Efficacy and Safety of Paliperidone Extended Release in Schizophrenia Patients Requiring a Switch in Antipsychotic Medication by Switching Previous Antipsychotics to Paliperidone Extended Release / 대한정신약물학회지

OBJECTIVE: This study aimed to evaluate the clinical efficacy, safety, and tolerability of paliperidone extended release (ER) in patients with schizophrenia by switching previous antipsychotics to paliperidone ER. METHODS: An open-label, 24 weeks, prospective, non-comparative, multi-center study evaluated total 387 patients with schizophrenia requiring a switch in antipsychotic medication due to suboptimal efficacy, intolerability, and non-compliance. Patients were switched to flexible-dose trial of paliperidone ER (3-12 mg/day). Efficacy was measured by Krawiecka Scale, Clinical Global Impression-Schizophrenia-Severity (CGI-SCH-S), Clinical Global Impression-Schizophrenia-Improvement (CGI-SCH-I), sleep visual analog scale (VAS), and Personal and Social Performance Scale (PSP). Safety assessments included adverse events (AEs), evaluation of extrapyramidal symptoms (EPS) using the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS), and laboratory tests. RESULTS: Data from a total of 321 subjects who took the paliperidone ER and had at least one follow-up assessment without a major protocol violation were analyzed. Switching to paliperidone ER led to a significant improvement in the Krawiecka, CGI-SCH-S, CGI-SCH-I, PSP, and DIEPSS scales. However, serum prolactin levels and metabolic parameters including body weight and waist circumference were significantly increased. Insomnia was the most common adverse event. CONCLUSION: This study suggested that patients with schizophrenia who showed insufficient response or intolerance to other previous antipsychotics can be switched to paliperidone ER, with efficacy, safety, and tolerability.

Effects of Smoking on Drinking Behavior / 신경정신의학

OBJECTIVES: This survey study was conducted to investigate the effect of smoking on drinking alcohol, depression, anxiety and impulsiveness. METHODS: The survey participants were 925 residents over 20 years of age in Gwanak-gu, Seoul. Subjects were divided into smoking and non-smoking groups, and all completed the Korean Version of the Alcohol Use Disorder Identification Test (AUDIT-K), the Beck Depression Inventory (BDI), the Barret Impulsiveness Scale (BIS) and the State-Trait Anxiety Inventory (STAI) to identify patterns of the alcohol consumption and smoking, and to assess levels of depression, anxiety and impulsiveness. RESULTS: The number of subjects with problem drinking was significantly higher in smokers (n=58, 37.2%) than non-smokers (n=81, 11.1%), and there was also a significant difference between smokers and non-smokers on the BDI. However, there were no significant differences between smokers and non-smokers on either the BIS or the STAI. When smokers with problem drinking (Smk_Alc) and smokers without problem drinking (Smk_non-Alc) were compared, the Smk_Alc subjects were found to have higher BDI and trait anxiety scores than the Smk_non-Alc group. CONCLUSION: The results of this study indicate that smoking is closely related to drinking alcohol and suggests that the more frequently people smoke, the more likely they will drink alcohol due to depression and anxiety. It may therefore important for smokers to control depressive mood, anxiety and impulsivity.

The Relationships between Online Game Player Biogenetic Traits, Playing Time, and the Genre of the Game Being Played

OBJECTIVE: Psychobiological traits may be associated with excessive Internet use. This study assessed the relationships between biogenetic traits, the amount of time spent in online game playing, and the genre of the online game being played. METHODS: Five hundred sixty five students who enjoyed one of the four types of games included in this study were recruited. The types of games examined included role playing games (RPG), real-time strategy games (RTS), first person shooting games (FPS), and sports games. Behavioral patterns of game play, academic performance, and player biogenetic characteristics were assessed. RESULTS: The amount of time that the participants spent playing online games was significantly greater on weekends than on weekdays. On weekends, the types of games with the largest numbers of participants who played games for more than three hours were ranked as follows: RPG and FPS, RTS, and sports games. The Young's Internet Addiction Scale (YIAS)score for the RPG group was the highest among the groups of the four types of game players. The time that participants spent playing games on weekdays was negatively associated with academic performance, especially for the RPG and FPS groups. Compared with the other groups, the RPG and RTS groups had higher novelty seeking (NS) scores and self-directedness (SD) scores, respectively. Additionally, the sports game group had higher reward dependency scores than the other groups. CONCLUSION: These results suggest that RPGs may have specific factors that are attractive to latent game addicts with higher NS scores. Additionally, excessive playing of online games is related to impaired academic performance.

