Neosensitization to Multiple Drugs Following Valproate-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is associated with severe skin eruptions, fever, hematological abnormalities, and multi-organ involvement. Although aromatic anticonvulsant drugs have been frequently associated with the manifestation of DRESS syndrome, its induction following treatment with nonaromatic anticonvulsants, such as valproate, has rarely been reported. Moreover, there are limited data regarding the development of neosensitization related to chemically unrelated drugs following an episode of DRESS syndrome. Here, a case of neosensitization to multiple drugs is described. The present case report describes a female patient who experienced neosensitization to amoxicillin, olanzapine, and quetiapine following the manifestation of DRESS syndrome induced by valproate.

Clinical Characteristics of Haenyeo with Depressive Disorders

OBJECTIVES: Haenyeo are Korean professional women breath-hold divers in Jeju island. The aim of this study was to investigate the clinical characteristics of depressed Haenyeo group, compared to non-Haenyeo depressed group. METHODS: This study included 75 Haenyeo and 340 non-Haenyeo with depressive disorders recruited from the Dementia Early Detection Program in Jeju island. Structural diagnostic interviews were performed using the Korean version of Mini International Neuropsychiatric Interview. All patients completed the questionnaires, including the Subjective Memory Complaints Questionnaire (SMCQ), the Patient Health Questionnaire-15 (PHQ-15), and the Blessed dementia scale. Depression was evaluated by the Korean version of short form the Geriatric Depression Scale (K-SGDS) and cognition was assessed by the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) assessment packet. RESULTS: Although the mean scores of the K-SGDS were similar between Haenyeo and non-Haenyeo depressed groups, the Haenyeo group showed a higher mean score on the PSQ-15 (p < 0.001, ANCOVA adjusting for age, the K-SGDS and education). The Haenyeo group showed poorer performance on the Korean Version of Frontal Assessment Batter (p < 0.001), the Mini-Mental State Examination in the Korean version of the CERAD Assessment Packet (p < 0.018), the word fluency test (p < 0.001), and the word list memory test (p = 0.012) in ANCOVA adjusting for age and education. The mean SMCQ score was higher in the Haenyeo depressed group than in the non-Haenyeo depressed group. CONCLUSIONS: The Haenyeo depressed group shows cognitive dysfunction, especially frontal lobe dysfunction, compared to the non-Haenyeo depressed group, indicating the Haenyeo depressed group may have more severe frontolimbic dysfunction due to chronic exposure to hypoxia. The Haenyeo depressed group suffers more somatic symptoms than the non-Haenyeo depressed group.

The Relationship between Cognitive Decline and Psychopathology in Patients with Schizophrenia and Bipolar Disorder

OBJECTIVE: The primary goals of the present study were to assess intellectual function in participants with schizophrenia or bipolar disorder (BD) and to investigate the relationships between cognitive decline and the severity of each type of psychopathology. METHODS: The present study included 51 patients with schizophrenia and 42 with BD who were recruited from the psychiatry outpatient clinic of Jeju University Hospital between March 2011 and March 2014. The Korean Wechsler Adult Intelligence Scale (K-WAIS) was administered to each of the 93 participants, and they were categorized into two groups based on their current intelligence quotient (IQ) and their estimated premorbid IQ: severely impaired group (SIG) and mildly impaired group (MIG). The Minnesota Multiple Personality Inventory (MMPI) and the Brief Psychiatric Rating Scale (BPRS) were used to assess psychopathology. RESULTS: The SIG schizophrenia participants exhibited significantly higher scores on the frequent (F) and schizophrenia (Sc) subscales of the MMPI, but significantly lower scores on the correction (K) and psychopathic deviate (Pd) subscales compared with the MIG schizophrenia participants. Furthermore, the BPRS scores were significantly higher in the SIG schizophrenia participants relative to the MIG schizophrenia participants. The SIG BD participants had significantly higher F, masculinity-femininity (Mf), paranoia (Pa), and Sc but significantly lower Pd scores compared with the MIG BD participants. CONCLUSION: The present findings revealed a significant discrepancy between the estimated premorbid levels of cognitive function and current cognitive function in participants with schizophrenia or BD. Moreover, this discrepancy was correlated with severity of psychopathology in both groups.

