Network Analysis of the Symptoms of Depressive Disorders Over the Course of Therapy: Changes in Centrality Measures

Objective@#Network analysis can be used in terms of a novel psychopathological approach for depressive syndrome. We aimed to estimate the successive network structures of depressive symptoms in patients with depressive disorder using data from the Clinical Research Center for Depression study. @*Methods@#We enrolled 1,152 South Korean adult patients with depressive disorders who were beginning treatment for first-onset or recurrent depressive episodes. We examined the network structure of the severities of the items on the Hamilton Depression Rating Scale (HAMD) at baseline and at weeks 2, 12, 25, and 52. The node strength centrality of all the HAMD items at baseline and at week 2, 12, 25, and 52 in terms of network analysis. @*Results@#In the severity networks, the anxiety (psychic) item was the most centrally situated in the initial period (baseline and week 2), while loss of weight was the most centrally situated item in the later period (weeks 25 and 52). In addition, the number of strong edges (i.e., edges representing strong correlations) increased in the late period compared to the initial period. @*Conclusion@#Our findings support a period-specific and symptom-focused therapeutic approach that can provide complementary information to the unidimensional total HAMD score.

A novel retentive type of dental implant prosthesis: marginal fitness of the cementlessdouble crown type implant prosthesis evaluated by bacterial penetration and viability

. This study aims to compare the marginal fitness of two types of implant-supported fixed dental prosthesis, i.e., cementless fixation (CL.F) system and cement-retained type. MATERIALS AND METHODS. In each group, ten specimens were assessed. Each specimen comprised implant lab analog, titanium abutment fabricated with a 2-degree tapered axial wall, and zirconia crown. The crown of the CL.F system was retained by frictional force between abutment and relined composite resin. In the cement-retained type, zinc oxide eugenolcement was used to set crown and abutment. All specimens were sterilized with ethylene oxide, immersed in Prevotella intermedia culture in a 50 mL tube, and incubated with rotation. After 48 h, the specimens were washed thoroughly before separating the crown and abutment. The bacteria that penetrated into the crownabutment interface were collected by washing with 500 μL of sterile saline. The bacterial cell number was quantified using the agar plate count technique. The BacTiter-Glo Microbial Cell Viability Assay Kit was used tomeasure bacterial adenosine triphosphate (ATP)-bioluminescence, which reflects the bacterial viability. The t-test was performed, and the significance level was set at 5%. RESULTS. The number of penetrating bacterial cells assessed by colony-forming units was approximately 33% lower in the CL.F system than in the cement-retained type (P<.05). ATP-bioluminescence was approximately 41% lower in the CL.F system than in the cementretained type (P<.05). CONCLUSION. The CL.F system is more resistant to bacterial penetration into theabutment-crown interface than the cement-retained type, thereby indicating a precise marginal fit.

The Effect of Oral Administration of Black Sticky Rice with Giant Embryo on Brain GABA Concentrations

OBJECTIVE: Black sticky rice with giant embryo (BSRGE) contains high GABA content and affects alcohol-related indices among social drinkers, and alcohol intake and anxiety-related behavior of mice. However, it is unknown whether the intake of BSRGE affects GABAergic activity of brain directly. The purpose of this study is to elucidate the effect of oral administration of BSRGE on brain GABA concentrations compared with commercially available GABA compound and regular feeds. METHODS: Twenty-one male C57BL/6 mice were assigned to BSRGE, a regular feed (AIN-76) lacking GABA, and a regular feed containing GABA compound. After feeding freely for 48 h, the cortex and striatum were separated from the brain. An enzyme-linked immunosorbent assay was conducted to measure GABA and glutamate concentrations in mouse brain. RESULTS: The GABA concentration of the BSRGE group was higher than that of regular feed and GABA compound group (p<0.001). However, the GABA compound group showed no significant difference from the regular feed group (p=0.50). CONCLUSION: Intake of BSRGE containing high GABA content increased GABA concentrations in mouse brain compared with regular feed unlike GABA compound. The results of this study constitute an important basis for further investigations into the clinical applications of BSRGE.

