Emotional Resolution through an Eagerly Desired Family Reunion after Long-Lasting Separation / 신경정신의학

OBJECTIVES: Separation and reunion is common experiences in our life but enduring unwanted early-life separation from family members may be a distressful event. This study was executed to observe emotional resolution in the subjects who eagerly desire and experience reunion with their families after long-lasting separation. METHODS: Thirty subjects who have participated in the reunion program of the Korean Broadcasting System (KBS) from April 2005 to July 2005 were interviewed to assess their demographic characteristics and memories about separation. Their anxiety and depressive mood were assessed using Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale before the family reunion. At the time of the reunion, psychological states of 14 participants who were able to meet their family members were assessed again using the same assessment tools and the follow-up assessment was performed for one possible case at 7 months after the reunion. RESULTS: The depression and anxiety levels of most subjects were significantly decreased after the reunion. Standardized T scores of their state-anxiety were mostly in abnormal range before the reunion but most of their anxiety levels were reduced within normal range after the reunion. Duration of education was negatively correlated with trait-anxiety level and duration of separation respectively even though trait-anxiety levels were not directly correlated with duration of separation. Emotional acceptability about childhood separation tended to contribute to the increased anxiety level. CONCLUSION: This is the first study to assess psychological distresses of the Korean people who have suffered from longlasting separation with their families. The results in this study suggest that the eagerly desired reunion after long-lasting separation from family may have a resolutive effect for emotional distress. Further study will be needed for larger population suffering from early-life separation.

Newer Neuroleptic Treatment in Behavioral and Psychological Symptoms of Dementia / 대한정신약물학회지

OBJECTIVE: To evaluate the treatment efficacy and safety of risperidone and olanzapine in elderly dementia patients. METHODS: The study population consisted of 42 elderly patients in BPSD (Behavioral and Psychological Symptoms of Dementia) with dementia for 'risperidone' and 'olanzapine' treatment. Clinical safety and efficacy were evaluated by CGI (Clinical Global Impression) and the side effects checklist. RESULTS: The mean subject age was 68.2+/-5.9 consisting of 16 (38.1%) males and 26 (61.9%) females. The types of dementia among the 42 demented patients were as follows: 30 (71.5%) with Alzheimer's disease, 5 (11.9%) with vascular dementia, and 7 (16.7%) with unclassified dementia. The efficacy of risperidone and olanzapine was "marked improved 14.9% vs 34.0%", "moderately improved 45.2% vs 29.9%", and "mildly improved 30.3% vs 36.1%" by CGI. The incidence of adverse reaction was 25.8% vs 36.3%, respectively. CONCLUSION: Risperidone and olanzapine demonstrated highly useful and presented to be a well tolerated antipsychotic drug for behavioral and psychological symptoms of dementia between 1-2 mg vs 5-7.5 mg per daily dosage, respectively. However proper evaluation of mini-mental state examination, IADL (Instrumental Activities of Daily Living) and larger number of elderly patients must be analyzed.

Therapeutic Effects of Psychosocial Programs in the Day Care Service on Cognitive Impairment and Depressive Symptoms in the Elderly Patients / 신경정신의학

Cognitive impairment and depression are the most common symptoms affecting the elderly on physical and mental states. Studies have shown that these symptoms in mild cases are improved by psychosocial intervention, emphasizing the importance of therapeutic intervention provided in the community. The purpose of this study was to investigate whether the psychosocial program at a geriatric day care service has any therapeutic effect on the cognitive function and depressive symptoms in the elderly and whether such effect can be maintained. The experimental group was composed of 37 elderly patients attending the day care service at the mental health center located in Kwangju county, Kyonggi province. The control group was composed of 22 elderly patients who either refused intervention or who dropped out of the program. Cognitive function was assessed with the Korean version of the Mini-Mental State Exam(MMSE-K) and depressive symptoms were assessed with the Short-form Geriatric Depression Scale(SGDS) The experimental group and the control group were compared on the score of on each test, which was administered before and after the program and 10 weeks after discontinuation of program. In the experimental group, the scores acquired immediately after the program and at 10 weeks of follow-up were also compared. The results showed that psychosocial intervention at a geriatric day care service was significantly associated with the change in SGDS scores dependent on time but not significantly associated with the change in MMSE-K scores. In the experimental group whose follow-up assessment was possible, it was further shown that 43% of patients had increased SGDS scores 10 weeks after the program ended, indicating that depressive symptoms had worsened. This study suggests that psychosocial therapeutic intervention in the geriatric day care service improve depressive symptoms but not cognitive functions in the elderly. In addition, for a considerable percentage of subjects in the experimental group, the improvements in depressive symptoms were not sustained after the intervention was withdrawn. These findings proposes a need of strengthening therapeutic intervention to maintain such effect.

