Correlations of Cerebellar Function with Psychotic Symptoms and Cognitive Function in Schizophrenic Patients

OBJECTIVES: There is increasing evidence that the cerebellum plays an important role in cognition and psychiatric symptoms as well as motor coordination. The concept of cognitive dysmetria has been making cerebellar function in schizophrenia the focus of current studies. In other words, disruption in the cortico-cerebellum-thalamic -cortical circuit could lead to disordered cognition and clinical symptoms of schizophrenia. The purposes of this study were to determine cerebellar dysfunction in male schizophrenic patients semiquantitatively with ICARS and to investigate the clinical and cognitive correlates of ICARS in patients. METHODS: We compared the scores of cerebellar neurologic sign using ICARS in 47 male patients with a DSM-IV-TR diagnosis of schizophrenia with 30 gender and age-matched healthy control subjects. The semiquantitative 100-point ICARS consists of 19 items divided into 4 unequally weighted subscores: posture and gait disturbances, kinetic functions, speech disorders and oculomotor disorders. All subjects were also assessed with cognitive function test. Cognitive functions were evaluated by Korean-Mini Mental Status Examination(K-MMSE), Verbal fluency test, and Clock drawing test. The patients were administered Korea version of Positive and Negative Symptom Scale(K-PANSS) to assess the symptom severity. RESULTS: Schizophrenic patients had significantly higher scores on the ICARS than control subjects with posture and gait disturbances, kinetic functions, and oculomotor disorders. They also showed more significant impairments in cognitive function tests than control subjects. There was a significant correlation between ICARS and negative symptoms of patients. In cognitive function test, Clock drawing test was significantly associated with negative symptoms. In addition, Clock drawing test was negatively correlated with the total score of ICARS. CONCLUSION: In this study, we confirmed that schizophrenic patients have significant impairments in cognitive and cerebellar function, and that those were related with negative symptoms of schizophrenic patients. These results support a role of the cerebellum in schizophrenia. It is meaningful that we used a structured, and reliable procedure for rating neurological soft signs, ICARS. We hope that future prospective studies using a similar design help that rate of neurological sign should have been visible with the progression of illness.

Comparison of P300 between Schizophrenia and Bipolar Disorder

OBJECTIVE: Asymmetries in evoked potential P300 topography of schizophrenia and bipolar disorder are still controversial. The purpose of this study was to examine the difference in P300 topography between schizophrenia and bipolar disorder. METHOD: P300 was recorded from 16 schizophrenic, 15 bipolar manic, and 16 control subjects. All were right-handed. Subjects silently counted target stimuli(2.0kHz) among trains of standard stimuli(1.0 kHz). Averages were constructed from brain responses to target stimuli. RESULTS: 1) Schizophrenics displayed significantly smaller peak amplitude of P300 over Cz, Pz, T3 than controls. 2) Schizophrenics displayed significantly smaller peak amplitude of P300 over T3 than bipolar manics. 3) Schizophrenics displayed significantly smaller peak amplitude of P300 over T3 than their T4. 4) Schizophrenics displayed significantly delayed latency of P300 over T3 than bipolar manics. 5) Schizophrenics displayed significantly delayed latency of P300 over T3 than their T4. CONCLUSION: Left-sided P300 abnormality, especially left superior temporal gyrus, in schizophrenics, relative to bipolar manics and controls suggests that psychophysiological cause of schizophrenia and bipolar disorder is different and P300 asymmetry is specific to the psychophysiological cause of schizophrenia.

Relationship between Clinical Symptoms and P300 in Schizophrenia / 신경정신의학

OBJECTIVE: This research was performed to evaluate the relation clinical symptoms and P300 in patients with schizophrenia. METHODS: 25 patients with schizophenia by DSM-IV in Soonchunhyang Chunan University hospital were participated. Clinical symptoms were checked by BPRS (Brief Psychiatric Rating Scale) and PANSS (Positive and Negative Syndrome Scale). Auditory event related potentials P300 components were obtained with "Oddball paradigm". RESULTS: P300 in T 3 was smaller and more delayed than T 4 in patients with schizophrenia. Especially, P300 on T 3 were correlated with BPRS scores and negative symptoms scores of PANSS, which were also correlated with P300 on Fz. CONCLUSION: The results of this study suggest that P300 on frontal and left temporal lobe reflect clinical symptoms in patients with schizophrenia.

Lamotrigine and Lithium in the Treatment of Acute Bipolar Disorder / 신경정신의학

BACKGROUND:To evaluate the efficacy of lamotrigine on bipolar disorder, both manic and depressed episode, the author compared the effects of lamotrigine with lithium and placebo. METHOD: Forty-seven manic patients with bipolar disorder and 43 depressed patients with bipolar disorder were treated with lamotrigine, lithium or placebo during 6 weeks. Their severity of symptoms were rated weekly using Young's Rating Scale for Mania and Hamilton Rating Scale for Depression. RESULTS: In manic patients the therapeutic efficacy of lamotrigine was lower than that of lithium during baseline to week 2, but after week 3, lamotrigine was as effective as lithium. In depressed patients the therapeutic efficacy of lamotrigine was superior to lithium from week 2 to endpoint. Most patients tolerated well except that one patient developed skin rashes. CONCLUSION: Lamotrigine seems to have antimanic and antidepressant effect as lithium in the treatment for acute bipolar disorder.

