Attempted Suicides in South Korea : A Multi-Center Analysis of Causes, Methods, and Psychiatric Diagnoses of Suicidal Attempters in 2013

OBJECTIVES: To examine direct causes of attempted suicides, methods adopted to commit suicide, and psychiatric diagnoses among suicide attempters in South Korea. METHODS: A total of 1359 suicide attempters who had visited emergency department of 17 medical centers due to suicide attempt from May 2013 to Nov 2013 were interviewed using semi-structured questionnaires. RESULTS: Psychiatric symptoms were the most common cause of suicide attempts (62.2%), followed by interpersonal relationships (24.4%). Women attempted suicide more often for interpersonal reasons, whereas men were more likely to do so for financial and jobrelated reasons. Half of participants (55.8%) attempted suicide by drug intoxication, which was more prevalent among females and those who had previous history of psychiatric disease or previous suicide attempt. Men were more likely to use more lethal methods such as pesticide poisoning and gas inhalation than women. Pesticide poisoning was also prevalent among the elderly group and the rural population. Near ninety-five percent (94.5%) of participants received a psychiatric diagnosis : the most frequent diagnosis was depressive disorder. CONCLUSIONS: This is the first nationwide study of cases of attempted suicide. When stratified by age groups, gender, urbanicity, living alone or not, presence of physical illness, previous psychiatric history, and previous suicide attempt, there were significant differences with respect to causes, methods of attempted suicides and psychiatric diagnoses of suicide attempters.

Delayed Respiratory Failure after Ingesting Imidacloprid Containing Solution

Compared with organophosphate or carbamate insecticides, neonicotinoids have several pharmacological benefits such as a broad spectrum of insecticidal activity, low application rate, and highly selective toxicity to insects. Imidacloprid was the first neonicotonid introduced in the market, in 1991. It has become one of the best selling insecticides globally. Several cases of imidacloprid intoxication have been reported worldwide, but few have been reported in Korea. Recently, we experienced a severe imidacloprid intoxication with delayed respiratory insufficiency and several toxicities. We report the case with the literature review.

Temporal Changes in Functional Magnetic Resonance Imaging Activation of Heterosexual Couples for Visual Stimuli of Loved Partners

OBJECTIVE: Previous neuroimaging studies on romantic love have focused on determining how the visual stimuli that serve as a representation of loved ones induce the neural activation patterns of romantic love. The purpose of this study was to investigate the temporal changes in romantic love over a period of 6 months and their correlated neurophysiological changes. METHODS: Five heterosexual couples (n=10, mean age 21.1+/-1.97) who started dating not less than 100 days previously were recruited to measure their blood oxygen level dependent (BOLD) signals using functional magnetic resonance imaging (fMRI) while showing them pictures of their loved ones and their previously identified, opposite-sex friends. Subsequently, the subjects were scanned under the same experimental conditions to assess possible changes in their brain activities after 180 days. RESULTS: We found that their Passionate Love Score (PLS) values (M: 118.6+/-9.1, F: 120.2+/-7.0) were significantly reduced after 6 months (M: 110.8+/-4.0, F: 106.2+/-3.0). Furthermore, significantly increased activations were found in the cingulate gyri, inferior frontal gyri, supramarginal gyri, etc., after 6 months, whereas the head and tail of the right caudate nucleus were deactivated, which is indicative of the inhibition of expression and sensory neglect. CONCLUSION: These findings suggest that dynamic neural processes in the cortical-subcortical regions are involved in temporal changes in romantic love.

Resistance to Thyroid Hormone with Missense Mutation (V349M) in the Thyroid Hormone Receptor Beta Gene

Resistance to thyroid hormone (RTH) is a syndrome characterized by reduced sensitivity to the thyroid hormone. It is generally caused by mutations in the thyroid hormone receptor beta (TRbeta) gene. On the basis of its clinical features, two different forms of this syndrome have been described: generalized resistance and pituitary resistance. A total of 122 TRbeta gene mutations have been identified thus far. A 38-year-old woman presented with intermittent palpitation. Thyroid function tests revealed elevated levels of free T4 and TSH. TSH alpha-subunit levels were 0.41 mIU/mL, and magnetic resonance images of the sellar region evidenced no abnormal findings. The TSH response to TRH stimulation was found to be normal. The sequence analysis of the TRbeta gene verified a missense mutation in exon 11, and the observed amino acid alteration was a substitution of a valine for a methionine at codon 349. We report the first case of a woman with RTH, which was found to be caused by a missense mutation (V349M) in the TRbeta gene.

