The Impact of Paliperidone Palmitate on Hospitalization in Patients with Schizophrenia: A Retrospective Mirror-image Study

OBJECTIVE: Whether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral anti-psychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days. METHODS: We performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after. RESULTS: The mean number of admissions fell from 0.83 to 0.17 per patient (p < 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p < 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points. CONCLUSION: Our results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.

Effects of Psychotropic Drugs on Seizure Threshold during Electroconvulsive Therapy

OBJECTIVE: To analyze the relationship between seizure threshold (ST) and psychotropic drugs in patients treated with ECT. METHODS: We examined clinical data from 43 patients. ST was titrated at each treatment session. We examined associations between ST and psychotropic drugs using multivariate correlation analyses. Data are presented as initial ST, the difference in ST between the first and 10th sessions (ΔST(10th)), and the mean difference in ST between the first and last sessions (mean ΔST(last)). RESULTS: Multivariate regression analyses showed associations between initial ST and the total chlorpromazine-equivalent dose of antipsychotics (β=0.363, p<0.05). The total fluoxetine-equivalent dose of antidepressants was associated with ΔST(10th) (β=0.486, p<0.01) and mean ΔST(last) (β=0.472, p<0.01). CONCLUSION: Our study elucidated possible effects of psychotropic drugs on ST shifts. Larger doses of antipsychotics were associated with higher initial ST, whereas higher doses of antidepressants were associated with stronger shifts in ST.

Dehydroepiandrosterone Sulfate Level Varies Nonlinearly with Symptom Severity in Major Depressive Disorder

OBJECTIVE: The pathophysiology of major depressive disorder (MDD) is still not well understood. Conflicting results for surrogate biomarkers in MDD have been reported, which might be a consequence of the heterogeneity of MDD patients. Therefore, we aim to investigate how the severity of depression and various symptom domains are related to the levels of dehydroepiandrosterone sulfate (DHEA-s) in MDD patients. METHODS: We recruited 117 subjects from a general practice. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Depressive symptoms were divided into three subdomains according to BDI items; somatic symptoms, guilt and failure, and mood and inhibition. RESULTS: In subjects with very-mild-to-moderate depression, the DHEA-s level increased as BDI score did. However, the DHEA-s levels in the subjects with severe depression were significantly lower than in subjects with moderate depression (p=0.003). DHEA-s level was correlated with the BDI subscore for guilt and failure in very-mild-to-moderate depression (r=0.365, p=0.006). CONCLUSION: The DHEA-s level appears to be indicative of MDD severity with respect to depressive symptoms, especially regarding guilt and failure. Our findings suggest that the upregulation of DHEA-s may be a part of a compensatory process in very-mild-to-moderate depression, and the failure of this compensation mechanism may underlie the development of severe depression.

Association Study between Norepinephrine Transporter Gene Polymorphism and Schizophrenia in a Korean Population

OBJECTIVE: We aimed to investigate possible associations between three norepinephrine transporter gene (SLC6A2) single nucleotide polymorphisms (T182C, A3081T, and G1287A) and schizophrenia. Also, we investigated the relationships of those polymorphisms with clinical severity and characteristics of schizophrenia. METHODS: Participants were 220 schizophrenia patients in the acute phase and 167 healthy controls. The genotype, allele frequency, and haplotype of each group were analyzed for T182C, A3081T, and G1287A polymorphisms. Of the 220 schizophrenia patients, 163 patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) and the Korean version of the Calgary depression scale for schizophrenia (K-CDSS) at baseline. RESULTS: We found no significant differences between the schizophrenia patient group and the control group in genotype distribution or allele frequency of the three tested polymorphisms. Likewise, we could not find any significant differences in genotype or allele frequency by analyzing according to gender. In the haplotype study, no significant association emerged between specific haplotype combinations and schizophrenia. We also found no association between clinical scales (PANSS and K-CDSS) and the studied polymorphisms. CONCLUSION: Our results suggest that the investigated polymorphisms of the NET gene are not associated with susceptibility to schizophrenia or its clinical features in a Korean population. However, this study remains significant because it is the first haplotype study to investigate associations between NET gene (SLC6A2) single nucleotide polymorphisms and schizophrenia in a Korean population. Future research with a larger sample size and more genetic markers is needed to replicate our results.