Clinical Significance of Restless Legs Syndrome in Patients with Late Life Depression

OBJECTIVES: Restless legs syndrome (RLS) is a sleep disorder characterized by uncomfortable and unpleasant sensations in the legs and an urge to move the legs, usually at night. The aim of this study is to investigate the incidence of RLS in patients with late life depression and its influence on various clinical outcomes such as severity of depression, sleep quality, cognitive function, and quality of life and accordingly, to elucidate the clinical significance of RLS in patients with late life depression (LLD). METHODS: This study enlisted 170 depressive patients aged 65 years or older from an outpatient clinic. Structured diagnostic interviews were performed using the Korean version of the Mini-International Neuropsychiatric Interview. All patients completed the questionnaires, including the International RLS Severity Scale, the Korean version of Short-Form 36-Item Health Survey (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). The severity of depression was evaluated by the Korean form of the Geriatric Depression Scale (KGDS) and the level of global cognition was assessed by the Mini-Mental State Examination in the Korean version of The Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (MMSE-KC). RESULTS: The incidence of RLS was 17.6% in LLD patients. RLS was more prevalent among the subjects with major depressive disorder (MDD) than those with minor depressive disorder or subsyndromal depressive disorder. The RLS group showed higher score in the KGDS than the Non-RLS group but the difference did not reach the statistical significance (p = 0.095, Student t-test). The mean PSQI score was significantly higher in the RLS group than in the Non-RLS group (p = 0.001, Student t-test). The MMSE-KC score was also lower in the RLS group than in Non-RLS group (p = 0.009, analysis of covariance). But, there was no difference in the score of SF-36 between the RLS group and the Non-RLS group. CONCLUSIONS: RLS is common in LLD patients, especially in the patients with MDD and is associated with poor sleep quality and cognitive dysfunction, indicating that RLS is clinically significant in patients with LLD. Therefore, RLS should be considered as an important clinical issue in the management of LLD.

Suicidal Ideation and Associated Factors among Korean Elementary School Students / 대한정신약물학회지

OBJECTIVE: This study evaluated the occurrence and associated factors with self-reported suicidal ideation within the last 12 months among Korean elementary school students. METHODS: In a school-based cross-sectional survey, a total of 657 students were recruited from elementary schools (age range: 11??2 years) in Jeju area. They filled out self-completing questionnaires on suicidality (suicidal ideation and suicidal attempt), depression (Kovacs' Children's Depression Inventory), and sociodemographic characteristics, including school and family factors. RESULTS: A total of 192 (29.2%) students reported suicidal ideation, and the rate of suicidal attempt was 6.1% (n=40). Logistic regression analysis identified factors associated with recent suicidal ideation. Female had higher rates of suicidal ideation than male [odds ratio (OR)=1.81, p=0.005], and students with depression (OR=3.23, p<0.001) and experience of abuse in the home (OR=6.77, p<0.001) were at high risk for suicidal ideation. CONCLUSION: These results suggest that suicidal ideation and actions are relatively common in Korean elementary school students, and have implications for prevention and intervention.

Factors Affecting Suicidal Ideation in Korean High School Students / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to evaluate the occurrence of the suicidal ideation and associated factors with self-reported suicidal ideation within the last 12 months among Korean high school students. METHODS: A total of 697 adolescents were recruited from high schools (age range: 15-16 years) in Jeju area. According to existence of suicidal ideation, they were divided into two groups-suicidal ideation group and non-suicidal ideation group, and the differences between groups in terms of various sociodemographic and clinical characteristics, including depression (Beck Depression Inventory), and health related conditions. RESULTS: A total of 187 (26.8%) high school students reported suicidal ideation, and the rate of suicidal attempt was 4.9% (n=34). The associated factors of suicidal ideation were depression [odds ratio (OR)=2.42, p< or =0.001], short sleep duration (OR=1.84, p=0.009), current alcohol use (OR=4.94, p< or =0.001), self reported poor health (OR=2.10, p=0.004), and school bullying (OR=3.06, p=0.002). CONCLUSION: These results may have important implications for the strategies and specified intervention in preventing suicidal ideation in Korean high school students.