Clonidine Treatment of Clozapine-Induced Hypersalivation

BACKGROUND: Hypersalivation can be a troublesome side effect of clozapine, limiting its usefulness in the management some cases of schizophrenia. But the pharmacodynamic basis of clozapine-induced hypersalivation remains obscure. Object : The aim of this study was to evaluate the effect of the alpha2-adrenergic agonist clonidine on clozapin-induced hypersalivation in the patients who were receiving clozapine. METHOD: Twenty one schizophrenic inpatients on clozapine participated in the study. The amount of saliva was measur on the 7th day at 8pm after starting clozapine treatment. Of them, 15 patients who had experienced hypersalivation treated with 0.1mg/day of clonidine. RESULT: Of 21 schizophrenic patients treated with clozapine in the psychiatric inpatients clinic, 15(71.4%) complain hypervalivation. After clonidine treatment, mean salivary flow-rate was decreased significantly in these patients. CONCLUSION: Clozapine-induced hypersalivation could be decreased by administration of alpha2-adrenergic agonist clonidine are compliance could be improved. Also our study supports the notion that increased adrenergic tone contributes to clozapine induce hypersalivation.

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.

The Relation of Antipsychotic Drug Induced-Acute Dystonia and Serum Iron Level

OBJECT: This study was performed in order to examine the correlation between acute neuroleptic-induced dystonic reactions and serum iron level. METHOD: Serum iron levels were measured in psychiatric inpatients who had developed acute neuroleptic-induced dystonia(N=41) and in control patients with no history of acute dystonic reactions(N=37). Serum iron levels were compared in acute dystonic inpatients before starting treatment with neuroleptics and after acute dystonic reaction. RESULTS: The patients exhibiting acute dystonic reactions had significantly lower serum iron levels than the patients without acute dystonic reactions. CONCLUSION: This result supports an association between low serum iron and the occurrence of neuroleptic-induced acute dystonic reactions.

The Relation of Family History and beta-Endorphin Levels in Alcohol Dependence

OBJECTIVES: To evaluated the relation of familial history of alcoholism and plasma level of beta-endorphin, ethanol, beta-endorphin, cortisol and blood glucose were compared in 48 male alcoholics and 29 normal controls. METHODS: Subjects are divided into two groups by family history of alcoholism. Blood samples were obtained before and after 0.75mg/kg of ethanol consumption a 7th admission day. RESULTS: 1) The ratio of family history positive to negative of the patient group was 2 to 1. 2) The age at admission of positive family history group was younger than negative groups. 3) There was no significant difference in change of plasma ethanol level among three groups. 4) There was no significant difference in change of plasma beta-endorphin level among three group. 5) There was no significant difference in change of plasma cortisol level among three groups. 6) There was no significant difference in change of fasting blood sugar level between two patients groups.

The Relation of Onset-Age and beta-Endorphin Levels in Alcohol Dependence

OBJECTIVES: To evaluate the relation of onset-age and plasma level of beta-endorphin, Ethanol, beta-endorphin, cortisol and blood glucose were compared in 48 male alcoholics and 29 normal controls. METHODS: Alcoholics are divided into two groups by onset-age of alcoholism. Blood samples were obtained before and after 0.75gm/kg of ethanol consumption at the 7th admission day. RESULTS: 1) The ratio of onset-age before 25 years to after 25 years of the patients group was 2 to 3. 2) There was no significant difference in age at admission between two patient groups. 3) There was no significant difference in change of plasma ethanol levels among three groups. 4) There was no significant difference in change of plasma beta-endorphin levels among three groups. 5) There was no significant difference in change of plasma cortisol levels among three groups. 6) There was no significant difference in change of fasting blood sugar levels among two patient groups.

A Case of Antipsychotic-Regression Syndrome in Haloperidol Treated Tourette's Syndrome

Authors report a case of separation anxiety disorder, which developed as a side effect during haloperidol treatment of Tourette syndromes(TS). In this case, 14 years old boys developed attention deficit symptoms during his infancy. At 4th grade of primary school, he developed vocal tic, motor tic, and coprolalia. With 5mg/day of haloperidol treatment his symptoms of TS were subsided. During the treatment, he developed features of separation anxiety disorder, including dependence, pleading, clinging, and sadness. Symptoms of attention deficit and separation anxiety disorder were improved by 25mg/day of imipramine treatment. During haloperidol treatment of TS, careful observation may be needed whether separation anxiety disorder-like symptom develops.

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.