The Effect of Social Cognition Deficit in Schizophrenia on Social Dysfunction / 신경정신의학

OBJECTIVES: Both story and cartoon task are sensitive to evaluate social cognition deficit in schizophrenia. However it is unclear whether social cognition deficits indexed by these tasks of schizophrenia reflect social functioning in their real life. To this purpose, we investigated the effect of social cognitive deficits detected in schizophrenic patients on social functioning. METHODS: Our investigation involved twenty-two schizophrenic patients and normal subjects. The story and cartoon tasks as mental state reasoning tasks and the 'Social Functioning Scale (SFS)' as a social functioning measure were administered for all subjects. RESULTS: The schizophrenic patients with average level of intelligence and mild psychotic symptoms, regarded as almost remitted, showed significantly poor performance on all of story task, cartoon task, and SFS. However, after controlling IQ's effects, only the performances on the story task were significantly contributed to the performances on the SFS, especially on subscales of 'Withdrawal', 'Independence performance' and 'Independence competence'. CONCLUSION: These findings indicate that performance of the story task is considered as a good predictor of social functioning for the schizophrenic patients in remission.

Social Cognition Deficits of Schizophrenia in Cartoon Task / 신경정신의학

OBJECTIVES: This study is to investigate the hypothesis that schizophrenic patients have difficulty in inferring mental state of others. METHODS: Twenty schizophrenic patients and twenty normal subjects were administered to the Cartoon Task required inferring the character's intention in a given context. RESULTS: The schizophrenic patients showed a statistically significant impairment in the Cartoon Task. Both groups chose the card depicting a frequent everyday action significantly more rather than the similar card to the last picture in each story for wrong answers. CONCLUSION: These preliminary results suggest that schizophrenia is associated with a specific deficit of the cognitive ability referred to as social cognition, and this deficit can be detected not only in the acute phase as found in previous research studies, but also in remission. Also when subjects fail to appreciate what is going on in the minds of other people, they seem to rely on a socially familiar experience.

Cognitive Dysfunctions in Patients with Obsessive-Compulsive Disorder: Two-Year Treatment Follow-up / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the changes of cognitive dysfunctions in patients with obsessive compulsive disorder (OCD) over the two-year of pharmacological treatment. METHODS: The thirty-three OCD patients and thirteen normal subjects were administered the neuropsychological tests and clinical evaluations twice (at the baseline and two-year). RESULTS: In spite of the two-year treatment, the accuracy of delayed recall on the Rey-Osterrieth Complex Figure Tests (RCFT), the numbers of responses on the category and letter test of Controlled Oral Word Association Test (COWA), the response time on the Trail Making Test part A (TMT-A) remained significantly impaired in the OCD patients compared with the normal controls. CONCLUSION: These findings suggest that the cognitive dysfunctions such as visuospatial memory and verbal fluency might be the underlying persisting neuropathophysiology of OCD.

Cognitive Dysfunctions in Patients with Obsessive-Compulsive Disorder: Two-Year Treatment Follow-up / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the changes of cognitive dysfunctions in patients with obsessive compulsive disorder (OCD) over the two-year of pharmacological treatment. METHODS: The thirty-three OCD patients and thirteen normal subjects were administered the neuropsychological tests and clinical evaluations twice (at the baseline and two-year). RESULTS: In spite of the two-year treatment, the accuracy of delayed recall on the Rey-Osterrieth Complex Figure Tests (RCFT), the numbers of responses on the category and letter test of Controlled Oral Word Association Test (COWA), the response time on the Trail Making Test part A (TMT-A) remained significantly impaired in the OCD patients compared with the normal controls. CONCLUSION: These findings suggest that the cognitive dysfunctions such as visuospatial memory and verbal fluency might be the underlying persisting neuropathophysiology of OCD.

The P300 Source Localization in the Patients with Obsessive-Compulsive Disorder using the LORETA Imaging and SPM

OBJECTIVES: We investigated the characteristics of P300 generators in obsessive-compulsive disorder(OCD) patients by using voxel-based statistical parametric mapping of current density images. METHODS: P300 generators, produced by a rare target tone of 1500Hz under a frequent non-target tone of 1,000Hz, were measured in 15 right-handed OCD patients and 15 controls. Low Resolution Electromagnetic Tomography(LORETA), using a realistic head model of the boundary element method based on individual MRI, was applied to the 128-channel EEG. Statistical parametric mapping(SPM) was applied for the statistical analysis. RESULTS: We found that both groups had the mean current density of P300 in the parietal, temporal and prefrontal lobe. There was a trend for decreased current density in the prefrontal area in OCD patients. The statistical comparison showed current density increase in the supraparietal area, a statistically significant longer P300 latency and a trend for reduced P300 amplitude in OCD patients. CONCLUSION: It suggests that P300 source of both groups exists in multiple brain regions at the same time. And both groups had no statistically significant differences in the current density of P300 except for increased current density in the supraparietal area in OCD patients. But, considering the statistically significant longer P300 latency, a trend for reduced P300 amplitude and relative mean current density reduction in the prefrontal area in OCD patients, this study suggests that the frontal lobe may have a reduced normal inhibitory process in OCD patients.

