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Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≤ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≤ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to survey the prevalence of antipsychotic polypharmacy and combined medication use across 15 Asian countries and areas in 2016. Methods: By using the results from the fourth survey of Research on Asian Prescription Patterns on antipsychotics, the rates of polypharmacy and combined medication use in each country were analyzed. Daily medications prescribed for the treatment of inpatients or outpatients with schizophrenia, including antipsychotics, mood stabilizers, anxiolytics, hypnotics, and antiparkinson agents, were collected. Fifteen countries from Asia participated in this study. Results: A total of 3744 patients’ prescription forms were examined. The prescription patterns differed across these Asian countries, with the highest rate of polypharmacy noted in Vietnam (59.1%) and the lowest in Myanmar (22.0%). Furthermore, the combined use of other medications, expressed as highest and lowest rate, respectively, was as follows: mood stabilizers, China (35.0%) and Bangladesh (1.0%); antidepressants, South Korea (36.6%) and Bangladesh (0%); anxiolytics, Pakistan (55.7%) and Myanmar (8.5%); hypnotics, Japan (61.1%) and, equally, Myanmar (0%) and Sri Lanka (0%); and antiparkinson agents, Bangladesh (87.9%) and Vietnam (10.9%). The average psychotropic drug loading of all patients was 2.01 ± 1.64, with the highest and lowest loadings noted in Japan (4.13 ± 3.13) and Indonesia (1.16 ± 0.68), respectively. Conclusion: Differences in psychiatrist training as well as the civil culture and health insurance system of each country may have contributed to the differences in these rates. The concept of drug loading can be applied to other medical fields. [ABSTRACT FROM AUTHOR]

Efficient syntheses of four aminocyclitols are reported. Each synthesis is accomplished in eight steps starting from D-(-)-quinic acid. The key step involves a highly regioselective ring opening of epoxides by sodium azide. [ABSTRACT FROM AUTHOR]

Purpose: We sought to explore the correlations of incontinence-related quality of life (QoL) measures with the symptom severity and pathophysiological factors for female stress urinary incontinence (SUI). Methods: We retrospectively reviewed the records of 707 women who had primary SUI. Clinical data for analysis included Ingelman-Sundberg scales, 1-h pad tests, incontinence-related QoL questionnaires comprising short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), ultrasound assessment of urethral support and urethral sphincter function determined by maximum urethral closure pressure and Valsalva leak point pressure. The correlations of incontinence-related QoL, measured by UDI-6 and IIQ-7 questionnaires, with the independent variables such as Ingelman-Sundberg scales, 1-h pad tests, urethral support and urethral sphincter function were investigated. Results: The scores of item 3 of UDI-6 as well as the sum scores of UDI-6 and IIQ-7 had significant correlation with incontinence severity assessed by Ingelman-Sundberg scales and 1-h pad tests. However, only the scores of item 3 of UDI-6 were significantly correlated with the presence of bladder neck funneling on ultrasound and maximum urethral closure pressure. No correlations exist between sum scores of UDI-6 or IIQ-7 and the pathophysiological factors of SUI. Conclusions: Urogenital Distress Inventory-6 and IIQ-7 play important and complementary roles in comprehensive assessment for SUI, but are not identical to the pathophysiological factors. [ABSTRACT FROM AUTHOR]

The pathophysiology of stress urinary incontinence (SUI) is multifactorial. The aim of this study was to explore the factor determining the symptom severity of SUI. One hundred twenty-four women with SUI were retrospectively investigated. Clinical data for analyses included demographics, pelvic organ prolapse quantification, SUI severity using a 4-point Likert scale, ultrasound, 1-h pad tests, and urodynamic studies. Data were analyzed using the Spearman's rho test and Kruskal–Wallis test. The symptom severity was not correlated with risk factors of SUI or the morphologic manifestations representing urethral support defect, but was significantly correlated with urine loss on 1-h pad test, Valsalva leak point pressure (VLPP) grading, and maximum urethral closure pressure (MUCP). Women with higher SUI severity had greater urine loss on 1-h pad tests, worse VLPP grading, and lower MUCP. Urethral sphincter function appears to be an important determinant for the symptom severity of SUI. [ABSTRACT FROM AUTHOR]

