Oct, 1, 2023

Vol.30 No.2, pp. 84-88


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Vol. 16 No.1

Chronic Treatment of Fluoxetine Increases Expression of NCAM140 in the Rat Hippocampus

Mi Ran Choi, PhD1;Young Gyu Chai, PhD1;Kyoung Hwa Jung, PhD1;Seung Youn Baik, PhD1;Seok Hyeon Kim, MD, PhD2;Sungwon Roh, MD, PhD2;Joonho Choi, MD, PhD2;Jun-Seok Lee, MD, PhD3;Ihn Geun Choi, MD, PhD4; and Byung-Hwan Yang, MD, PhD2;

1;Division of Molecular & Life Sciences, Hanyang University, Ansan, 2;Department of Neuropsychiatry, College of Medicine & Institute of Mental Health, Hanyang University, Seoul, 3;Department of Neuropsychiatry, College of Medicine, Kwandong University, Goyang, 4;Department of Neuropsychiatry, College of Medicine, Hallym University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 5-14.

Abstract

Objectives:Most of the mechanisms reported for antidepressant drugs are the enhancement of neurite outgrowth and neuronal survival in the rat hippocampus. Neural cell adhesion molecule 140(NCAM140) has been implicated as having a role in cell-cell adhesion, neurite outgrowth, and synaptic plasticity. In this report, we have performed to elucidate a correlation among chronic antidepressant treatments, NCAM140 expression, and activation of phosphorylated cyclicAMP responsive element binding protein(pCREB) which is a downstream molecule of NCAM140-mediated intracellular signaling pathway in the rat hippocampus. 

Methods:Fluoxetine(10mg/kg) was injected acutely(daily injection for 5days) or chronically(daily injection for 14days) in adult rats. RNA and protein were extracted from the rat hippocampus, respectively. Real-time RT-PCR was performed to analyze the expression pattern of NCAM140 gene and western blot analyses for the activation of the phosphorylation ratio of CREB.

Results:Chronic fluoxetine treatments increased NCAM140 expression 1.3 times higher than control in rat hippocampus. pCREB immunoreactivity in the rat hippocampus with chronic fluoxetine treatment was increased 4.0 times higher than that of control. 

Conclusion:Chronic fluoxetine treatment increased NCAM140 expression and pCREB activity in the rat hippocampus. Our data suggest that NCAM140 and pCREB may play a role in the clinical efficacy of antidepressants promoting the neurite outgrowth and neuronal survival. 

Keywords

Fluoxetine;Hippocampus;NCAM140;CREB;pCREB.

Comparison on the Efficacy of Quetiapine Versus Haloperidol in the Treatment of Delirium:Prospective, Randomized Trial

Yu-Jin Lee, MD;Han-Yong Jung, MD, PhD;Soyoung Irene Lee, MD, PhD;Shin Gyeom Kim, MD; and Joon Ho Park, PhD

Department of Neuropsychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 15-24.

Abstract

Objectives:The purpose of this study is to examine the efficacy and side effects of quetiapine and haloperidol for the treatment of symptoms of delirium.

Methods:One hundred and seven patients with delirium were recruited and randomly assigned to receive a flexible-dose regimen of quetiapine or haloperidol over 7days and seventy-seven patients completed the study(quetiapine group N=40, haloperidol group N=37). The severity of delirium was assessed by using Memorial Delirium Assessment Scale(MDAS) scores, the psychiatric and behavioral symptoms were assessed by Neurobehavioral Rating Scale(NRS) scores, and the cognitive status was measured by Mini-mental state examination Korean version(MMSE-K) scores. The side effects were measured by Drug Induced Extrapyramidal Symptoms Scale(DIEPSS) scores.

Results:MDAS scores significantly improved in both treatment groups. NRS scores also significantly improved in both treatment group, but the group-by-time effect approached significance, likely caused by the greater decrease in scores of the quetiapine group. MMSE-K scores significantly improved only in the quetiapine group. Side effects associated with treatment were not significant in either treatment groups.

Conclusion:This study suggests that quetiapine is as efficacious as haloperidol in the treatment of delirium. In particular, quetiapine seems to improve psychiatric and behavioral problems of delirium and was more effective than haloperidol in cognitive improvement.

Keywords

Delirium;Quetiapine;Haloperidol.

The Serotonin Transporter Gene Polymorphism in Korean Attention-Deficit/Hyperactivity Disorder Children

Soo-Churl Cho, MD1;Jung-Woo Son, MD2;Boong-Nyun Kim, MD1;Jae-Won Kim, MD1;Hee-Jeong Yoo, MD3;Jun-Won Hwang, MD4;Dae-Yeon Cho, PhD5;Un-Sun Chung, MD6; and Tae-Won Park, MD7;

1;Division of Child and Adolescent Psychiatry, Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, 2;Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, 3;Department of Psychiatry, College of Medicine, Seoul National University, Bundang Hospital, Seoul, 4;Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, 5;LabGenomics Clinical Research Institute, LabGenomics, Seoul, 6;Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, 7;Department of Neuropsychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 25-36.

Abstract

Objectives:The aim of this study was to investigate the association between Korean ADHD patients and the l/s polymorphism of serotonin transporter(5-HTTLPR).

Methods:The study sample consisted of 189 Korean ADHD children diagnosed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version(K-SADS-PL), both parents of ADHD children, and 150 normal children. DNA were extracted from the blood of all samples, and genotyping was done. Based on the allele and genotype information, not only the case-control analysis between ADHD and normal children but also the family-based association test among ADHD children and their parents. Transmission disequilibrium test(TDT) were performed for family-based associated test(number of trio=113). The results of the clinical rating and neuropsychological tests were compared according to the l/s genotype of ADHD children.

Results:In case-control analysis, there were no statistically significant difference of l/s gene polymorphism between ADHD and normal children in various kinds of analysis condition. In family-based association study, TDT failed to detect linkage disequilibrium between l/s gene polymorphism and ADHD in whole ADHD families. However, in the families of ADHD inattentive type only(number of trio=23), l allele was transmitted more preferentially in the proband with ADHD even if the number of families was small(χ2=4.57, p=.032). In the analysis of the results from the clinical scales and neuropsychological tests in ADHD children, the score of the Novelty-Seeking of ADHD children with l/l genotype was significantly lower than with the other genotypes(F=3.15, p=.047), and that of Self Transcendence was significantly higher(F=4.25, p=.017).

Conclusion:The results of this study suggest there were no significant genetic association between the 5-HTTLPR gene polymorphism and Korean ADHD.

Keywords

Attention-deficit/hyperactivity disorder;Serotonin transporter gene;Case-control analysis;Family-based association study.

Difference in Psychiatric Comorbidity of Panic Disorder According to Age of Onset

Eun-Jee Kim, MD;Se-Won Lim, MD; and Kang-Seob Oh, MD, PhD

Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 37-45.

Abstract

Objectives:It is reported that panic disorder is frequently comorbid with other psychiatric illnesses. The aim of this study was to investigate differences of psychiatric comorbidity according to age of onset of panic disorder.

Methods:Three hundred-two patients participated in the study. All the patients were evaluated by clinical instruments for the assessment the presence of other comorbid psychiatric disorders and various clinical features; Korean version of Mini International Neuropsychiatric Interview, Self-report questionnaires(Beck Anxiety Inventory, Beck Depression Inventory, Anxiety Sensitivity Index and State-Trait Anxiety Inventory) and clinical rating scale (Hamilton Anxiety Scale, Hamilton Depression Scale and Global Assessment of Functional score). Chi-square test was used to determine the difference between early onset and late onset panic disorder.

Results:
Forty percent of panic patients were found to have at least one comorbid psychiatric diagnosis. There were no differences among the groups divided by number of comorbidity in sex, agoraphobia comorbidity, duration of panic disorder, except onset age of panic disorder. Early onset group had more comorbidy with social phobia, agoraphobia, PTSD. We also found that Early onset panic disorder patients were more likely to experience derealization, nausea, parethesia than late onset panic disorder patients. 

Conclusion:The results of our study are in keeping with previous data from other parts of the world. Our finding suggest that earier onset of panic disorder related to more psychiatric comorbidity.

Keywords

Panic disorder;Comorbidity;Early onset;Agoraphobia;Social phobia.

Comparison of Clinical Characteristics Between Respiratory and Non-Respiratory Subtypes of Panic Disorder

Ju-Won Ha, MD;Se-Won Lim, MD; and Kang-Seob Oh, MD

Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 46-52.

Abstract

Objectives:The goal of this study was to compare the clinical characteristics of panic disorder respiratory subtype(PD-R) and non-respiratory subtype(PD-NR). 

Methods:84 patients with panic disorder were enrolled and divided into 2 groups, 29 PD-R and 55 PD-NR. Diagnosis of panic disorder was evaluated using Diagnostic and Statistical Manual of Mental Disorders 4th edition and Mini International Neuropsychiatric Interview. They were also measured with Hamilton Rating Scale for Anxiety(HAM-A), Hamilton Rating Scale for Depression(HAM-D), and Panic Disorder Severity Scale (PDSS). 

Results:PD-R group showed significantly higher scores in PDSS than those of PD-NR group(p=.027). After controlling for the severity of panic disorder and gender, PD-R group showed higher HAM-D and somatic anxiety subscale of HAM-A than those of PD-NR group. Furthermore, results of logistic regression analysis suggested that the somatic anxiety was a possible risk factor of PD-R(OR=1.404,p=0.009).

Conclusion:These results suggest that somatic anxiety and depressive symptom would be important clinical characteristics of PD-R.

Keywords

Panic disorder;Respiratory subtype;Somatic anxiety.

Vol. 16 No.2

Severity of Obstructive Sleep Apnea and Heart Rate Variability:Detrended Fluctuation Analysis

Gawon Ju, MD1;Chul-Jin Shin, MD1; and Doo-Heum Park, MD2;

1;Department of Neuropsychiatry, Chungbuk National University of Medicine and Medical Research Institute, Cheongju, 2; Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 69-75.

Abstract

Objectives:The detrended fluctuation analysis is one of the nonlinear methods for the investigation of biological time series. It quantifies the fractal scaling properties and is known to be useful in the evaluation of long-range correlations in time series. The heart rate variability(HRV) of obstructive sleep apnea syndrome (OSAS) patients during nighttime was analyzed by detrended fluctuation analysis to assess its relationship with the severity of the symptoms.

Methods:Fifty nine untreated male OSAS patients with moderate to severe symptoms(mean age=45.4±11.7 years, apnea-hypopnea index, AHI≥15) underwent nocturnal polysomnography. Moderate(AHI=15-30, N=22) and severe(AHI>30, N=37) OSAS patients were compared for the indices derived from detrended fluctuation analysis and frequency domain analysis of HRV.

Results:In the detrended fluctuation analysis, the alpha values were 0.75±0.11 and 0.82±0.07 for the severe and the moderate OSAS groups respectively. The difference was significant(p<.01). The alpha value had negative correlation with AHI(r=-.425, p=.001). Negative correlation coefficients were also found in the relationships between the alpha values and very low frequency(VLF)(r=-.425, p=.001), low frequency(LF)(r=-.633, p=<.001) and the LF/HF ratio(r=-.305, p=.019) respectively. LF/HF ratio(p=.005) was higher in the severe OSAS group compared to that of the moderate OSAS group.

Conclusion:In this study, the detrended fluctuation analysis showed the significant difference between the two OSAS groups classified according to their severity of symptoms. The scaling exponent showed the negative correlation with AHI and indicies of frequency domain analysis. This result suggests that detrended fluctuation analysis can be helpful to estimate the severity of OSAS.

Keywords

Detrended fluctuation analysis;Heart rate variability;Obstructive sleep apnea.

Development of the Korean Version of the Social Functioning Scale in the Schizophrenics:A Study on the Reliability and Validity

Chul-Kwon Kim, MD; and Ji-Ah Lee, MD

Department of Psychiatry, College of Medicine, Dong-A University, Busan, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 76-111.

Abstract

Objectives:The purpose of this study was to develop the Korean version of the Social Functioning Scale (KSFS) in the patients with schizophrenia.

Methods:KSFS was administered to 90 schizophrenic patients and 80 their parents and 90 normal controls for examining the reliability and validity.

Results:Data analysis showed statistically significant reliabilities and validities of KSFS. The test-retest reliability, rater vs. self-report reliability, and internal consistency for total scores of KSFS were 0.93, 0.44 and 0.94 respectively. Evidence for discriminant validity of KSFS comes from the results that the mean scores of schizophrenic patients were significantly higher than those of normal controls. Construct validity was assessed by calculating the 7 inter-areas correlations of the KSFS, and all areas were statistically significant. Significant correlations between the total scores of KSFS and those of SOFAS lend support for the concurrent validity of this instrument. Factor analyses were performed and two factors were extracted accounting for 63.7% of the variance. Sensitivity was assessed indirectly via the distribution and range of scores on the SFS. The normal control group showed a distribution around a higher mean with a moderate positive skew.

Conclusion:KSFS was found to be a valid, reliable, and sensitive instrument which can be used to evaluate the degree of social functioning in the patients with schizophrenia.

Keywords

Social functioning scale;Schizophrenia;Reliability;Validity.

The Standardization of the Korean Version of Brief Edinburgh Depression Scale as a Screening Tool for Depression in Cancer Patients

Jung Hyun Lee, MD1;Tae-Suk Kim, MD, PhD2,4,5;Yoon-Ho Ko, MD3;Sujung J. Yoon, MD, PhD2;In Kyoon Lyoo, MD, PhD1;Tae-Youn Jun, MD, PhD2,5; and Chul Lee, MD, PhD2;

1;Department of Psychiatry, Seoul National University Hospital, Seoul, 2;Department of Psychiatry, The Catholic University of Korea, College of Medicine, Seoul, 3;Department of Medical Oncology, The Catholic University of Korea, College of Medicine, Seoul, 4;Cancer Distress Clinic, Catholic Cancer Comprehensive Institute, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, 5;Clinical Research Center for Depression, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 112-20.

Abstract

Objectives:Depression is a common psychiatric disorder in cancer patients. The Brief Edinburgh Depression Scale(BEDS), which is an abbreviated version of the Edinburgh Depression Scale, may serve as a useful tool in screening for the depression in patients with the medical illnesses. This report investigated the reliability and validity of the Korean Version of the BEDS(K-BEDS) for the depression in cancer patients.

Methods:One-hundred cancer patients were enrolled in this study. All subjects completed the K-BEDS, the Hospital Anxiety Depression Scale(HADS), and the Karnofsky Performance Status Scale(KPSS). Reliability, validity and Receiver Operating Characteristic(ROC) curve analysis measures were assessed.

Results:The K-BEDS showed good internal consistency(Cronbach α=0.77) and test-retest reliability(0.94, p<0.001). All item-total correlations were above 0.3. Also, it revealed moderate correlation with the depression subscale of the HADS(r=0.617), but no correlation with the KPSS. Exploratory factor analysis produced only one factor, accounting for 47.1% of the total variance. The most valid cutoff value to screen for depression was a total score of 5 on the K-BEDS, which showed sensitivity of 62.5% and specificity of 86.4% with a positive predictive value of 4.60 and a negative predictive value of 0.43.

Conclusion:The present findings suggested that the K-BEDS would have good psychometric properties to screen for the depression in cancer patients.

Keywords

Brief edinburgh depression scale;Cancer;Depression;Reliability;Validity;Cutoff value.

No Association Study of SLC6A4 Polymorphisms with Korean Autism Spectrum Disorder

Hee Jeong Yoo, MD, PhD1;In Hee Cho, MD, PhD2;Mira Park, PhD3;So Young Yang4; and Soon Ae Kim, MD, PhD4,5;

1;Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, 2;Department of Neuropsychiatry, Gachon Medical School, Incheon, 3;Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, 4;Department of Pharmacology, School of Medicine, Eulji University, Daejeon, 5;Medical Sciences Research Institute, Eulji University, Daejeon, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 121-6.

Abstract

Objectives:The serotonin transporter gene(SLC6A4) is one of the most widely studied candidate genes in autism spectrum disorder(ASD), but there have been conflicting results from studies into the association between SLC6A4 and ASD. The aim of this study was to evaluate the association between single nucleotide polymorphisms(SNPs) in the SLC6A4 gene and ASD in the Korean population.

Methods:We selected 12 SNPs in SLC6A4 and observed the genotype of 151 Korean ASD trios. We tested the family-based association for each individual polymorphism and haplotype by using the standard TDT method in Haploview(http://www.broad.mit.edu/mpg/haploview/).

Results:Through transmission-disequilibrium testing and haplotype analysis, we could not find any statistically significant transmitted allele or haplotype. In addition, a case-control association test with Korean HapMap data did not reveal any statistical significance.

Conclusion:Although serotonin-related genes must be considered candidate genes for ASD, we suggest that common SNPs of SLC6A4 are not important markers for associations with Korean ASD.

Keywords

Autistic disorders;Serotonin transporter;Genetic polymorphism;Haplotypes;Association.

A Case of Marchiafava-Bignami Disease with Symmetrical Lesions of the Putamen in a Patient with Chronic Alcohol Dependence

So Youn Joo, MD1; and Tae Young Choi, MD, PhD2;

1;Department of Psychiatry, Chung-Ang University, College of Medicine, Seoul, 2;Department of Psychiatry, Catholic University of Daegu, School of Medicine, Daegu, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 127-32.

Abstract

Marchiafava-Bignami disease(MBD) is a rare complication of chronic alcoholism characterized by symmetrical demyelination of the corpus callosum. We report a case of MBD in a Korean patient having chronic alcohol dependence. The patient exhibited mental depression, weakness of all four limbs and dysarthria. Laboratory data showed mild hyponatremia. Magnetic resonance imaging(MRI) revealed unusual symmetrical resolving lesions of the putamen in addition to the typically observed lesion of the corpus callosum. The neurologic disturbances were gradually improved with the normalization of low plasma sodium levels. Marked improvement of abnormal MRI findings was noted after thiamine supplement, though the patient still exhibited severe cognitive impairment.

Keywords

Marchiafava-Bignami disease;Corpus callosum;Putamen;Demyelination;Hyponatremia;MRI.

Vol. 16 No.3

Association Analysis of Polymorphisms on Dystrobrevin Binding Protein 1(DTNBP1) Gene with Schizophrenia in the Korean Population

Hyun-Il Moon, MD1;Yeon Jung Lee, MD1;Byung-Lae Park, PhD2;Hyung Doo Shin, PhD2;Ihn-Geun Choi, MD3;Sun Ho Han, MD1; and Sung-Il Woo, MD1;

1;Department of Neuropsychiatry, College of Medicine Soonchunhyang University, Soonchunhyang University Hospital, Seoul, 2;SNP Genetics, Seoul, 3;Department of Neuropsychiatry, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 149-58.

Abstract

Objectives:This study was designed to investigate the association of schizophrenia and P1320, P1325, P1635, P1655, P1763 and SNP A polymorphisms on dystrobrevin binding protein 1(DTNBP1) gene in Korean patients.

Methods: We analyzed P1320, P1325, P1635, P1655, P1763 and SNP A polymorphisms on DTNBP1 gene from their DNAs extracted from their blood in 388 Korean schizophrenic patients (male 198, female 190) and 372 control subjects(male 247, female 125). We compared the differences of genotype and allele distributions of the six polymorphisms on DTNBP1 gene between the Korean schizophrenic patient group and the normal control group. 

Results:There were no statistically significant differences of genotype and allele distributions of the P1320, P1325, P1635, P1655, P1763 and SNP A polymorphisms on DTNBP1 gene between the schizophrenic patient group and the normal control group.

Conclusion:The results of this study suggest that P1320, P1325, P1635, P1655, P1763 and SNP A polymorphism on DTNBP1 gene do not have influence on the risk of the schizophnenic in the Korean population.

Keywords

Dystrobrevin Binding Protein 1(DTNBP1);Schizophrenia;Genetic polymorphism.

The Difference of Neural Activity in Viewing between one's own Emotional Situation and Other's:A Neuroimaging Study about Perspective-Taking

In-Kyung Oh, MD1;Jung-Woo Son, MD, PhD1;Seung-Bok Lee, PhD2; and Hei-Rhee Ghim, PhD2;

1;Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, 2;Department of Psychology, Chungbuk National University, Cheongju, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 159-69.

Abstract

Objectives:This study aimed to investigate the difference of brain activities in viewing a common emotional situation according to perspective-taking.

Methods:Using fMRI, brain activities were measured while performing the task viewing a common emotional situation on either self-perspective or third-person perspective in fourteen healthy men. The relatively activated brain areas on each perspective were investigated, then the relationship between the activated brain regions and the scores of self report about some emotion or empathic ability were explored.

Results:The relatively activated brain areas on self-perspective were bilateral paracentral lobule(BA 5), right postcentral gyrus(BA 3), right precentral gyrus(BA 4), left superior temporal gyrus(BA 22), left medial frontal gyrus(BA 6), whereas on third-person perspective right inferior frontal gyrus(BA 47), left caudate body and tail, right superior temporal gyrus(BA 38), right medial frontal gyrus(BA 8) were activated. The relative activity of left superior temporal gyrus on self-perspective was positively correlated with the score of Beck Depression Inventory.

Conclusion:This study demonstrated that the activated brain region according to perspective-taking were different while viewing a common emotional situation. The depressive feeling would have an influence on the brain activity related to perspective-taking.

Keywords

Perspective-taking;Emotion;fMRI.

Alteration in Plasma BDNF Level after Repetitive Transcranial Magnetic Stimulation(rTMS) in Treatment-Resistant Schizophrenia:A Pilot Study

So-Young Oh, MD; and Yong-Ku Kim, MD, PhD

Department of psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 170-80.

Abstract

Objectives:To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia.

Methods:Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale(PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia(K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment.

Results:After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness(rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level(rho=-0.821, N=7, p=0.023, two-tailed).

Conclusion:This preliminary study suggests that rTMS didn't make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.

Keywords

BDNF;TMS;PANSS;CDSS;Treatment-resistant schizophrenia.

N100 Amplitude Slopes in Major Depressive Disorder, Bipolar Disorder, Schizophrenia and Normal Controls

Eunkyoung Yang, MD1,2;Seung-Hwan Lee, MD, PhD1,2;Sunghee Oh, MA1; and Sangrae Kim, BA2,3;

1;Neuropsychiatry, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, 2;Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, 3;Cognitive Science, Yonsei University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 181-9.

Abstract

Objectives:N100 amplitude slope(the intensity dependence of the cortical auditory evoked potentials) is widely considered as an indirect indicator of central serotonergic neurotransmission. However, there are only a few studies about N100 amplitude slopes of major psychiatric disorders. In this study, we examined N100 amplitude slope differences among major depressive disorder(MDD), bipolar disorder(BD), schizophrenia (SCZ) and normal controls(NC).

Methods:We measured the N100 amplitude slopes of 35 patients with MDD, 33 patients with BD, 27 patients with SCZ and 35 NC subjects. Amplitude differences from N1 to P2 at the five different sound intensities(55, 65, 75, 85 and 95dB) were examined at Cz electrode. The N100 amplitude slope was calculated as the linear regression of five N1/P2 peak-to-peak amplitudes across stimulus intensities.

Results:BD patients showed significantly reduced N100 amplitude slope compared with NC(0.54±0.70 vs. 0.96±0.72, p=0.035). N100 amplitude slope of SCZ patients was significantly reduced compared with NC(0.50 ±0.47 vs. 0.96±0.72, p=0.027). N100 amplitude slope of BD patients was significantly lower than that of MDD patients(0.54±0.70 vs. 0.94±0.60, p=0.046). SCZ patients also showed significant reduction of N100 amplitude slope compared with MDD patients(0.50±0.47 vs. 0.94±0.60, p=0.036). There was no significant difference of N100 amplitude slope between MDD patients and NC(0.94±0.60 vs. 0.96±0.72, p=1.000). 

Conclusion:Interestingly, the N100 amplitude slopes of BD and SCZ were reduced compared to NC and MDD patients. Our results suggest the predictive use of N100 amplitude slope in making differential diagnoses of major psychiatric disorders. Clinical implications of N100 amplitude slope in major psychiatric disorders were discussed.

Keywords

N100 amplitude slope;Central serotonergic neurotransmission;Major depressive disorder;Bipolar disorder;Schizophrenia.

Gray Matter Changes in Patients with Pathological Gambling:A Preliminary Study Using Voxel-Based Morphometry Study

Jung-Seok Choi, MD1,2;Young-Chul Shin, MD, PhD3;Wi Hoon Jung, MS4;Myung Hun Jung, MD1;Joon Hwan Jang, MD1;Do-Hyung Kang, MD, PhD1;Chi-Hoon Choi, MD5;Jun Soo Kwon, MD, PhD1,4,6; and Jun-Young Lee, MD, PhD1,2;

1;Department of Psychiatry, Seoul National University College of Medicine, Seoul, 2;Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, 3;Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, 4;Interdisciplinary Program in Brain Science, Seoul National University, Seoul, 5;Department of Radiology, National Medical Center, Seoul, 6;Brain & Cognitive Science-WCU program, College of Natural Science, Seoul National University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 190-7.

Abstract

Objectives:The purpose of this study was to examine structural abnormalities of brain in patients with pathological gambling(PG) using voxel-based morphometry.

Methods:We compared gray matter(GM) volumes between 10 patients with PG and 14 age- and IQ-matched healthy controls and examined the relationship of GM volumes with clinical variables in patients with PG.

Results:We found significant increase of GM volume in the superior, middle, and inferior frontal gyri, the midbrain, the middle temporal gyrus, the precuneus, and the fusiform gyrus of patients with PG. A significant decrease of GM volume was observed in the parahippocampal gyrus and the lingual gyrus of the patient group. In addition, GM volumes in some of these regions were positively associated with South Oaks Gambling Screen score and negatively with age of onset in patients with PG.

Conclusion:Current findings indicate that structural abnormalities in the fronto-temporal cortex, the midbrain, and the precuneus might be involved in the pathophysiology of PG, and contribute to some of the behavioral changes observed in patients with PG.

Keywords

Pathological gambling;Voxel-based morphometry.

The Causes of Death of the Institutionalized Population of Kkottongnae:Comparison between Severe Mental Illness Group(SMI) and Non-Severe Mental Illness Group(Non-SMI)

Su Jin Moon, MD1;Kyoung Hoon Kim, MPH2;Ji Young Song, MD, PhD1; and Jong-Woo Paik, MD, PhD1;

1;Department of Neuropsychiatry, KyungHee University School of Medicine, Seoul, 2;Review & Assessment Policy Institute, Health Insurance Review & Assessment Service, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 198-204.

Abstract

Objectives:Schizophrenia and other psychiatric disorder are associated with an increased risk of premature death. For decades, there have been reports of shorter life expectancy among those with severe mental illness. The purpose of this study was to compare the risk of mortality among institutionalized population, treated for severe mental illness to control group who did not have severe mental illness.

Methods:The medical records and the death certificates of 2,029 institutionalized population who had died from 1985 to 2003 in Kkottongnae were investigated. 

Results:The mean age of the death of severe mental illness(SMI) group(51.4±15.3 years old) was lower than that of non-severe mental illness(non-SMI) group(65.0±19.3 years old) and it was statistically significant(p<0.0001). The most causes of death among the SMI group were respiratory diseases(23.3%), infectious disease (13.0%) and digestive disease(12.3%). Also, we found that the death due to injuries of the SMI group(8.9%) were three times higher than that of non-SMI group(2.5%). The most causes of death among the non-SMI group were respiratory disease(26.3%), circulatory disease(26.2%) and neoplasm(10.8%). 

Conclusion:The SMI group demonstrated higher mortality rates compared with the rate in the non-SMI group. The finding suggests that careful intervention is needed not only for menal health but also physical health in long-term facilities.

Keywords

Severe mental illness;Mortality.

Platelet BDNF Level in Patients with Acute Bipolar Manic Episode:The Preliminary Study

Kwang-Yeon Choi, MD;Yong-Ku Kim, MD, PhD; and Bun-Hee Lee, MD, PhD

Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 205-11.

Abstract

Objectives:Serum and plasma BDNF levels have been shown to be decreased in patients with mood disorder such as major depressive disorder and bipolar disorder. We investigated whether platelet BDNF levels would be lower in patients with acute bipolar manic episode compared with those of normal controls. 

Methods:BDNF levels were examined in platelet-rich plasma(PRP) and platelet-poor plasma(PPP) in 20 healthy controls and 20 hospitalized patients who were diagnosed as bipolar I disorder, most recent episode manic using a Structured Clinical Interview for DSM-IV. And severity of manic symptoms was measured using Young Mania Rating Scale(YMRS). Platelet BDNF level was calculated by subtracting PPP BDNF from PRP BDNF level, and dividing the result by the total platelet count, and it was expressed as pg/106 platelet.

Results:Platelet BDNF levels were significantly lower in patients with acute bipolar manic episode(4.55±3.36pg/106 platelet) than in normal controls(6.84±2.32pg/106 platelet)(p=0.008). However we failed to reveal the significant negative correlation between platelet BDNF levels and YMRS scores in patients with acute bipolar episode. 

Conclusion:Our finding suggests that there is a decrease in the platelet BDNF of patients with acute bipolar manic episode. 

Keywords

BDNF;Platelet;Bipolar disorder;Manic episode.

Vol. 16 No.4

Diagnosis and Treatment of Menopause-Related Depression

Su-Jin Yang, MD, PhD; and Jae-Min Kim, MD, PhD

Department of Psychiatry, Chonnam National University Medical School and Department Clinical Research Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 229-37.

Abstract

Recent Korean statistics show that a Korean woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by in-tense hormonal fluctuations, accompanied by sleep disturbance, vasomotor symptoms(e.g., hot flashes, night sweats), increased risk for osteoporosis, cardiovascular disease, and developing depression as well as mood disturbances. These symptoms can affect a woman's quality of life negatively. Therefore, a comprehensive understanding of the accurate detection and appropriate treatment of various menopause-related symptoms including depression in the menopausal transitions and postmenopause is mandatory. This review primarily focused on the current knowledge about the treatment of menopause-related depression.

Keywords

Menopause;Depression;Diagnosis;Therapy.

The Characteristics of Visuospatial Working Memory in Alzheimer's Disease

Seol-Min Kim, MA1; Young-Ho Lee, PhD2; Jung-Hae Youn, PhD3; Ju-Won Lee3; Jun-Young Lee, MD, PhD3;

1;Department of Neuropsychiatry, Kyung Hee University School of Medicine, Seoul, 2; Department of Psychology, The Catholic University of Korea, Seoul, 3;Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 238-45.

Abstract

Objectives:Mild Alzheimer's disease(AD) is uncertain to be related to visuospatial working memory subsystem dysfunction. We used the self ordered pointing test(SOPT) to find the characteristics of visuospatial working memory in mild AD.


Methods:We compared the visuospatial working memory abilities of 20 patients with mild AD and 20 normal elderly controls(NC) using SOPT, of which stimuli consisted of two stimuli types(A:abstract, C:concrete) and two stimuli numbers(8 and 12). Therefore, working memory was tested using C8, C12, A8, and A12 stimuli conditions in SOPT. Mixed-model ANOVA was conducted with the AD and NC groups as between-subjects factor, with stimuli types and stimuli numbers as the within-subjects factors and with SOPT error rates as the dependent variable.


Results:The AD group showed higher error rates in SOPT than the NC group. The NC group showed low error rates in concrete stimuli than in abstract stimuli and in small stimuli numbers than in large stimuli numbers. And the AD group showed no differences between stimuli types or stimuli numbers. 


Conclusion:AD patients showed a poor performance in visuospatial working memory using concrete stimuli. The result suggests that there is a non-transformation from visual input to phonological working memory in AD. Patients with AD showed a poor performance although in small stimuli number condition of SOPT. It suggests that in AD, visuospatial working memory is not working well although in low central executive loads.

Keywords

Working memory;Alzheimer's disease;SOPT.

Prevalence and Risk Factors of Polydipsia and Water Intoxication in Psychiatric Inpatients

Ae-Hwa Cho, MD1; Yeon-Soo Cho, MD1; Jaewoo Roh, MD1,2;

1;Yong-In Mental Hospital, Yongin, 2; Yong-In Psychiatric Research Institute, Yongin, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 246-55.

Abstract

Objectives:The aims of this study are to estimate the prevalence of polydipsia and water intoxication and to identify risk factors of polydipsia and water intoxication in psychiatric inpatient. 


Methods:1,108 Psychiatric inpatients at 2 mental hospitals in Yongin city were studied from September, 2008 to January, 2009. We diagnosed 'polydipsia' using staff reports(fluid intake>3L/day) or by specific gravity of urine(SPGU<1.008) and diagnosed 'at risk for water intoxication' using normalized diurnal weight gain (NDWG>4%). We attempted to identify clinical characteristics of patients by reviewing their medical records.


Results:Two hundred forty seven patients(22.3%) were polydipsic. Sixty eight patients(6.1%) were at risk for water intoxication. The factors associated with polydipsia were lithium, smoking, younger age and increased smoking amounts. The factors associated with risk for water intoxication were valproic acid and polydipsia. 


Conclusion:Polydipsia and water intoxication in psychiatric inpatients are not rare conditions. Therefore, clinicians' attention should be paid to these conditions.

Keywords

Polydipsia;Water intoxication;Prevalence;Psychiatric inpatient;Risk.

Comorbidity of Posttraumatic Stress Disorder and Its Effect on Treatment Outcomes in Patients with Schizophrenia : One-Year Prospective Follow-Up Study

Sung-Jong Park, MD; Nam Hee Kim, MD; Jae-Yeol Jeong, MD; Sunny Lee, MD;

Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 256-65.

Abstract

Objectives:The aims of this study were to assess a) the prevalence of trauma and posttraumatic stress disorder(PTSD) in schizophrenic patients and b) the differences in symptomatology and outcome after 1year treatment between those with and without PTSD.


Methods:Twenty eight schizophrenia and schizoaffective disorder patients completed the Positive and Negative Syndrome Scale(PANSS), Life Stressor Checklist-Revised(LSCL-R), Clinician-Administered PTSD Scale (CAPS), Dissociative Experiences Scale(DES), Hamilton Psychiatry Rating Scale for Depression(HAM-D), and Rosenberg Self-Esteem Scale(RSE).


Results:Twenty six patients(92.9%) had at least one trauma in their life time. Eleven patients(39.3%) were diagnosed with PTSD. PTSD group had significantly higher scores on HAM-D and DES but lower scores on RSE. PTSD group also had significantly lower score in the baseline PANSS Negative score. Higher CAPS scores were significantly correlated with lower baseline PANSS Negative score and greater change after 1year of PANSS Negative score.


Conclusion:These results showed that the prevalences of trauma and PTSD are high in schizophrenic patients and suggested that PTSD and trauma-related symptoms affected the symptomatology and treatment outcome. More research is warranted to better understand the effects of PTSD in schizophrenic patients.

Keywords

Schizophrenia;Posttraumatic stress disorder;Trauma;Prevalence;Outcome.

A Case of Skin Eruption Occurred after Switching Formulation of Quetiapine Fumarate

Yong-Seok Kwon, MD; Se-Won Lim, MD;

Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 16, No. , pp. 266-70.

Abstract

Adverse drug reactions are very common in clinical practice, and skin is one of the most frequent organs for adverse drug reactions. We report a case of a 71-year-old male patient who developed skin eruptions after switching formulation of quetiapine immediate release(IR) to quetiapine extended release(XR). He had been taking quetiapine IR(400mg/day) for treatment of manic episode which was developed one year ago. The patient showed great improvement of symptoms after taking quetiapine IR for about one year, thus dosage of medication was reduced to 50mg/day on the average. Unfortunately dose reduction has tended to worsen symptoms, so dose of quetiapine was increased again to 200mg/day with formulation changes to XR. Two days after he took new formulation, erythematous papules were occurred over his anterior neck and ventral side of left wrist. As he stopped quetiapine XR, the skin lesions gradually subsided. And he was successfully treated with readministration of quetiapine IR without any skin lesions.

Keywords

Quetiapine;Hypersensitivity;Drug eruption;Formulation.

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Vol. 15 No.1

An Association Between Apolipoprotein E ε4 and Cognitive Function in Community-Dwelling Elders with Questionable Dementia*

Seok Woo Moon, MD, PhD1;Jeong Seok Seo, MD, PhD1;Beom Woo Nam, MD, PhD1;Jin Young Choi, MD, PhD2;Chang Hoon Lee, MD, PhD3;Kyoung Un Park, MD, PhD4; and Ki Woong Kim, MD, PhD5;

1;Department of Neuropsychiatry, 2;Neurology, 3;Laboratory Medicine, School of Medicine Kunkuk University, Chungju Hospital, Chungju, 4;Department of Laboratory Medicine, 5;Neuropsychiatry, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 5-13.

Abstract

Objectives:It was the aim of the present paper to examine the impact of the apolipoprotein E(APOE) ε4 on cognitive performance in community-dwelling elderly samples with 'questionable dementia'.

Methods:Total 295 samples who were diagnosed with 'questionable dementia' in the recent year and completed the Korean version of the Consortium Establish a Registry for Alzheimer's Disease(CERAD-K) neuropsychological assessment protocol, were recruited. The CDR test established score of 0.5. Genomic DNA was extracted from the venous blood and APOE genotyping was done in this group. Their cognitive performance was compared by the occurrence of the APOE ε4 allele.

Results:The impact of ε4 allele was significant in the Word List Recall Test(WLRT, F=4.511, df=1, p=0.035). The 'young-old' group aged 75 years and under had a significantly lower performance on the Word List Recall Test(WLRT, F=5.090, df=1, p=0.015), but the 'old-old' group over 75 years of age had not significantly different performance on the all the item of tests in ε4+ allele group.

Conclusion:The conclusion to be drawn here is that community-dwelling elderly samples with ε4 allele in 'questionable dementia' had a significantly lower performance on the Word List Recall Test in the CERAD-K neuropsychological test batteries and the effect was prominent in the 'young-old' age group.

Keywords

CDR;Apolipoprotein E;CERAD-K;Neuropsychological test.

Effects of Genetic and Environmental Factors on the Depression in Early Adulthood

Sie-Kyeong Kim, MD1;Sang-Ick Lee, MD1;Chul-Jin Shin, MD1;Jung-Woo Son, MD1;Sang-Yong Eom2; and Heon Kim, MD2;

1;Department of Neuropsychiatry, 2;Preventive Medicine, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 14-22.

Abstract

Objectives:The authors purposed to present data for explaining gene-environmental interaction causing depressive disorder by examining the effects of genetic factors related to the serotonin system and environmental factors such as stressful life events in early adulthood.

Methods:The subjects were 150 young adults(mean age 25.0±0.54), a part of 534 freshmen who had completed the previous study of genotyping of TPH1 gene. We assessed characteristics of life events, depression and anxiety scale and checked if they had a depressive disorder with DSM-IV SCID interview. Along with TPH1 A218C genotype confirmed in previous study, TPH2 -1463G/A and 5HTR2A -1438A/G genes were genotyped using the SNaPshotTM method.

Results:In comparison with the group without C allele of TPH1 gene, the number of life events had a significant effect on the probability of depressive disorder in the group with C allele. Other alleles or genotypes did not have a significant effect on the causality of life events and depressive disorder.

Conclusion:The results of this study suggest that TPH1 C allele is a significant predictor of onset of depressive disorder following environmental stress. It means that the TPH1 gene may affect the gene-environmental interaction of depressive disorder.

Keywords

Depressive disorder;Tryptophan hydroxylase;Serotonin receptor;Life stress;Gene-environment interaction.

Serum Lipid Profiles after Abstinence in Korean Male Patients With Alcohol Dependence

Seung-Ho Lee, MD1; and Woong-Sub Park, MD2;

1;Department of Preventive Medicine and Public Health, Kwandong University, Department of Psychiatry, Dong-in Hospital in Gangneung, Gangneung, 2;Department of Preventive Medicine and Public Health, Kwandong University, Interdisciplinary Program in Social Welfare Policy, Graduate School of Yonsei University, Gangneung, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 23-8.

Abstract

Objectives:The treatment of alcohol dependence requires maintaining abstinence. However, some previous studies have suggested that the abstinence may increase the cardiovascular risk in patients with alcohol dependence. The aim of the present study was to examine the effect of alcohol abstinence on lipid profile in Korean male patients with alcohol dependence.

Methods:Twenty-eight male patients with alcohol dependence were recruited from a psychiatric unit located at Gangneung Dongin Hospital. Lipid profiles of the patients were compared before and after a month of alcohol abstinence. 

Results:After abstinence of 1 month, high-density lipoprotein(HDL) cholesterol and triglyceride(TG) level was significantly decreased(p=0.000; p=0.0086, respectively). Low-density lipoprotein(LDL) cholesterol level showed a tendency to increase(p=0.066). Total cholesterol level also showed a tendency to decrease (p=0.074). 

Conclusions:These results show that acute abstinence of alcohol might paradoxically aggravate dyslipidemia in patients with alcohol dependence. Thus, this study shows that more concern associated with cardiovascular risk is needed during short-term abstinence period.

Keywords

Alcohol dependence;Abstinence;Lipid profile;Cardiovascular risk.

Interaction of Apolipoprotein E ε4 and Education on Cognitive Decline in Korean Elders

Jae-Min Kim, MD, PhD1;Il-Seon Shin, MD, PhD1;Sung-Wan Kim, MD, PhD1;Su-Jin Yang, MD, PhD1;Sang-Wook Park, MD1;Hee-Young Shin, MD, PhD2; and Jin-Sang Yoon, MD, PhD1,2;

1;Department of Psychiatry, Chonnam National University Medical School, Gwangju, 2;Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 29-34.

Abstract

Objectives:This study aimed to test potential modifying effects of education on the association between apolipoprotein E ε4 (Apo E4) and cognitive decline.

Methods:A community cohort(N=683) aged 65 or over completed the Korean version of Mini-Mental State Examination(MMSE-K) at baseline and two years later(1999-2001). Apo E polymorphisms were genotyped, and classified into that with or without Apo E4. Educational levels were categorized into people with or without education. Covariates included demographic(age, gender), life style(smoking, alcohol drinking), clinical (depression, sleep disorder, vascular risk factors) characteristics.

Results:The association between Apo E4 and cognitive decline was significant only in the old persons with no education. The interaction term between education and Apo E4 on cognitive decline was significant (p=0.040).

Conclusion:Elders with no education might be more vulnerable to the impact of Apo E4 on cognitive decline, which suggests gene-environment interaction.

Keywords

Cognitive decline;Apolipoprotein E;Education;Elderly;Gene-environment interaction.

Effect of Horizontal Eye Movements on the Heart Rate Variability after Exposure to a Fear-Inducing Film Clip

Haewon Lee, MD1;Myung-Kul Yum, MD, PhD2;Seok Hyeon Kim, MD, PhD1;Yun Jeong Lee, MD, PhD3; and Daeho Kim, MD, PhD2;

1;Department of Neuropsychiatry, College of Medicine and Institute of Mental Health, Hanyang University, Seoul, 2;Department of Pediatric Cardiology, 3;Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 35-45.

Abstract

Objectives:There has been a continued debate regarding the role of eye movements in Eye Movement Desensitization and Reprocessing(EMDR). This study examined the possible autonomic effect of horizontal eye movements after being exposed to fearful stimuli.

Methods:Fifty two healthy adult women were randomly allocated to eye movement or eye fixed groups after watching a five minute fear-inducing film clip. ECG was recorded during the resting state, after watching the clip, and the treatment. A spectral power analysis of the heart rate variability was performed. As the variables violated the rule of normal distribution and the number in each group is small the non-parametric test was used.

Results:Overall, we did not find the differences between the groups in both time and frequency domains. Some minor differences found were not consistent with results from previous studies. 

Conclusions:Effect of eye movement on autonomic nervous system during fear desensitization was not supported in this experiment. Further study with other psychophysiological measures is needed to understand the role of eye movements in treatment of traumatic memory.

Keywords

Eye movement;Heart rate variability;Fear;Autonomic nervous system.

A case of Posterior Cortical Atrophy Presenting with Features of Atypical Dementia

Kee Hyung Park, MD1;Sung-Wan Kim, MD2;Dong-Jin Shin, MD1;Hyun-Mi Park, MD1;Yeong-Bae Lee, MD1; and Young-Hee Seung, MD1;

1;Department of Neurology, Gachon University Gil Medical Center, Incheon, 2;Department of Psychiatry and Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 46-53.

Abstract

Posterior cortical atrophy(PCA) is a presenile dementia that presents primarily with signs and symptoms of cortical visual dysfunction, while memory is relatively preserved until the late stage of the disease. We report a patient with PCA, confirmed by brain magnetic resonance imaging (MRI) and F18-fluorodeoxyglucose positron emission tomography(FDG PET). A 58-year-old right-handed woman presented initially with visual dimness and difficulty finding things around her. She had partial Balint's syndrome, partial Gerstmann syndrome, and idiomotor apraxia. She also had a mild memory disturbance, but preserved insight of her disease. Neuropsychological evaluation showed decreased parietal and left temporal functions bilaterally. Brain MRI and F18-FDG PET revealed typical bilateral occipitoparietal atrophy and hypometabolism, which were slightly worse on the right side. Cholinesterase inhibitor administration for 6 months improved the memory impairment slightly, but not the cortical visual dysfunction. This is a typical case of PCA, confirmed by neurologic signs and imaging findings.

Keywords

Posterior cortical atrophy;Cortical visual dysfunction;Balint's syndrome;Gerstman syndrome;Idiomotor apraxia;Occipitoparietal hypometabolism.

Vol. 15 No.2

Electroconvulsive Therapy in Major Depressive Disorder

Hwa-Young Lee, MD, PhD;Rhee-Hun Kang, MD, PhD; and Min-Soo Lee, MD, PhD

Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 75-82.

Abstract

Major depressive disorder(MDD) is one of the most common diseases with serious health consequences such as increased morbidity, disability, and mortality. Electroconvulsive therapy(ECT) has been used as a treatment for mental disorder since the 1930s. A growing number of recent publications support the conclusions that ECT is an effective and safe treatment for depressed patients. Dosing strategies, frequency, safety, side effects and efficacy of ECT in MDD will be considered. ECT may be an alternative to treatment with antidepressants.

Keywords

Electroconvulsive therapy;Efficacy;Major depressive disorder.

The Study About Intra-Familial Transmission of the Neurological Soft Signs in Schizophrenia

Sujung Yoo, MD1;Yongrak Choi, MD2;Sangick Lee, MD, PhD1;Chuljin Shin, MD, PhD1;Siekyeong Kim, MD1; and Jungwoo Son, MD, PhD1;

1;Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, 2;Chungbuk Hospital, Cheongju, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 83-90.

Abstract

Objectives:Neurological soft signs have been regarded as endophenotypes associated with the genetic basis of schizophrenia. This study was to investigate the intra-familial correlations of the neurological soft signs according to their genetic loading.

Methods:Schizophrenic patients(N=14) were included, who had one parent with a family history of schizophrenia and the other without it. Genetic loading was determined by the patient's family history of schizophrenia using the Family Interview for Genetic Studies(FIGS). These parents were subdivided into two groups. The first group was designated as 'presumed carriers'(N=9) of genetic loading, who had one or more schizophreic first- or second-degree relatives. The second group was designated as 'presumed non-carriers'(N=11) of genetic loading, who had no schizophrenic first- or second-degree relatives. Normal controls(N=12) consisted of people without schizophrenic relatives. NSS were evaluated using the Neurological Evaluation Scale-Korean Version (NES-K), and the intra-familial correlations of NSS were tested using the Intra-Class Coefficients(ICC) method.

Results:The scores of Motor Coordination subdimension of NES-K were significantly correlated between the patients and their presumed carriers(ICC=.804, p=.016), but not significantly correlated between the patients and their presumed noncarriers. In other subdimensions of NES-K, no significant correlation were found between the patients and their parents regardless of the genetic loading. But, there were no statistically significant differences in the scores of Motor Coordination subdimension of NES-K between the patients and controls.

Conclusion:This study did not prove that the neurological soft signs might be an endophenotype of schizophrenia that cosegregate with the genetic loading. The future study using more subjects than this would be needed.

Keywords

Schizophrenia;Neurological soft signs;Genetic loading;Intra-class coefficients.

Comparison of Neuropsychological Deficits between Depressed Episode and Remission in First-onset Patients with Major Depressive Disorder

Ji-Won Hur, MA; and Yong-Ku Kim, MD, PhD

Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 92-100.

Abstract

Objectives:The purpose of this study was to investigate 1) the neuropsychological deficits with major depressive disorder(MDD) in depressed state and 2) the changes of neuropsychological dysfunctions during depressed episodes and remitted periods in the MDD group.

Methods:12 patients with MDD and 70 normal controls who were diagnosed and classified by DSM-IV and SCID-IV interview participated in this study. The psychopathology was measured using the Hamilton rating scale for depression(HAM-D) and Brief Psychiatric Rating Scale(BPRS). The memory function, executive function, and sustained attention were measured by a trained psychologist using the Korean version of Memory Assessment Scale(K-MAS), Wisconsin Card Sorting Test(WCST), and Vigilance(VIG) and Cognitrone (COG) in Vienna Test System. After 6 weeks of treatment, we retested the cognitive tests in order to measure the cognitive functions in remitted states.

