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Accordingly, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) working committee, composed of domestic experts, developed Korea’s first KMAP-BP in 2002 and later in 2006, 2010, and 2010. A revised version of KMAP-BP was announced every four years four times in 2014 and 2018.6-10). The treatment strategy considering the safety and tolerability of KMAP-BP 2022 was developed by collecting opinions from domestic bipolar disorder experts.
Objectives
Safety and tolerability of drugs are very important factors in the treatment of bipolar disorder. An expert opinion survey was conducted on treatment strategies in various special clinical situations, such as significant weight gain, characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling.
Methods
A written survey about treatment strategies related to safety and tolerability was prepared and focused on significant weight gain, characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling. Ninety-three experts of the review committee completed the survey.
Results
In the case of weight gain occurring during drug treatment, it was preferred to replace it with a drug that caused less weight gain, such as lamotrigine, aripiprazole, or ziprasidone. If there was a significant weight gain due to the treatment drug, it was preferred to intervene as soon as possible. In the case of hyperprolactinemia, it was selected to change the medication and discontinue it for benign rash caused by lamotrigine. In improving drug adherence, the preference for long-acting injections increased. Antipsychotics can be used with great caution in pregnant or reproductive women.
Conclusions
Treatment strategies in various clinical situations related to safety and tolerability in drug treatment for bipolar disorder were described. It is hoped that it will be useful in practical clinical situations.
Majority of international guidelines for bipolar disorders are based on evidences from clinical trials. In contrast, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed to adopt an expert-consensus paradigm which was more practical and specific to the atmosphere in Korea.
Objectives
In this study, preferred medication strategies for acute mania over six consecutively published KMAP-BP (2002, 2006, 2010, 2014, 2018, and 2022) were investigated.
Methods
A written survey using a nine-point scale was asked to Korean experts about the appropriateness of various treatment strategies and treatment agents. A written survey asked about the appropriateness of various treatment strategies and treatment agents commonly used by clinicians as the first-line.
Results
The most preferred option for the initial treatment of mania was a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) in every edition. Preference for combined treatment for euphoric mania increased, peaked in KMAP-BP 2010, and declined slightly. Either MS or AAP monotherapy was also considered a first-line strategy for mania, but not for all types of episodes, including mixed/psychotic mania. Among MSs, lithium and valproate are almost equally preferred except in the mixed subtype where valproate is the most recommended MS. The preference of valproate showed reverse U-shaped curve. This preference change of valproate may indicate the concern about teratotoxicity in women. Quetiapine, aripiprazole, and olanzapine were the preferred AAP for acute mania since 2014. This change might depend on the recent evidences and safety profile. In cases of unsatisfactory response to initial medications, switching or adding another first-line agent was recommended. The most notable changes over time included the increasing preference for AAPs.
Conclusions
The Korean experts have been increasingly convinced of the effectiveness of a combination therapy for acute mania. There have been evident preference changes: increased for AAP and decreased for carbamazepine.
Olanzapine (OLA) is a common first-prescribed antipsychotic and has shown favorable efficacy in acutely exacerbated patients with schizophrenia. The mixed receptor activity of OLA and its greater affinity for serotonin 5-HT2A rather than dopamine D2 receptors are similar to those of clozapine. Pharmacokinetically, OLA is metabolized mainly by hepatic cytochrome enzyme P450 1A2 (CYP1A2). Because risks of antipsychotic polypharmacy include increased drug-drug interactions, pharmacokinetic considerations are important for selection of antipsychotics to be combined. Due to its pharmacological characteristics, amisulpride (AMI), another atypical antipsychotic with proven efficacy, is a promising adjuvant agent of special interest. AMI is unlikely to interact with other drugs due to the low plasma protein binding and metabolism and does not affect the activity of the CYP system. Furthermore, AMI is highly selective for dopamine D2/D3 receptors; has minimal or no affinity for D1, D4, or D5 receptors. Despite the potential benefits of the combination of OLA and AMI, only a few open-label studies have been conducted, and no randomized clinical trial has been performed to date to examine the efficacy and tolerability of the combination. Hence, the goals of this study were to test the hypothesis that AMI augmentation would improve psychotic symptoms and be well tolerated in schizophrenic patients who showed poor response to OLA monotherapy.
Objectives
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.
Conclusions
AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.
