The Relationship between Posttraumatic Stress Disorder and the Quality of Life among the Vietnam War Veterans / 정신신체의학

OBJECTIVES: Posttraumatic stress disorder(PTSD) has devastating effects on multiple aspects of the quality of life(QoL). Therefore, the purpose of this study is to compare the QoL between PTSD group and non-PTSD group, and identify the variables affecting the QoL of the Vietnam War veterans. METHODS: We recruited 39 veterans with PTSD and 43 veterans without PTSD, all of whom had deployed to the Vietnam War. We used the Korean version of Mini International Neuropsychiatric Interview-Plus, the Korean version of Clinician-Administered PTSD Scale, Combat Exposure Scale and the Korean version of World Health Organization Quality of Life Assessment Instrument abbreviated version. We used independent samples t-test to identify the differences between PTSD and non-PTSD group in each domains of the quality of life. We also used stepwise multiple linear regression analysis to figure out the variables affecting the QoL of the Vietnam War veterans. RESULTS: In the PTSD group, all domains of the QoL and the QoL total score(p<0.01) were significantly lower than those in the non-PTSD group. In the Vietnam War veterans, PTSD, major depressive disorder and education levels were the variables affecting the QoL. Among these, PTSD uniquely explained the QoL of the overall and general health(beta=-1.411, R2=0.180), the physical health domain(beta=-2.806, R2=0.089) and the total score (beta=-11.479, R2=0.104). CONCLUSIONS: These results suggest that among the Vietnam War veterans, the QoL of the PTSD group is significantly lower than that of the non-PTSD group. Among the combat exposed veterans, PTSD may be one of the main reasons that affect the multiple domains of the QoL.

Bone Density in Chronic Schizophrenia with Long-Term Antipsychotic Treatment: Preliminary Study

OBJECTIVE: Decreased bone mineral density has been found in the chronic schizophrenic patients who have been given a long-term administration of antipsychotics. Hyperprolactinemia from the antipsychotics and the negative symptom of schizophrenia were considered as the causes for this finding. In this study, the effect of hyperprolactinemia and the negative symptom of schizophrenia on bone mineral density was investigated on male schizophrenic patients. METHODS: The cross-sectional study was carried out with the subjects of 45 male schizophrenic patients who have undertaken the monotherapy with risperidone, olanzapine and clozapine for at least one year. The demographic factors, clinical symtoms, bone mineral density and hematological test were examined for all the subjects. RESULTS: No significant relationship was found between hyperprolactinemia and the decreased bone mineral density in the subjects. The negative schizophrenia symptom of the subjects showed a significant effect on the decreased bone mineral density. CONCLUSION: The decreased bone mineral density finding in the male schizophrenic patients may be caused by the negative schizophrenia symptom rather than the hyperprolactinemia due to the antipsychotics. Additional studies are further required regarding other factors that may affect the decreased bone mineral density such as activity, calcium intake and exposure to sunlight.

Cognitive Deficits Associated with Posttraumatic Stress Disorder / 신경정신의학

OBJECTIVES: In addition to the main symptoms of posttraumatic stress disorder (PTSD), which include reexperience, avoidance and hyperarousal, many patients complain of cognitive deficits and especially in attention and memory. This study was conducted to evaluate the cognitive deficits of survivors of a tragic shooting incident at a frontline guard post. All of the survivors experienced the same accident, and they were homogeneous in terms of age and education level, which are closely associated with cognitive performance. METHODS: We recruited 12 survivors who suffered from PTSD following the same traumatic incident and we also recruited 12 normal volunteers, and we assessed their neurocognitive functions with using a vigilance test, a continuous attention test, a reaction unit test and the Corsi block tapping test in the computerized Vienna Test System, as well as an auditory verbal learning test and complex figure test in the Rey-Kim Memory Test. Standardized clinical scales, including the Clinician-Administered PTSD Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the State-Trait Anxiety Scale I and II, were used to assess the involved mental areas and the severity of the PTSD symptoms. RESULTS: The patient group showed significant impairments in continuous attention, and the visual and auditory information processing time on the Vienna test when compared to the control group. The patient group also showed significant impairments in the verbal memory, visual memory and visuospatial function on the Rey-Kim Memory Test. CONCLUSION: In this study, the author reports on the cognitive impairments in patients with PTSD as measured by computerized neurocognitive tests and memory tests. Future studies are needed to determine the changes in cognitive functioning that are related to symptom improvement, as well as the influence of the therapeutic effects on the cognitive improvement.

