Treatment Compliance and Parents' Characteristics in Children with Attention-Deficit Hyperactivity Disorder : Pilot Study / 신경정신의학

OBJECTIVES: This study was conducted to compare characteristics of parents of attention-deficit hyperactivity disorder (ADHD) children in relationship to treatment compliance. METHODS: A total of 271 school-aged children diagnosed with ADHD were devided into two groups by treatment duration; early dropout group (n=117, treatments discontinued within three months) and continuous treatment groups (n=154, treatments continued for more than three months). Scores on the Korean Personality Inventory for Children (KPI-C), Minnesota Multiphasic Personality Inventory (MMPI), Korean Parenting Sense of Competence (K-PSOC), Korean Parenting Stress Index-Short Form (K-PSI-SF), and Parental Acceptance Rejection Questionnaire (PARQ) were compared between two groups. RESULTS: According to the results of the KPI-C, parents of the early dropout group showed a higher tendency to regard their children's symptoms as 'somatization' and 'delinquency', compared with those of continuous treatment groups (49.9 vs. 46.3 and 60.9 vs. 58.2, p=0.048 and 0.046, respectively). Parents in the early dropout group showed higher scores on hypochondriasis and psychasthenia subscales in MMPI (54.7 vs. 52.1 and 51.5 vs. 48.5, p=0.024, and 0.017, respectively). The results of the K-PSOC showed that parents in the early dropout group perceived a lower sense of parenting competence (27.3 vs. 58.6, p=0.047). CONCLUSION: Our findings suggested that characteristics of the parents and their perspectives regarding children's symptoms could be possible factors associated with treatment compliance in ADHD. Further researches on this issue may provide opportunities to improve treatment compliance for children with ADHD.

A Case of a Patient with Both Chorea and Restless Legs Syndrome

The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.

Comparison of Narcolepsy with Cataplexy and without Cataplexy: Clinical Variables, HLA-DQB1*0602, and Hypocretin / 신경정신의학

OBJECTIVES: Narcolepsy is a sleep disorder, characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucination. Among these symptoms, cataplexy is one of the most pathognomonic symptoms in narcolepsy. This study was designed to investigate the clinical features, frequency of DQB1*0602 and CSF hypocretin levels in Korean narcoleptics with cataplexy to compare with those who have not cataplexy. METHODS: From August 2003 to July 2005, we selected 72 patients who have narcolepsy confirmed by nocturnal polysomnography and multiple sleep latency test (MSLT) as well as their history and clinical symptoms at Sleep Disorders Clinic of St. Vincent's Hospital, Catholic University of Korea. Patients were divided into 56 cataplexy-positive group (narcolepsy with cataplexy group) and 12 cataplexy-negative group (narcolepsy without cataplexy group). HLA typing was done in all patients for the presence of DQB1*0602, and patients received spinal tapping to measure the level of CSF hypocretin. Clinical variables were examined by semi-structured interview for narcolepsy patients. RESULTS: 1) In cataplexy-positive group, compared with cataplexy-negative group, the frequency of HLA-DQB1*0602 was found to be significantly increased (50 subjects, 89.3% vs. 8 subjects, 50.0%)(p=0.000). 2) In 48 out of 56 cataplexy-positive patients (85.7%), hypocretin levels were decreased (< or =110 pg/ml) or were below the detection limit of assay (<40 pg/ml). However, only 6 out of 16 cataplexy-negative patients (37.5%) exhibited decreased hyopcretin level. The difference between two groups were statistically significant (p=0.000). 3) Cataplexy-positive group, compared to cataplexy-negative group, reported more frequent hypnagogic hallucinations (36 subjects, 64.3% vs. 4 subjects, 25.0%)(p=0.005). However, there were no significant differences in frequency or severity of daytime sleepiness, sleep paralysis and demographic data. 4. In nocturnal polysomnography and MSLT findings, there were no significant differences in all sleep parameters between two groups. CONCLUSION: Higher frequency of HLA-DQB1*0602, and lower hypocretin levels in cataplexy-positive groups than catapelxy-negatives suggest that narcoleptics with cataplexy might be a etiologically different disease entity from narcoleptics without cataplexy. Additionally, Current criteria prevail for the diagnosis of narcolepsy need to be reclassified according to the presence of cataplexy or not.