Results:Patients with MDD achieved significantly lower score in sentence immediately recall, verbal memory score and total memory score of the K-MAS, total errors of the WCST, response time of Vigilance and response time at "Yes" response of Cognitrone than normal controls at baseline. After 6 weeks of medication, the psychiatric symptoms in the patient group were attenuated, and most of the neuropsychological functions including attention, memory, and frontal/executive function were improved except for response time of Cognitrone.

Conclusions:This study provides evidence for distinct neuropsychological deficits in patients with MDD on their depressed states and remitted periods. The impairment on response time remains after remission, and this would be a trait marker of major depressive disorder.

Keywords

Major depressive disorder;Remission;Medication;Neuropsychological function;Attention;Memory;Executive function.

Effects of Amisulpride Administration on Body Weight and Metabolic Abnormalities in Mice

Hyo-Jin Lee, MD1;Yun-O Shin, MD1;Byeong-Wha Jeon, MD2;LongZhen Piao, MD3; and Jeong-Lan Kim, MD1;

1;Department of Psychiatry, 2;Physiology, 3;Pharmacy, Medical College, Chungnam National University, Daejeon, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 101-9.

Abstract

Objectives:This study was conducted to examine the effects on food intake, body weight, and metabolic parameters by amisulpride administration in male and female mice, comparing the effects of risperidone and vehicle administration.

Methods:Female and male C57BL/6 mice were grouped into low dose amisulpride(1.5mg/kg), high dose amisulpride(15mg/kg), risperidone(0.1mg/kg) and vehicle. Drugs were administered once daily through intraperitoneal injection over 21days. Body weight was measured weekly and food intake was measured daily. Levels of triglyceride, glucose, insulin and prolactin were determined at the end of experiment(on day 22). 

Results:In the female mice, low and high dose amisulpride as well as risperidone caused significant weight gains. But weight gains in amisulpride groups were numerically smaller than that of risperidone group. In male mice, only high dose amisulpride caused significant weight gain. Among weight gain groups, only weight gain of male mice with high dose amisulpride was significantly associated with increased food intake. Weight gain group in female mice did not show significant correlation with food intake. In male mice, both amisulpride groups showed significantly high plasma insulin levels compared to vehicle. In female and male mice, low and high dose amiulpride groups showed significant high plasma prolactin levels compared to vehicle. Tri-glyceride level were not significantly changed in all groups. Glucose level was changed significantly only in male risperidone group. 

Conclusions:Administration of amisulpride caused more significant weight gains in female and male mice than controls but changes of metabolic parameters were different according to sex of mice. Our results suggest that different mechanisms of amisulpiride are likely to affect weight gain between male and female mice.

Keywords

Amisulpride;Weight Gain;Metabolism;Sex;Difference;Mice.

Neural Substrates of Posttraumatic Stress Disorder:Functional Magnetic Resonance Imaging Study Using Negative Priming Task

Byeong-Taek Lee, PhD1,2;Jeong Ryu2,3;Dong Hoon Lee4;Myeong-Ho Sohn, PhD5;Nae Hee Kang, PhD6;Byung-Joo Ham, MD, PhD7; and Nam Hee Choi, PhD2,8;

1;Institute of Psychological Science, Seoul National University, Seoul, 2;Seoul Institute for Narrative Studies, Seoul, 3;Cognitive Science Program, Graduate School, Yonsei University, Seoul, Korea, 4;Department of Psychology, Indiana University, IN, 5;Department of Psychology, George Washington University, Washington D.C., MA, USA, 6;Department of English Language and Literature, Chung Ang University, Seoul, 7;Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University Medial Center, Seoul, 8;Seoul Wemen's College of Nursing, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 110-7.

Abstract

Objectives:Posttraumatic stress disorder(PTSD) has been primarily associated with emotional problems. Recently, however, the impact of PTSD on cognitive processes has interested a growing number of researchers. The current study is aimed at investigating the cognitive aspects of PTSD at both behavioral and neurological levels.

Methods:We recruited individuals with PTSD who survived the Daegu subway explosion in 2003 as well as non-PTSD individuals as a control group. To evaluate the inhibitory processes and the neural mechanisms, we had these individuals perform the negative priming task simultaneously with functional MRI scanning.

Results:Behaviorally, the negative priming effect was intact in the control group but was not evident in the PTSD group. In the imaging results, only the PTSD group showed the negative priming effect (i.e., increased activation of the negative priming condition as opposed to the neutral condition) in the dorsolateral prefrontal cortex, anterior cingulate cortex, and inferior temporal gyrus. The PTSD group also showed increased activity for the positive priming condition as opposed to the neutral condition in the claustrum. These results confirm and extend the previous findings that the integrity of the ACC is compromised in the trauma survivors due to disrupted white matter tract.

Conclusions:The current results suggest that deteriorated performance of the PTSD group may be due to the functional problem as well as the structural abnormalities.

Keywords

Posttraumatic stress disorder;Functional magnetic resonance imaging;Negative priming task;Anterior cingulate gyrus.

A Voxel-Based Morphometry of Gray Matter Reduction in Patients with Dementia of the Alzheimer's Type

Hyun-Kook Lim, MD;Eun-Hyung Choi, MD; and Chang-Uk Lee, MD

Department of Psychiatry, Kangnam St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 118-25.

Abstract

Objectives:The purpose of this study was to find brain regions in which gray matter volume was reduced and to show the capability of voxel-based morphpmetry(VBM) analysis for lateralizing clinically significant brain regions in dementia of Alzheimer's type patients compared to healthy group.

Methods:MR T1-weighted images of the 20 dementia of Alzheimer's type patients were compared with those of the 20 normal controls. Images were transformed to standard MNI space. In order to observe gray matter volume change. Gray matter was smoothed with a Gaussian kernel. After these preprocessing, stati-stical analysis was performed using statistical parametric mapping software(SPM2).

Results:Gray matter volume was significantly reduced in the bilateral parahippocampal gyri, Lt. anterior cingulate gyrus, Lt. posterior cingulate gyrus, bilateral superior temporal gyri Lt. middle temporal gyrus, Lt. superior, bilateral middle, Rt. anterior frontal gyri and Rt. precuneus in dementia of Alzheimer's type patient group.

Conclusions:These VBM results confirm previous findings of temporal lobe and limbic lobe atrophic cha-nges in dementia of Alzheimer's type, and suggest that these abnormalities may be confined to specific sites within that lobe, rather than showing a widespread distribution.

Keywords

Alzheimer disease;Voxel based morphometry;Cerebral cortex.

Vol. 15 No.3

An Overview of Psychoneuroimmunology

Do Hoon Kim, MD, PhD

Department of Psychiatry, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 147-51.

Abstract

This review briefly summarizes the relevant knowledge of psychoneuroimmunological basis for neuroimmunology, with particular emphasis on bidirectional neural-immune interactions. The immune system and the nervous system maintain extensive communication, including hardwiring of sympathetic and parasympathetic nerves to lymphoid organs. Immune system is modulated by various neurotransmitters such as acetylcholine, norepinephrine, substance P and histamine. Neuroendocrine hormones such as corticotrophin-releasing hormone(CRH) or substance P regulate cytokine balance. The immune system modulates brain activity including sleep and body temperature. Recent studies have revealed that psychological factors which influence immunity and immune-related disease may modulate brain-to -immune interaction. But, we still await the scientific research and evidences to prove whether or how behavioral or treatment intervention of stress can influence the development, progress or prevention of a specific disease.

Keywords

Psychoneuroimmunology;Neural-immune interactions;Stress.

Schizophrenia and Immunological Abnormalities

Hee Yeon Jung, MD, PhD1.3; and Yong-Sik Kim, MD, PhD2,3;

1;Department of Neuropsychiatry, Seoul National University, Boramae Medical Center, Seoul, 2;Department of Neuropsychiatry, Seoul National University Hospital, Seoul, 3;Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 152-74.

Abstract

There have been vast amount studies regarding immunologic dysregulation in schizophrenia. The mechanism of immune pathogenesis in schizophrenia still is unclear, even though various immune dysfunction have been reported. We endeavored to report on two major hypothesis on immunologic dysregulation in schizophrenia, the infection hypothesis and autoimmune hypothesis. We went on to focus on the autoimmune hypothesis, which has received the most attention over the years. We explored the accumulated data and the rational behind the autoimmune hypothesis and the implications of the autoimmune hypothesis for future research in the pathogenesis of schizophrenia.

Keywords

Schizophrenia;Immune dysregulation;Autoimmune hypothesis.

Cytokines and Depression

Yong-Ku Kim, MD, PhD

Department of Psychiatry, Korea University, College of Medicine, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 175-85.

Abstract

Accumulating evidence has suggested the existence of reciprocal communication between immune, endocrine, and neurotransmitter system. Cytokine hypothesis of depression implies that increased pro-inflammatory cytokine such as -1, IL-6, IL-12, TNF-α, and IFN-γ in major depression, acting neuromodulators, play a key role in the mediation of behavioral, neuroendocrine, and neurochemical disturbances in depression. Concerning the relation between cytokines and serotonin metabolism, pro-inflammatory cytokines have profound effects on the metabolism of brain serotonin through the enzyme indoleamine-2,3-dioxygenase(IDO) that metabolizes tryptophan, the precursor of 5-HT to neurodegenerative quinolinate and neuroprotective kynurenate. The neurodegeneration process is reinforced by the neurotoxic effect of the hypercortisolemia during depression. From this perspective, it is possible that efficacy of antidepressants in the treatment of depression may, at least in part, rely on downregulation of pro-inflammatory cytokine synthesis. So, the use of cytokine synthesis inhibitors or cytokine antagonists may be a new treatment approach in depression. However, at present the question whether cytokines play a causal role in the onset of depression or are mere epiphenomena sustaining depressive symptoms remains to be elucidated. Nevertheless, cytokine hypothesis has created new perspectives in the study of psychological and pathophysiological mechanism that are associated with major depression, as well as the prospect for developing a new generation antidepressants. 

Keywords

Cytokine;Depression;IDO;Immune;Serotonin;Psychoneuroimmunology.

Characteristics of Heart Rate Variability Among Adults with Metabolic Syndrome

Do Hwan Yeo, MD1;Jeong Il Kim, MD2;Dong Mug Kang, MD3;Jeong Yeon Kim, MD4;Jung Hin Cho, MD5;Won Kim, MD1;Seong Kyeon Lim, MA1; and Jong-Min Woo, MD, PhD1;

1;Department of Neuropsychiatry and Stress Research Institute, Seoul Paik Hospital, Inje Univiersity School of Medicine, Seoul, 2;Department of Occupational Medicine, College of Medicnie, Dong-A University, Busan, 3;Department of Preventive and Occupational Medicine, Pusan University School of Medicine, Busan, 4;Worker Health Protection Division, Occupational Safety and Health Bureau, Ministry of Labor, Gwacheon, 5;Department of Family Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 186-93.

Abstract

Objectives:The authors tried to investigate the characteristics of Heart Rate Variability(HRV) among the subjects with metabolic syndrome for testing the possibility of clinical application of HRV in evaluating metabolic syndrome.

Methods:We examined the difference of the means of HRV between 122 subjects of metabolic syndrome and 1057 healthy controls using T-test, and the change of means in HRV according to increasing risk factors of metabolic syndrome. Using multiple regression analysis, we examined the association of HRV with the risk factors of metabolic syndrome. 

Results:The HRV indices including SDNN(Standard Deviation of all normal NN intervals), RMSSD(the square Root of the Mean Squared Differences of successive all normal NN interval), TP(Total Power), LF(Low Freuency), and HF(High Frequency) were significantly lower in the metabolic syndrome group than in the normal control group, and the means of all HRV indices except LF/HF were decreased consistently according to increasing risk factors of metabolic syndrome. The fasting glucose, triglyceride, and waist circumference were dependent factors that contributed significantly to the change of HRV. 

Conclusion:
These findings suggest metabolic syndrome adversely affects cardiac autonomic system and HRV could be a useful method for evaluating metabolic syndrome.

Keywords

Metabolic syndrome;HRV(Heart rate variability);Autonomic system.

Relations between Somatic Symptoms, Depression, Anxiety, and Cognitive Function in Patients with Mild Traumatic Brain Injury

Myung Hun Kim, MD;Sang Woo Oh, PhD; and Seoung Ho Rho, MD, PhD

Department of psychiatry, Wonkwang University School of Medicine, Iksan, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 194-203.

Abstract

Objectives:This study was aimed at evaluating the relationship between somatic symptoms, depression, anxiety and cognitive function in the patients with Mild Traumatic Brain Injury(MTBI).

Methods:Thirty seven patients with MTBI were selected from those patients who had visited the Department of Neuropsychiatry of Wonkwang University Hospital from 2003 to 2007. To assess and quantify the somatic symptoms, depression and anxiety, Personality Assessment Inventory(PAI) was used. Assessment of cognitive function was carried out by using Korean Wechsler Adult Intelligence Scale(K-WAIS), Rey-Kim Memory Test, and Kims Executive Function Test. The effects of somatic symptoms, depression, and anxiety on the cognitive function were evaluated by Pearson correlation test.

Results:Somatic symptoms, depression, and anxiety, all showed inverse correlation to cognitive function. Specifically, 1) an increase in somatic symptoms was associated with a decrease in attention, verbal short term memory, verbal recall and recognition, and visual memory. 2) An increase in anxiety was associated with a decrease in verbal recall and recognition. 3) An increase in depression was associated with a decrease in cognitive function that requires high attention and verbal memory.

Conclusion:The patients with MTBI displayed diverse symptoms ranging from cognitive impairment to somatic symptoms, depression, and anxiety. Somatic and emotional symptoms were correlated with cognitive function(especially executive function). Importantly, this study raises the possibility of treating the cognitive impairment associated with MTBI by treating somatic symptoms, depression, and anxiety.

Keywords

Mild traumatic brain injury;Cognitive function;Depression;Anxiety.

The Study on Reliability and Validity of Korean Alcohol Urge Questionnaire(AUQ-K) for Alcohol Dependence

Cheol Min Kim, MD1;Sung Gon Kim, MD, PhD2;Min Jeong Kim, MA2;Ho Chan Kim, MD, PhD3;Kwang-Ook Oh4;Hyo Jeong Kim, MD5;Se Hoon Kim, MD5;Duk Ki Lee, MD, PhD5;Won Tan Byun, MD, PhD5; and Cheol Joong Kang, MD, PhD2;

1;Yangsan Hae-In General Hospital, Yangsan, 2;Department of Psychiatry, School of Medicine, Pusan National University, Busan, 3;Department of Psychiatry, College of Medicine, Kosin University, Busan, 4;School of Medicine, Pusan National University, Busan, 5;Yang San Hospital, Yangsan, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 204-10.

Abstract

Objectives:The Alcohol Urge Questionnaire(AUQ) has been used in alcohol dependence treatment and research. The goal of this study is to develop of the Korean Alcohol Urge Questionnaire(AUQ-K).

Methods:To examine the AUQ-K's psychometric properties, responses from 104 patients admitted in alcohol dependence treatment facility were investigated.

Results:The internal consistency of the 8-item AUQ-K, measured by coefficient α, was high(Cronbach's α=0.78). AUQ-K scores showed significant correlation when the retest interval was 1 day(p<0.01). The AUQ-K's validity was investigated using correlational analyses with two other craving scales[the Obsessive Compulsive Drinking Scale(OCDS) and the Visual Analogue Scale(VAS)]. The high correlations were obtained between total AUQ-K scores and total OCDS scores, and between total AUQ-K scores and the VAS scores(p<0.01, respectively).

Conclusion:The AUQ-K is a reliable and valid short scale for measurement of self-reported alcohol craving. This scale may offer significant advantages over existing single-item measures of alcohol craving in the fields of alcohol dependence treatment and research.

Keywords

Alcoholism;Urges;Craving;Reliability;Validity.

Ability of Facial Affect Perception in Patients with Schizophrenia

Woo-Young Im, MD1,2;Seong-Hee Oh, MD1,2;Seung-Hwan Lee, MD, PhD1,2;Young-Min Park, MD, PhD1,2; and Seong-Man Bae, MD1,2;

1;Department of Psychiatry, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, 2;Clinical Emotion and Cognition Research Laboratory, Goyang, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 211-8.

Abstract

Objectives:The purpose of this study is to compare the ability of facial affect perception among schizophrenia patients, their first degree relatives, and normal control subjects.

Methods:Thirty five patients with schizophrenia, 22 first degree relatives, and 34 normal control subjects were recruited in this study. All three groups were matched for age and education levels. The facial affect identification test(FAIT), and neurocognitive test were applied. In the FAIT, the correct response rate, perceived intensity, and sensitivity for 6 kinds of affects were compared among three groups. 

Results:We found that correct response rate of sadness and anger were decreased in the schizophrenia patients compared with the normal control group. Also the schizophrenia patients showed reduced sensitivity for all six affects compared with the normal control group. The ability of facial affect perception in first degree relatives of schizophrenia patients was decreased but there were not any significant differences compared with normal control group. 

Conclusion:This study confirmed significantly reduced ability of facial affect perception in schizophrenia patients compared with normal control. Decreased ability of facial affect perception in first degree relatives suggests that affective sensitivity can be influenced by genetic predisposition.

Keywords

Schizophrenia;Face;Affect;Perception;Family;Sensitivity.

Refeeding Syndrome Associated with Delusion in a Schizophrenic Patient

Ju-Won Ha, MD;Young-Do Kwon, MD; and Se-Won Lim, MD

Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 219-23.

Abstract

Refeeding syndrome is a life-threatening but treatable condition occurring in any patients with starvation. Electrolyte imbalance, especially hypophosphatemia and fluid shift result in metabolic changes in various systems. The authors reported a case of refeeding syndrome associated with prolonged starvation due to delusion and hallucination in a 38-year-old schizophrenia patient. Hypophosphatemia, hypokalemia, edema and elevation of liver enzyme was occurred despite careful treatment. The symptoms were improved after consistent electrolyte supplement. Close observation and repetitive monitoring are important to prevent refeeding syndrome.

Keywords

Refeeding syndrome;Schizophrenia;Malnutrition;Edema.

Vol. 15 No.4

Epigenetics and Psychiatric Disorders

Daeyoung Oh, MD1;Byung-Hwan Yang, MD, PhD1; and Yu-Sang Lee, MD, PhD2;

1;Department of Neuropsychiatry and Mental Health Institute, College of Medicine, Hanyang University, Seoul, 2;Department of Psychiatry, Yongin Mental Hospital, Yongin, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 243-53.

Abstract

In the post-genomic era, the mechanisms controlling activation of genes are thought to be more important. Gene-environment interactions are crucial in both development and treatment of psychiatric disorders as they are complex genetic disorders. Epigenetics is defined as a change of gene expression that occurs without a change of DNA sequence and can be heritable by certain mechanisms. Epigenetic changes play essential roles in control of gene activation. DNA methylation, chromatin remodeling and RNAi act as key mechanisms for epigenetic modifications of genes. Here, we review the basic mechanisms of epigenetics and discuss their potential involvement of human diseases, including psychiatric disorders.

Keywords

Gene;Epigenetics;DNA methylation;Chromatin remodeling;Psychiatric disorders.

Neural Substrates of Fear Based on Animal and Human Studies

Kwangyeol Baek, MS1;Jaeseung Jeong, PhD1;Min-Sun Park, BA2; and Jeong-Ho Chae, MD, PhD3;

1;Department of Bio and Brain Engineering, KAIST, Daejeon, 2;Department of Psychology, Graduate school, Sungshin Women's University, Seoul, 3;Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 254-64.

Abstract

Objectives:The neural substrate of fear is thought to be highly conserved among species including human. The purpose of this review was to address the neural substrates of fear based on recent findings obtained from animal and human studies.

Methods:Recent studies on brain regions related to fear, particularly fear conditioning in rodents and humans, were extensively reviewed.

Results:This paper suggests high consistency in anatomical structure and physiological mechanisms for fear perception, response, learning and modulation in animals and humans.

Conclusions:Fear is manifested and modulated by well conserved neural circuits among species interconnected with the amygdala, such as the hippocampus and the ventromedial prefrontal cortex. Further research is required to incorporate findings from animal studies into a better understanding of neural circuitry of fear in human in a translational approach.

Keywords

Fear;Fear conditioning;Amygdala;Neuroanatomy;Translational neuroscience.

Depression in Patients with End-Stage Renal Disease

Seon-Young Kim, MD, MSc1;Jae-Min Kim, MD, PhD1; and Jin-Sang Yoon, MD, PhD2;

1;Department of Psychiatry, Chonnam National University Medical School and Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, 2;Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 265-74.

Abstract

Depression is common in patients with end-stage renal disease(ESRD) and has a negative effect on the quality of life, functional ability, and mortality of the patients, with a prevalence rate as high as 20-25%. Especially, the increasing tendency of mortality in ESRD patients is associated with recent or current de-pression, and the suicide rate is also increased by depression in patients with ESRD. Therefore, accurate de-tection and appropriate treatment of depression is very important in ESRD patients. Also, a deferential diag-nosis is needed concerning uremic symptoms and depression in ESRD patients. However, there has been little data so far particularly in terms of randomized clinical trials. This review focused on the recent knowledge of depression in ESRD, and could encourage clinical study and trials in this field.

Keywords

End stage renal disease(ESRD);Depression;Diagnosis;Treatment.

Depression and Coronary Artery Disease(I):Pathophysiologic Mechanisms

Kyung-Yeol Bae, MD1;Jae-Min Kim, MD, PhD1; and Jin-Sang Yoon, MD, PhD2;

1;Department of Psychiatry, Chonnam National University Medical School and Depression Clinical Research Center, 2;Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 275-87.

Abstract

Depression and coronary artery disease are both highly prevalent diseases. Many previous studies suggest that depression is a common comorbid condition in patients with coronary artery disease and has a significant negative impact on the onset, course, and prognosis of coronary artery disease. However, the exact mechanisms that underlie the association between these two diseases remain unclear. Pathophysiologic mechanisms that may explain the effect of depression on coronary artery disease include hypercoagulability, hypothalamus-pituitary-adrenal axis and autonomic nervous system dysregulation, altered inflammatory response. On the contrary, pathophysiologic mechanisms in coronary artery disease that affect depression are less well known. It is also suggested that both diseases may share a common genetic vulnerability. The authors reviewed the literature on the pathophysiologic relationships of depression and coronary heart disease.

Keywords

Depression;Coronary artery disease;Pathophysiologic mechanism.

No Association between Val108/158Met Polymorphism on Catechol-O-Methyl Transferase(COMT) Gene and Smooth Pursuit Eye Movement(SPEM) Abnormality in Korean Schizophrenia Patients

Ho Joon Jang, MD1;Hyun-Il Moon, MD1;Yeon Jung Lee, MD1;Im-Yel Kim, MD2;In-Sang Lee, MD3;Han-Gil Seo, MD3;Ki-Hoon Kim, MA4;Tae-Min Shin, PhD4;Byung-Lae Park, PhD5;Hyung Doo Shin, PhD5,6;Sun Ho Han, MD1;Sang-Woo Han, MD1; and Sung-Il Woo, MD1;

1;Department of Neuropsychiatry, College of Medicine, Soonchunhyang University, Seoul, 2;Keyo Hospital, Euiwang, 3;Jinju Mental Hospital, Jinju, 4;Department of Biomedical Engineering, Yonsei University, Wonju, 5;SNP Genetics, Seoul, 6;Department of Life Science, Sogang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 288-96.

Abstract

Objectives:We investigated the association of Val108/158Met polymorphism on catechol-O-methyl transferase(COMT) gene with smooth pursuit eye movement(SPEM) abnormality in Korean schizophrenia patients.

Methods:We measured SPEM in 217 Korean schizophrenia patients(male 116, female 101) and divided them into two groups, one was a good SPEM function group and the other was a poor SPEM function group. Then we analyzed Val108/158Met polymorphism on COMT gene. We compared the differences of genotype and allele distributions of the polymorphism on COMT gene between the two groups.

Results:The natural logarithm value of signal/noise ratio(Ln S/N ratio) of the good SPEM function group was 4.39±0.33(mean±s.d.) and that of poor SPEM function group was 3.17±0.71. There were no statistically significant differences of age and male/female ratio between the two groups. There were no significant differences of genotype or allele distributions of the Val108/158Met polymorphism on COMT gene between the two schizophrenic groups.

Conclusions:The results suggest that Val108/158Met polymorphism on COMT gene is not related to SPEM function abnormality in schizophrenia.

Keywords

Schizophrenia;Catechol-O-methyl transferase(COMT);Smooth pursuit eye movement(SPEM);Genetic polymorphism.

The Effect of Schizotypal Personality Trait on the Ability of Facial Affect Identification in Healthy Person

Hyeon-Lyung Yi, MD1,2;Seung-Yeon Kim, MA1,2;Jung-Suk Choo, MD1,2;Kyoung-Uk Lee, MD3;Jeong-Ho Chae, MD3;Young Min Park, MD1,2;Hyun Kim, MD1;Kang Joon Lee, MD1;Young-Cho Chung, MD1; and Seung-Hwan Lee, MD1,2;

1;Department of Neuropsychiatry, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, 2;Clinical Emotion and Cognition Research Laboratory, Goyang, 3;Department of Neuropsychiatry, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 297-302.

Abstract

Objectives:The purpose of this study is to investigate whether the ability of facial affect perception is associated with schizotypal personality traits in healthy normal controls.

Methods:241 normal subjects were recruited in this study. The age range of all subjects was from 19 to 63 years. The schizotypal personality questionnaire(SPQ) and facial affect identification test(FAIT), which were developed and standardized in Korea, were applied. Subjects from high 1 standard deviation(H group, N=40) and low 1 standard deviation(L group, N=26) on SPQ score were compared.

Results:We found that the H group showed significantly reduced ability on the correctness of sadness and neutral compared with the L group. But, no significant association between SPQ and intensity or reaction point was observed in all subjects.

Conclusion:This study suggests the individuals with high schizotypal personality trait have impairments on the facial affect identification. Also, these findings may provide the reasonable explanation of social cognition deficit of schizotypal personality disorder.

Keywords

Facial affect identification test;Schizotypal personality questionnaire;Schizotypal personality.

Association of the 5-HT5A Receptor Gene Polymorphisms and Citalopram Response in Korean Patients with Major Depressive Disorder

Jin-Hyun Shim, MD, PhD1;Jong-Woo Paik, MD, PhD2;Jeung-Woong Oh, MD3;Rhee-Hun Kang, MD4;Hwa-Young Lee, MD4; and Min-Soo Lee, MD, PhD4;

1;Apple-tree Psychiatric Clinic, Seoul, 2;Department of Psychiatry, Kyunghee University College of Medicine, Seoul, 3;Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, 4;Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 303-9.

Abstract

Objectives:Some reports have suggested that 5-HT5A polymorphism allelic association was associated with depression, however, there has been no report about relationship between the 5-HT5A gene and antidepressant response. We conducted the association study of the 5-HT5A receptor gene polymorphisms (-19G/C,12A/T) and response to citalopram in Korean patients with major depressive disorder(MDD).

Methods:A total of 106 patients with major depressive disorder were included in this study. The patient's symptoms were measured by 21-item Hamilton Depression Rating Scale(HAMD) at baseline, week 1, week 2, week 4 and week 8 during citalopram treatment. A Responder to citalopram was defined by 50% reduction of total HAMD scores. To analyze genetic polymorphisms, a polymerase chain reaction based method was used.

Results:At week 8, responders were 62, non-responders were 44. No significant differences of genotypes or allelic association in 19G/C and 12A/T polymorphisms were observed between responsive and non-responsive patients.

Conclusion:These results do not support the hypothesis that this polymorphism of the HT5A receptor gene is involved in the therapeutic response to citalopram.

Keywords

Depression;5HT5A receptor;Polymorphism;Citalopram;Pharmacogenetics.

Opinion of Experts about Psychiatric Evaluation after Trauma in Korea

Boung Chul Lee, MD1;Sung-Gon Ryu, MD1; and Han Yong Jung, MD2;

1;Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, 2;Department of Neuropsychiatry, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 15, No. , pp. 310-5.

Abstract

Objectives:The evaluation of disability after trauma in psychiatry is relatively subjective compared with other departments. A consensus among evaluators could improve reliability of evaluations. We compared disability rate of common psychiatric disorders without definite brain injury depending on their diagnosis from experienced evaluators in Korea. 

Methods:A written questionnaire was mailed to each evaluator and the reply was analyzed. The questions included disability rate ranges of postconcussional syndrome, PTSD and depression. Other questions related with admission for evaluation, expected duration of treatment, life expectancy and need of supporting person were also asked. 

Results:Range of disability rate were from 8.6±4.5% to 26.6±12.8% in postconcussional syndrome, from 10.4±6.8% to 36.4±13.8% in PTSD and from 10.0±4.6% to 30.6±10.3% in depressive disorder. There were lots of diversity in expected duration of treatment with psychiatric disability. Decline of life expectancy and need of supporting person were considered at least 50% of disability.

Conclusion:There is much diversity in evaluation of psychiatric disabilities with disability rate and expected duration of treatments even among experienced evaluators. A common consensus among experts may increase reliability of psychiatric evaluations after trauma.

Keywords

Psychiatric disability;Postconcussional syndrome;Post traumatic disorder;Depression.

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Vol. 14 No.1

Self Care in Depression

Sun-Hea Lee, MD; and Yong Chon Park, MD, PhD

Department of Neuropsychiatry, College of Medicine, Hanyang University, Guri, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 5-13.

Abstract

ObjectivesDepression disturbs the individual life from the loss of productivity to suicide. Furthermore the whole society is also influenced by depression in social and economic areas. Many scientific treatment methods are known to be effective in depression. But in reality more than half of patients with depression prefer self help treatment rather than medically based treatment. For the patients with mild depression and primary physicians, it is reasonable to provide the evidence based self care including self help or alternative treatment. This study is supported by the Korean Health 21 R&D Project for the Depression Center to establish the Korean treatment guideline for depression.

Methods:The members of Depression Center including the authors attended the workshops where the methods of evidence based medicine such as literature search, quality evaluation of the articles, making the level of evidence were educated. The professional librarians helped the authors for get the searched articles. Among the total of 354 abstracts of systemic review and 300 abstracts of random controlled trials, 3 systemic reviews and 2 random controlled trials were the main structure of evaluation.

Result:Among the 37 self care methods known to be effective for depression, 11 kinds of methods were worth of evaluation. The first step for the self care of mild depression is to use St. John’s wort, exercise, bibliotherapy, and light therapy in depression during winter season. Acupuncture, negative ion therapy, massage, relaxation technique are known to be efective with evidence. Music therapy, hypnotherapy, and aromatherapy are known to be effective but until now the evidences is insufficient and further evaluations are needed.

Conclusion:Among 11 listed self-care methods, several methods need more evidence especially in Korean situation. Exercise is the most recommendable evidence based self care method in Korea nowadays. St. John's wort is effective with evidence, but it is not the OTC drug in Korea, so it is not recommendable now. For the bibliotherapy, there is no book such as "Feeling Good" in Korea. Only the introductory book about depression is available. Publishing the self help book based upon cognitive behavioral approach or psychodynamic approach is needed. Light therapy is practiced in a few clinics, but not self-help style. Exposure to the sunlight is recommended in the level of commen sense. These self care methods are for the mild patient. Moderate to severe patients with depression should seek the professional treatment.

Keywords

Depresion;Self help;Alterative treatment;Evidence based;Guideline;Self-care.

Pharmacological Treatments for Dysthymic Disorder and Atypical Depression

Se-Won Lim, MD; and Kang-Seob Oh, MD, PhD

Department of Psychiatry, Kangbuk Samsung Hospital, Sung-kyunkwan University School of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 14-20.

Abstract

ObjectivesThe diagnosis of depression is based on a highly variable set of symptoms. Therefore, depression should not be viewed as a single disease, but a heterogenous syndrome comprised of different pathophysiologies. There are several subtypes of depression which were already incorporated in DSM-IV. This article provides a systematic review of pharmacological treatments of two recognized subtypes of depression-dysthymic disorder and atypical depression.

Methods:Systematic search of relevant literatures on dysthymic disorder and atypical depression was performed by proposed search strategy of the Clinical Research Center for Depression of Korean Health 21 R&D Project. All identified literatures were carefully reviewed and classified according to SIGN grading system and summarized in a narrative manner.

Results:For the treatment of dysthymic disorder and atypical depression, selective serotonin reuptake inhibitors(SSRIs) and moclobemide have more evidence than the other antidepressants. SSRIs and moclobemide showed superior tolerability than tricyclic antidepressants.

Conclusions:The authors proposed treatment recommendations for dysthymic disorder and atypical depression by the methods of evidence-based medicine(EBM). However, guideline developing methods of EBM also have several inevitable limitations. Therefore, in the absence of clear and significant differences in efficacy, the choice of medication must be individualized for a particular patient based on psychiatrist's own clinical decision.

Keywords

Dysthymic disorder;Atypical depression;Antidepressant;Evidence-based medicine.

The Current Status and Requirements for Non-pharmacological Treatment of Depression in Korea

Hong Seok Oh, MD1;Hae Won Lee, MD2; and Yong Chon Park, MD, PhD2;

1;Yong-In Mental Hospital, Yongin, 2;Department of Neuropsychiatry, College of Medicine, Hanyang University, Guri, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 21-7.

Abstract

ObjectivesAs a part of plan to develop evidence-based treatment guidelines for depression that is more suitable for Korean situation, we investigate the present status and client's requirements for non-pharmacological treatment of depression in Korean clinical situation.

Methods:Subjects were patients with depression in 12 university hospitals which are located in metropolises in Korea. We analyzed the records from questionnaires about current clinical status and requirements for the non-pharmacological treatment of depression in Korea. 

Results:50.8% of the subjects have experienced non-pharmacological treatments for their depression. The preference of non-pharmacological treatment method of depression is exercise/interesting activity, counseling by psychiatrists and psychotherapy, and the best effective treatment method is psychotherapy (Es=4.36). Actually, the mean consultation time by psychiatrist is 11.31±7.16 min, and the appropriate consultation time for client's situation is 18.39±8.95 min. During consultation, patients' satisfaction measurement for psychiatrist's explanation about pharmacological treatment is 64.17±27.11, and satisfaction measurement for psychiatrist's counseling for their depression about personal problems, resent stress, interpersonal relationship is 61.66±26.63.

Conclusion:In Korea, many psychiatrists offered biologically oriented treatment to their patients with depression, and patients' satisfaction measurement about consultation by psychiatrists is low. Many patients wanted to combined pharmacological and non-pharmacological treatment for their depression, and aspired to information about complementary and self-help treatment methods. It is necessary to develop non-pharmacological treatment guideline for depression which reflect the clinical situation in Korea and meet Korean patients' need.

Keywords

Depression;Treatment guideline;Non-pharmacological treatment.

Virtual Reality in Current and Future Psychiatry

Kyung Ryeol Cha, MD, MPH; and Chan-Hyung Kim, MD, PhD

Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 28-41.

Abstract

Virtual reality technology is now being used in neuropsychological assessment and real-world applications of many psychiatric disorders, including anxiety disorders, schizophrenia, child psychiatric disorders, dementia, and substance related disorders. These applications are growing rapidly due to recent evolution in both hardware and software of virtual reality. In this paper, we review these current applications and discuss the future work of clinical, ethical, and technological aspects needed to refine and expand these applications to psychiatry.

Keywords

Virtual reality;Psychiatry;Therapy;Diagnosis;Research.

Electroencephalographic Alpha Asymmetry in Major Depressive Disorder Patients With Anxiety Symptoms

Jun-Seok Lee, MD, PhD1;Byung-Hwan Yang, MD, PhD2;So Hee Lee, MD, PhD3; and Seung-Min Lee, MD3;

1;Department of Psychiatry, Kwandong University College of Medicine, Myongji Hospital, Goyang, 2;Department of Neuropsychiatry, Hanyang University College of Medicine, Seoul, 3;Department Psychiatry, National Medical Center, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 42-7.

Abstract

ObjectivesStudies have reported differences between depressed adults and controls in quantitative me-asures of EEG alpha asymmetry, but, there are few using Korean subjects. So, the present study compared EEG regional alpha asymmetries of patients having major depressive disorder(MDD) and normal controls.

Methods:The subjects in this study were 11 unmedicated unipolar depressed patients and 11 non-depressed, age matched controls. Resting EEG(eyes closed and eyes open) was recorded from each participant using 8 scalp electrodes. Beck Depression Inventory(BDI), 17-item Hamilton Depression Rating Scale(HDRS), Zung’s Self-Rating Depression Scale(SDS) and Spielberger’s State-Trait Anxiety Inventory(STAI) were used to eva-luate depression and anxiety symptoms.

Results:The severities of depression measured by self-report questionnaires were positively associated with those of anxiety(state and trait);The subjects were both anxious and depressed. Anxious-depressed patients differed from controls in alpha asymmetry at T4 channels. They showed evidence of greater activation over right than left temporal site.

Conclusion:These findings are consistent with the previousely reported alpha asymmetry of depressed patients with an anxiety disorder. The failure to find the evidence of reduced right parietal activity in depre-ssion is presumed to be due to opposing effects of comorbid anxiety on parietotemporal activity.

Keywords

Alpha asymmetry;Electroencephalography;Depressive disorders;Anxiety.

Relationship between Behavioral and Psychological Symptoms and Patient and Caregiver Quality of Life in Alzheimer's Disease

Sung-Wan Kim, MD, PhD1,2,3; and Il-Seon Shin, MD, PhD1,2,3;

1;Clinical Trial Center, Chonnam National University Hospital, Gwangju, 2;Department of Psychiatry, Chonnam National University Medical School, Gwangju, 3;Department of Psychiatry, Hwasun Chonnam National University Hospital, Hwasun, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 48-54.

Abstract

ObjectivesThis study aimed to examine the relationship between behavioral and psychological symptoms of dementia(BPSD) and patient and caregiver QOL in Alzheimer’s disease(AD).

Methods:Fifty-one AD patients and their caregivers participated. Measures about patients were Neuropsychiatric Inventory(NPI), Korean version of QOL-Alzheimer’s Disease(KQOL-AD), Activities of Daily Living(ADL), Clinical Dementia Rating(CDR), and Korean version-Mini Mental State Examination(K-MMSE). Caregiver QOL was assessed with KQOL-AD and General Health Questionnaire/Quality of Life-12(GHQ/ QOL-12).

Results:Patient QOL-AD on patient ratings was negatively correlated with appetite/eating change and NPI scores. Patient QOL-AD on caregiver ratings was negatively correlated with hallucinations, depression/dysphoria, and NPI scores. Caregiver QOL assessed by the GHQ/QOL-12 was negatively correlated with agitation/aggression, depression/dysphoria, and NPI scores and was negatively correlated with distress related to agitation/aggression, depression/dysphoria, and NPI scores.

Conclusion:BPSD of AD patients was associated with low QOL of both patients and caregivers. Thus, interventions of BPSD were needed to improve both patient and caregiver QOL.

Keywords

Alzheimer’s disease;Behavioral and psychological symptoms;Quality of life;Caregiver.

Association between Panic Disorder and Dopamine Transporter Gene(DAT1) Polymorphism

:Seung-Min Bae, MD1;Se-Won Lim, MD1;Kang-Seob Oh, MD, PhD1; and Min-Soo Lee, MD, PhD2;

1;Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, 2;Department of Psychiatry, Korea University College of Medicine, Anam Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 55-60.

Abstract

ObjectivesThere have been many association studies of panic disorder. However, studies about the do-paminergic function in panic disorder have been few. This study was aimed to examine the possible as-sociation of dopamine transporter gene(DAT1) polymorphism and panic disorder in Korean population.

Methods:Ninety-eight patients with panic disorder(43 male(46.9%), mean age 42.13±10.88 years) and one hundred and thirteen comparison subjects(67 male(40.7%), mean age 33.14±8.55 years) were tested for DAT1 polymorphism. Genotypes of DAT1 with variable number of tandem repeats(VNTR) were determined using polymerase chain reaction. The differences of allelic frequency and genotype frequency distribution between patient and the control group were tested with Fisher-Freeman-Halton test.

Results:There was association between DAT1 polymorphism and panic disorder(allele:p<0.03, genotype:p<0.05). The frequency of 10/10 homozygotes of DAT1 was significantly higher in control group(χ2=4.452, df=1, p=0.035).

Conclusion:These results in our Korean samples suggest that DAT1 polymorphism might be associated with the vulnerability of panic disorder. Possible association of dopaminergic genes and panic disorder should be investigated with future studies using larger and different population.

Keywords

Panic disorder;Dopamine transporter gene;Polymorphism.

The Effect of Attention on Executive Function in Traumatic Brain Injury Patients:Testing for Stage Model

Han-Yong Jung, MD, PhD;Joon-Ho Park, MA;SoYoung Irene Lee, MD, PhD; and Yang-Rae Kim, MD

Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 61-7.

Abstract

ObjectivesThe purpose of this study was to test stage model in Traumatic Brain Injury(TBI) patients. According to the stage model, attention deficits which is basic stage in information processing lead to memory disturbance and subsequently affect higher-order cognitive function such as memory, decision-making, abstract thinking, and judgement related to executive function. Therefore, it was hypothesized that attention affect recall(retrieval efficacy) related to executive function mostly relative to other cognitive function, in TBI patients with low executive function.

Methods:Participants were referred to a TBI clinic and then was rated on K-WAIS and Executive Intelligence Test(EXIT). Participants were divided into two groups according to Executive IQ(EIQ) score, which of high function group(N=67) was more than 80(above low average) and of low function group(N=52) was under 80 (under borderline). To test the stage model, using hierarchical regression analysis, recall(retrieval efficacy) was regressed on 3 subscales(attention, verbal, visuospatial scale) after controlling for IQ according to each group. Furthermore, the mediation effect of attention between retrieval efficacy and verbal, visuospatial score was analyzed.

Results:In the low function group, only attention area predicted significantly recall(retrieval efficacy), indicating that lower attention were related to lower EIQ after controlling for IQ. In the high function group, no area predicted significantly retrieval efficacy. In the low function group, verbal and visuospatial scale did not predicted significantly retrieval efficacy, indicating that there was no evidences supporting the mediation model.

Conclusion:Only attention affect retrieval efficacy in TBI patients with low executive function. But, the mediation effect of attention between retrieval efficacy and verbal and visuospatial scale was not tested in the low function group. These results implied that stage model was tested partially. In treating cognitive deficit in TBI patients, it is necessary to develop cognitive rehabilitation program based on stage model. Furthermore, it is necessary to necessary to test mediation model in the future study.

Keywords

Stage model;Traumatic Brain Injury;Attention;Executive function;Retrieval efficacy.

Subclinical Hypothyroidism during Quetiapine Treatment:A Case Report

Kyeong-Sae Na, MD; and Yong-Ku Kim, MD, PhD

Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 68-71.

Abstract

Quetiapine is an atypical antipsychotic drug with a benign side effect profile. However, recent studies have reported that thyroid dysfunction is associated with quetiapine treatment. The authors report a patient with DSM-IV bipolar I disorder who developed subclinical hypothyroidism during quetiapine treatment. The patient showed no significant clinical symptoms, but only abnormal thyroid function test findings including antithyroglobulin antibody. The abnormal thyroid function test findings were normalized after discontinuation of quetiapine. The subclinical hypothyroidism developed during quetiapine treatment may be associated with autoimmune process.

Keywords

Bipolar I disorder;Quetiapine;Atypical antipsychotics;Hypothyroidism;Thyroid gland.

Vol. 14 No.2

Treatment Strategies for Depression during Pregnancy and Lactation

Soyoung Irene Lee, MD, PhD; and Han-Yong Jung, MD, PhD

Department of Psychiatry, Soonchunhyang Bucheon Hospital, Soonchunhyang University, College of Medicine, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 91-8.

Abstract

ObjectivesConsidering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation.

Methods:According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner.

Results:Pharmacotherapy during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed.

Conclusion:The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.

Keywords

Depression;Pregnancy;Lactation;Treatment strategy.

Risperdal Sachet and Oral Lorazepam versus Intramuscular Haloperidol and Lorazepam Injection for Acute Psychotic Symptom in the Elderly Patients with Organic Mental Disorder

Tak Youn, MD, PhD

Nampyeong Mirae Hospital, Naju, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 99-105.

Abstract

ObjectivesThe purpose of present study was to investigate the effect, safety and tolerability of risperdal sachet(oral solution) with lorazepam tablet versus intramuscular haloperidol and lorazepam injection for management of acute psychotic symptom in the elderly with organic mental disorder.

Methods:Total 37 patients who have dementia, medical or physical diseases, associated with acute psychotic symptom were randomly assigned to oral treatment with 1mg of risperdal sachet(oral solution) plus 1mg of lorazepam(N=17) or to intramuscular treatment with 2.5mg of haloperidol plus 2mg of lorazepam(N=20). The change of CGI scores was used for the evaluation of efficacy. 

Results:Mean score improvements at 15, 30, 60, and 120 minutes after treatment were statistically significant at each time point in both groups(p<0.001) and were similar in both groups(p=0.189).

Conclusion:A single oral dose of risperdal sachet(oral solution) plus lorazepam was as effective and tolerable as parenterally administered haloperidol plus lorazepam for the rapid control of acute psychotic symptom in the elderly with organic mental disorder.

Keywords

Risperdal sachet;Acute psychotic symptom;Dementia;Delirium;Elderly;Organic mental disorder.

Dopamine D2 Receptor Gene TaqI A Polymorphism in Korean Social Phobia Patients:Preliminary Study

Bum-Jo Kim, MD1;Se-Won Lim, MD1;Dong-Won Shin, MD1;Kang-Seob Oh, MD1; and Min-Soo Lee, MD2;

1;Department of Psychiatry, Sungkunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, 2;Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 106-14.

Abstract

ObjectiveIt is suggested that disturbance of dopaminergic system might be related to the possible mechanism of social phobia. The aim of this study was to investigate the possible association of DRD2 TaqI polymorphism and social phobia.

Method:Fifty-one patients with social phobia and 200 comparison subjects were tested for DRD2 TaqI A polymorphism. The severity of social phobic symptoms was measured by self-report version of the Liebowitz Social Anxiety Scale(LSAS-SR) and Hamilton anxiety scale(HAM-A).

Results:There was no signigicant difference in the genotype, allele frequency, A1 carrier frequency, and heterozygote frequency DRD2 TaqI A polymorphism between the social phobia patients and the control groups. However, we found significant decrease in somatic anxiety of the HAM-A in the patients having A2A2 homozygotes(p=0.014). In addition, patients having A1A2 heterozygotes showed more anxiety in two subscales(p=0.042 in anxiety, p=0.019 in performance) of the LSAS-SR.

Conclusion:These results suggest that DRD2 A2 homozygote might have a protective role against somatic anxiety, and molecular heterosis of DRD2 TaqI A polymorphism might be related with more severe anxiety in social phobia.

Keywords

Social phobia;Heterozygote;DRD2 <i>Taq</i>I A Polymorphism.

Microarray Analysis of Gene Expression in Rat Glioma after Ethanol Treatment

So Hee Lee, MD, PhD1;Dong-Yul Oh, MD, PhD2;Jin-Hee Han, MD, PhD3;Ihn-Geun Choi, MD, PhD4;Yang-Whan Jeon, MD, PhD5;Joon-Noh Lee, MD, PhD6;Tae Kyung Lee, MD, PhD6;Jong-Hyun Jeong, MD, PhD3;Kyung Hwa Jung, PhD7; and Young-Gyu Chai, PhD7;

1;Department of Psychiatry, National Medical Center, Seoul, 2;Department of Psychiatry, Myongji Hospital, College of Medicine, Kwandong University, Goyang, 3;Department Neuropsychiatry, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, 4;Department of Psychiatry, Han-Gang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, 5;Department Neuropsychiatry, Our Lady of Mercy Hospital, College of Me-dicine, The Catholic University of Korea, Incheon, 6;Seoul National Hospital, Seoul, 7;Department of Biochemistry and Molecular Biology, Hanyang University College of Sciences, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 115-21.

Abstract

ObjectivesIdentification of target genes for ethanol in neurons is important for understanding its molecular and cellular mechanism of action and the neuropathological changes seen in alcoholics. The purpose of this study is to identify of altered gene expression after acute treatmet of ethanol in rat gliom cells.

Methods:We used high density cDNA microarray chip to measure the expression patterns of multiple genes in cultured rat glioma cells. DNA microarrays allow for the simultaneous measurement of the expression of several hundreds of genes.

Results:After comparing hybridized signals between control and ethanol treated groups, we found that treatment with ethanol increased the expression of 15 genes and decreased the expression of 12 genes. Upregulated genes included Orthodenticle(Drosophila) homolog 1, procollagen type II, adenosine A2a receptor, GATA-bindning protein 2. Downregulated genes included diacylglycerol kinase beta, PRKC, Protein phosphatase 1, clathrin-associated protein 17, nucleoporin p58, proteasome.