Psychometric Validation of the Korean Version of Structured Interview for Post-traumatic Stress Disorder (K-SIP)

For diagnosis and management of post-traumatic stress disorder (PTSD), the easily administered assessment tool is essential. Structured Interview for PTSD (SIP) is a validated, 17-item, simple measurement being used widely. We aimed to develop the Korean version of SIP (K-SIP) and investigated its psychometric properties. Ninety-three subjects with PTSD, 73 subjects with mood disorder or anxiety disorder as a psychiatric control group, and 88 subjects as a healthy control group were enrolled in this study. All subjects completed psychometric assessments that included the K-SIP, the Korean versions of the Clinician-Administered PTSD Scale (CAPS) and other assessment tools. The K-SIP presented good internal consistency (Cronbach's alpha=0.92) and test-retest reliability (r=0.87). K-SIP showed strong correlations with CAPS (r=0.72). Among three groups including PTSD patients, psychiatric controls, and normal controls, there were significant differences in the K-SIP total score. The potential cut-off total score of K-SIP was 20 with highest diagnostic efficiency (91.9%). At this point, the sensitivity and specificity were 95.5% and 88.4%, respectively. Our result showed that K-SIP had good reliability and validity. We expect that K-SIP will be used as a simple but structured instrument for assessment of PTSD.

Treatment of Posttraumatic Stress Disorder / 신경정신의학

Posttraumatic stress disorder (PTSD) is a psychiatric disorder which cause is certain, and mechanism of PTSD has been studied actively for decades. The various kinds of therapy, based on the pathophysiology of PTSD, were applied and among them eye movement desensitization and reprocessing (EMDR), therapy for sleep, transcranial magnetic stimulation (TMS) and psychopharmacotherapy that showed considerable effect for patients with PTSD would be introduced.

Efficacy and Tolerability of Mirtazapine and Sertraline in Treatment of Patients with Posttraumatic Stress Disorder with Depression: A Randomized Open Label Trial / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the potential use of mirtazapine in Korean veterans diagnosed with PTSD, by comparing it with sertraline, a drug approved for use in PTSD in the USA. METHODS: Efficacy was eveluated by Clinician Adninistered PTSD Scale (CAPS-2), the Hamilton Rating Scale for Depressin (HAMD-17) and the Clinical Global lmpresaion Scale (CGI), at baseline and week 1, 2, 6. Response was defined as a > or =30% decrease in CAPS-2 total score, a > or =50% decrease in total HAMD-17 score, and s CGI-I score<3. RESULTS: 51 patients on mirtazapine (measn age/duration of illness:59.1/33.5 yrs) and 49 on sertratine (mean age/duration of illness:60.6/35.6 years) completed the study. Mean daily dosage was 34.1 mg for mirtazapine and 101.5 mg for sertraline. On CAPS-2 total score more patients responded in the mirtazapine group at weak 1 (13 vs. 2%) and week 2 (51vs. 31%). At week 6 this difference was statistically significant (88 vs. 69%, p=0.039), CAPS-2 total score. HAMD-17 total score and CGI-I score decreased significantly in both groups, with no significant differences between groups on all time points. Main side effects for the rnirtazapine group:dry mouth (19.8%) and constipation (19.6%), somnolence (15.7%), weight gain (1.96%). For the sertraline group:indigestion (14.3%), palpitation (6.1%) agitation (2.0%), epigastric soreness (2.0%), insomnia (2.0%), sexual dysfunction (2.0%). CONCLUSION: Mirtazapine appeared to be an effective and well-tolerated treatment for PTSD in Korean veterans.