Disclosure of Interest
W.-M. Bahk Grant / Research support from: Handok Pharmaceuticals, Seoul, Korea, Y. S. Woo: None Declared, S.-Y. Park: None Declared, B.-H. Yoon: None Declared, S.-M. Wang: None Declared, M.-D. Kim: None Declared
Students may need to decide whether to invest limited resources evenly across all courses and thus end with moderate grades in all, or focus on some of the courses and thus end with variable grades. This study examined which pattern of grades is perceived more favorably. When judging competency, people give more weight to positive than negative information, in which case heterogeneous grades would be perceived more favorably as they have more positive grades than homogeneous moderate grades. Furthermore, high school students are told to demonstrate their passion in college applications. Nonetheless, people generally overweigh negative information, which can result in a preference for a student with homogeneous grades lacking extremely negative grades. The college admissions decisions in particular may also involve emphasis on long-term stable, consistent, and responsible character, which the homogeneous grades may imply. Study 1 found that laypeople, undergraduate students, and admissions officers preferred to admit a student with homogeneous grades to a college than a student with heterogeneous grades even when their GPAs were the same. Study 2 used a heterogeneous transcript signaling a stereotypic STEM or humanities student, and found that while undergraduate students were more split in their choices, laypeople and admissions officers still preferred a student with homogeneous grades. Study 3 further replicated the preference for a student with homogeneous grades by using higher or lower average GPAs and wider or narrower range of grades for the heterogeneous grades. Possible reasons and limitations of the studies are discussed.
Disease-related malnutrition is prevalent among older adults; therefore, identifying the modifiable risk factors in the diet is essential for the prevention and management of disease-related malnutrition. The present study examined the cross-sectional association between dietary patterns and malnutrition in Chinese community-dwelling older adults aged ≥65 years in Hong Kong. Dietary patterns, including Diet Quality Index International (DQI-I), Dietary Approaches to Stop Hypertension (DASH), the Mediterranean Diet Score, ‘vegetable–fruit’ pattern, ‘snack–drink–milk product’ pattern and ‘meat–fish’ pattern, were estimated and generated from a validated food frequency questionnaire. Malnutrition was classified according to the modified Global Leadership Initiative on Malnutrition (GLIM) criteria based on two phenotypic components (low body mass index and reduced muscle mass) and one aetiologic component (inflammation/disease burden). The association between the tertile or level of adherence of each dietary pattern and modified GLIM criteria was analysed using adjusted binary logistic regression models. Data of 3694 participants were available (49 % men). Malnutrition was present in 397 participants (10⋅7 %). In men, a higher DQI-I score, a higher ‘vegetable–fruit’ pattern score and a lower ‘meat–fish’ pattern score were associated with a lower risk of malnutrition. In women, higher adherence to the DASH diet was associated with a lower risk of malnutrition. After the Bonferroni correction, the association remained statistically significant only in men for the DQI-I score. To conclude, a higher DQI-I score was associated with a lower risk of malnutrition in Chinese older men. Nutritional strategies for the prevention and management of malnutrition could potentially be targeted on dietary quality.
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.
Global inequity in access to and availability of essential mental health services is well recognized. The mental health treatment gap is approximately 50% in all countries, with up to 90% of people in the lowest-income countries lacking access to required mental health services. Increased investment in global mental health (GMH) has increased innovation in mental health service delivery in LMICs. Situational analyses in areas where mental health services and systems are poorly developed and resourced are essential when planning for research and implementation, however, little guidance is available to inform methodological approaches to conducting these types of studies. This scoping review provides an analysis of methodological approaches to situational analysis in GMH, including an assessment of the extent to which situational analyses include equity in study designs. It is intended as a resource that identifies current gaps and areas for future development in GMH. Formative research, including situational analysis, is an essential first step in conducting robust implementation research, an essential area of study in GMH that will help to promote improved availability of, access to and reach of mental health services for people living with mental illness in low- and middle-income countries (LMICs). While strong leadership in this field exists, there remain significant opportunities for enhanced research representing different LMICs and regions.
To identify clinical factors that can explain the differences in treatment outcome, and examine the value of human papillomavirus infection as a prognostic biomarker in stage IVa tonsillar carcinomas.
Methods:
Fifty-nine patients with tonsillar carcinoma classified as stage IVa were retrospectively analysed for survival outcomes according to various clinical factors. Human papillomavirus infection was evaluated using a human papillomavirus DNA chip test and immunohistochemical staining for p16 and p53.
Results:
Lower disease-free survival rates were associated with increasing local invasiveness and nodal status. Although human papillomavirus positivity and p16 expression was more common in locally advanced tonsillar carcinomas with advanced nodal status, the overall survival rate was better for patients with human papillomavirus positive, p16-positive tumours.
Conclusion:
The disease-free survival rate may differ according to local tumour invasiveness and nodal status, even for stage IVa tonsillar cancers. Human papillomavirus infection may be a useful biomarker for predicting treatment outcomes for stage VIa tumours.
