Clinical Correlates of Alcohol Use Disorder in Depressed Patients with Unipolar and Bipolar Disorder

OBJECTIVE: Alcohol use disorder (AUD) is one of the most frequent comorbid conditions in mood disorders. We aimed to examine the relationships between clinical phenotypes of acutely depressed subjects and co-occurring AUD.METHODS: Clinical assessment including diagnosis of mood disorder and co-occurring AUD, the severity of depressive or manic symptoms, and affective temperaments were conducted in 137 subjects suffering from a major depressive episode. According to the presence of AUD, clinical variables were compared between the two groups. Using binary logistic regression models, the effects of mood symptoms and affective temperaments on the risk of AUD were determined.RESULTS: Severity of manic symptoms, suicidal ideation, and childhood trauma were higher in the AUD group than in the non-AUD group. Scores for irritable and hyperthymic temperament were higher and the score for anxious temperament was lower in the AUD group. In regression models adjusting confounders, anxious temperament was an independent protector against AUD. On the other hand, the diagnosis of bipolar disorder and the irritable manic symptom dimension increased the risk of AUD.CONCLUSION: Anxious temperament decreased the AUD risk, whereas irritable manic symptoms increased the risk during depression. AUD in mood disorders may be an expression of manic psychopathology.

The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease

The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC > or = 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P < 0.001), higher St. George Respiratory Questionnaire (SGRQ) score (P = 0.019), and higher emphysema index (P = 0.010) were associated independently with resting hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P < 0.001) were independent predictors of all-cause mortality. Our data showed that older age, higher emphysema index, higher SGRQ score, and lower FEV1 were associated independently with resting pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.

N100 Amplitude Slopes in Major Depressive Disorder, Bipolar Disorder, Schizophrenia and Normal Controls

OBJECTIVES: N100 amplitude slope(the intensity dependence of the cortical auditory evoked potentials) is widely considered as an indirect indicator of central serotonergic neurotransmission. However, there are only a few studies about N100 amplitude slopes of major psychiatric disorders. In this study, we examined N100 amplitude slope differences among major depressive disorder(MDD), bipolar disorder(BD), schizophrenia (SCZ) and normal controls(NC). METHODS: We measured the N100 amplitude slopes of 35 patients with MDD, 33 patients with BD, 27 patients with SCZ and 35 NC subjects. Amplitude differences from N1 to P2 at the five different sound intensities(55, 65, 75, 85 and 95dB) were examined at Cz electrode. The N100 amplitude slope was calculated as the linear regression of five N1/P2 peak-to-peak amplitudes across stimulus intensities. RESULTS: BD patients showed significantly reduced N100 amplitude slope compared with NC(0.54+/-0.70 vs. 0.96+/-0.72, p=0.035). N100 amplitude slope of SCZ patients was significantly reduced compared with NC(0.50 +/-0.47 vs. 0.96+/-0.72, p=0.027). N100 amplitude slope of BD patients was significantly lower than that of MDD patients(0.54+/-0.70 vs. 0.94+/-0.60, p=0.046). SCZ patients also showed significant reduction of N100 amplitude slope compared with MDD patients(0.50+/-0.47 vs. 0.94+/-0.60, p=0.036). There was no significant difference of N100 amplitude slope between MDD patients and NC(0.94+/-0.60 vs. 0.96+/-0.72, p=1.000). CONCLUSION: Interestingly, the N100 amplitude slopes of BD and SCZ were reduced compared to NC and MDD patients. Our results suggest the predictive use of N100 amplitude slope in making differential diagnoses of major psychiatric disorders. Clinical implications of N100 amplitude slope in major psychiatric disorders were discussed.

Clinical Application P300 of Patients with Post-Traumatic Stress Disorder / 신경정신의학

OBJECTIVES: Previous studies have suggested that information processing impairment is the main pathophysiology of post-traumatic stress disorder (PTSD). The P300 event-related potential (ERP) has been widely used, in diseases with cognitive dysfunction, such as schizophrenia and Alzheimer's disease, for detecting abnormality in information processing. This study examined P300 characteristics of PTSD patients. METHODS: We recruited 23 patients (mean age 44.35) who met DSM-IV criteria for PTSD and matched 24 normal control (NC) subjects by age and education level. The NC group had no personal history of psychiatric or neurological abnormality. We conducted the Korean version of the structured interview for PTSD (K-SIPS) and Davidson trauma scale (DTS) with the PTSD patients. Then we measured P300 amplitude and latency on 3 electrodes (Cz, CPz, Pz) in both PTSD patients and the NC group. RESULTS: Compared with the NC, the P300 amplitudes of PTSD patients were lower on Cz (PTSD: NC=5.51+/-2.82 uV : 11.80+/-5.18 uV, p<0.01), CPz (PTSD : NC=5.84+/-2.71 uV : 12.69+/-4.51 uV, p<0.01) and Pz (PTSD : NC=5.01+/-2.60 uV : 10.99+/-4.24 uV, p<0.01). We found increasing tendency toward P300 latency in PTSD group compared with NC. However, the BDI and DTS symptom severity scores were negatively correlated with the P300 amplitude of Pz. CONCLUSION: There was a significant reduction of P300 amplitudes in PTSD patients. Compared to NC group, PTSD patients showed a reduced P300 amplitude significantly correlated with symptom severity. The present findings suggest PTSD patients experience cognitive dysfunction and ERP P300 can be a useful surrogate marker of symptom severity in PTSD patients.