Objective: The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar... more Objective: The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). Methods: A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. Results: The internal consistency (Cronbach's alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p ＜ 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). Conclusion: The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.
The objective of this study was to compare recommendations of the Korean Medication Algorithm Pro... more The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) with other recently published guidelines for treating bipolar disorder. We reviewed a total of six recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2022 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy in a same degree for mania. However, the KMAP-BP 2022 recommended MS + AAP combination therapy for psychotic mania, mixed mania and psychotic depression as treatment of choice. Aripiprazole, quetiapine and olanzapine were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Some guideline suggested olanzapine is a second-line options during maintenance treatment, related to concern about long-term tolerability. Most guidelines advocated newer AAPs (asenapine, cariprazine, long-acting injectable risperidone, and aripiprazole once monthly) as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. KMAP-BP 2022 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2022, predominantly in the treatment of psychotic mania, mixed mania and psychotic depression.
Objectives The present study was carried out to revise the guidelines for the Korean Medication A... more Objectives The present study was carried out to revise the guidelines for the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2018. The revision was carried out based on expert opinions to facilitate clinical decisions related to the treatment of bipolar disorders in patients with comorbid physical illnesses. Methods A 56-item questionnaire was developed; a consensus was arrived at by 87 out of 93 experts (93.5%), on the pharmacological treatment strategies to be used in cases of comorbid physical illnesses accompanying bipolar disorders. Results For patients with bipolar disorder exhibiting comorbid conditions, by consensus, lamotrigine, aripiprazole, and ziprasidone were recommended as the first-line strategies for metabolic
Objective: The purpose of this study was to compare the efficacy and tolerability of continued ol... more Objective: The purpose of this study was to compare the efficacy and tolerability of continued olanzapine (OLA) versus amisulpride (AMI) augmentation in schizophrenic patients with poor response to OLA monotherapy. Methods: The present 4-week, randomized, rater-blinded study included 25 patients with schizophrenia who were partially or completely unresponsive to treatment with OLA monotherapy. Eligible subjects were randomly assigned at a 1:1 ratio to continuation of OLA monotherapy (OLA group) or OLA with AMI augmentation (AMI group). Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 1, 2, and 4 weeks. Results: The changes in PANSS total score and PANSS-positive subscale score were significantly different (p ＜ 0.05) between the OLA and AMI groups. The differences between the two groups in PANSS-negative subscale, PANSS-general subscale, Brief Psychiatric Rating Scale, and Clinical Global Impression-Severity (CGI-S) scale scores were not statistically significant. Conclusion: AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.
Bipolar disorder is a mental illness that causes extreme mood swings and has a chronic course. Ho... more Bipolar disorder is a mental illness that causes extreme mood swings and has a chronic course. However, the mechanism by which mood episodes with completely opposite characteristics appear repeatedly, or a mixture of symptoms appears, in patients with bipolar disorder remains unknown. Therefore, mood stabilizers are indicated only for single mood episodes, such as manic episodes and depressive episodes, and no true mood-stabilizing drugs effective for treating both manic and depressive episodes currently exist. Therefore, in this review, therapeutic targets that facilitate the development of mood stabilizers were examined by reviewing the current understanding of the neuromolecular etiology of bipolar disorder.
Clinical Psychopharmacology and Neuroscience, 2022
Objective: This study investigated the prevalence and comorbidities of attention deficit hyperact... more Objective: This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. Methods: This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. Results: We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (＞ 18 years) during this period. Among adult and children/adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53− 78.91) had at least one psychiatric comorbidity, respectively. Conclusion: Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.
Clinical Psychopharmacology and Neuroscience, 2022
similar to those from other CPGs, although there were some differences. The KMAP-DD 2021 reflecte... more similar to those from other CPGs, although there were some differences. The KMAP-DD 2021 reflected social culture and the healthcare system in Korea and recent evidence about pharmacotherapy for depression, as did other recently published evidence-based guidelines. Despite some intrinsic limitations as an expert consensus-based guideline, the KMAP-DD 2021 can be helpful for Korean psychiatrists making decisions in clinical settings by complementing previously published evidence-based guidelines, especially for some clinical situations lacking evidence from rigorously designed clinical trials.
