Neuroleptic dosage in psychiatric outpatients.
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Adult↗
Biomedical subjects
K M Lin
Publications and source records attributed to K M Lin.
The evolving science of pharmacogenetics: clinical and ethnic perspectives.
The field of pharmacogenetics has witnessed remarkable progress during the past several decades. Clinical observations of severe toxic reactions and findings of dramatic interindividual as well as cross-ethnic differences in response to therapeutic agents have been instrumental in fostering advances of the field. Research on cytochrome P450 isozymes may be of particular importance to the field of psychiatry, because most psychotropics depend on these enzymes for their biotransformation. This article traces the progress of research in this area and highlights the importance of clinical and cross-ethnic observations in providing the impetus and direction for the field. Knowledge derived from this line of research is likely to make important contributions toward establishment of rational guidelines for psychopharmacotherapy. In addition, research on these enzymes may also have profound implications in regard to the pathogenesis of a number of major disorders, including several types of commonly encountered cancers, as well as neuropsychiatric problems, including Parkinson's disease, tardive dyskinesia, addiction, and drug-induced neurotoxicity.
Cytochrome P-450 Enzyme System↗
Brain imaging, antidepressants, and ethnicity: preliminary observations.
Magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) using 99mTc-hexamethylpropylene amine oxime (HMPAO) evaluations were completed on African-American and Caucasian depressed patients prior to their participation in an antidepressant medication trial. The degree of white matter hyperintensities (WMH), ventricle-to-brain ratio (VBR), and uptake of HMPAO did not vary significantly between the groups. After 1 week of placebo run-in, patients received paroxetine in an 8-week, open-label, flexible-dose trial. Final dosages and side effects were similar between groups. There was a trend for the Caucasian patients to have a better treatment response, but the relatively small sample size makes this finding tentative. In general, there were no major differences in either baseline neuroimaging findings or response to paroxetine between these two ethnic groups.
Black or African American↗
Clozapine dosage, serum levels, efficacy, and side-effect profiles: a comparison of Korean-American and Caucasian patients.
As the prototypic "atypical neuroleptic," clozapine plays an increasingly important role in the treatment of refractory psychotic patients. However, little is known about the efficacy and safety of the compound for Asian patients. This study compares dosage, efficacy, and side-effect profiles in 17 Korean-American and 17 Caucasian age- and sex-matched schizophrenia or schizoaffective patients treated with clozapine. Asians showed a greater change than Caucasians in total scores of the 8-item Brief Psychiatric Rating Scale while receiving a significantly lower mean dose of clozapine (t = 2.48; p < .025). Furthermore, Asians had significantly lower mean clozapine concentrations than Caucasians and were significantly more likely to experience anticholinergic and other side effects. No serious untoward effects, such as agranulocytosis were reported in either group. These data suggest that Asians may be treated effectively and safely with lower doses of clozapine than those used for Caucasians.
Adult↗
Comparison of lithium ratio between African-American and Caucasian bipolar patients.
Lithium RBC/plasma ratio (LR) was studied in 34 bipolar subjects on therapeutic doses of lithium carbonate. The sample was divided into 22 Caucasians and 12 African-Americans to observe possible ethnic differences in LR as previously reported. The latter group demonstrated a higher LR as well as increased reports of side effects (p < .05), even after controlling previous confounding factors. Our findings suggest that African-Americans may be more susceptible to the side effects associated with lithium treatment, and consequently, lower dosages may be necessary for this group.
Adult↗
Ethnicity and psychopharmacology. Bridging the gap.
Taken together, the literature reviewed clearly indicates that the disposition and effect of a large number of psychotropic agents are influenced substantially by ethnicity and culture. Recent advances in the realm of pharmacokinetics, pharmacogenetics, and pharmacodynamics have led to a greater understanding of some of the mechanisms responsible for such differences. In comparison, much less currently is known regarding how various psychosocial factors impinge on drug responses in different cultural settings. Progress in research in this area is important for clinical reasons, as psychiatric clinicians will increasingly be confronted with patients with divergent ethnic and cultural backgrounds. In addition, knowledge derived from such research will contribute significantly to a better understanding of how the effects of psychotropic agents are mediated, and also should be valuable for the drug development industry that will have to take into account the increasingly diversifying domestic and international markets.
Antidepressive Agents, Tricyclic↗
The reliability and validity of the Chinese Polarity Inventory.
