A Case of Restless Leg Syndrome Induced by Mirtazapine in a Patient with Major Depressive Disorder / 대한정신약물학회지

Mirtazapine is a novel antidepressant and has a unique dual action profile, combining the enhancement of the noradrenergic neurotransmitter system with specific actions on particular serotonergic receptor subtypes. The authors report a case of restless leg syndrome induced by mirtazapine. The patient (46 years old male) with major depressive disorder developed typical restless leg syndrome from the initial period of administration of mirtazapine. Restless leg syndrome was not relieved by reduction of mirtazapine and disappeared rapidly after discontinuation of mirtazapine. The major difference of the case from previously reported cases is the onset time of symptoms. We may consider that mirtazapine can induce dopaminergic side effect like a restless leg syndrome promptly as its fast-acting antidepressant effect.

Bipolar Spectrum Disorder / 대한정신약물학회지

The concept of bipolar disorder is an ongoing process, still in evolution, although its roots can be found from ancient Greek. Until recently, it was believed that no more than 1% of the general population has bipolar disorder. But literature on the lifetime prevalence of the bipolar spectrum disorder suggests rates of 4-5%. Bipolar spectrum disorder is a longitudinal diagnosis characterized by abnormal mood swings comprising some of the following cross-sectional clinical states: mania, hypomania, mixed states, hyperthymic temperament, major depressive episode, and depressive mixed state. Failure to recognize subthreshold expressions of mania, such as hypomania, cyclothymia, and hyperthymia, contributes to the frequent under-diagnosis of bipolar disorder. There are several reasons for the lower rate of recognition of subthreshold manic symptoms, when compared to the analogous pure depressive one. These include the lack of subjective suffering, enhanced productivity, egosyntonicity, diurnal and seasonal rhythmicity associated with many of the manic and hypomanic symptoms, and the psychiatrists' difficulty in differentiating with personality disorders. In addition, most patients with bipolar spectrum disorder seek treatment for depression, rather than mania or hypomania. Therefore clinicians often miss the diagnosis of bipolar spectrum disorder. The recent 10 years of researches have suggested that 30-55% of patients with major depressive disorder are actually identified with broader spectrum of bipolar disorders. However, 48% of patients of bipolar disorder consulted 3 or more professionals before receiving a correct diagnosis, and 10% consulted 7 or more for their first diagnosis of bipolar disorder. Several studies have documented that patients often wait as long as 10 years for the correct diagnosis of bipolar spectrum disorder. This delay in diagnosis often has substantial adverse results. Patients do not get the appropriate treatment to alleviate their symptoms. They may even get treatments that exacerbate their symptoms, such as prescription of antidepressants precipitating mania and producing rapid cycling. The concepts of hypomania, cyclothymia, mixed state, depressive mixed states, hyperthymic temperament are the new areas of studying mood disorders in recent 20 years. The authors will review the studies on various subtypes of bipolar spectrum disorder with their historic aspects, and introduce the suggested screening tests for bipolar spectrum disorder in clinical practice.

Platelet Serotonin Level and Psychological Features of the Suicidal Attempters

OBJECTIVES: Significant progress has been made in understanding psychosocial, psychological, and environmental factors associated with suicide. However it is only recently that attention has been paid to the understanding of the neurobiology of suicide. The aim of this study was to examine the relationship between platelet serotonin level and suicidal behavior and psychological features of the suicidal attempters. METHODS: After a suicidal attempt platelet serotonin level was measured from 21 patients and compared it with those from depression patients and normal controls. Also MMPI, HAM-D, Barratt impulsiveness scale(BIS) were done to evaluate their psychological features. RESULTS: 1) There was no significant difference in sex ratio of the suicidal attempters. 2) There was no significant difference in platelet serotonin levels among three groups. 3) The analysis of MMPI revealed that the scores of D, Hs, Pt in clinical scales were significantly higher in suicide patients and scores of D, Pa, Si were in depression patients. 4)The HAM-D score was significantly higher in depression and suicide patients, especially in depression patients. 5) The analysis of Barratt impulsiveness scale revealed that the scores of nonplanning, motor and cognitive impulsiveness scale were significantly higher in suicide patients. CONCLUSIONS: There was no significant difference in platelet serotonin levels among three groups. However the analysis of psychological features revealed significant differences. Therefore we concluded that psychological examinations are benefit to evaluate the suicidal tendency.

Defense Mechanisms in the Specialty Choice of Medical Students / 신경정신의학

OBJECTIVES: To determine differences of common personality profiles and coping mechanisms of medical students who prefer specific specialties (medicine and surgery), the authors evaluated the defense mechanisms of the medical students by using Ewha Defense Mechanisms Test. METHODS: The authors compared the defense mechanisms between two groups (medicine selection group and surgery selection group) who are in the senior year of the Soonchunhyang University School of Medicine. RESULTS: There were no significant differences in mean scores of the each defense mechanism and 4 groups of defense mechanisms divided by maturity level between the groups of students who selected medicine and surgery. But, frequency of major defense mechanisms were as follows; For the surgery selection group, the passive-aggression in the Immature defense mechanism and show-off in the Neurotic defense mechanism were significantly higher than in the medicine selection group. Contrarily, in the medicine selection group, humor in the mature defense mechanism as the major defense mechanism was significantly higher than in the surgery selection group. CONCLUSION: After analysis of the differences of frequency of major defense mechanisms between the two groups, there were no significant differences between the two groups in personality. However, the students of the medicine selection group used humor of the mature defense mechanism as a major defense mechanism in higher frequency than the surgery selection group. In situations of complications, anxiety and suffering, the use of the humor defense mechanism gave the students strength to endure these situations. Among these students, there is a high probability that many of them possess strong ego strength. Contrarily, the students of the surgery selection group did not express aggression directly, rather, they expressed these feelings indirectly through passive opposition. There was a high frequency of passive-aggression defense mechanism in dealing with feelings of aggression. Also, in the neurotic defense mechanism, compared to ability, excessive goals were set as was the resulting behavior. Especially, behavior was extremely sensitive to how others would evaluate those actions resulting in using show-off mechanism as a major defense mechanism in higher frequency by the surgery selection group. The results seem to be useful in understanding the student's optimal character for specific specialities that were selected by evaluating the differences of the common characteristics and coping mechanisms of each specialty group.