Close connections between depression and type 2 diabetes (T2DM) have been suggested by many epide... more Close connections between depression and type 2 diabetes (T2DM) have been suggested by many epidemiological and experimental studies. Disturbances in insulin sensitivity due to the disruption of various molecular pathways cause insulin resistance, which underpins many metabolic disorders, including diabetes, as well as depression. Several anti-hyperglycemic agents have demonstrated antidepressant properties in clinical trials, probably due to their action on brain targets based on the shared pathophysiology of depression and T2DM. In this article, we review reports of clinical trials examining the antidepressant effect of these medications, including insulin, metformin, glucagon like peptide-1 receptor agonists (GLP-1RA), and peroxisome proliferator-activated receptor (PPAR)-γ agonists, and briefly consider possible molecular mechanisms underlying the associations between amelioration of insulin resistance and improvement of depressive symptoms. In doing so, we intend to suggest an ...
Feasibility of Korean Medication Algorithm for Bipolar Disorder(IV):Quality of Life Kyung Joon Mi... more Feasibility of Korean Medication Algorithm for Bipolar Disorder(IV):Quality of Life Kyung Joon Min, MD, Won-Myong Bahk, MD, Duk-In Jon, MD, Young Chul Shin, MD, Chan-Hyung Kim, MD, Bo-Hyun Yoon, MD, Hyun-Sang Cho, MD, Jun Soo Kwon, MD and Feasibility of Korean Medication Algorithm for Bipolar Disorder Project Group Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Department of Psychiatry, College of Medicine, Catholic University, Seoul, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Koyang, Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Naju National Hospital, Naju, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korean College of Neuropsychopharmacology and Korean Academy of Schizophrenia, Korea Objective:The Korean College of Neuropsychopharmacology and the ...
Kyung Joon Min, MD, Won-Myong Bahk, MD, Bo-Hyun Yoon, MD, Won Kim, MD, Byungsu Kim, MD, Jung Goo ... more Kyung Joon Min, MD, Won-Myong Bahk, MD, Bo-Hyun Yoon, MD, Won Kim, MD, Byungsu Kim, MD, Jung Goo Lee, MD, Yeon Ho Joo, MD, Jeong-Seok Seo, MD, Eun Lee, MD, Yong Min Ahn, MD, Young Chul Shin, MD, Young Sup Woo, MD and Duk-In Jon, MD Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Naju National Hospital, Naju, Department of Psychiatry, College of Medicine, Inje University, Seoul, Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Stress Clinic, Health Promotion Center, Asan Medical Center, Seoul, Department of Psychiatry, College of Medicine, Inje Universtiy Haeundae Paik Hospital and Paik Institute for Clinical Research, Busan, Department of Psychiatry, College of Medicine, Konkuk University, Chungju, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Department of Psychiatry, College of Medicine, Seoul Na...
Feasibility of Korean Medication Algorithm for Bipolar Disorder(II): Choice of Medications Young ... more Feasibility of Korean Medication Algorithm for Bipolar Disorder(II): Choice of Medications Young Chul Shin, MD, Won-Myong Bahk, MD, Chan-Hyung Kim, MD, Kyung Joon Min, MD, Bo-Hyun Yun, MD, Hyun-Sang Cho, MD, Jun Soo Kwon, MD, Duk-In Jon, MD, and Feasibility of Korean Medication Algorithm for Bipolar Disorder Project Group Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Department of Psychiatry, College of Medicine, Catholic University, Seoul, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Naju National Hospital, Naju, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Goyang, Korean College of Neuropsychopharmacology and Korean Academy of Schizophrenia, Korea Objective:The Korean College of Neuropsychopharmacology a...