For the simultaneous measurement of manic and depressive symptoms, the Chinese Polarity Inventory (CPI), a 20-item self-report scale, was developed. A total of 329 depressive and 356 manic/hypomanic patients were recruited in this scale developmental study in China. All patients completed the CPI and either the Chinese version of the Hamilton Depression Rating Scale (for depressed subjects) or the Chinese version of the Bech-Rafaelsen Mania Scale (for manic subjects). The CPI was found to have excellent reliability and satisfactory concurrent validity. Construct validity analysis was performed using principal component analysis, which yielded 4 clinically meaningful factors: activity, pleasurability, capability and irritability. The CPI was sensitive in differentiating different severities of depression and mania. However, its ability to differentiate mixed phase from other mood states and its sensitivity to changes during the treatment still need to be studied further.
Adolescent↗
Ethical aspects of psychopharmacological studies in different ethnic groups.
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Ethics, Medical↗
Hwa-byung. A community study of Korean Americans.
One hundred nine Korean American community subjects were interviewed regarding their experiences with hwa-byung (HB), a Korean folk illness label commonly used by Koreans with a myriad of physiological and psychological complaints. During these interviews, standard instruments were also used to assess their depressive and somatic symptoms. The results indicated that a relatively high proportion (12%) of the subjects labeled themselves as having suffered from HB. While no apparent sociodemographic differences were found between HB and non-HB subjects, significantly more HB subjects fulfilled the diagnosis of DSM-III major depression and also had previous diagnoses of depression. The HB subjects also had significantly higher scores for the total, depressive, and somatic subscales and 16 of the 20 individual items of the Center for Epidemiologic Studies-Depression Scale. These data confirm previous observations of substantial overlap between HB and DSM-III major depression among Koreans and Korean Americans, and suggest that HB may be a culturally patterned way of expression for Koreans experiencing major depression and related conditions. The clinical and theoretical implications of these findings are also discussed.
Adult↗
Etiology and importance of alkaline esophageal reflux.
While an alkaline component to esophageal reflux disease is known to be present, little is known about its etiology and harmful effects. Simultaneous gastric and esophageal 24-hour pH monitoring was performed in 81 patients with foregut symptoms. The presence of a mechanically defective lower esophageal sphincter was determined by manometry and duodenogastric reflux by computer-assisted discriminant analysis of the gastric pH record. Heartburn, dysphagia, and regurgitation occurred more frequently in those with a mechanically defective sphincter (p < 0.05) and epigastric pain in those with duodenogastric reflux (p < 0.05). Esophagitis was more common and severe in those with a mechanically defective sphincter (p < 0.05). In these patients, the percentage of time over 24 hours that the esophageal pH was less than 4 was 40.5% in patients without duodenogastric reflux but only 10.2% in those with duodenogastric reflux (p < 0.005), suggesting acid damage in the former and alkaline damage in the latter. To establish the origin of the esophageal alkaline exposure, episodes of elevated fasting gastric pH greater than 4 lasting longer than 1 minute were searched for and identified in 45 patients. Esophageal pH tracings were compared for 30 minutes before and after these events. The esophageal pH was higher following these episodes in duodenogastric reflux patients (p < 0.05), suggesting a gastroduodenal origin of the esophageal alkalinization. This study shows that esophageal damage may be due to acid or alkaline reflux. The alkaline component of gastroesophageal reflux is important and should be considered in the evaluation of patients with foregut symptoms so that appropriate medical or surgical therapy can be instituted.
Esophagitis, Peptic↗
Pharmacotherapy for southeast Asian psychiatric patients.
Refugees have been demonstrated to be at high risk for developing major depressive and posttraumatic stress disorders, but are often not able to benefit from modern advances in psychopharmacology. Besides difficulties in cross-cultural psychiatric diagnosis, problems also arise from cultural differences in the expectation of drug effects and in compliance. Recent evidence has suggested that pharmacokinetic and pharmacodynamic profiles of various psychotropic medications may be different in Asians than in non-Asian patients, leading to differences in dosage requirements and side effect profiles. These issues and their relevance to the care of refugee patients are reviewed.
Asia, Southeastern↗
Ethnicity and family involvement in the treatment of schizophrenic patients.
In a cross-ethnic study of neuroleptic response, the level of family involvement with the treatment of 26 Asian and 26 Caucasian patients was evaluated. Asian family members were intimately involved, Caucasians much less so. These results quantitatively demonstrated the relatively greater importance of working with family members when treating Asian patients. They also indicate that relatively more effort is needed to increase involvement of Caucasian families in the treatment process.
Asia↗
Comparison of the Chinese Depression Inventory and the Chinese version of the Beck Depression Inventory.