HLA-DQB1 Allele and Hypocretin in Korean Narcoleptics with Cataplexy

Cataplexy is one of the most pathognomonic symptoms in narcolepsy. This study was designed to investigate the frequency of the HLA-DQB1 allele and cerebrospinal fluid (CSF) hypocretin levels in Korean narcoleptics with cataplexy as compared with those who do not have cataplexy. Seventy-two narcoleptics were selected based on polysomnography and multiple sleep latency test as well as their history and clinical symptoms at Sleep Disorders Clinic. The patients were divided into a narcolepsy with cataplexy group (n=56) and a narcolepsy without cataplexy group (n=16). All patients were subjected to HLA typing to determine the frequency of DQB1 allele and to spinal tapping to measure the level of CSF hypocretin. In cataplexy-positive patients, as compared with cataplexy-negative patients, the frequency of HLA-DQB1*0602 was found to be significantly high (89.3% vs. 50.0%) (p=0.003). On the other hand, the frequency of HLA-DQB1*0601 was found to be significantly low (0% vs. 43.8%) (p<0.001). In 48 of 56 cataplexy-positive patients (85.7 %), hypocretin levels were decreased (< or =110 pg/mL). However, only 6 of 16 cataplexy-negative patients (37.5%) exhibited a decreased hyopcretin level (p<0.001). The high frequency of HLA-DQB1*0602, low frequency of HLA-DQB1*0601 and low hypocretin levels in cataplexy-positive groups suggest that cataplexy-positive narcolepsy might be an etiologically different disease entity from the cataplexy-negative.

The Effect of Total Sleep Deprivation on the Physiological and Cognitive Function / 신경정신의학

OBJECTIVES: Purpose of this study was to investigate physiological and neurocognitive effects of total sleep deprivation by using laboratory blood tests and the computerized neurocognitive function test in healthy subjects. METHODS: Sixteen healthy volunteers participated in this study. Subjects were recommended to remain awake for 48 hours under continuous surveillance. Lab tests of cortisol, prolactin, thyroid hormone, growth hormone, and immunoglobulin (IgG, IgA, IgM, IgD, IgE), CBC, BC and the Vienna test were performed before and after 48 hours of total sleep deprivation. RESULTS: Concentration of T3 and T4 significantly increased after deprivation. In the reaction test, distribution reaction time significantly increased, and correct reaction significantly decreased. In the vigilance test, amount of correct reaction significantly decreased, and the mean value of correct reaction time was significantly delayed. Level of fasting blood sugar, total protein, albumin, alkaline phosphatase and potassium significantly increased, respectively, except for the level of total bilirubin which was decreased. After total sleep deprivation, WBC counts significantly increased. Regarding immunoglobulin level, IgG, IgA and Ag M concentrations appeared to decrease, but the results were not statistically significant. CONCLUSION: The effect of total sleep deprivation on physiological function was significant in the level of thyroid hormone. Although statistically not significant, the results of growth hormone and the immune system showed a trend in relations to the effect of total sleep deprivation. Results of blood chemistry suggest that sleep deprivation may influence metabolism of hepatobiliary system. Cognitive impairment was also seen in reactive and vigilant functions after total sleep deprivation.

A Case of Narcoleptic Patient with Psychotic Symptoms / 신경정신의학

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. We report a patient with a diagnosis of schizophrenia who was subsequently diagnosed as narcolepsy. A case of a 22-year-old woman with concomitant narcolepsy and psychotic symptoms was discussed from a perspective of the diagnosis and therapeutic challenges, particularly on pharmacological treatment dealing with issues raised by their coexistence.

A Case of Huntington's Disease with Generalized Seizure and Prominent Family History of the Disease / 신경정신의학

Huntington's disease(HD), an autosomal dominant disorder, is characterized by progressive involuntary choreiform movement, psychiatric symptoms, and dementia. We experienced a 44-year-old male HD patient with prominent family history of the disease who showed dementia and involuntary movements including chorea. The diagnosis was made by clinical symptoms, family history of the disease, and brain MRI findings to show bicaudate atrophy and diffuse cortical atrophy with marked ventricualr dilatation. Interestingly, the patient frequently exhibited generalized tonic-clonic seizures. The seizures first appeared about 3 to 4 years after the onset of HD and were controlled with valproic acid. To our knowledge, this may be the first case of lateonset HD accompanied by generalized seizures and we report this case with literature review.