Clinical Psychopharmacology and Neuroscience, 2021
The aim of the present study is to identify the factors that affect retention in outpatients with... more The aim of the present study is to identify the factors that affect retention in outpatients with psychiatric disorders as indicators of treatment adherence, including Minnesota Multiphasic Personality Inventory (MMPI) scores. Methods: The medical records of 146 patients diagnosed with major depressive disorder, bipolar disorder, or anxiety disorder for at least 10 years and discharged were retrospectively reviewed in the present study. The subjects were categorized based on the duration of outpatient treatment as ＜ 6 months (L6) or ≥ 6 months (M6) groups and reclassified as ＜ 36 months (L36) and ≥ 36 months (M36) groups. The demographic, clinical, and personality characteristics of the groups were compared. Results: Patients in M6 and M36 groups were more likely to have a higher educational level compared with those in the L6 and L36 groups, respectively. Patients in the M6 group showed significantly lower hypomania (Ma) scores on the MMPI test than did patients in the L6 group. Conclusion: The association between high Ma score on the MMPI test and early discontinuation of treatment suggests that impulsivity, hostility, and disinhibition confer higher risk of nonadherence.
Journal of Korean Neuropsychiatric Association, 2021
This edition reflected new findings and the latest trends in the areas of pharmacological treatme... more This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results For persisting depressive disorder, antidepressant monotherapy including selective
Growing evidence suggests that early life stress (ELS) has long-lasting effects on glucocorticoid... more Growing evidence suggests that early life stress (ELS) has long-lasting effects on glucocorticoid receptor (GR) expression and behavior via epigenetic changes of the GR exon 17 promoter. However, it remains unclear whether ELS regulates histone modifications of the GR exon 17 promoter across the life span. We investigated the effects of maternal separation (MS) on histone acetylation and methylation of GR exon 17 promoter in the hippocampus, according to the age of adults. Depression-like behavior and epigenetic regulation of GR expression were examined at young and middle adulthood in mice subjected to MS from postnatal day 1 to 21. In the forced swimming test, young adult MS mice showed no effect on immobility time, but middle-aged MS mice significantly increased immobility time. Young adult and middle-aged MS mice showed decreased GR expression. Their two ages showed decreased histone acetylation with increased histone deacetylases (HDAC5) levels, decreased permissive methylation...
Beginning with the concept of the brain–gut axis, the importance of the interaction between the b... more Beginning with the concept of the brain–gut axis, the importance of the interaction between the brain and the gastrointestinal tract has been extended to the microbiome with increasing clinical applications. With the recent development of various techniques for microbiome analysis, the number of relevant preclinical and clinical studies on animals and human subjects has rapidly increased. Various psychotic symptoms affect the intestinal microbiome through the hypothalamus–pituitary–adrenal gland axis. Conversely, the intestinal microbiome regulates the gastrointestinal tract environment and affects psychological factors by means of the microorganisms or their metabolites, either acting directly on the brain or through the synthesis of various neurotransmitters. This review discusses the clinical applicability of the brain–gut–microbiome axis and directions for improving psychological symptoms based on the studies published to date.