Effects of Renaming Schizophrenia in Korea: from “Split-Mind Disorder” to “Attunement Disorder”

OBJECTIVE: Korean Neuropsychiatric Association changed the Korean name of schizophrenia from ‘Split-mind Disorder’ to ‘Attunement Disorder’ in 2012. This study assessed attitudes towards the renaming of schizophrenia among mental health practitioners (n=440), patients with schizophrenia and their guardians (n=396), and the university students (n=140) using self-administered questionnaires. METHODS: The questionnaire included items related to participants’ perception of the renaming of the disease, the nature of informing about the disease to confirm the effect of the name change. RESULTS: It was confirmed the notification rate of disease name by mental health practitioners was increased significantly after the renaming. Among patients and their guardians, 24.9% and 15.0%, respectively, perceived their own or the family member’s illness as ‘attunement disorder’. CONCLUSION: Patients and their guardians continue to display a low awareness about the name of the disease as ‘attunement disorder.’ However, mental health practitioners were found to be able to easily use the name ‘attunement disorder’ as a result of the increased notification rate of the new disease name.

Reliability and Validity of the Korean Version of the Lifetime Stressor Checklist-Revised in Psychiatric Outpatients with Anxiety or Depressive Disorders

PURPOSE: Traumatic events and adverse stressful experiences are major etiological factors in a wide variety of physical and mental disorders. Developing psychological instruments that can be easily administered and that have good psychometric properties have become an integral part for research and practice. This study investigated the reliability and validity of the Korean version of the Lifetime Stressor Checklist-Revised (LSC-R) in a consecutive sample of psychiatric outpatients. The LSC-R is a 30-item self-reporting questionnaire examining lifetime traumatic and non-traumatic stressors. MATERIALS AND METHODS: A final sample of 258 outpatients with anxiety or depressive disorders was recruited at the psychiatric department of a university-affiliated teaching hospital. Self-reported data included the Life Events Checklist (LEC), the Zung Self-Rating Depression and Anxiety Scales, and the Impact of Events Scale-Revised, in addition to the LSC-R. A convenience sample of 50 college students completed the LSC-R on two occasions separated by a three week-interval for test-retest reliability. RESULTS: Mean kappa for temporal stability was high (κ=0.651) and Cronbach alpha was moderate (α=0.724). Convergent validity was excellent with corresponding items on the LEC. Concurrent validity was good for symptoms of post-traumatic stress disorder, depression, and anxiety. An exploratory factor analysis revealed that 11 factors explained 64.3 % of the total variance. CONCLUSION: This study demonstrated good psychometric properties of the Korean version of the LSC-R, further supporting its use in clinical research and practice with a Korean speaking population.

Clinical Validation of the Psychotic Depression Assessment Scale, Hamilton Depression Rating Scale-6, and Brief Psychiatric Rating Scale-5: Results from the Clinical Research Center for Depression Study

OBJECTIVE: The aim of this study was to validate the psychotic depression assessment scale (PDAS), which includes the six-item melancholia subscale from the Hamilton depression rating scale (HAMD-6) and the five-item psychosis subscale from the brief psychiatric rating scale (BPRS-5). Data from the Clinical Research Center for Depression (CRESCEND) study, which is a 52-week naturalistic trial, were analyzed. METHODS: Fifty-two patients with psychotic depression from the CRESCEND study met our inclusion criteria. The patients underwent the following psychometric assessments: the PDAS, including HAMD-6 and BPRS-5, the clinical global impression scales, the HAMD, the positive symptom subscale, and the negative symptom subscale. Assessments were performed at the baseline and then at weeks 1, 2, 4, 8, 12, 24, and 52. Spearman correlation analyses were used to assess the clinical validity and responsiveness of the PDAS. RESULTS: The clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, were acceptable, with the exception of the clinical responsiveness of the PDAS for positive symptoms and the clinical responsiveness of BPRS-5 for negative symptoms. CONCLUSION: The clinical relevance of the PDAS has been confirmed and this clinical validation will enhance its clinical utility and availability.