Insecure Attachment and Impulsivity-Inattention Problem in Adolescent with a High Risk of Substance or Internet Addiction / 신경정신의학

OBJECTIVES: This study was done in adolescents with a high risk of substance or internet addiction in order to confirm the assumption that insecure attachment formation and impulsivity-inattention problems are major risk factors in adolescent addictive behavior. METHODS: 2,188 middle and high school students including a nicotine dependent treatment group were assessed using self-reporting scales : Adolescent Drinking Index (ADI), Fagerstrom Tolerance Questionnaire, Young Internet Addiction Scale, Revised Adult Attachment Scale (RAAS), and the Conner and Well's Self-reporting Scale for ADHD (CASS) were used. Subjects were classified into risk groups including substance addiction, internet addiction, as well as a combined group. RESULTS: Significant correlations were found between attachment formation and internet addiction tendencies, with respect to dependence, anxiety, and closeness (r=-0.185, r=0.248, r=-0.147, p<0.01, respectively). Impulsivity-inattention problems had positive correlations with internet addiction, alcohol addiction and nicotine addiction groups (r=0.345, r=0.211, r=0.187, p<0.01). With regard to attachment formation, the four groups showed significant differences regarding dependence (F=19.427, p<0.01), anxiety (F=28.926, p<0.01), and closeness (F=12.853, p<0.01). In addition, the four groups showed significant difference with respect to impulsivity-inattention problems (F=83.857, p<0.01), of which the combined risk group showed the highest scores, and the non-addicted group had the lowest scores. CONCLUSION: Insecure attachment formation and impulsivity-inattention problems were major risk factors for adolescent addictive behavior including internet addiction.

The Association of Cognitive Dysfunction with White Matter Hyperintensity in Alzheimer's Disease and Mild Cognitive Impairment / 신경정신의학

OBJECTIVES : We investigated the relationship between periventricular and deep white matter hyperintensity and cognitive function in Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS : T2-weighted MRI scans were performed in 41 subjects with AD 38 subjects with mild cognitive impairment and 38 control subjects. Periventricular and deep white matter hyperintensities were rated on a Fazekas 0-3 scale by a medical specialist of the department of radiology blind to clinical diagnosis. Cognitive function was assessed by using Cognitive Assessment and Reference Diagnoses System. RESULTS : No significant differences between demographic characteristics and vascular risk factors were revealed comparing AD, MCI and controls. The frequencies of AD were significantly higher than those of MCI and normal control in Grade 2 and 3 of periventricular hyperintensity and Grade 3 of deep white matter hyperintensity. The scores of amnesia, executive function and attention were significantly lower in Grade 2 and 3 of periventricular hyperintensity than in Grade 0 and 1. The scores of attention were significantly lower in Grade 3 of deep white matter hyperintensity than in Grade 0, 1 and 2. CONCLUSION : Periventricualr hyperintensities are associated with cognitive decline in amnesia, executive function and attention, while deep white matter hyperintensities are associated with cognitive decline in attention.

The Association of Cognitive Dysfunction with White Matter Hyperintensity in Alzheimer's Disease and Mild Cognitive Impairment / 신경정신의학

OBJECTIVES : We investigated the relationship between periventricular and deep white matter hyperintensity and cognitive function in Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS : T2-weighted MRI scans were performed in 41 subjects with AD 38 subjects with mild cognitive impairment and 38 control subjects. Periventricular and deep white matter hyperintensities were rated on a Fazekas 0-3 scale by a medical specialist of the department of radiology blind to clinical diagnosis. Cognitive function was assessed by using Cognitive Assessment and Reference Diagnoses System. RESULTS : No significant differences between demographic characteristics and vascular risk factors were revealed comparing AD, MCI and controls. The frequencies of AD were significantly higher than those of MCI and normal control in Grade 2 and 3 of periventricular hyperintensity and Grade 3 of deep white matter hyperintensity. The scores of amnesia, executive function and attention were significantly lower in Grade 2 and 3 of periventricular hyperintensity than in Grade 0 and 1. The scores of attention were significantly lower in Grade 3 of deep white matter hyperintensity than in Grade 0, 1 and 2. CONCLUSION : Periventricualr hyperintensities are associated with cognitive decline in amnesia, executive function and attention, while deep white matter hyperintensities are associated with cognitive decline in attention.