Background Although mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT... more Background Although mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT) appear to be efficacious treatments for bipolar disorder (BD) in research settings, the longterm response to these mood stabilizers in clinical practice is highly variable among individuals. Thus, the present study examined the characteristics associated with good or insufficient responses to long-term treatment with LIT, VAL, or LMT for BD. Methods This study retrospectively analyzed the medical records of patients who visited an outpatient clinic with a diagnosis of BD I or II. Data from patients who were treated with one of three mood stabilizing medications (LIT, VAL, or LMT) for more than 6 months were selected, and the long-term treatment responses were evaluated using the Alda scale. For the purposes of this study, two response categories were formed: insufficient response (ISR), including non-response or poor response (Alda total score � 6), and good response (GR; Alda total score � 7). Results Of the 645 patients included in the present study, 172 were prescribed LIT, 320 were prescribed VAL, and 153 were prescribed LMT for at least 6 months. A binary logistic
Clinical Psychopharmacology and Neuroscience, 2019
Objective: The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depressi... more Objective: The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depression in the elderly. The primary aims of this study were to describe the validation of the Korean version of the DIA-S (K-DIA-S) and to compare its validity with that of other depression screening questionnaires used in elderly outpatients in medical settings. Methods: A total of 385 elderly outpatients completed the K-DIA-S and underwent the Mini International Neuropsychiatric Interview to diagnose depressive disorders. Other measures included the 15-item short form of the Geriatric Depression Scale (SGDS), the 9-item depression module of the Patient Health Questionnaire (PHQ-9), and the Montgomery-Asberg Depression Rating Scale (MADRS). Reliability and validity tests, an optimal cutoff point estimate, and receiver operating characteristic curve analysis were performed to investigate the diagnostic validity of the K-DIA-S. Areas under the curves (AUCs) for the K-DIA-S, SGDS, and PHQ-9 were compared statistically. Results: The K-DIA-S showed good internal consistency and strong correlations with the SGDS (r = 0.853), PHQ-9 (r = 0.739), and MADRS (r = 0.772). The cutoff point of the K-DIA-S that can be recommended for screening depressive symptoms was a score of 4. For "any depressive disorder", the AUC (standard error) for the K-DIA-S was 0.896 (0.015), which was significantly larger than that for the PHQ-9 (p = 0.033). Conclusion: The present findings suggest that the K-DIA-S has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in elderly populations and medically ill patients.
International Journal of Methods in Psychiatric Research, 2019
Objectives: The purpose of this study was to evaluate the prevalence of mixed features using the ... more Objectives: The purpose of this study was to evaluate the prevalence of mixed features using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and to examine how patients with mixed states would be classified using the DSM-5. Methods: In total, 12 hospitals participated in this study, and data on the demographic characteristics and clinical diagnoses of patients treated between October 2013 and September 2016 were obtained. We reviewed the data for oppositepolarity symptoms according to the DSM-5 criteria and the research-based diagnostic criteria. Results: Of the 859 patients included in the final analysis, the prevalence of mixed features in patients with major depressive episodes based on the DSM-5 remained low. Patients with major depressive disorder were more likely to be classified as experiencing anxious distress and/or a cluster-B personality disorder in mixed state patients not diagnosed with DSM-5 mixed features, whereas more mixed state patients with bipolar disorder were diagnosed with mixed features using the DSM-5. Conclusions: The prevalence of mixed features did not increase significantly when the DSM-5 was used, and patients with mixed states were more likely to be classified as having anxious distress and/or a cluster-B personality disorder in addition to mixed features.
Clinical Psychopharmacology and Neuroscience, 2019
Objective: Although the association between low vitamin D levels and depressive symptoms has been... more Objective: Although the association between low vitamin D levels and depressive symptoms has been widely reported, studies investigating the relationship between hypovitaminosis D and depressive symptomatology are scarce. Methods: We retrospectively studied the relationship between vitamin D status and depressive symptoms in 196 patients hospitalized for a major depressive episode. Results: The baseline 17-item Hamilton Depression Rating Scale total and depression factor (item 1, 2, 3, 7) scores were significantly higher in the vitamin-D-insufficiency/deficiency group than in the vitamin-D-sufficiency group. Conclusion: It is important to consider measuring the vitamin D levels of patients with severe and core depressive symptoms and providing vitamin D supplementation when necessary.
Background: Impairment of cognitive function as well as negative symptom is the major factor caus... more Background: Impairment of cognitive function as well as negative symptom is the major factor causing the decline of a patient's functioning in chronic stages of schizophrenia. However, until now, there were no definite treatment options that could effectively reduce the impairment. Case presentation: We report a case of mood dysregulation associated with use of Ginkgo biloba in a patient with schizophrenia. After Ginkgo biloba was given, the patient experienced cluster symptoms of mood dysregulation including irritability, difficulty in controlling anger, agitation and restlessness. We estimated the possibility as "probable" according to Naranjo scale considering circumstantial evidence. Conclusions: This case suggests that Ginkgo biloba may have caused mood dysregulation in this patient. Although it is generally accepted as safe, more attention should be given to the adverse effect when treating with Ginkgo biloba.
