration: 1–3 hours), metabolized mainly by CYP3A4 and eliminated by hepatic metabolism. In two large, well-designed, 6-week trials in adult patients with bipolar 1 depression, lurasidone monotherapy and adjunctive therapy with mood stabilizers were significantly more effective than placebo at improving depressive symptoms assessed using the Montgomery–Åsberg Depression Rating Scale total score. In both trials, lurasidone also reduced the Clinical Global Impression–Bipolar Severity depression score to a greater extent than placebo. In these two trials, discontinuation rates due to adverse events in the lurasidone group were small (<7%) and were not different from those of the placebo group. The most common adverse events in the lurasidone group were headache, nausea, somnolence, and akathisia. The changes in lipid profiles, weight, and parameters of glycemic control were minimal, and these findings were in line with those observed in schizophrenia trials. Further active comparator trials and long-term tolerability and safety data in bipolar patients are required. Lurasidone may be an option for the management of depressive symptoms in patients with bipolar 1 disorder, and it may be considered as a treatment alternative for patients who are at high risk for metabolic abnormalities.

A diagnosis of bipolar spectrum disorder predicts diagnostic conversion from unipolar depression to bipolar disorder: A 5-year retrospective study

BACKGROUND The major aims of this study were to identify factors that may predict the diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BP) and to evaluate the predictive performance of the bipolar spectrum disorder (BPSD) diagnostic criteria. METHODS The medical records of 250 patients with a diagnosis of MDD for at least 5 years were retrospectively reviewed for this study. RESULTS The diagnostic conversion from MDD to BP was observed in 18.4% of 250 MDD patients, and the diagnostic criteria for BPSD predicted this conversion with high sensitivity (0.870) and specificity (0.917). A family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age of onset, antidepressant wear-off, and antidepressant resistance were also independent predictors of this conversion. LIMITATIONS This study was conducted using a retrospective design and did not include structured diagnostic interviews. CONCLUSIONS The diagnostic criteria for BPSD were highly predictive of the conversion from MDD to BP, and conversion was associated with several clinical features of BPSD. Thus, the BPSD diagnostic criteria may be useful for the prediction of bipolar diathesis in MDD patients.

The bipolar diathesis of treatment-resistant major depressive disorder

Objective. In this study, we determined the prevalence of bipolarity in patients with treatment-resistant depression (TRD) by investigating demographic and clinical characteristics, diagnostic subtypes and illness outcome of patients with resistant depression. Methods. A medical record review of patients who were admitted to a university hospital with the diagnosis of major depressive disorder (MDD) was conducted. DSM-IV diagnoses at the index hospitalization and 6 months after discharge and detailed clinical information were obtained. We categorized subjects into a TRD group or a non-TRD group and re-evaluated the patients using the criteria for bipolar spectrum disorders. Results. There were 281 patients diagnosed with MDD. At discharge, the number of patients who fulfilled the criteria for BSD was higher in the TRD group (47.1%) than in the non-TRD group (3.8%) (P<0.001). At the end of the 6-month follow-up period, the diagnoses of 38 patients were changed; 18 (26.5%) of the TRD group were subsequently classified as having a bipolar disorder, as were seven (3.3%) in the non-TRD group (P<0.001). There was no difference between these two groups for other clinical and demographic variables. Conclusion. The findings of this study suggest that many patients with TRD have a bipolar diathesis.

Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients

Background. Numerous reports have linked atypical antipsychotics, especially clozapine and olanzapine, to the development of cardiovascular risk factors. In this retrospective chart review study, we investigated the blood pressure changes in Korean schizophrenic inpatients treated with clozapine or olanzapine. Method. We reviewed the medical record of schizophrenic patients treated with clozapine or olanzapine for 8 weeks. A total of 167 patients were included in the study; 70 patients in clozapine group and 97 patients in olanzapine group. Systolic and diastolic blood pressures prior to medication and at post-treatment (8-week) were assessed, and changes in blood pressure were analyzed. The prevalence of hypertension at the time of study period was assessed and compared between the two groups. Results. There was a significant difference in hypertension prevalence in comparisons between the clozapine and olanzapine group. The systolic and diastolic blood pressures in the clozapine group were significantly increased after treatment, but systolic and diastolic blood pressures in olanzapine group did not change significantly. Conclusion. Our findings suggest that clozapine treatment may be associated with increased blood pressure and higher prevalence of hypertension, which may have a significant impact on medical morbidity and mortality.

Caffeine-induced psychiatric manifestations: a review.

The association between caffeine consumption and various psychiatric manifestations has long been observed. 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. 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. 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.

Obesity and Its Potential Effects on Antidepressant Treatment Outcomes in Patients with Depressive Disorders: A Literature Review

Accumulating evidence regarding clinical, neurobiological, genetic, and environmental factors suggests a bidirectional link between obesity and depressive disorders. Although a few studies have investigated the link between obesity/excess body weight and the response to antidepressants in depressive disorders, the effect of weight on treatment response remains poorly understood. In this review, we summarized recent data regarding the relationship between the response to antidepressants and obesity/excess body weight in clinical studies of patients with depressive disorders. Although several studies indicated an association between obesity/excess body weight and poor antidepressant responses, it is difficult to draw definitive conclusions due to the variability of subject composition and methodological differences among studies. Especially, differences in sex, age and menopausal status, depressive symptom subtypes, and antidepressants administered may have caused inconsistencies in the results among studies. The relationship between obesity/excess body weight and antidepressant responses should be investigated further in high-powered studies addressing the differential effects on subject characteristics and treatment. Moreover, future research should focus on the roles of mediating factors, such as inflammatory markers and neurocognitive performance, which may alter the antidepressant treatment outcome in patients with comorbid obesity and depressive disorder.

Atypical antipsychotics in the treatment of posttraumatic stress disorder.

ObjectivesThis study reviewed extant published articles on the efficacy and safety of atypical antipsychotics for the treatment of posttraumatic stress disorder (PTSD). MethodsWe performed a literature search using PubMed, EMBASE, and the Cochrane database in January 2013. Selection criteria for this review included prospective, controlled studies using validated rating scales of PTSD symptoms in the management of PTSD. ResultsA total of 12 prospective, controlled studies were included in this review. This review found that atypical antipsychotics are effective and safe in treating PTSD, although there were some negative findings. In particular, atypical antipsychotics also seem to be effective in treating anxiety, depression, and psychotic symptoms frequently accompanied by PTSD. ConclusionsThis review found that atypical antipsychotics seemed to be effective and tolerable in the management of PTSD, although the evidence was limited.