Images in Psychiatry / 신경정신의학

No abstract available.

The Influence of Cigarette Smoking on Alcohol Craving in Alcohol Dependent Individuals / 신경정신의학

OBJECTIVES: This study aimed to determine the effects of smoking on alcohol cravings in alcoholdependent individuals. METHODS: Study participants were 123 male smokers, 18 to 65 years of age, diagnosed with alcohol dependence. The study questionnaire consisted of demographic characteristics, alcohol drinking habits, smoking habits, the Korean Obsessive-Compulsive Drinking Scale (OCDS), the 12-item Tobacco Craving Questionnaire (12-item TCQ), and the Fagerstrom Test for Nicotine Dependence (FTND). We divided the subjects into high-OCDS score and low-OCDS score groups. RESULTS: The high-OCDS group had a higher alcohol drinking frequency and greater average amount of alcohol consumed than did the low-OCDS group. Also, the high-OCDS group smoked a higher average number of cigarettes per day and had higher 12-item TCQ scores and FTND scores. Logistic regression analysis showed scores of the 12-item TCQ and the FTND were the most significant variables for predicting alcohol cravings. CONCLUSION: This study shows that alcohol cravings are significantly related to cigarette cravings and to severity of nicotine dependence.

Folate nutrition is related to neuropsychological functions in the elderly

We investigated the nutritional state of B vitamins and the neuropsychological functions in 25 subjects, aged 63.1 +/- 6.3 years, residing in rural areas of Korea. Nutritional states of thiamin, riboflavin, and pyridoxine were assessed enzymatically in the erythrocytes, and folate concentrations were measured microbiologically in the plasma and erythrocytes. A battery of composite neuropsychological test was administered to the subjects. Plasma folate was correlated with the total intelligence score (p=0.049). Folate levels in the erythrocytes were correlated with the performance intelligence scores such as block design (p=0.017) and picture arrangement (p=0.016). The red cell folate was correlated with memory scores such as general memory (p=0.009) and delayed recall (p=0.000). Although it did not reach statistical significance, verbal memory (p=0.053) was highly correlated with the red cell folate. The red cell folate was also correlated positively with the percent of conceptual level response number score (p=0.029), and negatively with the grooved pegboard test score for the non-dominant hand (p=0.010). Fine motor coordination was also influenced by folate nutrition, as finger tapping scores in both hands were significantly correlated with red cell folate (dominant hand; p=0.026, non-dominant hand; p=0.004). Other B vitamins such as thiamin, riboflavin, and vitamin B6 were not as strongly correlated with neuropsychological function test scores as folate was. These results suggest that folate nutrition influences neuropsychological function test scores significantly in humans. Further studies are needed to explore the relationship between folate or other vitamin B nutrition and neuropsychological functions and the implications thereof.

Dysfunction of the Left Dorsolateral Prefrontal Cortex is Primarily Responsible for Impaired Attentional Processing in Schizophrenia

OBJECTIVE: The results for finding the deficit in the anterior cingulate (ACC) in schizophrenic patients (SZ) have been inconsistent according to the studies that used different Stroop tasks, which is unlike the deficit in the dorsolateral prefrontal cortex (DLPFC). In order to explore for the core region that's responsible for the selective attention deficit in SZ, we examined the results of a functional neuroimaging study, which involved the performance of the Stroop task using high or low prefrontal cortex related loads in SZ. METHODS: Ten schizophrenic patients and healthy controls (HC) received functional magnetic resonance imaging (fMRI) during a Short/Long-term latency Stroop task. The changes in the neural activity were determined in well-known Stroop related regions of interest (ROIs) that consisted of the DLPFC, ACC, the parietal lobule and in the whole brain regions for both the main and interaction effects of latency, and the results of the short-term and long-term latency Stroop conditions were compared. RESULTS: The response times for both the congruency and latency effects were more prolonged in the schizophrenics than in the HC. For the congruency effect, the schizophrenics showed significantly less activation in the same site of the left DLPFC in both the short-term and long-term latency conditions, as compared with the HC. For the latency effect, the regions of the left-side language network were over- or under-activated in the schizophrenics, as compared with the HC. Any interaction effect was not found for both the behavioral and fMRI results. CONCLUSION: Our results indicate that the deficit in the left DLPFC is the core impairment of attentional processing in schizophrenics, regardless of other possible interactions such as the latency effect.

