Biomarker potential of hsa-miR-145-5p in peripheral whole blood of manic bipolar I patients

Objective: Bipolar I disorder (BD-I) is a type of bipolar spectrum disorder characterized by manic or mixed episodes. Detecting microRNA regulations as epigenetic actors in BD-I is important to elucidate the pathogenesis of the disease and reveal the potential of microRNAs (miRNAs) as biomarkers. Methods: We evaluated the expression profile of six candidate miRNAs (hsa-miR-145-5p, hsa-miR-376a-3p, hsa-miR-3680-5p, hsa-miR-4253-5p, hsa-miR-4482-3p, and hsa-miR-4725) in patients with BD-I and in healthy controls (aged 11-50 years). We also determined the potential target genes of these miRNAs through in silico analysis. The diagnostic values of the miRNAs were calculated through receiver operating characteristic curve analysis. Results: Four miRNAs were upregulated (hsa-miR-376a-3p, hsa-miR-3680-5p, hsa-miR-4253-5p, hsa-miR-4482-3p) and hsa-miR-145-5p was downregulated in patients (p < 0.001). The target gene analyses showed that hsa-miR-145-5p specifically targets the dopamine decarboxylase (DDC) gene. The area under the curve of hsa-miR-145-5p was 0.987. Conclusion: Differential expression of five miRNAs in peripheral blood may be associated with the pathogenesis of BD-I, and hsa-miR-145-5p has potential as a BD-I biomarker. This miRNA can be used in dopamine-serotonin regulation and dose adjustment in drug therapy via the DDC gene.

Differences in Psychopathology between Offspring of Parents with Bipolar I Disorder and Those with Bipolar II Disorder: A Cross-Sectional Study

OBJECTIVE: The aim of this study was to evaluate differences in psychopathology between offspring of parents with bipolar I disorder (BP-I) and those with bipolar II disorder (BP-II). METHODS: The sample included 201 offspring between 6 and 17 years of age who had at least one parent with BP-I or BP-II. The offspring were diagnostically evaluated using the Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Psychopathology and Clinical characteristics were evaluated, including lifetime DSM-5 diagnoses, depression, and childhood trauma. Lifetime DSM-5 diagnoses were also compared between schoolchildren aged 6 to 11 years and adolescents aged 12 to 17 years. RESULTS: In lifetime DSM-5 diagnoses, offspring of parents with BP-I had significantly increased risk of developing MDD and BP-I than those with BP-II. Regarding clinical characteristics, ADHD rating scale and childhood trauma scale were significantly higher in offspring of parents with BP-I than that in those with BP-II. CONCLUSION: The present study supports that BP-I may be etiologically distinct from BP-II by a possible genetic liability. Our findings indicate that additional research related to bipolar offspring is needed to enhance understanding of differences between BP-I and BP-II.

Función ejecutiva en pacientes con trastorno bipolar tipo I durante la fase asintomática / Executive functions in patients with bipolar disorder type I during asymptomatic phase

La función ejecutiva se ve involucrada en la mayor parte de las actividades que realizamos a diario, repercutiendo en la calidad de vida de las personas. Los rendimientos ejecutivos en el trastorno bipolar tipo I pueden fluctuar en función de la fase clínica en la que se encuentra el paciente. El objetivo de este trabajo se centra en revisar los hallazgos encontrados respecto a la función ejecutiva durante la fase asintomática del trastorno bipolar tipo I. Se han analizado 37 artículos científicos que abordan el rendimiento ejecutivo de pacientes eutímicos con trastorno bipolar tipo I. Se puede concluir que la mayoría de los estudios reportan dificultades ejecutivas en estos pacientes, aunque no parece existir consenso en los diferentes trabajos al indicar el tipo de déficit. Esta falta de acuerdo podría ser debida a aspectos metodológicos de los estudios y a distintas variables clínicas y farmacológicas. Las alteraciones ejecutivas en la eutimia son menores que en las fases agudas del trastorno y afectan sobre todo a la velocidad de procesamiento de la información. Los déficits ejecutivos de los pacientes podrían estar vinculados a posibles alteraciones funcionales a nivel de la corteza prefrontal, así como al propio efecto de los psicofármacos utilizados. Sería de especial relevancia que el tratamiento de estos pacientes incorporase estas alteraciones, lo que podría conseguirse mediante un enfoque neurocognitivo dentro de un abordaje terapéutico integrado...

