C-fos mRNA Expression in Rat Hippocampal Neurons by Antidepressant Drugs

This study was designed to examine the effects of two antidepressant drugs on the expression of c-fos mRNA in cultured embryonic rat hippocampal neurons. The drugs used were imipramine and amitriptyline. On the fourth day of culture, hippocampal neurons were treated with variable concentrations of each drug. Competitive RT-PCR(Reverse Transcriptase-PCR) analysis was used to quantify the c-fos mRNA expression induced by each drug. Experimental results showed that acute and direct treatment with imipramine and amitriptyline with relatively low concentrations(imipramine or =100micrometer, amitriptyline > or =100micrometer) c-fos mRNA was not detected. These findings suggest the followings. Firstly, the action mechanisms of these drugs on the hippocampal neurons might not be mediated by c-fos but by other immediate-early genes(IEGs). Secondly, their actions may be mediated indirectly via other areas of the brain. Thirdly, the expression of c-fos might be inhibited by high concentrations of these drugs, or the high concentrations could induce cell death. Finally, though cell death remains to be confirmed, the inhibition of c-fos induction or cell death could play a role in the cognitive impairments known to be adverse effects of some antidepressants. This study is believed to be a first step toward understanding the mechanisms of learning and memory. Further studies are needed to investigate the expression of various IEGs and changes in the hippocampal neurons of rat resulting from chronic treatment with antidepressant drugs.

The Analysis of the OSCE in Psychiatry of Senior Medical Students / 신경정신의학

OBJECTIVES: The Objective Structured Clinical Examination(OSCE) has been recently introduced in various Korean medical schools to evaluate clinical competence of medical students in the psychiatry setting. This study attempts to provide basic data for the future research to improve reliability and validity in implementing OSCE in psychiatry by analyzing OSCE checklists and scores that Hanyang University Medical School has produced for the past 4 years and examining any problems related to station duplication and correlation between OSCE scores and other test scores. METHODS: OSCE was conducted for senior students of Medical School of Hanyang University from 1996 through 1999. In 1996, it was given to students in a form of self checklist after a relevant video tape was shown to them. The clinical professor evaluated them using checklists after a relevant video tape was shown to them in 1997 and 1998. In 1999, the clinical professor evaluated them using further detailed checklists after interviewing standardized patients. Stations were duplicated in 2 places over 4 years. The scores were compared and analyzed based on overall scores, each question and each duplicated station. The correlation of scores of OSCE and other examinations has been also explored. RESULTS: The OSCE scores have changed significantly every year. The scores of the questions related to diagnosis and management showed significant correlation between the OSCE and other examinations conducted in 1998 and 1999. The overall scores for each duplicated station showed significant difference between 1997 and 1998, but not between 1996 and 1999. However the analysis of questions of OSCE conducted in 1999 indicated that the scores of 9 questions demonstrated significant difference between the duplicated stations. CONCLUSION: It is required to formulate and distribute checklists suited to evaluate students attitudes and qualification as clinical doctors. In order to enhance reliability across stations, the assessor needs to take sufficient training prior to examination: evaluation criteria need to be clearly defined: and further study on standardized patients is required.

A Case Report of Triazolam Dependence: Focusing Anxiety Symptoms and Treatment / 신경정신의학

Benzodiazepines, which used to and would be prescribed frequently as anxiolytic sedative hypnotics not only in psychiatric field but also in almost all clinical departments, are prone to develop tolerance, physical and psychological dependence, and withdrawal symptoms after abrupt discontinuation. Owing to shorter plasma half life, severe degree of tolerance, physical and psychological dependence, and withdrawal symptoms after abrupt discontinuation have been developed in a case of triazolam dependence. Nevertheless, no single case of triazolam dependence was reported yet in Korea. The authors experienced a single case of triazolam dependence, so report with literature review.

A Transcultural Study of Eating Attitudes and Behaviors among Adolescents / 신경정신의학

OBJECTIVES: The goal of this research was to attempt to examine ethnic and cultural differences in factors associated with disordered eating attitudes and behaviors. METHODS: Data were collected from the four groups of 3,129 high school students aged between 13 and 16 years who completed school-based survey conducted in 1996. The students(663 Korean urban, 821 Korean rural, 830 Korean-Chinese and 815 Chinese adolescents) completed an instrument which assessed weight, height, Body Mass Index(BMI), parental income, father's level of education, weight control questionnaire, Body Image Scale(BIS), and eating attitudes and behaviors using the Eating Attitude Test-26(EAT-26). RESULTS: BMI did not vary significantly by race, sex, and socioeconomic status. There were many severely underweight and severely overweight students among Korean-Chinese and Chinese than among Korean urban and Korean rural students. The EAT-26 mean scores of Korean-Chinese and Chinese subjects were significantly higher than those of Korean urban and Korean rural subjects. The EAT-26 mean score of Korean-Chinese was the highest among the four racial groups. The prevalence of high risk EAT-26(EAT-26> or =20) students of Korean-Chinese was 6.9% which was the highest among the four groups. The BIS mean scores of Korean rural and Korean urban subjects were significantly higher than those of Korean-Chinese and Chinese subjects. The Korean subjects were more dissatisfied with their body than the Chinese. The prevalences of weight control behaviors were 26.7% in Korean urban, 23.2% in Korean rural, 10.6% in Korean-Chinese, and 4.6% in Chinese subjects. Dieting and exercise were most popular for weight reducing in Korean subjects. Dieting and drug use were most popular in Chinese subjects. CONCLUSION: These data suggest that there must be many eating disorder patients in Korea and China, and the eating attitudes and behaviors are influenced by ethnic and cultural factors. Implications for understanding sociocultural influence on eating attitudes and behaviors and acculturation are discussed.