This study aimed to evaluate the efficacy of post-operative voice therapy after phonomicrosurgery for vocal polyp removal.
Methods:
The study retrospectively enrolled 55 consecutive patients who had undergone voice therapy after phonomicrosurgery for vocal polyp removal occurring between June 2010 and June 2011. A historical group of 63 similar patients not receiving voice therapy was used as an external control. We compared voice analysis parameters and Voice Handicap Index scores for the two groups.
Results:
Most objective and subjective voice outcome parameters were significantly improved after surgical treatment. Although the study and control groups showed no significant difference regarding objective parameters (using acoustic and aerodynamic analysis) or the subjective parameters assessed using the grade-roughness-breathiness-asthenia-strain scale, the study group had significantly better final Voice Handicap Index scores.
Conclusion:
Following surgery for vocal polyps, post-operative voice therapy can improve patients' vocal discomfort, emotional responses and everyday self-perception.
Δ14C values of leaves of deciduous trees provide a means to map the regional-scale fossil fuel ratio in the atmosphere. We collected a batch of ginkgo (Ginkgo biloba Linnaeus, a deciduous tree) leaf samples from across Korea in the month of July in both 2010 and 2011 to obtain the regional distribution of Δ14C. The Δ14C values of the samples were measured using accelerator mass spectrometry (AMS) at the Korea Institute of Geoscience and Mineral Resources (KIGAM). The average of the Δ14C values from clean air sites in Korea in 2011 measured slightly lower than the average of Δ14C values in 2010. Distribution maps of Δ14C of 2011 and 2010 in Korea were made based on a series of Δ14C values of ginkgo leaf samples from Korea using the Geostatistical and Spatial analyst tools in ESRI's ArcMap software. The distribution maps of Δ14C showed that Δ14C values in the western part of Korea are lower than those in the eastern part of Korea. This is because the western part of Korea is densely populated and contains many industrial complexes, and also because westerly winds from China, containing CO2 from fossil fuel use, blow into Korea. We compared the distribution maps of 2010 and 2011 and tried to find traces of the Fukushima power plant accident in Japan.
The objective of the present study is to explore the association between lower urinary tract symptoms (LUTS) and dietary isoflavone in elderly men. In a large prospective cohort of 2000 Chinese men, the association between dietary isoflavone and LUTS were studied using standardized structured questionnaires. Dietary intake was assessed by a modified version of the Block FFQ. LUTS were assessed by the Chinese version of the International Prostatic Symptoms Score. Demographic, lifestyle and other medical information were also collected and were adjusted for in the analysis. After excluding 299 men with history of bladder surgery, bladder or prostate cancer or who were current users of medication for urinary problems, the association between LUTS and dietary isoflavone was explored. A total of 96·2 % of subjects reported some consumption of genistein, glycitein or daidzein. In ordinal multinominal logistic regression, subjects with dietary total isoflavone of more than 5·1 mg were significantly less likely to suffer from more severe LUTS (dietary intake from 5·1 to 9·5 mg: OR 0·59; 95 % CI 0·44, 0·80; from 9·6 to 14·3 mg: OR 0·81; 95 % CI 0·61, 1·09; from 14·4 to 21·7 mg: OR 0·68; 95 % CI 0·51, 0·92; 21·8 mg and above: OR 0·73; 95 % CI 0·54, 0·98) after adjustment for covariates. In this cross-sectional study, we showed a strong inverse association between dietary intake of isoflavone and the risk of LUTS.
Thyroid hemiagenesis is a rare abnormality in which one thyroid lobe fails to develop. Most of the patients diagnosed have an associated thyroid disease. We report the case of a 32-year-old woman who presented with a left thyroid mass which had been gradually increasing in size over a period of two years. A thyroid scan revealed the absence of the right thyroid lobe and isthmus, and a hypoactive nodule was evident in the lower pole of the left lobe. Ultrasonography confirmed the right lobe and the isthmus agenesis. The operative findings confirmed hemiagenesis of the right lobe and nodular hyperplasia in the left lobe.
The purpose of this report is to present a patient with hemiagenesis of the thyroid gland who concomitantly had nodular hyperplasia; we also stress the importance of pre-operative differentiation between benign lesions and malignancy in order to aid critical decision making and to facilitate preservation of thyroid function if possible.