Conclusion:The gene changes noted were those related to the regulation of transcription, signal transduction, second messenger systems. modulation of ischemic brain injury, and neurodengeneration.Although some of the genes were previously known to be ethanol responsive, we have for the most part identified novel genes involved in the brain response to ethanol.

Keywords

DNA microarray;Ethanol;Brain;Gene expression;Rat glioma.

Relationships between Psychotic Symptoms and Cognitive Functions in Schizophrenic Patients

Min-Young Yi, MS; and Hongkeun Kim, PhD

Department of Rehabilitation Psychology College of Rehabilitation Science, Daegu University, Daegu, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 122-8.

Abstract

ObjectivesThe aim of this study was to investigate relationships between psychotic symptoms and cognitive functions in schizophrenia.

Methods:The study group was composed of 36 schizophrenic patients. Positive, negative, and disorganization symptoms were assessed using the PANSS. Verbal, visuospatial, attention, memory, and executive functions were assessed using a battery of cognitive tests.

Results:Correlation analysis between symptom vs. cognitive measures showed that (a) positive symptoms were significantly correlated with no cognitive measures, (b) negative symptoms were significantly correlated with all cognitive measures, and (c) disorganization symptoms were significantly correlated with executive and memory measures. Correlation analyses between symptom vs. cognitive factors showed that negative-disorganization factor is significantly correlated with executive-memory factor.

Conclusion:Significant relationships were confined mostly to frontal symptoms vs. frontal cognitive functions. Thus, the relationships may be mediated mainly by variations in severity of frontal pathology among patients.

Keywords

Schizophrenia;Negative symptom;Positive symptom;Executive function;Cognitive function.

Empathy and Mood Awareness Reflected in the Resting-State Brain Metabolic Activity in the Patients with Schizophrenia and Normal Subjects

Il Ho Park, MD1,2;Jiwon Chun, MS1;Young Chul Jung, MD1,2; and Jeong Ho Seok, MD3;Hae-Jeong Park, PhD4;Jong Doo Lee, MD, PhD4; and Jae-Jin Kim, MD, PhD1,2,4;

1;Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Gwangju, 2;Department of Psychiatry, Yonsei University College of Medicine, Seoul, 3;Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, 4;Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 129-41.

Abstract

ObjectivesEmpathy has been conceptualized as the ability of emotional resonance and perspective-taking. Emotional awareness has been proposed as the basis of empathy. In this study we examined the relationship between empathy and mood awareness and their neural correlates in resting-state activity in normal controls and patients with schizophrenia.

Methods:Empathy and mood awareness scale scores were compared between 29 patients with schizophrenia and 21 normal controls by voxel-based t-tests and voxel-based correlation analyses of resting-state 18F-FDG PET images.

Results:Empathy and mood labeling scale scores were significantly decreased in schizophrenic patients. Mood monitoring was positively correlated with empathy score in normal controls, but not in schizophrenic patients. In normal controls, empathy was positively correlated with resting-state activities in the intraparietal sulcus and mood monitoring was positively correlated with the temporal pole, frontopolar cortex, inferior temporal gyrus, entorhinal cortex and the subgenual prefrontal cortex resting activities. The orbitofrontal cortex resting activity was positively correlated with mood monitoring-related subgenual prefrontal cortex activity in the normal controls. Patients with schizophrenia showed decreased orbitofrontal resting activity and loss of its correlations with mood monitoring-related regional activities.

Conclusion:This study showed that alteration in the resting-state activity in schizophrenia may reflect dysfunctional empathy and distorted characteristic of emotional awareness. However, the resting-state activity may not reflect the relationship between emotional awareness and empathy.

Keywords

Empathy;Emotional awareness;Schizophrenia;Resting-state;Orbitofrontal cortex;PET.

Vol. 14 No.3

The Alteration of Carbohydrate-Deficient Transferrin and Nerve Growth Factor in the Patients with Alcohol Dependence

Chan-Min Jeon, MD1;Boung-Yang Park, MD1;Jung-Hyun Byun, MD1;Boung-Chul Lee, MD1;Byung-Joo Ham, MD1;Mina Hur, MD2; and Ihn-Geun Choi, MD1;

1;Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, 2;Department of Laboratory Medicine, College of Medicine, Hallym University, Chuncheon, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 161-6.

Abstract

ObjectivesRecent studies have raised the possibility that nerve growth factor(NGF) is abnormally regulated in the central nervous system(CNS) of animal models with alcohol dependence. The possible alteration of NGF by prolonged alcohol intake may play an important role in alcohol-induced neurotoxicity. Carbohydrate-deficient transferrin(CDT) is regarded as a reliable biological marker of alcohol dependence. The goal of this study was to estimate the changes of %CDT and serum NGF level according to the duration of alcohol abstinence, and to identify whether %CDT level is associated with the serum NGF level in the patients with alcohol dependence.

Methods:The subjects were 24 patients with alcohol dependence. We used the Axis-Shield ASA to measure the %CDT level and the enzyme-linked immunosorbent assay(ELISA) to measure the serum NGF level. %CDT and NGF levels were measured immediately after the admission and at 2 weeks after the admission. 

Results:Decreased %CDT were observed during the period of 2 weeks after the admission. NGF level was not significantly different after 2 weeks. The NGF levels were not correlated with %CDT. The possibility of %CDT as a predictor of alcohol-induced neurotoxicity was not confirmed.

Conclusion:Serum NGF levels is not a reliable indicator of abstinence state in the patients with alcohol dependence. Further studies are needed to evaluate the relation between two indicators in regard to hematological and neurological changes in alcohol dependence.

Keywords

Alcohol dependence;Carbohydrate-deficient transferrin;Nerve growth factor;Neurotoxicity.

The Relationship between the Therapeutic Response to Antipsychotic Drugs and the Dopamine D2, D3, and D4 Receptor Gene Polymorphisms in Korean Schizophrenic Patients

Hee-Cheol Kim, MD, PhD1,2;Sung-Won Jung, MD, PhD3;Dae-Kwang Kim, MD, PhD2,4; and Chul-Ho Jung, MD, PhD1;

1;Department of Psychiatry, Keimyung University College of Medicine, Daegu, 2;Department of Psychiatry, Keimyung University Colleg of Medicine&Institute for Medical Genetics, Daegu, 3;Kwakhosoon Mental Hospital, Daegu, 4;Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 167-76.

Abstract

ObjectivesA considerable number of pharmacogenetic studies have been performed in recent years to define the association of antipsychotic drug response with dopamine receptor polymorphisms. The purpose of this study was to investigate the relationship between the therapeutic response to antipsychotic drugs and the polymorphisms of the dopamine D2, D3, and D4 receptor genes(DRD2, DRD3 and DRD4, respectively). 

Methods:We conducted retrospective chart review of 200 consecutively hospitalized patients with the diagnosis of schizophrenia(DSM-IV) who were treated with various antipsychotics(94% atypical antipsychotics) at Bugok National Hospital, Korea. The patients were divided into two groups, responders and non-responders, by responsiveness to antipsychotic drugs according to a four-point scale used in previous studies; responders included moderate to marked responded patients and non-responders included none to minimal responded patients. We analyzed the Ser311Cys polymorphism in the DRD2, the Ser9Gly polymorphism in the DRD3, and the exon III 48 bp repeat polymorphism in the DRD4.

Results:Among the total patients of 200, 141(70.5%) were categorized as responders. There were no significant differences in the frequencies of the DRD2, DRD3, and DRD4 alleles and genotypes between responders and non-responders.

Conclusion:These results suggest that the Ser311Cys polymorphism in the DRD2, the Ser9Gly polymorphism in the DRD3, and the exon III 48bp repeat polymorphism in the DRD4 are not associated with the therapeutic response to antipsychotic drugs in Korean schizophrenic patients. A larger prospective study is needed to elucidate the association between antipsychotic response and dopamine receptor gene polymorphism.

Keywords

Schizophrenia;Antipsychotic agents;Therapeuticresponse;Dopamine receptors;Genetic polymorphism.

Serum S100B Protein in Medication-Free Schizophrenic Patients

Seong Nam Jin, MD1;Doo-Byung Park, MD, PhD2;Hye-Ryun Kim, MD, PhD3; and Hyung Tae Baek, MD2;

1;Incheon Chamsarang Hospital, Seojin Medical Research Institute, Incheon, 2;Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, 3;Department of Clinical Pathology, College of Medicine, Chung-Ang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 177-83.

Abstract

ObjectivesPrevious studies have suggested that S100B protein play an important role in the pathogenesis and progress of schizophrenia. In the present study, we evaluate the serum levels of S100B in the patients with schizophrenia, and compare them with those of healthy controls.

Method:The serum S100B levels were measured by lectrochemiluminescence immunoassay in 21 schizophrenic patients (8 males, 13 females) and 27 normal controls(11 males, 16 females). The Positive and Negative Syndrome Scale(PANSS) was used to evaluate the symptoms of the patients with schizophrenia, and the correlation between PANSS subscale scores and serum S100B levels was examined. 

Results:No significant difference was found between the serum S100B levels of the schizophrenic patients (0.074±0.039ng/ml) and those of the normal controls(0.072±0.030ng/ml)(p=0.925). Correlationships between the high serum S100B level with high negative symptom scores(p=0.065) or with the low positive symptom scores(p=0.080) did not exist.

Conclusion:The relation between serum S100B level and schizophrenia was not found in the present study. However, to confirm this result, further studies, such as measurement of S100 protein level in CSF, postmortem study, long-term follow-up study, and studies with other neurotrophic proteins are needed.

Keywords

S100B protein;Schizophrenia;Negative symptoms.

Correlations of Cerebellar Function with Psychotic Symptoms and Cognitive Function in Schizophrenic Patients

Seo Young Kim, MD1;Yong Ho Jun, MD2;Young Joon Kwon, MD1;Hee Yeon Jeong, MD1;Bo Young Hwang, MD3; and Se Hoon Shim, MD1;

1;Department of Neuropsychiatry, College of Medicine, Soonchunhyang University, Cheonan, 2;Goodmind Neuropsychiatry Clinic, Bucheon, 3;Department of Preventive medicine, College of medicine, Soonchunhyang University, Cheonan, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 184-93.

Abstract

ObjectivesThere is increasing evidence that the cerebellum plays an important role in cognition and psychiatric symptoms as well as motor coordination. The concept of cognitive dysmetria has been making cerebellar function in schizophrenia the focus of current studies. In other words, disruption in the cortico-cerebellum-thalamic -cortical circuit could lead to disordered cognition and clinical symptoms of schizophrenia. The purposes of this study were to determine cerebellar dysfunction in male schizophrenic patients semiquantitatively with ICARS and to investigate the clinical and cognitive correlates of ICARS in patients.

Methods:We compared the scores of cerebellar neurologic sign using ICARS in 47 male patients with a DSM-IV-TR diagnosis of schizophrenia with 30 gender and age-matched healthy control subjects. The semiquantitative 100-point ICARS consists of 19 items divided into 4 unequally weighted subscores:posture and gait disturbances, kinetic functions, speech disorders and oculomotor disorders. All subjects were also assessed with cognitive function test. Cognitive functions were evaluated by Korean-Mini Mental Status Examination (K-MMSE), Verbal fluency test, and Clock drawing test. The patients were administered Korea version of Positive and Negative Symptom Scale(K-PANSS) to assess the symptom severity. 

Results:Schizophrenic patients had significantly higher scores on the ICARS than control subjects with posture and gait disturbances, kinetic functions, and oculomotor disorders. They also showed more significant impairments in cognitive function tests than control subjects. There was a significant correlation between ICARS and negative symptoms of patients. In cognitive function test, Clock drawing test was significantly associated with negative symptoms. In addition, Clock drawing test was negatively correlated with the total score of ICARS. 

Conclusion:In this study, we confirmed that schizophrenic patients have significant impairments in cognitive and cerebellar function, and that those were related with negative symptoms of schizophrenic patients. These results support a role of the cerebellum in schizophrenia. It is meaningful that we used a structured, and reliable procedure for rating neurological soft signs, ICARS. We hope that future prospective studies using a similar design help that rate of neurological sign should have been visible with the progression of illness.

Keywords

International Cooperative Ataxia Rating Scale(ICARS);Male schizophrenia;Cognitive function;PANSS.

A Comparison of the Clinical Features between Panic Disorder with and without Agoraphobia

Ho-Sang Lee, MD1;Sang-Woo Hahn, MD, PhD2;Se-Won Lim, MD1; and Kang-Seob Oh, MD, PhD1;

1;Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 2;Department of Psychiatry, Soonchunhyang University Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 194-200.

Abstract

ObjectivesThis study was performed to investigate the differences of the clinical feature between panic disorder with agoraphobic patients and panic disorder without agoraphobic patients.

Methods:Two hundred nine patients meeting the criteria of DSM-IV panic disorder were recruited. One group was panic disorder with agoraphobia(n=78, 42 male(53.8%), mean age 37.6±9.9 years), another was panic disorder without agoraphobia(n=131, 81 male(61.8%), mean age 40.5±10.3 years). The numbers and frequency of panic symptoms were compared between two groups with t-test, and the logistic regression analysis were used for predicting panic disorder with agoraphobia.

Results:The number of panic symptoms during panic attack was significantly higher in the group of panic disorder with agoraphobia than the group of panic disorder without agoraphobia(p<0.05). 'Sweating', 'nausea or abdominal distress', 'fear of losing control of going crazy', 'chills or hot flushes' were more frequent in the group of panic disorder with agoraphobia(p<0.05). Among panic symptoms on logistic regression analysis, 'sweating', 'nausea or abdominal distress', 'fear of losing control or going crazy'turned out to correlate significantly with risk of development of agoraphobia in panic disorder. 

Conclusion:These results suggest that the frequency of some symptoms during panic attack may be a predictor of agoraphobia in patients with panic disorder.

Keywords

Panic disorder;Agoraphobia.

Vol. 14 No.4

Heat Shock Proteins as Molecular Chaperons in Neuropsychiatry

Dong-Hoon Oh, MD;Byung-Hwan Yang, MD, PhD; and Joonho Choi, MD, PhD

Department of Neuropsychiatry and Mental Health Institute, College of Medicine, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 221-31.

Abstract

Recent researches have shown that important cellular-based autoprotective mechanisms are mediated by heat-shock proteins(HSPs), also called 'molecular chaperones'. HSPs as molecular chaperones are the primary cellular defense mechanism against damage to the proteome, initiating refolding of denatured proteins and regulating degradation after severe protein damage. HSPs also modulate multiple events within apoptotic pathways to help sustain cell survival following damaging stimuli. HSPs are induced by almost every type of stresses including physical and psychological stresses. Our nervous system in the brain are more vulnerable to stress and damage than any other tissues due to HSPs insufficiency. The normal function of HSPs is a key factor for endogenous stress adaptation of neural tissues. HSPs play an important role in the process of neurodevelopment, neurodegeneration, and neuroendocrine regulation. The altered function of HSPs would be associated with the development of several neuropsychiatric disorders. Therefore, an understanding of HSPs activities could help to improve autoprotective mechanism of our neural system. This paper will review the literature related to the significance of HSPs in neuropsychiatric field.

Keywords

Heat shock proteins;Molecular chaperones;Autoprotective mechanism;Neuropsychiatry.

The Effect of Antipsychotic Drug Treatment on Serum VEGF, sVEGFR-1, and sVEGFR-2 Level in Schizophrenia - A Preliminary Study -

Tae Hyun Kim, MD1;Do Hoon Kim, MD, PhD1;Sang Kyu Lee, MD, PhD1;Bong Ki Son, MD, PhD1; and Jun Sub Jung2;

1;Department of psychiatry, Hallym University College of Medicine, Chuncheon Sacred-Heart Hospital, Chuncheon, 2;Institute of Natural Medicine Science, Hallym University, Chuncheon, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 232-40.

Abstract

ObjectivesVascular endothelial growth factor(VEGF), one of potent cytokines, and its receptors were related with various biological functions and pathological conditions. The purpose of this study was to investigate the changes of serum level of free VEGF, soluble VEGFR-1, and soluble VEGFR-2 after treatment with atypical antipsychotic drug in schizophrenia.

Method
The schizophrenic patients were diagnosed with DSM-IV and were prospectively followed up for 4 and 8 weeks. Thirteen schizophrenic patients were evaluated their clinical assessment with serum levels of free VEGF, sVEGFR-1, sVEGFR-2, and positive and negative symptom scale(PANSS) at baseline, 4 weeks, and 8 weeks after treatment with atypical antipsychotic drug. Thirteen normal control subjects were recruited and matched with the patient group by age and sex.

Result
The serum level of free VEGF(295.2±43.7pg/ml)and sVEGFR-2(8259±336.7) at baseline(before treatment) in schizophrenic patients were not significantly different, compared with the control group(199.0±28.8 and 8481±371.9) respectively. However, the serum level of sVEGFR-1(86.2±10.3, p<0.05) was significantly increased in the schizophrenic patients compared with the control group(59.0±6.4). After treatment with antipsychotic drug, the serum levels of free VEGF at 4 weeks(338.9±56.5) and 8 weeks(309.5±58.7) were not significantly, different compared with baseline. But the serum levels of sVEGFR-1 was significantly decreased at 8 weeks(57.3±6.3, p<0.05) after antipsychotic drug treatment. The serum levels of sVEGFR-2 were decreased at 4 weeks(7761±403.0, p<0.05) and 8 weeks(7435±333.5, p<0.05) compared with baseline.

Conclusion
The decreased serum level of sVEGFR-1 and sVEGFR-2 might be affected by dopaminergic system which was influenced by antipsychotic drug.

Keywords

Vascular endothelial growth factor(VEGF);Soluble VEGF receptor 1(sVEGFR-1);Soluble VEGF receptor 2(sVEGFR-2);Schizophrenia;Dopamine;Atypical antipsychotic drug.

Association Study between 2 Single Nucleotide Polymorphisms in Estrogen Receptor 1 Gene and Korean Female Schizophrenic Patients

Jin Kyung Park, MD1;Seo Kyong Lee, MD1;Sang Min Lee, MD1;Jun Heon Park, MD1;Ji Yeong Kim, MS2; and Ah Rang Cho, MD, PhD1;

1;Department of Neuropsychiatry, College of Medicine, Kyung-Hee University, Seoul, 2;Department of Preventive Medicine, College of Medicine, Kyung-Hee University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 241-8.

Abstract

ObjectivesSchizophrenia is equally distributed in both sexes. However, later-onset, milder psychopathology, and better outcome are associated with the females. This reason is thought to be partly due to the estrogen system. Recently, it was suggested that estrogen receptor 1(ESR1) gene polymorphisms might affect the expression of ESR1 and were associated with several psychiatric disorders. Thus, we investigated the association between two single nucleotide polymorphisms(SNPs) in the ESR1 gene and Korean schizophrenic patients in this study.

Methods
Genotype, allele, and haplotype frequencies of the two SNPs(rs 2234693 and rs 2228480) were analyzed between 218 Korean controls and 158 Korean schizophrenic patients. Also, age of onset and negative symptom scale scores according to genotypes were analyzed in the patients with schizophrenia.

Results
There was a significant difference in allele frequencies of rs 2234693 between the schizophrenic patients and the controls(p=0.03). Genotype distributions(p=0.03) and allele frequencies(p=0.01) of rs 2234693 were significantly different between the female schizophrenic patients and the female controls. The frequency of TC-CC genotypes compared with TT genotype in the female schizophrenic patients was significantly higher than that in the female controls(OR=2.36). The mean age of onset in the schizophrenic patients with TC-CC genotypes was significantly lower than that in the patients with TT genotype. The frequency of rs 2234693C-rs 2228480G haplotype in the female schizophrenic patients was relatively higher than that in the female controls.

Conclusions
These results of our study support the possibility that the ESR1 gene polymorphisms might be involved in the susceptibility of females to schizophrenia and play a role in sex difference of schizophrenia.

Keywords

Estrogen receptor 1;Schizophrenia;Association;Single nucleotide polymorphism.

A Study on Relapse Predictors in Korean Alcohol-Dependent Patients - A 24 Weeks Follow up Study -

Cheol Min Kim, MD1;Sung Gon Kim, MD, PhD2;Kee NamKoong, MD, PhD3;Dong Hwan Cho, MD, PhD4;Byung Ook Lee, MD, PhD5;Ihn Geun Choi, MD, PhD6; and Min Jeong Kim, MA2;

1;Department of Neuropsychiatry, Yangsan Hae-In General Hospital, Yangsan, 2;Department of Psychiatry, School of Medicine, Pusan National University, Busan, 3;Department of Psychiatry, College of Medicine, Yonsei University, Seoul, 4;Department of Neuropsychiatry, Maryknoll Hospital, Busan, 5;Department of Psychiatry, National Health Insurance Corporation Ilsan Hospital, Goyang, 6;Department of Neuropsychiatry, College of Medicine, Hallym University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 249-55.

Abstract

ObjectivesThe aim of this prospective study is to investigate predictors estimating relapse in Korean alcohol-dependent patients using variables like alcohol history, drinking craving, treatment motivation and insight.

Methods
Alcohol dependent patients(N=48) who completed questionnaires about sociodemographic variables and drinking history, Timeline Follow-Back(TLFB), Obsessive-Compulsive Drinking Scale(OCSD), Alcohol Urge Questionnaire(AUQ), Pennsylvania Alcohol Craving Scale(PACS), University of Rhode Island Change Assessment(URICA), Hanil Alcohol Insight Scale(HAIS) were followed-up for 24weeks. Subjects who drank heavily(5 standard drinking or more/day) or were not followed up anymore were classified as the relapse group. We used logistic regression analysis with backward elimination of SPSS PC+11.5 to investigate relapse estimate predictors.

Results
Average drinking amount per drinking day for last 1 year and HAIS score were predictors of relapse in alcohol-dependent patients.

Conclusions
Our findings suggest that therapist should give more attention to alcohol-dependent patients who had more drinks per drinking day for last 1 year and had lower insight level.

Keywords

Alcohol dependence;Relapse predictor;Follow-up.

The Effect of Maternal State Anxiety on the Children's Somatic Symptom in Attention-Deficit/Hyperactivity Disorder

Gyungmee Kim MD1;Dong-Won Shin MD, PhD2; and Keunmun Lee MD3;

1;Seoul National Mental Hospital, Seoul, 2;Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Psychiatry, Seoul, 3;Mental Health Clinic Yoo & Kim, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 256-61.

Abstract

ObjectivesThe aim of the present study was to examine whether anxiety and depression of children and mothers were associated with the children's medically unexplained somatic symptoms in attention-deficit/hyperactivity disorder(ADHD).

Methods
83 clinic-referred boys with ADHD and 52 boys without ADHD were included in this study. The frequency of the medically unexplained somatic symptoms, such as general-ache, headache, nausea, eye problems, skin problems, abdominal pain, vomiting was evaluated using the somatic symptom domain of the Child Behavior Checklist(CBCL). Children's anxiety and depression were evaluated using Kovacs Children's Depression Inventory(CDI) and Spielberger's State-Trait Anxiety Inventory(STAI) for children. Maternal anxiety and depression were measured by Spielberger's State-Trait Anxiety Inventory(STAI) and Beck's Depression Inventory(BDI). Stepwise linear regression analysis was used to examine the hypothesis.

Results
Score of maternal state anxiety affects the T score of the somatic symptom domain in CBCL significantly(adjusted R2=0.057;p=0.026).

Conclusion
The frequency of medically unexplained somatic symptom of children perceived by mothers was associated with the high level of maternal state anxiety in ADHD. Frequent maternal report of the children's somatic symptom may be a warrant for the evaluation and management of the maternal state anxiety in ADHD.

Keywords

Attention-deficit/hyperactivity disorder;Somatic symptom;Maternal state anxiety.

No Association between the 5-HT6 Receptor C267T Polymorphism and Response to Citalopram Treatment in Patient with Major Depressive Disorder

Sang-Woo Hahn, MD1;Se-Won Lim, MD2;Kang-Seob Oh, MD2;Rhee-Hun Kang, MD3; and Min-Soo Lee, MD3;

1;Department of Psychiatry, Soonchunhyang University of College of Medicine, Seoul, 2;Department of Psychiatry, Sungkunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, 3;Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 262-7.

Abstract

The serotonin 6(5-HT6) receptor gene is a candidate gene for influencing the clinical response to treatment with antidepressants. The purpose of this study was to determine the relationship between the C267T polymorphism in the 5-HT6 receptor gene and the treatment response to citalopram in a Korean population with major depressive disorder(MDD).

Methods
Citalopram was administered for 8 weeks to the 90 patients who completed study. 21-item Hamilton depression rating scale(HAMD-21) was used as a outcome measure.

Results
We found that the genotype, allele, and allele-carrier distributions did not differ significantly between MDD patients and normal controls. A main effect of an interaction of genotype with time on the decrease in the HAMD-21 score during the 8 weeks study period was not found. ANOVA revealed no significant effects of the C825T polymorphism on the decrease in the HAMD-21 score at each time period.

Conclusions
These results suggest that the C267T polymorphism in the 5-HT6 receptor gene is not associated with the treatment response to citalopram.

Keywords

Major depressive disorder;5-HT6 receptor;C267T polymorphism;Citalopram.

Serotonin Transporter-Linked Promoter Region Polymorphism and Personality Traits in a Korean Female Population

Seung Min Lee, MD1;Jong Hyuck Choi, MD1;Byung Joo Ham, MD, PhD2; and So Hee Lee, MD, PhD1;

1;Department of Psychiatry, National Medical Center, Seoul, 2;Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 14, No. , pp. 268-73.

Abstract

ObjectivesFindings from behavioral genetics which demonstrate the high heritability of personality traits have stimulated the search for the specific genes underlying personality. A large number of association studies have investigated a correlation between serotonin transporter-linked promoter region(5-HTTLPR) polymorphism and personality traits but the results have been inconsistent. So, the aim of this study is to investigate in a large sample with homogenous background about ethnicity, gender, occupation, and age.

Methods
The participants included 247 healthy Korean female adults(mean age=23.12, SD=3.22)with no history of psychiatric disorders and other physical illnesses. Genomic DNA was extracted from peripheral blood, and genotyping was performed by PCR. Personality assessment was done with the Temperament and Character Inventory(TCI).

Results
Genotype Frequencies are l/l 3.6%, l/s 32.8% and s/s 63.6%(l allele:20%, s allele:80%). This low frequency of the l allele and l/l genotype was different from Caucasian results. No significant association was observed between 5-HTTLPR polymorphism and personality traits in a Korean female population.

Conclusions
This study investigated the association between 5-HTTLPR polymorphism and personality traits in Korean female subjects, a large sample with homogeneous background about ethnicity, gender, occupation, and age. No significant association was observed between 5-HTTLPR polymorphism and personality traits in a Korean female population.

Keywords

5-HTTLPR;Temperament and character inventory;Personality traits.

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Vol. 13 No.1

Diagnosis and Treatment of Postpartum Depression

Su-Jin Yang, MD, PhD; and Jae-Min Kim, MD, PhD

Department of Psychiatry, Chonnam National University Medical School and Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 3-10.

Abstract

Depression is the leading cause of disease-related disability among women. Postpartal depression (PPD) can produce substantial clinical, economic, and psychosocial impairment, not only for the women experiencing it but also for the women's children and family. Therefore, a comprehensive understanding the accurate detection and appropriate treatment of depression is mandatory in women of childbearing age. This review focused on the current knowledge of PPD.

Keywords

Postpartal depression;Diagnosis;Treatment.

Korean Clinical Practice Guideline for the Treatment of Depressive Disorders - The Present State and Future Direction of Development -

Se-Won Lim, MD1; and Min-Soo Lee, MD, PhD2;

1;Department of Psychiatry, Kangbuk Samsung Hospital, Seoul, 2;Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 11-8.

Abstract

Depressive disorder is one of well-known major public health problems in Korea. The socioeconomic burden of depression is growing bigger and bigger. Therefore, the Korean government decided to establish the clinical research center for depression for better care of patients with depression. One of the major task of the center is the development of Korean clinical practice guideline for depressive disorders. This guideline should reflect the clinical situation in Korea and meet Korean physicians' needs. In addition, it should be feasible and easy to use. We reviewed the present status of the guideline development in Korea and other countries, and introduces the scope, method, and goals of Korean clinical practice guideline for depression.

Keywords

Depressive disorders;Korean;Clinical practice guideline;Research.

Plasma Levels of Nitric Oxide Metabolites in Patients with Postpartum Depression

Bun-Hee Lee, MD1;Kye Hyun Kim, MD2;Young Chul Shin, MD3;Jung Bum Kim, MD4; and Yong-Ku Kim, MD1;

1;Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, Ansan, 2;Department of Obstetrics, KangBuk Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, 3;Department of Psychiatry, KangBuk Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, 4;Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 19-25.

Abstract

Background:Some reports have suggested that decreased nitric oxide metabolites(NOx) and activity of nitric oxide synthase could be related to the pathophysiology of depression. We evaluated plasma levels of NOx in pregnant women with and without postpartum depression at prenatal and postnatal period.

Methods:The plasma concentrations of NOx were measured in 104 pregnant women in the third trimester and at 6 weeks postpartum and in 64 normal controls. The severity of depression and anxiety was measured with the Edinburgh Postnatal Depression Scale(EPDS), Beck Depression Inventory(BDI), and Beck Anxiety Scale(BAI). 

Results:Plasma NOx levels at 6 weeks postpartum were significantly lower in cases of postpartum major depression(EDPS scores≥13 points) than in cases without depression(EDPS scores≤9 points). Plasma NOx levels had significantly negative correlation with EPDS scores at 6 weeks postpartum.

Conclusion:We demonstrate that decreased plasma NOx is associated with postpartum depression. Further studies are required to determine whether individual serum concentration of plasma NOx alone could predict maternal depression.

Keywords

Postpartum depression;EPDS;Nitric oxide;NO<sub>x</sub>.

The Therapeutic Factors Affecting Post-discharge Course of Schizophrenia Patients in a University Hospital

Jung Hyun Nam, MD, PhD;Sungwon Roh, MD, PhD;Joonho Choi, MD, PhD; and Kyung Woo Lee, MD

Department of Neuropsychiatry, College of Medicine, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 26-31.

Abstract

ObjecTo evaluate how the therapeutic factors affect post-discharge course of patients with schizophrenia, we analyzed relationship between each therapeutic factor and outcome of inpatients with schizophrenia in Hanyang University Hospital. 

Methods:This study is a retrospective report. Subjects were schizophrenic inpatients who were discharged from Hanyang University Hospital from January 1, 2003 through December 31, 2004. We obtained demographic and clinical data from review of inpatient and outpatient charts. 

Results:We analyzed the records of 104 patients with schizophrenia(44 males and 60 females). Patients who had longer first admission days have fewer number of readmission. There were no significant correlation between psychiatric rehabilitation and course of schizophrenia. Courses, such as duration of outpatient department follow-up and number and duration of rehospitalization, did not differ according to the existence of extrapyramidal symptoms or types of antipsychotics prescribed. 

Conclusion:Among the therapeutic factors, longer duration of the first admission only affected better post-discharge course of patients with schizophrenia.

Keywords

Schizophrenia;Clinical course;Therapeutic factors.

The Change of Interleukin-12 and Transforming Growth Factor-β1 Level in Manic Patients after Treatment

Hyun-Seok Choi, MD; and Yong-Ku Kim, MD, PhD

Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 32-7.

Abstract

BackgroundSeveral studies have suggested that alterations of cytokine level could be related to the pathophysiology of bipolar disorder. In this study, we measured plasma level of Interleukin-12(IL-12), a pro-inflammatory cytokine and transforming growth factor-β1(TGF-β1), an anti-inflammatory cytokine before and after treatment in acute manic patients.

Methods:The plasma concentrations of IL-12 and TGF-β1 were measured using quantitative ELISA in 18 bipolar disorder patients and 25 normal controls at admission and 6 weeks later. The psychopathology was measured by Brief Psychiatric Rating Scale(BPRS) and Young Mania Rating Scale(YMRS).

Results:IL-12 levels were significantly higher in bipolar manic patients than in controls before treatment. Following the 6-week treatment, the IL-12 level was decreased than before treatment, but sustained still higher level than normal control. TGF-β1 level was not significant different between manic patients and normal controls before treatment, but was increased after treatment comparing with before treatment in bipolar patients. The ratio of IL-12 and TGF-β1 was significantly decreased after treatment.

Conclusion:Cytokine abnormalities in bipolar disorder might be involved in the pathophysiology of the illness. It is possible that TGF-β1 plays an important role in the regulation of immunological imbalance in bipolar disorder.

Keywords

Cytokine;Interleukin;TGF;Bipolar disorder.

A Case of Idiopathic Basal Ganglia Calcification with Dementia

Hee-Young Shin, MD, PhD1; and Il-Seon Shin, MD, PhD1,2,3;

1;Clinical Trial Center, Chonnam National University Hos-ipital, Kwangju, 2;Department of Psychiatry, Chonnam National University Me-dical School, Gwangju, 3;Department of Psychiatry, Hwasun Chonnam National University Hospital, Hwasun, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 38-42.

Abstract

The case of a 66- year-old woman with coexisting idiopathic basal ganglia calcification(IBGC) and dementia was presented. The calcification was detected in bilateral basal ganglia, dentate nucleus, and thalamus by brain imaging. Serum calcium and phosphorus levels were normal. The underlying diseases of calcification of basal ganglia such as parathyroid dysfunction and other infectious, toxic, or metabolic illness were excluded. The patient had memory impairment and frontal executive dysfunction without aphasia, agnosia, apraxia, and visuospatial impairment in neuropsychological test. It suggested that the cognitive impairment might be due to the dysfunction of frontal-subcortical circuit. 

Keywords

Basal ganglia;Calcification;Dementia;Neuropsychiatric symptom.

Vol. 13 No.2

Depression in Cancer Patients

Sung-Wan Kim, MD, PhD;Sam-Yeon Lee, MD; and Jae-Min Kim, MD, PhD

Department of Psychiatry, Chonnam National University Medical School and Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 59-69.

Abstract

Bidirectional relationships exist between cancer and depression; the prevalence of depression in cancer patients is higher than in the general population, and depression predicts cancer progression and mortality. The mechanisms through which depression contributes to the progression of cancer are related with dysregulation of the hypothalamic-pituitary-adrenal axis and impairment of immune function. However, depression in cancer patients tends to be underdiagnosed and not appropriately treated. The methods of diagnosis and assessment of depression in cancer patents have been debated because physical symptoms of depression mimic both cancer symptoms per se and the side effects of cancer treatment. Many studies have shown that various psychosocial and/or pharmacological interventions are effective at improving depressive symptoms and quality of life in cancer patients. Furthermore, antidepressant treatments are effective for various physical symptoms related to cancer, such as fatigue, anorexia, pain, hot flashes, and itching. This article reviews and discusses current knowledge about depression in cancer patients.

Keywords

Cancer;Depression;Antidepressant;Psychosomatic.

The Cognitive Performance, Emotional and Behavioral Problems of the Children with ADHD Showing the Difference between Visual and Auditory Attention

Jung Woo Son, MD

Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 70-81.

Abstract

ObjectiveThe purpose of this study was to investigate the differences of the cognitive performance, emotional and behavioral problems among the attention-deficit/hyperactivity disorder(ADHD) groups that show the difference between visual and auditory attention.

Method:Using‘ADHD Diagnostic System(ADS)’, visual attention and auditory attention of 98 children diagnosed as ADHD were measured. According to the omission and commission error of ADS, they were divided into three groups;1) the group whose each visual omission and commission error scores were higher than each auditory omission and commission error scores(VV group), 2) the group whose each auditory omission and commission error scores were higher than each visual omission and commission error scores(AA group), 3) the group that was the rest of VV and AA group(M group). And the results of both the subscales of Korean Educational Development Institute-Wechsler Intelligence Scale for Children(KEDI-WISC) and the subscales of Korean Child Behavior Checklist(K-CBCL) among three groups were compared. Finally, the correlation between the visual omission, visual commission, auditory omission, auditory commission error and the results of KEDI-WISC, K-CBCL were investigated. 

Results:The results were as follows;1) In 98 ADHD children, the number of VV group(N=56) was higher than that of AA (N=10) and M group (N=32). 2) All mean scores of the subscales of KEDI-WISC of VV group were higher than those of M and AA group. The score of verbal IQ(p=.039) of VV group was significantly higher than that of AA group and the scores of block design(p=.015), Kaufman's factor 2(p=.045), performance IQ(p=.004) were significantly higher than those of M group. The score of full IQ(p=.004) were significantly higher than that of M and AA group. 3) The mean scores of all K-CBCL subscales of VV group were higher than those of M and AA group, except the score of Somatic complaint subscale. The score of Social subscale(p=.041) of VV group was significantly higher than that of AA group. The score of Withdrawn subscale(p=.021) of AA group was significantly higher than that of VV group. 4) There were no significant correlation between the scores of visual omission/commission error and those of each subscale of KEDI-WISC. But, there were many significant correlations between the scores of auditory omission/commission error and those of each subscale of KEDI-WISC. 5) There were significant correlation between the score of the visual omission error and that of Thought problem subscale(r=.205, p=.043) of K-CBCL. There were significant correlation between the scores of the auditory omission error and those of Social subscale(r=-.319, p=.001), Social problems subscale(r=.206, p=.042), Thought problem subscale(r=.235, p=.021). Finally, there were significant correlation between the scores of auditory commission error and those of Social subscale(r=-.241, p=.017), Thought problem subscale(r=.235, p=.020). 

Conclusion:The ADHD children whose auditory attention ability were higher than visual attention ability had relatively better cognitive performance and less emotional/behavioral problems than the others. The more comprehensive experiment will be needed about the cognitive performance, emotion and behavior problems of the ADHD children showing the difference between visual and auditory attention.

Keywords

ADHD;Visual attention;Auditory attention;KEDI-WISC;K-CBCL;ADS.

The Effects of Board-Game Therapy on Cognitive Rehabilitation in Patients with Chronic Schizophrenia

Tak Youn, MD1; and An-Soon Jeong, PhD2;

1;Chook-Ryoung Evangelical Hospital, Namyangju, 2;Department of nursing, Kyungbok College, Pocheon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 82-94.

Abstract

ObjectivesIn order to explore effects of board-game therapy for cognitive rehabilitation in patients with schizophrenia, we investigated the change of executive cognitive function over a 2-month period of board-game therapy in patients with schizophrenia.

Methods:Two groups of chronic schizophrenic inpatients were participated in this study. One group(n=21) were treated with board-game therapy for 2 months and the other control group(n=19) were not treated. For the evaluation of the executive cognitive function, a Wisconsin Card Sorting Test(WCST) was administered before and after the introduction of the board-game therapy. PANSS score change was also evaluated.

Result:At the beginning of this study, there was no significant difference in performance of cognitive function tests, demographical data or clinical severity between both patient groups. After 2 months of treatment with the board-game therapy, the board-game therapy group showed significant improvements of executive cognitive function without any significant change of their schizophrenic symptoms. On the contrary, there was no change in control group.

Conclusion:This study showed that a board-game therapy is effective for the enhancement of executive cognitive function in patients with chronic schizophrenia. A board-game therapy could be introduced with ease into psychiatric fields, such as inpatients’or outpatients’clinic wards and day hospital. Our result indicates that the board-game therapy is a promising tool for the enhancement of cognitive function, especially executive cognitive function and helpful for cognitive rehabilitation for schizophrenic patients.

Keywords

Board-game therapy;Schizophrenia;Executive cognitive function;Wisconsin card shorting test (WCST);Cognitive rehabilitation.

Alteration of Plasma β-Nerve Growth Factor Concentration in Depressed Patients with Suicidal Attempt

Se-Hoon Shim, MD1;Seong-Doo Won, MD2;Bun-Hee Lee, MD2;Chang Su Han, MD2;Jong-Chul Yang, MD3;Young-Joon Kwon, MD1; and Yong-Ku Kim, MD2;

1;Department of Psychiatry, Soonchunhang University Cheon-An Hospital1, Cheonan, 2;Department of Psychiatry, College of Medicine, Korea University, Ansan, 3;Department of Psychiatry, Department of Psychiatry, Chonnam University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 95-102.

Abstract

ObjectNerve growth factor(NGF) is a protein involved in neuronal survival and plasticity in the central nervous system, which might play an important role in stress, depression and suicide. This study was performed to determine whether there is an alteration in plasma NGF concentrations in depressed patients with suicidal attempt.

Methods:The subjects were 32 depressed patients who attempted suicide and admitted in emergency room. Forty-four hospitalized non-suicidal depressive patients and the 30 normal controls were closely matched with the suicidal group in terms of age and sex. Individuals in all 3 groups were evaluated independently by a semi-structured interview for the purpose of establishing a DSM-IV criteria diagnosis. The severity of depressive symptoms was evaluated using Hamilton depression rating scale(HDRS). The severity of the suicidal behavior was evaluated by Weisman and Worden's risk-rescue rating(RRR) system and the Lethality Suicide Attempt Rating Scale(LSARS). Plasma NGF level was measured by the enzyme linked immunosorbent assay(ELISA) method.

Results:There were no statistically significant differences of the plasma NGF levels among groups. LSARS and RRR did not reveal any significant correlation with β-NGF level in suicidal depressive patients.

Conclusion:This study do not support an association between β-NGF and suicidal depression. However it is necessary to investigate this association through other route such as postmortem brain.

Keywords

Suicide;Depression;NGF.

Interactions of Vascular Risk Factors and Apolipoprotein E4 on Geriatric Depression

Hye-Young Park, MD, PhD1;Jae-Min Kim, MD, PhD1,2;Il-Seon Shin, MD, PhD1,2;Su-Jin Yang, MD, PhD1,2;Sung-Wan Kim, MD, PhD1,2;Seon-Young Kim, MD1;Hee-Young Shin, MD, PhD2,3; and Jin-Sang Yoon, MD, PhD1,2,3;

1;Department of Psychiatry, Chonnam National University Medical School, Gwangju, 2;Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, 3;Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 103-9.

Abstract

ObjectiveAssociations of vascular risk/disease or apolipoprotein E ε4(APOE4) with geriatric depression has been unclear at a population level. This study aimed to evaluate whether there would be interactions of vascular risk/disease and APOE4 on depression in a Korean elderly population.

Methods:732 community residents aged 65 or over were assessed for depression(GMS), information on vascular risk/disease(reported stroke, transient ishemic attack, heart disease, hypertension, diabetes, smoking), examinations for vascular risk/disease(blood pressure, blood tests for glucose and lipid profiles, body size), APOE genotypes, demographic characteristics(age, gender, education), physical health, and cognitive function(MMSE).

Results:Previous stroke and lower level of high density lipoprotein(HDL) cholesterol were significantly associated with geriatric depression independent of demographic characteristics, physical illnesses, and cognitive function. These associations were statistically significant only in those with APOE4, although the interaction terms didn't reach to statistical significance.

Conclusion:Associations between vascular risk/disease and geriatric depression might be more prominent in those with APOE4. However further research would be needed to clarify this issue.

Keywords

Stroke;Vascular risk;Apolipoprotein E;Depression;Elderly.

Microarray Analysis of Gene Expression in Rat Hippocampus of Maternal Social Separation Model

Hee Jae Lee, PhD1;Chang Hee Son, MD1;Hyong Ryol Kwak1;Sang-Hyun Lee, MS1;Yoon Hee Han, MD1;Soo Young Kim, MD1;Jong-Ik Park, MD, PhD2;Wanjoo Chun, PhD1; and Sung-Soo Kim, MD, PhD1;

1;Department of Pharmacology, 2;Psychiatry, College of Medicine, Kangwon National University, Chuncheon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 110-6.

Abstract

ObjectivesAlteration of hippocampus was demonstrated in the maternal social separation(MSS) pups, se-parated from dams on postnatal day(pnd) 14 and placed alone. Therefore, to understand the molecular events involved in the MSS, we have initiated a search for gene profiles that are up or down-regulated in the hippocampus of MSS pups.

Methods:Analysis of cDNA microarray was performed by using total RNA extracted from the hippocampus of control and MSS pups on pnd 17. Also, passive-avoidance test was demonstrated on pnd 35.

Results:Up-regulation of Nedd4a was observed in the hippocampus of MSS pups. Also, MSS rats showed less elongation of latency in passive avoidance test. 

Conclusion:We suggest that environmental effects of MSS may be altered the neural and/or glial differentiation and synapse formation-related genes which may lead cognitive alterations in MSS rats.

Keywords

Maternal social separation;Microarray;<i>Nedd4a</i>;Memory.

Mass on Left Cingulate Cortex in Patient with Localized Amnesia

Na-Hyun Kim, MD;Jae-Hun Lee, MD; and Se-Won Lim, MD

Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 117-20.

Abstract

Localized amnesia is characterized by a failure to recall events that occurred during a circumscribed period of time. Localized amnesia is the most common type of dissociative amnesia. It is assumed that this is a disorder of memory retrieval. Recent neuroimaing studies reported that posterior cingulate cortex may play a important role in memory(autobiographical) retrieval. The authors reported a case of localized amnesia with mass on left posterior cingulate cortex.

Keywords

Localized amnesia;Dissociative amnesia;Cingulate cortex.

Vol. 13 No.3

P50 and Schizophrenia

Seung-Hwan Lee, MD, PhD;Hyung-Seok Seo, MD; and Young-Cho Chung, MD, PhD

Department of Psychiatry, Ilsanpaik Hospital, Inje University of Korea, Goyang, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 137-43.

Abstract

One of the most widely recognized neurophysiologic endophenotypes for schizophrenia is deficient gating or inhibition of the P50 component of the auditory event-related potential(ERP). A deficit in P50 sensory gating refers to a dysfunction in the mechanism responsible for modulating the brain's sensitivity of filtering out irrelevant or background stimuli, perhaps as a result of dysfunction in inhibitory neural circuits. In this paper, we review the neuronal and genetic aspects as well as medication effects on P50 in schizophrenia.

Keywords

P50;Event-related potential;ERP;Schizophrenia.

The Effects of Cognitive Therapy in Major Depressive Disorder

Kang-Joon Lee, MD, PhD

Department of Neuropsychiatry, Inje University, College of Medicine, Ilsanpaik Hospital, Goyang, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 144-51.

Abstract

Objectives:Cognitive therapy is the most extensively researched psychological treatment for nonpsychotic unipolar outpatient depressive disorders. This review focused on the utility of this approach in severe or chronic depressive disorders, in relapse prevention and also on the potential benefits of combining cognitive therapy with medication.

 

Methods:The author reviewed original studies and quantitative analyses on the effects of cognitive therapy, predictors of response, and neuroimaging studies of cognitive therapy in major depressive disorder. The sources used for the literature search were data bases:PubMed, EMBASE, CDSR on the internet, references in papers or books.

 

Results:This review suggests that cognitive therapy is as effective as antidepressant medication in severe depressive disorders. And cognitive therapy can be an effective alternative to antidepressant medication. Patients benefited significantly more from combined cognitive therapy and antidepressant treatment than from either treatment alone. Most importantly, the addition of cognitive therapy to usual treatment appears to protect against future relapse in individuals known to be at high risk of repeated episodes of depression. In addition, subjects who received cognitive therapy showed significantly greater improvements in chronic depression than receiving antidepressant medication. Pooled data suggests that there is a significant relationship between the therapist's level of training or experience, the type of therapy used and patient outcome. Recent functional imaging studies examining brain changes following cognitive therapy report a variety of regional effects, but there is no consistent pattern across the few published studies.

 

Conclusion:Cognitive therapy has proved beneficial in treating depressive patients. Despite empirical data supporting its efficacy, there are still problems in gaining access to cognitive therapy in clinical practice.

Keywords

Cognitive therapy;Depressive disorder;Antidepressant.

Plasma Concentrations of Clozapine and its Metabolites and FMO3 Variations in Korean Schizophrenic Patients

Kyung-Hoon Lee, MD, PhD1; and Chul Eung Kim, MD, PhD2;

1;Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine/Clinical Trial Center, Clinical Re-search Institute, Samsung Medical Center, Seoul, 2;Department of Psychiatry, College of Medicine, Inha University, Inha University Hospital, Incheon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 152-61.

Abstract

Objective:The relationship between the total daily dose of clozapine given and the plasma concentrations of clozapine and its metabolites(N-desmethylclozapine and clozapine N-oxide) and the effect of Glu158Lys (wild-type:Glu, 'H';variant:Lys, 'h') and Glu308Gly(wild-type:Glu, 'D';variant:Lys, 'd') variation in FMO3 gene on plasma concentrations of clozapine and its metabolites was studied in schizophrenic patients.

 

Methods:Trough plasma concentrations of clozapine and its metabolites were measured in 34 schizophrenic patients receiving clozapine. The genetic variation of 'h' and 'd' in FMO3 were analyzed in 21 among 34 patients. 

 

Results:A linear relationship between the total daily dose of clozapine given(mg/kg body weight per day) and the plasma concentrations(nM) of clozapine was revealed by regression analysis(p<0.001) in the 23 patients receiving a constant daily dose of clozapine for 8 days. The plasma molar concentration ratios of clozapine N-oxide/clozapine in 8 subjects with 'hh' or 'Hh' alleles were not different from those in 6 subjects with 'HH' alleles and the plasma molar concentration ratios in 6 subjects with 'dd' or 'Dd' alleles were not different from those in 8 subjects with 'DD' alleles.