Risperidone Combination in the Acute Treatment of Bipolar Mania and Mixed Episode: Prospective, Multicenter, Open Trial / 대한정신약물학회지

OBJECTIVE: Although mood stabilizer monotherapy is the recommended initial therapy for bipolar disorder, the use of atypical antipsychotics in bipolar patients is increasing recently. Moreover, the medical literature is demonstrating that the combination of atypical antipsychotics and mood stabilizers is a more effective therapy. The goal of this study was to assess the efficacy of risperidone in patients with acute manic and mixed state of bipolar disorder. METHODS: This study was a 4-week, open-label, combination, prospective investigation using risperidone in combination with mood stabilizers. In total, 114 patients with a DSM-IV diagnosis of bipolar disorder, manic or mixed episode, were recruited. Risperidone was given in combination with mood stabilizers in doses according to clinical response and tolerability. Efficacy was assessed with the Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAMD), the Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), and the Clinical Global Impressions Scale-Bipolar (CGI-BP). The Simpson-Angus Rating Scale (SARS) was applied to assess extrapyramidal symptoms. RESULTS: The combination of risperidone with mood stabilizers produced highly significant improvements (p<0.001) on the YMRS, HAMD, BPRS, GAS, and CGI-BP at both 1 week and 4 weekweeks. Analysis of the YMRS, BPRS, GAS, and CGI-BP scores revealed significant improvement in both the manic and mixed group. The HAMD score was decreased only in the mixed group. Body weight was increased significantly after 1 week. Risperidone was well tolerated, and adverse events were mostly mild, with the most frequent extrapyramidal symptoms and sedation. CONCLUSION: Our findings suggest that the combination of risperidone with mood stabilizers was an effective and safe treatment for acute manic symptoms and coexisting depressive symptoms of bipolar disorder. Randomized, double-blind, placebo or active controlled studies are needed.

Psychometric Properties of Korean Version of Drug Attitude Inventory(KDAI-10) / 대한정신약물학회지

OBJECTIVE: The aim of this study was to test the psychometric properties of Korean version of 10 items of Drug Attitude Inventory (KDAI-10). METHODS: A total of 157 stabilized schizophrenic patients were entered into the study after completion of screening tests. They completed the KDAI-10. And then they were interviewed with various scales such as Subjective Response Scale (SRS), Positive and Negative Syndrome Scale (PANSS), Extrapyramidal Side Effects Rating Scale (ESRS), and Global Assessment of Functioning (GAF). Correlations of KDAI-10 with these scales were tested. RESULTS: The Cronbach's alpha used to measure the internal consistency of the scale, was high (0.83). Principal component analysis with varimax rotation produced 2 factors, which explained 50.37% of the total variances. The First factor including 6 items was the positive subjective feelings and the second factor including 4 items was the negative subjective feelings, which were identical to the original authors'. Individual item correlations with total scores were all statistically significant (r=0.48-0.72, p<.001). And correlations of KDAI-10 with SRS, PANSS, ESRS and GAF showed that they were significantly correlated. CONCLUSION: Although the results were not quite satisfactory, KDAI-10 was demonstrated to have good reliability and construct validity.

Effects of Low Frequency Repetitive Transcranial Magnetic Stimulation on Visual Short Term Memory in Healthy Individuals / 신경정신의학

OBJECTIVES: Repetitive transcranial magnetic stimulation (rTMS) is a novel, noninvasive method of brain stimulation. Since conventional rTMS does not cause seizure, marked advantage over electroconvulsive therapy (ECT), rTMS can be used easily and widely. Once the effects of rTMS on cognitive function are elucidated, its application will be further extended. However, the effects of rTMS on cognitive function have not been well examined. This study aimed to evaluate the effect of low frequency rTMS on visual short term memory. METHODS: Forty normal healthy volunteers were randomly assigned to rTMS (n=20) or sham (n=20) groups. The rTMS group were again randomly divided into left prefrontal (n=10) and right prefrontal (n=10) groups. For each group rTMS was given at 1 Hz for 20 minutes with 100% of motor threshold. As a cognitive task, Corsi Block Tapping Test (CORSI) in the computerized Vienna Test System, which can assess visual short term memory, was performed before, during, and after the rTMS. RESULTS: No significant difference was found in the visual short term memories between the rTMS and the sham groups before, during, or after 1 Hz rTMS, nor between the left and right prefrontal rTMS groups. CONCLUSION: This study demonstrates that rTMS, contrary to ECT, has no adverse visual short term memory effect when used as the standard treatment paradigm. Therefore, rTMS could be a new and safe treatment method in various neuropsychiatric fields without any interference of cognitive function.

