Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico / Age of onset symptoms and gender in schizophrenic spectrum disorders

Introducción. Existe controversia sobre la posibilidad de que la edad de inicio de la esquizofrenia y de algunas características clínicas del trastorno, sean diferentes entre hombres y mujeres. Objetivo. Evaluar la relación entre sexo, edad de inicio y síntomas negativos en pacientes con trastornos del espectro esquizofrénico. Materiales y métodos. Se evaluaron 225 pacientes para medir la edad de inicio de los síntomas y el puntaje en la escala SANS (Scale for the Assessment of Negative Symptoms). Se usaron estimadores de densidad kernel para evaluar las características de la edad de inicio. Se estimaron los parámetros de distribuciones mezcladas usando algoritmos de máxima verosimilitud. La relación síntomas negativos-edad de inicio se evaluó usando regresión múltiple. Resultados. Hubo diferencia significativa en la edad de inicio según el sexo (24,5 años en hombres Vs. 27,5 años en mujeres). Se encontró asociación entre sexo y comienzo temprano de síntomas, siendo este último más frecuente en hombres. Los estimadores de densidad para la edad de inicio sugieren un modelo mezclado con tres componentes, con los siguientes parámetros: m1=21,55, sd1=5,25; m2=29,54, sd2=7,22; y m3=40,01, sd3=3,98. Al tener en cuenta el sexo, se aíslan dos estructuras bimodales: la de hombres tiene la menor media de edad de inicio (18,02 años) mientras que la de media más alta corresponde a las mujeres (41,03 años). Los coeficientes de regresión sugieren incremento en los síntomas negativos a medida que aumenta el tiempo con enfermedad. Conclusión. Nuestros resultados apoyan la hipótesis de que existe relación entre la edad de inicio de los síntomas, el sexo y las características clínicas, en pacientes con trastornos del espectro esquizofrénico, lo que demuestra que los hombres tienen un inicio más temprano y un curso de la enfermedad con mayor deterioro.

Introduction. Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. Objective. The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. Materials and methods. A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. Results. A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. Conclusion. The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Association Study of Single-Nucleotide Polymorphism in Lymphotoxin Alpha Gene and Bipolar I Disorder

OBJECTIVES: Proinflammatory process has been implicated as an underlying mechanism of bipolar disorder and schizophrenia. Previous studies have suggested a possible role of lymphotoxin alpha (LTA) gene in the development of schizophrenia and have prompted further investigation in bipolar patients. Association of the LTA +252A/G polymorphism with susceptibility to bipolar I disorder itself as well as with vulnerability among a subset of psychotic bipolar patients were tested. METHODS: DNA extraction was done by a standard method and genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 114 Korean patients with bipolar I disorder and 202 healthy controls. SPSS v18.0 was used for statistical analysis. Comparisons of the genotype and allele distributions in LTA +252A/G polymorphism were made using a chi-square test. The genotype and allele associations were also evaluated using odds ratio (OR) and 95% confidence interval (CI). Statistical significance was accepted when p was < 0.05. RESULTS: No significant association was found between the LTA +252A/G polymorphism and bipolar disorder. However, LTA +252G allele was present with significantly higher frequency among bipolar patients with psychotic features compared to those without (chi2 = 4.69, p = 0.034, OR = 2.495, 95% CI = 1.069-5.827). CONCLUSION: The results suggest that the allele LTA +252G of the polymorphism may be associated with the psychotic subset of bipolar disorder but not with bipolar I disorder itself. Adequately powered subsequent studies should be conducted.

Korean Medication Algorithm for Depressive Disorder 2006 (II): Major Depressive Disorder without Psychotic Features / 신경정신의학

OBJECTIVES: There have been noticeable progresses in the pharmacological management of depressive disorders along with vigorous preclinical and clinical trials of newer antidepressant drugs during the last decade. Since the first development of Korean Medication Algorithm for Major Depressive Disorder (KMAP-MDD) in 2002, there has been a substantial need for the revision of this algorithm. We amended the KMAP-MDD to Korean Medication Algorithm for Depressive Disorders (KMAP-DD) in 2006 and included treatment strategies for other types of depressive disorders. This article is about the treatment of MDD without psychotic features in the KMAP-DD 2006. METHODS: Questionnaires were developed by the executive committee for KMAP-DD. The first part of this questionnaire is about the treatment strategies of MDD without psychotic features, minor depressive disorder and dysthymic disorder. Seven questions and 10 sub-items were prepared to investigate the experts' opinions about treatment of major depressive disorders without psychotic features. The expert review committee composed of 101 experienced Korean psychiatrists was asked to evaluate the medication strategies for various clinical situations of depressive disorders using a 9-point scale. The scale was slightly modified from the format developed by the RAND corporation. We classified the expert opinions into 3 categories (first-line, high second-line and low second-line) by the 95% confidence interval of response score and evaluated the consensus of opinions of Korean experts using Chi2-test. RESULTS: For patients with MDD without psychotic features, antidepressant monotherapy was the optimal first-line treat-ment strategy regardless of the severity of an episode. In case of no or partial response to antidepressant monotherapy for severe episode of MDD, combination treatment with another antidepressant drug or augmentation treatment with triiodothyronine or lithium was considered as the second-line treatment. Meanwhile, for mild-to-moderate episode of MDD without psychotic features, switching to another antidepressant as well as augmentation or combination treatment was also considered as the second-line treatment. Selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine were chosen as the 1st-line antidepressant drugs for MDD without psychotic features in Korea. CONCLUSION: The initial treatment strategy for patients with major depressive disorder without psychotic features is similar to that of the previous medication algorithm (KMAP-MDD). However, combination treatment with two antidepressant drugs and augmentation treatment strategies were considered at a relatively earlier step in this algorithm than in the previous version of Korean medication algorithm (KMAP-MDD) for the severe episode of major depressive disorder. The recent trials of newer antidepressant drugs and the preference of more active treatment strategy in up-to-date clinical psychiatry fields may have affected these changes in Korea.