 

Conclusion:The effect of Glu158Lys and Glu308Gly variation in FMO3 gene on clozapine metabolism could not be shown.

Keywords

Clozapine;Clozapine <i>N</i>-oxide;Flavin-containing monooxygenase 3(<i>FMO3</i>);Genetic variation;Schizophrenia.

Brain-Derived Neurotrophic Factor(BDNF) Genetic Polymorphism and the Long-term Outcome of Antidepressant Treatment in Korean Depressive Patients

Jae-Woo Koo, MD1;Hwa-Young Lee, MD2;Jong-Woo Paik, MD1;Rhee-Hun Kang, MD1; and Min-Soo Lee, MD, PhD1;

1;Department of Psychiatry, Depression Center and Pharmacogenomic Research Center for Psychotropic Drugs, 2;Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 162-9.

Abstract

Objective:Since some studies have shown that the brain-derived neurotrophic factor(BDNF) has an important role in the pathophysiology of depression, this study investigated the relationship between BDNF genetic polymorphism and the long-term outcome of the antidepressant treatment.

 

Method:One hundred and eight patients with major depressive disorder were evaluated for the long-term outcome(up to 3 years) of antidepressant treatment. The severity and improvement of depression were assessed with the Clinical Global Impression(CGI) Scale. The genotypes of BDNF 196A/G polymorphism in the patients were determined using Restriction Fragment Length Polymorphism(RFLP).

 

Result:The genotypes of 128 patients were investigated and 95 patients of those have been evaluated for 3 years. No significant differences were noted comparing three-genotype groups for CGI scales at baseline, 4 weeks, 8 weeks, 1 year, 2 years and 3 years.

 

Conclusion:This result shows that BDNF polymorphism investigated in this study was not associated with the long-term outcome of the antidepressant treatment. However, further studies with another BDNF polymorphism should be needed. 

Keywords

Depression;Brain-Derived Neurotrophic Factor;Polymorphisms;Antidepressive agents;Pharmacogenetics.

Association between Social Phobia and Serotonin Transporter Gene Polymorphism:Preliminary Study

Jae-Hon Lee, MD1;Se-Won Lim, MD2;Kang-Seob Oh, MD, PhD1; and Min-Soo Lee, MD, PhD2;

1;Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, 2;Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 170-7.

Abstract

Objectives:Disturbances of serotonergic system might be related to the possible mechanism of social phobia. This study was to investigate the association of serotonin transporter gene and social phobia.

 

Methods:Sixty nine patients with social phobia(51 male(73.9%), mean age 35.17±11.89 years) and seventy four normal controls(54 male(73.0%), mean age 33.46±9.63 years) were tested for serotonin transporter gene-linked polymorphic region(5-HTTLPR) polymorphism. Additionally, patients were grouped into 46 generalized(GEN) and 23 nongeneralized(NGEN) subgroups and 5-HTTLPR polymorphism was compared with that of normal controls. The genotypes and allele frequencies of the 5-HTTLPR polymorphism between social phobia and the control group were compared. Genomic DNA was extracted from their blood and 5-HTTLPR polymorphisms were determined by using polymerase chain reaction.

 

Results:Significant association was observed between the S(ss) genotype and social phobia, by functional classification(p=.010). In allele frequency analysis, a significant association was also observed between the short allele and social phobia(p=.030). A significant associations between S genotype and each subgroup were observed(GEN p=.045;NGEN p=.033), but there were no differences in allele frequency. And, no differences in genotype and allele distribution between two subgroups were found.

 

Conclusion:The results in our Korean sample suggest that S genotype of 5-HTTLPR may be associated with social phobia and s allele may be an important genetic factor that activates social phobic symptoms. But, further studies including large number of samples are necessary to elucidate these present findings.

Keywords

Social phobia;Serotonin trasporter(5-HTT);Polymorphism.

Relationship between Alcohol Withdrawal Symptoms and Dopaminergic Gene Polymorphisms(DRD2, DAT, COMT) in Alcohol Dependence Patients

Tai Young Choi, MD, PhD1;Ho-Nam Kim, MD1;Doug-Hyun Han, MD, PhD2;Kyung-Jun Min, MD, PhD1;Young-Sik Lee, MD, PhD1; and Chul Na, MD, PhD1;

1;Department of Neuropsychiatry, Chung-Ang University School of Medicine, Seoul, 2;Department of Neuropsychiatry, Seoul University School of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 178-90.

Abstract

Objectives:We investigated the relationship of the alcohol withdrawal symptoms with genetic polymorphism among alcohol dependence patients.

 

Method:The measuring instruments used in this study were the Clinical Institute Withdrawal Assessment for Alcohol(CIWA-Ar). We analyzed DRD2 TaqI A polymorphism, dopamine transporter(DAT 1) polymorphism, and catechol-O-methyltransferase(COMT) polymorphism in 108 male alcoholics and 76 healthy controls.

 

Results:The major findings was as follows. No significant differences for genotype distribution or allele frequency were revealed comparing controls and alcoholic patients. 
DRD2 Taq I:The subscale score of auditory hallucination among CIWA-Ar scale in homozygote was significantly higher than in heterozygote(OR=1.34). The total score of CIWA-Ar scale in heterozygote was significantly higher than in homozygote. DAT1:In the subject without DAT-9 gene allele, it was significantly higher of the subscale score of sweating, anxiety among CIWA-Ar scale than in the subject with DAT-9 gene allele. And The total score of CIWA-Ar scale in the subject without DAT-9 gene allele was significantly higher than in the subject with DAT-9 gene allele. COMT:The total score of CIWA-Ar scale in heterozygote was significantly higher than in homozygote.

 

Conclusion:Our results suggest the relationship between specific genetic factors and the withdrawal symptoms of alcohol dependent patients. As the candidate gene of the severity of alcohol withdrawal syndrome, DRD2 Taq1 gene was recommended.

Keywords

Alcohol withdrawal;Genetic polymorphism;CIWA-Ar.

Correlation between Cognitive Functions and Psychotic Symptoms in Schizophrenic Patients

Yong-Ku Kim, MD;Jung-Ae Lee, PhD;So-Youn Lee, MS;Bun-Hee Lee, MD; and Chang-Su Han, MD

Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 191-201.

Abstract

Objectives:The purpose of this study was to investigate whether the cognitive functions would be correlated with psychotic symptoms and whether antipsychotic treatments would affect the cognitive functions after 8 weeks.

 

Methods:The thirty-five schizophrenic patients were conducted in this study. The psychopathology was measured using PANSS. The memory function, executive function, and sustained attention were measured using Memory Assessment Scale(MAS), Wisconsin Card Sorting Test(WCST), and Vigilance(VIG) and Cognitrone(COG) in Vienna Test System. After 8 weeks of antipsychotic treatment, we retested the cognitive tests.

 

Results:1) The cognitive tests after the 8 week's treatment showed significant improvements in memory and executive function in the schizophrenic patients. On the other side, sustained attention did not show improvement. 2) The change of PANSS were correlated with perseverative response, perseverative error and total correct in WCST at baseline. WCST scores at baseline were correlated with negative symptoms, but not positive ones.

 

Conclusion:These study suggests that 1) the impaired sustained attention could be a vulnerability marker in schizophrenia, 2) memory & executive function deficit could be reversible after treatment, and 3) medication might have a benefit in improving the cognitive functions in schizophrenia. Furthermore, the data supports that the better premorbid executive function was, the more favorable was the treatment response in schizophrenic patients. Finally, this study indicates that executive function might be an index of treatment improvement.

Keywords

Schizophrenia;Antipsychotic drug-naive;Cognitive function;Attention;Memory function;Executive function.

Vol. 13 No.4

Korean Clinical Practice Guideline for the Treatment of Depressive Disorder(II)

Rhee-Hun Kang, MD, PhD1,2;Soo-Young Kim, MD, PhD3; and Min-Soo Lee, MD, PhD1,2;

1;Department of Neuropsychiatry, College of Medicine, Korea University, Seoul, 2;Depression Center, Korea University, Seoul, 3;Department of Family Medicine, College of Medicine, Hallym University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 219-25.

Abstract

Depression has been causing huge direct and indirect losses to people's health because of its high prevalence, various clinical patterns, drug reaction and diverse courses different among individuals, but its treatment has not been systematic but dependent on individual clinicians' experience and knowledge. To correct this problem, it has been highly necessary to develop clinical guidelines defined as "systematically developed statements to assist practitioners' and patients' decisions about appropriate healthcare for specific clinical circumstances." Currently, countries throughout the world are making efforts to establish evidence-based guidelines among different levels of guidelines and to evaluate and test them. Although such efforts have been unsatisfactory in Korea because of several constraints including lack of high-quality RCT, the Korean Depression Clinical Practice Guideline has started to develop evidence-based guidelines, which are established through strictly designed processes. Thus, the present study purposed to review methods adopted in the development processes and to present the processes of developing the evidence-based guidelines clearly and transparently.

Keywords

Depression;Clinical practice guideline.

Characteristics of Depression in Korea and Non-Pharmacological Treatment

Sungwon Roh, MD, PhD; and Yong Chon Park, MD, PhD

Department of Neuropsychiatry, College of Medicine, Han-yang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 226-33.

Abstract

Depression is one of the most common mental disorders. Some characteristics of depression in Korea were elucidated. The tendency to express depressive feeling through somatic complaints is more prominent in Korea than in Western countries. Careful studies on depressive symptoms suggest that guilt and suicidal idea are apparent among Korean depressive patients as well as among Western subjects. But most depressive patients in Korea are reluctant to express suicidal idea, which is hidden under the somatic complaints. We should remember the possibility of research artifacts or cultural bias with regard to the evaluation of depressive symptoms of a country in comparison with other countries. Non-pharmacological treatment of depression includes dynamic psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, self-care treatment, etc. Some kinds of Korean culture relevant psychotherapies are introduced: Tea therapy, Imago therapy, Tao psychotherapy, and combined approach. Interest in the aged people is growing recently, and the research about the factors which affect the depressive disorders in older patients and treatment strategy for them is ongoing.

Keywords

Depression;Korea;Culture;Non-pharmacological treatment.

Treatment Strategies for Psychotic Depression

Soyoung Irene Lee, MD, PhD; and Han-Yong Jung, MD, PhD

Department of Psychiatry, College of Medicine, Soonchunhyang Bucheon Hospital, Soonchunhyang University, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 234-43.

Abstract

ObjectivesSeveral factors, such as biological markers, clinical correlates, and course of the depressive disorders with psychotic symptoms differ from those without psychotic symptoms. Therefore, specification of a treatment algorithm for depressive disorder with psychotic symptoms is legitimated. This article provides a systematic review of somatic treatments for depressive disorder with psychotic symptoms.

Methods:According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, first, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders with psychotic symptoms(until July 2006). Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. 

Results:Treatment options, such as a combination of an antidepressant and an antipsychotic versus an antidepressant or an antipsychotic alone are summarized. In addition, issues regarding the electroconvulsive therapy(ECT), combination therapy, and maintenance treatment are discussed. 

Conclusion:In former times, the combination of an antidepressant and an antipsychotic or ECT were recommended as the first line treatment for depressive disorder with psychotic symptoms. Recently, however, there was a suggestion that there was no conclusive evidence that the combination of an antidepressant and an antipsychotic drug is more effective than an antidepressant alone. More evidence regarding the pharmacological treatment for depressive disorder with psychotic symptoms is needed.

Keywords

Psychotic depression;Treatment strategy.

Antidepressant and Suicide

Boung-Chul Lee, MD; and Byung-Joo Ham, MD

Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 244-51.

Abstract

Depression is a frequent cause of suicide. Although there have been reports that SSRIs might increase suicidal ideations and behaviors, most studies found antidepressants are effective treatments of suicidal ideations and behaviors. Antidepressants have also been shown to have prophylactic effects in preventing suicidal behaviors. Most double-blind studies do not suggest a causal relationship between antidepressant and the increased suicidality. Our review results suggest that the undertreatments of depression are more significant problems with the use of antidepressants in suicidal patients.

Keywords

Depression;Antidepressant;Suicide.

Antidepressant-Induced Adverse Effects and Management Strategy - Focused on Sexual Dysfunction -

Jeong-Gee Kim, MD, PhD; and Soo Jin Lee, MD

Maryknoll General Hospital, Department of Psychiatry, Busan, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 252-9.

Abstract

Sexual dysfunction is a relatively common adverse effect in the use of antidepressants. The sexual side effects may result in a lack of compliance with the prescribed antidepressants. The author reviewed the prevalence and updated treatment for the antidepressant-induced adverse effects focusing on sexual dysfunction. The incidence of sexual dysfunction is reported to exceed more than 50% especially with SSRIs. In order to obtain a quantified baseline and as an ongoing evaluation tool, clinicians may use some of the established questionnaires and validated instruments such as the Arizona Sexual Experience scale and Changes in Sexual Functioning Questionnaire. Clinicians should be aware that delayed ejaculation and orgasm, symptoms most frequently associated with antidepressants, are not usually associated with depression itself. Although many antidotes have been proposed, few have been subjected to double-blind trials. Some evidences have suggested that bupropion and buspiron may be the effective antidotes for SSRI induced sexual dysfunction. Additional trials will be requied to define what role, if any, bupropion and buspiron might have in the treatment of SSRI-induced sexual side effects. The available evidence is rather limited, with only small number of trials assessing each strategy. While further randomized data is awaited, for men with antidepressant induced erectile dysfunction, the addition of sidenafil or tadalafil may appear to be an effective strategy.

Keywords

Antidepressant;Adverse effect;Sexual dysfunction;Management.

No Associations between Schizophrenia and D22S280 Marker on Synapsin Ⅲ Gene in Korean Males

Yu-Sang Lee, MD1;Chong-Won Park, MD1;Seung-Yeoun Lee, PhD2;Suk-Jin Lee, MD1;Yong-Bum Park, MD1;Yoon-Sik Shin, MD1;Jang-Keun Yoo, MD1;Kyung Sue Hong, MD, PhD3; and Byung-Hwan Yang, MD, PhD4;

1;Yong-In Mental Hospital, Yong-In, 2;Department of Applied Mathematics, Sejong University, Seoul, 3;Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Seoul Hospital, Seoul, 4;Department of Neuropsychiatry, College of Medicine and the Mental Health Research Institute, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 260-6.

Abstract

ObjectivesSynapsin III near VCFS region on chromosome 22q affects. It could be an interesting candidate gene for schizophrenia. D22S280 is a highly polymorphic genetic marker residing in synapsin III. We examined association of D22S280 marker on synapsin III with Korean patients with schizophrenia.

Methods:The subjects were 46 male Korean patients with schizophrenia and 60 male normal controls. Using polymerase chain reaction, gel electrophoresis, ABI 310 genetic analyzer, and GeneScan Collection 3.1 software, we confirmed genotypes of D22S280 marker. We examined Hardy-Weinberg equilibrium and case-control association using SAS/Genetic 9.1.3. 

Results:Genotypes of both schizophrenia and control groups were in Hardy-Weinberg equilibrium. We could not find any significant statistical differences in allele-wise(χ2=10.4, df=6, p=0.098) and genotype-wise (χ2=22.1 df=19, p=0.258) analyses of D22S280 marker between schizophrenia and normal controls. Individual allele analyses with df=1 showed significant differences in A1(p=0.025) and A7(p=0.034) allele, which were not significant following Bonferroni corrections(A1:p=0.177, A7:p=0.235).

Conclusion:We couldn’t find any association between schizophrenia and the synapsin III gene. Given the small number of subjects studied, further investigations are needed.

Keywords

Schizophrenia;Synapsin III;D22S280;Association.

An Association Study of the Brain-Derived Neurotrophic Factor Val66Met Gene Polymorphism and Schizophrenia

Hwa-Young Lee, MD1;Dae-Jin Kim, MD, PhD2; and Yong-Ku Kim, MD, PhD1;

1;Department of Psychiatry, College of Medicine, Korea University, Ansan, 2;Department of Psychiatry, College of Medicine, The Catholic University of Korea, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 267-72.

Abstract

ObjectivesSchizophrenia is a clinically heterogenous disease with a strong genetic component. Many studies have suggested that brain-derived neurotrophic factor(BDNF) is involved in the pathophysiology of schizophrenia. This study was performed to determine whether there is an association between BDNF Val66Met polymorphism and schizophrenia.

Methods:To identify any genetic predisposition to schizophrenia, we investigated the BDNF Val66Met polymorphism in 106 patients with schizophrenia and 147 normal controls with PCR-RFLP method. Statistical analyses were used to test the association between and BDNF Val66Met genotype and Schizophrenia. 

Results:No association was found between BDNF Val66Met polymorphism and schizophrenia. No significant differences were found comparing the BDNF genotype distributions according to the age of onset, the number of admission and familial loading in schizophrenia.

Conclusion:This result indicates that BDNF Val66Met polymorphism is not associated with schizophrenia. However, further studies with a large number of subjects are needed to confirm whether the BDNF gene is related to schizophrenia.

Keywords

BDNF;Polymorphism;Schizophrenia;Association.

Comparing Biological Markers of Alcohol Dependence in the Patients of an Alcohol Counseling Center

Jung-Hyun Byun, MD1;Boung-Chul Lee, MD1;Byung-Joo Ham, MD1;Chan Seung Chung, MD1;Mina Hur, MD2;Jung-Joon Lee, MD3; and Ihn-Geun Choi, MD1;

1;Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, 2;Department of Laboratory Medicine, College of Medicine, Hallym University, Chuncheon, 3;Asan Mental Health Center, Asan, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 273-8.

Abstract

ObjectivesBiochemical markers can provide an objective evidence of heavy alcohol drinking. The purpose of this study was to compare and evaluate the usefulness of biological markers detecting alcohol dependence, such as mean corpuscular volume(MCV), gamma-glutamyl transferase(GGT), and carbohydrate-deficient transferrin(CDT) in the patients of an alcohol counseling center. 

Methods:This study was done with 64 patients with alcohol dependence and 36 healthy subjects. Relative values(%) of CDT were determined in their sera with turbidimetric immunoassay(Bio-Rad %CDT assay, Axis-Shield ASA, Oslo, Norway), and were compared with conventional markers of alcohol consumption, GGT and MCV. 

Results:Among the patients with alcohol dependence, 78.1% showed abnormal %CDT levels compared with GGT(61.9%) and MCV(20.7%). The areas under the receiver operating characteristic(ROC) curves(95% confidence interval) for %CDT, GGT, and MCV were 0.934(0.866-0.973), 0.871(0.789-0.930), and 0.575 (0.472-0.673), respectively. 

Conclusion:%CDT seems to be the most reliable biological marker for the detection and monitoring of alcohol consumption in the patients with alcohol dependence of the alcohol counseling center.

Keywords

Alcohol dependence;Biological marker;Carbohydrate-deficient transferrin;Gamma-glutamyltransferase;Mean corpuscular volume.

Relationship between SNP A and P1763 Polymorphisms on Dystrobrevin Binding Protein 1(DTNBP1) Gene and Smooth Pursuit Eye Movement(SPEM) Abnormality in Korean Schizophrenic Patients

Chang Hee Lee, MD1;Byung-Lae Park, PhD2;Lyoung Hyo Kim, PhD2;Dong Hyeon Kim, MD3;Sook Hyun Cho, MD1;Jin-Soo Park, MD4;Im-Yel Kim, MD4;In-Sang Lee, MD5;Han-Gil Seo, MD5;Ki-Ook Byun, MD6;Bong-Jo Kim, MD7;Kyu-Hee Hahn, MD7;Ki-Hoon Kim, MA8;Tae-Min Shin, PhD8;Hyung Doo Shin, PhD2; and Sung-Il Woo, MD1;

1;Department of Psychiatry, Soon Chun Hyang University Hospital, Seoul, 2;SNP Genetics, Seoul, 3;Division of Mental Health, Ministry of Health and Welfare, Gwacheon, 4;Keyo Hospital, Euiwang, 5;Jinju Mental Hospital, Jinju, 6;Hadong Wooridle Hospital, Hadong, 7;Department of Psychiatry, Gyeongsang National University Hospital, Jinju, 8;Department of Biomedical Engineering, Yonsei University, Wonju, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 279-88.

Abstract

ObjectivesWe investigated the association of SNP A and P1763 polymorphisms on dystrobrevin binding protein 1(DTNBP1) gene with smooth pursuit eye movement(SPEM) abnormality in Korean schizophrenic patients.

Methods:We measured SPEM function in 217 Korean schizophrenics(male 116, female 101) and divided them into two groups, one is a good SPEM function group and the other is a poor SPEM function group. We then analyzed SNP A polymorphism and P1763 polymorphism on DTNBP1 gene from their DNAs extracted from their blood. We compared the differences of genotype and allele distributions of the two polymorphisms on DTNBP1 gene between the two groups.

Results:The Ln S/N ratio(mean±SD) of the good SPEM function group was 4.39±0.33 and the ratio of poor SPEM function group was 3.17±0.71. There were no statistically significant differences of age and male/female ratio between the two groups. There were no significant differences of genotype or allele distributions of the SNP A polymorphism and P1763 polymorphism on DTNBP1 gene between the two schizophrenic groups divided by SPEM function.

Conclusion:The results suggest that SNP A polymorphism and P1763 polymorphism on DTNBP1 gene might not be related to SPEM function abnormality in schizophrenia.

Keywords

Schizophrenia;Dystrobrevin binding protein 1(DTNBP1);Smooth pursuit eye movement (SPEM);Genetic polymorphism.

Polymorphisms in Glutamate Receptor, Ionotropic, N-methyl-D-aspartate 2B(GRIN2B) Genes of Autism Spectrum Disorders in Korean Population:Family-based Association Study

Hee Jeong Yoo, MD, PhD1;In Hee Cho, MD, PhD2;Mira Park, PhD3;Hanik K. Yoo, MD, PhD4;Jin Hee Kim, BA5; and Soon Ae Kim, MD, PhD5;

1;Department of Psychiatry, College of Medicine Seoul National University, Bundang Hospital, Seongnam, 2;Department of Psychiatry, Gacheon Medical College, Incheon, 3;Department of Biostatistics, School of Medicine, Eulji University, Daejeon, 4;Department of Psychiatry, College of Medicine Ulsan University, Asan Medical Center, Seoul, 5;Department of Pharmacology, School of Medicine, Eulji University, Daejeon, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 289-98.

Abstract

ObjectivesAutism is a complex neurodevelopmental spectrum disorder with a strong genetic component. Previous neurochemical and genetic studies suggested the possible involvement of glutamate N-methyl-D-aspartate(NMDA) receptor in autism. The aim of study was to investigate the association between the NMDA2B receptor gene(GRIN2B) and autism spectrum disorders(ASD) in the Korean population.

Methods:The patients with ASD were diagnosed with Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule based on DSM-IV diagnostic classification. The present study was conducted with the detection of four single nucleotide polymorphisms(SNPs) in GRIK2 and family-based association analysis of the single nucleotide polymorphisms in Korean ASD trios using transmission disequilibrium test (TDT).

Results:One hundred twenty six patients with ASD and their biological parents were analyzed. 86.5% were male and 85.1% were diagnosed as autistic disorder. The mean age was 71.9±31.6 months(range:26-185 months). We found that rs1805247 showed significantly preferential transmission(TDT χ2=12.8, p<0.001) in ASD.

Conclusion:One SNP in GRIN2B gene was significantly associated with ASD in the Korean population. This result suggests the possible involvement of glutamate NMDA receptor gene in the development of ASD.

Keywords

Autism spectrum disorders;Transmission disequilibrium test(TDT);Glutamate NMDA receptor.

Association Study between Tic Disorder and Dopamine D2 Receptor Gene Polymorphism in Korean Population

Soyoung Irene Lee, MD, PhD1;In Hee Cho, MD, PhD2;Seon Mee Kim, MD, PhD3;Min-Soo Lee, MD, PhD4; and Han-Yong Jung, MD, PhD1;

1;Department of Psychiatry, College of Medicine Soonchunhyang University, Bucheon Hospital, Bucheon, 2;Department of Psychiatry, Gachon University of Medicine and Science, Incheon, 3;Department of Family Medicine, College of Medicine Korea University, Guro Hospital, Seoul, 4;Department of Psychiatry, College of Medicine Korea University, Anam Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 13, No. , pp. 299-304.

Abstract

ObjectivesThe purpose of the present study was to investigate whether the Taq I A polymorphism of dopamine receptor D2 gene(DRD2) is associated with Tourette syndrome(TS) and chronic motor tic disorder(CMT) in Korean population.

Methods:DRD2 Taq I A RFLP genotyping was carried out with DNA extracted from blood samples of 75 patients with tic disorders(47 with TS and 28 with CMT) and 90 healthy subjects. Genotype and allelic frequencies for the DRD2 gene polymorphisms of the tic disorder group as a whole were compared to those of the control group. Separating the TS group, thereafter, the frequency of genotypes and alleles were compared to those of the controls.

Results:The results demonstrated that genotype and allele distributions for the DRD2 gene polymorphism in the tic disorder as a whole, TS, and control groups were not significantly different.

Conclusion:No association was found for DRD2 gene, TS and CMT. The data suggest that DRD2 gene may not be a useful marker for the prediction of the susceptibility of tic disorder.

Keywords

Tourette syndrome;Chronic motor tic disorder;Gene polymorphism;Receptors, dopamine D2;<i>Taq</i> I RFLP.

  • Vol. 12 No.1
  • Vol. 12 No.2

Vol. 12 No.1

Biological and Genetic Prediction Factors Associated with Suicidal Behavior

Yong-Ku Kim, MD, PhD

Department of Psychiatry, College of Medicine, Korea University, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 3-12.

Abstract

Most suicides(about 90%) occur in the context of psychiatric disorders. Prediction of suicide risk in patients with mental illness is very important in preventing suicide attempts. However, current approaches to predict suicidality are based on clinical history and have low specificity and biological markers are not yet included. Many studies have explored the association between different biological parameters and suicidality. Studies of cerebro-spinal fluid(CSF) demonstrated that 5-HIAA and HVA levels were lower in patients with a history of suicide. Platelet serotonin transporter and the 5-HT2 serotonin receptor have also been studied in relation to violence and suicide. Depressive patients with greater suicidal tendency had significantly lower cholesterol concentrations but some researchers failed to find the correlation. DST non-supression is reported to predict suicidality in major depression. Several studies demonstrated a relationship between intron 7 polymorphism of tryptophan hydroxylase and suicidal behavior. Since suicide is not occurred in a single disease, the systematic and comprehensive study in large samples with various diagnoses is necessary to find the biological and genetic predictors of suicidal behavior.

Keywords

Suicide;Biological marker;Genetic marker;Prediction;Serotonin;Neurotransmitter.

Heart Rate Variability of Korean Generalized Anxiety Disorder Patients

Chung-Sook Choo, MD;Seung-Hwan Lee, MD;Hyun Kim, MD;Kang-Joon Lee, MD;Min Nam, MD; and Young-Cho Chung, MD

Department of Psychiatry, Ilsanpaik Hospital, Inje University of Korea, Goyang, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 13-9.

Abstract

ObjectiveThe purposes of this study were to investigate heart rate variability(HRV) in patients with generalized anxiety disorder(GAD) compared with major depressive disorder in Korea.

Methods:Fifty-six GAD patients(20 male and 36 female) was classified into their comorbid psychiatric illness. Among them, Twenty-five patients(10 male and 15 female) who do not have any psychiatric comorbidity were compared with 30 major depressive disorder patients(12 male and 18 female). Clinical symptoms, HRV and MMPI were analysed between two group.

Results:Comorbid psychiatric illnesses of GAD were ranked into no diagnosis(44.6%), MDD(32.1%), panic disorder(10.7%), social phobia(5.3%), PTSD(1.7%), OCD(1.7%), MDD+panic disorder(1.7%) and MDD+ specific phobia(1.7%). GAD patients showed low functioning in HRV, but degree of decreasing HRV is not so severe compared with MDD patient. Balance of sympathetic and parasympathetic nerve tone is more severely impaired in GAD patients compared with MDD patient. The score of MMPI did not reveal any differences between two groups.

Conclusions:
The result showed that HRV can differenciate GAD and MDD patients. GAD patients could show decreased HRV functioning, less than MDD patients. But autonomic imbalance could be more severe in GAD than MDD patients.

Keywords

Generalized anxiety disorder;Major depressive disorder comorbidity;Heart rate variability;MMPI.

Personality Assessment Inventory Profiles of Patients with Mild and Severe Traumatic Brain Injury

Seok-Joon Kweon, MD; and Seung-Ho Rho, MD, PhD

Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 20-31.

Abstract

ObjectivesThis study was designed to investigate the characteristics of personality changes and emotional distress using the Personality Assessment Inventory (PAI) in patients with traumatic brain injury(TBI), divided into mild (MTBI) and severe (STBI) groups according to the severity of injury.

Methods:The subjects were consisted of 25 patients with MTBI, 25 patients with STBI, and 25 normal controls. They were interviewed with the PAI. The data were analyzed by χ2 test, analysis of variance and Tukey test. 

Results:The results were the followings. First, Negative Impression in validity scales was elevated above cutoff point(T score 70) in both MTBI and STBI groups. Second, the clinical scales of which scores elevated above the cutoff point were Somatic Complaints, Anxiety, Anxiety-Related Disorders, Depression, and Schizophrenia in the MTBI, and Somatic Complaints and Depression in the STBI. Third, the clinical subscales above the cutoff point were Conversion, Somatization, Health Concerns, Affective Anxiety, Physiological Anxiety, Traumatic Stress, Cognitive Depression, Affective Depression, Physiological Depression, Thought Disorder, and Affective Instability in the MTBI, and Health Concerns, Cognitive Depression, Affective Depression, and Physiological Depression in the STBI. Fourth, Suicide Ideation in treatment scales was the only scale above the cutoff point in the MTBI and the others of the treatment and interpersonal scales in the MTBI and all of these scales of the STBI were not elevated above the cutoff point. Fifth, the scales of which scores showed significant difference between the MTBI and the STBI were Somatic Complaints, Anxiety, Depression, and Suicide Ideation, the subscales were Conversion, Somatization, Health Concerns, Affective Anxiety, Physiological Anxiety, Physiological Depression, and Psychotic Experiences. 

Conclusion:These results suggest that the patients with MTBI had more somatic and anxiety symptoms, depressed mood, and suicidal ideation than the patients with STBI. These characteristics are generally consistent with clinical observation and findings from previous studies of the patients with TBI, and the PAI seems to be a beneficial adjunctive assessment tool for the evaluation of patients with traumatic brain injury.

Keywords

Mild and severe traumatic brain injury;Personality assessment inventory.

Working Memory Deficits in Patients with Schizophrenia:fMRI Investigation

Yuh-Jin Park, MD;Tae-Suk Kim, MD;Sa-Bong Roh, MD;Chi-Un Pae, MD;Jung-Jin Kim, MD;Soo-Jung Lee, MD;Chul-Lee, MD;In-Ho Paik, MD and Chang-Uk Lee, MD

Department of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 32-41.

Abstract

ObjectiveImpaired processing of working memory is one of the cognitive deficits seen in patients with schizophrenia. This aimed at corroborating the differences in the brain activities involved in the process of working memory between patients with schizophrenia and the control subjects. 

Method:Fourteen patients with schizophrenia and 12 healthy volunteers were recruited in this study. Functional magnetic resonance imaging(fMRI) was used to assess cortical activities during the performance of a 2-back visual working memory paradigm using the Korean alphabet as mnemonic content. 

Results:Group analysis revealed that left lateral prefrontal cortex and right parietal lobule showed decreased cortical activities in the patient group. On the other hand, an increased activation in left superior and middle frontal gyrus, left middle temporal gyrus, right cuneus, both occipital lobes, right fusiform gyrus and right cingulate gyrus. The activation in left anterior lobe and both declive of cerebellum was also increased. 

Conclusions:This study showed a decreased activation in left lateral prefrontal and right parietal neural networks from the patient group and confirmed the earlier findings on the impaired working memory of patients with schizophrenia using fMRI investigation. The regions implicated in our study suggest an abnormal functioning of the fronto-parietal cortical areas that are critical to the information processing stream, which might be correspondent to common pathophysiology rather than a common etiology in schizophrenia.

Keywords

Schizophrenia;Working memory;fMRI.

Gene Expression Profiling of SH-SY5Y Human Neuroblastoma Cells Treated with Ginsenoside Rg1 and Rb1

Joon-Noh Lee, MD, PhD1;Byung-Hwan Yang, MD, PhD2;Seung-Hak Choi, MD2;Seok-Hyun Kim, MD, PhD2;Young-Gyu Chai, PhD3;Kyoung-Hwa Jung, MS3Jun-Seok Lee, MD, PhD4;Kang-Ju Choi, PhD5; and Young-Suk Kim, PhD5;

1;Seoul National Hospital, Seoul, 2;Department of Neuropsychiatry, College of Medicine & The Mental Health Research Institute, Hanyang University, Seoul, 3;Division of Molecular and Life Science, College of Science, Hanyang University, Ansan, 4;Department of Psychiatry, College of Medicine, Kwandong University, Myongji Hospital, Goyang, 5;KT & G Central Research Institute, Daejeon, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 42-61.

Abstract

ObjectivesThe ginsenoside Rg1 and Rb1, the major components of ginseng saponin, have neurotrophic and neuroprotective effects including promotion of neuronal survival and proliferation, facilitation of learning and memory, and protection from ischemic injury and apoptosis. In this study, to investigate the molecular basis of the effects of ginsenoside on neuron, we analyzed gene expression profiling of SH-SY5Y human neuroblastoma cells treated with ginsenoside Rg1 or Rb1.

Methods:SH-SY5Y cells were cultured and treated in triplicate with ginsenoside Rg1 or Rb1(80μM, 40μM, 20μM). The proliferation rates of SH-SY5Y cells were determined by MTT assay and microscopic examination. We used a high density cDNA microarray chip that contained 8K human genes to analyze the gene expression profiles in SH-SY5Y cells. We analyzed using the Significance Analysis of Microarray(SAM) method for identifying genes on a microarray with statistically significant changes in expression. 

Results:Treatment of SH-SY5Y cells with 80μM ginsenoside Rg1 or Rb1 for 36h showed maximal proliferation compared with other concentrations or control. The results of the microarray experiment yielded 96 genes were upregulated(≥3 fold) in Rg1 treated cells and 40 genes were up-regulated(≥2 fold) in Rb1 treated cells. Treatment with ginsenoside Rg1 for 36h induced the expression of some genes associated with protein biosynthesis, regulation of transcription or translation, cell proliferation and growth, neurogenesis and differentiation, regulation of cell cycle, energy transport and others. Genes associated with neurogenesis and neuronal differentiation such as SCG10 and MLP increased in ginsenoside Rg1 treated cells, but such changes did not occur in Rb1-group.

Conclusion:Our data provide novel insights into the gene mechanisms involved in possible role for ginsenoside Rg1 or Rb1 in mediating neuronal proliferation or cell viability, which can elicit distinct patterns of gene expression in neuronal cell line. Ginsenoside Rg1 have more broad and strong effects than ginsenoside Rb1 in gene expression and related cellular physiology. In addition, we suggest that SCG10 gene, which is known to be expressed in neuronal differentiation during development and neuronal regeneration during adulthood, may have a role in enhancement of activity dependent synaptic plasticity or cytoskeletal regulation following treatment of ginsenoside Rg1. Further, ginsenoside Rg1 may have a possible role in regeneration of injured neuron, promotion of memory, and prevention from aging or neuronal degeneration.

Keywords

Ginsenoside Rg1;Ginsenoside Rb1;Microarray;Gene expression;SCG10.

The CDH2 Gene Polymorphism in Schizophrenia

Won Seok Lee, MD1;Mi Kyung Kim, MD, PhD1;Han Yong Jung, MD, PhD2;Sung Il Woo, MD, PhD2;Young Joon Kwon, MD, PhD2;Jong Woo Kim, MD, PhD3; and Hee Je Lee, PhD4;

1;Seoul National Mental Hospital, Seoul, 2;Department of Psychiatry, College of Medicine, Soonchunhyang University Hospital, Buchoen, 3;Department of Neuropsychiatry, College of Medicine, Kyunghee University Hospital, Seoul, 4;Department of Pharmacology, College of Medicine, Kangwon University Hospital, Chuncheon, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 62-7.

Abstract

ObjectiveThere has been increasing evidence that neurodevelopmental dysfunction is involved in the pathophysiology of schizophrenia. Cadherin is known to be one of the important molecules in neurodevelopment. This study was performed to examine the relationship between T816C polymorphism of CDH2 gene and schizophrenia.

Methods:Genoytypes of T816C polymorphism of CDH2 gene were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 156 Korea patents with schizophrenia and 170 controls.

Results:No difference was found between the patients with schizophrenia and the controls in genotype and allele frequencies of T816C polymorphism of CDH2 gene.

Conclusion:The results of this study do not support an association between T816C polymorphism of CDH2 gene and schizophrenia. However, it is necessary to investigate other polymorphic regions of CDH2 in schizophrenia.

Keywords

CDH2;Polymorphism;Schizophrenia.

fMRI Investigation on Cue-induced Smoking Craving:A Case Report

Hyun-Kook Lim, MD1;Chi-Un Pae, MD2; and Chang-Uk Lee, MD2;

1;Department of Psychiatry, Chuncheon National Hospital, Chuncheon, 2;Department of Psychiatry, Kangnam St. Marys Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 68-72.

Abstract

ObjectNicotine dependence is the most common substance abuse disorder. One of the characteristics of nicotine dependence is craving. Regional activation of the brain induced by craving for nicotine was evaluated by using functional magnetic resonance imaging to investigate neuroanatomical site of smoking craving. 

Method:A smoker who satisfied DSM-IV criteria for nicotine dependence and a non smoker was studied. MRI data were acquired on a 1.5T Magnetom Vision Plus with a head volume coil. Two sets of visual stimuli were presented to subjects in a random manner. One was the film scenes of inducing smoking craving and the other was neutral stimuli not related to smoking. There were two fMRI sessions before and after smoking or sham smoking. Data were analyzed using SPM99. 

Results:fMRI showed significant activated area in anterior cingulate and medial frontal lobes in the smoker during smoking craving. Right dorsolateral prefrontal cortex and parietal lobes were activated in the control during visual stimulation before smoking. After smoking, there was no brain activation during visual stimulation in both of smoker and non smoker.

Conclusion:Metabolic activity of the anterior cingulate and medial frontal lobes increased during craving for smoking. This result suggests that fMRI may be a valuable tool in the identification of neurobiological process of craving.

Keywords

Smoking;Craving;fMRI.

Vol. 12 No.2

Diagnosis and Treatment of Poststroke Depression

Jae-Min Kim, MD, PhD1; and Hee-Yung Shin, MD, PhD2;

1;Department of Psychiatry, Chonnam National University Medical School and Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, 2;Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 89-97.

Abstract

Depression is a frequently developed psychiatric symptom after stroke. Poststroke depression(PSD) causes not only psychological distress related to depression but also other disturbances in many areas such as cognitive function, activities of daily living and quality of life. Therefore, a comprehensive understanding of accurate detection and appropriate treatment of depression is mandatory in patients with stroke. This review focused on the current knowledge of PSD.

Keywords

Poststroke depression;Diagnosis;Treatment.

The Change of K-MMSE Following Donepezil Medication in Patients with Alzheimer's Disease and Small Vessel Dementia, and the Characteristics of Alzheimer's Disease with Meaningful K-MMSE Change

Yong Tae Kwak, MD1;Il-Woo Han, MD2;June Kim, MD3; and Yu-Sang Lee, MD3;

1;Department of Neurology, 2;Psychiatry, Hyoja Geriatric Hospita, Yongin, 3;Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 98-106.

Abstract

ObjectivesDonepezil is a widely used drug for the treatment of patients with Alzheimer's disease(AD). The aim of the present study was to clarify the efficacy and the characteristics of responders to donepezil. 

Methods
Patients with probable AD(n=80;75.7 years) and small vessel dementia(SVD)(n=18;77.8 years) who received donepezil were retrospectively analyzed using Alzheimer's registry, and three questions were asked:1) Does donepezil therapy improves cognitive symptoms in patients with dementia? 2) If donepezil improves cognitive symptoms, which items of the K-MMSE are improved? 3) What are the characteristics of responder to donepezil medication? 

Results
1) After donepezil medication, cognitive function measured by the K-MMSE was significantly improved in both types of dementia(AD and SVD), However, statistical differences were not found between these groups. 2) In a clinical trial of donepezil, the patients performed better than before mediation on K-MMSE items assessing orientation, recall, construction, concentration, calculation. 3) In AD, the K-MMSE score before medication was closely related with response of donepezil. 

Conclusion
This study suggests that donepezil improves various cognitive functions in both types of dementia, and the responsive group had significantly lower K-MMSE scores than the non-responsive group before medication.

Keywords

Donepezil;Alzheimer's disease;Small vessel dementia;K-MMSE;Responsive group.

The Relationship between Taq A Dopamine D2 Receptor Polymorphism and Therapeutic Response to Antipsychotics in Schizophrenic Patients

Cheol Joong Kang, MD, PhD

Department of Psychiatry, School of Medicine, Pusan National University, Busan, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 107-13.

Abstract

PurposeIn an attempt to predict the interpersonal differences of therapeutic response to antipsychotic drugs on pharmaco-genetic bases, this study was designed to investigate the relationship between the therapeutic response to antipsychotic drugs and Taq I A dopamine D2 receptor polymorphism in schizophrenic patients. 

Methods
The subjects were 158 patients diagnosed with schizophrenia(DSM-IV). The therapeutic response to antipsychotic drugs was evaluated using the Treatment Response Scale(TRS) retrospectively. Patients were divided into two groups, dopamine receptor antagonist responders, and serotonin-dopamine antagonist responders. The patients' Taq I A dopamine D2 receptor polymorphism was determined by polymerase chain reaction(PCR) and restriction fragment length polymorphism(RFLP). 

Results
The dopamine receptor antagonist responders had the A1 allele in significantly higher incidences (χ2(1)=4.875, p=0.027, two-tailed). No significant difference was found among the serotonin-dopamine antagonist responders between those with or without the A1 allele.

Conclusions
The patients with the A1 allele responded better to dopamine receptor antagonists than those with no A1 allele. Based on these results, it is suggested that the pharmacological effect of dopamine receptor antagonists can be predicted depending on the presence of the A1 allele in schizophrenic patients.

Keywords

Schizophrenia;Dopamine D<sub>2</sub> receptor polymorphism;<i>Taq</i> I A1 allele.

Serum Homocysteine Level and MTHFR C677T, A1298C Gene Polymorphism in Korean Schizophrenics

Young Sik Lee, MD, PhD1;Chang Moo Jeon, MD, PhD1;Chul Na, MD, PhD1; and Seok Lae Chae, MD, PhD2;

1;Department of Psychiatry, 2;Department of Labaratory Medicine, Chung-Ang University, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 114-22.

Abstract

ObjectivesRecently in schizophrenia high incidence of MTHFR(methylenetetrahydrofolate reductase), which is a main relating enzyme that reduce homocysteine level, genetic variations were reported. So we examined serum homocysteine level and MTHFR gene polymorphism in Korean schizophrenics.

Method
We compared serum homocysteine level and MTHFR polymorphism between 235 schizophrenics (100male, 135female) and 235 normal controls(100male, 135female). C677T and A1298C polymorphism of MTHFR gene were analyzed. 

Results
1) C677T genetic mutation(CT and TT) were more frequent in schizophrenia group than normal control group(p<0.01). But the difference of A1298C mutation frequency was not found between two groups. 2) In schizophrenia patients, TT genotype of C677T mutation showed significantly higher homocysteine level (29.99uM/L) than other group(CT:13.34uM/L, CC:9.34uM/L p<0.01). 3) MTHFR 677 TT homogeneous mutation genotype showed two times more risk(odds ratio=2.15) than 677CC normal genotype in schizophrenia.

Conclusion
Some schizophrenia patients with high homocysteine serum level may have C677T TT genotype. In that case, folate ingestion could be a good management for clinical improvement.

Keywords

Schizophrenia;Homocysteine;MTHFR;Polymorphism.

The Differences of EEG Coherence between Schizophrenia and Bipolar Disorder

Yong-Kyu Kim, MD1;Jae-Kong Shin, MD2;Chong-Won Park, MD1;Kyung Sue Hong, MD, PhD3;Seung-Yeoun Lee, PhD4;Hong-Seok Oh, MD1;Yong-Suk Lee, MD1;Yong-Tae Kwak, MD, PhD5;Jae Seung Chang, MD6; and Yu-Sang Lee, MD1;

1;Yong-In Mental Hospital, Yongin, 2;Kyunggi Provincial Hospital For The Elderly, Yongin, 3;Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Seoul Hospital, Seoul, 4;Department of Applied Mathematics, Sejong University, Seoul, 5;Hyoja Geriatric Hospital, Yongin, 6;Department of Neuropsychiatry and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 123-35.

Abstract

ObjectivesEEG coherence could imply the connectivity between two different areas of the brain, which is known to be important in the pathophysiology of bipolar I disorder(BPD I) and schizophrenia. The authors investigated EEG coherence in patients with BPD I and schizophrenia to examine the connectivity of the neural circuit.

Methods
EEGs were recorded in 15 schizophrenia and 14 bipolar disorder patients, and 14 age-matched normal control subjects from 16 electrodes with linked-ear reference. Spectral parameters and coherence were calculated for the alpha bandwidth(8-13Hz) by a multi-channel autoregressive model using 20 artifact-free 2-seconds epochs and the differences were compared among three groups by two different statistical methods;F-test and Kruskal-Wallis test. Furthermore, when there were significant differences among three groups, Scheffe's multiple comparison tests were provided and Jonckheere-Terpstra tests for the ordered alternative were given.

Results
In the intra-hemispheric comparison, left frontal coherence was increased in order of control, BPD I and schizophrenia. In the inter-hemispheric comparison, 1) inter-prefrontal coherence in BPD I was significantly higher than in normal controls, and 2) inter-prefrontal coherence in schizophrenia was significantly lower than in controls.

Conclusion
These results suggest that 1) both schizophrenia and BPD I are diseases having the abnormality of neural circuit connectivity in both frontal and prefrontal lobes, and 2) the abnormality is more severe in schizophrenia than in BPD I. Furthermore, the data support that a common pathogenetic process may reside in both schizophrenia and BPD I.

Keywords

EEG;Coherence;Schizophrenia;Bipolar disorder.

Effects of Venlafaxine and Dexamethasone Treatment on HSP70 Expression in Rat C6 Glioma Cells

Jae-Hak Yu, MD, PhD1;Jun-Seok Lee, MD, PhD2;Byung-Hwan Yang, MD, PhD3;Mi-Ran Choi, PhD3;Young-Gyu Chai, PhD4;Seok-Hyeon Kim, MD, PhD3;Sung-Won Roh, MD, PhD3;Dong-Yul Oh, MD, PhD2; and Ihn-Geun Choi, MD, PhD5;

1;Department of Neuropsychiatry, School of Medicine Konkuk University Hospital, Seoul, 2;Department of Psychiatry, College of Medicine Kwandong University, Myongji Hospital, Goyang, 3;Department of Neuropsychiatry & The Mental Health Research Institute, Hanyang University, Seoul, 4;Department of Biochemistry & Molecular Biology, Hanyang University, Ansan, 5;Department of Neuropsychiatry, Hyllym University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 136-42.

Abstract

ObjectThe intracellular action of the antidepressant, venlafaxine, was studied in C6-gliomas using heat shock protein 70(HSP70) immunocytochemistry and HSP70 Western blots because HSP70 is associated with stress and depression.

Methods
To examine how the glucocorticoid affects the expression of HSP70 in nerve cells, the rat C6 glioma cell was treated with dexamethasone for 6 hours. In addition, venlafaxine was administered to the experimental groups of C6 glioma cells for 1, 6, 24, and 72 hours each, after which the expression of HSP70 was investigated. Finally, venlafaxine and dexamethasone were simultaneously administered to the experimental groups for 1, 6, 24, and 72 hours, followed by an investigation of the expression of HSP70. 

Results
The short term(1 hour) venlafaxine treatment significantly increased the level of HSP70 expression. The short term treatment of venlafaxine with dexamethasone also increased the level of HSP70 expression but this reduction was not statistically significant. The long term(72 hours) venlafaxine with dexamethasone treatment significantly reduced the level of HSP70 expression. The long term treatment of venlafaxine also reduced the level of HSP70 expression but this reduction was not statistically significant. Dexamethasone(10uM, 6hours) did not affect the level of HSP70 expression compared with controls. 

Conclusion
Venlafaxine increases the expression of HSP70 at short term treatment, but prolonged treatment with dexamethasone suppresses the expression of HSP70.

Keywords

Venlafaxine;Dexamethasone;Heat shock protein 70(HSP70).