Using a sample of 329 currently depressed patients from 24 hospitals across China, the Chinese Depression Inventory (CDI) was developed based on its own culture and verbal expression styles. The reliability and validity of CDI were much better for these patients than the Chinese version of the Beck Depression Inventory (CBDI). This study demonstrated that the CDI is both a culturally sensitive and cross-culturally useful self-report scale for measuring the severity of depression in Chinese. The authors suggest that such a rating scale would eliminate serious cultural biases, control for the severity of illness among different ethnic groups and thereby make cross-cultural studies more valid.
Adolescent↗
Cytochrome P-450 monooxygenases and interactions of psychotropic drugs.
The authors review drug biotransformation. Phase I reactions are preconjugation processes that take place through cytochrome P-450--a hepatic mixed function oxidase (MFO) enzyme system with multiple isozymes to metabolize foreign substances. Phase II reactions are conjugation processes of the substrates. Based on the characteristics of the cytochrome P-450 microsomal enzyme systems, the authors explain the clinical phenomena of induction and inhibition of these enzymes when psychotropic agents interact. This article describes both MFO inducers (barbiturates) and inhibitors (cimeditine, fluoxetine and neuroleptic drugs). With this information, clinicians can enhance the ability to monitor drug interactions of psychotropic agents.
Biotransformation↗
Pharmacokinetic and other related factors affecting psychotropic responses in Asians.
The last decade has witnessed substantial progress in our understanding of ethnic differences and similarities between Asians and other ethnic groups in response to various psychotropics. Capitalizing on recent advances in cross-cultural and psychobiological research methodology, a number of recent studies have suggested a special sensitivity of Asians to various psychotropic medications. Whereas pharmacokinetic differences have been consistently found with haloperidol and some benzodiazepines, results of studies focusing on tricyclic antidepressants (TCAs) have remained inconclusive. In addition, ethnic differences in protein binding and in the pharmacodynamics of some of these drugs have also been reported. Future studies should explore newer assay methods and imaging techniques capable of measuring receptor-drug interactions, in addition to utilizing existing research methodologies to more systematically scrutinize the nature and extent of such differences. They should be designed not only to ascertain differences in drug responses, but also to examine genetic and environmental (e.g., diet, exposure to enzyme inducers) factors that may contribute to these differences. Pharmacogenetic probes could be used in combination with studies examining pharmacokinetic and pharmacodynamic issues for such purposes.
Asian↗
Psychopharmacologic considerations in the treatment of black American populations.
Although striking ethnic differences in pharmacologic responses to various medications have been documented in the general medical literature, there is a paucity of such information in the psychopharmacologic literature. Recent work has provided a number of studies that illustrate interesting inter-ethnic pharmacogenetic, pharmacokinetic, and pharmacodynamic differences. In general, however, such studies have reported inconsistent findings relative to dose response relationships with various psychotropics. Results of our literature review, with a particular focus on black Americans, suggest that the lack of consistency in these investigations is largely attributable to various methodological and design problems. Prominent among these problems are: diagnostic misclassification, treatment of various ethnic groups in a homogeneous undifferentiated manner, lack of appropriate control for age and gender, and minimal consideration for chronicity of illness. As a result, though there exist some interesting data suggesting inter-ethnic genetic and kinetic differences, the extant literature on black Americans and other ethnic groups should be evaluated with some caution. The purpose of this article is to provide a systematic review of the existing psychopharmacologic literature on the black American population.
Black or African American↗
Ethnic psychopharmacology: the Hispanic and Native American perspective.
There is ample evidence attesting to differences in drug response and disposition among certain ethnic groups. The existing body of knowledge concerning pharmacological issues in the Hispanic and Native American ethnic groups, however, is both meager and confusing. In this article, the authors first attempt to briefly characterize these increasingly important ethnic groups, citing recent population figures and epidemiological findings. This is followed by a review of several existing retrospective studies concerning the pharmacological treatment of patients belonging to these groups. Recent findings in the area of pharmacogenetics are critically appraised and other factors influencing drug responsiveness are also examined. The clinical significance of this research for the optimal treatment of patients in cross-cultural settings is highlighted. The need for further research that would both fortify and clarify the available information with respect to these issues and the Hispanic and Native American populations is obvious.
Ethnicity↗
Changes in red blood cell choline and choline-bound lipids with oral lithium.
The influence of oral lithium on the concentration of red blood cell choline (Ch), lecithin, glycerophosphorylcholine (GPCh) and phosphorylcholine (PCh) was studied. The concentration of RBC Ch was significantly elevated and the concentration of lecithin, GPCh and PCh significantly depressed in 16 patients on oral lithium compared to 9 age-matched controls. We conclude that lithium markedly depletes the red blood cell of choline containing compounds including lecithin. These changes may be responsible for both the therapeutic efficacy and the toxicity of lithium.
Administration, Oral↗