Objective: The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar... more Objective: The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). Methods: A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. Results: The internal consistency (Cronbach's alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p ＜ 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). Conclusion: The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.
The objective of this study was to compare recommendations of the Korean Medication Algorithm Pro... more The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) with other recently published guidelines for treating bipolar disorder. We reviewed a total of six recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2022 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy in a same degree for mania. However, the KMAP-BP 2022 recommended MS + AAP combination therapy for psychotic mania, mixed mania and psychotic depression as treatment of choice. Aripiprazole, quetiapine and olanzapine were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Some guideline suggested olanzapine is a second-line options during maintenance treatment, related to concern about long-term tolerability. Most guidelines advocated newer AAPs (asenapine, cariprazine, long-acting injectable risperidone, and aripiprazole once monthly) as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. KMAP-BP 2022 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2022, predominantly in the treatment of psychotic mania, mixed mania and psychotic depression.
Objectives The present study was carried out to revise the guidelines for the Korean Medication A... more Objectives The present study was carried out to revise the guidelines for the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2018. The revision was carried out based on expert opinions to facilitate clinical decisions related to the treatment of bipolar disorders in patients with comorbid physical illnesses. Methods A 56-item questionnaire was developed; a consensus was arrived at by 87 out of 93 experts (93.5%), on the pharmacological treatment strategies to be used in cases of comorbid physical illnesses accompanying bipolar disorders. Results For patients with bipolar disorder exhibiting comorbid conditions, by consensus, lamotrigine, aripiprazole, and ziprasidone were recommended as the first-line strategies for metabolic
Objective: The purpose of this study was to compare the efficacy and tolerability of continued ol... more Objective: The purpose of this study was to compare the efficacy and tolerability of continued olanzapine (OLA) versus amisulpride (AMI) augmentation in schizophrenic patients with poor response to OLA monotherapy. Methods: The present 4-week, randomized, rater-blinded study included 25 patients with schizophrenia who were partially or completely unresponsive to treatment with OLA monotherapy. Eligible subjects were randomly assigned at a 1:1 ratio to continuation of OLA monotherapy (OLA group) or OLA with AMI augmentation (AMI group). Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 1, 2, and 4 weeks. Results: The changes in PANSS total score and PANSS-positive subscale score were significantly different (p ＜ 0.05) between the OLA and AMI groups. The differences between the two groups in PANSS-negative subscale, PANSS-general subscale, Brief Psychiatric Rating Scale, and Clinical Global Impression-Severity (CGI-S) scale scores were not statistically significant. Conclusion: AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.
Bipolar disorder is a mental illness that causes extreme mood swings and has a chronic course. Ho... more Bipolar disorder is a mental illness that causes extreme mood swings and has a chronic course. However, the mechanism by which mood episodes with completely opposite characteristics appear repeatedly, or a mixture of symptoms appears, in patients with bipolar disorder remains unknown. Therefore, mood stabilizers are indicated only for single mood episodes, such as manic episodes and depressive episodes, and no true mood-stabilizing drugs effective for treating both manic and depressive episodes currently exist. Therefore, in this review, therapeutic targets that facilitate the development of mood stabilizers were examined by reviewing the current understanding of the neuromolecular etiology of bipolar disorder.
Clinical Psychopharmacology and Neuroscience, 2022
Objective: This study investigated the prevalence and comorbidities of attention deficit hyperact... more Objective: This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. Methods: This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. Results: We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (＞ 18 years) during this period. Among adult and children/adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53− 78.91) had at least one psychiatric comorbidity, respectively. Conclusion: Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.
Clinical Psychopharmacology and Neuroscience, 2022
similar to those from other CPGs, although there were some differences. The KMAP-DD 2021 reflecte... more similar to those from other CPGs, although there were some differences. The KMAP-DD 2021 reflected social culture and the healthcare system in Korea and recent evidence about pharmacotherapy for depression, as did other recently published evidence-based guidelines. Despite some intrinsic limitations as an expert consensus-based guideline, the KMAP-DD 2021 can be helpful for Korean psychiatrists making decisions in clinical settings by complementing previously published evidence-based guidelines, especially for some clinical situations lacking evidence from rigorously designed clinical trials.