Psychometric Properties of the Korean Version of the Clinical Language Disorder Rating Scale (CLANG)

OBJECTIVE: Our study aimed to measure inter-rater and test-retest reliability, concurrent and convergent validity, and factor solutions of the Korean version of the Clinical Language Disorder Rating Scale (CLANG). METHODS: The Korean version of the CLANG for assessing thought, language, and communication, the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used to evaluate language disorder, formal thought disorder, positive and negative symptoms, manic symptoms, and depressive symptoms, respectively, in 167 hospitalized patients with schizophrenia. The factor solution was obtained by the direct oblimin method. A receiver operating characteristic curve was used to find the optimal cut-off score for discriminating schizophrenia patients with and without disorganized speech. RESULTS: Inter-rater reliability was considered moderate (intraclass coefficient=0.67, F=3.30, p=0.04), and test-retest reliability was considered high (r=0.94, p<0.001). Five factors, namely, pragmatics, disclosure, production, prosody, and association, were identified. An optimal cut-off score of 7 points with 84.5% sensitivity and 81.7% specificity was proposed for distinguishing schizophrenia patients with and without disorganized speech. CONCLUSION: Our findings suggest that the Korean version of the CLANG is a promising tool for evaluating language disorder in patients with schizophrenia.

Desensitization of Triggers and Urge Reduction for Paruresis: A Case Report

Paruresis is a special type of non-generalized social phobia that involves fear and avoidance of urination in public restrooms. We administered eight 60-minute sessions of desensitization of triggers and urge reduction (DeTUR), an addiction protocol of eye movement desensitization and reprocessing (EMDR) therapy, to a 29-year old man with paruresis of 10 year duration. Because phobic avoidance is the hallmark of any anxiety disorder, we applied DeTUR targeting the urge to avoid each anxiety-provoking situation in succession. After treatment, the participant no longer met the requirements for a diagnosis of social anxiety disorder, and the self-reported symptoms of social anxiety had decreased to non-clinical levels; furthermore, these treatment gains were maintained at the one-year follow-up. Further clinical studies are needed to generalize this finding.

The Role of Psychological Factors in Tinnitus / 한양의대학술지

Based on the limitation of biomedical model of tinnitus, more attention has been paid to personalities or psychological aspects. Depressive disorder, anxiety disorder, and sleep disturbance were comorbid illnesses of tinnitus and research showed that neurobiological mechanisms such as dysfunction of limbic system or HPA axis were common in tinnitus and affective disorders and that comorbid psychiatric disorders enhanced the negative outcome of tinnitus. Recently, more attention is being paid to the relation of tinnitus with personality and the role of stress. Although the causal relation of personality and tinnitus is unclear, stress in itself showed that it can be a trigger in the development of tinnitus, and stress of tinnitus can cause adverse effects. Since the effect of fear-related cognition such as catastrophic thought about tinnitus was revealed more recently, its therapeutic implication should be explored. This review will describe the product of previous research and discuss future direction about psychological factors related to tinnitus.

Symptomatic Conceptualization of Disorganized Speech in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Our study aimed to present the distinctive correlates of disorganized speech in patients with schizophrenia, using the Scale for the Assessment of Thought, Language and Communication (TLC scale). METHODS: We compared the formal thought and other clinical characteristics between schizophrenia inpatients with (n=82) and without (n=80) disorganized speech. Psychometric scales including the TLC scale, Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Calgery Depression Scale for Schizophrenia (CDSS) and Word Fluency Test (WFT) were used. The presence or absence of disorganized speech was established using transformed dummy variable of score on the Clinician-Rated Dimension of Psychosis Symptom Severity (CRDPSS). RESULTS: After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the poverty of contents of speech (p=0.001), distractible speech (p<0.0001), tangentiality (p<0.0001), derailment (p<0.0001), incoherence (p<0.0001), ilogicality (p<0.0001), word approximations (p=0.003), loss of goal (p<0.0001), blocking (p=0.006) and self-reference (p=0.002) items than those without disorganized speech. With defining the mentioned item scores as covariates, binary logistic regression model predicted that derailment (p=0.0001) and poverty of contents of speech (p<0.0001) were significant independent-correlates of disorganized speech in patients with schizophrenia. CONCLUSION: Our findings suggest that derailment and poverty of contents of speech are significant correlates of disorganized speech in patients with schizophrenia. Our findings might be used to evaluate disorganized speech in patients with schizophrenia efficiently.