Influence of Early Childhood Care and Education on Children's Mental Health (I) - Status and Prospects of Child Care and Education Policies of Korea -

Most preschool children in Korea attend kindergarten (KG) or a child care center (CCC). CCCs, which focus on caring for the child, belong to the ministry of health and welfare. On the other hand, KGs are responsible for education, and belong to the ministry of education, science and technology. In order to resolve the decline in population due to low birthrates, the government is expanding the free child care and education policies. CCCs and KGs are combined together to form the 'NURI curriculum' and supporting funds have been increased in both governmental departments. In addition, economic support is provided for homeschooling households. Because this is a nationwide policy and applies to every single household, thorough preparation regarding the effect and side effects must be made. This policy is currently being implemented, and as child and adolescent psychiatrists, great consideration should be given to the influence on the population. Therefore, the Korean Academy of Child and Adolescent Psychiatry intends to investigate the effects and problems of the nationwide policy by analyzing the current condition of Korea's free child care and education and foreign policies. In the current paper, we reviewed the developmental process of Korea's free child care and education policy, as well as suggested future directions.

Efficacy of the Mentalization Improvement Program for Adolescent (MIPAdo) for Enhancement of Mental Health in School Children

OBJECTIVES: Understanding the emotions, thoughts, feelings and behaviors of others, as well as oneself, is part of the mentalizing function. We developed a new school-based community model for mental health, called the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM), based on the concept of mentalization. METHODS: The MIPAdo-CM was composed of 12 sessions and was applied to 403 students in the 2nd grade of a middle school. Every session was conducted after the regular school hours for 6 weeks. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test (EET), Peer Aggression Scale (PAS), Peer Bullying Scale (PBS), School Adjustment Scale (SAS), Test Anxiety Inventory (TAI) and Visual Analogue Scale between the subject and the control group. RESULTS: There was no significant difference between two groups in AMPQ-R, EET, PAS, PBS, SAS, and TAI. On the Visual Analoge Scale, however, students in the trial classes reported more increase in understanding and respect for both others and themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves, erence between two groups in AMPQ-R, Empathy test, To prove objective usefulness of this program, further studies with more structured design will be needed.

Efficacy of the Short Form of Mentalization Improvement Program for Adolescent (MIPAdo) for Enhancement of Mental Health in School Children

OBJECTIVES: We developed the short form of the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM-S), based on the concept of the mentalization. METHODS: The MIPAdo-CM was composed of 6 sessions and was applied to 133 students in the 1st grade of a middle school for six weeks during their regular school hours. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test, Peer Aggression Scale, Peer Bullying Scale, School Adjustment Scale, Test Anxiety Inventory and Visual Analogue Scale between the subject and the control group. RESULTS: On the Visual Analoge Scale, students in the trial classes reported an increased understanding and respect for others, as well as themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves. To prove objective usefulness of this program, further studies should be administered in the form of long-term, regular and structured courses.

Factors Affecting Adherence to Pharmacotherapy in Children with Attention-Deficit Hyperactivity Disorder:A Retrospective Study

OBJECTIVES: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). METHODS: A retrospective medical record review of 239 ADHD patients (mean age 9.3+/-2.6 years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. RESULTS: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. CONCLUSION: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

Alteration in Plasma BDNF Level after Repetitive Transcranial Magnetic Stimulation(rTMS) in Treatment-Resistant Schizophrenia: A Pilot Study

OBJECTIVES: To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia. METHODS: Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale(PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia(K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment. RESULTS: After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness(rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level(rho=-0.821, N=7, p=0.023, two-tailed). CONCLUSION: This preliminary study suggests that rTMS didn't make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.