Executive function is present in most of dairy activities, so it influences in quality of life. Executive performances in bipolar disorder type I can change in function of clinical phase that patient is. The aim of this work is to review the studies that have investigated executive function during asymptomatic phase in bipolar disorder type I. It has been analyzed 37 scientific articles that examine executive performance in euthymic patients with bipolar disorder type I. It can be concluded that bipolar patients in asymptomatic phase suffer executive difficulties, but it doesn’t seem to exist consensus regarding the type of deficits. This lack of agreement could be due to methodological diversity in studies, as well as the influence of different clinical or pharmacological variables. Executive alterations in euthymic phase are lower than the acute phases in bipolar disorder and affect mainly to processing speed. Executive deficits in patients could be linked to possible functional alterations in prefrontal cortex, as well as the psychopharmacological effect. It would be specially relevant treatment in bipolar disorder keep in mind this alterations, which it can get it with a neurocognitive approach within integrate treatment...

Análisis neuroforense de la violencia: propuesta de revisión / Neuroforensic analysis of violence: proposed revision

Frente a la conducta homicida se presenta una diferenciación de posiciones biologicistas que relacionan la pauta homicida con factores filogenéticos y posibles daños en funciones neuropsicológicas complejas principalmente relacionadas con el control consciente de la conducta y la planeación. El planteamiento neuropsicológico relaciona el funcionamiento del cerebro con el comportamiento homicida principalmente con alteraciones en funciones ejecutivas y de planeación relacionadas con el lóbulo frontal, así como con alteraciones en el cuerpo calloso, la amígdala, el tálamo y alteraciones en la región medial de los lóbulos temporales...

Facing homicidal behavior differentiation biologicist positions relating to phylogenetic pattern homicidal factors and possible damage to complex neuropsychological functions related primarily conscious control of behavior and planning is presented. Neuropsychological approach to brain function related to homicidal behavior primarily with changes in executive and planning related to the frontal lobe functions, as well as alterations in the corpus callosum, amygdala, thalamus and alterations in the medial lobes temporary...

The cognitive impairments of euthymic patients with early-onset or late-onset bipolar Ⅰ disorder / 中国神经精神疾病杂志

Objective To explore the characteristics of cognitive impairments in euthymic patients with early-on?set or late-onset bipolar I disorder (BD-I). Methods Ninety-four with onset age less than 21 (early onset group), 41 eu?thymic patients with onset age above 35 (late onset group) and 135 normal controls with matched education and age were enrolled. Seven classical neuropsychological tests were used to assess attention, processing speed, working memory and executive functions. Results The early-onset group was significantly worse than its corresponding normal controls in 14 indexes of all tests, including digital symbol, digital span, visual graphic reproduction (c1 and c2), time of TMT-A and TMT-B, verbal fluency, number of sorting, error and preserved error in WCST, as well as total score, completed missions, planning time and executing time in TOH (P<0.05). Moreover the effect size of difference were more than 0.4 in verbal fluency, time of TMT-A and TMT-B, and executing time in TOH. Compared with its matched control group, the late-on?set group was significantly impaired in 9 indexes, including digital span, visual graphic reproduction (c1,c2 and total), time of TMT-A, number of error and preserved error in WCST, as well as total score and completed missions in TOH (P<0.05), merely two indexes of TOH with effect size more than 0.4, while the late-onset group was no significantly impaired in digital symbol, TMT-B and verbal fluency. Conclusions There are significant cognitive impairments in euthymic BD-I patients with no matter early-onset or late-onset. But it seems that the cognitive impairments in early-onset bipo?lar disorder are more extensive and serious.