Changes of Interleukin-12 and Transforming Growth Factor Beta 1 before and after Antipsychotic Treatments in Schizophrenic Patients

Sung-Jae Kim, MD;Bun-Hee Lee, MD; and Yong-Ku Kim, MD

Department of Psychiatry, College of Medicine, Korea University, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 143-50.

Abstract

BackgroundSeveral reports have suggested that cytokine alterations could be related to the pathophy-siology of schizophrenia. In this study, we measured plasma level of interleukin-12(IL-12), a pro-inflammatory T helper 1(Th1) cytokine and transforming growth factor-β1(TGF-β1), an anti-inflammatory Th3 cytokine before and after antipsychotic treatment in schizophrenic patients.

Methods
The plasma concentrations of IL-12 and TGF-β1 were measured by using quantitative ELISA in 23 schizophrenic patients and 31 normal controls at admission and 8 weeks later. The psychopathology was measured by Brief Psychiatric Rating Scale(BPRS). 

Results
IL-12 and TGF-β1 levels were significantly higher in schizophrenic patients than in controls before treatment. At the 8 week of treatment, the TGF-β1 levels returned to control values, while IL-12 levels were not significantly changed. There were no significant correlations between the changes of BPRS scores and the changes of IL-12 or TGF-β1 levels in schizophrenic patients.

Conclusion
Cytokine abnormalities in schizophrenia might be involved in the pathophysiology of the illness. It is possible that TGF-β1 plays an important role in the schizophrenia.

Keywords

Cytokine;Interleukin;TGF;Schizophrenia.

Treatment of Clozapine-induced Obsessive-compulsive Symptoms in Schizophrenia

Yun-Jung Kim, MD, PhM1;Young-Joon Kwon, MD, PhD1;Hee-Yeun Jung, MD, PhD1;Sae-Hoon Shim, MD, PhM1;Han-Yong Jung, MD, PhD2; and Sang-Woo Han, MD, PhD3;

1;Department of Psychiatry, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, 2;Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, 3;Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 151-8.

Abstract

BackgroundClozapine is a unique atypical antipsychotic medication. It is considered to be superior, even amongst the newer agents, in treatment-resistant schizophrenia. However, de novo emergence or exacerbation of obsessive-compulsive(OC) symptoms during treatment with clozapine has been reported. We prospectively evaluated 19 cases which newly developed OC symptoms during clozapine treatment and discussed the treatment of OC symptoms induced by it.

Methods
We recruited 19 patients(8 males, 11 females) with a DSM-IV diagnosis of schizophrenia and schizoaffective disorder who had developed OC symptoms during clozapine treatment. OC symptoms were assessed using the Padua-ICMA and YBOCS on a monthly basis over three months.

Results
Eleven female and eight male patients were enrolled and the average age of patients was 32.8 years. At baseline, no patients showed OC symptoms. Moderate to severe OC symptoms appeared with mean daily dose of 298.68 mg of clozapine. There were no significant differences in improving OC symptoms between the clozapine dose reduction group and the OC treatment group.

Conclusion
We noticed the possibility that the appearance of OC symptoms is connected with the effect of clozapine. The clozapine-induced OC symptoms were improved both by reducing clozapine daily doses, and by adding OC treatment drugs. With other atypical antipsychotics now available, to know and treat the side effects of clozapine would be of considerable value, offering clinical guidance in making a decision on treatment-resistant schizophrenia.

Keywords

Schizophrenia;Clozapine;Obsessive-compulsive symptoms.

Temperament and Charcater Dimensions of Posttraumatic Stress Disorder in Burn Patients

Suk-Chan Yoon, MD1;Byung-Joo Ham, MD1;Jeong-Hyun Byun, MD1;Heon-Jeong Eun, MD2;Hyeon-Gyun Son, MD1;Kuk-Hee Suh, MD1; and Ihn-Geun Choi, MD1;

1;Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, 2;Department of Psychiatry, Presbyterian Medical Center, Jeonju, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 159-64.

Abstract

ObjectiveThe aim of this study was to evaluate the temperament and character profiles of the patients with posttraumatic stress disorder(PTSD) after burn injury.

Methods
The study subjects consisted of 23 PTSD patients after burn injury, 24 patients not being diagnosed as PTSD after burn injury(non-PTSD) and 53 healthy controls. The assessment of PTSD was performed using clinician administered PTSD scale. All participants were instructed to complete the Temperament and Character Inventory(TCI), the Beck Depression Inventory and the State and Trait Anxiety Inventory of Spielberger. 

Results
The PTSD group after burn injury, compared with the non-PTSD group and the normal controls, had the higher novelty seeking and harm avoidance scores. But there were no differences in other dimensions in the TCI among the three groups.

Conclusion
The results of this study suggest that the PTSD group after burn injury showed the specific properties of temperament and character compared with the non-PTSD group and the normal group.

Keywords

Posttraumatic stress disorder;Temperament and character inventory;Burn.

Comparison between Logistic Regression and Artificial Neural Networks as MMPI Discriminator

Jaewon Lee, MD1;Bum Seok Jeong, MD, PhD3;Mi Sug Kim,2;Jee Wook Choi, MD4; and Byung Un Ahn, MD2;

1;Department of Biosystems, Korea Advanced Institute of Science & Technology(KAIST), Daejeon, 2;Department of Psychiatry, Gongju National Hospital, Gongju, 3;Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, 4;Department of Psychiatry, School of Medicine, Catholic University, Daejeon Sungmo Hospital, Daejeon, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 165-72.

Abstract

ObjectivesThe purpose of this study is to 1) conduct a discrimination analysis of schizophrenia and bipolar affective disorder using MMPI profile through artificial neural network analysis and logistic regression analysis, 2) to make a comparison between advantages and disadvantages of the two methods, and 3) to demonstrate the usefulness of artificial neural network analysis of psychiatric data.

Procedure
The MMPI profiles for 181 schizophrenia and bipolar affective disorder patients were selected. Of these profiles, 50 were randomly placed in the learning group and the remaining 131 were placed in the validation group. The artificial neural network was trained using the profiles of the learning group and the 131 profiles of the validation group were analyzed. A logistic regression analysis was then conducted in a similar manner. The results of the two analyses were compared and contrasted using sensitivity, specificity, ROC curves, and kappa index.

Results
Logistic regression analysis and artificial neural network analysis both exhibited satisfactory discriminating ability at Kappa index of greater than 0.4. The comparison of the two methods revealed artificial neural network analysis is superior to logistic regression analysis in its discriminating capacity, displaying higher values of Kappa index, specificity, and AUC(Area Under the Curve) of ROC curve than those of logistic regression analysis.

Conclusion
Artificial neural network analysis is a new tool whose frequency of use has been increasing for its superiority in nonlinear applications. However, it does possess insufficiencies such as difficulties in understanding the relationship between dependent and independent variables. Nevertheless, when used in conjunction with other analysis tools which supplement it, such as the logistic regression analysis, it may serve as a powerful tool for psychiatric data analysis.

Keywords

Neural network;Logistic regression;MMPI(Minnesota Multiphasic Personality Inventory).

The Effect of Hormone Replacement Therapy for Cognitive Function of Postmenopausal Depression

Sang Hoon Lee, MD;Young-Hoon Ko, MD;Sook-Haeng Joe, MD;In-Kwa Jung, MD;Seung-Hyun Kim, MD; and Moon-Soo Lee, MD

Department of Psychiatry, Korea University, Guro Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 173-80.

Abstract

PurposeWe investigated the effect of menopausal duration on cognitive function using adjunctive hormone replacement therapy(HRT) in postmenopausal women with depression.

Method
Twelve postmenopausal women with depressive disorder were enrolled. Six patients having menopausal duration of less than 3 years was assigned to the short duration group and six patients of more than 3 years to the long duration group. Each patient was treated with conjugated equine estrogen(1.25mg) plus medroxyprogesterone(5mg) for 8 weeks. Cognitive performance was measured by the Verbal Memory Test, Visual Memory Test, Trail Making Test, Digit Symbol Test, and Attention Shift Test. The Beck Depression Inventory was used for evaluation of depressed mood. The reproductive hormone levels were also measured.

Results
The long duration group showed the lower performance only in Trail Making Test B compared with the short duration group at baseline. After 8 weeks, the long duration group performed significantly better in the Trail Making Test B compared with the short duration group. The differences in change of depressive mood and gonadal hormone level between two groups were not significant.

Conclusion
Menopausal duration before HRT may influence the effect of estrogen on cognition in some cognitive domains. This might be related with estrogen receptor hypersensitivity which induced by the longer estrogen deficiency.

Keywords

Menopausal;Depression;Cognitive function;Hormone replacement therapy.

Neurocognitive Function in Patients with Hwa-byung and with Major Depressive Disorder

Young Hwan Yun, MD;So Hee Lee, MD; and Jong Hyuck Choi, MD

Department of Psychiatry, National Medical Center, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 181-8.

Abstract

ObjectivesHwa-byung has been studied clinically for several years and introduced as Korean Culture-Bound Syndrome. However, the definition and the diagnostic method are not yet clarified, and there has not been any sufficient comparative study on this disease entity. This study was conducted to determine the clinical symptoms and the profile of the neurocognitive functions in Hwa-byung(HB) and Major Depressive Disorder(MDD), and We wish to identify any critical factors that differentiate the disorders.

Methods
A total of 102 participants were examined, including 34 participants with MDD, 34 with HB, and 34 healthy controls. The MDD and HB patients were recruited from among inpatients and outpatients at the National Medical Center for the period from May to December of 2004. As a major diagnostic tool of MDD, diagnostic reference of DSM-IV-TR was used and as HB's diagnostic tool, We used computerized neurocognitive function test. Psychiatric symptomatology was evaluated by the Beck Depression Inventory(BDI), and Symptom Checkist-90-Revision(SCL-90-R). Oneway ANOVA, Scheffe post-hoc test and Chi-Squre Tests were used for statistical analysis.

Results
The participants in three groups did not differ in terms of age, sex, and education. Assessment of BDI indicated that the MDD group had significantly higher total score than the HB group. MDD and HB groups showed significantly higher total scores on the SCL-90-R in comparison to the controls. The MDD group was found to have significantly more symptoms of depression than the HB group, based on the depression subscale of the SCL-90-R. The computerized neurocognitive function test suggest several results 1) Within the memory domain, it was found that one of the two memory tests in MDD and HB groups were significantly impaired in comparison to the control group. 2) Within the attention domain, it was found that only the MDD group was significantly impaired in comparison to the control group. 3) Within the higher cortical function domain, it was found that significant impairment exist in MDD group and HB group compared to the control group; the severity of impairment was found to be more profound in the MDD group than in the HB group.

Conclusion
These results suggest that both HB group and MDD group have significantly decreased neurocognitive function than the control group, and neurocognitive function of the HB group is better than that of the MDD group.

Keywords

Hwa-byung;Major depressive disorder;Neurocognitive function.

Decreased Concentration of Plasma Brain-Derived Neurotrophic Factor in Suicide Attempters

Seong-Doo Won, MA1;Se-Hoon Shim, MD2;Jong-Chul Yang, MD3;Heon-Jeong Lee, MD1;Bun-Hee Lee, MD1;Chang-Su Han, MD1;Kye-Hyun Kim, MD4; and Yong-Ku Kim, MD1;

1;Department of Psychiatry, College of Medicine, Korea University, Seoul, 2;Department of Psychiatry, Soonchunhyang University CheonAn Hospital, Cheonan, 3;Department of Psychiatry, Chonnam University Hospital, Gwangju, 4;Department of Obstetrics and Gynecology, KangBuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 189-95.

Abstract

ObjectsSome studies have suggested that brain-derived neurotrophic factor(BDNF), one of the most important neurotrophins, is involved in pathophysiology of depression and suicide. This study was performed to determine whether there is an abnormality in plasma BDNF concentration in suicidal attempters.

Methods
The subjects were 71 suicidal attempters who visited emergency rooms in multi-medical centers. All subjects had been interviewed by using Structured Clinical Interview for DSM-IV(SCID), Hamilton Depression Rating Scale(HDRS), Young Mania Rating Scale(YMRS), and Positive And Negative Syndrome Scale(PANSS). The severity of the suicidal behavior was measured by Lethality of Suicide Attempt Rating Scale(LSARS) and Risk-Rescue Rating(RRR) system. Seventy-one age, sex, and diagnosis matched non-suicidal psychiatric patients who were consecutively admitted to a psychiatric ward during the same period recruited as psychiatric controls. They were drug-naive or drug-free at least more than 2 months. In addition, 80 healthy controls were randomly selected as normal controls. Plasma BDNF level was measured by the enzyme linked immunosorbent assay(ELISA) methods.

Results
In overall F-test, differences of the plasma BDNF levels among the groups were statistically significant(F=20.226, p<0.001). In the multiple comparisons(Scheffe), while mean levels of plasma BDNF between normal controls and non-suicidal psychiatric patients were similar(p=0.984), the BDNF levels of suicidal attempters were lower than those of other two groups(p<0.001). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal attempters.

Conclusion
These results suggest that reduction of plasma BDNF level is related to suicidal behavior and BDNF level may be a biological marker of suicidal behavior.

Keywords

Suicide;Neurotrophin;BDNF;Lethality of suicide attempt rating scale;Risk-rescue rating.

Acute Alcohol Responses and Personality Traits by Aldehyde Dehydrogenase 2 Genotype Variances in Patients with Alcohol Dependence

Jong-Il Lee, MD, PhD1;Jung-Sik Lee, MD, PhD2;Sung Nam Cho, MD3;Young-Gyu Chai, PhD4;Jung Hyun Nam, MD, PhD5;Byung Hwan Yang, MD, PhD5;Ihn-Geun Choi, MD, PhD6;Seok Hyeon Kim, MD, PhD5; and Sungwon Roh, MD, PhD5;

1;Seoul National Hospital, Seoul, 2;Yongin Mental Hospital, Yongin, 3;Bugok National Hospital, Changnyung, 4;Division of Molecular & Life Science, College of Science and Technology, Hanyang University, Ansan, 5;Department of Neuropsychiatry, College of Medicine, Hanyang University, Seoul, 6;Department of Neuropsychiatry, College of Medicine, Hallym University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 196-206.

Abstract

ObjectivesThe purpose of this study is to evaluate the pathophysiology of alcoholics by investigating the differences in frequency of Aldehyde Dehydrogenase 2(ALDH2) genotypes and ALDH2 alleles between patients with alcohol dependence and controls, and the differences of drinking and personality traits in Korean male alcoholics with ALDH2 genotype variances.

Methods
The authors selected 98 patients with alcohol dependence and 53 controls. Self-report questionnaires for acute reponses after alcohol ingestion, the AUI(Alcohol Use Inventory), and the NEO-PI-R(NEO Personality Inventory Revised) were given to all patients with alcohol dependence. ALDH2 genotypes were typed with MboⅡ RFLP(Restriction Fragment Length Polymorphism) method in 53 controls and 98 patients with alcohol dependence. The authors divided alcoholic patients into two groups according to the presence of variant ALDH22 allele;normal ALDH2 alcoholics(N=87) and variant ALDH2 alcoholics(N=11).

Results
1) The genotypic frequencies of subjects with ALDH21/1 were higher and those with ALDH21/2 and ALDH22/2 were lower in patients than in controls. 2) Alcohol dependence could be found in ALDH22/2 homozygote individuals. 3) Variant ALDH2 alcoholics had more family problems in the AUI than normal ALDH2 alcoholics. 4) Variant ALDH2 alcoholics experienced more flushing and cardiovascular responses after alcohol ingestion than normal ALDH2 alcoholics. 5) Variant ALDH2 alcoholics had less altruistic personality traits in the NEO-PI-R than normal ALDH2 alcoholics. 6) Variant ALDH2 alcoholics tended to have more tolerance to alcohol than normal ALDH2 alcoholics.

Conclusion
Variant ALDH22 allele might play a protective role in the pathogenesis of alcohol dependence and there were several significant differences of drinking and personality traits in Korean male alcoholics with ALDH2 genotype variances.

Keywords

Alcohol dependence;ALDH2 genotype;Drinking pattern;Personality.

Verbal Memory Function and Characteristics of Memory Process in Schizophrenia and Affective Disorder

So-Youn Lee, MA1;Bun-Hee Lee, MD1;Jung-Ae Lee, MD1;Kye-Hyun Kim, MD2;Yong-Ku Kim, MD1; and Sun-Wha Park, MD3;

1;Department of Psychiatry, College of Medicine, Korea University, Ansan, 2;Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 3;Department of Anatomy, College of Medicine, Brain Korea 21, Korea University, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 207-15.

Abstract

ObjectivesThis study was to compare verbal memory ability among patients with schizophrenia, bipolar manic patients and unipolar depressive patients, and to understand their charicteristics of memory process.

Methods
All subjects were hospitalized patients and had been interviewed by using the Structured Clinical Interview for DSM-IV(SCID). Schizophrenic patients(N=40), bipolar manic patients(N=17), and unipolar depressive patients(N=20) were assessed with K-AVLT for verbal memory and with K-WAIS for verbal IQ. Three groups were compared regarding total immediate recall, delayed recall, delayed recognition, learning curve, memory retention, and retrieval efficiency under controlled verbal IQ. Multiple regression analysis was performed to find which clinical factors have an influence on verbal memory ability.

Results
In MANCOVA, differences of verbal memory test scores among the groups were statistically significant(F=1.800, p<.05). In post hoc analysis, Patients with schizophrenia and bipolar mania showed poorer performance in immediate recall, delayed recall, delayed recognition, retrieval efficiency than unipolar depres-sive patients. And schizophrenics performed poorly in delayed recall, delayed recognition, retrieval efficiency than nonpsychotic affective disorder group, but no difference in total immediate recall, delayed recall, delayed recognition, retrieval efficiency between the schizophrenic group and the psychotic affective group. 

Conclusions
These results partially confirm previous reports of verbal memory ability among major psychiatric disorders. Our results showed that psychotic symptoms were related with verbal memory, and longer duration of illness was related with poorer performance in schizophrenia and unipolar depression.

Keywords

Verbal Memory Ability;Memory Process;K-AVLT;SPR;Mania;Depression.

An Association Study of the Brain-Derived Neurotrophic Factor Genes Polymorphisms and Personality Traits

Byung-Joo Ham, MD1;Hwei-Beom An, MD1;Su-Min Cho, MD1;Sung-Gon Ryu, MD1;Myoung-Jin Choi, MD2;Min-Soo Lee, MD2; and Ihn-Geun Choi, MD1;

1;Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, 2;Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 216-20.

Abstract

BackgroundBrain-derived neurotrophic factor(BDNF) genes are thought to be important factors in some personality traits. The goal of this study was to determine the role of these genes in personality traits.

Method
The participants included 170 healthy adults with no history of psychiatric disorders and other physical illnesses for the last 6 months. All participants were tested by the Temperament and Character Inventory (TCI). BDNF Val64Met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with ANOVA. 

Result
There was a significant correlation between BDNF Val64Met and Persistence(PS)(p=0.036) in female subjects, but none with the other TCI dimensions. A post-hoc comparison revealed significant a difference between Val/Val and Met/Met (p=0.031). 

Conclusion
Our study suggests that the BDNF Val64Met gene polymorphism is associated with persistence in Korean female subjects, but the small number of subjects limits generalization of our results. Further studies with a larger number of homogenous subjects are needed to confirm whether the BDNF gene is related to personality traits.

Keywords

Temperament and character inventory;Brain-derived neurotrophic factor;Personality traits;Genetic polymorphism.

OROS Methylphenidate Treatment of Secondary Adult ADHD after Traumatic Brain Injury

Myung Ho Lim, MD; and Woo Chul Lee, MD

Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Korea

Korean Journal of Biological Psychiatry, Vol. 12, No. , pp. 221-6.

Abstract

The incidence of the Attention Deficit Hyperactivity Disorder secondary to the traumatic brain injury, such as traffic accidents, is increasing;the variety of the treatment modality is also increasing. This case was studied to see if OROS Methylphenidate(Concerta), which is one of the most commonly used medication in Attention Deficit Hyperactivity Disorder patients, not only improves the patient's attention, but also their impulsivity, hyperactivity and aggression. According to the case result, the medication showed an improvement of the impulsivity, aggression, and attention in the secondary Attention Deficit Hyperactivity Disorder patients after the traumatic brain injury.

Keywords

OROS methylphenidate(Concerta);Traumatic brain injury(TBI);Adult attention deficity hyperactive disorder(ADHD).

  • Vol. 11 No.1
  • Vol. 11 No.2

Vol. 11 No.1

Functional Magnetic Resonance Imaging and Schizophrenia

Kyoo-In Chung, MD, PhD; and Chang-Uk Lee, MD, PhD

Department of Psychiatry, College of Medicine The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 3-13.

Abstract

ObjectivesFunctional magnetic resonance imaging(fMRI) is one of the most useful techniques for assessing localized changes in cerebral blood flow and oxygenation using diverse challenge paradigms. This review presents the results of fMRI studies relating to schizophrenia.

Methods:Several fMRI articles on this subject in psychiatric journals were surveyed.

Results:Even with some methodological limitations, most studies showed activity differences between schizophrenics and control subjects.

Conclusion:fMRI extends our understanding of the pathophysiological basis of schizophrenia and offer an opportunity for the assessment and management of its pathology.

Keywords

fMRI;Schizophrenia.

Recent Development on Future Antidepressants

Yong-Ku Kim, MD, PhD

Department of Psychiatry, Korea University College off Medicine Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 14-25.

Abstract

The current understanding of the mechanisms of pharmacotherapy for depression is characterized by an emphasis on increasing synaptic availability of serotonin, noradrenaline, and possibly dopamine, while minimizing side effects. The acute effects of current available effective antidepressants include blocking selective serotonin or noradrenaline reuptake, alpha2 autoreceptors or monoamine oxidase. Although efficacious, current treatments often produce partial or limited symptomatic improvement rather than remission. While current pharmacotherapies target monoaminergic systems, distinct neurobiological underpinnings and other systems are likely involved in the pathogenesis of depression. Recently, several promising hypotheses of depression and antidepressant action have been formulated. These hypotheses are largely based on dsyregulation of neural plasticity, CREB, BDNF, corticotropin-releasing factor, glucocorticoid, hypothalamic-pituitary adrenal axis and cytokines. Based on these new theories and hypotheses of depression, a number of new and novel agents, including corticotropin-releasing factor antagonists, antiglucocorticoids, and substance P antagonists show a considerable promise for refining treatment options for depression. In this article, the current available pharmacotherapies, current understanding of neurobiology and pathogenesis of depression and new and promising directions in pharmacological research on depression will be discussed. 

Keywords

Antidepressant;Neurobiology;Monoamine;Cytokine;Neuropeptide;Depression.

Association between D2 Dopamine Receptor Gene Polymorphisms and Reward Dependence Personality Traits

Rhee-Hun Kang, MD1;Heon-Jeong Lee, MD1;Kang-Ho Kwak, MD2;Leen Kim, MD1;Min-Soo Lee, MD1; and Kwang-Yoon Suh, MD1;

1;Department of Psychiatry, College of Medicine, Korea University, Seoul, 2;Department of Neuropsychiatry, Yangsan Hospital, Yangsan, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 26-32.

Abstract

BackgroundThe dopaminergic genes have been implicated with some personality traits. Many recent studies indicated that there is a correlation between D2 dopamine receptor gene(DRD2) polymorphisms and the personality traits. The purpose of this study is to investigate a possible association between DRD2 gene (TaqI A, TaqI B) polymorphism and personality traits.

Methods:The subjects were consisted of 173 blood-unrelated young female Koreans with a mean age(±SD) of 13.88(±0.29) years. These volunteers were recruited from one of the junior high schools in Seoul and were tested by the Korean version of the Temperament and Character Inventory(TCI). Genotyping of the DRD2 polymorphisms by PCR methods were carried out. Two DRD2 gene polymorphisms were classified and individually assessed as follows:TaqI A1+ vs A1-, TaqI B1+ vs B-. The associations between the TCI scores and TaqI A, TaqI B polymorphisms were assessed by Student's t-test.

Results:In the 173 subjects, the allele frequencies of the DRD2 TaqI A1, TaqI B1 alleles ranged from 0.42 to 0.43, and these results are quite different from the ranges of 0.15-0.20 in the case of a Caucasian population. The genotype frequencies of DRD2(TaqI A1, TaqI B1) variants showed no significant deviation from the Hardy-Weinberg equilibrium. RD4(dependence vs. independence) of Cloninger's TCI, a sub-dimension of Reward Dependence, was significantly higher in the subjects having DRD2 less frequent alleles than those without these alleles.

Conclusion:This study suggests that the female subjects carrying the less frequent DRD2 alleles exhibited higher reward-dependent personality trait compared to those without these alleles. 

Keywords

Personality;Reward dependence;DRD2;Polymorphisms.

Alcohol Withdrawal and Serum Nitrite Concentration

Boung Chul Lee, MD;Hyun-Gyun Son, MD, PhD; and Ihn-Geun Choi, MD, PhD

Department of Neuropsychiatry, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 33-9.

Abstract

ObjectiveNitric oxide(NO) has been known to be associated with tolerance and preference to alcohol. It has also been known to affect various alcohol drinking behavior, alcohol withdrawal symptoms and alcohol-induced brain damage. The purpose of this study was to determine the difference, among alcohol dependence group, alcohol drinking group and abstinence group, in serum concentration of nitrite, a stable metabolite of NO, and it's relationship to clinical and biochemical markers of alcoholism.

Methods:Forty subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated for the clinical characteristics and biochemical markers of alcohol dependence including nitrite with their CIWA-Ar scores checked just after admission. Thirty-nine healthy controls were also evaluated, divided into twenty-three alcohol drinking group and sixteen abstinence group. Clinical characteristics were evaluated by CIWA-Ar, CAGE and AUDIT questionnaires. Aspartate aminotransferase(AST), alanine aminotransferase (ALT), gamma glutamyltransferase(GGT) and mean corpuscular volume(MCV) were used as the biochemical markers of alcohol dependence. Serum nitrite concentrations were measured by Griess reaction.

Results:1) The concentrations of nitrite in alcohol dependence patients were not different from those in the control subjects. 2) There were no significant association between the nitrite concentrations and the CIWA-Ar scores in alcohol dependence patients. 3) Nitrites are significantly increased in alcohol dependence group and alcohol drinking group compared with abstinence group. 

Conclusions:These findings suggest that serum nitrite concentration has no relation with alcohol withdrawal symptoms, but alcohol drinking increases serum nitrite concentration influenced by general condition of the body.

Keywords

Alcohol dependence;Nitric oxide(NO);Nitrite;Alcohol withdrawal;Alcohol drinking.

A Study of Visual Event-Related Potential P300 in Schizophrenia

Dong-Hoon Oh, MD;Jung-Hyun Nam, MD, PhD;Dong-Hyun Ahn, MD, PhD;Seok-Hyun Kim, MD, PhD; and Joon-Ho Choi, MD

Department of Neuropsychiatry, College of Medicine, Hanyang University and Mental Health Institute, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 40-8.

Abstract

ObjectiveEvent-related potentials(ERPs) are electrical changes recorded at the surface of the scalp in response to stimulus presentation, and their latency and amplitude change according to cognitive processes. Through past studies of the auditory ERP in schizophrenia, the P300 has been reported to be statistically smaller and delayed in schizophrenia than comparison groups. However, studies of the visual ERP have not been systematically examined. The present study was designed to investigate the visual P300 in patients with schizophrenia and normal controls and to compare the pattern of P300 between them. 

Methods:The subjects were composed of patients(N=22) with schizophrenia by DSM-IV and normal controls(N=22). The visual ERPs were measured by the visual continuous performance test. P300 amplitude and latency measured on 5 scalp electrodes(Fz, Cz, Pz, T7, T8) were compared between patients and controls.

Results:The P300 latencies measured on Fz, Cz, Pz, and T7 electrodes were significantly longer in patients than controls(p<0.05). The P300 amplitudes in patients were smaller than controls. However, the difference between them was not statistically significant. 

Conclusion:Analysis of the visual ERPs showed that the P300 latency is significantly delayed and the P300 amplitude is slightly smaller in patients than controls. These results are similar to established studies of the auditory P300 in schizophrenia. 

Keywords

Visual event-related potential;P300;Schizophrenia.

Association of Antipsychotic-Induced QTc Prolongation with 5-HTTLPR

Beom-Joo Seo, MD1;Jung-Goo Rhee, MD2;Sung-Woo Park, PhD3;Bo-Geum Kong, MD1;Do-Oun Chung, MD2; and Young-Hoon Kim, MD1,3;

1;Department of Psychiatry, School of Medicine, Inje University, Busan, 2;Department of Psychiatry, Masan Dong-Suh Hospital, Masan, 3;Paik Institute for Clinical Research, Inje University, Busan, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 49-53.

Abstract

ObjectiveA Comparison of QTc prolongation for various antipsychotics and an analysis of QTc prolongation for the various types of serotonin transporter polymorphism were performed.

Method:EKG was checked, followed by QTc measurement as Bazett's correction, and the serotonin transporter polymorphism was examined in 110 chronic schizophrenia patients were performed EKG before 24 weeks ago. We defiened QTc prolongation as over 450ms. The risk factor of sudden cardiac death were defiend as QTc prolongation and or 60ms in delta value.

Result:The prevalence of QTc prolongation in this study was 7.3%, and the prevalence of over 60ms was 4.5%. Patients who had the risk factors were 10(9.1%). 6/52 who prescribed atypical antipsychotics and 2/58 who prescribed haloperidol showed QTc prolongation. The prevalence who had the risk factor of sudden cardiac death were 16% in atypical antipsychotics group, 3.4% in haloperidol group. QTc prolongation were observed more frequently in l/l type than s/s type. l allele frequency were 50% in QTc prolongated group, 19% in not prolongated group. l allele had an association with QTc prolongation(p<0.01).

Conclusion:The prevalence of QTc prolongatin was frequent in chronic schizophrenia patients who were prescribed atypical antipsychotics. It has strong association with l allele of 5-HTTLPR. 

Keywords

QTc;Antipsychotics;Serotonin transporter polymorphism.

Association between Tardive Dyskinesia and 267C/T Polymorphism of 5-HT6 Receptor Gene in Schizophrenia

Sang-Woo Han, MD, PhD1;Dong-Hyeon Kim, MD1; and Yong-Ho Jun, MD2;

1;Department of Psychiatry, University of Soonchunhyang, College of Medicine, Seoul, 2;Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 54-60.

Abstract

ObjectivesTardive dyskinesia(TD) is a serious side effect associated with long-term antipsychotic treatments. Some candidate genetic polymorphisms were reported to be associated with TD and possible involvement of serotonergic receptors in the pathophysiology of TD has been suggested. In the present study, we investigated the association between 5-HT6 receptor gene polymorphism and TD with schizophrenia.

Methods:To investigate the relationship between 5-HT6 receptor gene polymorphism and TD, 60 patients with TD were compared with 60 patients without TD. The 267C/T allele of 5-HT6 receptor gene was genotyped by means of polymerase chain reaction method. TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS).

Results:The patients with the three 267C/T genotype showed no significant differences in age, gender, and duration of illness. No significant difference in genotype frequencies was observed between schizophrenic patients with and without TD. In addition, there was no difference in allele frequencies. Further analysis with an measure of AIMS scores showed that these scores were not significantly influenced by the 5-HT6 receptor gene polymorphism. 

Conclusion:These results suggest that 267C/T polymorphism of 5-HT6 receptor gene is not significantly associated with susceptibility to TD in schizophrenia.

Keywords

Tardive dyskinesia;Schizophrenia;Serotonin;Polymorphism;Genetics.

Manic Patient with Meningioma Treated with Low dose Risperidone and Valproic Acid

Chang-Su Han, MD;Bun-Hee Lee, MD; and Yong-Ku Kim, MD

Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 61-3.

Abstract

We describe the case of a 73 year-old female patient, YSG, who initially presented with a manic episode without any previous psychiatric history and was later diagnosed as having a meningioma in the left frontal lobe. YSG's symptoms were characterized by hyperactivity, insomnia, aggressive behavior with an auditory hallucination. She showed no abnormal signs on a complete neurologic examination. A gadolinium-enhanced MRI study showed a huge, extra-axial mass with homogenous enhancement in the left high convexity of the frontal lobe. Her manic symptoms subsided after administration of risperidone 1mg and valproic acid 500mg daily, for three weeks without surgical resection of the tumor. These findings suggest that YSG's mania might have resulted from the left-sided frontal tumor, and that her symptoms were treated rapidly by small doses of risperidone combined with valproic acid. Medical staff who care for manic patients should be aware of this possibility of a organic lesion without evidence of neurologic disease.

Keywords

Mania;Left frontal;Meningioma.

Vol. 11 No.2

Can We Predict Treatment Response in Major Depression?

Young Hoon Ko, MD1; and Yong Ku Kim, MD, PhD2;

1;Department of Psychiatry, College of Medicine, Korea University, Guro Hospital, Seoul, 2;Department of Psychiatry, College of Medicine, Korea University, Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 77-87.

Abstract

Due to the high population prevalence of major depression and the strong emphasis on pharmacotherapy for this disorder, antidepressants are among the most frequently prescribed pharmacological agents. But the clinicians are still unable to predict accurately the response of their depressed patients to medication. This article reviews the biological predictors of treatment response including monoamine, neuroendocrine, pharmacogenetic, and psychophysiologic markers. The biological predictors of response, despite some interesting leads that may in the long term be of considerable importance, are not yet sufficiently established to be of routine clinical usefulness. Many of the predictive factors explored in this article are examples of mediators and moderators that affect outcomes. Each one alone may not provide definitive answers for predicting response to treatment, but each must be taken into account at the outset of treatment. It is clear that treatments must be individualized for each patient. It would be necessary to develop the algorithm in order to predict the responsiveness of antidepressant treatment with integration of the results from the previous studies.

Keywords

Depression;Predictor;Monoamine;Neuroendocrine;Pharmacogenetics;Antidepressant.

An Association Study of the 5-HTTLPR and COMT Genes Polymorphisms and Personality Traits

Jee-Hyun Ha, MD1;Byung-Joo Ham, MD2;Sung-Gon Ryu, MD2;Tae-Yeon Hwang, MD1;Jong-Gook Lee, MD1;Yu-Sang Lee, MD1;Jung-Sik Lee, MD1;Dae Yeob Kang, MD1;Ihn-Geun Choi, MD2; and Min Soo Lee, MD3;

1;Yong-In Psychiatric Research Institute, Yongin, 2;Department of Neuropsychiatry, College of Medicine, Hallym University, Chuncheon, 3;Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 88-93.

Abstract

Background:Serotonin transporter gene-linked polymorphism region(5-HTTLPR) and catechol-O-methyl-transferase(COMT) genes are thought to be important factors in some personality traits and the etiology of anxiety disorder. The goal of this study was to determine the role of these genes in personality traits.

Method:The participants included 116 healthy adults with no history of psychiatric disorders and other physical illness for the last 6 months. All participants were tested by Temperament and Character Inventory(TCI). The 5-HTTLPR, COMT val158met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differ-ences on TCI dimensions and sub-scales among groups were examined with t-test and ANOVA.

Result:There were possible relationships of the 5-HTTLPR with self-transcendence(P=0.050) and COMT val158met polymorphism with cooperativeness(P=0.053).

Conclusion:We found associations between 5-HTTLPR, COMT polymorphisms and the some TCI character dimensions. Further studies of polymorphisms of other genes and their interactions may clarify the complex relationship between personality and genes.

Keywords

Temperament and Character Inventory;5-HTTLPR;COMT;Personality traits;Genetic polymorphism.

Comparison of Serum Homocysteine, Folate and Vitamin B12 Level in Korean Schizophrenics

Tae Ho Kim, MD1;Young Sik Lee, MD, PhD2;Seong Yong Song, MD2;Kyung Joon Min, MD, PhD2;Baik Seok Kee, MD, PhD2;Chul Na, MD, PhD2; and Seok Lae Chae, MD, PhD3;

1;Department of psychiatry, Han-Yang University, College of Medicine, Seoul, 2;Department of Psychiatry, 3;Laboratory Medicine, Chung-Ang University, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 94-103.

Abstract

Objective:There have been a kind of transmethylation theory that high homocysteine serum concentration affects schizophrenia by neurotoxic mechanism and clinical reports that some schizophrenic patients with high homocysteine were improved by high folate ingestion. This study was done to confirm previous research results and find the clinical characteristics of schizophrenia showing high serum homocysteine and low folate.

Method:We compared the serum levels of homocysteine, folate and vitamin B12 level between 234 schizophrenic patients(male 99, female 135) group and 234 normal controls(male 99, female 135) group. The subjects of two groups were age and sex matched. The evaluated clinical characteristics items were sex, age, onset of disease, hereditary loading, disease course, hallucination and subtype of schizophrenia.

Results:1) Homocysteine level of the schizophrenia group was significantly higher than the normal control group and folate level of the schizophrenia group was significantly lower than the normal control group. Homocysteine level was more negatively correlated with folate level in the schizophrenia group than the normal control group. 2) The percentage of high homocysteine(above 12.46umol/L;90 percentile of normal control) was 33.8% of schizophrenia patients and 51.5% of male schizophrenia. The percentage of low folate(below 3.8nM/L;bottom tertile of normal control) was 66.2% of schizophrenia. 3) In low folate group and not-low folate group, schizophrenia showed significantly higher homocysteine level than normal control. Especially, low folate schizophrenia group showed significantly higher homocysteine level than low folate normal control group.

Conclusions:Some schizophrenia patients with high serum homocysteine may be genetic defector and having low folate serum level. In that case, folate ingestion could be a good management for clinical improvement.

Keywords

Schizophrenia;Homocysteine;Folate;Vitamin B12.

Serum Brain-Derived Neurotrophic Factor in Schizophrenia

So Youn Kim, MD;Kyung Joon Min, MD, PhD;Baik Seok Kee, MD, PhD;Doo Byung Park, MD, PhD; and Joo Hee Kim, MD

Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 104-9.

Abstract

Objectives:Abnormalities in neurotrophic factors that regulate neuronal development and synaptic plasticity are often implicated as some causes of schizophrenia. In previous studies, researchers reported that brain and serum BDNF levels underwent similar changes during maturation and aging processes in rats. They also found a positive correlation between serum and cortical BDNF levels. In this study, we investigated whether the serum levels of BDNF in Korean schizophrenic patients would be different from those of healthy controls.

Methods:Using an ELISA kit, serum BDNF levels were assessed in schizophrenic group(N=49) and control group(N=50).

Results:Serum BDNF levels in the schizophrenic group(36.29±19.78ng/ml) were significantly higher than those in control group(22.4±14.4ng/ml). The BDNF levels did not correlate with duration of treatment, age or daily dose of antipsychotics in patients with schizophrenia.

Conclusions:This result suggests that schizophrenia is characterized by high serum BDNF levels and supports the hypothesis of neurotrophic factor involvement in psychotic disorder. Serum BDNF level is likely to be one of the possible biological markers for schizophrenia.

Keywords

BDNF;Schizophrenia;Neurotrophin.

Association between Serotonin 2A(T102C) and 1B(G861C) Receptor Gene Polymorphism and Suicidal Attempt with Drug Intoxication in Korean Populations

Dong-Hyeon Kim, MD2;Young-Joon Kwon, MD, PhD1;Jae-Woo Kim, MD, PhD3;Se-Hoon Shim, MD1; and Hee-Yeon Jung, MD, PhD1;

1;Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, 2;Department of Psychiatry, College of Medicine, Soonchunhyang University Hospital, Seoul, 3;Department of Emergency Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 110-6.

Abstract

Objectives:Recently, polymorphisms of several serotonin genes have been suggested to be associated with suicide, but the results are still unclear. We examined whether the T102C polymorphisms of the serotonin 2A receptor gene and the G861C polymorphisms of the serotonin 1B receptor gene were associated with suicidal behavior using drug intoxication.

Methods:The subjects were 52 patients who visited emergency room with suicidal behaviors. Fifty controls were selected from healthy volunteers matched for sex and age to the suicide subjects. The polymorphisms were analyzed with TaqMan® assay using primers based on previous studies.

Results:The T102C polymorphism of the serotonin 2A receptor gene showed no significant difference between the suicidal attempters and controls in both genotype and allele frequency analyses(p=0.179 and p=0.422, respectively). There was no statistically significant difference between the suicidal attempters and the controls in the G861C polymorphism of the serotonin 1B receptor gene and any significant effect of the genotype distributions or the allele frequencies was not observed(p=0.092 and p=0.987, respectively).

Conclusion:These findings suggest that the T102C polymorphism in serotonin 2A receptor gene and the G861C polymorphism in serotonin 1B receptor gene are not related to the susceptibility to suicide attempts using drugs. To clarify the genetic influences of the serotonergic system on suicidal behavior, the polymorphisms of other candidate genes in the serotonergic system should be studied with larger numbers of subjects.

Keywords

Suicide;Serotonin;Polymorphism;Association;Gene.

Correlations of Abnormal Involuntary Movements with Blood Glucose, Lipid Levels in Chronic Schizophrenics

Hyeong-Seob Kim, MD;Eung-Jo Kim, MD;Joo-Ho Lee, MD; and Seong-Hak Ji, MD

Yongin Mental Hospital, Yongin, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 117-26.

Abstract

Objects:It has been reported that the incidence of tardive dyskinesia(TD), the remarkable abnormal involuntary movement, was higher in the schizophrenics with high blood sugar levels and that TD had been improved by small amount of insulin-injection for 90 days. And also it was generally known that the blood lipids were higher in the schizophrenics with tardive dyskinesia. Thus, we tried to replicate the correlations of abnormal involuntary movements with blood sugar levels and blood lipids in chronic schizophrenics treated with antipsychotics.

Methods:Thirty-eight male schizophrenic inpatients who were stable in clinical state with medications, were included. The patients who had been already diagnosed as diabetes mellitus(DM), organic brain disorder, substance-related disorder, physical illness were excluded and also we excluded female patients to remove the hormonal effect on TD. Eleven patients who ranked higher(above five) in the Abnormal Involuntary Movement Scale(AIMS) were assigned into 2 groups, a dibenese group and a placebo group. Diabinese or placebos were administrated for 3 weeks with antipsychotics and AIMS was rechecked.

Results:There were no correlations between the total AIMS scores and blood sugar and lipids levels in all subjects. The means of total and subscale scores(objective, face, and extremity) of AIMS did not reveal statistical significances between diabinese and placebo groups. However(total, jaw, face, upper arm, and objective feeling), were statistically higher in the diabinese group than those in the placebo group. And correlations of total cholesterol(TC) with fast blood sugar(FBS), weight with body mass index(BMI) and waist, total glycerol(TG) with BMI were statistically significant.

Conclusion:In this study, there were statistical significances in the changes in ratings of AIMS scores bet-ween the diabinese group and the placebo group. Application of oral hypoglycemic agent might be a way of improving abnormal involuntary movements in schizophrenics with abnormal involuntary movements or TD. Althogugh it was not certain that there were correlations of abnormal involuntary movement with blood sugar and lipids, correlations of TC/TG with AIMS, of FBS with AIMS cautiously suggest that the regular check of HbA1C, waist, and weight are recommended for schizophrenics.

Keywords

Tardive dyskinesia;Abnormal involuntary movement;Antipsychotics;Schizophrenia;Hyperglycemia;Hyperlipidemia;Hypoglycemic agent.

The Influences of Risperidone and Clozapine on Body Weight and Glucose Level in Patients with Chronic Schizophrenia - Comparison Study with Haloperidol -

Cheon-Woo Nam, MD1;Byung-Hwan Yang, MD2; and Joon-Noh Lee, MD1;

1;Seoul National Hospital, Seoul, 2;Department of Neuropsychiatry, College of Medicine & the Mental, Health Research Institute, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 127-35.

Abstract

Object:The goal of this study was to examine the changes in body weight and glucose levels of the patients treated with risperidone, clozapine or haloperidol in order to compare the effect of risperidone or clozapine with that of haloperidol.

Methods:For nine months(January to September, 2003), a prospective study was performed in 60 patients with chronic schizophrenia who were in Seoul National Hospital. Two-week period was required for a drug wash-out. The patients were randomly assigned to risperidone, clozapine and haloperidol groups. They were given risperidone(n=20), clozapine(n=20) and haloperidol(n=20), respectively, everyday for 12 weeks. To examine the effects of these drugs on body weight and fasting glucose levels, we measured body weight and glucose levels of all the patients first without the drug treatment and at each end of 4, 8, and 12-week periods with the treatment. And we examined the differences among three groups in the changes of body weight and fasting glucose levels.

Results:There were no significant differences in the changes of the body weight and fasting glucose levels between the atypical antipsychotics(risperidone or clozapine) and the typical antipsychotics(haloperidol).

Conclusion:The study in the patients with chronic schizophrenia suggests that risperidone or clozapine do not cause any additional effects on body weight or glucose levels compared to haloperidol.

Keywords

Weight gain;Glucose level;Risperidone;Clozapine;Haloperidol.

No Association between Genetic Polymorphism of Tryptophan Hydroxylase A218C and Serotonin Transporter Linked Polymorphic Region and Panic Disorder

Young Hee Choi, MD, PhD1;Jong Min Woo, MD1;Hun Ku Park, MD1;Kyung Sik Yoon, MD, PhD,2;Dae Yeon Cho, PhD3; and Min Soo Lee, MD, PhD4;

1;Department of Neuropsychiatry, Inje University Seoul Paik Hospital, Seoul, 2;Department of Biochemistry, Kyunghee University School of Medicine, Seoul, 3;LabGenomics Clinical Research Institute, LabGenomics, Yong-In, 4;Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 136-45.

Abstract

Objectives:Genetic variations of the tryptophan hydroxylase(TPH) gene and the serotonin transporter linked polymorphic region(5-HTTLPR) polymorphism have been associated with its functional capacity. The authors investigated whether the allelic constitution of the TPH gene and 5-HTTLPR are associated in Korean panic patients.

Methods:244 Korean patients with panic disorder and 227 normal healthy controls were tested for a genetic polymorphism of TPH A218C and 5-HTTLPR polymorphism. To assess the severity of panic disorder during the last one month, anticipatory anxiety, panic difficulty, panic distress, agoraphobic difficulty and agoraphobic distress were measured with visual analogue scale(VAS) score, STAI-S & T, BDI, SCL-90-R, ASI-R, CGI, PDSS, and HAMD.

Results:There was no significant difference in genotype and allele frequencies of TPH A218C and 5-HTTLPR polymorphism between panic patients and controls. Although we observed some differences in genotype and allele frequencies of TPH A218C polymorphism among male subjects, these differences disappeared after Bonferroni correction. And there were no significant differences in clinical variables.

Conclusion:Our results suggested that there are no association between the genetic polymorphism of TPH gene and 5-HTTLPR with panic disorder.

Keywords

Tryptophan hydroxylase;Serotonin transporter;Panic disorder;Association;Genetic polymorphism.

A Family-Based and Case-Control Association Study of the Serotonin 1B Receptor Gene Polymorphism in Korean Attention Deficit Hyperactivity Disorder

Tae Won Park, MD, PhD1,6;Boong Nyun Kim, MD, PhD2;Myung-Ho Im, MD, PhD3;Hee Jeong Yoo, MD, PhD4;Daehee Kang, MD, PhD5; and Young-Chul Chung, MD, PhD6;

1;Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, 2;Division of Child & Adolescent Psychiatry, Department of Psychiatry, College of Medicine, Seoul National University, Seoul, 3;Department of Psychiatry, College of Medicine, Dankook University, Cheonan, 4;Department of Psychiatry, College of Medicine, Gyeongsang National University, Jinju, 5;Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, 6;Department of Psychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 146-54.

Abstract

Objective:Attention deficit hyperactivity disorder(ADHD) is the most common childhood psychiatric disorder, affecting 3-5% of school-aged children. Although the biological basis of ADHD is unknown, family studies provide strong evidence that ADHD has a genetic basis. Recent genetic studies have suggested associations between ADHD and serotonin 1B(5HT1B) receptor gene G861C polymorphism. The aim of this study is to test for the association between ADHD and 5HT1B receptor gene G861C polymorphism in Korean population.

Method:We processed DNA extraction and genotyping. 106 Korean children with ADHD and their parents were analyzed using the transmission disequilibrium test(TDT) and haplotype-based haplotype relative risk(HHRR). And the ADHD children were compared with 212 age and gender matched normal controls.

Results:There was no statistical difference of distributions between ADHD cases and controls. We did not observe any preferential transmission of alleles of 5HT1B receptor gene G861C polymorphism in ADHD.

Conclusions:Though there is the possibility of failing to detect small genetic effects, our results show no evidence of an association between ADHD and 5HT1B receptor gene G861C polymorphism in the Korean population and indicate that it is unlikely that the 5HT1B receptor is implicated in the susceptibility to ADHD.

Keywords

Attention deficit hyperactivity disorder(ADHD);Serotonin;5HT1B receptor;G861C polymorphism;Association study.