Serum S100B Protein in Medication-Free Schizophrenic Patients

OBJECTIVES: Previous 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.

Changes in Glucose and Cholesterol Level in Schizophrenic Patients Treated with Atypical Antipsychotics or with Valproate Combination / 대한정신약물학회지

OBJECTIVE: The association of obesity, diabetes mellitus, drug compliance, and body image with use of antipsychotic medication has been documented in many studies. We aimed to assess the effects of antipsychotics and sodium valproate combination therapy on glucose, cholesterol level and weight in schizophrenic patients. METHODS: Chronic schizophrenic patients were grouped according to drug combination: risperidone, olanzapine, haloperidol, risperidone+valproic acid (VP), olanzapine+VP, haloperidol+VP. Planned assessment of included glucose and cholesterol, which were collected at baseline and at the end of the 12 weeks later. RESULTS: There were significantly increased glucose and cholesterol level, in olanzapine+VP group, but not in risperidone group. Cholesterol levels were not increased at the end of 12 weeks for haloperidol and risperidone group. Glucose and cholesterol levels had no significant association with weight gain. CONCLUSION: Changes in glucose and cholesterol level, weight, and body mass index associated with antipsychotics including sodium valproate combination were reported in our report. In the future, we need follow up study and various studies about other combination drug and metabolic symptoms.

Serum Brain-Derived Neurotrophic Factor in Schizophrenia

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.

The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(II): Comparison of Safety / 신경정신의학

OBJECTIVES: This multicenter clinical trial involving 13 hospital sites compared the safety of switching to olanzapine between 'direct switching method' and 'start-tapering switching method'. METHOD: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The safety of switching to olanzapine was measured with vital signs including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS), Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). RESULTS: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in 'direct switching method' group, and the concomitant use of anticholinergics was comparatively greater in 'start-tapering switching method' group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. CONCLUSION: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

Apolipoprotein E Genotype in Korean Schizophrenic Patients

The apolipoprotein E (APOE) epsilon4 allele is a known risk factor for the development of Alzheimer's disease, however, an association of the APOE genotype with schizophrenia is controversial. We investigated the association in 60 Korean schizophrenic patients and 60 healthy controls. APOE genotypes were identified by reverse hybridization-based line probe assay. There were significant differences in the distribution of APOE genotypes between schizophrenic patients and controls. APOE epsilon2 and epsilon3 allele frequencies in schizophrenic patients were significantly different from those in controls. Our results suggest that APOE alleles seem to be operative in the pathogenesis of schizophrenic disorders.

Alexithymia in Patients with Alopecia Areata / 신경정신의학

OBJECTIVES: Alexithymia has been regarded as the general personality of psychosomatic disease, but it's controversial. The object of the study is to find out the relationship between alexithymia and alopecia areata. METHODS: Thirty one alopecia areata patients were compared to 31 normal healthy persons in alexithymic tendency using TAS-20K. Also MMPI and SCL-90-R were checked in both groups. Psychiatric diseases were ruled out. RESULTS: The scores of F, K, Hs, D, Hy, Pd, Pa, Pt and Sc of MMPI in alopecia areata patients were different from those in normal healthy persons. The scores of SOM, O-C, I-S, DEP, ANX, HOT, PHOB, PAR, PSY, GSI, PSDI, and PST of SCL-90-R in alopecia areata patients were significantly higher than those in normal healthy persons. In TAS-20K, the scores of Factor 1 and Total in alopecia areata patients were higher than those in normal healthy persons. CONCLUSION: Our results suggest that alopecia areata patients are more alexithymic than normal healthy persons.

Effects of Atypical Antipsychotics on Serum Prolactin and Testosterone Levels in Schizophrenic Patients

OBJECTIVES: The dopamine-blocking effects and the associated side effects(amenorrhea, lactation, sexual dysfunct of classical antipsychotics in schizophrenic patients have been studied for a long time. The purpose of this study to find out these effects of new antipsychotics(risperidone, olanzapine) in schizophrenic patients treated with clinical relevant doses. 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+/-.33) and haloperidol group(161.66+/-37.53). And prolactin level of risperdone 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 we higher than that of haloperidol, while olanzapine showed no significant difference in terms of prolactin plasma level haloperidol. New antipsychotics may not influence the testosterone plasma level.