Enhanced Resolution of Eosinophilic Liver Abscess Associated with Toxocariasis by Albendazole Treatment / 대한소화기학회지

BACKGROUND/AIMS: Visceral larva migrans, caused by Toxocara canis and Toxocara cati, has emerged as a significant cause of eosinophilic liver abscess (ELA). Differentiation of ELA associated with toxocariasis (ELA-T) from metastasis or primary liver malignancy is sometimes difficult. However, the role of albendazole treatment remains uncertain in this condition. The aim of this study was to evaluate whether albendazole can enhance the radiologic resolution of ELA-T. METHODS: We retrospectively reviewed the medical records of the patients diagnosed with ELA-T at our institution between January 2008 and December 2011. ELA-T was diagnosed based on the imaging findings on computed tomography or magnetic resonance imaging and the presence of positive serum IgG antibody for Toxocara canis. Among a total of 163 patients, 32 patients received albendazole (albendazole group) and 131 did not (control group). Baseline characteristics and fate of liver nodules were compared between the two groups. RESULTS: Baseline characteristics (age, sex, number and maximal size of lesions, eosinophil count) were similar between the two groups. Median duration for achieving radiologic resolution in the albendazole group was significantly shorter than in the control group (207 days [range 186-228] vs. 302 days [range 224-380], p=0.023). In Cox regression analysis of the cumulative rates of radiologic resolution, the hazard ratio for albendazole treatment was 1.99 (95% confidence interval, 1.22-3.23). CONCLUSIONS: Radiologic resolution of ELA-T can be accelerated with albendazole treatment. Hence, inconvenience associated with long-term follow-up and unnecessary worries among patients can be eliminated with albendazole treatment.

Lung Abscess During the Treatment of Relapsed Churg-Strauss Syndrome / 대한내과학회지

Churg-Strauss syndrome (CSS) is a rare disease characterized by asthma, peripheral eosinophilia and vasculitis. A quarter of CSS patients with clinical remission have experienced a relapse. We report here a case of lung abscess in a patient with relapsed CSS. A 46-year-old man who achieved clinical remission of CSS was confirmed for relapse by the presence of peripheral eosinophillia, pulmonary lesions and perivascular infiltrate of eosinophils in colon pathology. After administration of systemic glucocorticoid and one cycle of cyclophosphamide pulse therapy, he complained of dyspnea, sputum and chest pain. There were necrotic masses containing internal air-fluid levels in the right upper and the left lower lobes of the lung on chest radiography. Percutaneous needle aspiration culture specimens revealed the presence of K. pneumoniae. The patient was successfully treated with a 5-week course of antibiotics.

Intranasal Oxytocin Lessens the Attentional Bias to Adult Negative Faces: A Double Blind within-Subject Experiment

OBJECTIVE: Oxytocin is a neuropeptide that is involved in social emotional processing. A leading hypothesis is that oxytocin facilitates positive prosocial behaviors; the peptide may also play a more general role in inhibiting withdrawal-related social behaviors. The present study examined these possibilities. METHODS: A double-blind, placebo controlled crossover design was used with 31 healthy women. Forty-five minutes following the administration of 40 IU of intranasal oxytocin or a placebo, the participants were presented with two dot probe tests with pairs of face stimuli depicting emotional and neutral faces in adults. RESULTS: Oxytocin specifically reduced the attention bias toward the location of the faces of adults showing negative emotions, particularly in the case of disgust. Oxytocin did not enhance the attentional bias toward adult happy faces. The effect of oxytocin toward adult negative emotion was correlated with the sensitivity of the drive in the behavioral motivational system. CONCLUSION: Oxytocin reduces attention to negative social emotions in adults, which supports oxytocin serves to inhibit withdrawal-related social behaviour.