The Relationship between Neurocognitive Functioning and Emotional Recognition in Chronic Schizophrenic Patients

Hye-Li Hwang, MA;Tae-Yeon Hwang, MD, PhD;Woo-Kyung Lee, MA; and Eun-Sun Han, MD

Yongin Psychiatric Rehabilitation Center, Yongin Mental Hospital, Yongin, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 155-64.

Abstract

Objective:The present study examined the association between basic neurocognitive functions and emotional recognition in chronic schizophrenia. Furthermore, to Investigate cognitive variable related to emotion recognition in Schizophrenia.

Methods:Forty eight patients from the Yongin Psychiatric Rehabilitation Center were evaluated for neurocognitive function, and Emotional Recognition Test which has four subscales finding emotional clue, discriminating emotions, understanding emotional context and emotional capacity. Measures of neurocognitive functioning were selected based on hypothesized relationships to perception of emotion. These measures included:1) Letter Number Sequencing Test, a measure of working memory;2) Word Fluency and Block Design, a measure of executive function;3) Hopkins Verbal Learning Test-Korean version, a measure of verbal memory;4) Digit Span, a measure of immediate memory;5) Span of Apprehension Task, a measure of early visual processing, visual scanning;6) Continuous Performance Test, a measure of sustained attention functioning. Correlation analyses between specific neurocognitive measures and emotional recognition test were made. To examine the degree to which neurocognitive performance predicting emotional recognition, hierarchical regression analyses were also made.

Results:Working memory, and verbal memory were closely related with emotional discrimination. Working memory, Span of Apprehension and Digit Span were closely related with contextual recognition. Among cognitive measures, Span of Apprehension, Working memory, Digit Span were most important variables in predicting emotional capacity.

Conclusion:These results are relevant considering that emotional information processing depends, in part, on the abilities to scan the context and to use immediate working memory. These results indicated that multifaceted cognitive training program added with Emotional Recognition Task(Cognitive Behavioral Rehabilitation Therapy added with Emotional Management Program) are promising.

Keywords

Schizophrenia;Neurocognitive functioning;Emotional recognition;Working memory.

Polymorphism of Dopamine Transporter Gene(DAT1) in Korean Social Phobia Patients:Preliminary Study

Kang Seob Oh, MD, PhD1;Hyung Kun Yoon, MD1; and Min Soo Lee, MD, PhD2;

1;Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 2;Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 165-72.

Abstract

Objective:Although polymorphism of dopamine transporter gene(DAT1) has been considered to be implicated in the pathogenesis of social phobia, previous investigations have been inconsistent and controversial. The authors investigated the relationship between DAT1 polymorphism and social phobia in Koreans.

Methods:DAT1 and alleles of fifty subjects who met DSM-IV criterion of social phobia, and those of age- & sex- matched fifty normal controls in Korea were compared. Additionally, patients were grouped into generalized(33) and nongeneralized(17) types and DAT1 polymorphism was compared with that of age- & sex- matched controls. DAT1 with variable number of tandem repeats(VNTR) were determined by using polymerase chain reaction. To compare the distribution of the DAT1 polymorphism between different groups, Fisher’s exact test was used.

Results:There were no significant differences in either genotypic(p=0.451) or allelic(p=0.452) distributions between the social phobia patients and the controls. There also were no differences in genotypic distribution between subtypes of social phobia patients and the controls.

Conclusion:We couldn’t find any association between DAT1 polymorphism and social phobia. Further studies including larger number of samples and diverse clinical variables should be conducted to elucidate the present findings.

Keywords

Social phobia;Dopamine transporter gene(DAT1);Polymorphism;Association study.

Changes in the Regional Cerebral Perfusion after Eye Movement Desensitization and Reprocessing:A SPECT Study of Two Cases

Dong-Hoon Oh, MD; and Joonho Choi, MD

Department of Neuropsychiatry, College of Medicine, and Mental Health Institute, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 11, No. , pp. 173-80.

Abstract

Over the last decade, EMDR(Eye Movement Desensitization and Reprocessing) has emerged as a promising new treatment for trauma and other anxiety-based disorders. However, neurobiological mechanism of EMDR has not been well understood. Authors report SPECT findings of two patients of PTSD before and after EMDR. Brain 99mTc-ECD-SPECT was performed before and after EMDR treatment. To evaluate the significance of changes in the regional cerebral perfusion, t-test was conducted on the resulting images using SPM99 . In addition, clinical scales(CAPS, CGI, STAI) were employed to asses the changes in the clinical symptoms of the patients. After EMDR treatment, each showed significant improvement in clinical symptoms. The cerebral perfusion increased in bilateral dorsolateral prefrontal cortex, and decreased in the temporal association cortex. The differences in the cerebral perfusion between patients after treatment and normal controls decreased. These changes appeared mainly in the limbic area the and the prefrontal cortex. These results suggest that EMDR may show the therapeutic effect through 1) improvement in the emotional control by increased activity in the prefrontal cortex, 2) inhibited hyperstimuli on amygdala by deactivation of the association cortex, 3) inhibition on past trauma related memory, and 4) keeping the functional balance between the limbic area and the prefrontal cortex. This case report needs further replication from studies with larger sample.

Keywords

EMDR;SPECT;SPM.

  • Vol. 10 No.1
  • Vol. 10 No.2

Vol. 10 No.1

The Mechanisms of Atypical Antipsychotics-Induced Weight Gain and Related Pharmacogenetics

Joon-Noh Lee, MD1; and Byung-Hwan Yang, MD2;

1;Seoul National Hospital, Seoul, 2;Department of Neuropsychiatry, College of Medicine & the Mental, Health Research Institute, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 3-19.

Abstract

The use of atypical antipsychotics is limited by occurrence of adverse reactions such as weight gain, despite of their benefits. This article provides a comprehensive review and discussion of the most significant findings regarding obesity-related pathways and integrates these with the known mechanism of atypical antipsychotic action. The focus of this article is primarily on the genetics of obesity related pathways that may be disrupted by atypical antipsychotics. This review also discussed weight gain, hyperglycemia or occurrence of diabetes while being treated with atypical antipsychotics from the point of view of pharmacogenetics. Pharmacogenetic research seeks to uncover genetic factors that will help clinicians identify the best treatment strategies for their patients. It will aid clinically in the prediction of response and side effects, such as antipsychotic-induced weight gain, and minimize the current "trial and error" approach to prescribing in the near future. This article also presents the genetics of both central and peripheral pathways putatively involved in antipsychotic-induced weight gain while providing a comprehensive review of the obesity literature. This article also review obesity related candidate molecules which may be disrupted during atypical antipsychotic drug treatment.

Keywords

Atypical antipsychotics;Weight gain;Phrmacogenetics.

Hippocampus and Schizophrenia

Young Chul Chung, MD, PhD

Department of Psychiatry, School of Medicine, Chonbuk National University, Institute for Medical Sciences, Jeonju, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 20-44.

Abstract

Schizophrenics suffer not only psychotic symptoms but also cognitive deficits such as an attentional difficulty, memory impairment, poor abstraction, etc. These cognitive abnormalities have been reported to be significantly related to the social and occupational outcome in schizophrenia. Thus, it is important to explore the cause and pathophysiology for the cognitive abnormalities in patients with schizophrenia. In this regard, hippocampus is one of the most promising brain areas to search for the clue because it is closely involved in memory related function. In fact, during the past several decades, there have been extensive studies supporting hippocampal abnormalities as a cause of schizophrenia in both clinical and preclinical field. In this review, basic anatomical knowledge about hippocampus and major findings of preclinical and clinical studies which investigated the correlation between schizophrenia and hippocampus were highlighted. The contents are 1) anatomical structure of hippocampus, 2) neuronal pathway and receptor distribution in hippocampus, 3) function of hippocampus, 4) hippocampal animal model for schizophrenia, 5) hippocampus-related studies on antipsychotic drugs, and 6) clinical studies in hippocampus in patients with schizophrenia.

Keywords

Hippocampus;Schizophrenia.

Obesity:Genetic vs Environmental Factors

Soyoung Irene Lee, MD, PhD; and Han-Yong Jung, MD, PhD

Department of Psychiatry, College of Medicine, Soonchunhyang Bucheon Hospital, Soonchunhyang University, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 45-53.

Abstract

Debates relevant to the etiology of weight gain or obesity, i.e., the dichotomous understandings about whether obesity arises from the genetic predisposition or from the environmental influences, has long existed. This is an important issue because it is related to the therapists's prejudice when treating patients with obesity. In this review, the authors first discuss the environmental and the genetic factors that cause the obesity, and in the latter part, the interactions between genetic and environmental factors will be discussed. This issue is considered and described especially in a conceptual aspect for the therapists ultimately to understand how the genetic and the environmental factors interact to arise obesity. Conclusively, obesity is best understood as a complex, multifactorial, and chronic disabled state, which cause an individual with genetic predispostion to obesity under the environmental influences. In future, in favor of the accumulated knowledge about the genetic and environmental impacts and their interactions in detail, we will be able to provide a client-specific management or prevention of obesity. 

Keywords

Obesity;Genetic predisposition;Environmental impacts.

Prevalence of Tardive Dyskinesia among the Hospitalized Schizophrenic Patients

Chung Goo Rhee, MD1;Jeung Hwan Park, MD1;Tae Hwan Lee, MD2;Young Hoon Kim, MD, PhD2;

1;Department of Psychiatry, Masan Dong Suh Hospital, Masan, 2;Department of Neuropsychiatry, Scool of Medicine and Paik Inje Memorical Clinical Research Institute, Inje University, Busan, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 54-61.

Abstract

ObjectThis cross-sectional study was performed in order to evaluate the prevalence of tardive dyskinesia among the hospitalized schizophrenic patients.

Methods:Four hundred nineteen hospitalized schizophrenic patients(male=263, female=156) were recruited for this study. They were treated with antipsychotics for more than 3 months. The prevalence of tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale.

Results:The prevalence of tardive dyskinesia was 35.6%(Male=36.9%, Female 33.3%). There were no significant differences in the prevalence of tardive dyskinesia among male and female schizophrenic patients. The prevalence of tardive dyskinesia among the patients over 30years old was much higher than those below 30years old. There were no significant correlations between the prevalence of tardive dyskinesia and the duration of hospitalization, the total amount of antipsychotics. The frequently involved parts of the body in the schizophrenic patients who have tardive dyskinesia were tongue, upper extremity, lips and perioral area, jaw, lower extremity, muscles of facial expression trunk, respectively.

Conclusions:There was significant correlation between the age and the prevalence of tardive dyskinesia in the antipsychotic-treated schizophrenic patients. There were no correlations between the prevalence of tardive dyskinesia and gender difference, the duration of hospitalization, the total amount of antipsychotics.

Keywords

Schizophrenia;Tardive dyskinesia;Antipsychotic;Adverse effect.

Changes of Corticotropin-Releasing Factor(CRF) and Neuropeptide Y(NPY) of Rats in Response to Footshock or Reexposure to Conditions Previously Paired with Footshock

Kyung-Ho Shin, MD, PhD1;Sung Jin Kim, BS1,2;Kuem Ju Lee, MS1,2;Seung Gun Shin, BS1;You Chan Shin, MD1; and Min-Soo Lee, MD, PhD2;

1;Department of Pharmacology, Korea University College of Medicine, Seoul, 2;Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 62-9.

Abstract

Corticotropin-releasing factor(CRF) and neuropeptide Y(NPY) are known to play important roles in mediating stress responses and stress-related behavior. To elucidate the role of neuropeptides in response to the condition that had paired with traumatic event, we observed the changes of CRF and NPY by immunohistochemistry using a conditioned footshock paradigm. Male Sprague-Dawley rats were placed in a shuttle box and exposed to 20 pairings of a tone(< 70dB, 5sec) followed by a footshock(FS, 0.8mA, 1sec) over 60min. A second group was exposed to the tone-footshock pairings, returned to the homecage for 2days, and then reexposed to the test chamber and 20tones alone for 60min, prior to sacrifice. Control groups were:a) sacrificed without exposure to FS;b) exposed to the tone-footshock pairings and then sacrificed two days later;or c) exposed to the chamber and tones alone, returned to the homecage for 2days and then reexposed to the chamber and 20tones over 60min prior to sacrifice. CRF was increased in animals exposed to FS or the aversive condition(context and tone) that had paired to FS in bed nucleus of the stria terminalis (BNST) compared to the control. NPY was increased by FS in amygdala and PVN, but the condition previously associated with FS results in slight increase only in amygdala area. These results suggest that the BNST appears to be the mostly involved neural circuit in response to explicit cues previously paired with footshock. Moreover, this study raise the possibility that increased CRF peptide in the BNST in response to re-exposure to the aversive condition may underlie, in part, the experience of conditioned fear-related anxiety behavior.

Keywords

CRF NPY;Central nucleus of amygdala;Bed nusleus of the stria termalis;Conditioned fear.

The Relationship between the Serum Cytokine and Clinical Improvement in Major Depressive Disorder

Hyon Chul Kim, MD;Sang Kyu Lee, MD;Do Hoon Kim, MD; and Bong Ki Son, MD

Department of Psychiatry, Hallym University College of Medicine, Chunchon, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 70-9.

Abstract

ObjectCurrently, the alteration of cytokine system has been known to play an important role in regard to depressive symptom. We focused on the relationship between immunological parameters and clinical improvement in major depressive disorder.

Method:Data were collected on 26 patients with major depressive disorder using a 8-week prospective follow-up design. After 8-week treatment period with fluoxetine, patients were classified into a response group and a non-response group according to their psychopathological outcome as evaluated by Hamilton Depression Rating Scale. The differences of the immunological parameters between pre-treatment phase and post-treatment phase were compared among patients. The difference of those was also compared within each phase among them. The relationship between socio-demographic variables, depression, cytokine, mononuclear cells was examined by correlation analysis. Multiple regression analyses were performed to explore the predictors of clinical improvement of major depressive disorder.

Result:Pre-treatment levels of IL-1β in the response group were significantly higher than those in the non-response group. Pre-treatment levels of IL-1β of all patients and in the response group were positively correlated with pre-treatment monocyte counts. Patients with subsequent remission showed significantly lower IL-6 values at baseline than those with non-response. Post-treatment values of IL-6 did not differ significantly among the patients. The correlation test showed more frequent relations among cytokines and mononuclear cells in the response group than in the non-responder group. Especially, serum level of IL-6 in pre-treatment phase was only significantly correlated with HAMD score after 8-week treatement phase, while other cytokines and mononuclear cells were not. Pretreatment level of IL-6 was of paramount impor-tance in predicting clinical improvement of depressive symptom.

Conclusion:The immune system of major depressive disorder patients might dichotomize the patients into subsequent responders and non-responders. Immune system might be of great influence on the clinical improvement of major depressive disorder. The mode of interaction between depression and cellular immune function and the mediators responsible for the cytokine production need to be studied further.

Keywords

Major depressive disorder;Cytokine;Lymphocyte;Monocyte;CRP;IL-1β;IL-6;TNF-α.

Polymorphism of CTLA-4 Gene in Patients with Bipolar Disorder

Tae-Youn Jun, MD;Kyoung-Uk Lee, MD;Hyuk-Jae Lee, MD;Chi-Un Pae, MD;Jeong-Ho Chae, MD;Won-Myong Bahk, MD; and Kwang-Soo Kim, MD

Department of Psychiatry, College of Medicine The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 80-4.

Abstract

ObjectiveBipolar disorder is known to have strong genetic background and cellular immune activation. Based on the hypothesis that abnormalities of normal inhibitory control of T cell immunity can contribute to the pathophysiology of bipolar disorder, we investigated the relationship between the first exon at position +49(A/G) polymorphism of cytotoxic T lymphocyte antigen 4(CTLA4) gene and bipolar disorder.

Method:Among the Korean patients diagnosed as bipolar disorder according to DSM-IV, 90 patients without serious medical illness, neurologic illness, hormonal disorder, or concomitant mental illness were selected. The normal control group consisted of 149 age-and sex-matched subjects without current or past history of autoimmune diseases or mental disorder. DNA was extracted from whole blood and the exon 1 region of CTLA-4 gene was amplified by polymerase chain reaction. Gene typing was performed using single strand conformation polymorphism. 

Results:There were no significant differences in genotype frequencies of G/G, G/A, and A/A between the patients with bipolar disorder and the control group(48.9% vs 46.3%, 44.4% vs 39.6%, and 6.7% vs 14.1%, respectively). There were no significant differences in allelic frequencies of G and A between the patients with bipolar disorder and the control group(71.1% vs 66.1%, and 28.9% vs 33.9%, respectively).

Conclusion:This study did not show the association of exon 1 polymorphism of CTLA-4 gene with bipolar disorder.

Keywords

CTLA-4;Polymorphism;Bipolar disorder.

Vol. 10 No.2

Clinical and Pathological Characteristics of Frontotemporal Lobar Degeneration(FTLD) and Molecular Genetics of Tau Protein

Sung-Il Woo, MD, PhD

Department of Neuropsychiatry, Soonchunhyang University Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 97-106.

Abstract

Criticisms about amyloid cascade hypothesis of Alzheimer's disease(AD) are based on the findings, first, that the degree of dementia does not correlate with the number of plaques, and second, that the neurofibrillary tangle formation seems to predate plaque formation. In addition, neurofibrillary tangle counts correlate well with the degree of cognitive impairment. These findings suggest the independent importance of tau abnormality in AD research which is involved in the neurofibrillary tangle formation. Recently, tau pathology without amyloid deposits and mutations in tau protein gene were reported to be the major pathogenic mechanism in Pick's disease, progressive supranuclear palsy, corticobasal degeneration and FTDP-17(frontotemporal dementia and parkinsonism linked with chromosome 17). These data suggest that understanding the causes and consequences of tau dysfunction might give new clinical and therapeutic solutions to many known tauopathies. 

Keywords

Tau;FTLD;PiD;PSP;CBD;FTDP-17.

Antipsychotics and Abnormality in Glucose Regulation

Jae-Sung Hwang, MD;Hyun Kim, MD;Young-Joon Kwon, MD; and Hee-Yeon Jung, MD

Department of Psychiatry, College of Medicine, Soonchunhyang University Hospital, Cheonan, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 107-15.

Abstract

ObjectiveThe purpose of this study was to know about the mechanism of pathogenesis of type 2 diabetes mellitus by using of blood glucose, glucoregulatory factor, insulin resistance in schizophrenic patients receiving antipsychotics.

Method:Modified oral glucose tolerance tests were performed in 20 schizophrenic patients receiving haloperidol, risperidone and olanzapine. Insulin, glucagon, C-peptide and cortisol were measured in 0, 15, 45, 75 minutes after glucose loading, and insulin resistance was calculated by HOMA(homeostasis model assessment) method.

Result:Olanzapine-treated patients had significant glucose elevation 45 minutes after glucose challenge. Also modest increases in HOMA IR values were detected in patients treated with olanzapine.

Conclusion:Olanzapine treatment of non-diabetic patients with schizophrenia can be associated with type 2 diabetes mellitus through the elevation of glucose and insulin resistance. Elevated insulin resistance may be a causative mechanism of type 2 diabetes mellitus in patients receiving olanzapine. 

Keywords

Antipsychotics;Blood glucose;Insulin resistance.

Genetic Polymorphisms of Apolipoprotein E in Korean Schizophrenic Patients

Gwang-Hyun Cho, MD;Sang-Geun Chung, MD; and Ik-Keun Hwang, MD

Department of Psychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 116-20.

Abstract

ObjectivesAlthough polymorphisms of apolipoprotein E have been investigated in many neuropsychiatric disorders, results were controversial and even contradictory. The purpose of this study was to investigate the genotypes of apolipoprotein E in schizophrenia and healthy controls, and to compare them in two groups in terms of distribution of apolipoprotein E genotype and allele.

Method:Using polymerase chain reaction and amplified refractory mutation system, apolipoprotein E genotypes were identified in 77 schizophrenics and 115 healthy control persons.

Results:The results were as follows 1) When genotypes of apolipoprotein E were classified into ε2/2, ε2/3, ε2/4, ε3/3, ε3/4, ε4/4 according to phenotypes, there were no statistical differences in genotypes between two groups 2) In terms of allele frequency, there were also no statistical differences between two groups

Conclusion:These results suggest that genotypes and alleles of apolipoprotein E seem to be unrelated to the pathogenesis of schizophrenia.

Keywords

Apolipoprotein E;Schizophrenia;Genotypes.

Association of a Polymorphism in the Promoter Region of Apo-1/Fas Gene with Bipolar Disorder

Kyu Hyun Kim, MD;So-Jeong Son, MD;Hee Jae Lee, MD;Jong Woo Kim, MD; and Joo-Ho Chung MD

1;Kohwang Medical Research Institute, College of Medicine, Kyunghee University, Seoul, 2;Seoul National Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 121-5.

Abstract

ObjectiveRecently, many experimental evidences have been reported that psychiatric diseases are closely related with neurodevelopmental abnormalities and this can be properly explained by apoptosis. It is known that Apo-1/Fas is one of the genes in charge of apoptosis related with neurodevelopmental abnormalities. In this study, the association between bipolar disorder and functional polymorphism in Apo-1/Fas promoter gene has been investigated.

Method:For 81 bipolar disorder patients and 217 healthy control subjects, MvaI restriction fragment length polymorphism(RFLP) of Apo-1/Fas promoter gene was analyzed after polymerase chain reaction(PCR) amplification.

Result:There was a statistical significant difference in genotypic distribution(χ2=16.656, df=2, p=0.0002) and allelic frequencies(χ2=14.225, df=1, p=0.0002) between bipolar disorder patients and healthy control subjects.

Conclusion:Our results suggest an association between functional polymorphism in Apo-1/Fas promoter gene and bipolar disorder and provide the important genetic information related with the pathogenesis of the disease. Further studies employing larger samples are required to clarify the present results.

Keywords

Apo-1/Fas gene;Bipolar disorder.

The Effects of Venlafaxine on Neurite Growth of PC12 Cells

Hong-Seok Oh, MD1;Joon-Ho Choi, MD1;Jun-Seok Lee, MD, PhD2;Joon-Noh Lee, MD3;Mi-Ran Choi, MS4;Young-Gyu Chai, PhD4;Seok-Hyeon Kim, MD, PhD1; and Byung-Hwan Yang, MD, PhD1;

1;Department of Neuropsychiatry, College of Medicine and Institute of Mental Health, Hanyang University, Seoul, 2;Department of Neuropsychiatry, College of Medicine, Kwandong University, Myongji Hospital, Goyang, 3;Department of Neuropsychiatry, College of Medicine, Hanyang University and Seoul National Hospital, Seoul, 4;Department of Biochemistry and Molecular biology, College of Science, Hanyang University, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 126-32.

Abstract

ObjectivesThe purpose of this study is to examine the effects of venlafaxine, one of novel antidepressant drugs, on neurite growth in PC12 cells.

Methods:PC12 cells were cultured with NGF for eight days. Then different concentrations(0μM, 1μM, 5μM) of venlafaxine were mixed with cultured PC12 cells. After 24 hours and 48 hours of culture, we compared the effects of venlafaxine on the total length of neurites of cultured PC12 cells between no venlafaxine treated group(0μM) and venlafaxine treated groups(1μM and 5μM). Additionally, we studied the concentration-dependent effect of venlafaxine on differentiation in PC12 cells.

Results:Experimental results showed that 1) the mean length of neurites in 1μM and 5μM venlafaxine treated group was more increased than no venlafaxine treated group(p=0.002). 2) the length of neurite in 5μM venlafaxine treated group was more elongated than 1μM venlafaxine treated group(p=0.046). 3) the length of neurite in 6μM venlafaxine treated group was more elongated than all the other concentrations in our experiment. Above 6μM, the length of neurite was shortened in inverse proportion to the concentration of venlafaxine.

Conclusions:This results suggest that venlafaxine, one of novel antidepressant drugs, promotes the differentiation of neuron. This study is believed to be a first step toward understanding the molecular and cellular mechanisms of antidepressant treatment.

Keywords

Antidepressant;PC12 cell;Neurite growth;NGF.

Association between Tardive Dyskinesia and T103C Polymorphisms of 5-HT2A Receptor Gene

Sang Woo Hahn, MD1;Jeong Won Shin, MD2;Tae Youn Choi, MD2;Sung Il Woo, MD1;Han Yong Jung, MD4;Hee Yeoun Jung, MD3; and Sun Ho Han, MD1;

1;Department of Psychiatry, College of Medicine, Soonchunhyang University Hospital, Seoul, 2;Department of Laboratory Medicine, College of Medicine, Soonchunhyang University Hospital, Seoul, 3;Department of Psychiatry, College of Medicine, Soonchunhyang University Hospital, Cheonan, 4;Department of Psychiatry, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 133-40.

Abstract

ObjectiveSome candidate gene polymorphisms were reported to be associated with tardive dyskinesia (TD). The aim of this study was to investigate the association of the 5-HT2A receptor gene polymorphisms with TD in Korean schizophrenic subjects.

Method:Subjects were of 59 schizophrenic patients with TD and 60 schizophrenic patients without TD for studying of 5-HT2A receptor gene polymorphisms. TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). Genomic DNA was amplified by PCR and digestion with MspI and BsmI.

Result:There were no statistically significant differences in the demographic variables, such as age, male to female percentage, duration of illnesses and duration of antipsychotic drug exposure between the TD group and control group. 1) T102C polymorphisms and TD Comparing the TD group and control group, the 102T/C allele was associated with a significantly increased risk for TD (χ2=5.560, df=1, p=0.018). 2) Three AIMS categories of TD and T102C genotype. There were statistically significant differences in the three AIMS categories(χ2=6.835, df=2, p=0.033).

Conclusion:These result suggest 102T/C genotypes of the 5-HT2A receptor gene are related to the development of TD. The 102T/C genotypes were associated with significantly higher AIMS orofacial dyskinesia scores. These findings suggest that the 5-HT2A receptor gene is significantly associated with susceptibility to TD in patients with chronic schizophrenia.

Keywords

Tardive dyskinesia;5-HT<sub>2A</sub> receptor gene;T102C.

The Resolution of Amenorrhea in Female Patients Taking Risperidone

Bun-Hee Lee, MD;Yong-Ku Kim, MD;Chang-Su Han, MD; and Young-Hoon Ko, MD

Department of Psychiatry College of Medicine, Korea University Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 141-6.

Abstract

ObjectiveTo find out the optimal assessment that can relieve amenorrhea associated with risperidone.

Methods:Sixteen female outpatients who have taken risperidone for more than 3 months reported voluntarily amenorrhea during Nov 2001 to May 2002. Since the reports of the amenorrhea, the resolution of amenorrhea has been prospectively followed during the next six months. The dosage of risperidone was reduced or discontinued in nine of sixteen patients, while risperidone was switched to olanzapine or quetiapine in other 7 patients according to the clinician's decision.

Results:Fourteen of 16 patients showed higher levels of prolactin than normal level. Five patients of the risperidone-reduction group recovered from the amenorrhea while all subjects of the drug-switch group recovered. The resolved patients of the former group recovered from amenorrhea in the dosage below 3mg per day of risperidone. Two patients of the risperidone-reduction group were dropped out during the reduction.

Conclusion:These findings suggest that risperidone-induced amenorrhea may be alleviated by reducing dosage to less 3mg per day(including discontinuation) or by switching to other antipsychotic drugs. Whether we would choose which method depends on patient's clinical status, diagnosis, and dose of medication and so on.

Keywords

Risperidone;Amenorrhea;Schizophrenia;Mania;Depression.

Neurocognitive Functions in Posttraumatic Stress Disorder

Sun-Kook Kim, MD;Kang-Joon Lee, MD, PhD;Seung-Hwan Lee, MD, PhD;Min Nam, MD, PhD; and Young-Cho Chung, MD, PhD

Department of Neuropsychiatry, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 147-58.

Abstract

ObjectiveThe differences of various neurocognitive functions, including attention, memory, motor function, and higher cognitive function were compared between PTSD patients and normal control subjects. Also, correlation with PTSD symptom severity and neurocognitive functions were evaluated between PTSD patients and normal control subjects.

Method:We assessed the neurocognitive functions by computerized neurocognitive test(CNT) batteries. The visual continuous performance test(CPT) and digit span test, finger tapping test and Wisconsin card sorting test(WCST) were executed. The Impact of Event Scale-Revised(IES-R) was used in the evaluation of the severity of PTSD.

Result:The PTSD patients showed significantly impaired neurocognitive performance in all of the items, compared with normal control subjects. The relation between impairment in neurocognitive functions and symptom severity showed significant correlations. 

Conclusion:These results imply that PTSD patients have impaired neurocognitive functions concerning with specific brain areas, especially the frontal area. For the thorough evaluation of further neurocognitive functions, more detailed evaluation items of neurocognitive functions and brain imaging studies are necessary in the future study.

Keywords

PTSD;Neurocognitive functions.

Association of Serotonin Transporter Gene Polymorphism with Alcohol Dependence

Hyun-Gyun Son, MD1;Ihn-Geun Choi, MD1;Young-Gyu Chai, PhD2;Mi Ran Choi, PhD2;Jae Hwan Kim, PhD3;Byung-Hwan Yang, MD3;Seok Hyeon Kim MD3; and Seung Mo Sung, MD4;

1;Department of Neuropsychiatry, Hallym University, Seoul, 2;Department of Biochemistry and Molecular biology, Hanyang University, Ansan, 3;Department of Neuropsychiatry, Hanyang University, Seoul, 4;Seoul Baikjae Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 159-67.

Abstract

ObjectiveUnder the hypothesis that 5-HTTLPR polymorphism plays some role in the susceptibility or vulnerability of some subgroup of alcohol dependence, associations of 5-HTTLPR polymorphism with alcohol dependence were examined. 

Method:This association analysis included 109 Korean alcohol dependent and 113 Korean control subjects. DNA of all subjects were genotyped for the biallelic functional polymorphism in the 5-HTTLPR. Considering the likelihood of heterogeneity in the alcohol dependence phenotype, alcohol dependent subjects were subgrouped by onset age, family history of alcohol dependence and severity of withdrawal symptoms. 

Results:There were no significant differences in the frequencies of either the 5-HTTLPR genotype or the short vs. long allele in alcohol dependent and control subjects. The frequency of the S allele and S-carrier (LS or SS genotype) was significantly increased in the early onset alcohol dependent subjects and the familial alcohol dependent subjects compared with that in the control subjects.

Conclusion:The results suggest that the 5-HTT 'S' promoter polymorphism is associated with an increased susceptibility or vulnerability to develop early onset alcohol dependence and familial alcohol dependence, which characterize Cloninger's type 2 alcohol dependence. 

Keywords

Serotonin transporter;Polymorphism;5-HTTLPR;Alcohol dependence.

The P300 Source Localization in the Patients with Obsessive-Compulsive Disorder using the LORETA Imaging and SPM

Sung-Kun Park, MD1;Jung-Seok Choi, MD1;Soh-Young Yu, MD1;Bo Reom Lee, MD2;Seung-Suk Kang, MD2;Kyu Sik Roh, MD1;Tae-Hyun Ha, MD1;Jun Soo Kwon, MD, PhD1;

1;Department of Psychiatry, Seoul National University College of Medicine, Seoul, 2;Clinical Research Institute, Seoul National University Hospital, College of Medicine, Seoul. Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 168-76.

Abstract

ObjectivesWe investigated the characteristics of P300 generators in obsessive-compulsive disorder(OCD) patients by using voxel-based statistical parametric mapping of current density images.

Methods:P300 generators, produced by a rare target tone of 1500Hz under a frequent non-target tone of 1,000Hz, were measured in 15 right-handed OCD patients and 15 controls. Low Resolution Electromagnetic Tomography(LORETA), using a realistic head model of the boundary element method based on individual MRI, was applied to the 128-channel EEG. Statistical parametric mapping(SPM) was applied for the statistical analysis.

Results:We found that both groups had the mean current density of P300 in the parietal, temporal and prefrontal lobe. There was a trend for decreased current density in the prefrontal area in OCD patients. The statistical comparison showed current density increase in the supraparietal area, a statistically significant longer P300 latency and a trend for reduced P300 amplitude in OCD patients.

Conclusion:It suggests that P300 source of both groups exists in multiple brain regions at the same time. And both groups had no statistically significant differences in the current density of P300 except for increased current density in the supraparietal area in OCD patients. But, considering the statistically significant longer P300 latency, a trend for reduced P300 amplitude and relative mean current density reduction in the prefrontal area in OCD patients, this study suggests that the frontal lobe may have a reduced normal inhibitory process in OCD patients.

Keywords

Obsessive-compulsive disorder;P300;Source localization;LORETA;SPM.

Prolactin Response to Antipsychotic Drug and Dopamine Transporter Gene Polymorphisms

Bun-Hee Lee, MD1;Yong-Ku Kim, MD1; and Kwang-Yoon Suh, MD2;

1;Department of Psychiatry College of Medicine, Korea University Ansan Hospital, Ansan, 2;Department of Psychiatry College of Medicine, Korea University Anam Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 177-85.

Abstract

ObjectWe investigated the relationship between prolactin response to antipsychotics and clinical courses of psychotic symptoms and DAT gene polymorphisms.

Method:Twenty-four acute psychotic inpatients completed the 12-week trial of risperidone. Serum prolactin, BPRS, ESRS and hyperprolactinemia-related symptoms were measured at baseline, 2, 4, 8 and 12 weeks after medication. The DAT gene polymorphisms were analyzed.

Results:The serum prolactin was significantly increased over time. According to the prolactin level at 2-week, the subjects were divided into the severe group(serum prolactin>60ng/mL, N=15) and the mild group (serum prolactin<60ng/mL, N=9). The prolactin levels of the mild group didn't increase beyond 60ng/mL throughout 12 weeks. Severe group had slower decrement of BPRS scores than those of mild group. Six females in severe group complained of irregular menstruations, but no female in mild group. Most patients had 10 allele of DAT gene.

Conclusion:This study suggests that the magnitude of prolactin elevation at the 2-week of risperidone medication is correlated with severity of hyperprolactinemia throughout treatments. Our results did not show the relationship between prolactin responses and DAT gene polymorphisms.

Keywords

Antipsychotic drug;Risperidone;Prolactin;Dopamine transporter gene polymorphisms;Schizophrenia;Bipolar disorder.

The Development of Behavioral Modification Program on Weight Reduction in Overweight Patients taking Atypical Antipsychotics - Preliminary Study -

Hong Beom Shin, MD1;Jong Ho Park, MD1;Bo Seok Cha, MD1;Byung Soo Kim, MD1;Suk Kyung Lee, RN2;Hak Lyung Kim, SW3;Yong Sik Kim, MD1;Young Min Ahn, MD1; and Ung Gu Kang, MD1;

1;Department of psychiatry, Seoul National University College of Medicine, Seoul, 2;Department of Psychiatry, Seoul National University Hospital, Seoul, 3;Department of Social Work, Seoul National University Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 10, No. , pp. 186-96.

Abstract

ObjectsThe authors developed a behavioral modification program for overweight outpatients with schizophrenia and bipolar disorder who had been treated with atypical antipsychotics, and evaluated the applicability of this program to outpatients.

Methods:Two men and nine women who had been treated with atypical antipsychotics and who had gained at least 5 percent of their pre-treatment body weight for 10 weeks, attended a behavioral modification program. The patients' weight, body mass index and the diet-activity scale were assessed and were compared with those of a matched comparison group who did not attend the behavioral modification program.

Results:The body weight of patients who attended the behavioral modification program reduced with statistical significance. The treatment group showed significant improvement in diet-related items but not in activity-related items of the diet-activity scale.

Conclusions:This study suggested the applicability of a behavioral modification program on weight reduction to overweight patients taking atypical antipsychotics for the first time in Korea. Additional large scale studies are needed to validate the effectiveness of this program.

Keywords

Atypical antipsychotics;Behavioral modification;Weight reduction.

  • Vol. 9 No.1
  • Vol. 9 No.2

Vol. 9 No.1

Serotonin(2A) Receptor Gene Promoter Polymorphism in Mood Disorder and Mood-Related Disorders

Ik-Seung Chee, MD

Department of Psychiatry, College of Medicine, Chungnam National University, Daejon, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 3-7.

Abstract

Genes involved in the serotonin system are good candidates for the pathogenesis of mood disorder and mood-related disorders, such as eating disorder, obsessive-compulsive disorder, alcoholism, and suicide. Serotonin type 2A(5-HT2A) receptor gene promoter polymorphism(-1438A/G) has been reported. In this article, authors reviewed the literatures regarding association studies between -1438A/G and mood disorder and mood-related disorders. There are controversial results with limited data to date. Further researches on the -1438A/G in psychiatric disorders are required.

Keywords

Mood disorders;5-HT2A receptor gene promoter;Polymorphism;-1438A/G.

Dopamine Transporter Gene Polymorphism in ADHD

Dongwon Shin, MD, PhD

Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 8-14.

Abstract

Patients with attention deficit hyperactivity disorder(ADHD) have symptoms of inattention, hyperactivity, impulsivity. Symptoms of ADHD are responsive to medications such as methylphenidate, dextroamphetamine, pemoline, and bupropion. The functional change of the dopamine transporter is related to the therapeutic effect of these drugs. This can be one reason for the dopamine transporter to be emphasized in the research field of ADHD. ADHD has a genetic tendency. Since dopamine transporter gene(DAT1) knock out mice were reported to be several times more active than normal mice in a novel situation, lights has been shed on DAT1 as a candidate gene for ADHD. Though there have been several studies which reported an association between DAT1 and ADHD, the association between DAT1 and ADHD is not conclusive. Since Vandenbergh reported the DAT1 polymorphism with variable number of tandem repeats(VNTR), and the racial differences in allelic frequencies of the DAT1, wide ethnic variation in the distribution of the DAT1 polymorphism had been confirmed. Wide ethnic variation in the distribution of the DAT1 suggested that there might be ethnic difference in the association between DAT1 and ADHD. Before applying previous findings to Koreans, verification might be needed for Korean patients with ADHD.

Keywords

Dopamine transporter gene;Polymorphisms;Attention deficit hyperactivity disorder.

Polymorphisms of the Dopamine Receptor Genes in Alcoholism

Seung Ho Ryu, MD

Department of Psychiatry, Konkuk University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 15-24.

Abstract

Even though alcoholism is a multi-factorial psychiatric disorder, it is reasonable to suppose that genetic factors play a substantial role in the manifestation of this disorder. Because alcohol is the reinforcing substance which manifests its effects through activation of the mesolimbic dopaminergic reward pathway of the brain, the gene encoding dopamine receptor subtypes can be a major natural candidate gene. Since 1990, many association studies have identified strong evidence implicating the dopamine D2 receptor(DRD2) gene in alcoholism, specifically TaqI A minor(A1) allele. Association studies have also been conducted on other dopamine receptor(DRD3 & DRD4) polymorphisms but the results have yet to be confirmed. Through a number of other approaches, each dopamine receptor gene has been investigated in association with different phenotypes in alcoholism, but further researches will be needed. In conclusion, studies in the past decade have shown that the TaqI A1 allele of the DRD2 gene is associated with alcoholism in various subject groups. Other dopamine receptor genes have since been added to the list but yet to be identified. Thus, the knowledge of these genes and their functional significance will enhance the understanding of the underlying biological mechanisms of alcoholism. Furthermore, it could lead to more helpful prevention and treatment approaches to alcoholism.

Keywords

Alcoholism;Dopamine receptor genes;Allele;Polymorphism.

The Use of Pharmacogenomic Method for the Prediction of Antidepressant Responsiveness

Doh Kwan Kim, MD1; and Shinn-Won Lim, MD2;

1;Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 2;Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 25-33.

Abstract

Serotonin transporter(5-HTT) is one of the major action site of antidepressants in neuronal cells. According to the recent studies, it is known that the functional polymorphism in the promoter region of the 5-HTT gene(5-HTT linked polymorphism repetitive element in promoter region, 5-HTTLPR) is associated with antidepressant responsiveness, and the distributions of 5-HTTLPR is various among the different populations. Our preliminary study suggested that it is possible to measure the endophenotype of 5-HTTLPR genotype by examining the pharmacodynamic research of the 5-HTT in platelet membranes. However, there are limitations to predicting the antidepressant responsiveness only from the endophenotypic characteristics of 5-HTT gene promoter polymorphism, and therefore we propose to use the pharmacogenomic methods for overcoming these limitations. We found that the significant correlations existed among the genetic polymorphisms of biogenic amine transporters whose structure and characteristics are similar to the 5-HTT, and the predictable odds ratio of antidepressant responsiveness are increased significantly by combining the effect with other associated polymorphisms, compared to the effect of 5-HTT promoter polymorphism only. These results support the hypothesis that antidepressant treatment has to be individualized according to the genetic and ethnic background of depressed patients. It would be possible to develope the evaluation tools to predict the antidepressant responsiveness and its side effect profile, if scientists reveal the genes related to the action mechanism as well as the metabolism of antidepressants so as to discover the interaction of those genes and contribution of endogenotypes toward antidepressant responsiveness.

Keywords

Serotonin transporter;Biogenic amine transporter;Pharmacogenomics;Antidepressant.

5-HTTLPR and Long-term Effect of Antidepressant Treatment in Korean Depressive Patients

Hwa Young Lee, MD;Byung-Joo Ham, MD; and Min Soo Lee, MD, PhD

Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 34-41.

Abstract

BackgroundSince serotonin neurotrasnmission plays an important role in the pathophysiology of depression, the drug that acts on serotonin transporter can be an effective antidepressant. The aim of this study was to investigate the relationship between serotonin transporter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment.

Method:The 175 depressive patients, who met DSM-IV criteria for major depressive disorder or dysthymic disorder were enrolled into three year study. The genotypes of the patients were investigated by polymerase chain reaction of genomic DNA with promoter regions of the serotonin transporter gene. The patients were assessed by the Clinical Global Impression Scale, at the 1st visit, 8th week, 16th week, 1st year, 2nd and 3rd year after the antidepressant treatment.

Result:The genotypes of 138 patients were investigated and 128 of them finished this 1st year study and 107 remained in the study after 2-year treatment, and, 97 completed this 3-year study. The therapeutic response of each subset was not different at 8th, 16th week, but the subset with homozygote(l/l) of long variant showed a better antidepressant therapeutic response than heterozygote(l/s). The heterozygote(l/s) showed a better response than the subset with homozygote(s/s) of short variant at 1st, 2nd and 3rd year after the antidepressant treatment in CGI-global improvement score. 

Conclusion:This result shows that the serotonin transporter polymorphism may be related to the long-term effect of antidepressant treatment and there may be also ethnic difference.

Keywords

Depression;Serotonin transporter;Polymorphisms;Long-term;Antidepressant.

Association of Genetic Polymorphisms of Aldehyde Dehydrogenase II and CYP2E1 and Clinical Characteristics of Patients with Alcohol Dependence

In-Won Chung, MD, PhD1;Yeoung-Rang Kim, MD1;Kyung-Hwan Chi, MD1; and Heon Kim, MD, PhD2;

1;Department of Neuropsychiatry, 2;Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 42-9.

Abstract

ObjectiveThis study was to explore the relation of genetic polymorphisms of ALDH2 and CYP2E1 to clinical characteristics of alcoholic patients and alcohol induced liver damage.

Methods:The genotype and allele frequencies of 128 male hospitalized patients who met DSM-IV criteria for alcohol dependence were compared with 128 healthy male control subjects. The genetic informations of ALDH2 and CYP2E1 were identified with the technique of polymerase chain reaction and restriction fragment length polymorphism. The clinical characteristics of the alcoholic patients were assessed and analyzed in relation to the family history of alcoholism. For the relation of CYP2E1 genetic polymorphism to the liver damage, the blood levels of various liver function indicators such as ALT, AST, and protein were checked out.

Results:1) The alcoholic patients with the family history of alcoholism had the earlier onset of age(p=0.001), the longer duration of illness(p=0.045), and higher NCA scores(p=0.018) than those without the family history of alcoholism. 2) Most alcoholic patients were homozygous for ALDH2*1, compared to control subjects(p=0.000). 3) There was no difference of CYP2E1 distribution between alcoholic patients and control subjects. However, alcoholic patients having mutant c2 allele showed higher alcoholism severity scores(p=0.004) and more hospitalizations(p=0.014) than those having c1 allele. 4) There was no relationship between CYP2E1 genotype and the functional abnormalities of the liver.

Conclusion:This study suggests that ALDH2*1 is highly related with alcohol dependence. Also mutant c2 allele of CYP2E1 is correlated with the severity of alcoholism and the number of hospitalization. But genetic polymorphim of CYP2E1 seems to have no relation to liver damages.

Keywords

Alcohol dependence;Genetic polymorphism;Aldehyde dehydrogenase;Cytochrome P4502E1.

Relationships between Nailfold Plexus Visibility, and Clinical Variables and Neuropsychological Functions in Schizophrenic Patients

Dae-Yeob Kang MD; and Hye-Ryeon Jang MD

Yong-In Mental Hospital, Yongin, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 50-61.

Abstract

ObjectivesHigh nailfold plexus visibility can reflect central nervous system defects as an etiologic factor of schizophrenia indirectly. Previous studies suggest that this visibility is particularly related to the negative symptoms of schizophrenia and frontal lobe deficiency. In this study, we examined the relationships between nailfold plexus visibility, and various clinical variables and neuropsychological functions in schizophrenic patients. 

Methods:Forty patients(21males, 19 females) satisfying the DSM-IV criteria for schizophrenia and thirty eight normal controls(20 males, 18 females) were measured for Plexus Visualization Score(PVS) by using the capillary microscopic examination. For the assessment of psychopathology, process-reactivity, premorbid adjustment, and neuropsychological functions, we used Positive and Negative Syndrome Scale(PANSS), Ullmann-Giovannoni Process-Reactive Questionnaire(PRQ), Phillips Premorbid Adjustment Scale(PAS), Korean Wechsler Adult Intelligence Scale(KWIS), Continuous Performance Test(CPT), Wisconsin Card Sort Test(WCST), and Word Fluency Test. We also collected data about clinical variables. 

Results:PVS was correlated with PANSS positive symptom score and composite score negatively. There were no correlations between PVS and PRQ score, PAS score and neuropsychological variables respectively. 

Conclusions:This study showed that nailfold plexus visibility was a characteristic feature in some schizophrenic patients, and that higher plexus visibility was associated with the negative symptoms of schizophrenia. There was no association between plexus visibility and neuropsychological functions.

Keywords

Schizophrenia;Nailfold plexus visibility;Negative symptoms;Neuropsychological function.

The Association between Korean Schizophrenics and Catalase Gene Polymorphism

Jin-Kyung Park, MD1;Hee-Jae Lee, MS2;Geon-Ho Bahn MD1;Jong-Deuk Park, MD3;Joo-Ho Chung, MD2; and Hwan-Il Chang, MD1;

1;Department of Neuropsychiatry, 2;Pharmacology, College of Medicine, Kyung-Hee University, Seoul, 3;Kim-Cheon Neuropsychiatric Hospital, Kim-Choen, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 62-7.

Abstract

ObjectiveThere is increasing evidence that free radical-mediated CNS neuronal dysfunction is involved in the pathophysiology of schizophrenia. This study was performed to examine the relationship between antioxidant defense system and schizophrenia by analyzing polymorphism of catalase gene, an antioxidant enzyme. 

Method:Genotype and allele frequencies in the promoter region in the catalase gene using restriction fragment length polymorphism were studied, comparing 155 Korean controls with 167 Korean schizophrenics. 

Results:No difference was found between the schizophrenics and the controls in genotype and allele frequencies of HinfⅠ polymorphism in the catalase gene. Significant difference was found between the female schizophrenics and the female controls in the genotype distribution(χ2=11.096, df=2, p=0.004). 

Conclusions:The results do not support an association between polymorphism of catalase gene and schizophrenia. However, this study suggests that HinfⅠ polymorphism in the catalase gene could be associated with female schizophrenics. 

Keywords

Schizophrenia;Free radical;Catalase;Polymorphism;Association.

Vol. 9 No.2

Neurobiological Mechanism of Psychotherapy

Seung-Hwan Lee, MD, PhD1;Seung-Hyun Kim, MD, PhD2;

1;Department of Neuropsychiatry, Ilsanpaik hospital, College of Medicine, Inje University, Koyang, 2;Department of Neuropsychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 79-94.

Abstract

Polarisation of biological and psychosocial aspects of psychiatry is nowadays main stream. Current knowledges of the interaction between biology and psychology make it possible to consider a truly integrative approach of the two aspects. Research findings suggest that the neuronal plasticity is the key mechanism to answer how the mental function work to an environmental stimuli and how the psychotherapeutic approach work on the brain. Advances in neuroscience research have led to a more sophisticated understanding of how psychotherapy may affect brain function. Even though there have been a tremendous efforts to find out the neurobiological mechanism of mental function, the answer is at best premature. In this article, research findings about of neuronal plasticity, implicit memory, animal studies which were associated with psychotherapy and psychological aspects were reviewed.

Keywords

Psychotherapy;Neurobiology;Neural plasticity;Implicit memory.

Depression and the Frontal Lobe

Jeong-Ho Chae, MD;Kyung-Uk Lee, MD;Wan-Seok Yang, MD;Won-Myong Bahk, MD;Tae-Youn Jun, MD;Kwang-Soo Kim, MD

Department of Psychiatry, College of Medicine, The Cath-olic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 95-102.