Close connections between depression and type 2 diabetes (T2DM) have been suggested by many epide... more Close connections between depression and type 2 diabetes (T2DM) have been suggested by many epidemiological and experimental studies. Disturbances in insulin sensitivity due to the disruption of various molecular pathways cause insulin resistance, which underpins many metabolic disorders, including diabetes, as well as depression. Several anti-hyperglycemic agents have demonstrated antidepressant properties in clinical trials, probably due to their action on brain targets based on the shared pathophysiology of depression and T2DM. In this article, we review reports of clinical trials examining the antidepressant effect of these medications, including insulin, metformin, glucagon like peptide-1 receptor agonists (GLP-1RA), and peroxisome proliferator-activated receptor (PPAR)-γ agonists, and briefly consider possible molecular mechanisms underlying the associations between amelioration of insulin resistance and improvement of depressive symptoms. In doing so, we intend to suggest an ...
Feasibility of Korean Medication Algorithm for Bipolar Disorder(IV):Quality of Life Kyung Joon Mi... more Feasibility of Korean Medication Algorithm for Bipolar Disorder(IV):Quality of Life Kyung Joon Min, MD, Won-Myong Bahk, MD, Duk-In Jon, MD, Young Chul Shin, MD, Chan-Hyung Kim, MD, Bo-Hyun Yoon, MD, Hyun-Sang Cho, MD, Jun Soo Kwon, MD and Feasibility of Korean Medication Algorithm for Bipolar Disorder Project Group Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Department of Psychiatry, College of Medicine, Catholic University, Seoul, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Koyang, Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Naju National Hospital, Naju, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korean College of Neuropsychopharmacology and Korean Academy of Schizophrenia, Korea Objective:The Korean College of Neuropsychopharmacology and the ...
Kyung Joon Min, MD, Won-Myong Bahk, MD, Bo-Hyun Yoon, MD, Won Kim, MD, Byungsu Kim, MD, Jung Goo ... more Kyung Joon Min, MD, Won-Myong Bahk, MD, Bo-Hyun Yoon, MD, Won Kim, MD, Byungsu Kim, MD, Jung Goo Lee, MD, Yeon Ho Joo, MD, Jeong-Seok Seo, MD, Eun Lee, MD, Yong Min Ahn, MD, Young Chul Shin, MD, Young Sup Woo, MD and Duk-In Jon, MD Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Naju National Hospital, Naju, Department of Psychiatry, College of Medicine, Inje University, Seoul, Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Stress Clinic, Health Promotion Center, Asan Medical Center, Seoul, Department of Psychiatry, College of Medicine, Inje Universtiy Haeundae Paik Hospital and Paik Institute for Clinical Research, Busan, Department of Psychiatry, College of Medicine, Konkuk University, Chungju, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Department of Psychiatry, College of Medicine, Seoul Na...
Feasibility of Korean Medication Algorithm for Bipolar Disorder(II): Choice of Medications Young ... more Feasibility of Korean Medication Algorithm for Bipolar Disorder(II): Choice of Medications Young Chul Shin, MD, Won-Myong Bahk, MD, Chan-Hyung Kim, MD, Kyung Joon Min, MD, Bo-Hyun Yun, MD, Hyun-Sang Cho, MD, Jun Soo Kwon, MD, Duk-In Jon, MD, and Feasibility of Korean Medication Algorithm for Bipolar Disorder Project Group Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Department of Psychiatry, College of Medicine, Catholic University, Seoul, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Naju National Hospital, Naju, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Goyang, Korean College of Neuropsychopharmacology and Korean Academy of Schizophrenia, Korea Objective:The Korean College of Neuropsychopharmacology a...