Development of a Cognitive Rehabilitation Program for Patients with Schizophrena / 신경정신의학

OBJECTS: The purpose of this study was to investigate the effects of cognitive differentiation training program-Korean version(a training program of attention and conceptual abilities) on cognitive function, psychopathology and problem solving skills in patients with schizophrenia. METHODS: A total of patients diagnosed as schizophrenia using DSM-IV were randomly assigned to 2 groups. The training group went through a total of 22 sessions of cognitive differentiation training (60min/sessionX2sessions/wkX11wks). The attention-placebo control group received psychoeducation program during the same period. Arithmetic, vocabulary, similarities, picture completion of Wechsler Adult Intelligence Scale-Korean version, Positive and Negative Syndrome Scale, and Social Problem Solving Scales were administered to all patients, both before and after the training program. RESULTS: In the arithmetic scores(F=6.35, af=1, p=0.018) of Wechsler Adult Intelligence Scale-Korean version, and total scores(F=6.35, af=1, p=0.018) and problem solving skill scale scores (F=4.88, af=1, p=0.036) of social problem solving scale, interaction effects of training was significant. CONCLUSION: Our findings suggest that cognitive differentiation training program-Korean version is effective on improving auditory attention and problem solving skills in patients with schizophrenia.

Effects of Emotional Management Training in Schizophrenic Patients / 신경정신의학

OBJECTIVES: Schizophrenic patients having a disturbance of cognition and emotion are least likely to identify emotional (especially negative) stimuli and cue in tense background stimuli. Also, schizophreinic patients tend to experience relapse if they are exposued to a situation which is emotionally laden. Although emotion itself is important, emotional processing has not been a therapeutic target and skill trainig which improves social competence has provided patients with emotional load. Therefore, we introduced Emotional Management Trainig (EMT) which deal with indirect and direct emotional processing, applied it to schizophrenic patients, and investigated the therapeutic effects. METHODS: We applied the Emotional Management Training (EMT) to 30 schizophrenic patients for 12 weeks, 2 times every week and psychoeducation to 23 schizophrenic patients as control group attention-placebo for 12 weeks, during the same period. Before and after treatment, we used the Trait Meta Mood Scale-short form (TMMS-S) as emotional proper, Social Perception Scale, Verbal Fluency Test, Verbal Paired Associates, and Similarities for cognitive functions. We also used Positive And Negative Syndrome Scale (PANSS) as psychopathology measurement and Social Problem Solving Scale (SPSI) as various kinds of social problem solving function measurement before and after treatment. RESULTS: The results showed that EMT group appeared to be more effective in improving the visual perception of social perception scale, verbal fluencies, positive symptoms, general psychopathology, and total score in PANSS than the control group. Also EMT group seemed to be more effective in total score and Problem Orientation score in SPSI than the control. But there were no differences in abstract function and verbal memory, negative symptoms, and Problem-Solving Skill score between the two groups. CONCLUSION: This study suggests that despite the limitations of the generalizability and the questions for the persistence of effectiveness, EMT might help schizophrenics get the motivational aspects, the familiarity with emotional-loaded situation, and initial processes, for social problem-solving.