Effects of the aqueous extract of Schizandra chinensis fruit on ethanol withdrawal-induced anxiety in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We previously demonstrated that the aqueous extract of the Schizandra chinensis fruit (AESC) ameliorated Cd-induced depletion of monoamine neurotransmitters in the brain through antioxidant activity. In the present study, we investigated the effect of AESC on anxiety-like behavior and the levels of norepinephrine and 3-methoxy-4-hydroxy-phenylglycol (a metabolite of norepinephrine) in different brain regions during ethanol withdrawal in rats.</p><p><b>METHODS</b>Male Sprague-Dawley rats were treated with 3 g/kg of ethanol (20%, w/v) or saline by daily intraperitoneal injection for 28 days followed by three days of withdrawal. During withdrawal, rats were given AESC (100 mg × kg(-1)× d(-1) or 300 mg × kg(-1)× d(-1), P.O.) once a day for three days. Thirty minutes after the final dose of AESC, the anxiogenic response was evaluated using an elevated plus maze, and the plasma corticosterone levels were examined by radioimmunoassay. Meanwhile, the concentrations of norepinephrine and 3-methoxy-4-hydroxy-phenylglycol in the hypothalamic paraventricular nucleus and hippocampus were also measured by high performance liquid chromatography.</p><p><b>RESULTS</b>Rats undergoing ethanol withdrawal exhibited substantial anxiety-like behavior, which was characterized by both the decrease in time spent in the open arms of the elevated plus maze and the increased level of corticosterone secretion, which were greatly attenuated by doses of AESC in a dose-dependent manner. The high performance liquid chromatography analysis revealed that ethanol withdrawal significantly increased norepinephrine and 3-methoxy-4-hydroxy-phenylglycol levels in the hypothalamic paraventricular nucleus, while not significantly altering them in the hippocampus. Similar to the results from the elevated plus maze test, the AESC significantly inhibited the elevation of norepinephrine and its metabolite in the hypothalamic paraventricular nucleus in a dose-dependent manner.</p><p><b>CONCLUSIONS</b>These results suggest that AESC attenuates anxiety-like behavior induced by ethanol withdrawal through modulation of the hypothalamic norepinephrine system in the brain.</p>

The Predictor of Suicidal Ideation and Attempt of Middle School Adolescents in an Urban Community / 신경정신의학

OBJECTIVES: This study was conducted in order to explore the prevalence of suicidal behavior and the risk or protecting factors. In addition, childhood trauma, school violence, and social support were hypothesized to have an association with suicidal behavior. METHODS: Data were collected by self-report questionnaire from 1219 students selected from middle schools in Guri-city, Korea. The students were asked to complete self-questionnaires and sociodemographic variables were collected for identification of factors associated with suicidal behavior. RESULTS: The prevalence of suicidal attempt was 1.1% (0.6%, 1.3%) from the total sample. Meaningful predictors of suicidal ideation were female, low socioeconomic status, low self-esteem, emotional abuse, neglect, delinquency, perpetration of school violence, family support, and friend support, in addition to the significant effect of depressive mood. In the case of suicidal attempt, female, low socioeconomic status, or delinquency showed a significant incremental effect, in addition to the explaining variance of depressive mood and suicidal ideation. CONCLUSION: Childhood experience should be dealt with, and school violence should be controlled in order to modulate mood disturbance and pessimistic ideation, which can block the channel to suicidal attempt. In addition, development of strategies for management of depression and delinquency is needed for prevention of suicidal attempt.

Localized Mass-Forming Autoimmune Pancreatitis Associated with an Intraductal Papillary Mucinous Neoplasm Mimicking Pancreatic Cancer / 대한내과학회지

Autoimmune pancreatitis (AIP) has been increasingly recognized in recent years, and most cases are diagnosed without surgery. However, focal-type mass-forming AIP is difficult to differentiate from pancreatic cancer without surgical resection. A 61-year-old male patient with a clinical impression of pancreatic cancer underwent surgery. A postoperative pathologic examination showed locally dense lymphoplasma cell infiltration and numerous lymphoid follicles with fibrosis and a low-grade intraductal papillary mucinous neoplasm (IPMN). Here, we report the first case of localized mass-forming AIP combined with a low-grade IPMN, which mimicked pancreatic cancer, in Korea.