Effect of Topiramate on Risperidone-Induced Weight Gain: A Pilot Study / 대한정신약물학회지

OBJECTIVE: It is known that risperidone induces weight gain moderately which has been previously considered of little clinical concern. And there was no specific effective treatment for atypical antipsychotics-induced weight gain. The study was performed to evaluate the effectiveness of topiramate as an weight-reducing medicine for schizophrenia patients with risperidone-induced weight gain. METHODS: Topiramate, 100-200 mg/day, was administered to 12 schizophrenia patients with risperidone-induced weight gain. Body weight and body mass index (BMI) were measured at baseline, 4-week and 8-week. Brief Psychatric Rating Scale (BPRS) and Positive And Negative Syndrome Scale (PANSS) were used to evaluate psychotic symptoms. RESULTS: Body weight and BMI were decreased significantly at 4-week and 8-week treatment compared to baseline (weight loss: 1.17+/-1.80 kg and 2.50+/-2.24 kg; BMI: -0.41+/-0.65 kg/m2 and -0.88+/-0.82 kg/m2 on 4-week and 8-week). Psychiatric symptoms were improved significantly in BPRS and PANSS. Adverse effects were showed such as fatigue, paresthesia, difficulty in concentration and diarrhea, which were mild and self-limited. CONCLUSION: It is suggested that topiramate have significant effects on patients with risperidone-induced weight gain. Randomized controlled study would be necessary in the near future.

Effects of Sertraline on Memory Function of Patients with Posttraumatic Stress Disorder / 대한정신약물학회지

OBJECTIVE: This study was conducted to evaluate effects of sertraline treatment on symptoms and memory function of posttraumatic stress disorder (PTSD). METHODS: Thirty Vietnam veterans were collected for this study, among whom fifteen were PTSD patients and fifteen were combat control subjects. We used Mississippi Scale for Combat-Related PTSD, Combat Exposure Scale (CES), Hamilton Depression Rating Scale (HDRS) and Clinician Administered PTSD Scale (CAPS). Digit Span, Paired Association Learning Test (PALT) and Rey- Osterreith Complex Figure Test (CFT) were assessed for memory function. We evaluated HDRS, CAPS and memory function tests at baseline, 2-week and 6-week intervals with each subjects. RESULTS: There were significant differences between PTSD and Non-PTSD veterans in Mississippi Scale for Combat-Related PTSD, CES, HDRS and CAPS. Significant difference was found in memory function tests between PTSD and Non-PTSD veterans. PTSD veterans showed significant improvement in HDRS and CAPS at 2-week and 6-week and in memory function tests at 6-week of sertraline treatment. There was no significant correlation between symptoms and memory function. CONCLUSION: These results suggest that sertraline improve symptoms and memory function of PTSD. There was no significant correlation between PTSD sysmtoms and memory function.

Therapeutic Effect of Tianeptine on Elderly Depression and Hippocampal Volume Change / 대한정신약물학회지

OBJECTIVE: This research was performed to study the effect of tianeptine, a novel antidepressant, on elderly depressed patients, to compare the hippocampus size between a normal control group and the elderly depressed group, and to measure the change of hippocampal volume according to the treatment effect of tianeptine. The relationship between hippocampus size and severity of depression at baseline was also studied. METHODS: A group of elderly depressed patients and normal control subjects over 62 years old were recruited fifteen elderly depressed patients, all male, of average age 70 (range 62-80 years old) and 15 normal control subjects were recruited along with age and education duration matched. To investigate the effect of the antidepressant, Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) scale were applied at baseline, and the 4th and 8th weeks. MRI was used to compare the volume of the hippocampus between the patients group and the control group, and to measure the hippocampal volume of the patients at baseline and after the 8-week treatment. RESULTS: For the elderly depressed patient group, tianeptine significantly reduced MADRS, HDRS and CGI (Ed-deleted part is unnecessary as this meaning is obvious from being in the `Results' section). There was no significant difference of hippocampal volume between the elderly depressed patients group and the normal control group, nor between the elderly depressed patients group at baseline and after the 8-week treatment. CONCLUSION: This study shows that tianeptine is a safe, effective and well-tolerated antidepressant for elderly depression. However, a change of hippocampal volume was not observed over the course of an 8-week, short-term therapy.