Korean Medication Algorithm for Depressive Disorder 2006 (III): Major Depressive Episode with Psychotic Feature / 신경정신의학

OBJECTIVES: Since the publication of Korean Medication Algorithm Project for Major Depressive Disorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management of depressive disorder. We revised KMAP-MD 2002 and developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. METHODS: We developed a questionniare for surveying the opinion of experts on pharmacotherapy of depressive disorder. The questionnaire consisted of 4 parts; 1) treatment of non-psychotic depressive disorder, 2) treatment of psychotic depressive disorder, 3) treatment according to clinical subtypes and drugs choice considering adverse effects, and 4) treatment of depressive disorder in women. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. It is composed of 22 questions, and each question includes 54 sub-items. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line) by Chi2-test. RESULTS: For depressive disorder with psychotic features, most reviewers prefer the combination of antidepressant and atypical antipsychotics. Electroconvulsive therapy and the combination of antidepressant and typical antipsychotics were the second-line treatment. Among antidepressants, venlafaxine was the most preferred, and SSRI and mirtazapine followed. Among atypical antipsychotics, quetiapine, risperidone and olanzapine were the most preferred, in this order. In patients who have no response to the first-line treatment, many reviewers recommended switching to another antidepressant or adding another atypical antipsychotics. CONCLUSION: For severe depressive disorder with psychotic features, the combination of antidepressant and atypical antipsychotics was preferred for the first-line treatment. These results suggest that the medication strategies of depressive disorder are rapidly changing and reflects the recent studies and clinical experiences.

Temperament and Character in Euthymic Bipolar I Patients with or without Psychotic Features / 신경정신의학

OBJECTIVES: The aim of this study was to exam whether personality, i.e. temperament and character, has an association with a previous presence of psychotic features in euthymic bipolar I disorder. METHODS: We recruited 25 psychotic patients with bipolar I disorder, 23 non-psychotic bipolar I patients and 48 normal controls. All subjects were asked to perform Temperament and Character Inventory (TCI). Euthymic state was defined in bipolar patients by scores of below 10 on the Hamilton Depression Rating Scale (HDRS) and on the Young Manic Rating Scale (YMRS). RESULTS: Psychotic bipolar patients, compared to normal controls, showed higher harm avoidance (HA) and self-transcendence (ST). In addition, HA in psychotic bipolar patients was higher than that in non-psychotic bipolar patients. However, no significant differences on TCI were demonstrated between non-psychotic patients and normal controls. CONCLUSION: There are significant discrepancies in personality between psychotic and non-psychotic bipolar patients on HA and ST. These findings are consistent with the hypothesis of a continuum between bipolar disorder with psychotic features and psychotic disorders.

The Characteristics and Treatments of Major Depressive Disorder with Psychotic Features / 대한정신약물학회지

Major depressive disorder with psychotic features is fairly common but difficult to be diagnosed and managed. The patients with psychotic depression have psychomotor impairments, guilt, suicidal ideation or attempt, and neuropsychological impairments. Compared with non-psychotically depressed patients, these patients exhibit more frequent relapses and recurrences and have increased use of medical services, greater disability, more social and occupational impairments, and a poorer clinical course. They demonstrate distinct biological abnormalities in various studies. Several studies support a relationship between bipolar affective disorder and psychotic depression. The combination of an antidepressant and an antipsychotic or electroconvulsive therapy may be most efficacious treatments for psychotic depression. The combination of a selective serotonin reuptake inhibitor and an atypical antipsychotic may have particular relevance for the treatment of psychotic depression because of the potential for decreased risk of side effects, as well as possible antidepressant properties of an atypical antipsychotic itself. Additionally, glucocorticoid antagonist may have as good or better efficacy for the disorder. This article focused on recognizing the characteristics of psychotic depression, favorable treatment options, and new treatments under investigation.