Abstract

ObjectivesAbnormalities in the frontal lobe have been consistently suggested in the pathophysiology of depression. The purpose of this review is to discuss the relationship between the frontal lobe and depression.

Methods:Recent researches on the frontal lobe in depression were reviewed and abnormalities in this region were considered within the context of modern functional neuroanatomy.

Results:This paper reviewed evidence strongly implicating the frontal lobe as a key brain structure in depression.

Conclusion:Taken together, these abnormalities in the function of the frontal lobe implicate interconnected neural circuits in depression and offer suggestions for the themes of future research and treatment. Further research is needed to investigate the association between emotion and the brain in the paradigm of "affective neuroscience".

Keywords

Depression;Frontal lobe;Neuroanatomy;Functional neuroimaging;Affective neuroscience.

The Comparison of the Neurocognitive Functions between Dysthymic Disorder and Major Depressive Disorder

Rhee-Hun Kang, MD;Byung-Joo Ham, MD;Ji-Hyun Cha, MD;Min-Soo Lee, MD, PhD

Department of Neuropsychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 103-11.

Abstract

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal brain-damaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.

Keywords

Neurocognitive functions;Dysthymic disorder;Major depressive disorder.

Speech Perception Ability of Schizophrenics- A Comparative Study with Depressives & Normal Control -

Young-Cho Chung, MD;PhD;Soon Jeong Lee, MD;Seung-Hwan Lee, MD, PhD

Department of Neuropsychiatry, College of Medicine, Inje University, Ilsan Paik hospital, Koyang, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 112-9.

Abstract

ObjectThis study was to investigate the difference of speech perception ability in schizophrenic patients, and depression patients in order to explore trait-dependent speech perception ability of each disorder.

Methods:The speech perception ability was assessed with masked speech tracking test(MST) in schizophrenic patients(N=31), depression patients(N=25), and normal controls(N=21). The continuous performance test(CPT) and sentence repetition test(SRT) were also used for assessment of attention and working memory. 

Results:The schizophrenic patients showed significant impaired MST performance, compared with depressive patients and normal controls. The performances of CPT and SRT were also more impaired in schizophrenic patients. The difference of MST performances between two patient group was cancelled out after consideration of differences in CPT & SRT performances.

Conclusions:These results imply that schizophrenic patients have the impaired speech perception ability compared with depressive patients and normal controls. But speech perception ability was significantly influenced with CPT and SRT. For evaluation of pure speech perception ability, the more elaborate controlled study that excluded factors such as attention, working memory and intelligence is needed.

Keywords

Schizophrenia;Speech perception.

The Effect of Cognitive Rehabilitation Program for Traumatic Brain Injury Patients

Joon-Ho Park, MA;Han-Yong Jung, MD, PhD;SoYoung Irene Lee, MD, PhD

Department of Psychiatry, College of Medicine, Soonchunhyang Bucheon Hospital, Soonchunhyang University, Bucheon, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 120-8.

Abstract

ObjectivesThe purpose of this study was to develop a cognitive rehabilitation program and to investigate the effect of the program that restores the deficiency of memory, which is necessary to operate on high cognitive function such as problem-solving or judgement, for TBI(traumatic brain injury) patients.

Methods:Sixteen TBI patients participated in this study. The inclusion criteria were:1) aged 18 to 60;2) higher than IQ 80;3) lower than MMSE-K 25 and K-MAS(Korean version of Memory Assessment Scale) 85. We administered our program to an experimental group(N=8) in order to improve attention and memory for 4 weeks(total 12 section). Our program was not administrated to a control group(N=8) for 4 weeks. After administrating this program, we measured MMSE-K and K-MAS for the experimental and control groups.

Results:The findings of the study were as follows. 1) the experimental group showed significant improvement on MMSE-K score in comparison with baseline, but the control group did not. 2) the experimental group showed significant improvement on K-MAS score in comparison with baseline, but the control group did not. In particular, among the three subscales of K-MAS, only verbal memory scale revealed significant improvement, while visual and short-term memory scales revealed no differences.

Conclusion:Our cognitive rehabilitation program improves cognitive state and memory, particulary verbal memory, for TBI patients. These results imply that our program aids in rehabilitation of basic cognition such as memory which is necessary to operate on high cognitive function such as problem-solving or judgement, for TBI(traumatic brain injury) patients.

Keywords

Traumatic brain injury;Cognitive rehabilitation;Stage model.

Trends in the Prescribing of Antimanic Agents for Acute Manic Inpatients

So Young Irene Lee, MD, PhD;Han-Yong Jung, MD, PhD;Yong-Ho Jun, MD

Department of Psychiatry, College of Medicine, Soonchunhyang Bucheon Hospital, Soonchunhyang University, Gyeonggi, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 129-39.

Abstract

ObjectiveThis study was performed to investigate the prescribing patterns of antimanic agents in the treatment of acute bipolar disorder inpatients in Korea from 1990 through 2000. The results will serve as the basic data for the practice guideline for the pharmacotherapy of bipolar disorder patients in Korea.

Method:Retrospective chart review of bipolar disorder inpatients of Soonchunhyang Medical Center in Seoul and Chun-An was conducted for each of the year 1990, 1995, and 2000. The following data are collected; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, 4) detailed drug titration records of antimanic agents and antipsychotic agents.

Results:During the last decade, the frequency of lithium monotherapy was decreased obviously. Instead, more than half of the patients in 2000 were on combination therapy of lithium and anticonvulsants. Lithium-valproate combination was the preferred strategy and the use rate of carbamazepine has been decreased. In addition, most of the patients were given antipsychotic agents during the last 10 years. And recently, atypical antipsychotics were increasingly prescribed. These changes in the field of pharmacology of bipolar disorder have resulted neither in shorter hospital stays nor lower dosages of concurrent neuroleptics.

Conclusions:The results indicate the trends in the prescribing of antimanic agents for the treatment of bipolar disorder in Korea across the past 10 years. Mostly, the change seems to correspond to the international practice guideline. More systematic research is needed to find out the clinical benefits of the anticonvulsants in the real practice of treatment of bipolar disorder.

Keywords

Bipolar disorder;Pharmacotherapy;Antimanic agents;Antipsychotic agents.

Minor Physical Anomalies in Patients with Schizophrenia

Eun-Jeong Joo, MD1;Seong Hoon Jeong, MD2;So Jin Maeng, MD3;Se Chang Yoon, MD4;Jong Hoon Kim, MD4;Chul Eung Kim, MD, PhD5;Youngmin Shin, MD, PhD6;Yong Sik Kim, MD, PhD4;

1;Department of Psychiatry, Eulji Medical University, Eulji Hospital, Seoul, 2;Chookryoung Evangelical Hospital, Namyangju, 3;Department of Psychiatry, Seoul National University Hospital, Seoul, 4;Department of Psychiatry, Seoul National University, College of Medicine, Seoul, 5;Department of Psychiatry, Inha University, College of Medicine, Incheon, 6;Department of Psychiatry, Kangnam General Hospital, Public Corporation, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 140-51.

Abstract

Object and MethodMinor physical anomalies(MPAs) are frequently seen in patients with schizophrenia. MPAs are considered to arise from the anomalous development of ectoderm-originated tissues in the developing fetus. Since the central nervous system originates from ectoderm, MPAs can be regarded as externally observable and objective indicators of the aberrant development which might have taken place in the central nervous system. To investigate whether MPAs are more frequent in schizophrenic patients, the frequencies of MPAs were compared between schizophrenic patients and normal controls. Total 245 schizophrenic patients diagnosed with DSM-IV(male:158, female:87), and 418 normal control subjects(male:216, female:202) were included in this study. The MPAs were measured using the modified Waldrop scale with fifteen items in six bodily regions; head, eye, ear, mouth, hand, and foot. 

Result:The total scores of Waldrop scale were 4.40±1.93(mean±standard deviation) in patients and 3.43±1.68 in controls for females, and for males, 4.58±1.75 in patients and 4.28±1.59 in controls. For females, the excess of MPAs in schizophrenic patients was statistically significant(t-test:p<0.001). For males, schizophrenic patients also showed more MPAs than normal controls, but this tendency did not reach statistical significance (t-test:p=0.094). When the modified Waldrop total scores excluding head circumference were compared, the total scores in schizophrenic patients were significantly higher for both male and female subjects(t-test:male p<0.001, female p=0.001). The individual anomaly items included in Waldrop scale were also investigated. The items of epicanthus, hypertelorism, malformed ears, syndactylia were significantly more frequent in schizophrenic patients. In contrast, the items of adherent ear lobes, asymmetric ears, furrowed tongue, curved fifth finger, single palmar crease and big gap between toes did not show any differences in frequency between schizophrenic patients and normal controls. Since a lot of statistical analyses showed different results between male and female subjects, it seems to be necessary to consider gender as an important controlling variable for the analysis, however only the item of head circumference showed statistically significant gender-related difference according to log-linear analysis. 

Conclusion:With a relatively large sample size, the frequencies of MPAs enlisted in Waldrop scale were compared between schizophrenic patients and normal controls in this study. MPAs were more frequently seen in schizophrenic patients and, especially, several specific items in the Waldrop scale showed prominent excess in schizophrenic patients. Although definite conclusions cannot be drawn due to the inherent limitation of the study using Waldrop scale, these results seem to support the possibility that aberrant neurodevelopmental process might be involved in the pathogenesis of schizophrenia in some of the patients.

Keywords

Minor physical anomalies;Waldrop scale;Schizophrenia;Neurodevelopmental anomaly.

Reduced Regional Cerebral Blood Flow in Patients with Traumatic Brain Injury Who Had No Structural Abnormalities on Magnetic Resonance Imaging:A Quantitative Evaluation of Tc-99m-ECD SPECT Findings

Nam-Hee Kim, MD;Young-Ki Chung, MD

Department of Psychiatry, School of Medicine, Ajou University, Suwon, Korea

Korean Journal of Biological Psychiatry, Vol. 9, No. , pp. 152-8.

Abstract

Background & PurposeNeuropsychological disorders after traumatic brain injury(TBI) are poorly correlated with structural lesions detected by structural neuroimaging techniques such as computed tomography(CT) scan or magnetic resonance imaging(MRI). It is well known that patients with TBI have cognitive and behavioral disorders even in the absence of structural lesions of the brain. This study investigated whether there are abnormalities of regional cerebral blood flow(rCBF) in TBI patients without structural abnormality on MRI, using technetium 99m ethyl cysteinate dimer(Tc-99m-ECD) single photon emission computed tomography(SPECT) scans.

Materials and Methods:Twenty-eight TBI patients without structural abnormality on MRI(mild, n=13/moderate, n=9/severe, n=6) and fifteen normal controls were scanned by SPECT. A voxel-based analysis using statistical parametric mapping(SPM) was performed to compare the patients with the normal controls.

Results:rCBF was reduced in the right uncus and the right lateral orbitofrontal gyrus in the TBI patients. However, no increase of rCBF was noted in the patients in comparison to the normal controls.

Conclusions:These results suggest that the TBI patients, even in the absence of structural lesion of the brain, may have dysfunction of the brain, particularly of the orbitofrontal and anterior pole of the temporal cortex. They also suggest that SPECT can be a useful method to identify brain dysfunctions in combination with structural brain imaging and neuropsychological tests.

Keywords

Traumatic brain injury;Single photon emission computed tomography;Statistical parametric mapping.

  • Vol. 8 No.1
  • Vol. 8 No.2

Vol. 8 No.1

The New Neurobiology of Depression

Yong Ku Kim, MD, PhD

Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 3-19.

Abstract

Recent basic and clinical studies demonstrate a major role for neural plasticity in the etiology and treatment of depression and stress-related illness. The neural plasticity is reflected both in the birth of new cell in the adult brain(neurogenesis) and the death of genetically healthy cells(apoptosis) in the response to the individual's interaction with the environment. The neural plasticity includes adaptations of intracellular signal transduction pathway and gene expression, as well as alterations in neuronal morphology and cell survival. At the cellular level, repeated stress causes shortening and debranching of dendrite in the CA3 region of hippocampus and suppress neurogenesis of dentate gyrus granule neurons. At the molecular level, both form of structural remodeling appear to be mediated by glucocorticoid hormone working in concert with glutamate and N-methyl-D-aspartate(NMDA) receptor, along with transmitters such as serotonin and GABA-benzodiazepine system. In addition, the decreased expression and reduced level of brain-derived neurotrophic factor(BDNF) could contribute the atrophy and decreased function of stress-vulnerable hippocampal neurons. It is also suggested that atrophy and death of neurons in the hippocampus, as well as prefrontal cortex and possibly other regions, could contribute to the pathophysiology of depression. Antidepressant treatment could oppose these adverse cellular effects, which may be regarded as a loss of neural plasticity, by blocking or reversing the atrophy of hippocampal neurons and by increasing cell survival and function via up-regulation of cyclic adenosine monophosphate response element-binding proteins(CREB) and BDNF. In this article, the molecular and cellular mechanisms that underlie stress, depression, and action of antidepressant are precisely discussed.

Keywords

Neural plasticity;Intracellular signal transduction;Apoptosis;Neurogenesis;Stress;Depression.

The Understanding of Depression Subtypes

Chang-Hwan Han, MD, PhD; and Seong Gon Ryu, MD

Department of Neuropsychiatry, Hallym University College of medicine, Kang-Dong Sacred Heart Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 20-36.

Abstract

The debate about whether depressive disorders should be divided into categories or arrayed along a continuum has gone for decade, without resolution. In our review, there is more evidence consistent with the spectrum concept than there is with the idea that depressive disorders constitute discrete clusters marked by relatively discontinuous boundaries. First, "depression spectrum", "is there a common genetic factors in bipolar and unipolar affective disorder", "threshold model of depression" and "bipolar spectrum disorder" are reviewed. And, a new subtype of depression is so called SeCA depression that is a stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression. SeCA depression is discussed. But, there is with the idea that depressive disorders constitute discrete subtypes marked by relatively discontinuous boundaries. This subtypes of depressive disorder were reviewed from a variety of theoretical frames of reference. The following issues are discussed;Dexamethasone suppression test(DST), TRH stimulation test, MHPG, Temperament Character Inventory(TCI), and heart rate variability(HRV).

Keywords

Depression;Subtype;Depressive spectrum disease;SeCA depression;Dexamethasone suppression test(DST);Heart rate variability(HRV).

Difficult Clinical Problems of Treatment in Depression

Kyung-Joon Min, MD

Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 37-46.

Abstract

Whenever a clinician manages the patients with depression, he may meet various problems that make it difficult to treat them. Even though he has good skills and knowledge about depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather than the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used during pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms during pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes following prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.

Keywords

Depression;Treatment-resistance;Pregnancy.

Interaction between Personality and Depression Outcome

Yong Chon Park, MD, PhD; and Seok Hyeon Kim, MD, PhD

Department of Neuropsychiatry, College of Medicine, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 47-52.

Abstract

It is known that the personality is the crucial factor in the treatment outcome of depression. The authors tried to identify the results of such studies and various components which determine the treatment outcome of depression. Nearly 60 papers published between the year 1990 and 2000 about the treatment of depression and personality were reviewed. Among them about 30 papers were selected to compare the research methods, results and discussions. The arguments and critics of the papers were discussed. In the many debates, the authors admitted the fact that premorbid personality trait influences the treatment outcome of depression negatively regardless of treatment method. Subtyping of depression is feasible along the presence of good or bad predictors of treatment outcome for depression. Differentiation of depression and personality seems to have no problem, however test of personality state before the development of psychiatric disorder such as depression is not amenable. For example, cluster A personality trait is often misunderstood as depression in clinical setting. In some cases cognitive behavioral therapy is effective in the treatment of depression accompanying personality disorder. The authors insist that the analysis of personality in the dimensional aspect rather than in the categorical aspect gives more information in the research of personality influencing the treatment outcome of depression. In addition, the reason why we understand the relationship between depression and personality were discussed.

Keywords

Depression;Personality;Treatment outcome;Interaction.

Psychiatry, Is It Now Okay?- Enlarging the Boundary of Psychiatry in the Neuroscience Era

Jonghan Park, MD, MA, DMSc1; and Nam Soo Kim, MD2;

1;Department of Psychiatry, Catholic University of Taegu School of Medicine, Teagu, 2;Teagu Mental Hospital, Taegu, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 53-61.

Abstract

The authors, in this paper, addressed a variety of problems and difficulties which Korean psychiatrists should cope with. The surprising development of neurosciences, splitting of neuropsychiatry into neurology and psychiatry, easygoing attitude of psychiatrists, changes in the delivery system of health care and ill-balanced education of psychiatry were listed as causes of or contributors to them. Social bias to psychiatry and regulations from outside are also considered as contributors. Psychiatric education, including medical school, residency training, continuing medical education and psychiatric textbooks, need to be changed in order to enlarge the boundary of psychiatry. Reestablishment of identity of psychiatry and psychiatrist is unavoidable, considering far-reaching new knowledge of neuroscience and gradually invisible borderzone between neurology and psychiatry. The other ways worth while to consider are:the expansion of psychiatrists' activities, development of medical behavioral science to a clinical specialty, creation of new psychiatric subspecialties, and additional training of psychiatric residencies in the primary medical care.

Keywords

Neurology;Neuropsychiatry;Neuroscience;Psychiatry.

Neurobiology of Alzheimer's Disease

Young-Cho Chung, MD;Seung-Woo Seo, MD; and Seung-Hwan Lee, MD

Department of Neuropsychiatry, College of Medicine, Ilsan Paik Hospital, Inje University, Ilsan, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 62-70.

Abstract

Alzheimer's disease(AD) is associated with a characteristic neuropathology. The major hallmarks of AD are senile plaques (SPs) and neurofibrillary tangles(NFTs). β-amyloid protein(Aβ) is derived from the proteolysis of amyloid precursor protein(APP) and then converted to SPs. Mature SPs produce cytotoxicity through direct toxic effects and activation of microglia and complement. NFTs are composed of paired helical filaments(PHFs) including abnormally phosphorylated form of the microtubule-associated protein(MAP) tau and increased tau level in cerebrospinal fluid may be observed in most AD. The aggregation of Aβ and tau formation are thought to be a final common pathway of AD. Acetylcholine, dopamine, serotonin, GABA and their receptors are associated with AD. Especially, decreased nicotinic acetylcholine receptors(nAChRs) in AD are reported. Genetic lesions associated with AD are mutations in the structural genes for the APP located on chromosome 21, presenilin(PSN)1 located on chromosome 14 and PSN2 located on chromosome 1. Also, trisomy 21, Apo-E gene located on chromosome 19, PMF locus, low density lipoprotein receptor-related protein and α-macroglobulin increase risk of AD. In this article, we will review about the neurobiology of AD and some newly developed research areas.

Keywords

Alzheimer's disease;β-amyloid protein;MAP tau;Genetics.

Neurobiology of Anxiety

Seong Gon Ryu, MD; and Chang Whan Han, MD, PHD

Department of Psychiatry, College of medicine, Hallym University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 71-8.

Abstract

The current understanding of the neurobiology of anxiety is generally based on experimental animal model, empirical effective psychopharmacological agents, chemical and naturalistic challenge paradigms, and psychoendocinological assessment. This article focuses on reviewing neuroanantomical, neuroendocinological and neurofunctional research of anxiety disorder. In the decade ahead, we anticipate that extension of current research and the new integrated approach promise novel insight into mechanism of anxiety.

Keywords

Anxiety;Neuroanatomy;Neuroendocrinology;Neuroimaging.

Effect of Pretreatment of(-)-3-PPP on the Haloperidol-Induced Extracellular Dopamine Concentrations in the Nucleus Accumbens of Rats

Young-Chul Chung, MD1;Hong-Bae Eun, MD1;Ik-Keun Hwang, MD1; and Tae-Won Park, MD2;

1;Department of Psychiatry, Institute for Medical Science and Research Institute of Clinical Medicine, Chonbuk National University, Medical School, Chonju, 2;Department of Psychiatry,Chonbuk National University Hospital, Chonju, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 79-84.

Abstract

Objectives:To investigate the effects of(-)-3-PPP(0.5, 2, and 10mg/kg, s.c.) and haloperidol(0.1, 0.5, and 2mg/kg, s.c.) on the extracellular dopamine concentrations, and the effect of pretreatment with(-)-3-PPP(2mg/kg) on the haloperidol(2mg/kg)-induced extracellular dopamine concentrations in the nucleus accumbens(NAS) of free moving rats.

Methods:Dopamine levels in dialysate were determined with high pressure liquid chromatography(HPLC) with electrochemical detection(ECD). 

Results:(1)(-)-3-PPP had dual actions depending on the doses: at 2mg/kg, it decreased and at 10mg/kg, increased extracellular dopamine concentrations;(2) haloperidol at all doses increased dopamine levels with higher dose having a greater increase; and(3) pretreatment of(-)-3-PPP reduced the increase in dopamine levels elicited by acute treatment with haloperidol. 

Conclusions:These findings suggest that pretreatment of(-)-3-PPP in low dose could accelerate the onset of therapeutic effect of haloperidol by diminishing the haloperidol-induced dopamine release in the limbic system. 

Keywords

(-)-3-PPP;Haloperidol;Dopamine;Nucleus accumbens.

C-fos mRNA Expression in Rat Hippocampal Neurons by Antidepressant Drugs

Eung-Chul Park, MD1;Yun-Gyoo Cho, MD2;Byung-Hwan Yang, MD2;Kwang-Iel Kim, MD2;Bo-Gee Yang, MA3; and Young-Gyu Chai, PhD3;

1;Park's Neuropsychiatric Clinic, Seong-Nam City, Kyung-Ki Province, 2;Department of Neuropsychiatry and Mental Health Research Institute, Han-Yang University, Seoul, 3;Department of Biochemistry, College of Science, Han-Yang University, An-san, Kyung-Ki Province, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 85-95.

Abstract

This study was designed to examine the effects of two antidepressant drugs on the expression of c-fos mRNA in cultured embryonic rat hippocampal neurons. The drugs used were imipramine and amitriptyline. On the fourth day of culture, hippocampal neurons were treated with variable concentrations of each drug. Competitive RT-PCR(Reverse Transcriptase-PCR) analysis was used to quantify the c-fos mRNA expression induced by each drug. Experimental results showed that acute and direct treatment with imipramine and amitriptyline with relatively low concentrations(imipramine ≤10μM, amitriptylne ≤10μM) had no inductive effect on the expression of c-fos mRNA in the rat hippocampal neurons. However, after treatment with relatively high concentrations(imipramine ≥100μM, amitriptyline ≥100 μM) c-fos mRNA was not detected. These findings suggest the followings. Firstly, the action mechanisms of these drugs on the hippocampal neurons might not be mediated by c-fos but by other immediate-early genes(IEGs). Secondly, their actions may be mediated indirectly via other areas of the brain. Thirdly, the expression of c-fos might be inhibited by high concentrations of these drugs, or the high concentrations could induce cell death. Finally, though cell death remains to be confirmed, the inhibition of c-fos induction or cell death could play a role in the cognitive impairments known to be adverse effects of some antidepressants. This study is believed to be a first step toward understanding the mechanisms of learning and memory. Further studies are needed to investigate the expression of various IEGs and changes in the hippocampal neurons of rat resulting from chronic treatment with antidepressant drugs.

Keywords

<i>C-fos</i> mRNA expression;Antidepressant;Hippocampal neuron.

The Relationship between Change of Lymphocyte Inositol Monophosphatase mRNA Level by Lithium and Clinical Course in Bipolar Affective Disorder

Seok Hyeon Kim, MD1;Min Soo Lee, MD2; and Jang Han Lee, MD1;

1;Department of Neuropsychiatry, College of Medicine, Hanyang University, Seoul, 2;Department of Neuropsychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 96-105.

Abstract

Objective:Lithium inhibits the action of inositol monophosphatase(IMPase) in phosphoinositide(PI) signal transduction system at therapeutically relevant concentration. The depletion of inositol by lithium itself cannot explain the lithium's therapeutic effect. However, attention has focused on the abnormality of PI signal transduction system as the pathophysiology of bipolar affective disorder(BPD). We investigated whether IMPase mRNA levels of lymphocytes would be different between BPD patients(n=16) and age, sex-matched normal controls(n=16). We also investigated the change of IMPase mRNA level by lithium during 4 weeks to probe the possibility that IMPase mRNA levels could predict the therapeutic response to lithium and clinical course.

Method:Relative IMPase mRNA levels in lymphocyte were quantified by reverse transcriptase(RT)-PCR in sixteen drug-free BPD patients and sex, age-matched normal controls. The psychopathology of patients were measured using YMRS(Young Mania Rating Scale) and CGI(Clinical Global Impression). 

Results:There was no significant difference in IMPase mRNA levels between BPD patients and normal controls. And the IMPase mRNA levels were not significantly changed by 4 week treatment with lithium. However, the basal IMPase mRNA levels were negatively correlated with the changes of CGI after 4 weeks. Furthermore, the patients with relatively high basal IMPase mRNA levels showed much more improvement during 4 weeks.

Conclusions:
BPD patients and normal controls were not distinguished by lymphocyte IMPase mRNA level. Although we do not support the hypothesis that lymphocyte IMPase activity would be related with the pathogenesis of BPD and the action of lithium, these data raise the possibility that lymphocyte IMPase mRNA levels could function as a predictor of therapeutic response and clinical course of BPD.

Keywords

Lithium;Inositol monophosphatase mRNA;Bipolar affective disorder;Lymphocyte.

The Association between the Dopamine D1 Receptor Genotype and Treatment Response in Korean Schizophrenic Patients

Jong Woo Paik, MD1;Min Soo Lee, MD, PhD1;Choong Soon Rhee, MD, PhD2;Dong Ju Lim, MD1;and Won Hun Ham, PhD3;

1;Department of Psychiatry, College of Medicine, Korea University, Seoul, 2;Yong-In Mental Hospital, Kyunggi-do, 3;Sungkyunkwan University School of Pharmacy, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 106-10.

Abstract

Background:Dopamine receptors have been regarded as a strong candidate involved in etiology of schizophrenia and a target for various antipsychotic drugs. The purpose of our study was to investigate whether dopamine D1 receptor(DRD1) gene polymorphisms would predict the treatment response to antipsychotics in schizophrenia. 

Method : One hundred thirty-four schizophrenic patients, who met DSM-IV criteria for schizophrenia were entered into a 48 -week study. The psychopathology of the patients was assessed at baseline, 12th, 24th 48th weeks of treatment by PANSS. Responders were defined by a 20% of the reduction in total PANSS score at end point. The genomic DNA fragment corresponding to nucleotides of dopamine D1 receptor gene was amplified by polymerase chain reaction(PCR).

Result: Neither allelic frequencies nor genotypes for dopamine D1 receptor differed significantly between responders and non-responders. Also, there was no difference of changes of PANSS scores among three genotype groups of the dopamine D1 receptor.

Conclusion : Allelic variation in the dopamine D1 gene is not associated with individual differences in antipsychotic response.

Keywords

Dopamine D<sub>1</sub> receptor;Receptor gene;Schizophrenia;Treatment response.

An Association Study of COMT Gene Polymorphism with Korean Alcoholism

Min-Jung Kim, PhD1;Byung-Hwan Yang, MD2;Jung-Sik Lee, MD3;Young-Gyu Chai, PhD4;and Taek-Kyu Park, PhD5;

1;Department of Clinical Pathology, Hanyang University Hospital, Seoul, 2;Department of Neuropsychiatry, College of Medicine and The Medical Health Research Insititute, Hanyang University, Seoul, 3;Yong-In Mental Hospital, Yongin, Kyunggi-do, 4;Department of Biochemistry and Molecular Biology, Hanyang University, Ansan, 5;Department of Chemistry, College of Science, Kon-Kuk University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 111-5.

Abstract

An association study with Korean alcoholic patients(n=50) and normal controls(n=53) was performed to find the relationship between catechol-O-methyltransferase(COMT) gene polymorphism and alcoholism using polymerase chain reaction-restriction fragment length polymorphism. When we compared the allele and genotype frequencies of Nla III COMT gene polymorphism in alcoholism and normal controls, there was no significant difference between two groups. Our results do not support an association between the Nla III polymorphism of COMT gene and alcoholism. 

Keywords

Alcoholism;Association;COMT;Polymorphism.

The Association between Polymorphism of the Dopamine D3 Receptors and Concentrations of Plasma Homovanillic and 5-hydroxyindoleacetic Acid, and Therapeutic Response of Chronic Schizophrenic Patients

Geo Jang Jeong, MD1;Min Soo Lee, MD, PhD1;Sang Yoon Kim1;Dae Yeop Kang, MD2;and Dong Il Kwak, MD, PhD1;

1;Department of Psychiatry, College of Medicine, Korea University, Seoul, 2;Yong-In Mental Hospital, Kyunggi-do, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 116-22.

Abstract

Objectives:Schizophrenia manifests a variety of interindividual differences in therapeutic response to antipsychotics. This might be attributable to dopamine and serotonin receptors that a important target for various antipsychotics, and the D3 receptor(DRD3) alleles they carry. The purpose of our study was to investigate whether the plasma levels of homovanillic acid(HVA) and 5-hydroxyindoleacetic acid(HIAA), and the polymorphism of DRD3 can be held as a predictor of treatment response in chronic schizophrenic patients. 

Methods:Therapeutic response for 116 korean schizophrenia patient treated during 48 weeks were assessed by PANSS used as the clinical symptom rating scales. The levels of concentration of HVA and 5-HIAA were examined by HPLC at baseline and at 48 weeks. We classified the polymorphism of DRD3 receptor using amplifying by polymerase chain reaction(PCR). 

Results:Neither concentrations of HVA and 5-HIAA nor genotype of dopamine 3 receptor were not significantly associated with the therapeutic response. But, the patients who has A1 alleles of DRD3 gene showed poor therapeutic responses.

Conclusion:A1 allele of DRD3 gene is associated with poor prognosis of chronic schizophrenia.

Keywords

Schizophrenia;Dopamine D3 receptor gene;Ser-9-Gly polymorphism;Homovanillic acid;5-Hydroxyindoleacetic acid.

Comparison of P300 between Schizophrenia and Bipolar Disorder

In-Joon Park, MD;Hee-Yeon Jeong, MD; and Young-Joon Kwon, MD

Department of Psychiatry, College of Medicine, Soonchunhyang University, Chun-an, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 123-30.

Abstract

Objective:Asymmetries in evoked potential P300 topography of schizophrenia and bipolar disorder are still controversial. The purpose of this study was to examine the difference in P300 topography between schizophrenia and bipolar disorder. 

Method:P300 was recorded from 16 schizophrenic, 15 bipolar manic, and 16 control subjects. All were right-handed. Subjects silently counted target stimuli(2.0kHz) among trains of standard stimuli(1.0kHz). Averages were constructed from brain responses to target stimuli. 

Results:1) Schizophrenics displayed significantly smaller peak amplitude of P300 over Cz, Pz, T3 than controls. 2) Schizophrenics displayed significantly smaller peak amplitude of P300 over T3 than bipolar manics. 3) Schizophrenics displayed significantly smaller peak amplitude of P300 over T3 than their T4. 4) Schizophrenics displayed significantly delayed latency of P300 over T3 than bipolar manics. 5) Schizophrenics displayed significantly delayed latency of P300 over T3 than their T4.

Conclusions:Left-sided P300 abnormality, especially left superior temporal gyrus, in schizophrenics relative to bipolar manics and controls suggests that psychophysiological cause of schizophrenia and bipolar disorder is different and P300 asymmetry is specific to the psychophysiological cause of schizophrenia.

Keywords

P300;Schizophrenia;Bipolar disorder.

Hippocampal Volume and Memory Function in Patients with Posttraumatic Stress Disorder

Moon-Yong Chung MD1;Hwa-Yong Chung MD1;Hyun Ryu, MD2;Hae-Gyung Chung MD1;and Jin-Hee Choi MD1;

1;Department of Neuropsychiatry, Korea Veterans Hospital, Seoul, 2;Department of Radiology, Korea Veterans Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 131-9.

Abstract

This study was conducted to evaluate the effect of PTSD on memory function and hippocampal volume, and to identify major variables correlated to hippocampal volume and memory function. Thirty four Vietnam veterans were collected for this study, among whom eighteen were PTSD patients and sixteen were combat control subjects. The author used Impact of Event Scale(IES), Combat Exposure Scale(CES), Hamilton Depression Rating Scale(HDRS) and Beck Depression Inventory(BDI). Korea Memory Assessment Scale(K-MAS) was assessed for memory function. Magnetic resonance imaging(MRI) was used to measure hippocampal volume. There were significant differences between PTSD and Non-PTSD veterans in IES, HDRS and BDI. Significant difference was found in verbal memory and total memory of K-MAS between PTSD and Non-PTSD veterans. There was significant difference in hippocampal volume between PTSD and Non-PTSD veterans. Short term memory, verbal memory and total memory were positively correlated to hippocampal volume. Hippocampal volume was negatively correlated to IES, HDRS, and BDI. These results suggest that PTSD severity be associated with hippocampal atrophy and memory dysfunction. Reduced or smaller hippocampal volume may be preexisting risk factor for stress exposure or the development of PTSD on combat exposure.

Keywords

Memory;Hippocampus;PTSD.

Switch to Olanzapine from Clozapine or Risperidone and 12-months Follow Up

Bang Hyun Cho, MD;In Kwa Jung, MD; and Jong Woo Paik, MD

Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 140-6.

Abstract

In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effectiveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%)). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 12(70.5%)). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refractoriness and drug induced side effect.

Keywords

Schizophrenia;Switch;Olanzapine.

Relationship of Estrogen to Extrapyramidal Symptoms in Female Schizophrenic Patients

Dong Seon Chung, MD1;Hee Yeon Jung, MD2;Young Joon Kwon, MD2;In Joon Park, MD2;Sun Ho Han, MD3; and Han Yong Jung, MD4;

1;Chun-an Medical Center, Chun-an, 2;Department of Psychiatry, College of Medicine, Soonchunhyang University, Chun-an, 3;Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul, 4;Department of Psychiatry, College of Medicine, Soonchunhyang University, Buchon, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 147-52.

Abstract

Objective:It has been thought that estrogen has neuroleptic like effect in women schizophrenic patients. This study aimed to investigate neuroleptic side-effects severity in women with schizophrenia and to investigate their putative association with variations in sex steroids over menstrual cycle. Based on the estrogen theory, The author hypothesized that parkinsonian side-effects would be exacerbated when estrogen levels were high.

Method:26 schizophrenic women were assessed using the ESRS(Extrapyramidal Symptom Rating Scale) and estrogen analysis. Tests were conducted twice, in the mid luteal and mid follicular phase.

Result:It was hypothesized that high level of estrogen would lead to an exacerbation of parkinsonian side-effects but the results indicated that parkinsonian side effects decreased overall when estrogen levels were high. This effects were more marked for the group taking typical neuroleptics than those taking atypical neuroleptics.

Conclusion:The results of this study suggest that estrogen and progesteron may reduce the severity of neuroleptic induced extrapyramidal side effects over menstrual cycle in women with schizophrenia. It was concluded that estrogen has different effects on dopamine dynamics in the mesolimbic and mesostriatal pathways according to estrogen, progesteron, catecol estrogen, prolactine.

Keywords

Female schizophrenics;EPS;Estrogen.

A Case of Transient Psychosis Suspected to be Induced by Arachnoid Cyst, Which was Responsive to Risperidone

Won-Myong Bahk, MD;Chi-Un Pae, MD;Taeyoun Jun, MD;Kwang-Soo Kim, MD;and Tae-Yul Lew, MD

Department of Psychiatry, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 153-5.

Abstract

There had been few reports of arachnoid cyst accompanying psychiatric disturbance and no report treated with low-dose risperidone administration. We report a patient, developed first-transient psychotic episode considered to be provoked by an arachnoid cyst, responsive to risperidone, which was found in the middle cranial fossa as follows. A 57-year-old man was admitted by suddenly developed headache, auditory hallucination, delusion of persecution and, an arachnoid cyst in the anteromedial aspect of middle cranial fossa was found on MRI after admission. The psychotic episode was first to him and he was also negative to other clinical evaluation including endocrine abnormality, his psychotic symtom was suspected to be induced by arachnoid cyst and was well controlled to low-dose risperidone administration. He left hospital free from psychotic symptoms on 14 hospital days.

Keywords

Arachnoid Cyst;Transient Psychosis;Risperidone.

Therapeutic Effect of Amantadine in Traumatic Brain Injury Patients:Two Cases and Review

Han Yong Jung, MD;Soyoung Irene Lee, MD; and Yang Rae Kim, MD

Department of Psychiatry, Soonchunhyang University Buchon Hospital, Pusan, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 156-61.

Abstract

We reported two cases of amantadine treatment in traumatic brain injury patients and reviewed the literature of amantadine treatment of those patients. Problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive deficit could occur following traumatic brain injury or other types of acquired brain injury. This report described results of amantadine using in two patients with this type of symptom profile. Patients received neuropsychiatric examination as well as BPRS and Barthel index. These patients were improved, respectively from 57 point to 82 point(case 1), from 85 to 94(case 2) in Barthel index, and from 66 point to 35 point(case 1), from 55 to 32 point(case 2) in BPRS. These two patients did not reveal any other adverse effect. The rationale for using amantadine were discussed.

Keywords

Amantadine;Traumatic brain injury(TBI);Dopamine agonist;NMDA receptor antagonist.

Three Cases of Mirtazapine Induced Akathisia

Seung-Hwan Lee, MD;Min Nam, MD, PhD; and Young-Cho Chung, MD, PhD

Department of Neuropsychiatry, College of medicine, Inje University, Koyang, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 162-6.

Abstract

The mirtazapine is a relatively new antidepressant that has noradrenergic and specific serotonin antagonist action(NaSSAs). This has been known as one of the most safest drugs because of its few side effects. Until now, there have been only one case report that mirtazapine causes a EPS side effect(restless leg syndrome). But the peculiar mechanism of this drug makes it impossible to explain the exact reasons why the mirtazapine could induce EPS symptoms. Authors observed three cases of mirtazapine induced akathisia. We could not explain the phenomenon the other way except akathisia. So here we presents the three case of mirtazapine induced akathisia and a few possible hypothesis of this phenomenon.

Keywords

Mirtazapine;Akathisia.

A Case of Severe Serotonin Syndrome Induced by Fluoxetine and Sertraline

Jin-Sook Cheon, MD1;Sang-Shin Lee, MD1;Sung-Hi Kim, MD2; and Woong Cho, MD3;

1;Department of Neuropsychiatry, Kosin University, School of Medicine, Pusan, 2;Department of Neurology, Kosin University, School of Medicine, Pusan, 3;Department of Psychiatry, National Bugok Mental Hospital, Bugok, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 167-74.

Abstract

A 54-year old male patient who was suffering from bipolar I disorder for 19 years and was admitted to the National Bugok Mental Hospital due to a depressive episode, was referred to the Kosin University Gospel Hospital. On arrival at the emergency room, he had confused mentality with disorientation, memory impairment, hypomania, marked anxiety and hyperirritability. The change of neuromuscular activity such as ataxia, gait disturbance, tremor, shivering, myoclonus and epileptic seizures was also shown. In addition, the symptoms and signs of autonomic instability including diaphoresis, tachycardia, hypotension, fever and facial flushing were noticed. The above symptoms developed after the administration of sertraline successive to the discontinuation of fluoxetine without any washout period. The degree of severity seemed to be severe because he had epileptic seizures, fever and hypotension. He was recovered from the severe serotonin syndrome by the supportive symptomatic treatment with sodium valproate, clonazepam, lorazepam and cyproheptadine after cessation of the selective serotonin reuptake inhibitors during hospitalization. Therefore, this rare case of severe serotonin syndrome was reported and related literatures were also reviewed. 

Keywords

Confusion;Tremor;Myoclonus;Diaphoresis;Fever;Epileptic seizures.

Vol. 8 No.2

Legal & Ethical Issues in Human Genomics and Its Application

Young-Mo Koo, PhD

Department of Medical Humanities and Social Sciences, University of Ulasn College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 183-95.

Abstract

Keywords

Human Genome Project

Oh-Joo Kwon, MD

Department of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 196-202.

Abstract

The completion of the rough draft of the human genome is a remarkable achievement. It provides the overall structures of huge DNA molecules that constitute the genome and an outline of the information needed to create a human being. This paper reviewed new ideas, projects, and scientific advances made by the Human Genome Project. We also discussed the future of medicine and biomedical research in postgenomic era.

Keywords

Gene;Genome;Genomics;Proteome;Proteomics;Microarray;SNP.

Basic Concept of Gene Microarray

Seung Yong Hwang, PhD

Department of Biochemistry and Molecular Biology, Hanyang University/GenoCheck Co. Ltd., Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 203-7.

Abstract

The genome sequencing project has generated and will continue to generate enormous amounts of sequence data including 5 eukaryotic and about 60 prokaryotic genomes. Given this ever-increasing amounts of sequence information, new strategies are necessary to efficiently pursue the next phase of the genome project-the elucidation of gene expression patterns and gene product function on a whole genome scale. In order to assign functional information to the genome sequence, DNA chip(or gene microarray) technology was developed to efficiently identify the differential expression pattern of independent biological samples. DNA chip provides a new tool for genome expression analysis that may revolutionize many aspects of biotechnology including new drug discovery and disease diagnostics. 

Keywords

Genome;DNA chip;Gene microarray;Expression;Bioinformatics.

Pharmacogenomics and Schizophrenia

Kyu Young Lee, MD; and In Won Chung, MD, PhD

Department of Psychiatry, Chungbuk National University Hospital, Cheong-ju, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 208-19.

Abstract

The pharmacotherapy of schizophrenia exhibits wide inter-individual variabilities in clinical efficacy and adverse effects. Recently, human genetic diversity has been known as one of the essential factors to the variation in human drug response. This suggests that drug therapy should be tailored to the genetic characteristics of the individual. Pharmacogenetics is the field of investigation that attempts to elucidate genetic basis of an individual's responses to pharmacotherapy, considering drug effects divided into two categories as pharmacokinetics and pharmacodynamics. The emerging field of pharmacogenomics, which focuses on genetic determinants of drug response at the level of the entire human genome, is important for development and prescription of safer and more effective individually tailored drugs and will aid in understanding how genetics influence drug response. In schizophrenia, pharmacogenetic studies have shown the role of genetic variants of the cytochrome P450 enzymes such as CYP2D6, CYP2C19, and CYP2A1 in the metabolism of antipsychotic drugs. At the level of drug targets, variants of the dopamine D2, D3 and D4, and 5-HT2A and 5-HT2C receptors have been examined. The pharmacogenetic studies in schizophrenia presently shows controversial findings which may be related to the multiple involvement of genes with relatively small effects and to the lack of standardized phenotypes. For further development in the pharmacogenomics of schizophrenia, there would be required the extensive outcome measures and definitions, and the powerful new tools of genomics, proteomics and so on.

Keywords

Pharmacogenomics;Schizophrenia;Cytochrome P450 enzymes;Dopamine receptor;Serotonin receptor;Phenotype.

5-HT Transporter and Mood Disorder

Min Soo Lee, MD, PhD

Department of Psychiatry, Korea University Anam Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 220-5.

Abstract

As numbers of serotonin's function are so many, studies of serotonin are numerous nowadays. In the beginning, concentration of metabolites such as 5-HIAA was a key issue, but recent studies have been challenged for serotonin receptor genes and their relation to mood disoder. Serotonin transporter(5-HTT) gene is a strong candidate gene of mood disoder for following reason. Serotonin transporter is a key protein in the serotonin pathway as it regulate the concentration of serotonin in the synaptic clept and essential pathophysiology of depression is dysregulation of 5-HTT so that all antidepressants have effect of 5-HTT antagonist. The decrease of 5-HTT in the platelet and in brain of the depressive patients is much consistent results in the studies of the pathophysiology of mood disorder till now. By this, we will be able to develop simple and easy marker for diagnosis, type, and treatment monitoring of depression. Many psychiatrists have sought the independent genes in relation to depression or schizophrenia. Obviously, the hereditary vulnerability contributes to etiology of mood disorders, but it is difficult to discriminate the independent genes because of many environmental factors. Moreover, in the hereditarily complex diseases such as mood disorder, the only vulnerability of gene can not sufficiently explain the etiology. In the future, to exclude the role of the gene-environmental interaction, the methods such as gene transfer can be considered. In the opposite direction, by using the gene destruction method, the role of target genes can be examined. As yet the concept of the gene expression, neural plasticity, neurogenesis and etc, is the elementary stage. The development of this field will help to establish the treatment strategy of chronic and refractory mood disorders.

Keywords

Serotonin transporter;Mood disorder.

Pharmacogenomics of Depressive Disorders

Byung-Joo Ham, MD; and Min-Soo Lee, MD, PhD

Department of Neuropsychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 226-32.

Abstract

The pharmacotherapy of depression has reduced morbidity and improved outcome for many depressive patients. A wide range of classical and new antidepressants are available for their treatment. However, 30-40% of all patients do not respond sufficiently to the initial treatment and present adverse effects. Pharmacogenetics studies the genetic basis of an individual's ability to respond to pharmacotherapy. Recently, some reports on serotonin transporter gene polymorphisms and their influence on the response to antidepressive therapy provide an interesting diagnostic tool in assessing the chances of response to antidepressants. We also investigated the relationship between serotonin transprter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. 128 depressive patients were enrolled into 2nd year study. The therapeutic response of each subset was not different at 8th, 16th week, but the subset with homozygote(l/l) of long variant showed a better therapeutic response to antidepressant than the heterozygote(l/s) of long and short variant, which showed a better therapeutic response than the subset with homozygote(s/s) of short variant at 1st year and 2nd year after the antidepressant treatment. This result shows that the serotonin transporter polymorphisms may be related to the long-term effect of antidepressant treatment. The potential for pharmacogenomics, the use of genetic information to guide pharmacotherapy and improve outcome by providing individualized treatment decisions, has gained increasing attention. pharmacogenomics will contribute to individualize drug choice by using genotype to predict positive clinical outcomes, adverse reactions, and levels of drug metabolism. Personalized medicine, the use of marker-assisted diagnosis and targeted therapies derived from an individual molecular profile, will impact the antidepressant therapy and this approach will replace the traditional trial-and-error practice of medicine.

Keywords

Depression;Pharmacogenomics;Antidepressant.

Interictal EEG in Diagnosis and Assessment of Epilepsy

Kun-Woo Park, MD, PhD

Department of Neuroloy, Korea University, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 233-8.

Abstract

The routine interictal electroencephalogram(EEG) continues to play an important role in the diagnosis and treatment of epilepsy. The clinical investigation of brain disease in the last decade has been marked by dramatic advances in functional imaging, magnetic resonance scanning and digitized EEG. Epilepsy is a disorder of electrical hyperirritability of cerebral cortex and the interictal EEG remains the most convenient means available to demonstrate cortical hyperirritability. The sensitivity and specificity of the EEG in the diagnosis of epilepsy have been disputed. In this review, the type of EEG findings in epilepsy are reviewed and the sensitivity and specificity of interictal epileptiform discharge are discussed. And also the role of EEG in various clinical situations are summarized.

Keywords

Interictal EEG;Interictal epileptic discharges;Epilepsy.

Association Study of Dopamine Transporter(DAT1) G2319A Genetic Polymorphism in Alcohol Dependence

Byung-Hwan Yang, MD1;Mi-Gyung Lee, MD1;Ju-Yoen Choi, MD1;Dong-Yul Oh, MD2;Gil-Sook Kim, MD2;Hyung-Tae Kim, PhD3; and Young-Gyu Chai, PhD3;

1;Department of Neuropsychiatry, College of Medicine & The Mental Health Research Institute, Hanyang University, Seoul, 2;Seoul National Mental Hospital, Seoul, 3;Department of Biochemistry, Molecular Biology, College of Science-technelogy, Hanyang University, Ansan, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 239-45.

Abstract

Objective:Dopamine transporter is member of family of Na/Cl dependent neurotransmitter transporter, 12 transmembrane domain, that has high substrate specificity, affinity. It is related with dopamine reuptake in presynaptic vesicle. DAT has a VNTR in its 3'-untranslated region(UTR). 3'-UTR VNTR polymorphism is related with modification of dopamine transmission. The association between with VNTR polymorphism and neuropsychiatric disorders such as alcohol dependence, and low activity ALDH has been studied, but their relationship is unclear. We study about association of 3'-UTR VNTR of DAT gene and G2319A and alcohol dependence.

Method:Group of Korean subjects were studied with alcohol dependence(n=49 male) compared to mentally healthy controls(n=53 male). The peripheral blood sample was acquired, and Polymerase Chain Reaction(PCR) amplification, MspI procedure was done. 

Result:There was a significant difference between alcohol dependence group and normal control(genotype frequency p<0.05, allele frequency p<0.05) Allele A frequency and genotype(GG, GA) frequency was a significant difference between alcohol dependence group and normal control(p<0.05).

