A Combination of the Korean Version of the Mini-Mental State Examination and Korean Dementia Screening Questionnaire Is a Good Screening Tool for Dementia in the Elderly

OBJECTIVE: The aim of this study is to investigate whether a combination of the Korean version of the mini-mental state examination (K-MMSE) and the Korean dementia screening questionnaire (KDSQ) is better than the use of test alone when differentiating patients with dementia from those without dementia in Korea. METHODS: The subjects (patients without dementia, 1120; patients with dementia, 908) were recruited from the Clinical Research Center for Dementia of South Korea. K-MMSE and KDSQ were used. Diagnosis of dementia was made according to the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. The weighted sum rule derived from logistic regression analysis was used for the combination of K-MMSE and KDSQ. RESULTS: On comparing the Area Under the Curve for each test using the method of Hanley and McNeil, the weighted sum was significantly greater than KDSQ or K-MMSE, and K-MMSE was significantly greater than KDSQ. CONCLUSION: This study shows that when differentiating patients with dementia from those without dementia in Korea, a combination of K-MMSE and KDSQ achieved using the weighted sum method is better than either test performed alone. Further epidemiological studies in community-based settings are required before our results can be generalized to nonclinical samples.

Clinical Characteristics of Completed versus Non-Completed Suicide and Re-Attempt Rates in 2-4 Years / 신경정신의학

OBJECTIVES: We compared demographic and some clinical characteristics of completed and noncompleted suicide victims with those of non-completed. Additionally, we analyzed Re-attempt rates of non-completed suicides' in 22-4 years re-attempt ratesfrom index-attempt were also analyzed. METHODS: Subjects were 198 suicide victims visited admitted to the Pusan National University Hospital Eemergency medical center after attempting suicide of Pusan national university hospital during 2005.1.1-to 2006.12.31. Data In February 2009, we retrospectively collected the data on these persons were collected retrospectively in Feb. 2009 fromvia medical records and telephone interviews. We analyzed their demographic data, history of previous suicide attempts, psychiatric treatments, if any, and number of re-attempts in during the 2-4 years after the index-attempt were analyzed. RESULTS: Thirty-three were deadvictims were killed by the attempt (completed suicides), and 165 were discharged alive (non-completed suicides). Only 94 cases victims (47.5%) were consulted referred to the psychiatric department. Among the 121 survivors followedsurvivors we followed-up on, 17 (14.0%) re-attempted within 2-4 years and 2 (1.2%) were dead eventuallydied within that time frame. Twenty one (63.6%) of the 33 completed suicidesuicides, 21 (63.6%) were making their were dead by the first suicide attempt. No psychiatrist was contacted regarding these victims and did not received any psychiatric evaluation nor treatment. The completed group was characterized ascharacteristically consisted of men who were'older, married, and/or physically ill men'. Fortyfive (27.3%) of 165 non-completed suicides had previous historiesy of suicide attempts. The noncompleted group was characterized by higher rates of previous history of psychiatric treatment, psychiatric referrals, and re-attempts during the followed-up period. Sixty-five (53.7%) of the survivors received psychiatric treatments for 8.9+/-15.4 months (mean+/-SD), but their re-attempt rate (16.9%) in over 2-4 years did not significantly differ from that (10.7%) of those who did not receive treatment (10.7%). CONCLUSION: About 2/3 of completed suicides occurs at the first attempt. These cases were on in psychiatry' the blind spot, of psychiatry because most of them did not visited psychiatry receive psychiatric attention when they were alive and were not reported to the psychiatry department after death. Psychiatric autopsies on such victims arey is necessary to develop more effective suicide screening tools and preventionve programs.