Differences in Cognitive Function and Activities of Daily Living between Alzheimer Patients with Depression and Those without Depression / 신경정신의학

OBJECTIVES: Coexistence of depression is one of the important behavioral symptoms in patients with dementia of Alzheimer type. The study on the relationship between depression and cognitive abilities and/or functional abilities emerges as very important one. The aim of this study was to investigate whether depression is related to the impairment of daily activities and to certain areas of cognitive function in mild to moderate dementia of Alzheimer type. METHODS: In this study, 48 patients with dementia of Alzheimer type among elderly community-residents in Kwangju, Kyunggi province, aged 65 and older, were finally included. We examined their demographics and administered Korean Version of the Mini-Mental State Examination(MMSE-K), Korean Version of the Neurobehavioral Cognitive Status Examination(Korean version of NCSE), Korean Form of Geriatric Depression Scale(KGDS), Activities of Daily Living(ADL), and Instrumental Activities of Daily Living(IADL) to the subjects. We classified the subjects into two groups, dementia with and without depression on the basis of KGDS scores. The two groups were compared using X2 test and independent ttest. RESULTS: The results show that the two groups did not differ in sex, age, education, and scores of MMSE-K. The depressed dementia group showed significantly poorer performance in bathing, one item of ADL, than the nondepressed dementia group. The depressed dementia group showed significantly more impairment in total scores of IADL and each score of three items(shopping, housework, handling finances) than the non-depressed dementia group. However, the two groups showed no significant differences in five major cognitive ability areas of Korean version of NCSE. CONCLUSION: These results suggest that depression in patients with dementia of Alzheimer type is highly related to the functional impairments, instrumental activities of daily living and part of activities of daily living, beyond the effects of cognitive impairments.

Neuropsychological Functioning and Dimensions of Symptoms in Schizophrenia / 대한정신약물학회지

OBJECTIVES: On the basis of the relationship between positron emission tomography and symptom profiles in schizophrenia by Liddle et al, the authors attempted to investigate the related brain regions associated with clinical symptoms by studying the correlations between the performance of neuro-psychological tests likely to reflect functioning of dorsolateral preftontal, orbitofiontal or cingulate, parietal, and temporal cortices and 3 dimensions (psychotic or reality distortion, negative, and disorganization) of symptoms. METHODS: 41 subjects with a confirmed diagnosis of schizophrenia were scored for each of the three dimensions by Positive and Negative Syndrome Scale. Subjects performed 12 neuropsychological tests designed to measure impairment in specific areas of the brain. RESULTS: According to partial co-rrelations to remove possible confounding variables, the neuropsychological correlates of psychotic(reality distortion) and disorganization dimensions were some tests considered to be related to dorsolateral prefrontal and parietal lobes, and cingulate and dorsolateral preliontal cortices, respectively. CONCLUSION: The results support a part of hypotheses, a specific relation between disorganization and cingulate cortex. In addition our results suggest the possibile relations between a psychotic dimension and functions of dorsolateral prefrontal and parietal lobes, and between a disorganization one and functions of cingulate and dorsolateral prefrontal cortices. The authors believe that our study supports different neural circuits associated with each of dimensions of symptoms, particularly psychotic and disorganization, in schizophrenia.

Effects of Cognitive Differentiation Training of Intergrated Psychological Therapy to the Basic Cognitive Functions in Schizophrenic Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the effects of cognitive differentation training of Integrated Psychological Therapy(a training program of executive function,concept formation,language,and abstraction) on micro-level cognitive function such as attention,memory and reaction time in patients with schizophrenia. METHODS: Twenty-four inpatients diagnosed as schizophrenia using DSM-lV were randomly assigned to 2 group. The training group went through a total of 12 sessions of cognitive differentiation training for 4 weeks. The control group received psychoeducation Timer of Vienna Test System were administered to all patients, both before and after the training program. RESULTS: 1) In the attention and concentration scores of Wechsler Memory Scale-Revised, between group, within group and interaction effects of training were not significant. 2) In the short-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09,p<0.05), but the between group and interaction effects did not reach significance. 3) In the long-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09,p<0.05), but the between group and interaction effects did not reach significance. 4) In the reaction time scores of Decision-Reaction Timer,interaction effect of training was significant(F(1,24)=5.18,p<0.05). 5) In the motor time scores of Decision-Reaction Timer,between group,within group and interaction effects of training were not significant. 6) In the decision time scores of Decision-Reaction Timer,interaction effect of training was significant(F(1,24)=6.00,p<0.05). CONCLUSION: Our findings suggest that cognitive differentiation training of Integrated Psychological Therapy is partly effective on improving micro-level cognitive functions such as reaction time(especially,decision time)in patients with schizophrenia.