An electrochemical cell employing a YSZ electrolyte and two Au electrodes was utilized as a model system for investigating the mechanisms responsible for impedancemetric NOx (NO and NO2) sensing. The cell consists of two dense Au electrodes on top of a porous/dense YSZ bilayer structure (with the additional porous layer present only under the Au electrodes). Both electrodes were co-located on the same side of the cell, resulting in an in-plane geometry for the current path. The porous YSZ appears to extend the triple phase boundary and allows for enhanced NOx sensing performance, although the exact role of the porous layer is not completely understood. Impedance data were obtained over the frequency range of 0.1 Hz to 1 MHz, and over a range of oxygen (2 to 18.9%) and NOx (10 to 100 ppm) concentrations, and temperatures (600 to 700 °C). Data were fit with an equivalent circuit, and the values of the circuit elements were obtained for different concentrations and temperatures. Changes in a single low-frequency arc were found to correlate with concentration changes, and to be temperature dependent. In the absence of NOx, the effect of O2 on the low-frequency resistance could be described by a power law, and the temperature dependence described by a single apparent activation energy at all O2 concentrations. When both O2 and NOx were present, however, the power law exponent varied as a function of both temperature and concentration, and the apparent activation energy also showed dual dependence. Adsorption mechanisms are discussed as possibilities for the rate-limiting steps.
An impedancemetric technique for NOx sensing using a yttria-stabilized zirconia (YSZ) electrochemical cell is reported. The cell consists of a dense YSZ substrate disk with two YSZ/metal-oxide electrodes deposited on the same side. The cell is completely exposed to the test gas (no air reference). The NOx and O2 response of the cell were evaluated during constant-frequency operation at frequencies in the range from 1 to 1000 Hz. At 10 Hz, the NOx response (as measured by phase angle shift) is shown to be linear with concentration over the range from 8-50 ppm, with comparable response to both NO and NO2. A method of operation is described which enables compensation for the O2 response at oxygen concentrations greater than approximately 4%. This mode of operation allows the sensor to provide sub-10 ppm detection of NOx irrespective of the O2 concentration. The sensor exhibits good stability during continuous operation for more than 150 hr. It was observed that the O2 response of the cell may be too slow to be of practical use, taking several minutes to equilibrate after changing the concentration by a few percent. However, data will be presented which demonstrate that this response is related to the metal oxide used for the electrode, and that more rapid response times can be achieved by modification of the electrode material.
Single ZnO nanowire metal-oxide semiconductor field effect transistors (MOSFETs) were fabricated using nanowires grown by site selective Molecular Beam Epitaxy. When measured in the dark at 25°C, the depletion-mode transistors exhibit good saturation behavior, a threshold voltage of ∼-3V and a maximum transconductance of order 0.3 mS/mm. Under ultra-violet (366nm) illumination, the drain-source current increase by approximately a factor of 5 and the maximum transconductance is ∼ 5 mS/mm. The channel mobility is estimated to be ∼3 cm2 /V.s, which is comparable to that reported for thin film ZnO enhancement mode MOSFETs and the on/off ratio was ∼25 in the dark and ∼125 under UV illumination.
ZnO is a very promising material for spintronics applications, with many groups reporting room temperature ferromagnetism in films doped with transition metals during growth or by ion implantation. In films doped with Mn during PLD, we find an inverse correlation between magnetization and electron density as controlled by Sn doping. The saturation magnetization and coercivity of the implanted single-phase films were both strong functions of the initial anneal temperature, suggesting that carrier concentration alone cannot account for the magnetic properties of ZnO:Mn and factors such as crystalline quality and residual defects play a role. Plausible mechanisms for the ferromagnetism include the bound magnetic polaron model or exchange is mediated by carriers in a spin-split impurity band derived from extended donor orbitals. We will also review progress in ZnO nanowires. The large surface area of nanorods makes them attractive for gas and chemical sensing, and the ability to control their nucleation sites makes them candidates for micro-lasers or memory arrays. Single ZnO nanowire depletion-mode metal-oxide semiconductor field effect transistors exhibit good saturation behavior, threshold voltage of ∼-3V and a maximum transconductance of 0.3 mS/mm. Under UV illumination, the drain-source current increased by approximately a factor of 5 and the maximum transconductance was ∼ 5 mS/mm. The channel mobility is estimated to be ∼3 cm2 /V.s, comparable to that for thin film ZnO enhancement mode MOSFETs and the on/off ratio was ∼25 in the dark and ∼125 under UV illumination. Pt Schottky diodes exhibit excellent ideality factors of 1.1 at 25 °C, very low reverse currents and a strong photoresponse, with only a minor component with long decay times thought to originate from surface states. In the temperature range from 25–150 °C, the resistivity of nanorods treated in H2 at 400 °C prior to measurement showed an activation energy of 0.089 eV and was insensitive to the ambient used. By contrast, the conductivity of nanorods not treated in H2 was sensitive to trace concentrations of gases in the measurement ambient even at room temperature, demonstrating their potential as gas sensors. We have also made sensitive pH sensors using single ZnO nanowires.