The Reliability and Validity of the Korean Version of Tobacco Craving Questionnaire / 신경정신의학

OBJECTIVES: The objective of this study is to assess the reliability and validity of the Korean version of the Tobacco Craving Questionnaire (K-TCQ), a multidimensional, self report instrument evaluating tobacco craving in a population of current smokers. METHODS: The Korean version of TCQ was administered to 216 current cigarette smokers. RESULTS: The Cronbach's alpha coefficient of the K-TCQ was high (0.95) which provided the evidence for the internal consistency. The test-retest reliability of K-TCQ was 0.66 (correlation coefficient, p<0.01). The correlation coefficients between the K-TCQ and each five VAS questionnaires were high (0.50-0.59, p<0.01). Inter-correlations of K-TCQ, VAS, FTQ, BDI, STAI-I and STAI-II were significant (p<0.01). CONCLUSION: The Korean version of TCQ is a valid and reliable scale for evaluating tobacco craving.

Efficacy and Safety of Long-term Aripiprazole Therapy in Patients with Schizophrenia, Schizophreniform Disorder, and Schizoaffective Disorder: A 52-week, Prospective, Open-label Study / 대한정신약물학회지

OBJECTIVE: We investigated the long-term efficacy, safety, and tolerability of aripiprazole in a large number of patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder in Korea. METHODS: This was an open-label, multi-center, single-arm, 52-week study of patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder. Korean patients (N=300) experiencing either a first episode or recurrence participated in this study. The primary efficacy measure was the Positive and Negative Syndrome Scale (PANSS) total score. Secondary efficacy measures included the PANSS positive and negative subscales, and the Clinical Global Impression-Severity of Illness (CGI-S). Safety was evaluated prospectively by recording treatmentemergent adverse events; measuring extrapyramidal symptoms (EPS), vital signs, and body weight; and performing laboratory tests. RESULTS: Overall, 55 (18.33%) of the patients completed the entire 52-week study. Treatment with aripiprazole provided rapid and significant improvement in all of the efficacy measures. Comparing PANSS total scores, PANSS positive subscale scores, and CGI-S scores, first-episode patients showed significant improvement than the patients who had experienced at least one recurrence. There were no significant differences in the mean change of EPS during the study, except for akathisia at week 8 and a significant decrease in serum prolactin level in patients experiencing first and recurrent episodes. At the end of the study, the mean weight gain was 2.40 kg. CONCLUSION: Aripiprazole is effective and safe for patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder during a long-term, 52-week treatment. The result may be associated with the unique mechanism of aripiprazole. We have extended the findings of previous studies in the United States and other countries and demonstrated a similar effectiveness of aripiprazole for Korean patients.

Comparison between Logistic Regression and Artificial Neural Networks as MMPI Discriminator

OBJECTIVES: The 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.

Compensatory Neural Correlates of Selective Attention Deficit in Schizophrenics Showing Normal Accuracy during Stroop / 신경정신의학

OBJECTIVES: This study investigated the compensatory neural correlate of selective attention deficit in schizophrenics showing near-normal performance. METHODS : A 'modified Stroop' was developed that can be used measure the response time during functional imaging. An event-related functional magnetic resonance imaging study was carried out in 10 clinically stabilized schizophrenics and 10 healthy controls during the performance of a 'modified Stroop'. In the 'modified Stroop', the subjects were required to respond with a two-button mouse to whether or not the color of a subsequent word corresponded to one of T-shirt. The significantly activated brain regions were investigated in a voxel-wise t-test of the Stroop load. RESULTS : Schizophrenics, compared with healthy controls, showed poorer response time, but had similar accuracy. Compensatory activation in the right inferior frontal gyrus (IFG) was observed in schizophrenics. The left paracingulate sulcus was less activated in the schizophrenics than in the healthy controls. CONCLUSION : These results suggest that, in schizophrenics showing a normal accuracy during the Stroop, selective attention deficits might be related to the left paracingulate sulcus as well as the anterior cingulate. In addition, their deficits may be compensated with the right IFG.