Results of 1998 Korean Depression Screening Day and Sociodemographic Characteristics of Participants / 신경정신의학

OBJECTIVES: This study was performed to analyze the sociodemographic characteristics of participants in '1998 Korean Depression Screening Day' and to evaluate the results of the screening test. METHODS: By using the survey results of 619 volunteers from 8 hospitals, the authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and the psychiatric treatment history of respondents. The assessment measure was the Zung Self-Rating Depression Scale. RESULTS: The mean depression score of all participants was 57.5+/-13.8 and it came under mild depression. Of all participants, 69.5% (N=430)had at least mild depressive symptoms, 43.1% (N=267)had at least moderate symptoms, and 18.4% (N=114)had severe symptoms. Never have 56.8% of respondents in the severely depressed range and 63.9% of those in the moderately depressed range had psychiatric treatment. The results suggest that the age group of 29-year-old or younger (relative to 60-year-old or older group)and full-time employment status (relative to unemployment)are protective factors of depression. CONCLUSIONS: By '1998 Korean Depression Screening Day', many depressed patients were detected and their depressive symptoms had statistically significant relationships with some sociodemographic characteristics. The results suggest that the education and screening test programs for depressive illness facilitated by Depression Screening Day are useful to the patients regardless of being under current treatment or not.

An Association Study of Schizophrenics and Their Clinical Variables with Tryptophan Hydroxylase Gene Polymorphism / 신경정신의학

OBJECTIVES: The genetic polymorphism of tryptophan hydroxylase (TPH) the rate-limiting enzyme in the biosynthesis of serotonin, has been to be related with various psychiatric disorders such as bipolar disorders. However, the role of TPH gene polymorphism in schizophrenia is totally unknown. Author examined the association of the TPH gene polymorphism with the development and the clinical variables of schizophrnia. METHODS: Genomic DNAs from 217 schizophrenic patients and 236 healthy controls were isolated, and TPH gene was amplified using PCR. Amplified TPH DNA was digested with NheI and the polymorphism was examined by electrophoresis on agarose gel. RESULTS: The allele frequencies and the genotypes of TPH gene were not significantly different between the schizophrenics and the control groups. They were also not associated with most of the clinical variables of schizophrenia such as subtypes, suicidal ideation, age at onset, and family histories. Among the clinical variables, only suicidal rate was highly correlated with genotype 218C/C. CONCLUSION: We found possible association of the suicical behavior with 218C/C polymorphism. However, it seems that A218C polymorphism of TPH gene does not associated with the development and other clinical variables of schizophrenia.

The Effect of Electroconvulsive Shock on Chloramphenicol-Induced Insomnia in Freely-Moving Rats / 신경정신의학

OBJECTIVES: Muramyl peptide derived from bacterial cell wall has been identified as one of several endogenous sleep-promoting factors. Several studies have shown that the administration of antibiotics decreased sleep amount as well as bacterial colony numbers in rats. Electroconvulsive shock (ECS)has been widely used in the treatment of many psychiatric disorders, including depression, bipolar disorder, and some cases of schizophrenia. However exact mechanism of ECS on the normal or psychiatric condition is not well understood so far. Previous studies indicated that ECS has diverse effects on sleep parameters both in the human and animal subjects. However, there was no report to examine the relationship between effects of ECS and sleep in the antibiotic imposed animal subjects. Therefore the author studied the effects of ECS on chloramphenicol-induced insomnia in rats. METHODS: Twelve Sprague-Dawley strain rats were divided into control (N=6)and experimental group (N=6) The sleep-wake activity was recorded continuously for consecutive three days(baseline, day 1 and day 2) On day 1, both groups were intraperitoneally injected with chloramphenicol 150mg/kg. On day 2, the control group was intraperitoneally injected with chloramphenicol 150mg/kg only, whereas experimental group received ECS an hour after they were injected with chloramphenicol 150mg/kg. RESULTS: 1)Chloramphenicol administration decreased light period slow wave sleep (SWS) (t=4.944, p=0.000) and paradoxical sleep (PS) (t=3.887, p=0.003) as well as total SWS(t=2.98, p=0.012)and total PS (t=4.391, p=0.001) 2)ECS increased dark period SWS(t=-3.863, p=0.003)and dark period PS (t=-2.458, p=0.034)as well as total dark period sleep (t=-4.302, p=0.002) CONCLUSION: These results suggest that ECS may be effective to reverse chloramphenicolinduced insomnia in rats. Furthermore, chloramphenicol-induced insomnia in rats could be a useful animal model for the future sleep research.