Epidemiologic Study of Cognitive Impairment and Depressive Symptoms of the Elderly in a Korean Rural Community

OBJECTIVE: Elderly Dementia and depression are major neuropsychiatric disorders. Epidemiologic study considered essential part to evaluate and treatment guideline for community mental health. METHOD: The cross-sectional study evaluates the dementia and depression of community- living elderly, over 65 older in a Korean rural community. Mini-Mental State Examination- Korean (MMSE-K) and Geriatric Depression Scale (GDS) was conducted. RESULTS: The prevalence of dementia is 14.0% below the 17 of MMSE-K score. Cognitive function decline is increasing with age. The prevalence of dementia in female elderly is higher than that in male with statistical significance (p<.001). The prevalence of depression is 10% among elderly population. Female elderly have higher frequency than male with statistical significance. CONCLUSION: Elderly dementia and depression is very important neuropsychiatric disorders. MMSE-K and GDS-K is useful instruments for evaluation of elderly dementia and depression. Age and sex are important factors for dementia and depression. More developed instruments for accurate detection and differentiation of dementia and depression are need for mental health program to manage effectively them.

Predictability of Neurocognitive Functions on the Treatment Effect in Schizophrenia / 신경정신의학

OBJECTIVES: This study was to investigate a wider range of neurocognitive function tests to find out how accurately each subtest could predict the outcomes of treatment in schizophrenics. METHODS: The subjects were 33 inpatients diagnosed as schizophrenia according to DSM-IV. Each subject had a drug wash-out period of at least 1 week, and had been given K-WAIS, WMS-R, and Signal Detection, Decision Reaction Timer, and Motor Performance Series in Vienna Test System just before drug administration. Treatment response was evaluated with BPRS and CGI scales before and 8 weeks after drug treatment. We divided the subjects into responders and non-responders according to the outcomes of the above clinical scales in week 8. The responder group was defined with having 20% increase in BPRS score and a CGI score of less than 3. Then we compared the neuropsychological test results between the two groups. RESULTS: Significantly different results between responders and non-responders were Verbal IQ and Full Scale IQ in K-WAIS, the number of correct responses in Signal Detection and Decision Reaction Timer in Vienna Test System. In discrimination analysis of the two groups using these subtests as variables, we could predict the responders with 66.7% accuracy, even though statistically non-significant. CONCLUSION: Although discriminating between responders and non-responders using neurocognitive function tests were proven to be statistically non-significant, the possibility that neurocognitive function tests can be utilized to predict the treatment outcome in schizophrenia cannot be completely ruled out.

Effects of Integrated Psychological Therapy for Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study, as a preliminary one attempting to develop the Korean version of Integrated Therapy for the rehabilitation of schizophrenic patients, was designed to investigate the results of Integrated Psychological Therapy(IPT) and review the problems during the program application. METHODS: Cognitive Differentiation Scale, Problem-Solving Scale, and PANSS(Positive And Negative Syndrome Scale) were administered to schizophrenic inpatients before and after IPT incorporating cognitive differentiation, social perception, verbal communication, social skill and interpersonal problem-solving skill subprograms. The therapy groups were offered activities three times per week during the 12-week program. The control groups were attention-placebo groups for control ling factors such as group interaction and social attention, and were offered psychoeducation. RESULTS: The 12-week IPT groups, compared with the control groups, demonstrated significant improvements in the general psychopathology and the total symptoms of PANSS, but did not in cognitive functions and problem-solving skill. Significant improvements in cognitive functions were found only after cognitive differentiation subprogram and social skill subprogram had limited effects on social skills. But within 12-week IPT groups significant improvements in the positive symptoms, negative symptoms and general psychopathology were found. CONCLUSION: These findings support some effectiveness of IPT, but do not address the unique contribution by cognitive components. Applied to schizophrenic patients in this country, this modality had the problems such as differences in sociocultural and lingual background, duration of treatment, homogeneity in the level of the functioning among group members, management of emotions in activities, and the therapists' skill in the training of cognitive components. So the modification of this modality will be required.