Clinical Psychopharmacology and Neuroscience, 2021
The aim of the present study is to identify the factors that affect retention in outpatients with... more The aim of the present study is to identify the factors that affect retention in outpatients with psychiatric disorders as indicators of treatment adherence, including Minnesota Multiphasic Personality Inventory (MMPI) scores. Methods: The medical records of 146 patients diagnosed with major depressive disorder, bipolar disorder, or anxiety disorder for at least 10 years and discharged were retrospectively reviewed in the present study. The subjects were categorized based on the duration of outpatient treatment as ＜ 6 months (L6) or ≥ 6 months (M6) groups and reclassified as ＜ 36 months (L36) and ≥ 36 months (M36) groups. The demographic, clinical, and personality characteristics of the groups were compared. Results: Patients in M6 and M36 groups were more likely to have a higher educational level compared with those in the L6 and L36 groups, respectively. Patients in the M6 group showed significantly lower hypomania (Ma) scores on the MMPI test than did patients in the L6 group. Conclusion: The association between high Ma score on the MMPI test and early discontinuation of treatment suggests that impulsivity, hostility, and disinhibition confer higher risk of nonadherence.
Journal of Korean Neuropsychiatric Association, 2021
This edition reflected new findings and the latest trends in the areas of pharmacological treatme... more This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results For persisting depressive disorder, antidepressant monotherapy including selective
Growing evidence suggests that early life stress (ELS) has long-lasting effects on glucocorticoid... more Growing evidence suggests that early life stress (ELS) has long-lasting effects on glucocorticoid receptor (GR) expression and behavior via epigenetic changes of the GR exon 17 promoter. However, it remains unclear whether ELS regulates histone modifications of the GR exon 17 promoter across the life span. We investigated the effects of maternal separation (MS) on histone acetylation and methylation of GR exon 17 promoter in the hippocampus, according to the age of adults. Depression-like behavior and epigenetic regulation of GR expression were examined at young and middle adulthood in mice subjected to MS from postnatal day 1 to 21. In the forced swimming test, young adult MS mice showed no effect on immobility time, but middle-aged MS mice significantly increased immobility time. Young adult and middle-aged MS mice showed decreased GR expression. Their two ages showed decreased histone acetylation with increased histone deacetylases (HDAC5) levels, decreased permissive methylation...
Beginning with the concept of the brain–gut axis, the importance of the interaction between the b... more Beginning with the concept of the brain–gut axis, the importance of the interaction between the brain and the gastrointestinal tract has been extended to the microbiome with increasing clinical applications. With the recent development of various techniques for microbiome analysis, the number of relevant preclinical and clinical studies on animals and human subjects has rapidly increased. Various psychotic symptoms affect the intestinal microbiome through the hypothalamus–pituitary–adrenal gland axis. Conversely, the intestinal microbiome regulates the gastrointestinal tract environment and affects psychological factors by means of the microorganisms or their metabolites, either acting directly on the brain or through the synthesis of various neurotransmitters. This review discusses the clinical applicability of the brain–gut–microbiome axis and directions for improving psychological symptoms based on the studies published to date.