Conclusion:Our study showed that genetic polymorphism of DAT1 G2319A had relation with alcohol dependence.

Keywords

Alcohol dependence;Genetic polymorphism;Dopamine transporter.

Allelic Association of the Dopamine D4 Receptor Gene in Korean Alcoholism

Seung Ho Ryu, MD1; and Min Soo Lee, MD2;

1;Department of Psychiatry, Konkuk University College of Medicine, Seoul, 2;Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 246-50.

Abstract

The dopamine D4 receptor gene has a hypervariable segment in the coding region characterized by a varying number of 48bp repeats in exon III of the gene. Varying the numbers of repeated segments may change the length, structure, and function of the receptor, which makes this gene a possible candidate for variations in dopamine-related behaviors, such as alcoholism and drug abuse. We evaluated the dopamine D4 receptor genotype in male alcoholics and normal controls. All alcoholics and controls were unrelated and from the Korean population. Genotype and allele frequencies in 67 alcoholics were compared to 67 controls who were free of alcohol abuse, substance abuse, and major mental illness. No association was found between the dopamine D4 receptor allele and alcoholism. This result indicate that there is no association of the dopamine D4 receptor with alcoholism in Korean. Further systemized investigation to determine the role of dopamine D4 receptor gene in alcoholism with a larger sample size will be required.

Keywords

Alcoholism;Dopamine D4 receptor;Genotype;Allele.

The Analysis of 40Hz Event-Related Potentials in Schizophrenia

Tak Youn, MD1,2;Hae-Jeong Park, PhD3;Do-Hyung Kang, MD1;Myung-Sun Kim, PhD4;Jae-Jin Kim, MD, PhD2; and Jun Soo Kwon, MD, PhD1,2,4;

1;Department of Psychiatry, Seoul National University College of Medicine, Seoul, 2;BK21 Life Science, Seoul National University College of Medicine, Seoul, 3;Institute of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 4;Clinical Research Institute, Seoul National University Hospital, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 251-7.

Abstract

Backgrounds:Gamma band oscillatory activity is considered to be related to cognitive functions and illustrates that the concept of event-related oscillations bridges the gap between single neurons and neural assemblies. An event-related gamma oscillation is the time-locked responses of specific frequency, and can be identified by computing the amplitude frequency characteristics of the averaged event-related potentials(ERPs) after stimulation. 

Objectives:We purposed to present experimental paradigm to investigate γ-band oscillation activities from the recording of ERPs by using auditory oddball paradigm and investigate the difference of γ-band activity between schizophrenia and normal controls. 

Methods:The ERPs resulting from auditory stimuli with oddball paradigm in a group of schizophrenics(n=11), and also a group of age-, sex-, and handedness matched normal controls, were recorded by 128 channel EEG. The γ-band oscillatory activities were calculated by using time-frequency wavelet decomposition of the signal between 20 and 80Hz. The γ-band oscillatory activities of both groups were compared by t-test. 

Results:The γ-band oscillatory of the leads Fz, Cz, and Pz of both groups were represented well in the time-frequency maps. Significant increases of the γ-band activity in normal controls compared with schizophrenics were observed around 160 msec, 350 msec, and 800 msec after stimulation.

Conclusions:Our results suggested that the increment in γ-band oscillatory activity during cognitive operations and decreased γ-band activity in schizophrenics may be associated with the cognitive dysfunctions and the pathophysiology of the schizophrenia.

Keywords

Gamma activity;Synchronization;40Hz;Auditory P300;Schizophrenia.

Assessment of Cognitive Disorders in Alcoholics Using the 7 Minute Screening Battery

Jin-Sook Cheon, MD1;Han-Cheol Yoon, MD1;Kwang-Young Lee, MD2; and Byoung-Hoon Oh, MD3;

1;Department of Neuropsychiatry, Kosin University, School of Medicine, Busan, 2;Department of Occupational and Environmental Medicine, Kosin University, School of Medicine, Busan, 3; Department of Psychiatry, Yonsei University, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 258-65.

Abstract

Objectives:Chronic alcohol consumption has been known to result in various neurocognitive deficits. Many neuropsychological studies revealed that the major disturbances occurred in the executive function, learning and short-term memory, visuospatial performance function, perceptuo-motor skills, and abstraction and problem solving abilities. This study was done to identify which cognitive areas might be mainly affected.

Methods:The cognitive disturbance was evaluated using the Korean Version of the Mini Mental State Examination(MMSE- K) and the 7 Minute Screen(7MS) in male inpatients with alcohol dependence(N=31) as well as in age and education level matched healthy male controls(N=30). Four individual tests of the 7MS were consisted of the Benton Temporal Orientation Test, the Enhanced Cued Recall, the Clock Drawing and the Category Fluency.

Results:1) The average scores of four individual test of the 7MS for the alcoholics were 2.77±4.38 for the Benton Temporal Orientation Test, 13.90±2.02 for the Memory Test(the Cued Recall 6.77±1.94, the Uncued Recall 7.10±2.45), 5.84±1.86 for the Clock Drawing, and 12.58±3.29 for the Category Fluency. Except the Benton Temporal Orientation Test, there were statistically significant differences between test scores of alcoholics and those of controls(p<0.01). 2) The alcoholics who had MMSE-K score <24 were 9.68%. The average(±S.D.) score of the MMSE-K for the patient group(27.23±2.62) was significantly(p<0.001) lower than that of the healthy controls(29.20±1.24). There were no statistically significant differences between four individual test scores of the 7MS of alcoholics with the MMSE-K score <24(N=3) and those of alcoholics with the MMSE-K score ≥24(N=28). 3) Four individual test scores of the 7MS seemed to have statistically significant association with such variables as MMSE-K, duration of alcohol drinking, blood magnesium concentration, liver function and thyroid function.

Conclusion:Mild deficits of cognitive areas such as orientation, memory, visuospatial abilities and verbal fluency could be found in alcohol dependence.

Keywords

Alcohol dependence;Neurocognitive deficit;The 7 Minute Screen;Executive function;Short-term memory;Visuospatial.

Plasma Level of Amitriptyline after Fluoxetine Addition

Yong-Ho Jun, MD1;Young-Joon Kwon, MD2;Hee-Yeon Jung, MD2; and Sun-Ho Han, MD1;

1;Department of psychiatry, College of medicine, Soonchunhyang University Hospital, Seoul, 2;Department of psychiatry, College of medicine, Soonchunhyang University Hospital, Chunan, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 266-70.

Abstract

Objective:The purpose of this study was to compare the plasma amitriptyline and nortriptyline level between before and after fluoxetine addition with patients who were currently taking amitriptyline.

Method:From the inpatient and outpatient unit of Soon Chun Hyang University Hospital, Chunan, fourteen subjects who were taking amitriptyline 25mg more than 1 week at least were given fluoxetine 20mg. Before and 2 weeks after fluoxetine addition, the plasma level of amitriptyline and nortriptyline are analyzed simultaneously by High Performance Liquid Chromatography(HPLC). At the same times, HAM-D(Hamilton Rating Scale for Depression) score and the UKU(Uldvalg for Klinske Undersф gelser) side effect scale were checked.

Results:After fluoxetine addition to the patients who were taking amitriptyline, the plasma level of amitriptyline, nortriptyline and sum of amitriptyline and nortriptyline had risen. The mean plasma amitriptyline level increased from 168.9±89.4ng/ml to 183.0±102.0ng/ml after fluoxetine addition(p=0.011), but the change was not statistically significant. The mean plasma nortriptyline level increased significantly from 114.3±70.2ng/ml to 168.0±86.2ng/ml after fluoxetine addition(p=0.011). In addition, the mean plasma level of total amitriptyline and nortriptyline increased significantly from 283.1±125.3ng/ml to 350.9±78.4ng/ml after fluoxetine addition(p=0.016). After fluoxetine addition, no significant change was noted in the UKU side effect scale score.

Conclusion:As consequence of comparison of plasma amitriptyline and nortriptyline level before and after fluoxetine addition, mean amitriptyline, nortriptyline and total plasma level was increased after fluoxetine addition. This suggests that coadministration of amitriptyline and fluoxetine may induce improvement of depressive symptom in depressive patients by way of increased plasma level of amitriptyline.

Keywords

Amitriptyline;Nortriptyline;Fluoxetine;Plasma level of amitriptyline.

A Case Report:Hypersexuality and Obsessive-Compulsive Behaviors in a Stroke Patient with the Left Mesial Frontal Cortex and Both Basal Ganglia Lesion

Se Joo Kim, MD1;Young Shin Kim, MD1;Nak Kyung Choi, MD1;Byung-Chul Lee, MD2;and Man Hong Lee, MD3;

1;Department of Psychiatry, 2;Neurology, College of Medicine, Hallym University, Anyang, 3;Department of Psychiatry, College of Medicine, Yonsei University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 8, No. , pp. 271-5.

Abstract

Hyposexuality after stroke has been frequently observed, but hypersexuality as a sequela of stroke has not been commonly documented. We report a patient who exhibited hypersexuality and obsessive-compulsive behaviors after stroke in the region of the left mesial frontal cortex and both basal ganglia. At 2 months after stroke, he visited psychiatric unit due to these symptoms. His motor function was almost full recovered. He was treated with fluvoxamine and perphenazine. With two-month medication, his hypersexuality and obsessive-compulsive behavior disappeared. This case may indicate that basal ganglia-thalamocortical circuit plays an important role in the mediation of sexual behavior and obsessive-compulsive behavior. Since changes in sexual activity may not be spontaneously reported, a systemic inquiry into patient's sexual functioning after infarction in frontal lobe or basal ganglia is warranted.

Keywords

Hypersexuality;Obsessive-compulsive symptom;Depressive symptom;Infarction;Frontal lobe;Basal ganglia.

  • Vol. 7 No.1
  • Vol. 7 No.2

Vol. 7 No.1

Basic Principles of Drug Interaction

Boe-Gwun Chun, MD

Department of Pharmacology, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 3-13.

Abstract

There is nothing that is harmless;the dose alone decides that something is no poison(Paracelsus, 1493-1541). So, in a point of view to maximize the therapeutic efficacy of drug therapy in a way that minimize the drug toxicity, the knowledges of the drug-ineractions as well as the pharmacokinetic and pharmacodynamic principles of every therapeutic drug used in the medical clinic cannot be emphasized too much. Many drug interactions can be predicted if the pharmacokinetic properties, pharmacodynamic mechanisms of action of the interacting drugs are known, and most adverse interactions can be avoided. In this paper, the clinical importance, classification, and general principles of clinical drug-interactions are presentated with a few explanatory examples.

Keywords

Drug-Interaction;Drug response variations.

Drug Interaction in New Antipsychotics

Yong Sik Kim, MD;Ung Gu Kang, MD; and Myoung Sun Roh, MD

Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 14-20.

Abstract

Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well known through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs, especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation, delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.

Keywords

Atypical antipsychotics;Drug interaction;Cytochrome P450;Clozapine;Risperidone;Olanzapine.

Antidepressants and Related Drug Interactions

Min Soo Lee, MD, PhD

Department of Neuropsychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 21-33.

Abstract

As the clinical practice of using more than one drug at a time increase, the clinician is faced with ever-increasing number of potential drug interactions. Although many interactions have little clinical significances, some may interfere with treatment or even be life-threatening. This review provides a better understanding of drug-drug interactions often encountered in pharmacotherapy of depression. Drug interactions can be grouped into two principal subdivisions:pharmacokinetic and pharmacodynamic. These subgroups serve to focus attention on possible sites of interaction as a drug moves from the site of administration and absorption to its site of action. Pharmacokinetic processes are those that include transport to and from the receptor site and consist of absorption, distribution on body tissue, plasma protein binding, metabolism, and excretion. Pharmacodynamic interactions occur at biologically active sites. In this review, emphasis is placed on antidepressant medications, how they are metabolized by the P450 system, and how they alter the metabolism of other drugs. When prescribing antidepressant medications, the clinician must consider the drug-drug interactions that are potentially problematic.

Keywords

Drug-drug interaction;Antidepressants;Cytochrome P450(CYP).

Drug-Drug Interactions:Mood Stabilizers and Anti-Anxiety Drugs

Young Hoon Kim, MD; and Jung Goo Rhee, MD

Department of Neuropsychiatry, School of Medicine, and Institute of Neuroscience, Inje University, Busan, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 34-45.

Abstract

Pharmacotherapy of bipolar disorder is a rapidly evolving field. Mood stabilizers and anticonvulsants have varying biochemical profiles which may predispose them to different adverse effects and drug-drug interactions. Several of the new anticonvulsants appear less likely to have the problems with drug-drug interaction. To provide more effective combination pharmacotherapies, clinicians should be allowed to anticipate and avoid pharmacokinetic and pharmacodynamic drug-drug interactions. We reviewed the role of cytochrome P450 isozymes in the metabolism of the drugs and their interactions. The drug-drug interactions of several classes of drugs which used as mood stabilizers and new anticonvulsants, some of which may have psychotropic profiles, are discussed mainly in this article. Finally, potential pharmacokinetic interactions between the benzodiazepines and other coadministered drugs are discussed briefly.

Keywords

Drug-Interaction;Mood stabilizer;Anti-anxiety drug.

Anxiety Disorders after Traumatic Brain Injury

Young-Chul Kim, MD

Department of Neuropsychiatry, Ewha Womans University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 46-54.

Abstract

Traumatic brain injury(TBI) is generally considered to be a risk factor for psychiatric disorders, especially depression and anxiety disorder. Despite the anxiety disorders are frequent sequelae after traumatic brain injury, the patients have not been payed medical attention and treated by doctors properly. The factors of precipitating and sustaining the anxiety disorders after TBI are brain injury itself, and the patient's or caregiver's response to the disability after TBI. To diagnose and treat them effectively, the knowledge about the mechanisms of and symptoms after TBI have to be needed. Psychiatrist should be a supportive and good listener to the patients who are complaining anxiety symptoms and differentiate whether the psychiatric symptoms are due to TBI or not. Because the TBI patients are very sensitive to drug side effects, doctors have to be familiar with the side effects as well as the mechanisms of action of the common psychotropics.

Keywords

Traumatic brain injury;Anxiety disorder.

The use of Amantadine in Traumatic Brain Injury Patients

Han Yong Jung, MD; and Yang Rae Kim, MD

Department of Psychiatry. College of Medicine, Soonchunhyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 55-63.

Abstract

A variety of symptoms can occur following traumatic brain injury(TBI) or other types of acquired brain injury. These symptoms can include problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive deficit. These symptoms may respond to certain drugs, such as dopaminergic agents. Amantadine may protect patients from secondary neuronal damage after brain injury as a effect of NMDA receptor antagonists and may improve functioning of brain-injured patients as a dopaminergic agonist. Clinically, based on current evidence, amantadine may provide a potentially effective, safe, and inexpensive option for treating the cognitive, mood, and behavioral disorders of individuals with brain injury. The rationales for using amantadine are discussed, and pertinent literatures are reviewed.

Keywords

Amantadine;Dopamine agonist;NMDA receptor antagonist;Traumatic brain injury.

The Effects of Monoamine Oxidase A CA Repeat Polymorphism on Behavioral Trait and Clinical Characteristics in Korean Male Alcoholics

Jung-Sik Lee, MD, PhD1;Byung-Hwan Yang, MD, PhD2;Kyung-Mee Lee, MD1;Hong-Kwan Kim, MD1;Yong-In Kim, MS3; and Young-Gyu Chai, PhD3;

1;Yong-In Mental Hospital, Yong-In, 2;Department Neuropsychiatry, College of Medicine, Hanyang University, Seoul, 3;Department of Biochemistry and Molecular Biology, College of Science, Hanyang University, Ansan,

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 64-73.

Abstract

There are several candidate genes in genetic study of alcoholism. Among them, allelic associations have been reported between MAOA CA repeat polymorphism and alcohol dependence, recently. And also, several studies have been investigated genotype-phenotype relationships between MAOA CA repeat polymorphism and clinical manifestations. The authors tried to identify differences in allelic frequency of MAOA CA repeat polymorphism between alcohol dependence and controls, and in behavioral trait and clinical characteristics according to MAOA CA repeat polymorphism. We also tried to investigate genotype-phenotype relationships between MAOA CA repeat polymorphism and behavioral trait such as aggression. We examined 49 male patients with alcohol dependence(DSM-IV) who had been admitted in Yong-In Mental Hospital from June 1st 1998 to October 31th 1998. We performed semistructured interview for demographic and clinical characteristics. Self-report questionnaire for BDHI(Buss-Durkey Hostility Inventory) was given to all subject at least 4weeks later after admission. Using polymerase chain reaction and polyacrylamide gel electrophoresis, MAOA CA repeat polymorphism were observed in 52 male controls and 49 male patients with alcohol dependence. We devided alcoholic patients into two groups according to allelic length of MAOA CA repeat polymorphism;alcoholics with short alleles(≤119bp, N=20) and alcoholics with long alleles(≥123bp, N=29). T-test, χ2-test and Fisher exact probability test were used for statistical analysis. There were no significant differences in frequency of each allele and short and long alleles of MAOA CA repeat polymorphism between alcoholics and controls. But there were significant differences in clinical symptoms and behavioral trait between alcoholics with short and long alleles. In clinical symptoms, alcoholics with long alleles used alcohol more frequently during one month before admission, had much more maximum amount of beer drinking and reported withdrawal seizure more frequently than with short alleles. In contrary, alcoholics with short alleles expressed depressed mood and guilty feeling more frequently and wanted complete abstinence as a treatment goal more frequently than with long alleles. In behavioral trait, alcoholics with long alleles had higher total aggression score and showed much more self-assertive attitude(subscale of expression of aggression) than with short alleles. Allelic length of MAOA CA repeat polymorphism was correlated with self-assertive attitude and accounted for 9% of the variance of self-assertive attitude. And also, predictable variables of allelic length of MAOA CA repeat polymorphism were drinking frequency and self-assertive attitude. Our findings suggest that MAOA CA repeat polymorphism may provide some behavior modifying role especially in self-assertive attitude and indirect symptom modifying role in Korean male alcoholics.

Keywords

Alcohol dependence;Monoamine oxidase;Polymorphism.

Effects of Atypical Antipsychotics on Serum Prolactin and Testosterone Levels in Schizophrenic Patients

Duck-Hyun Han, MD1;Doo-Byung Park, MD1;Young-Don Kim, MD2;Kyung-Joon Min, MD1;and Kil-Hong Lee, MD1;

1;Department of Neuropsychiatry, College of medicine, Chung-Ang University, Seoul, 2;Department of psychiatry, School of medicine, Eul-ji University, Taejon, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 74-9.

Abstract

Objectives:The dopamine-blocking effects and the associated side effects(amenorrhea, lactation, sexual dysfunction) of classical antipsychotics in schizophrenic patients have been studied for a long time. The purpose of this study was to find out these effects of new antipsychotics(risperidone, olanzapine) in schizophrenic patients treate

Method:Plasma levels of both prolactin and testosterone were measured in 91 schizophrenic patients(28 taking haloperidol, 4-20mg/day;31 taking risperidone, 2-6mg/day;32 taking olanzapine, 5-20mg/day).

 

Results:In male schizophrenic patients, the prolactin levels of risperidone group(76.44±38.85ng/ml) and haloperidol group(60.26±20.74ng/ml) had no significant difference, but were significantly higher than that of olanzapine(26.90±5.36ng/ml). In female, the prolactin level of olanzapine group(36.66±17.55) was significantly lower than those of risperidone(121.7±48.33) and haloperidol group(161.66±37.53). And prolactin level of risperidone group was lower than that of haloperidol group. While the testosterone plasma level of risperidone, haloperidol and olanzapine in both male and female schizophrenic patients had no significant difference.

Conclusions:At doses known to be effective in popular clinical setting, prolactin level in patients taking risperidone was higher than that of haloperidol, while olanzapine showed no significant difference in terms of prolactin plasma level from haloperidol. New antipsychotics may not influence the testosterone plasma level.

Keywords

Olanzapine;Risperidine;Haloperidol;Testosterone;Prolactine.

Clonidine Treatment of Clozapine-Induced Hypersalivation

Hyung-Keun Lee, MD;In-Joon Park, MD;Young-Joon Kwon, MD; and Hee-Yeon Jeong, MD;

Department of Psychiatry, College of Medicine, Soonchunhyang University, Chun-an, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 80-4.

Abstract

Background:Hypersalivation can be a troublesome side effect of clozapine, limiting its usefulness in the management of some cases of schizophrenia. But the pharmacodynamic basis of clozapine-induced hypersalivation remains obscure.

 

Object:The aim of this study was to evaluate the effect of the α2-adrenergicagonist clonidine on clozapine-induced hypersalivation in the patients who were receiving clozapine.

 

Method:Twenty one schizophrenic inpatients on clozapine participated in the study. The amount of saliva was measured on the 7th day at 8pm after starting clozapine treatment. Of them, 15 patients who had experienced hypersalivation was treated with 0.1mg/day of clonidine.

 

Result:Of 21 schizophrenic patients treated with clozapine in the psychiatric inpatient clinic, 15(71.4%) complained hypervalivation. After clonidine treatment, mean salivary flow-rate was decreased significantly in these patients.

Conclusion:Clozapine-induced hypersalivation could be decreased by administration of α2-adrenergic agonist clonidine and compliance could be improved. Also our study supports the notion that increased adrenergic tone contributes to clozapine-induced hypersalivation.

Keywords

Clozapine;Clonidine;Hypersalivation.

Review of Sexual Dysfunction in Male Schizophrenics

Yeong Tae Choi, MD1;Jin Sook Cheon, MD2;Byoung Hoon Oh, MD3;

1;Department of Psychiatry, Busan Dong In Hospital, Busan, 2;Department of Neuropsychiatry, College of Medicine, Kosin University, Busan, 3;Department of Psychiatry, College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 85-98.

Abstract

Objective:There are four possible explanations for the sexual dysfunction of schizophrenics. The first is the possibility of a real structural aspect. The second possibility is that sexual function changes secondary to the illness. The third possibility is that there are medical and sociocultural barriers to sexual expression for chronic schizophrenics. The fourth possibility is that sexual dysfunction due to antipsychotic medication. However, we didn't know the precise cause of sexual dysfunction in schizophrenics. Therefore, the purpose of this study was to explore the mechanism of illness itself and antipsychotics on sexual dysfunction in male schizophrenics.

 

Methods:The serum prolactin(PRL), testosterone(TST), and the plasma serotonin(5-HT) concentrations were measured by radioimmunoassay and high performance liquid chromatography method for 100 healthy male schizophrenics according to the DSM-IV. Concomitantly, the severity of psychotic symptoms using Clinical Global Impression(CGI), Brief Psychiatric Rating Scale(BPRS), Positive and Negative Syndrome Scale(PANSS), and the severity of side effects for antipsychotics using Extrapyramidal Side Effects Scale(EPSE), Anticholinergic Side Effects Scale(ACSE), the cognitive function using PANSS-Cognitive Function(PANSS-CF), Mini Mental State Exam-Korean(MMSE-K), and the sexual dysfunction using Sexual Functioning Questionnaire(SFQ), Questionnaire for Sexual Dysfunction in Men were assessed. The PRL, TST, and 5-HT levels of 50 healthy male controls who had no medical, neurological, and psychiatric illnesses were evaluated. The sexual function using SFQ(items FGa, FNa) were also assessed. Furthermore, the correlation with age, education, religion, economic status, age at onset, duration of illnesses, duration of admission, levels of PRL, TST, 5-HT, antipsychotic dosages, potency, benztropine, total duration of medication, EPSE, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K and sexual dysfunctions were identified in male schizophrenics.

 

Results:1) The frequencies of sexual dysfunctions for schizophrenics(80%) were significantly(p<0.001) higher than those for controls(42%). The sexual dysfunctions according to sexual response cycle were ‘low sexual desire’76%, ‘impairment of achieving erection’75%, ‘impairment of maintaining erection’75%, ‘impairment of obtaining orgasm’32%, ‘impairment in the quality of orgasm’61%, ‘impairment in quantity of ejaculate’44%, ‘premature ejaculation’15%, and ‘delayed ejaculation’50%. 2) The PRL, 5-HT levels of schizophrenics(28.5±20.6ng/ml, 298.5±89.1ng/ml) were significantly(p<0.001) higher than those of controls(10±5.6ng/ml, 169.2±37.8ng/ml), while the TST levels of schizophrenics(4.3±1.5ng/ml) and controls(4.5±1.2ng/ml) were not significantly different. The sexual dysfunctions of schizophrenics who had abnormal 5-HT levels(4.7±1.3 scores) were significantly(p<0.05) higher than those of who had normal 5-HT levels(3.8±1.6 scores) on item D7. 3) The sexual dysfunctions of unmarried schizophrenics were significantly(p<0.01:p<0.05) higher than those of married schizophrenics(6.1±2.8 scores, 4.7±1.3 scores on item FGa:β=-0.211 on item FNa). The sexual dysfunctions were positively correlated with the rise of 5-HT levels(r=0.209, p<0.05 on item D4 and r=0.241, p<0.05 on item D7), the higher age at onset(r=0.275, p<0.01 on item FNa:r=-0.202, p<0.05 on item FDa), the longer duration of illnesses(r=0.237, p<0.05 on item D6), the longer duration of admission(r=0.234, p<0.05 on item D4:r=0.328, p<0.05 on item D6), the longer total duration of medication(r=0.237, p<0.05 on item D6). However, age, education, religion, economic status, PRL, TST levels, antipsychotics dosage, potency, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K scores were not correlated with increased sexual dysfunctions.

Conclusions:Male schizophrenics have significantly more sexual dysfunction to compare with controls. The higher frequencies of sexual dysfunctions were low sexual desire and erectile disorder. The unmarried, higher age at onset, and longer duration of diseases were positively correlated with increased sexual dysfunctions. Also high 5-HT levels were positively correlated with increased sexual dysfunctions. This means that studies of plasma 5-HT levels, albeit questionable indicators of central 5-HT function, offer some additional support for the association of sexual dysfunction with excess 5-HT activity as primary pathology of schizophrenia. Our findings suggest that excess 5-HT activity seems to affect the patient's sexual function.

Keywords

Male schizophrenics;Sexual dysfunctions;Serotonin;Prolactin;Testosterone.

Clinical Factors Related with Antipsychotics Treatment in Bipolar Inpatients ­Comparison of Risperidone and Classical Antipsychotics­

Se-Won Lim, MD;Min Soo Lee, MD;Dong-Il Kwak, MD; and In-Kwa Jung, MD

Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 99-106.

Abstract

Background:In spite of relative high risk of extrapyramidal side effect and tardive dyskinesia, it is common clinical practice to use antipyschotics in treatment of bipolar I disorder. But in Korea, there has been few study about clinical factors related with antipsychotics treatment in bipolar disorder patients. So the author studied about the clinical factors related with antipsychotics treatment in bipolar inpatients focusing on the comparison of risperidone and classical antipsychotics.

 

Method:By reviewing medical record retrospectively, datas about patient-related, illness-related, and treatment-related clinical factors on antipsychotics use were collected. Association between antipsychotics dose and duration and clinical factors were analysed by statistical method.

 

Results:Aggressive behavior was only statistically significant factor associated with antipsychotics use. And in the case of aggression, maintenance dose of risperidone was not changed(p=0.84), but dose of classical antipsychotics was increased significantly(p=0.005). Total hospital days and antipsychotics treatment duration showed no difference between risperidone and classical antipsychotics treatment groups.

Conclusion:Clinical factors associated with antipsychotics use was aggressive behavior. In the case of aggression, risperidone required lesser dose increment compared with classical antipsychotics.

Keywords

Bipolar disorder;Antipsychotics;Risperidone;Clinical factors;Aggression.

Vol. 7 No.2

Molecular Application in Psychiatry

Ihn-Geun Choi, MD, PhD

Department of Neuropsychiatry, Hangang Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 115-22.

Abstract

The development of molecular biology has brought many changes in psychiatry. Molecular biology makes us possible to know the cause of mental disorders that provide the way to prevent the disorders, and to develop various accurate diagnostic and treatment methods for mental disorders. The author discusses the concept, cause, and treatment of mental disorders in the aspect of molecular biology. Importing the methods of molecular biology into psychiatry, we can anticipate to get a number of the goals of psychiatric genetics, including identification of specific susceptibility genes, clarification of the pathophysiological processes whereby these genes lead to symptoms, establishment of epigenetic factors that interact with these genes to produce disease, validation of nosological boundaries that more closely reflect the actions of these genes, and development of effective preventive and therapeutic interventions based on genetic counseling, gene therapy, and modification of permissive or protective environmental influences. In addition to their capacity to accelerate the discovery of new molecules participating in the nervous system's response to disease or to self-administered drugs, molecular biological strategies can also be used to determine how critical a particular gene product may be in mediating a cellular event with behavioral importance. Molecular biology probably enables us discover the environmental factors of mental disorders and allow rational drug design and gene therapies for mental disorders, by isolation of gene products that facilitate a basic understanding of the pathogenesis of these disorders. A specific genetic linkage may suggest a novel class of drugs that has not yet been tried. With respect to gene therapy, the hypothetical method would use a gene delivery system, most likelya modified virus, to insert a functional copy of a mutant gene into those brain cells that require the gene for normal function.

Keywords

Molecular biology;Psychiatry;Implication;Mental disorder;Etiology;Treatment.

cDNA Microarray in Psychiatry

Byung-Hwan Yang, MD; and Ja-Yoon Kim, MD

Department of Neuropsychiatry, College of Medicine & The Mental Health Research Institute, Hanyang University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 123-30.

Abstract

The development of inexpensive high throughput methods to identify individual DNA sequences is important to the future growth of medical genetics. This has become increasingly apparent as psychiatric geneticists focus more attention on the molecular basis of complex multifactorial diseases at which most of psychiatric disease is estimated. Furthermore, candidate gene approaches used in identifying disease associated genes necessitate screening large sequence blocks for changes tracking with the disease state. Even after such genes are isolated, large scale mutational analysis will often be needed for risk assessment studies to define the likely medical consequences of carrying a mutated gene. This review provide basic knowledge of up-to-date technology, cDNA microarray which enables above mentioned various research themes.

Keywords

cDNA microarray;Psychiatric genetics;Pxpharmacogenetics.

Combination & Augmentation Strategies in the Treatment of Depressive Disorder

Hyeong-Seob Kim, MD

Yong-In Mental Hospital, Yong-In, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 131-9.

Abstract

Even the pharmacotherapy is more effective than placebo for the treatment of depression, the outcome of pharmacoltherapy remains unsatisfactory for many patients. Apart from side effects, there are two major limitations of antidepressant therapy. One is the delayed onset of improvement and another is partial response. In order to address these clinical dilemmas, many psychiatrists more commonly employ add-on therapy. In past, the practice of using multiple drugs to enhance treatment response was called polypharamcy, and was disparaged as poor clinical practice. However, with improved understanding of how drugs affects the central nervous system and increased communication in journals and on computer networks about the relative merits of specific combinations, the scientific basis for the combining drugs is being defined. Indeed, the use of multiple medications as a stratege to enhance response has become both acceptable and widespread now a days. It is now referred to more positively as add-on therapy, co-medication, combination therapy, or drug augmentation. Thus, as the methods of practical strategies for treatment of depression, switching classes antidepressant drugs, combination therapy, augmentation strategies and brief treatment algorithm will be presented with items of considerations. However, when combination of drugs being tried, knowledges about the action of mechanism, pharamcokinetics, and pharmacodynamics are essential to cope with the possible adversive reactions and to get the appropriate responses for the treatment of depressive symptoms.

Keywords

Depression;Pharmacotherapy;Combination;Augmentation.

No Association of CYP2D6*4 and CYP2D6*10 Polymorphisms with Tardive Dyskinesia in Korean Schizophrenics

Sung-Il Woo, MD1,6;Dong-Woo Kang, MD2;Han-Gil Seo, MD1;Bong-Jo Kim, MD3;In-Sang Lee, MD3;Geun-Hoa Jeong, MD3;So-Young Park, MD3;Chi-Yeong Jung, MD4;Hwan-Cheol Lee, MD4;Kyeong-Cheon Jeong, MD5; and Jin-Wook Sohn, MD1,6;

1;Department of Psychiatry, College of Medicine, Gyeongsang National University, Chinju, 2;Hanbit Neuropsychiatric Clinic, Chinju, 3;Gyeongnam Provincial Mental Hospital, Sachun, 4;Hanmaeum Hospital, Samcheonpo, Chinju, 5;Chinju Mental Hospital, Chinju, 6;Gyeongsang Institute for Neuroscience, Chinju, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 140-6.

Abstract

P450 CYP2D6 enzyme(=debrisoquine hydroxylase) is known to metabolize many neuroleptics and some genetic polymorphisms in the CYP2D6 gene were reported to be associated with tardive dyskinesia(TD). We investigeted the association of two genetic polymorphisms in the CYP2D6 gene, CYP2D6*4 and CYP2D6*10, with TD in Korean schizophrenic subjects. Subjects consisted of 71 Korean schizophrenics and TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). There were no statistically significant differences in the demographic variables of age, male to female percentage and the current antipsychotic(CPZ equivalent) dose between the group with TD and the group without TD. But the duration of antipsychotic drug exposure was significantly higher in the group without TD(p=0.000, by independent t-test). The mean AIMS score in the group with TD was 11.2±6.6(S.D.). Genotypings for the presence of CYP2D6*4 and CYP2D6*10 were done using PCR amplifications and endonuclease digestions. There were no statistically significant genotypic and alleleic associations between TD and CYP2D6*4(by chi-square tests), and between TD and CYP2D6*10(by chi-square tests). These results indicate that the CYP2D6*4 and CYP2D6*10 polymorphisms have no significant roles in the causation of TD.

Keywords

Tardive dyskinesia;CYP2D6*4;CYP2D6*10;Koreans.

Restriction Fragment Length Polymorphism of Interleukin-10 Gene in Major Depression

Taeyoun Jun, MD;Chi-Un Pae, MD;Chung Tai Lee, MD;Won-Myong Bahk, MD;and Kwang-Soo Kim, MD

Department of Psychiatry, College of Medicine The Catholic University of Korea, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 147-51.

Abstract

Objective:Major depression is known to have immunologic dysfunctions, the recent studies revealed that cytokines including IL-6 and IL-1β were increased in patients with major depression. Since molecular genetic methods have been progressed, this study was to investigate the relationship between major depression and immunologic aspects by analyzing polymorphism of IL-10 gene.

Method:92 patients with major depression were included and data of 146 normal controls obtained from the Catholic Hemopoietic Stem Cell Information Bank of Korea were used in this study. DNA was extracted from whole blood, thereafter amplified by polymerase chain reaction, and digested by MaeⅢ After that procedure, we obtained and assessed RFLP of two alleles, IL-10T and IL-10C. All data were analyzed by χ2 test.

Results:1) There were no significant difference in genotype frequencies of IL-10*T/T, IL-10*T/C, and IL-10*C/C between major depression patients group and control group. 2) There were no significant difference in allelic frequencies of IL-10*T and IL-10*C between major depression patients group and control group.

Conclusion:We did not verified the differences in frequencies of IL-10*T/*IL-10*C gene between the major depression patients group and control group, respectively. But the results of this study do not declare that the IL-10 gene has no association with major depression. We do suggest that further systematic studies including various clinical variables should be conducted.

Keywords

IL-10 gene;Polymorphism;Major depression.

Association of Dopamine D4 Receptor(DRD4) Gene Polymorphism with Korean Schizophrenic Patients

Hong Seock Lee, MD1;Min Soo Lee, MD, PhD1;Deock-Jeong Han, MD2; and Heon-Jeong Lee, MD3;

1;Department of Psychiatry, College of Medicine, Korea University Hospital, Seoul, 2;Chunchon National Hospital, Chunchon, 3;Department of Psychiatry, Eumsung Mental Hospital, Chungbuk, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 152-8.

Abstract

Background:No association between schizophrenia and dopamine D4 receptor polymorphisms have been reported. Despite these results, it is premature to exclude the association. It has been suggested that the susceptibility to develop schizophrenia could result from variation at a number loci which may interact or coact with each other. Therefore, we investigated a possible association of combinations of exon Ⅲ 48bp polymorphism [D4E3] and exonⅠ12bp polymorphism of the DRD4 gene [D4E1] with schizophrenia.

Methods:207 unrelated Korean schizophrenic patients and 191 healthy controls were recruited. DRD4 genotype was established using the polymerase chain reaction. Statistical analysis consisted of χ2 tests for Hardy-Weinberg proportions and genotypic and allelic frequencies in the patients and control groups.

Results:There were no statistically significant differences in the each polymorphisms between schizophrenics and controls. And all genotype frequencies were within Hardy-Weinberg expectations. When the combinations of the polymorphism in schizophrenia and controls were compared, however, there were significant differences at A1A2*2/4 in the distributions of the combinations of D4E1 and D4E3(p<0.01).

Conclusions:These findings suggest that the certain combination of D4E1 and D4E3 (A1A2*2/4) has the protective role to a susceptibility for schizophrenia.

Keywords

Dopamine D4 receptor;Polymorphism;Association study;Schizophrenia.

The Association between the Dopamine D5 Receptor Genotype and Treatment Response for KoreanSchizophrenic Patients

Sung Min Kang, MD1;Min Soo Lee MD, PhD1; and Choong Soon Rhee, MD, PhD2;

1;Department of Psychiatry, College of Medicine, Korea University, Seoul, 2;Yong-In Mental Hospital, Kyunggi-do, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 159-63.

Abstract

Background:Dopamine receptors are strong candidates for involvement in schizophrenia and are target of a wide variety of antipsychotics. Dopamine D5 receptor(DRD5) gene polymorphisms may be associated with various treatment response. The purpose of our study was define to what significance can be held as a predictor of treatment response in this polymorphism.

Method:The total number of 116 Korean chronic schizophrenic patients was assessed after 48 weeks treatment. The Positive and Negative Syndrome Scale(PANSS) was rated for the clinical response to various antipsychotics. With the use of polymerase chain reaction amplification, we assessed this dopamine D5 receptor polymorphism in schizophrenic patients who had been treated with antipsychotics, and related genotype with treatment response, to test the hypothesis that DRD5 polymorphism may lead to varying response to antipsychotics.

Result:DRD5 polymorphism was not associated with treatment response to a variety of antipsychotics in chronic schizophrenic patients.

Conclusion:Genetic variation of D5 receptors do not predict treatment response to antispychotics.

Keywords

Dopamine D<sub>5</sub> receptor;Receptor gene;Schizophrenia;Treatment response.

Effects of Long-Term Alcohol Treatment Combined with Vitamins or Piracetam on the Ultrastructure of Rat Hippocampal and Cerebellar Neurons

Chang-Ho Sohn, MD1;Sang-Ik Lee, MD2;Jeong-Sik Kwak, MD3; and In-Won Jeong, MD 2;

1;Department of Neuropsychiatry, Seoul Paik Hospital, Inje Medical College, Seoul, 2;Department of Neuropsychiatry, School of Medicine, Chungbuk National University, Cheongju, 3;Department of Pathology, School of Medicine, Kyungbuk National University, Daegu, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 164-73.

Abstract

This study was carried out to investigate the direct neurotoxicity of alcohol on CNS and the effects of piracetam or vitamins on ultrastructural changes of the rat cerebellar and hippocampal neurons during long-term alcohol treatment. To evaluate the results, quantitative analysis were done for light and electronic microscopic findings. On the light microscopy, red degeneration of pyramidal cells and Purkinje cells was found more apparently in the alcohol only treated group than in the control group. On the electron microscopy, increased lipofuscin pigments were found in cerebellum and hippocampus. In quantitative analysis, vitamins significantly reduced red degeneration in both hippocampus and cerebellum. However, piracetam significantly reduced red degeneration in cerebellum but not in hippocampus. Lipofuscin pigments in Purkinje cells and pyramidal cells were significantly reduced in the alcohol with piracetam treated group than the alcohol only treated group. However, vitamins had no significant reducing effect of lipofuscin pigments in Purkinje cells and pyramidal cells. According to the results, it is concluded that vitamins deficiency might cause red degeneration of pyramidal cell after long-term alcohol treatment, but increment of lipofuscin pigments in pyramidal and Purkinje cell may be caused by alcohol itself or its metabolite rather than vitamins deficiency. Piracetam seems to improve cognitive function impairment caused by alcohol consumption.

Keywords

Alcohol;Hippocampus;Cerebellum;Piracetam;Vitamins;Lipofuscin;Red neuron.

The Influence of Negative Emotion to Cortical Activity Induced by Auditory Verbal Imagery in Patients with Schizophrenia

Hong-Shick Lee, MD, PhD;Ji-Woong Kim, MD; and Yully Kim, MD

Department of Psychiatry, College of Medicine, Yonsei University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 174-9.

Abstract

Objectives:Cognitive psychological models propose that auditory hallucinations arise from a problem with monitoring one's auditory verbal imagery. Most auditory hallucinations are derogatory in content and accompany negative emotions. If auditory verbal imagery plays an critical role in the pathogenesis of auditory hallucination, it must be influenced by negative emotions. This study was aimed at understanding the influence of negative emotions on the development of hallucinations by investigating the way by which negative emotions have influence on cortical activity induced by auditory verbal imagery.

Methods:For both normal subjects and patients with schizophrenia, quantitative electroencephalography(Q-EEG) was applied during the auditory verbal imagery tasks using a two word list. The one word list accompanied negative emotion and the other accompanied neutral emotions. The difference of EEG activity between two tasks was compared by paired t-test. We also compare the difference of the influence of negative emotions between normal subjects and patients with schizophrenia

Results:In normal subjects, amplitude of beta wave was increased in temporal area such as TCP1, and, the amplitude of theta frequency wave was decreased in right hemisphere such as FP2, F4, C4, CP2, P4. But, in the schizophrenia group, there were no significant differences.

Conclusion:These results may suggest that auditory verbal imagery with negative emotion requires more activation in left temporal area, but, appropriate activation may not achieved in schizophrenia patients. So, the possibility that the resultant disturbance of verbal self monitoring may be related to auditory hallucination is suggested in this study.

Keywords

Negative emotion;Auditory verbal imagery;Verbal self monitoring;Auditory hallucination;Schizophrenia.

Comparison of Global Field Power Measurement and Conventional Method in Multi-channel Auditory Event Related Potential P300 Determination

Yang-Whan Jeon, MD; and Sang-Ick Han, MD

Department of Neuropsychiatry, Our Lady of Mercy Hospital, The Catholic University of Korea, Inchon, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 180-5.

Abstract

Objective:The present study was designed to compare Global Field Power Measurement and conventional method in P300 determination.

Method:The subjects were composed of patients(N=20) with schizophrenia by DSM-IV and normal controls(N=20). The auditory event related potential P300 was measured by “oddball paradigm”. P300 components were determined by Global Field Power Measurement and conventional method at 5 electrodes(Fz, Cz, Pz, T3, T4).

Results:P300 amplitudes of patients were smaller than those of controls across all electrodes and in both methods, but there was no differential power in P300 determination between two methods. Asymmetry of auditory event-related potential P300 was not shown between patients with schizophrenia and normal controls.

Conclusion:It is implicated that it depends on clinical situations and research purposes what method of P300 determination will be more appropriate for patients with schizophernia.

Keywords

정신분열병;P300;전부위장력측정법;전통적 방법;비대칭성.

Predicting Factors of Discontinuation of Medication after Cognitive Behavioral Therapy for Panic Disorder

Young Hee Choi, MD1;Kee Hwan Park, PhD2;Han Seok Kim, MD1; and Oh Ryeong Ha, MA2;

1;Department of Neuropsychiatry, 2;Neuropsychology, Seoul Paik Hospital, Inje University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 186-90.

Abstract

Objective:The authors experienced that cognitive behavioral therapy(CBT) could replace medication for controlling panic attacks and anticipatory anxiety symptoms. The objective of this study was finding out predicting factors of discontinuation of medication after CBT for patients with panic disorder.

Method:A hundred forty-eight patients who met DSM-Ⅳ criteria for panic disorder with or without agoraphobia for at least 3 months had completed 12 weekly sessions of Panic Control Therapy(PCT;Barlow et al). Eighty-one patients who could discontinue medication and sixty-seven patients who could not discontinue medication were measured with several scales as the pre- and post-treatment aassessment. The scales were Beck Depression Inventory(BDI), Clinical Global Impression(CGI), Spielberger State Anxiety Inventory(STAI-state), Anxiety Sensitivity Index(ASI), Body Sensation Questionnaire(BSQ), Panic Belief Questionnaire(PBQ), Agoraphobic Cognition Questionnaire(ACQ), Fear Questionnaire(FQ), Toronto Alexithymia Scale(TAS).

Results:At the pre-treatment assessment, the scores of BDI, CGI, STAI-state, ACQ, BSQ were higher in the patients who could discontinue medication than in the patients who could not discontinue medication(t=-2.68, t=-4.88, t=-3.07, t=-3.68, t=-3.35, p<0.01).

Conclusion:Patients with panic disorder who were less depressed, less anxious, less agoraphobic and who had less negative cognitions for the bodily sensation and who had higher scores in the therapist's assessment could discontinue their medications.

Keywords

Panic disorder;Cognitive behavioral therapy;Discontinuation of medication.

The Cardiovascular Effect of Risperidone

Se-Jin Choi, MD1;Jin-Sook Cheon, MD1; and Young-Tai Choi, MD2;

1;Department of neuropsychiatry, Kosin University, School of Medicine, Pusan, 2;Department of Psychiatry, Busan Dong In Geriatric Hospital, Pusan, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 191-7.

Abstract

Objectives:Risperidone is a new antipsychotic drug developed to overcome the therapeutic limitation of conventional antipsychotics. It responses to negative as well as positive symptoms by blocking both dopaminergic and serotonergic receptors, causing no significant side effects such as agranulocytosis and seizure. It is, however, not known whether it induces any serious cardiovascular side effects as evoked by other conventional antipsychotic drugs. The aims of this study were to evaluate the effect of risperidone on cardiovascular function, and to discuss the factors affecting the cardiovascular function.

Methods:For 42 patients(22 males and 20 females) diagnosed as schizophrenia, schizophreniform disorder or schizoaffective disorder according to the DSM-
classification, the cardiovascular fuctions such as heart rate, systolic and diastolic blood pressure, PR interval, QRS interval and QT interval were successively checked before and after 2 weeks and 4 weeks risperidone administration. Furthermore, variables such as body weight, Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGI), Extrapyramidal Symptom Rating Scale(ESRS), Anticholinergic Rating Scale(ARS), serum cholesterol level, serum triglyceride level, serum high-density-lipoprotein level, serum WBC, serum Hb, serum platelet level, prothrombin time and partial thromboplastin time were also analyzed before and after 2 weeks and 4 weeks risperidone administration.

Results:1) Risperidone treatment resulted in a significantly decreased heart rate and increased QT interval after 4 weeks administration(p<0.005 respectively). 2) The scores of BPRS and CGI were significantly decreased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). The scores of ESRS and ASRS were significantly increased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). 3) There were positive correlations between heart rate after 4 weeks and total dose(p<0.05). Blood pressure was significantly(p<0.05) correlated with sex(higher in male) and significantly(p<0.05) positive correlated with body weight. QT interval was significantly(p<0.05) correlated with sex(longer in female) and smoking history(shorter in smokers).

Conclusions:Risperidone could induce significant change in heart rate and Q-T interval. Therefore, the cardiovascular safety for risperidone should be reconsidered according to the duration and dosage increase.

Keywords

Risperidone;Heart rate;QT interval;Dose.

Cost Effectiveness of Clozapine and Risperidone in “Revolving Door” Schizophrenia

Jong-Won Nam, MD1;Min-Soo Lee, MD2;In-Kwa Jeong, MD2; and Dong-Il Kwak, MD2;

1;Kunsan Mental Health Center, Kunsan, 2;Department of Neuropsychiatry, College of Medicine, Korea University, Seoul, Korea

Korean Journal of Biological Psychiatry, Vol. 7, No. , pp. 198-205.

Abstract

Objectives:Risperidone and clozapine belong to a new generation of antipsychotics that are reportedly more effective and better tolerated than conventional neuroleptics. However, each of these agents costs far more per unit than conventional neuroleptics. The purpose of our retrospective study was to ascertain the total cost and effectiveness of treatment before and after administration of risperidone and clozapine in “revolving door” schizophrenia patients.

Method:Data collected on revolving door schizophrenics for 2 years before clozapine and risperidone treatment and for at least 2 years after clozapine and risperidone treatment. Direct cost of inpatient and outpatient treatment was measured. Effectiveness was scaled as “years of mild disability gained”.

Result:Both risperidone and cloazpine result in higher costs and additional benefits to patients, for example, increased mild disability, reduced number of relapse, and reduced hospital length-of-stay. An ICER of risperidone was less than Rc and ICER of clozapine was greater than Rc. According to decision-analytic this model, risperidone had favorable cost-effectiveness ratios relative to clozapine.

Conclusion:We have assumed that risperidone is more cost-effective than clozapine.

Keywords

Risperidone;Clozapine;Cost-effectiveness.