The Effect of Attention Training Using Computer-Aided Cognitive Rehabilitation Program(REHACOM) in Chronic Schizophrenics / 신경정신의학

OBJECTIVE: The authors study evaluated the effect of a cognitive rehabilitation program designed to enhance the attention skill of chronic schizophrenics. METHODS: Dependent variables included measures of perceptual sensitivity and response criterion derived from the Vigilance test of Vienna test system. Each of 10 subjects received 10 sessions of repeated training with computer-aided cognitive rehabilitation program(REHACOM). Eleven subjects were assigned to a control group. All subject were rated on measures of positive and negative symptoms before training. RESULTS: Significant changes on the outcome measures were observed following attention training. CONCLUSION: It is suggested that cognitive rehabilitation with chronic schizophrenics should stress the possibility of remediating deficiencies in basic abilities, such as attention.

Clozapine-induced Agranulocytosis / 신경정신의학

The authors reported one case of agranulocytosis that occurred in the clozapine treatment in a 34-year-old male patient with chronic schizophrenia. Agranulocytosis, a WBC count of 2700 with 4% neutrophils, developed on Day 25 of clozapine treatment, when clozapine was stopped. On Day 26, he became febrile with temperature of 38 degrees C and he was treated with antibiotics, Claforan for 4 days, and received carefully daily blood monitoring and observation. Six days after stopping the administration of clozapine, his WBC exhibited the normal range with increasing numbers of neutrophils(WBC, 6000/mm3 ; neutrophils, 43%) and he began to improve clinically. Also, we described the recent review of incidence, the natural history and implicated possible mechanisms for clozapine-induced agranulocytosis.

Relationship between Clozapine-Induced Therapeutic Responses and Plasma Homovanillic Acid and 5-Hydroxyindoleacetic Acid Levels in Patients with Chronic Schizophrenia

This study was done to examine changes of plasma homovanillic, acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week clozapine trial and to investigate the relationship between the plasma monoamine metabolites and treatment responses. Twenty-seven chronic schizophrenic patients were treated for 8 weeks with clozapine. The psychopathology was assessed at baseline just clozapine trial and then every 2 weeks until the end of 8-week clozapine treatment using the positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured also biweekly using high preformance liquid chromatography with electrochemical detection method. Plasma HVA and 5-HIAA levels were significantly decreased during a 8-week chozapine treatment, although plasma HVA/5-HIAA ratio showed no significant change. The changes of plasma HVA levels were in significant correlations with the changes of PANSS positive scores, of general psychophathology scores, and changes of total scores. The changes of plasma 5-HIAA levels were in significant correlations with the changes of PANSS negative scores. But the changes of plasma HVA/5-HIAA ratio had no significant correlation with any PANSS subscale score changes. 48% of the patients treated with clozapine was categorized as responders, who showed at least a 20% decrease in PANSS total score and a CGI severity score of mildly ill or less(< or =3) of the end pint of the study. The baseline plasma HVA levels and HVA/5-HiAA) ratio were significantly higher in responders(N=13) than in nonresponders(N=14). But no significant difference in the change of plasma HVA between responders(40.3% decrement) and nonresponders(3.1% increment). But no significant difference in the change of plasma 5-HIAA and the change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. These results suggest that the antipsychotic effect of clozapine on positive symptoms may be associated with dopaminergic blocking activity, and that on negative symptoms may be associated with serotonergic blocking activity. The baseline plasma HVA levels and the change of HVA levels from baseline may be useful predictors of treatment response with clozapine.

Statistical Classification of Alcohol Dependence by MMPI / 신경정신의학

OBJECTS AND METHODS: The authors tried to classify 75 male patients with alcohol dependence by using cluster analysis of their MMFI data, to Identify the characteristics of each subtype classified through that process and to evaluate the discriminant validity of the classification. RESULTS: The subjects were divided into 3 subtypes by K-means cluster analysis of MMPI scores: a psychotic subtype of 6(Fa)-7(Ft)-8(Sc) profile(21.4%), a neurotic subtype of 2(D)-3(Hy)-1(Hs) profile(49.3%), a normal subtype(29.3%). But, there were no statistically significant differences of age, educational level, marital status, admission history due to alcoholic problems, number of drinking day per week, average amount of ethanol consumed per drinking occasion, age at onset of drinking and family history of alcoholism among these three subtypes. CONCLUSION: It seems that the subjects with alcohol dependence could be classified into three subtypes with statistical significance, but this statistical classification does not constitute any evidence of discriminant validity.