Cognitive Impairment and Decreased Quality of Life in Elderly Patients with Subsyndromal Depression

OBJECTIVES: Non-major depression with fewer symptoms than required for a Diagnostic and Statistical Manual of Mental Disorders-4th edition diagnosis of major depressive disorder (MDD) has consistently been found to be associated with functional impairment. In this study, we aim to estimate the cognitive impairment and the quality of life in elderly patients with subsyndromal depression (SSD) compared with non-depressive elderly (NDE). METHODS: The Korean version of Mini International Neuropsychiatric Interview was administered to 194 outpatients with depression and 108 normal controls. SSD is defined as having five or more current depressive symptoms with core depressive symptoms (depressive mood or loss of interest or pleasure) during more than half a day and more than seven days over two weeks. Depression was evaluated by the Korean form of Geriatric Depression Scale of a 15-item short version. Global cognition was assessed by Mini-Mental State Examination in the Korean version of CERAD assessment packet (MMSE-KC). Subjective cognitive impairment was assessed by the Subjective Memory Complaint Questionnaire. Quality of life was evaluated by the Korean Version of Short-Form 36-Item Health Survey. RESULTS: The mean score of the MMSE-KC in the SSD group was lower than that in the NDE group with adjustment for age, gender, and education [F = 4.270, p = 0.04, analysis of covariance (ANCOVA)]. If we defined those having Z-score of MMSE-KC < -1.5 as a high risk group of cognitive impairment, the odds ratio for the high risk group of cognitive impairment was 1.86 [95% confidence intervals (CI) 1.04-3.34] in SSD and 7.57 (95% CI 3.50-16.40) in MDD compared to NDE. The scores of physical component summary (F = 9.274, p = 0.003, ANCOVA) and mental component summary (F = 53.166, p < 0.001, ANCOVA) in the SSD group were lower than those in the NDE group with adjustment for age, gender, and education. CONCLUSIONS: The subjects with SSD, as well as those with MDD, showed impairment of global cognition and also experienced low quality of life in both physical and mental aspects, compared to the NDE group.

Prevalence of Dementia and Its Correlates among Participants in the National Early Dementia Detection Program during 2006-2009

OBJECTIVE: To investigate the prevalence of dementia and its correlates among people with poor socioeconomic status, poor social support systems, and poor performance on the Korean version of the Mini-Mental Status Exam (MMSE-KC). METHODS: We used 2006-2009 data of the National Early Dementia Detection Program (NEDDP) conducted on Jeju Island. This program included all residents >65 years old who were receiving financial assistance. We examined those who performed poorly (standard deviation from the norm of <-1.5) on the MMSE-KC administered as part of the NEDDP, using age-, gender-, and education-adjusted norms for Korean elders. A total of 1708 people were included in this category. RESULTS: The prevalence of dementia in this group was 20.5%. Multivariate logistic regression analysis revealed that the following factors were statistically significantly associated with dementia: age of 80 or older, no education, nursing home residence, and depression. CONCLUSION: The prevalence of dementia is very high among those with lower MMSE-KC scores, and significant correlates include older age, no education, living in a nursing home, and depression. Enhancing lifetime education to improve individuals' cognitive reserves by providing intellectually challenging activities, encouraging living at home rather than in a nursing home, and preventing and treating depression in its early phase could reduce the prevalence of dementia in this population.

Clinical Case Conference / 신경정신의학

No abstract available.

Clinical Case Conference / 신경정신의학

No abstract available.

Development of Group Therapy Program for North Korean Refugees with Posttraumatic Stress Disorder and Pre-Study on Its Effect / 신경정신의학