Background Although mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT... more Background Although mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT) appear to be efficacious treatments for bipolar disorder (BD) in research settings, the longterm response to these mood stabilizers in clinical practice is highly variable among individuals. Thus, the present study examined the characteristics associated with good or insufficient responses to long-term treatment with LIT, VAL, or LMT for BD. Methods This study retrospectively analyzed the medical records of patients who visited an outpatient clinic with a diagnosis of BD I or II. Data from patients who were treated with one of three mood stabilizing medications (LIT, VAL, or LMT) for more than 6 months were selected, and the long-term treatment responses were evaluated using the Alda scale. For the purposes of this study, two response categories were formed: insufficient response (ISR), including non-response or poor response (Alda total score � 6), and good response (GR; Alda total score � 7). Results Of the 645 patients included in the present study, 172 were prescribed LIT, 320 were prescribed VAL, and 153 were prescribed LMT for at least 6 months. A binary logistic
Clinical Psychopharmacology and Neuroscience, 2019
Objective: The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depressi... more Objective: The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depression in the elderly. The primary aims of this study were to describe the validation of the Korean version of the DIA-S (K-DIA-S) and to compare its validity with that of other depression screening questionnaires used in elderly outpatients in medical settings. Methods: A total of 385 elderly outpatients completed the K-DIA-S and underwent the Mini International Neuropsychiatric Interview to diagnose depressive disorders. Other measures included the 15-item short form of the Geriatric Depression Scale (SGDS), the 9-item depression module of the Patient Health Questionnaire (PHQ-9), and the Montgomery-Asberg Depression Rating Scale (MADRS). Reliability and validity tests, an optimal cutoff point estimate, and receiver operating characteristic curve analysis were performed to investigate the diagnostic validity of the K-DIA-S. Areas under the curves (AUCs) for the K-DIA-S, SGDS, and PHQ-9 were compared statistically. Results: The K-DIA-S showed good internal consistency and strong correlations with the SGDS (r = 0.853), PHQ-9 (r = 0.739), and MADRS (r = 0.772). The cutoff point of the K-DIA-S that can be recommended for screening depressive symptoms was a score of 4. For "any depressive disorder", the AUC (standard error) for the K-DIA-S was 0.896 (0.015), which was significantly larger than that for the PHQ-9 (p = 0.033). Conclusion: The present findings suggest that the K-DIA-S has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in elderly populations and medically ill patients.
International Journal of Methods in Psychiatric Research, 2019
Objectives: The purpose of this study was to evaluate the prevalence of mixed features using the ... more Objectives: The purpose of this study was to evaluate the prevalence of mixed features using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and to examine how patients with mixed states would be classified using the DSM-5. Methods: In total, 12 hospitals participated in this study, and data on the demographic characteristics and clinical diagnoses of patients treated between October 2013 and September 2016 were obtained. We reviewed the data for oppositepolarity symptoms according to the DSM-5 criteria and the research-based diagnostic criteria. Results: Of the 859 patients included in the final analysis, the prevalence of mixed features in patients with major depressive episodes based on the DSM-5 remained low. Patients with major depressive disorder were more likely to be classified as experiencing anxious distress and/or a cluster-B personality disorder in mixed state patients not diagnosed with DSM-5 mixed features, whereas more mixed state patients with bipolar disorder were diagnosed with mixed features using the DSM-5. Conclusions: The prevalence of mixed features did not increase significantly when the DSM-5 was used, and patients with mixed states were more likely to be classified as having anxious distress and/or a cluster-B personality disorder in addition to mixed features.
Clinical Psychopharmacology and Neuroscience, 2019
Objective: Although the association between low vitamin D levels and depressive symptoms has been... more Objective: Although the association between low vitamin D levels and depressive symptoms has been widely reported, studies investigating the relationship between hypovitaminosis D and depressive symptomatology are scarce. Methods: We retrospectively studied the relationship between vitamin D status and depressive symptoms in 196 patients hospitalized for a major depressive episode. Results: The baseline 17-item Hamilton Depression Rating Scale total and depression factor (item 1, 2, 3, 7) scores were significantly higher in the vitamin-D-insufficiency/deficiency group than in the vitamin-D-sufficiency group. Conclusion: It is important to consider measuring the vitamin D levels of patients with severe and core depressive symptoms and providing vitamin D supplementation when necessary.
Background: Impairment of cognitive function as well as negative symptom is the major factor caus... more Background: Impairment of cognitive function as well as negative symptom is the major factor causing the decline of a patient's functioning in chronic stages of schizophrenia. However, until now, there were no definite treatment options that could effectively reduce the impairment. Case presentation: We report a case of mood dysregulation associated with use of Ginkgo biloba in a patient with schizophrenia. After Ginkgo biloba was given, the patient experienced cluster symptoms of mood dysregulation including irritability, difficulty in controlling anger, agitation and restlessness. We estimated the possibility as "probable" according to Naranjo scale considering circumstantial evidence. Conclusions: This case suggests that Ginkgo biloba may have caused mood dysregulation in this patient. Although it is generally accepted as safe, more attention should be given to the adverse effect when treating with Ginkgo biloba.
Uploads
Papers by Won-myong Bahk