ObjectivezzThe purpose of this study was to assess the effect of the weight reduction program designed for schizophrenic patients. It’s effects were assessed especially in the aspects of the obesity-related quality of life, emotional and physical wellbeing of the patients. MethodszzFifty-one obese schizophrenic inpatients were enrolled in a 12-week, randomized weight reduction program. Thirty-two patients were randomly assigned to an intervention group in which they received the weight management program. Nineteen patients were allocated to the control group in which they received the usual clinical inpatient treatments. Body weight, Body Mass Index (BMI) and Quality of Life Scales such as Short Form of Medical Outcome Study (SF-36), Korean version of Obesity-related Quality of Life Scale (KOQOL) and Korean version of Body Weight, Image and Self-Esteem Evaluation Questionnaire (B-WISE-K) were evaluated during 12-week period. All assessments were done at baseline, 4, 8 and 12 week. Repeated measures of analysis of variance and post-hoc comparisons were done to compare the group differences from baseline at each visit. ResultszzSixteen of 32 (50%) patients in intervention group and 12 of 19 (69.4%) patients in control group completed this study. We found significant group by time interaction effects in weight, BMI and waist circumferences (p<0.05, respectively). The weight changes from baseline to 8 week and 12 week were significant in post-hoc comparisons between intervention and control groups (p<0.05 and p<0.01, respectively). The changes of BMI and waist circumference from baseline to 12-week were also significant in post-hoc comparisons (p<0.05). After completion of the weight management program, there were significant differences on the subjective estimates such as physical component summary of SF-36, and total scores, psychosocial heath, physical health and diet of the KOQOL, and total scores of B-WISE-K between intervention and control group. These significant differences were found at 12-week of treatment in post-hoc comparisons (p<0.05, respectively). ConclusionzzThe weight reduction program was effective for weight loss in schizophrenic inpatients. In addition, it might improve the subjective estimates such as obesity-related quality of life and weight-related body image in schizophrenic inpatients. Korean J Psychopharmacol 2012;23:190-199 Key WordszzSchizophrenia · Obesity · Weight reduction · Obesity-related quality of life · Well-being.
Many treatment guidelines for bipolar disorders have been introduced to assist clinical decision. Majority of these guidelines are based on evidences from clinical trials. The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed to adopt and maintain an expert-consensus paradigm which was more practical and specific to the atmosphere in Korea. In this research, preferred medication strategies for acute mania over four consecutively published KMAP-BP guidelines (2002, 2006, 2010, 2014, and 2018) were investigated. The KMAP-BP questionnaire using a nine-point scale had covered some specific clinical situations divided into subsections with many treatment options. A written survey asked about the appropriateness of various treatment strategies and treatment agents commonly used by clinicians as the first-line. The most preferred initial treatment strategy for all subtypes of mania was a combination of mood stabilizer (MS) and atypical antipsychotic (AAP) in every edition. In contrast to MS monotherapy, the preference of combination therapy has been increased over time. Among MSs, lithium and valproic acid are almost equally preferred except in the mixed subtype where valproic acid is the most recommended MS. Carbamazepine was the first-line MS only in the first edition. Olanzapine, quetiapine, and aripiprazole were the preferred AAP for acute manic episode in later editions. This change might depend on the recent research results and safety profile. In cases of unsatisfactory response to the first-line medications, we recommended switching or adding another first-line agent. In KMAP-BP 2018, MS (more preferred as treatment of choice) or AAP monotherapy was first-line medication. The Korean experts have been increasingly convinced of the effectiveness of a combination therapy for acute manic episode. There have been evident preference changes: increased for AAP and decreased for carbamazepine.
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. 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. 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. The results suggest that blonanserin may be effective and well tolerable in schizophrenic patients who showed inadequate treatment response or poor tolerability.
Young Sup Woo, MD, PhD, Won-Myong Bahk, MD, PhD, Duk-In Jon, MD, PhD, Jeong Seok Seo, MD, PhD, Jung Goo Lee, MD, PhD, Jong-Hyun Jeong, MD, PhD, Moon-Doo Kim, MD, PhD, Inki Sohn, MD, PhD, Se-Hoon Shim, MD, PhD, Kyung Joon Min, MD, PhD, Bo-Hyun Yoon, MD, PhD and Young-Chul Shin, MD, PhD Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Department of Psychiatry, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University and Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan, Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Department of Psychiatry, Jeju National University Hospital, Jeju, Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Department of Psychiatry, Naju National Hospital, Naju, Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea
Introduction There have been many changes in the treatment of bipolar disorder. Objective It is necessary to develop guidelines that can more aptly respond to cultural issues and specifics in different countries. Aims The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder. Methods The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts. Results Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Combination of MS and AAP was the treatment of choice for management of mixed features. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options. Conclusion Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
Abstract Background The objective of this study was to investigate the effects of group arts therapy based on emotion management training on emotional expression, positive emotion and negative emotion, alexithymia, depression and quality of life in patients with schizophrenia. Methods 24 of 160 in-patients with schizophrenia, according to DSM-IV from H Mental Health Hospital, were randomly assigned to either an experimental or control group. Each group were consisting of 12 patients. Group arts therapy was conducted on the experimental group twice a week, 60 minutes per session, for a total of 16 sessions, while the control group was left untreated. The following scales were used for assessment: Berkeley Expressivity Questionnaire (BEQ), Positive Affective and Negative Affect Schedule (PANAS), Toronto Alexithymia Scale-Korean vesion (TAS-20K), Depression Scale for Schizophrenia (K-CDSS), Positive and Negative Syndrome Scale (PANSS), and Schizophrenia Quality of Life Scale (SQLS-R4K). Independent t-test was conducted to confirm the homogeneity, and to find the effects of group arts therapy, Repeated measures ANOVA was conducted to confirm the differences for scores of each scales regarding groups, measuring timing, and also the interaction between groups and measuring timing by pre, post and follow-up test. Results The result of this study are as follows. First, total score, expressivity factors and impulse strength factors of emotional expressivity were significantly increased after group arts therapy compared to the control group. Second, positive emotion was significantly increased and negative emotion was significantly decreased after group integrative therapy compared to the control group. Third, total score, difficulty identifying feelings of Alexithymia were significantly decreased after group arts therapy compared to the control group. Fourth, depression was significantly decreased after group integrative arts therapy compared to the control group. Fifth, negative syndromes and general psychopathology were significantly decreased after group arts therapy compared to the control group. Sixth, quality of life was significantly increased after group arts therapy compared to the control group. Discussion The group arts therapy have significantly improved the emotional expression, positive emotion, negative emotion and Alexithymia in patients with schizophrenia and also improved negative syndromes, general psychopathology, depression and quality of life. These result suggest that group arts therapy based on emotion management training could be a useful intervention for emotional disturbance treatment for in patients with schizophrenia.
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