The Study on Reliability and Validity of Korean Alcohol Urge Questionnaire(AUQ-K) for Alcohol Dependence

OBJECTIVES: The Alcohol Urge Questionnaire(AUQ) has been used in alcohol dependence treatment and research. The goal of this study is to develop of the Korean Alcohol Urge Questionnaire(AUQ-K). METHODS: To examine the AUQ-K's psychometric properties, responses from 104 patients admitted in alcohol dependence treatment facility were investigated. RESULTS: The internal consistency of the 8-item AUQ-K, measured by coefficient alpha, was high(Cronbach's alpha =0.78). AUQ-K scores showed significant correlation when the retest interval was 1 day(p<0.01). The AUQ-K's validity was investigated using correlational analyses with two other craving scales[the Obsessive Compulsive Drinking Scale(OCDS) and the Visual Analogue Scale(VAS)]. The high correlations were obtained between total AUQ-K scores and total OCDS scores, and between total AUQ-K scores and the VAS scores(p<0.01, respectively). CONCLUSION: The AUQ-K is a reliable and valid short scale for measurement of self-reported alcohol craving. This scale may offer significant advantages over existing single-item measures of alcohol craving in the fields of alcohol dependence treatment and research.

The Impact of Hot Food Preferences on Naltrexone's Effects on Subjective Acute Responses to Alcohol in Social Drinkers / 신경정신의학

OBJECTIVES: Both capsaicin, a pungent substance of hot food, and alcohol, are known to affect central opioid activity. The purpose of this study was to investigate the difference in the subjective acute responses to alcohol and the effect of naltrexone on them among those who prefer hot food to varying degrees. METHODS: Twelve male medical students were divided into two groups using a cross-over design. One group was given naltrexone on only the first (25 mg) and the second day (50 mg), and the other group was given naltrexone on only the eighth (25 mg) and the ninth day (50 mg). On the second and the ninth day, the acute effect of alcohol was assessed in all subjects, using the Biphasic Alcohol Effects Scale (BAES) just before drinking and at 15 minutes, 30 minutes and 60 minutes after drinking (0.6 ml/kg). Alcohol craving was also measured, using Visual Analogue Scale for craving (VAS-C) and blood alcohol concentration (BAC), at the same interval. For statistical analysis, subjects of both group were re-divided into two group, those with a strong preference and those with a less preference (LP) for hot (spicy) food (SP), using the Food Preference Scale. RESULTS: 1) Repeated measures of ANOVA (2 preference groups x 4 time blocks) on the stimulative subscale of BAES yielded no significant group by block interaction of naltrexone administration. Repeated measures of ANOVA (2 drug groups x 4 time blocks) on the stimulative subscale of BAES revealed a significant group by block interaction in SP (p=0.028), but not in LP. The paired t-test revealed that significant suppression of the stimulative subscale of BAES was observed at 15 minutes and 30 minutes after drinking when naltrexone condition was compared with no-medication condition in SP (p=0.014; p=0.007). 2) For the sedative subscale of BAES, VAS-C and BAC, repeated measures of ANOVA yielded no significant group by block interaction by either hot food preference or naltrexone administration. CONCLUSION: For those who prefer hot food, the effect of stimulative acute alcohol was suppressed by naltrexone. This result strongly suggests that naltrexone could prevent relapse more effectively in those who prefer hot food.

The Morris Water Maze Performance in Androgenized Female Rats: Sexual Dimorphisms in Spatial Memory and Effects of Testosterone / 신경정신의학

OBJECTIVES: It is widely accepted that gonadal steroids are involved in organization and activation of sexual dimorphism in the brain areas related with spatial learning. This study aimed to test the following hypothesis: 1) spatial memory is affected by sex, 2) this difference is related with brain differentiation by exposure to testosterone in the neonatal period, and/or 3) the sexual difference of spatial memory is the result of the interaction between organization of sexual dimorphism in the brain and the circulating testosterone after growing up. METHODS: Testosterone enanthate 100 microgram ('androgenized') or vehicle ('control') was randomly administered to 28 female and 25 male rat pups within 24 hour of birth. The escape latencies (EL) in Morris water maze were measured in 15 and 16 week of age with vehicle ('baseline') and with 10 micromol/kg of testosterone ('with testosterone'), respectively. Each session consisted of 10 trials, and means of the last 5 trials were analyzed. RESULTS: The baseline EL of the males were significantly shorter than females regardless of neonatal exposure to testosterone. With testosterone, EL of the androgenized females were significantly shorter than control females and comparable to those of males. CONCLUSION: Neonatal exposure to testosterone in female rats may develop a tesosterone-dependent male-like spatial learning system.