Development of Psychiatric Computerized Medical Records System / 신경정신의학

OBJECTIVES: Computer-based patient record (CPR, Electronic medical record) improves the quality of medical record which reflects the quality of clinical practice. It provides more efficient and convenient way of input, retrieval, storage, communication and management of medical data. The purpose of this study was to develop a practical domestic model and theoretical basis for CPR for psychiatric patients. This model can be applied in other clinical departments. METHODS: The contents and types of items to be included in the data-base were determined through consensus meetings of investigators on the basis of our previous works on the 'comprehensive assessment of symptoms and history in psychiatric disorders' and analysis of structure and items of medical records. The computer program(Asan Medical Center Psychiatric Information System, APIS, version 1.0) was developed using Oracle 7-3-4, Power builder 4.0, Hangul Windows NT and TCP/IP as a programming, development tools, system operation and transmission protocol. RESULTS: The characteristics of APIS are as follows. 1) APIS ensures comprehensive and high quality psychiatric record through combinations of free-text and structured data format and through many available 'help pop-up windows' of required items for better documentations. 2) APIS provides convenient and efficient ways of data input, particularly for narrative input of texts, with various tools such as 'template copy', various 'pop-up lists for block or phrase copy'. 3) APIS enables users to create and modify the template files or scales for research. 4) APIS which adopted principles of POMR (Problem Oriented Medical Record) makes cumbersome management of problem titles very convenient 5) APIS also provides additional statistics necessary for hospital audit and managements as well as mail communication and schedule management of department. 6) Access to APIS requires authorized ID and password where several levels of privileges (view only, edit allowed, master) are assigned to secure the data. And also modification of data was not allowed after completion of medical record except by persons with master ID. User's password and the data before modification can be traced. CONCLUSIONS: Our study results demonstrate the practical model and theoretical basis for CPR for psychiatric patients. We believe that this model and methods contained in this program can also be applied for developments of CPR for other clinical departments.

Prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among Korean College Women / 신경정신의학

OBJECT: More than 75% of women have been reported to experience premenstrual symptoms and three to eight percent of them suffer from premenstrual dysphoric disorder(PMDD). But little is known about prevalence of premenstrual syndrome(PMS) and PMDD among Korean women. The purpose of this study was to investigate the prevalence of PMDD and PMS in Korean women who attended universities at the time of survey. METHODS: One thousand four hundred and nineteen subjects were randomly selected with cluster sampling method among four women's university in Seoul. We measured the severity of premenstrual symptoms using six-point rating scale developed by the authors on the basis of the research criteria for PMDD in DSM-IV. Premenstrual worsening of symptoms was defined as increase in symptom scores of more than 75% from follicular to luteal phase score. And also, we compared characteristic symptoms, eating behaviors, and functional impairments between PMS and PMDD. RESULT: After excluding inadequate data according to our exclusion criteria, 873 of 1419 subjects(61.5%) were included in the estimation of the prevalence of PMS and PMDD. Each prevalence rate of PMS and PMDD was found to be 83.3% and 5.0% on the basis of 75% change method respectively. The most frequent symptom was physical symptoms such as headache or breast tenderness(56.4%) in PMS and 'felt irritable'(95.5%) in PMDD. Of the 44 subjects with PMDD, 39(88.6%) reported to have experienced the impairment in work or school at least once per month because of premenstrual symptoms. CONCLUSION: Our results indicate that prevalence and symptoms of PMDD in Korean university women are similar to those in western culture. The finding that mood symptoms were more frequent and severe in PMDD than in PMS implies that the former may be a disordered condition to be distinguished from the latter physiologic one.