Effect of Elderly Leisure Functioning on Depression Scale

The purpose of this study is to compare the difference of the tendency for depression and leisure functioning between two elderly groups in differnt socio-cultural environment. Also, this study investigated whether the difference of lesiure functioning affected the tendency for depression. The participants are 55 elderly residing in the nursing home in Seoul and 35 Sahalin returning Koreans in KangWon-Do. Leisure Diagnostic Battery (LDB) developed by Witt and Eliss (1987) was used to measure leisure functioning of the elderly and Yesavage (1983)'s Geriatric Depression Scale (GDS measured the tendency of depression. The LDB and GDS were gathered through interviewing. The result of this study reports that the tendency of depreesion in Sahalin returning Koreans was higher than the elderly in Seoul. And the result supports the hypothesis that the elderly in Seoul who have maintained higher leisure functioning showed lower depression level than the Sahalin elderly who had poor leisure functioning. In other words, there were significance between these two groups. This study suggests that education and the leisure program shoud developed and applied for the higher leisure functioning and satisfaction of the elderly (especially elderly in nursing home).

Effects of Cigarette Smoking on Psychomotor Performance in Schizophrenic Patients / 대한정신약물학회지

Many researchers have reported that smoking enhanced psychomotor performance in healthy subjects, but little is known about the effects of cigarette smoking on psychomotor performance in schizophrenic patients who have a high prevalence of smoking and various psychomotor dysfunctions. The author investigated the effects of cigarette smoking on psychomotor performance in schizophrenic patients. Subjects were grouped into (1) smokers with no smoking for 90 minutes prior to testing, (2) smokers with smoking a cigarette after 90 minutes abstinence prior to testing and (3) nonsmokers. The scores of Motor performance series(MPS) and Decision-reaction timer(DRT) were compared among these three groups. No significant differences were found in MPS. In DRT, schizophrenic smokers with smoking a cigarette after 90 minutes abstinence prior to testing showed significantly shorter reaction time and decision time but no significant differences in motor time and correct response rate. In conclusion, this study suggests that smoking enhances cognitive processes in schizophrenic patients but does not influence motor performance.

The validity of the Korean version of neurobehavioral cognitive status examination on the assessment of dementia in the elderly / 신경정신의학

No abstract available.

Neuropsychological effects of chronic alcoholism on the tactual-spatial performance and memory / 신경정신의학

No abstract available.

Regional differences in the levels of biogenic amines and their metabolites in rat brain after tricyclic antidepressant treatments

Changes in the levels of biogenic amines in different brain regions and the cerebrospinal fluid in rats were measured after acute or chronic treatment with tricyclic antidepressants. After single or 3 weeks' treatment with imipramine or desipramine, blocks of tissues were obtained from seven regions of the brain (frontal cortex, corpus striatum, hippocampus, thalamus, hypothalamus, substantia nigra and cerebellum) immediately after collection of the cerebrospinal fluid (CSF) from the cisterna magna. The concentrations of biogenic amines and their metabolites (norepinephrine, epinephrine, dopamine, 5-hydroxytryptamine (5-HT), dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA)) in brain tissues and the CSF were measured using the high performance liquid chromatography-electrochemical detection system (HPLC-ECD). Treatment with desipramine or imipramine caused major alterations in the concentrations of central norepinephrine or 5-HT and its metabolite, respectively. Brain regional responses were variable according to the kind of tricyclic antidepressants and the duration of treatment. It is noteworthy that chronic treatment with both desipramine and imipramine caused altered hippocampal concentrations of norepinephrine and/or 5-HT and its metabolites. Striatal DOPAC concentrations were also changed after acute or chronic treatment with both drugs. These results suggest that tricyclic antidepressants altered neurotransmission according to the brain region, and the hippocampal norepinephrine and 5-HT and/or the striatal dopamine may have a significant role for the expression of antidepressant action of tricyclic antidepressants.