Non-Relapse Rate in a 24 Week Follow-up Clinical Study with Korean Male Alcohol-Dependent Patients / 신경정신의학

OBJECTIVES: In order to provide useful data for the further clinical studies with Korean alcohol-dependent patients, enrollment and non-relapse rates were investigated while alcohol-dependent patients were followed up for 24 weeks. METHODS: The subjects of this study were alcohol-dependent male patients who, for the first time, visited a hospital among 3 groups of hospitals, University Hospital, General Hospital or Mental Hospital, or those who needed to be followed up after discharge from those hospitals. After assigning 12 subjects to each hospital, we investigated enrollment and non-relapse rates while cognitive-behavioral therapy and pharmacotherapy were provided. RESULTS: 1) Forty-eight patients were enrolled and the rate of enrollment was 36.4%. The enrollment rate in the University Hospital group was 52.1%, in the General Hospital group 50.0%, and in the Mental Hospital group 10.4%. 2) In 48 patients, non-relapse rate was 27.1% at 12 week and 18.8% at 24 weeks after starting follow-up. It was 24.4% and 20.0% at 12 and 24 weeks, repectively, in the University Hospital group while the General Hospital group showed 33.3% and 16.7%, respectively, and the Mental Hospital Group showed 20.0% at both 12 and 24 weeks. CONCLUSION: These results provide important data for further clinical studies of Korean alcohol-dependent patients.

The Relationship between Taq I A Dopamine D2 Receptor Polymorphism and Therapeutic Response to Antipsychotics in Schizophrenic Patients

PURPOSE: In an attempt to predict the interpersonal differences of therapeutic response to antipsychotic drugs on pharmaco-genetic bases, this study was designed to investigate the relationship between the therapeutic response to antipsychotic drugs and Taq I A dopamine D2 receptor polymorphism in schizophrenic patients. METHODS: The subjects were 158 patients diagnosed with schizophrenia(DSM-IV). The therapeutic response to antipsychotic drugs was evaluated using the Treatment Response Scale(TRS) retrospectively. Patients were divided into two groups, dopamine receptor antagonist responders, and serotonin-dopamine antagonist responders. The patients' Taq I A dopamine D2 receptor polymorphism was determined by polymerase chain reaction(PCR) and restriction fragment length polymorphism(RFLP). RESULTS: The dopamine receptor antagonist responders had the A1 allele in significantly higher incidences (chi2(1)=4.875, p=0.027, two-tailed). No significant difference was found among the serotonin-dopamine antagonist responders between those with or without the A1 allele. CONCLUSIONS: The patients with the A1 allele responded better to dopamine receptor antagonists than those with no A1 allele. Based on these results, it is suggested that the pharmacological effect of dopamine receptor antagonists can be predicted depending on the presence of the A1 allele in schizophrenic patients.

Association Study of Functional micro Opioid Receptor Genotypes with Korean Female Alcoholics / 대한정신약물학회지