Prevalence of Premenstrual Dysphoric Disorder and Occupational Function in a Nurse Group / 신경정신의학

OBJECTIVES: Despite the high prevalence of premenstrual dysphoric disorder and premenstrual syndrome, little attention has been paid to these problems until now. Two of the possible reasons for this inattention seem to be the lack of awareness of women as a whole about these disorders and the tolerability of the functional impairments caused by them. The objectives of this study were to find out the prevalence of premenstrual dysphoric disorder and premenstrual syndrome in a nurse group and to evaluate the occupational function of nurses with these problems. METHODS: The cross sectional retrospective data was obtained from 1301 nurses who were employed in a hospital. Premenstrual symptoms were measured with DRSP(the Daily Record Severity of Problems). A new scale developed by authors was used to evaluate the occupational function. To measure burnout intensity, self-esteem and strength of stressful events, MBI(Maslach Burnout Inventory), Self-Esteem Scale and Social Readjustment Rating Questionnaire were used. Nurses' attempts made for managing premenstrual symptoms were also surveyed. RESULTS: Among 1,078 responders 626(58%)cases were analyzed. Prevalence of premenstrual dysphoric disorder was 4.6%(N=29). Prevalence of premenstrual syndrome was 78.3%(N=490). Comparing occupational function between the groups, the premenstrual dysphoric disorder group had more impairments than the premenstrual syndrome group and no symptom group(p<0.001). Emotional burnout was prominent in premenstrual dysphoric disorder and premenstrual syndrome group(p<0.001). But, there was no significant difference in loss of ambition(p=0.124). To manage their premenstrual symptoms, nurses preferred to nonpharmacologic treatments or nonprescription drugs. None of the nurses with premenstrual dysphoric disorder reported doctor's prescriptions. CONCLUSION: Prevalence of premenstrual dysphoric disorder in a nurse group is comparable to that in general population. The premenstrual dysphoric disorder group has more impairments in occupational function than the premenstrual syndrome group and no symptom group. Nurses have inadequate managements about their premenstrual symptoms as general population do.

Treatment-Seeking Behaviors among Korean University Women with Premenstrual Symptoms / 대한정신약물학회지

OBJECTIVE: The aim of the present study was to determine the treatment-seeking behaviors of Korean university women with premenstrual symptoms. METHODS: Of 1419 subjects who randomly selected in 4 women's university in Seoul, 771 who experienced at least one premenstrual symptom during past three months were included in this study. Treatment-seeking behaviors for relieving premenstrual symptoms were grouped into five categories [doctor's prescription, self-prescription with over-the-counter drug, use of oriental medicine, use of other conservative-alternative medicine (CAM), nonpharmacological treatment]. We investigated what the preferential treatment was and how many subjects were experienced the medical evaluation by doctor. The attitude and knowledge to premenstrual symptoms were evaluated. RESULTS: Subjects who experienced at least one kind of treatment for relieving premenstrual symptoms were 50.2% of women with premenstrual syndrome (PMS) and 63.6% of premenstrual dysphoric disorder (PMDD). Nonpharmacological treatment such as exercise or rest was the most preferential treatment. Only 2.3% of PMDD was examined and prescribed by doctor. Subjects with doctor's or oriental doctor's prescription had more severe premenstrual symptoms and showed functional impairment than others. Only 7% of university women reported to know well about premenstrual symptoms and their treatment. CONCLUSIONS: This study shows that Korean university women prefer self-diagnosis and self-prescription to the evaluation and prescription by doctor for relieving premenstrual symptoms even though they suffer from PMDD. It indicates that the adequate evaluation and treatment for premenstrual symptoms are not carried out because of the lack of knowledge about them. Therefore, the correct information about symptoms and management of PMS and PMDD should be serviced to general population. Also, systematic evaluation of efficacy and safety of oriental medicine and other CAM for premenstrual symptom is needed.