The Effect of Ethanol Inhalation on Postoperative Nausea in Patients using Patient Controlled Analgesia / 성인간호학회지

PURPOSE: The study was done to investigate the effect of ethanol inhalation on postoperative nausea in patients using Patient Controlled Analgesia (PCA). METHODS: The data were collected from June 1st 2006 to September 30th, 2007. The subjects were 70 patients who had had orthopedic surgery under general anesthesia. The levels of the Visual Analogue Scale (VAS) was used to measure postoperative nausea. The experimental group was given ethanol inhalation using ethanol pads and the control group received normal saline pads. All participants were instructed to take two deep sniffs with the pad one inch from the nose. This was repeated every five minutes for three doses. The collected data were analyzed using SPSS/WIN 12.0 program. RESULTS: The study supported all hypotheses. "The experimental group given first dose of ethanol inhalation would have a lower level postoperative nausea compared to the control group"(t = -5.900, p = .000). "The experimental group given second doses of ethanol inhalation would have a lower level postoperative nausea compared to the control group"(t = -7.507, p = .000). "The experimental group given third doses of ethanol inhalation would have a lower level postoperative nausea compared to the control group"(t = -6.685, p = .000). CONCLUSION: According to these results, the ethanol inhalation can be considered an effective nursing intervention for relieving the postoperative nausea in patients using PCA.

The functional role of the CARM1-SNF5 complex and its associated HMT activity in transcriptional activation by thyroid hormone receptor

We have investigated the function and mechanisms of the CARM1-SNF5 complex in T3-dependent transcriptional activation. Using specific small interfering RNAs (siRNA) to knock down coactivators in HeLa alpha2 cells, we found that coactivator associated arginine methyltransferase 1 (CARM1) and SWI/SNF complex component 5 (SNF5) are important for T3-dependent transcriptional activation. The CARM1- SWI/SNF chromatin remodeling complex serves as a mechanism for the rapid reversal of H3-K9 methylation. Importantly, siRNA treatment against CARM1 and/or SNF5 increased the recruitment of HMTase G9a to the type 1 deiodinase (D1) promoter even with T3. Knocking- down either CARM1 or SNF5 also inhibited the down- regulation of histone macroH2A, which is correlated with transcriptional activation. Finally, knocking down CARM1 and SNF5 by siRNA impaired the association of these coactivators to the D1 promoter, suggesting functional importance of CARM1- SNF5 complex in T3-dependent transcriptional activation.

The Association between Helicobacter pylori Infection and Gastric Adenocarcinoma: a Review of the Literature / 한국역학회지

PURPOSE: Stomach cancer is a major cancer in the world as well as in Korea. Helicobacter pylori infection was suggested causing atropic gastritis, but there has been a debate on the association with the gastric adenocarcinoma. We reviewed recent literatures and meta-analyses on the association between Helicobacter pylori infection and the development of gastric adenocarcinoma. PESULTS: The animal experiments suggested that Helicobacter pylori is a causative agent of gastric adenocarcinoma. Meta-analyses on the relationship between Helicobacter pylori infection and gastric adenocarcinoma showed increased risk in infected person, but the strength of association was varied with study design, characteristics of study participants and the nature of tumors. CONCLUSIONS: Recent study results suggested that Helicobacter pylori is a necessary causative agent for development of gastric adenocarcinoma. Assessment of the association between Helicobacter pylori infection and other factors related with gastric cancer risks and the effects of the eradication therapy of Helicobacter pylori infection on the prevention of gastvic cancer need further evaluation.

Goblet Cell Carcinoid of the Appendix: A case report

Carcinoid tumors of the appendix are common incidental findings, but appendiceal tumors with histologic features of both carcinoids and adenocarcinomas are rare, and their biologic behavior and histogenesis are still unclear. We report a case of goblet cell carcinoid of the appendix in a 54-year-old male, who exhibited pain in the right lower abdomen. Microscopically, the tumor contained smooth-bordered, widely separated nests composed of tumor cells with abundant mucin. The principal tumor cell type had a close resemblance to the normal goblet cell. Histochemically, the tumor cells revealed positive reaction for PAS and alcian blue stain. Immunohistochemically, the tumor showed strong reactivity for carcinoembryonic antigen, chromogranin and, neuron specific enolase but none for cytokeratin and epithelial membrane antigen.