OBJECTIVES: Previous studies have shown that the endogenous opioid system, which plays an important role in drinking behavior, might be related to the genetic etiology of alcohol dependence. And a recent study reported that the affinity of micro opioid receptor, which is closely related to the endogenous opioid system activity, is affected by the genotype of micro opioid receptor gene (OPRM1) A118G. To investigate the gender difference in genetic etiology of alcohol dependence, this study examined the association of the genotype of OPRM1 A118G with female alcohol dependence in Koreans. METHODS: The author studied the genotype of OPRM1 A118G in 106 male and 35 female Korean with alcohol dependence and 80 male and 60 female healthy Koreans as control. RESULTS: 1) A statistically significant increase in A/G or G/G (G+) genotype of OPRM1 A118G was observed in women with alcohol dependence compared to the controls. 2) Among men with alcohol dependence, no significant difference in OPRM1 A118G polymorphism was observed relative to the age at which drinking started, age of onset of alcohol-related problems, age of first admission to psychiatric hospital for alcohol-related problems, drinking days per month, drinks per drinking day, family history of alcohol dependence in the first-degree relatives or history of severe alcohol withdrawal symptoms. But the drinking days per month is significantly less in those who have A/G or G/G genotypes of OPRM1 A118G. CONCLUSION: These results suggest that G+ genotypes of micro opioid receptor gene A118G are important genetic factors in the etiology of female alcohol dependence.

Effect of Radix Puerariae on Alcohol Craving and Regional Cerebral Blood Flow in the Patients with Alcohol Dependence / 신경정신의학

In light of recent reports of the effectiveness of Radix puerariae in the alcoholics and recent formulation of a hypothesis that craving far alcohol In the alcohol-dependent individual is mediated by a limbic circuit involving the fronto-thalamic and fronto-striatoaccumbal region, the authors studied the effect of Radix puerariae on craving for alcohol and cerebral blood flow(rCBF) of these regions. The subjects were hospitalized patients with alcohol dependence recovered from acute intoxication and withdrawal symptoms. On the first day of experiment, rCBF in the areas of caudate nuclei, thalamus and orbitofrontal cortices was measured by Single-Photon Emission Computed nomography. On the third day, the same procedure was repeated artier intake of a small priming dose of alcohol. Radix puerariae in dose of 12gm/day for 10 days was given from fourth day of experiment to the thirteenth day and on the eleventh and thirteenth days, the measurements of rCBF were repeated in the same method as in the first and third day, respectively. Immediately before measurements of the rCBF in each experiment, craving far alcohol was measured by means of Visual Analogue Scale. The results were as follows: 1) Before the treatment of radix puerariae, the alcohol-dependent patients developed a significant alcohol-induced alcohol craving and a concomitant increase of rCBF in the right head of caudate nucleus. 2) Radix puerariae significantly lowered alcohol crating and significantly increased rCBF In the right head of caudate nucleus and the left orbitofrontal cortex in alcohol-free, basal condition. 3) After the treatment of radix puerariae, the rCBF after alcohol intake in bilateral caudate nuclei and bilateral hemithalami was significantly decreased. 4) Radix puerariae did not induce post-alcohol craving for alcohol and significantly decreased post-alcohol rCBF in bilateral caudate nuclei. From these results, it is suggested that Radix puerariae decreases basal alcohol craving in the alcohol-dependent patients, and further that there ma!~ exist a significant association between these changes of alcohol craving and concomitant changes of rCBF in the limbic striatim, especially caudate nucleus.

Effect of Hypophysectomy on Monoamine-synthesizing Enzyme Activities in Rat Brain and Adrenal Gland / 대한정신약물학회지

In an attempt to investigate the regional specificity of effect of pituitary hormones on the activities of tyrosine hydroxylase(TH) and tryptophan hydroxylase(TPH), which are the rate-limiting enzymes in catecholamine and serotonin biosyntheses, respectively, the authors measured enzyme activities after hormonal deprivation, using the hypophysectomized animal model. The results are summarized as follows. First, whereas body weights of sham-operated group were increased gradually over time, those of hypophysectomized group were little changed. Second, the change of TH activity between sham-operated and hypophysectomized groups was not observed in each region of brain. Third, the change of TPH activity between two groups also was not observed in dorsal raphe nucleus and hypothalamus. It appears from the above findings that neural stimuli may be much more significant in the maintenance of normal level of TH and TPH in the brain than hormonal stimuli, and endocrine hormones might not directly affect monoaminergic neurotransmission in the absence of stress.