La terapia cognitivo conductual en el tratamiento de la depresión del trastorno bipolar tipo I / Cognitive behavioral therapy for the acute major depressive episodes in bipolar I disorder

A pesar de la farmacoterapia, tratamiento esencial del trastorno bipolar I, un porcentaje importante de pacientes experimenta nuevos episodios afectivos. La terapia cognitivo conductual (TCC), la psicoterapia interpersonal y ritmo social y la terapia familiar focalizada, lo mismo que la psicoeducación, enfoques psicosociales útiles en el tratamiento del trastorno bipolar, comparten el énfasis en el empoderamiento del paciente para convertirlo en participante activo de su tratamiento. La adición de la TCC al tratamiento tiene como objetivos aliviar los síntomas depresivos, restablecer el funcionamiento psicosocial y prevenir la aparición de nuevos episodios afectivos. Aunque la investigación es limitada, en este trabajo se describen las bases teóricas y los estudios empíricos que avalan el uso de la TCC como una intervención psicosocial indispensable. Objetivos El presente trabajo tuvo como objetivo demostrar la utilidad de la TCC como tratamiento coadyuvante en la depresión del trastorno bipolar I para los síntomas residuales, la adherencia y el cumplimiento del tratamiento, la conciencia y la comprensión del trastorno bipolar, la identificación temprana de los síntomas de los episodios afectivos y el desarrollo de habilidades de afrontamiento. Método Se revisaron los ensayos clínicos controlados acerca de la utilidad de la TCC como tratamiento del paciente con depresión del trastorno bipolar I. Resultados La TCC aumenta la adherencia al tratamiento farmacológico, disminuye la frecuencia de recaídas en el primer año, los síntomas depresivos residuales, las hospitalizaciones y la duración de los episodios y mejora la adherencia terapéutica y el funcionamiento psicosocial; su utilidad es similar a la terapia familiar focalizada y la psicoterapia interpersonal y ritmo social. Los efectos terapéuticos disminuyen a lo largo del tiempo y sus resultados son menores en pacientes con mayor número de episodios afectivos (>12) y mayor comorbilidad. Conclusiones La TCC es una intervención que mejora la evolución del trastorno bipolar tipo I.

Although pharmacotherapy is the essential treatment for bipolar I disorder depression, a significant percentage of patients continue experiencing emotional episodes. Cognitive behavioral therapy (CBT), interpersonal psychotherapy and social rhythm and focused family therapy, as well as psychoeducation, share the emphasis on the empowerment of the patient so she/he becomes an active participant in treatment, becomes aware of the nature of the disorder who suffers, and learns to recognize early symptoms of depressive episodes in order to prevent its recurrence. The addition of the CBT aims to alleviate depressive symptoms, restore the psychosocial functioning and prevent the appearance of new affective episodes. Objectives This paper aimed to demonstrate the importance and usefulness of the CBT as an adjuvant of the pharmacological management of depression in bipolar disorder type I in those areas which cannot be resolved by pharmacological treatment (residual symptoms, adherence and compliance with treatment, awareness and understanding of bipolar disorder, identification of prodromal symptoms and developing coping skills). Method Controlled clinical trials about the usefulness of CBT as an adjunctive treatment of patient with depression due to bipolar disorder type I are reviewed. Results CBT increases adherence to drug therapy, decreases the frequency of relapses, diminishes residual symptoms, the need for hospitaliza-tion, and the duration time of depressive episodes; it also improves psychosocial functioning. However, these effects diminish over time and its results are lower in patients with more affective episodes and greater comorbidity. Conclusions There is evidence of the utility of the CBT as a useful tool to improve the evolution of the condition in depressed patients due to bipolar I disorder and of the need to extend the time of this and other psychosocial interventions, since this disorder is a condition that lasts a lifetime and causes significant impact on psychosocial functioning of the person.