Drug Prescribing Patterns of Outpatients with Schizophrenia in a University Hospital / 신경정신의학

OBJECTIVES: To provide basic data for psychopharmacologic research of schizophrenic patients, we analyzed and characterized prescribing patterns of outpatients with schizophrenia in Seoul National University Hospital (SNUH). METHODS: This study is a descriptive and retrospective report. Subjects were outpatients with schizophrenia in SNUH from March 1, 2002 through June 31, 2002. We obtained data of prescriptions and diagnoses from order communication system (OCS). RESULTS: There were 825 outpatients with schizophrenia (476 males and 349 females). 805 schizophrenia outpatients were taking antipsychotics. The total number of antipsychotic prescription was 862. The percentage of taking atypical antipsychotics was 88.1% among total antipsychotic prescription and 11.9% taking typical antipsychotics. Risperidone was prescribed most frequently (39.0%), and the next was clozapine (29.0%). There were 57 cases of antipsychotic polypharmacy. CONCLUSION: Our results which reflected evidence-based prescriptions in SNUH showed that atypical antipsychotics were replacing typical antipsychotics. But there was a possibility that clinician's selection of medication was influenced by health insurance policy. Clinical guideline for the treatment of schizophrenia seems necessary for effective pharmacotherapy.

A 2-Year Naturalistic Study on Trends in Pharmacotherapy and Change of Clinical Symptoms in the Patients with Obsessive-Compulsive Disorder / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to examine the pharmacological treatment patterns and clinical responses in inpatients and/or outpatients with obsessive compulsive disorder (OCD) at a university hospital. METHODS: A total of 71 OCD patients were included and followed during the first 4 months, first year and second year from 1998. The patterns of medication use and clinical responses according to the Yale-Brown obsessive-compulsive scale (Y-BOCS) were analyzed descriptively in this period. RESULTS: During the first 4 months, 26.7% of the patients underwent monotherapy in which most of the drugs were serotonin reuptake inhibitors (SRIs). Therapy with two or more drugs was administered in 66.6% of the patients and combination drugs with SRIs were atypical antipsychotics and clonazepam. The clinical response rate using Y-BOCS was 24.0% compared with baseline score. During the first year, the frequency of the monotherapy decreased to 6.5%, while that of therapy with two or more drugs increased to 80.6% (two and three drug frequencies were 35.3%, and 32.3%, respectively). The clinical response rate was 26.4% during this period. During the second year, the frequency of the monotherapy was 25% and that of multidrug therapy was 70.8% (two and three drug frequencies were 20.8%, and 45.8%, respectively). The clinical response rate was 39.3% compared with baseline score. CONCLUSIONS: In this study, the frequency of the combination therapy was relatively high compared with SRI monotherapy during the first 4 months and it increased further during the first year. The combination therapy was maintained without change of SRI dosage during the second year. Most of the drugs used in the combination therapy were atypical antipsychotics and clonazepam.

Effects of Cognitive Differentiation Training of Intergrated Psychological Therapy to the Basic Cognitive Functions in Schizophrenic Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the effects of cognitive differentation training of Integrated Psychological Therapy(a training program of executive function,concept formation,language,and abstraction) on micro-level cognitive function such as attention,memory and reaction time in patients with schizophrenia. METHODS: Twenty-four inpatients diagnosed as schizophrenia using DSM-lV were randomly assigned to 2 group. The training group went through a total of 12 sessions of cognitive differentiation training for 4 weeks. The control group received psychoeducation Timer of Vienna Test System were administered to all patients, both before and after the training program. RESULTS: 1) In the attention and concentration scores of Wechsler Memory Scale-Revised, between group, within group and interaction effects of training were not significant. 2) In the short-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09,p<0.05), but the between group and interaction effects did not reach significance. 3) In the long-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09,p<0.05), but the between group and interaction effects did not reach significance. 4) In the reaction time scores of Decision-Reaction Timer,interaction effect of training was significant(F(1,24)=5.18,p<0.05). 5) In the motor time scores of Decision-Reaction Timer,between group,within group and interaction effects of training were not significant. 6) In the decision time scores of Decision-Reaction Timer,interaction effect of training was significant(F(1,24)=6.00,p<0.05). CONCLUSION: Our findings suggest that cognitive differentiation training of Integrated Psychological Therapy is partly effective on improving micro-level cognitive functions such as reaction time(especially,decision time)in patients with schizophrenia.