OBJECTIVES: We evaluated the design, application, and preliminary effect of a new group therapy program for assisting the psychological adaptation of North Korean refugees with posttraumatic stress disorder (PTSD). METHODS: We recruited 16 female participants from the student body of Hanawon (North Korean refugees) or K city refugee residents, both governed by the Ministry of Unification. Of the participants, 11 scored more than 28 points, the cut-off score, on the MMPI-II PTSD Keane (PK) scale. Another 5 females, who had been diagnosed with PTSD and received treatment, were included in the study. We divided the participants into 2 groups, each of whom participated in group therapy 10 times. Group (A) consisted of 8 Hanawon refugees, while the other group (B) consisted of 8 refugee residents of K City. To examine the therapy's effects, we utilized the Beck Depression Inventory, Beck Anxiety Inventory, Self-esteem Scale, and Impact of Event Scale-Revised, both before and after treatment. We analyzed the results using paired t-tests and repeated measures. RESULTS: Anxiety scores decreased significantly in group A after the group therapy (t=5.04, pbeta.01 ; t=5.44, pbeta.01). In Group B, there were no statistically significant changes on any scales after the treatment. Furthermore, there were no significant differences between the two groups on any measures, but group A showed lower mean SES scores and higher mean BDI and BAI scores than did group B. CONCLUSION: This was a preliminary application of this newly designed group therapy program for aiding the psychological adaptation of North Korean refugees, utilizing a small group of refugees with PTSD. In spite of many shortcomings and poor results, we expect further refinement and research of into treatment modalities despite this challenging developments.

Prevalence and Correlates of Depressive Symptoms among North Korean Defectors Living in South Korea for More than One Year

OBJECTIVE: This study examined the prevalence and correlates of depressive symptoms in North Korean defectors who have been living in South Korea for more than one year. METHODS: We used questionnaires developed by the authors to collect sociodemographic data in addition to the Center for Epidemiologic Studies Depression Scale (CES-D), the Psychosocial Well-being Index to measure stress, and a social support scale. A total of 367 subjects were included in this study. RESULTS: The results showed that 30.5% of the men and 34.7% of the women reported depressive symptoms, and 33.1% of the men and 36.1% of the women exhibited signs of severe distress. Correlates of depressive symptoms were lack of occupation [odds ratio (OR)=2.198, 95% confidence interval (CI), 1.247-3.873], having escaped without family (OR=1.725, 95% CI, 1.006-2.959), and a poor subjective sense of health status (OR=3.111, 95% CI, 1.591-6.085). CONCLUSION: Continuing vocational training and career management, psychological support programs, and intensive physical health services are needed to improve the mental health of this population.

A Study on Regional Differentials in Death Caused by Suicide in South Korea / 간호학회지

PURPOSE: The purpose of this study was to compare suicide mortality by region in South Korea. METHOD: Suicide mortality differentials were calculated for several mortality indicators by geographical regions from raw data of the cause of death from KNSO. RESULTS: The results are as follows; the Crude suicide death rate was 22.63 per 100,000. The highest was in Kangwon showing 37.84% whereas, Chungnam, and Jeonbuk followed after. Suicide was 4.4% of all causes of death, but Inchon and Ulsan showed a higher proportion. The male suicide death rate was 31.12 per 100,000 and females 14.09. The ratio of gender suicide mortality was 2.21, per 100,000 and was the highest in Jeju. For age-specific suicide death rates, the rate increased as age advanced, showing 2.33 per 100,000 in 0-19years, 18.68 in 20-39, 30.48 in 40-59,63.33 in 60 years and over. In Ulsan, Kangwon, and Inchon, age-specific suicide death rates of the 60 and over age group were higher than other regions, Daegu, Busan, and Kangwon showed a higher age-specific suicide mortality of the 40-59 age group, and Kangwon, Jeonnam, and Chungnam had a higher age-specific suicide mortality of the 20-39 age group. CONCLUSIONS: Suicide mortality differed by region. These results can be used for a regional health care plan and planning for suicide prevention by regions.

Neurokinin and Its Receptors: Association with Learning and Memory / 대한정신약물학회지

The neurokinin Substance P is widely distributed in the central nervous system and has been extensively studied in various functional aspects. Substance P has been reported to have memory-promoting, reinforcing, and anxiolyticlike effects when administered systemically or locally. N-terminal fragment of Substance P has memory-promoting effects, whereas the C-terminal sequence of Substance P has been shown to have a memory-reinforcing effect. These properties of Substance P are thought to be mediated through activation of the nucleus accumbensventral pallidum circuitry. Substance P facilitates long-term potentiation (LTP) in the hippocampus, and the distribution of ERK neurons seems to overlap with that of NK1 neurons. Hippocampal ERK activation is critical for the induction of LTP. In conclusion, Substance P might have a neuroprotective capacity in parallel with its recovery promoting actions.