Effect of Mirtazapine on Memory Function of Patients with Posttraumatic Stress Disorder / 대한정신약물학회지

OBJECTIVE: This study was conducted to evaluate efficacy on symptoms and memory function of mirtazapine treatment of posttraumatic stress disorder. METHODS: Thirty Vietnam veterans were collected for this study, among whom fifteen were PTSD patients and fifteen were combat control subjects. We used Mississippi Scale for CombatRelated PTSD, Combat Exposure Scale (CES), Hamilton Depression Rating Scale (HDRS) and Clinician Administered PTSD Scale (CAPS). Digit Span, Paired Association Learning Test (PALT) and Rey-Osterrith Complex Figure Test (CFT) were assessed for memory function. We also evaluate HDRS, CAPS and memory function tests intervals of baseline, 2 week and 6 week in PTSD patients during mirtazapine treatment. RESULTS: There were significant differences between PTSD and Non-PTSD veterans in Mississippi Scale for Combat-Related PTSD, CES, HDRS and CAPS. Significant difference was found in memory function tests between PTSD and Non-PTSD veterans. PTSD veterans showed significant improvement in HDRS and CAPS at 2 week and 6 week during mirtazapine treatment and in memory function tests at 6 week during mirtazapine treatment. There was no significant correlation between symptoms and memory function. CONCLUSION: These results suggest that mirtazapine improve symptoms and memory function of PTSD. There was no significant correlation between PTSD sysmtoms and memory function.

Hippocampal Volume and Memory Function in Patients with Posttraumatic Stress Disorder

This study was conducted to evaluate the effect of PTSD on memory funtion and hippocampal volume, and to identify major variables correlated to hippocampal volume and memory function. Thirty four Vietnam veterans were collected for this study, among whom eighteen were PTSD patients and sixteen were combat control subjects. The author used Impact of Event Scale(IES), Combat Exposure Scale(CES), Hamilton Depression Rating Scale(HDRS) and Beck Depression Inventory(BDI). Korea Memory Assessment Scale(K-MAS) was assessed for memory function. Magnetic resonance imaging(MRI) was used to measure hippocampal volume. There were significant differences between PTSD and Non-PTSD veterans in IES, HDRS and BDI. Significant difference was found in verbal memory and total memory of K-MAS between PTSD and Non-PTSD veterans. There was significant difference in hippocampal volume between PTSD and Non-PTSD veterans. Short term memory, verbal memory and total memory were positively correlated to hippocampal volume. Hippocampal volume was negatively correlated to IES, HDRS, and BDI. These results suggest that PTSD severity be associated with hippocampal atrophy and memory dysfunction. Reduced or smaller hippocampal volume may be preexisting risk factor for stress exposure or the development of PTSD on combat exposure.

The Risk Factors for Posttraumatic Stress Disorder in Veterans / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the risk factors in veterans for posttraumatic stress disorder and to find the correlation between the disorder and the characteristics of the variables. METHODS: We compared the risk factors in veterans between 40 diagnosed PTSD patients and 78 controls, using psychiatric by psychiatrists and measurement instruments such as CES, Mississippi scale, and BDI RESULTS: 1) There was statistically significant difference in prevalence on pre-military factor with regard to age at recruit(p<0.05) 2) PTSD on military factor was closely correlated with CES score(p<0.05) 3) There was statistically significant difference in PTSD on post-military factor with regard to occupation(p<0.05) 4) Scores of Mississippi scale, and BDI in PTSD were higher than those in control subjects(p<0.05, p<0.05) CONCLUSION: This results suggest that the likehood of developing PTSD in veterans depends on pre-military and post-military factors in addition to features of the trauma itself. Age of entry into the military, CES score, and occupation had statistically significant relationships with PTSD.

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.

MMPI configuration of Korean War veterans with posttraumatic stress disorder / 신경정신의학

No abstract available.

Posttraumatic stress disorder and thyroid function / 신경정신의학

No abstract available.