The Effect of Tricyclic Antidepressant(Dothiepin) on Sleep in Depressed Patients: A Polysomnographic Study / 신경정신의학

OBJECTIVE: This study was designed to investigate 1) sleep changes after antidepressant(dothiepin) treatment, and 2) sleep variables which seem to be associated with clinical response in the depressed patients. METHODS: The subjects consisted of 16 patients who fullfilled the criteria for major depression by the Diagnostic and Statistical Manual,(4th edition). Their sleep was recorded using polysomnography at the baseline and after one week and three weeks of dothiepin treatment. All subjects were further interviewed using Hamilton Rating Scale for Depression (HRSD) to rate the severity of their depression. High response to the drug was defined as a reduction of more than 50% of the HRSD score. Result : The results were as follows : 1) Depressed patients after dothiepin treatment showed more total sleep time(p=0.019), shorter sleep latency(p=0.05), less awake time(p=0.033), more sleep efficiency(p=0.018), more stage 2 sleep(p=0.002), less REM time(p=0.000), and longer REM sleep latency(p=0.004) than before treatment. 2) There were no differences in sleep variables between those who received 1 week and 3 weeks of dothiepin treatment except of th shortening of sleep latency after 3 weeks(p<0.05). 3) Depressive symptom scores on HRSD were reduced after 1 week and 3 weeks of dothiepin treatment as compared with the baseline. 4) High responers showed a tendency of increased wake time(p=0.054), while their stage 4 sleep decreased after 1 week of dothiepin treatment as compared with the low responders(p=0.0136). Conclusions : These results suggest that sleep of the depressed patients after dothiepin treatment tends to be nomalized and sleep chages seem to appear early in the treatment phase. In addition, clinical response might be associated with greater wake time at the baseline and lesser atage 4 sleep 1 week of dothiepin treatment.

A Case of Creutzfeldt-Jacob Disease / 신경정신의학

We report a case of Creutzfeldt-Jacob disease and review the relevant literatures. This 56-year-old male patient was admitted to our hospital with a history of rapidly progressing cognitive dysfunction, visual disturbance, gait disturbance, weakness, involuntary movement of lower extremities, and the symptoms of delirium. On mental status examination, he showed psychomotor retardation, speech disturbance, perseveration, disorientation, impairement of short-term and long-term memory, and inability of abstract thinking. He had a rapid downhill course, along with shakiness of trunk, rigidity of the limbs, myoclonus, confusion, and finally, inability to speak or move on the bedside. On electroencephalogram(EEG), continuous multifocal slow delta activities were found in all leads, especially in the right frontal areas. Brain biopsy showed, spongiosis with neuronal loss and gliosis noted at the cerebral cortex. These findings were compatible with Creutzfeldt-jacob disease.

Effects of the Sanjoin on the Rat Brain: Focused on Serotonin, Sleeping Time, Sleep EEG and Autonomic Activity

OBJECTS: Sanjoin, the seeds of Zizyphus vulgaris var. spinosus has been used as the most important hypnotic agent in chinese medicine to treat insomnia. This research was performed in order to examine the effect of betulinic acid and sanjoinine-A which are components of Sanjoin. METHOD: Sleeping time, sleep recordings of EEG, serum serotonin level, and locomotor activity were measured in rats which received betulinic acid and sanjoinine-A as sleep induction material extracted from Sanjoin. RESULTS: 1) Groups received betulinic acid, sanjoinine-A, and lorazepam showed increased sleep time than control group with saline. 2) Groups with betulinic acid, sanjoinine-A, lorazepam and saline recorded beta-wave in sleep recording of EEG. In there was no significant difference among all groups. 3) No significant difference in serum serotonin level among all groups was found. 4) In autonomic activity testing, groups of betulinic acid, sanjoinine-A, and lorazepam showed significantly more decreased in activity than saline group. In comparison of groups of betulinic acid and sanjoinine-A with a group of lorazepam, there was no significant difference. CONCLUSION: These results suggests that betulinic acid and sanjoinine-A have the sedative effect like lorazepam rather than sleep effect.