Understanding and Treatment of Premenstrual Dysphoric Disorder / 대한정신약물학회지

Many reproductive women, at least 20-50%, suffered from premenstrual syndrome and 2-8% of them have premenstrual dysphoric disorder(PMDD). Prospective daily records during 2 menstrual cycles are required to differentiate PMDD from other various similar conditions such as concurrent psychiatric or medical diseases or their premenstrual magnification and also to determine the efficacy of treatment. The etiology of PMDD is largely unknown. Recently as several randomized placebo-controlled trial in women with PMDD have reported the efficacy of serotonin reuptake inhibitors(SSRIs), SSRIs have been preferred to other treatment regimens though response rates to SSRIs were variable with high placebo response rate and though their long-term and preventive effect were not yet determined.

Reaction Times in Schizophrenia / 신경정신의학

The reaction time(RT) has been known to reflect attention that controls the flow of information processing. Extensive research has demonstrated cognitive impairment in schizophrenia subjects using RT tasks. However, little work has been done examining the relative contribution of DT(decision time) and MT(motor time) to slowed RT in schizophrenics. Also, recent investigators have observed that schizophrenic patients exhibit larger intra-individual variability in RT than do normal comparison subjects. The purpose of this study, using multi-stimulus convergent RT task, was to explore the speed of RT, relative contribution of decision time(DT) and motor time(MT) to slowed RT, overall sequential profile in 25 repeated-time measurements in 10 schizophrenic out-patients and 10 normal control subjects. Overall reaction time and decision time were slower in schizophrenic subjects than in normal controls. The motor time was not shown to be significantly different between the two groups with 0.05 significance level, although there was some trend indicating schizophrenic subjects were slower consistently in repreated measurements over time. These results suggested that the slower reaction time in schizophrenic subjects was mostly determined by cognitive component, decision time rather than motor time. Sequential profile of repeated measurements showed greater intraindividual and interindividual variations in schizophrenics than in normal controls. These results indicate that high variabilities are not merely measurement errors but characteristic of schizophrenic psychopathology.

Correlation of Cognitive Function and Proton Magnetic Resonance Spectroscopic(1H MRS) Findings in Subclinical Hepatic Encephalopathy / 신경정신의학

OBJECTIVES: To investigate the relationship of neurochemical changes of brain in SCHE patients and the level of cognitive function, the authors measured hydrogen containing neurochemicals in two brain regions using 1H MRS, and compared those changes with the level of cognitive performances such as attention, visual analysis, or fine motor function. METHODS: A total of patients with liver cirrohosis were defined as SCHE, for they performed poorly(out of 1 SD of normative data) in more than one neuropsychological tests conventionally used(digit symbol and block design tests in KWIS, trail making test A and B). They were further evaluated in attentional ability and efficacy of visual analysis using Cognitrone subtest in Vienna Neurocognitive Test battery. Fine motor coordination were also measured by Grooved Pegboard test. Patients and 20 normal controls underwent proton MRS study. Proton containing neurochemicals, such as myoinositol(mI), N-acetyl-L-aspartate(NAA), creatine(Cr), choline(Cho) were measured from 2*2*2cm3 voxel of basal ganglia and parietal white matter using 1.5 tesla clinical MRI/MRS system. The ratios of above metabolites to Cr were analyzed. RESULTS: 1) Patients with SCHE showed reductions in Cho/Cr and mI/Cr in both basal ganglia and parietal white matter compared to normal subjects. 2) Performance of Grooved Pegboard test were negatively correlated with mI level of basal ganglia and with Cho level of parietal white matter(r=-0.59, p<.05). 3) Mean time of correct responses in Cognitrone test showed negative correlation with NAA level of parietal white matter(r=-0.55, p<.05). CONCLUSION: Certain neurocognitive disturbances in SCHE patients seemed to be related with neurochemical changes in basal ganglia or parietal white matter. To further elucidate the relationship of focal biochemical changes and neurocognitive deficits in SCHE patients, however, follow-up study according to the illness stage must be performed. Studies on other disorders showing similar cognitive deficit patterns would be helpful.