The aberrant expression of retinoic acid receptor‑α (RARα) has been reported in various types of cancer. However, its association with the prognosis and development of laryngeal squamous cell carcinoma (LSCC) has not yet been determined. Therefore, the present study aimed to examine the expression and function of RARα in patients with LSCC. The expression of RARα in LSCC tissues was investigated using immunostaining. An MTT assay and flow cytometry analysis were also performed to investigate the function of RARα in the proliferation and cell cycle of LSCC cells. The expression of RARα was significantly elevated in LSCC tissues compared with adjacent noncancerous tissues (78.1 vs. 6.3%, P<0.05). The overexpression of RARα was associated with poorly differentiated features of LSCC (P<0.05). Furthermore, the downregulation of RARα inhibited the proliferation of LSCC cells, and arrested the cell cycle at the G1 phase via upregulation of cyclin dependent kinase inhibitor 1A, which may be associated with inhibition of the protein kinase B signaling pathway. Therefore, the overexpression of RARα may contribute to the development of LSCC through the regulation of the cell cycle. The results of the present study provide evidence that RARα serves an important function in LSCC development and may be a potential therapeutic target or prognostic predictor for LSCC. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the use of high doses of antipsychotic medications (≥ 600 mg/day chlorpromazine equivalent) in older Asian patients with schizophrenia and its demographic and clinical correlates. Method: Information on hospitalized patients with schizophrenia aged ≥ 50 years was extracted from the database of the Research on Asian Psychotropic Prescription Patterns study (2001-2009).Data on 2203 patients in six Asian countries and territories, including China, Hong Kong, Japan, Korea, Singapore and Taiwan, were analyzed. Socio-demographic and clinical characteristics and antipsychotic prescriptions were recorded. Results: The frequency for high-dose antipsychotic medications was 36.0% overall, with 38.4% in 2001, 33.3% in 2004 and 36.0% in 2009. Multiple logistic regression analysis of the whole sample showed that compared to patients receiving low-medium antipsychotic doses, those on high doses had a longer illness duration (odds ratio (OR): 2.0, 95% confidence interval (CI):1.2-3.3, p = 0.008), were more likely in the 50-59-year group (OR: 0.95, 95% CI: 0.94-0.97, p<0.001), more often had current positive (OR: 1.5, 95% CI: 1.2-1.8, p<0.001) or negative symptoms (OR: 1.3, 95% CI: 1.03-1.6, p = 0.03), and more commonly received antipsychotic polypharmacy (OR: 5.3, 95% CI: 4.1-6.7, p<0.001). Extrapyramidal symptoms (p = 0.25) and tardive dyskinesia (p = 0.92) were not more frequent in the high-dose group. Conclusions: High doses of antipsychotic medications were used in more than one third of older Asian patients with schizophrenia. The reasons for the frequent use of high antipsychotic doses in older Asian patients warrant further investigation. [ABSTRACT FROM AUTHOR]

Obesity is related to hyperlipidemia and risk of cardiovascular disease. Health benefits of vegetarian diets have well-documented in the Western countries where both obesity and hyperlipidemia were prevalent. We studied the association between BMI and various lipid/lipoprotein measures, as well as between BMI and predicted coronary heart disease probability in lean, low risk populations in Southern China. The study included 170 Buddhist monks (vegetarians) and 126 omnivore men. Interaction between BMI and vegetarian status was tested in the multivariable regression analysis adjusting for age, education, smoking, alcohol drinking, and physical activity. Compared with omnivores, vegetarians had significantly lower mean BMI, blood pressures, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, total cholesterol to high density lipoprotein ratio, triglycerides, apolipoprotein B and A-I, as well as lower predicted probability of coronary heart disease. Higher BMI was associated with unfavorable lipid!lipoprotein profile and predicted probability of coronary heart disease in both vegetarians and onmivores. However, the associations were significantly diminished in Buddhist vegetarians. Conclusions: Vegetarian diets not only lower BMI, but also attenuate the BMI-related increases of atherogenic lipid/lipoprotein and the probability of coronary heart disease. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the sex differences in prescribing patterns of psychotropic drugs and drug-induced side effects in schizophrenia patients in Asia using the data of the Research on Asian Psychotropic Prescription Pattern (REAP) surveys. Method: The prescription patterns of 6,441 schizophrenia inpatients in six Asian countries and regions were investigated during the 2001--2009 period. The patients' socio-demographic and clinical characteristics and their prescriptions for psychotropic drugs were recorded using a standardized protocol and data collection procedure. Results: Univariate analyses found the following factors to be significantly associated with the male sex: a younger age, higher doses of antipsychotics, less prominent delusions and hallucinations, more prominent negative symptoms, less likelihood of a prescription for second-generation antipsychotics (SGAs), greater use of antipsychotic polypharmacy, mood stabilizers and depot antipsychotics, more frequent tardive dyskinesia (TD), and less weight gain. In multivariate analyses, fewer prescriptions for SGAs, greater use of mood stabilizers, anticholinergics, antipsychotic polypharmacy and depot antipsychotics, extrapyramidal side effects (EPS) and TD, and less weight gain were independently associated with the male sex. Conclusions: Sex is one of the independent contributors to psychotropic prescription and side effects in Asian schizophrenia patients. Psychopharmacological treatment guidelines for schizophrenia should consider the sexes separately. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • High-dose antipsychotic use in schizophrenia has been a topic of continuous debate since the introduction of the first antipsychotic in the 1950s. • There are reasons arguing for (such as pharmacokinetic reasons for the possible use of high antipsychotic doses in those with genetic polymorphisms associated with unusually high metabolic rates and the presence of inducers such as co-prescriptions of other medications and smoking) and against high-dose antipsychotic use (such as the pharmacokinetic understanding that Asians may need lower antipsychotic doses, the association of high antipsychotic doses with more frequent adverse effects, and receptor occupancy data from neuroimaging studies). • There is increasing awareness of the need for more practice-based research in order to highlight discrepancies between the empirical data and clinical practice. WHAT THIS STUDY ADDS • There was an overall significant decrease in the frequency of high-dose antipsychotic use from 17.9% in 2001 to 6.5% in 2004 within East Asia. • The association of high antipsychotic doses with demographic, psychopathological and treatment variables identified the clinical profile of schizophrenia patients who are at risk of receiving high antipsychotic doses. • These findings provide information and impetus for clinicians to constantly monitor the drug regimes and to foster rational, evidence-based prescribing practices. AIMS We aimed to examine the frequency of high-dose (defined as mean chlorpromazine mg equivalent doses above 1000) antipsychotic prescriptions in schizophrenia and their clinical correlates in the context of a comparison between studies in 2001 and 2004 within six East Asian countries and territories. METHODS Prescriptions of high-dose antipsychotic for a sample of 2136 patients with schizophrenia from six countries and territories (mainland China, Hong Kong, Korea, Japan, Taiwan and Singapore) were evaluated in 2004 and compared with data obtained for 2399 patients in 2001. RESULTS Overall, the comparison between 2001 and 2004 showed a significant decrease in high-dose antipsychotic use from 17.9 to 6.5% [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.26, 0.39, P < 0.001]. Patients who received high-dose antipsychotics were significantly more likely to have multiple admissions (OR 1.96, 95% CI 1.16, 3.33, P = 0.009), more positive psychotic symptoms such as delusions (OR 2.05, 95% CI 1.38, 3.05, P < 0.001) and hallucinations (OR 1.85, 95% CI 1.30, 2.64, P = 0.001), but less likely to have negative symptoms (OR 0.58, 95% CI 0.40, 0.82, P = 0.002). Multivariate regression analyses revealed that prescription of high-dose antipsychotics was also predicted by younger age ( P < 0.001), time period of study (2001; P < 0.001), use of first-generation antipsychotic ( P < 0.001) and depot antipsychotics ( P < 0.001) as well as antipsychotic polytherapy ( P < 0.001). CONCLUSIONS We identified the clinical profile and treatment characteristics of patients who are at risk of receiving high antipsychotic doses. These findings should provide impetus for clinicians to constantly monitor the drug regimes and to foster rational, evidence-based prescribing practices. [ABSTRACT FROM AUTHOR]