A Case of Riata(R) Dual Coil Defibrillator Lead Failure in a Patient with Ventricular Fibrillation

A 50-year-old man, who underwent a procedure for an implantable cardioverter defibrillator (ICD), visited the outpatient department of our clinic after suffering multiple ICD shocks. The ICD interrogation revealed recurrent shock due to a high frequency of noise that is sensed by the device as ventricular fibrillation. Chest radiography revealed a significant split in the insulation of the lead allowing the inner wire to protrude. We considered the removal of the failed lead, but the removal of ICD lead is potentially a high risk procedure, so we cut and capped a proximal part of the failed lead and inserted a new lead. This is the first report of a St. Jude Riata(R) dual coil defibrillator lead failure with clinical and radiologic evidence of a defect in lead insulation in Korea.

Development of the Scale of Strategies for Enhancing Self-Esteem among Medical School Students / 한국의학교육

PURPOSE: From the point of view that medical students are under the pressure of academic achievement and vulnerable to subjective distress, there is need for evaluate their strategies for enhancing self-esteem when they failed academically. This study was to develop the scale for enhancing self-esteem and to confirm the convergent, discriminant and criteria validity. METHODS: Data were collected from 279 students at a medical school in Seoul. The scale of strategies for enhancing self-esteem (SSES) comprised comparison with inferior, doubting academic failure, accepting failure, and attribution to incidental factors. Also, to confirm the validities, participants responded to items measuring self-esteem, narcissism, 5 personality factors, depression and adjustment. RESULTS: By explanatory factor analysis of SSES, composed of three factors-comparison, doubting, and acceptance-and in the confirmatory factor analysis, 3 dimensions were best fit. Notably, comparison and doubting strategies were positively associated with depression and negatively associated with adjustment. In contrast, acceptance strategies were negatively associated with depression and positively associated with adjustment. Additionally, comparison and doubting strategies were positively associated with narcissism. CONCLUSION: The SSES of medical school students after academic failure yields 3 dimensions reliably and consistently. Also, it shows satisfactory convergent and concurrent validities.

Predictors and Longitudinal Changes of Depression and Anxiety among Medical College Students / 한국의학교육

PURPOSE: This longitudinal study was designed to examine the change in depression and anxiety and their predictors over 1 year among premedical and medical students. We compared depression and anxiety from 2 waves and determined the predictive power of personality, narcissism, social comparison, and social reward value on them. METHODS: Two hundred twenty-six students at a medical school in Seoul were divided into 4 groups according to academic year and completed a questionnaire at the end of 2010 and 2011. The questionnaire included the Zung Depression Scale; Zung Anxiety Scale; scales for social comparison, narcissism, and social reward value; and Neuroticism-Extraversion-Openness Personality Inventory. RESULTS: Among first- and second-year medical students, depression and anxiety increased significantly over the previous year. However, irrespective of academic year, depression increased significantly after 1 year. Also, social reward value had a moderating effect. Specifically, among students with low social reward value who entered their first year of medical school, the negative impact of the tendency toward depression and anxiety was amplified compared with older students. CONCLUSION: Because the predictors of mental health differ between groups, each group must receive specific, appropriate education. Also, because social reward value is important moderating factor of mental health, education and intervention programs that focus on social reward value are needed.

A Case of Gastric Calcifying Fibrous Tumor Presenting as a Subepithelial Tumor

Gastric subepithelial tumor is a common finding of upper gastric endoscopy. Differential diagnosis is needed, sometimes a rare disease can be found. Calcifying fibrous tumor is a rare benign fibrous tumor, and mostly affects children and young adults. It can involve all over the body, and shows predilection for abdominal cavity and peritoneum. Stomach lesions are quite rare. We report a case of a 43-year-old woman with a calcifying fibrous tumor presenting as gastric subepithelial tumor. Initially, a subepithelial lesion measuring 8 cm in diameter was incidentally found on her gastric endoscopy, and she had no symptoms. Computed tomography showed an exophytic mass originating from the gastric wall. Laparoscopic wedge resection was performed on the suspicion of gastrointestinal stromal tumor. Pathologically, the tumor showed hypocellular and densely hyaline collagen. Psammomatous calcifications and fibroblastic spindle cells were also found. On the basis of pathological findings, calcifying fibrous tumor was diagnosed.