Effects of Diazepam on Restraint Stress-induced Fos Expression in the Rat Brain / 신경정신의학

This study was conducted to Identify the effects of diazepam on stress-induced c-fos expression In rat brain. The rats were divided into 4 groups according to injection agents [0.9% isotonic saline 1ml, diazepam(5 mg/kg)] and restraint stress, respectively. Saline or diazepam was injected into the peritoneum of rats 10 minutes before the restraint groups were restrained in a wire chamber. Fos-immunoreactive neurons were calculated in the hippocampal area CA2, dentate gyrus, amygdalohippocampal area, paraventricular nucleus, ventral lateral geniculate nucleus, supramammillary nucleus, temporal cortex area 3, occipital cortex area 2, piriform cortex, and cingulate cortex area 3. The results were as follows: 1) In the hippocampal formation including hippocampal area CA2 and dentate gyrus, Fos expression increased significantly in the saline-injected restraint animals than in any other groups. A two-way factorial ANOVA retreated a significant erects of stress and diazepam, and a significant stress by diazepam interaction. 2) In amygdalohippocampal area, Fos expression increased significantly in the saline-injected restraint animals than in diazepam-injected animals. A two-way factorial ANOVA revealed a significant effects of stress and diazepam, but no significant Interaction of stress and diazepam. 3) In paraventricular nucleus, Fos expression increased significantly in the saline-injected restraint animals than in saline-Injected animals and diazepam-injected animals. A two-way factorial ANOVA revealed a significant effects of stress, no significant effects of diazepam, and no significant Interaction of stress and diazepam. 4) In ventral lateral geniculate nucleus, Fos expression Increased significantly in the saline-injected restraint animals than in diazepam-Infected animals and diazepam-injected restraint animals. A two-way factorial ANOVA revealed a significant effects of diazepam, no significant effects of stress, and no significant interaction of stress and diazepam. 5) In supramammillary nucleus, temporal cortex area 3, occipital cortex area 2, piriform cortex, and cingulate cortex area 3, there was no significant difference of Fos expression in each group. A two-way factorial ANOVA revealed no significant effects of stress and diazepam, and no significant interaction of stress and diazepam. These results suggest that the hippocampal formation is involved in the response to the stress and the tension reduction effect of diazepam.

Altered Auditory Event Related Potentials Following Administration of Methylphenidate in Children with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTS: Event related potential(ERF) has been recently applied to examine the neurophysiological disturbance in attention deficit hyperactivity disorder(ADHD), particularly with regard to N100 and P300 which are known as one of ERP components closely linked with cognitive function. On the basis of these aspects, this study was designed to evaluate electrophysiologic characteristics and its availability for diagnosis and treatment of ADHD children by comparison of ERP between normal controls and ADHD children before and after methylphenidate (MFD) administration. METHODS: We examined the topographic auditory ERF and T.O.V.A.(Test of variables of attention), a standardized computerized visual continuous performance test following administration of stimulant drug, MPD 10mg in 13 ADHD children and compared these results with those of 11 normal controls. RESULTS: The results were as follows: 1) Thought the difference was not spastically significant(P=0.0548), N100 latencies seemed to be longer in ADHD children than in normal controls. N100 amplitudes also seemed to be larger in ADHD children than in normal controls(P=0.0629). 2) The F300 latencies significantly shortened after MFD administration when compared with those before MPD administration in ADHD group(P<0.01). 3) ADHD group performed significantly less well than normal controls in T.O.V.A.(P<0.05). And T.O.V.A. scores significantly improved after MFD administration in ADHD group(P<0.01). 4) The N100 and P300 latencies and the T.O.V.A. scores were significantly correlated before MPD administration in ADHD group(P<0.05). 5) The F300 latencies before MFD administration were significantly correlated with the amplitudes of changes of T.O.V.A. scores after MFD administration(P<0.05). CONCLUSION: It seems that prolonged N100 latency of ADHD children can be regarded as a relatively enduring trait marker and that F300 latency may reflect attentional response ability along with therapeutic effect by stimulant.

Subjective characteristics of nocturnal sleep in hospital shift workers / 신경정신의학

No abstract available.

Polysomnographic findings of a case of narcolepsy / 신경정신의학

No abstract available.

A comparison on symptoms of the generalized anxiety disorder and the panic disorders / 신경정신의학

No abstract available.