Aims Antidepressant use in East Asia is poorly documented. We compared patients given newer and older antidepressants to test the hypothesis, suggested in the literature, that use of newer antidepressants is associated with treatment settings rather than specific diagnostic categories. Methods We compared rates of use of older (pre1990) vs. newer antidepressants among 1898 patients identified as antidepressant treated at 21 centres in five East Asian countries (China, Japan, Korea, Singapore, Taiwan) in 2003. Demographics, treatment setting and clinical factors associated with preferential use of newer drugs were tested in univariate and multivariate analyses. Results Newer antidepressants were included in the treatment regimens of 67.5% ( N = 1282/1898) of study subjects. Prescription for newer antidepressants was significantly associated with younger age (z = −4.55, d.f. = 1888, P < 0.001), hospitalization [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.07, 1.64, P < 0.01] and treatment within psychiatric hospitals (OR 1.59, 95% CI 1.27, 2.00, P < 0.001). On multivariate analyses, treatment with newer antidepressants was independently associated with younger age ( P < 0.001), country ( P < 0.001) and treatment within private hospitals ( P < 0.001), but not with sex or diagnosis of affective or anxiety disorders (all P > 0.1). Conclusion Demographic factors and treatment settings appear to influence antidepressant choice more than clinical factors such as diagnosis. [ABSTRACT FROM AUTHOR]

Aims Few studies have examined the use of depot antipsychotics in East Asian patients with schizophrenia. This study examined the prevalence of depot antipsychotic use and its clinical correlates. Methods Across six East Asian countries and territories, 2399 patients with schizophrenia were surveyed using a standardized protocol. Results Depot antipsychotic medications were prescribed in 15.3% (n =368) of the patients, being the most common in Singapore, followed by Taiwan, Japan and China. Being on depot antipsychotic drugs was significantly associated with male gender (particularly in Taiwan and Japan), delusions in Japan, aggression, higher daily CPZ equivalent dose and co-prescription of anticholinergic drugs but less likely with disorganized speech (particularly in China) and negative symptoms (particularly in Japan and Singapore). On multivariate analysis, the significant associated factors were treatment setting, younger age, longer duration of illness, aggression and the lack of use of an oral, atypical antipsychotic. Conclusion There was a wide variation in the prevalence of depot antipsychotic prescription, suggesting that it may not be guided by any recognizable principles and is more likely determined by local traditions and prescription culture. There is a need to re-examine the risk–benefit profile of each patient before deciding on the initiation or continuation of depot antipsychotic medication. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]