An Association Study between the Dopamine D5 Receptor Gene and Korean Schizophrenia / 신경정신의학

OBJECTIVE: This study was performed to define the genetic relationship between the micro-satellite (CT/GT/GA)n polymorphism for the dopamine D5 receptor gene and schizophrenia. An association study in 100 schizophrenic patients and 100 normal controls of Korea was made by means of using polymerase chain reaction. RESULTS: The microsatellite(D5(CT/GT/GA)n) had 11 alleles. There was a significant difference in the allele distribution between schizophrenia and normal controls(p<0.05). In schizophrenic patients, the frequency of allele A10 was decreased. As to the genotype distribution, there was no difference in both groups. CONCLUSIONS: This finding suggests that dopamine D5 gene is likely to be related to the development of schizophrenia in Korea but with only this result, we cannot come to the conclusion that this genetic locus is the genetic determinant of schizophrenia. Further studies of dopamine D5 receptor genetic locus that can confirm this result should be made.

Association Study of the Sequence Mutation(T978C) of the Dopamine D5 Receptor Gene in Korean Schizophrenics / 신경정신의학

OBJECTIVE: This study was performed to assess the possible involvement of the dopamine D5 receptor gene(DRD5) in the etiology of schizophrenia. METHODS: We identified the distribution of the T978C varient of the dopamine D5 receptor gene in 100 schizophrenics and 100 normal controls in Korean population, and evaluated the association between two groups. RESULTS: There were no significant differences in genotype frequency of T978C variation and genotype prevalence of homozygotes between schizophrenic and control groups. There was no significant difference in T978C allele frequencies between schizophrenic and control groups. CONCLUSION: We present evidence of a lack of allelic association between the exonic common polymorphism of the dopamine D5 receptor gene and Korean schizophrenic patients. The assumption that the T978C varient of the dopamine D5 receptor gene has a genetic role in the development of schizophrenia was not examined by this case-control study. However, because it is considered that DRD5 may act as the expression factor for the symptoms of schizophrenia or affect the difference in an individual's susceptibility to the disease, future studies to investigate the influence of other variations of DRD5 are needed.

A Study on the Standardization of the Hospital Anxiety and Depression Scale for Koreans: A Comparison of Normal, Depressed and Anxious Groups / 신경정신의학

OBJECTIVE: The Purpose of this study was to standardize the Hospital Anxiety and Depression Scale for Koreans(HAD-K). METHOD: HAD-K, Beck Depression Inventory(BDI), and Self-Rating Anxiety Scale(SAS) were administered to 66 anxious and 74 depressed patients and 189 normal controls. RESULTS: The median correlation between items of the HAD-A and corrected item total score was 0.55 and HAD-D was 0.47. The values of Cronbach's alpha coefficient were 0.89 and 0.86. The results of testing the validity of the HAD examined by t-test proved that anxious and depressed groups were significantly different from normal controls. The construct validity of HAD-D with BDI was r=0.80, and HAD-A with SAS was r=0.79. The result of examining the sensitivity and specificity of HAD-D revealed that cut-off point of 8 yielded 89.2% sensitivity rate and 82.5% specificity rate. And those of HAD-A revealed that cut-off point of 8 yielded 78.8% sensitivity rate and 82.5% specificity rate. The result of the factor analysis found 3 factors in HAD, which were anxiety(factor 1) and depression (factor 2). The total percent of two factors were 59.6%. CONCLUSION: The HAD-K was proven to measure the anxiety and depression validly. Primary physicians and non-psychiatrists also can easily measure anxiety and depression of patients within a short time with HAD-K.

