Clozapine-Induced Acute Hepatitis / 신경정신의학

The authors report two cases of clozapine-induced acute hepatitis. Two patients developed asymptomatic hepatitis and got better with conservative care. We decreased the dosage of clozapine and added hepatic protectors, resulting in normalized laboratory findings. The authors also reviewed side effects of clozapine in this report. We reviewed the suggested mechanism of either clozapine or chlorpromazine-induced hepatitis. Clozapine influences the liver cell via cytochrome P 450 and chlorpromazine does so via mild cholestasis. There may be a possibility that a patient who has experienced drug-induced hepatitis is vulnerable to clozapine-induced acute hepatitis. In this respect, those who have experienced drug-induced hepatitis must be observed more closely.

The Effect of Marital Satisfaction and Dysfunctional Attitudes on Married Women's Depression / 신경정신의학

OBJECTIVES: This study was designed to examine the effect of marital satisfaction and dysfunctional attitudes on depression in married women. METHODS: Forty depressed married female patients and 34 non-depressed married women as normal control group completed three self-report questionnaires, Beck Depression Inventory(BDI) Dysfunctional Attitude Scale(DAS) and Dyadic Adjustment Scale(DYAS) Marital satisfaction and dysfunctional attitudes were compared by student t-test between the two groups. Also, relative importances of each variables to depression were examined with stepwise multiple regression analysis. RESULTS: Depressed patients reported significantly lower level of marital satisfaction and showed higher level of dysfunctional attitudes than normal controls. Dyadic satisfaction, approval need, and perfectionism subfactors were more important in predicting depressive symptomatology than other variables in patients. CONCLUSION: We conclude that marital satisfaction has significant influence on development and maintenance of depression in married women, and in underlying thinking process, dysfunctional attitudes serve as a cognitive vulnerability factor. This conclusion involves the expectation that if dysfunctional attitudes of depressed married women could be changed positively, their marital satisfaction will be increased to higher level and depression will be decreased. Overall, our findings stress that we need to consider the degrees of marital satisfaction and dysfunctional attitudes of depressed maried women, when treating them, in order to individualize treatments and optimize our ability to predict responsiveness to therapy.

The Pattern of Neurocognitive Deficits in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Schizophrenic patients have been reported to be associated with abnormal performance on a broad range of neuropsychological tests. But it has been a persistent controversy in the neuropsychology of schizophrenia whether this disorder is characterized by generalized deficits or specific deficits. The purpose of this study was to investigate, using standardized Benton Neuropsychological Assessment(BNA), whether the specific pattern of neurocognitive deficits is found in schizophrenics. METHODS: The subjects were composed of (1) 30 schizophrenic inpatients who were diagnosed as paranoid subtype according to DSM-IV diagnostic criterior and (2) 30 normal subjects with matching demographic variables(i.e. age, sex, educational level). All tests of BNA were given to schizophrenic patients and normal subjects, and the performances of schizophrenic patients and normal subjects were compared on all aspects of BNA. Schizophrenic symptoms were assessed via Positive and Negative Syndrome Scale(PANSS) to determine the relationship between clinical symptoms and schizophrenic cognitive deficits. RESULTS: Of 12 tests of BNA, schizophrenic patients' performances on Serial Digit Learning(SDL), Facial Recognition Test(FR), Tactile Form Perception(TFP), Finger Localization(FL) were significantly lower than those of normal subjects. In addition, schizophrenic patients showed significantly lower performances than those of normal subjects on Right Hand, Left Hand, Identification of two simultaneously touched fingers of FL, and more Peripheral Error on Visual Form Perception Test(VFPT). Finally, no significant correlation was found with respect to the relationships between total scores, positive symptom scores, negative symptom scores of PANSS, and all scores of BNA tests in schizophrenic patients. CONCLUSION: These results suggest that schizophrenic patients may have a specific pattern of neurocognitive deficits in verbal working memory, learning, attention, and complex sensory information processing in visual and haptic modality such as facial perception skills, tactile information processing, independent of psychotic symptoms. The pattern of deifcits is at least in partial, in agreement with many previous study results. On the tests of linguistic functions, visuospatial perception, and constructional abilities, schizophrenic patients' performances were not significantly different from those of normal subjects. The findings on visuospatial perception and constructional abilities imply that some posterior cortical zones may be relatively uncompromised in schizophrenia. Both poor performances on object recognition tests relative to normal performances on object location tests and verbal working memory dysfunction may be associated with the putative dysfunction of the reciprocal connections either (1) between the prefrontal and parietal cortex or (2) between the prefrontal cortex and hippocampal formation. This tentative explanation remains to be confirmed.

Study on the Bone Mineral Metabolic Change in Long-term Anticonvulsant-treated Epileptic Outpatients: Measurement by DR-XRA(Quantitative Dual-Energy Radiography; X-Ray Absorptiometry) / 신경정신의학

This study examined, among others, the relationship between the use of anticonvulsant and the bone mineral metabolism(measured via DR-XRA and biochemical study) in 46 adult epileptic outpatients who had been on anticonvulsant for more than one year at Seoul Red Cross Hospital. The study finding wet as follows. 1) There was statistically significant difference between index group(i.e. 46 adult epileptic outpatients) and control group(i.e. 46 healthy adults without previous exposure to anticonvulsant) in terms of bone mineral density. Specifically, the bone mineral density in the epileptic outpatients was significantly lower than that in the healthy adult. Although there was no statistically significant difference between male and female outpatients, their bone mineral density tended to decrease with the increase of age. 2) The bone mineral density in the epileptic outpatients was negatively correlated to both I) the age when the outpatients stared anticonvulsant treatment and ii) the period for which the outpatients were on anticonvulsant 3) Index group was further classified into three subgroup(i.e. low, normal and high subgroup) based on the mean and standard deviation of the bone mineral density in healthy adults control group. 24 outpatients(52.5%) out of 46 fell into low subgroup, of which 10 were male. Overall, there was no statistically significant difference between male and female outpatients in terms of their bone mineral density. 4) Low subgroup's average age(38.6 with SD of 12.5) was significantly higher than those of the other two subgroup. Low subgroup stained anticonvulsant treated when their average age was 24.8(SD 15.0) years, which was higher than those of the other two subgroups. Low subgroup was on anticonvulsant, on average, far 13.3(SD 7.6) years, which was also higher than those of the other two subgroups although there was no significant difference among the subgroups. 5) A series of comparison regarding the possible impact of various types of anticonvulsan(e.g. PHT, CBZ, FB, SV) in terms of i) overall dosage and ii) daily average dosage on bone mineral density showed no significant difference across the three subgroups. 6) There was no significant difference in terms of bone mineral density between the epileptic outpatients on only one type of anticonvulsant and those on two or more types of anticonvulsant. 7) A biochemical study showed that i) each subgroup fell into normal range in terms of blood serum Ca, F, and ALF with no significant difference among the subgroups, and ii) in low subgroup, there were 6 outpatients(25%) with Ca decrease, 2(9.5%) with P decrease, and 5(20.8%) with ALF increase.

A study on depressive tendency of long-term hemodialytic patients with end stage renal disease / 신경정신의학

No abstract available.