Two Cases of Olfactory Reference Syndrome / 신경정신의학

Disease identity of dysmorphophobia and olfactory reference syndrome which used to be manifested by a kind of monosymptomatic somatic delusion is not yet established definitely. So many issues such as whether it be regarded as separate disease, or a spectrum of preexisting diseases such as schizophrenia or obsessive compulsive disorder and whether the monosymptom should be considered as a delusion or not are still on debate and the results are controversial. Consequently few is known about the etiology of the disorder.Obvioulsy, somatic delusion in dysmorphophobia and olfactory reference syndrome is the result of cognitive distortion of body image of the self. It reflects symbolic meaning of unresolved psychological conflict by defense mechanisms such as repression, dissociation, symbolization, projection, and so on. Though psychopharmacological and psychotherapeutic treatment modality has been reported, the treatment efficacy is unclear. Prognosis has been reported unfavorable and one of the leading causes has been thought to be treatment noncompliance. The authors experienced 2 cases of olfactory reference syndrome, so reported with literature review.

A Case of Narcissistic Personality Disorder with Brief Psychotic Episode / 신경정신의학

OBJECTIVES: The Objective of this case report is to present basic materials of clinical symptomatologic study in narcissistic personality disorder by reviewing a case diagnosed as narcissistic personality disorder with brief psychotic episode. METHODS: The subject was a psychiatric inpatient diagnosed concomitantly as narcissistic personality disorder and brief psychotic disorder by DSM- IV. Practical clinical diagnostic process for narcissistic personality disorder was applied and reviewed. Clinical characteristics of brief psychotic episode in narcissistic personality disorder such as precipitating psychological factors, main psychotic symptoms, and course were investigated as well. RESULTS AND CONCLUSION: For diagnosing narcissistic personality disorder, it is essential besides superficially manifested symptoms, to search for underlying psychological meanings of those symptoms, careful observations of behavior and attitude, and to take reliable informations from family or relatives. In case of encountering blow-out of pathologically inflated grandiose self mainly in middle age, brief psychotic episode could be broken out. Main features of the episode were affective symptoms, failure in impulse and behavior control, and perceptual disturbances rather than thought disorder.

Comparison of MMPI Characteristics in Ulcerative Colitis, Hemodialysis patients & Normal Control Group / 대한내과학회지

OBJECTIVES: For many years, inflammatory bowel disease has been thought to have a strong psychosomatic component, but recent prospective studies show no evidence of correlation between various psychologic factors and the disease activity. However, chronic renal disease still places unique stresses on the hemodialysis patients, with consequent emotional reactions. The aims of this study are to investigate the psychologic factors of ulcerative colitis and hemodialysis patients using MMPI scales, which are objective psychological test, thus give aid to psychological understanding of these patients. MOTHODS: We investigated 23 ulcerative colitis patients in remission followed at outpatient department of Hanyang University Hospital and 25 patients receiving hemodialysis between June, 1994 and August, 1995. Twenty students were selected for normal control group. We utilized T-score of each MMPI scale for analyzing characteristics of each group and regard T-score over 70 or below 40 as abnormal. RESULTS: The average T-scores of each MMPI scale in ulcerative colitis, hemodialysis patients & normal control group were within normal range between 40 and 70, except for T-score of Es scale in hemodialysis patient group(34.5). The results of comparison between each MMPI scale of two patients & normal control group were as follows. 1) L scale was significantly elevated in ulcerative colitis & hemodialysis patients group compared with that of normal control group. F scale was significantly elevated in hemodialysis patients compared with that of ulcerative colitis patients & normal control group (p<0.01). 2) Hs(p<0.01), D, Pt(p<0.05) and Sc(p<0.01) scales were significantly elevated in hemodialysis patients compared with those of ulcerative colitis patients & normal control group. 3) Es scale was significantly lower in hemodialysis patients compared with that of ulcerative colitis patients & normal control group(p<0.01). CONCLUSION: The result presented in this study reflects emotional disturbances, functional impairment, stressful life condition, excessive hypochondriacal thinking, depressed mood and egocentric tendency of hemodialysis patients compared with ulcerative colitis patients & normal control group. This result also reflects the projective tendency, hostility, difficulty in rapport formation, psychologic disturbance, obssesive and rigid personality, anxiety and retiredness of hemodialysis patients compared with ulcerative colitis patients & normal control group. On the other hand, we can't find any statistically significant differences between ulcerative colitis and normal control group.