Efficacy and Safety Profile of Risperidone in Schizophrenia: Open Multicenter Clinical Trial / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Serum Sex hormones, Gonadotropins, Cortisol, and Prolactin in the Patients with Alcohol Dependence / 신경정신의학

OBJECTIVES: Sexual dysfunction has been frequently experienced by male alcoholics. The possible etiologies of the sexual problems in alcoholics has been known to be hormonal rather than neuropathic or psychosocial. The main purpose of our study was, therefore, to examine the different parameters of the hypothalamic -pituitary- gonadal awis(testosterone, estradiol, luteinizing hormone, follic1e-stimulating hormone ; HPG axis) in chronic alcoholic men. On the other hand, cortisol and prolactin were included because they could influence the HPG axis. METHODS: Serum concentrations of testosterone, estradiol, luteinizing hormone, follic1e-stimulating hormone, cortisol, and prolactin were measured in 15 male patients with alcohol dependence once during withdrawal and once after 21 days of abstinence. The results were compared with those of 12 healthy male volunteers. RESULTS: During withdrawal, luteinizing hormone, estradiol, cortisol and prolactin levels were significantly enhanced. Estradiol and cortisol concentrations fell significantly during abstinence, whereas luteinizing hormone and prolactin concentrations remained elevated. CONCLUSIONS: These results suggest that normal serum concentrations of testosterone were maintained in chronic alcoholic men without hepatic cirrhosis. In contrast to this, estrogen and prolactin concentrations seemed to be markedly enhanced. Whether this increase in estrogen and prolactin concentrations is implicated in different clinical and psychological symptoms seen in chronic alcoholics remains to be investigated.

Temporal Lobe Volume Measurement in Mood Disorder Using Magnetic Resonance Imaging / 신경정신의학

OBJECTS: This study was performed to investigate neuroanatomical change in the temporal lobe in the patients with mood disorder. METHODS: The study groups were consisted of 13 patients with major depressive disorder with psychotic feature,23 patients with major depressive disorder without psychotic feature, 13 patients with bipolar disorder and 50 age-matched control group. We used DSM-III-R criteria far classifying our patients. We estimated the area and volume of the left, right and total temporal lobe In selected 6-8 coronal MR images including the boundary of the temporal lobe. We compared the results of both patients with mood disorder and control group. RESULTS: There was no significant difference in the volume of total and right temporal lobe between the patients with mood disorder and control group. But the average volume of the left temporal lobe was significantly smaller than that of the control group. After patients were divided according to subtype, the patient group was compared with control group. The average volume of the left temporal lobe in the patients with depressive disorder was smaller than that of control group, however there were no significant difference In between the patients with bipolar and control group. Among the subtype of depressive diseases, the patients with psychotic feature was significantly smaller than control subjects in the volume of left temporal lobe. CONCLUSION: Finally, we could find that there was significantly smaller volume in left temporal lobe only in the patients with major depressive disorder with psychotic feature. This findings support the previous hypothesis that in contrast to other subtype of mood disorder, major depressive disorder with psychotic feature should be classified to be the spectrum disease lying between schizophrenia and mood disorder.

Changes of the Lymphocyte Subset in Major Depressive Disorders and Schizophrenia / 신경정신의학

An association between immunity and psychiatric diseases such as depression and schizophrenia has been suggested but has not been consistently demonstrated. In the present study immune status of major depressive disorder and schizophrenia has compared with normal controls by investigating the changes in lymphocyte subpopulation. The number of lymphocyte subpopulation was determined by monoclonal antibody staining in conjunction with flow cytometry, and following surface antigens were determined: CD3+(pan T), CD7+(pan B), CD4+(T helper/inducer) and CD8+(T suppressor/cytotoxic). Fifteen untreated depressive patients and schizophrenic patients were examined along with the control who consisted of sixteen healthy volunteers matched by sex and age. The result showed that in the depression patients, number and percent of CD8+ cells were reduced(p<.05) as compared to control, while in the schizophrenic patients, number of CD8+ cells were increased(p<.05) as compared to control. The result also showed variation between sex where in male depressives, the number of CD8+ cells was reduced % compared with male control, while female patients did not show such correlation. In addition, male depressives showed decrease in the number of B cell, compared with female depressives. In the patient group with positive symptoms as measured by PANSS, number and percentage of T cells decreased(p<.05 respectively) while percentage of B cells increased(p<.05) both as compared to control. Furthermore, in contrast with positive correlation found in depression between percentage of lymphocytes and age, a negative correlation was noted in schizophrenias between BPRS and the percentage of lymphocytes, number of CD8+ cell, and the total number of lymphocytes.