Prevalence of Severe Distress and Its Correlates Among Cheju Medical College Students / 한국의학교육

PURPOSE: To determine the prevalence of severe distress and its correlates among Cheju medical college students. METHODS: Data were gathered in December 2005, and all medical college students were included. Of a total of 170 medical college students, 52(30.6%), 41(24.1%), 37(21.8%), and 40(23.5%) were 1st, 2nd, 3rd, and 4th year students, respectively. The questionnaire for sociodemographic information included age, sex, year, hometown, accommodation, education level of parents, socioeconomic status of parents, GPA(grade point average), and standing. Subjective sense of health status, level of health concern, smoking habit, drinking habit(CAGE), sleep pattern, degree of obesity, and body image satisfaction were included to reveal health habits and health behaviors of the subjects. CES-D for depression, Psychosocial Well-being Index(PWI) for stress level, State-Trait Anxiety Inventory(STAI) for level of anxiety, and SCL-90-R(Symptom Checklist 90 revised) for level of general psychopathology were used RESULTS: 1st year students were 4.338 times(95% CI; 1.412-13.324) more likely than other years to experience severe distress. Students who felt that they had insufficient time for relaxation showed 5.027 times(95% CI; 1.489-16.969) higher prevalence of severe distress than those who felt they had sufficient time for relaxation. Those with poor self-esteem were 18.347 times(95% CI; 5.484-61.382) more likely to experience severe distress than those with 'good' self-esteem. CONCLUSION: Offering various programs for improving coping skills, advanced counseling program, or tutoring system and providing sufficient relaxation timeby various methods, such as modifying curriculum, are needed to ameliorate severe distress.

Idiopathic Granulomatous Hypophysitis

Idiopathic granulomatous hypophysitis is a chronic inflammation of the pituitary gland. It has a rare occurrence and is diagnosed only on pathologic examination. We report a case of a 60-year-old patient presenting with headache, vomiting and isolated hyponatremia. MRI study showed a space occupying lesion of the pituitary gland with a marked enhancement after gadolinium injection. Pituitary biopsy was consistent with the diagnosis of idiopathic granulomatous hypophysitis. The aim of this case report is to discuss the variable clinical and radiological aspect of the disease.

The Effect of Nimodipine on Single High Dose Irradiation-Induced Apoptosis in the Rat Spinal Cord

OBJECTIVE: Radiation injury includes radiation necrosis and apoptosis. Though some of its mechanism in brain are reported, those in spinal cord are not determined yet. The purpose of this study is to see whether nimodipine, one of calcium channel blockers, is effective for the prevention of high dose irradiation-induced apoptosis in the rat spinal cord. METHODS: Forty eight Sprague-Dawley rats were divided into four experimental groups, such as non-treated group(control group) after 5Gy and 10Gy irradiation(n=24), and nimodipine-treated group after 5Gy and 10Gy irradiation(n=24). Each group was divided by irradiation doses. After the drug was administered, the spinal cord was exposed to 5Gy and 10Gy dose of gamma rays using Ir-192. All spinal cord underwent histological examination at 4 hours, 8 hours, 12 hours after irradiation to evaluate the number of apoptotic cells. Apoptotic cells were detected by TUNEL assay, and determined by direct visual counting at x200, magnification RESULTS: In nimodipine-treated group, apoptotic cell counts were reduced significantly, compared to that of control group after irradiation(p < 0.05). CONCLUSION: These results suggest that nimodipine treatment may have effects on the prevention of radiationinduced apoptosis. If it could be established that calcium channel blockers inhibit radiation injury, they might be useful in radiation therapy.