Effects of Low Frequency Repetitive Transcranial Magnetic Stimulation on Visual Short Term Memory in Healthy Individuals / 신경정신의학

OBJECTIVES: Repetitive transcranial magnetic stimulation (rTMS) is a novel, noninvasive method of brain stimulation. Since conventional rTMS does not cause seizure, marked advantage over electroconvulsive therapy (ECT), rTMS can be used easily and widely. Once the effects of rTMS on cognitive function are elucidated, its application will be further extended. However, the effects of rTMS on cognitive function have not been well examined. This study aimed to evaluate the effect of low frequency rTMS on visual short term memory. METHODS: Forty normal healthy volunteers were randomly assigned to rTMS (n=20) or sham (n=20) groups. The rTMS group were again randomly divided into left prefrontal (n=10) and right prefrontal (n=10) groups. For each group rTMS was given at 1 Hz for 20 minutes with 100% of motor threshold. As a cognitive task, Corsi Block Tapping Test (CORSI) in the computerized Vienna Test System, which can assess visual short term memory, was performed before, during, and after the rTMS. RESULTS: No significant difference was found in the visual short term memories between the rTMS and the sham groups before, during, or after 1 Hz rTMS, nor between the left and right prefrontal rTMS groups. CONCLUSION: This study demonstrates that rTMS, contrary to ECT, has no adverse visual short term memory effect when used as the standard treatment paradigm. Therefore, rTMS could be a new and safe treatment method in various neuropsychiatric fields without any interference of cognitive function.

The Changes of short-term memory and Autonomic neurocardiac function after 4-10Hz sound and light stimulation: A pilot study / 수면정신생리

OBJECTIVES: Sound and light (SL) stimulation has been used as a method to induce some useful mental states in the fields of psychology and psychiatry. It is believed that sound and light entrainment device (SLED) has some specific effects through synchronization of EEG in patients who use it. Theta frequency is believed to stimulate deep relaxation and short term memory processing. This study was conducted to evaluate if 4-10Hz SL stimulation can induce relaxation and improve short term memory function. METHODS: Ten medical students with no medical or psychiatric problems participated in this study. Subjects were randomly divided into two groups. One group was applied with real SLED was applied to one group (R group) and pseudo SLED to the other group (P group). The two groups were exposed to SL stimulation with SLED 15 minutes a day for 5 days, and after two days rest the two groups were switched over. The Korea Wechsler Adult Intelligence Scale (K-WAIS), Academic Motivation Tests (AMT), Test Anxiety Scale (TAS), Korea Auditory Verbal Learning Test (K-AVLT), and digit span were used to evaluate short term memory. Spielberger's State-Trait anxiety inventory and heart rate variability (HRV) test were used to evaluate degree of relaxation. RESULTS: Compared with S group, R group showed a significant improvement in K-AVLT and digit span after a single application of SL stimulation. But 5-day long application did not reveal any differences between the two groups. A significant change in HRV was observed in 5-day long application of SL stimulation after being switched over to other SLED. CONCLUSION: This pilot study suggests that 4-10Hz SL stimulation has some positive influences on short term memory and relaxation.

Depression and the Frontal Lobe

OBJECTIVES: Abnormalities in the frontal lobe have been consistently suggested in the pathophysiology of depression. The purpose of this review is to discuss the relationship between the frontal lobe and depression. METHODS: Recent researches on the frontal lobe in depression were reviewed and abnormalities in this region were considered within the context of modern functional neuroanatomy. RESULTS: This paper reviewed evidence strongly implicating the frontal lobe as a key brain structure in depression. CONCLUSION: Taken together, these abnormalities in the function of the frontal lobe implicate interconnected neural circuits in depression and offer suggestions for the themes of future research and treatment. Further research is needed to investigate the association between emotion and the brain in the paradigm of "affective neuroscience".