The Prevalence and Related Factors of Depressive Symptoms among the Elderly in Rural Areas of Jeju Island

OBJECTIVE: Depressive disorder is one of the most frequent and serious neuropsychiatric disorders in the elderly. This study is aimed to investigate the prevalence and related factors of depressive symptoms among the elderly in rural areas of Jeju island. METHODS: The Short form of Geriatric Depression Scale (SGDS) and structured questionnaire about factors related with depression were administered to 590 rural-dwelling elderly in Jeju island. RESULTS: The overall prevalence of depressive symptoms over score 10 in SGDS is 16.6% (Male 14.2%, Female 17.8%). But there was no sex difference. And statistically significant factors related with depression by multiple logistic regression analysis were economic status, chronic physical illness, and self-perceived health status. Factor of physical limitations would be a possible associated one. CONCLUSIONS: The prevalence of depressive symptoms of Jeju island was nearly same as that of other areas. And several risk factors for depression were identified but further evaluation will be needed because of those complex and controversial findings.

Relationships between Subjective Symptoms and Objective Psychopathology in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Kyung Hee-Frankfurter Beschwerde-Fragebogen(K-FBF) is a representative subjective symptom measuring tool of schizophrenic patients. We performed psychopathology measurements using K-FBF, Positive and Negative Syndrome Scale(PANSS) and Symptom Checklist-90-Revised(SCL-90-R) in patients with schizophrenia and then compared the results of these three examinations one another, in order to examine which psychopathologic aspects K-FBF might reflect and to measure the possibility whether this instrument reflect the negative symptoms or cognitive impairments, which are difficult to measure by conventional objective instruments measuring psychopathology. METHODS: All 66 patients satisfying DSM-IV criteria for schizophrenia, were approached. Their education level was more than high school and they were not in the acute stage of schizophrenia. They performed K-FBF and SCL-90-R, and at the same day, they were interviewed by one of both psychiatirsts using PANSS. We examined the patterns of K-FBF response and performed facor analysis about 10 subscales. We examined the correlation between K-FBF and age, sex and insight. Also, we performed correlation analysis among the K-FBF, PANSS and SCL-90-R. RESULTS: As for K-FBF, with increasing age, the number of positive response items and the symptom severity were decreased. Even when controlling prevalence period as control variable, the correlation remained unchanged. Performing factor analysis to the K-FBF subscales, we created 2 factors, ie summation subscales. We named those recognized distress(RD) and perceptual alteration(PA) each. Using K-FBF standardized total scores as controlling variable, we performed partial correlation between PA and PANSS negative symptom scale. The result was PA and PANSS have statistically significant correlation. This correspons with the view that Huber's basic symptoms are reflecting subjective approach of negative symptoms of schizophrenia. While K-FBF standardized total scores and PANSS total scores had statistically strong correlations, SCL-90-R total scores and PANSS total scores had statistically significant, but very mild correlations. So, we had the judgement that the correlations among the psychopathology measurement tools are more influenced by the rater than the contents of tools. CONCLUSION: We concluded that Huber's basic symptoms, measured by K-FBF, reflect more negative symptoms of schizophrenia than other symptoms. And K-FBF has more correlation with the PANSS, objective psychopathology measuring tool, than the SCL-90-R, self-report quetionnaire. But, more studies using patients with another disease stages and another demographic variables are needed in order to generalize the results of this study.

The Effect of Polygalasaponins in Polygalae Tenuifolia on Apomorphine-Induced Hyperlocomotions in Mice / 대한정신약물학회지

OBJECTIVE: This study was to investigate in vivo antidopaminergic activities of polygalasaponins which included in the roots of Polygalae tenuifolia, one of the natural plants prescribed to treat psychotic disorders in traditional medicine. METHODS: The chemical separations were conducted by chromatographies with various columns and the chemical structures were identified using spectroscopy, NMR and so on. The apomorphine-induced stereotyped behaviors and climbing behaviors in mice as animal models of psychotic disorders were applied to explore the antidopaminergic activity. RESULTS: The active compounds with antidopaminergic effects in the roots of Polygalae tenuifolia were identified as polygalasaponin A-D. The polygalasaponins showed to suppress the apomorphine-induced stereotyped behaviors and climbing behaviors in dose-related fashions. CONCLUSION: This study suggests that polygalasaponins might have antipsychotic activities. The natural products need to be explored extensively as sources of new medications in psychiatric fields. Further explorations for chemical and pharmacological properties of polygalasaponins are required.