A Case of Clozapine Induced Acute Renal Failure

There have been a few case reports that clozapine, an atypical antipsychotic, caused acute renal failure of interstitial type. Here we report a case of a 38-year-old Korean male patient with treatment-resistant bipolar I disorder who developed acute renal failure after the initiation of treatment with clozapine. We describe the clinical and laboratory findings of the case and discuss the measures for early detection of this life threating condition. Within our knowledge, this is the first report of clozapine-induced acute renal failure in South Korea.

Circadian Rhythm Characteristics in Mood Disorders: Comparison among Bipolar I Disorder, Bipolar II Disorder and Recurrent Major Depressive Disorder

OBJECTIVE: Morningness/eveningness (M/E) is a stable characteristic of individuals. Circadian rhythms are altered in episodes of mood disorder. Mood disorder patients were more evening-type than normal population. In this study, we compared the characteristics of M/E among the 257 patients with bipolar I disorder (BPD1), bipolar II disorder (BPD2) and major depressive disorder, recurrent (MDDR). METHODS: M/E was evaluated using the Korean version of the composite scale of morningness (CS). Factor analysis was done to extract specific elements of circadian rhythm (morning preference, morning alertness, and evening tiredness). The total score and scores for factors and individual items of CS were compared in order to evaluate differences among the three different diagnostic groups. Factor scores of CS were different among the diagnostic groups. RESULTS: BPD1 subjects had a higher score for evening tiredness than BPD2 subjects (p=0.060), and BPD1 subjects had a significantly higher score for morning alertness than subjects with MDDR (p=0.034). This difference was even more profound for the representative item scores of each factor; item 2 of CS for evening tiredness (BPD1>BPD2, p=0.007) and item 5 of CS for morning alertness (BPD1>MDDR, p=0.002). Total score of CS were not different among 3 diagnostic groups. CONCLUSION: Circadian rhythm characteristics measured by CS were different among BPD1, BPD2, and MDDR. BPD2 showed more eveningness than BPD1. MDDR showed less morningness than BPD1. CS would be a reasonable endophenotype associated with mood disorders. More studies with large sample size of mood disorders on M/E are warranted.

Verbal and Visual Memory Impairments in Bipolar I and II Disorder

OBJECTIVE: To compare verbal and visual memory performances between patients with bipolar I disorder (BD I) and patients with bipolar II disorder (BD II) and to determine whether memory deficits were mediated by impaired organizational strategies. METHODS: Performances on the Korean-California Verbal Learning Test (K-CVLT) and the Rey-Osterrieth Complex Figure Test (ROCF) in 37 patients with BD I, 46 patients with BD II and 42 healthy subjects were compared. Mediating effects of impaired organization strategies on poor delayed recall was tested by comparing direct and mediated models using multiple regression analysis. RESULTS: Both patients groups recalled fewer words and figure components and showed lower Semantic Clustering compared to controls. Verbal memory impairment was partly mediated by difficulties in Semantic Clustering in both subtypes, whereas the mediating effect of Organization deficit on the visual memory impairment was present only in BD I. In all mediated models, group differences in delayed recall remained significant. CONCLUSION: Our findings suggest that memory impairment may be one of the fundamental cognitive deficits in bipolar disorders and that executive dysfunctions can exert an additional influence on memory impairments.

Comparative Study of Personality Traits in Patients with Bipolar I and II Disorder from the Five-Factor Model Perspective

OBJECTIVE: The distinguishing features of Bipolar I Disorder (BD I) from Bipolar II Disorder (BD II) may reflect a separation in enduring trait dimension between the two subtypes. We therefore assessed the similarities and differences in personality traits in patients with BD I and BD II from the perspective of the Five-Factor Model (FFM). METHODS: The revised NEO Personality Inventory (NEO-PI-R) was administered to 85 BD I (47 females, 38 males) and 43 BD II (23 females, 20 males) patients. All included patients were in remission from their most recent episode and in a euthymic state for at least 8 weeks prior to study entry. RESULTS: BDII patients scored higher than BD I patients on the Neuroticism dimension and its four corresponding facets (Anxiety, Depression, Self-consciousness, and Vulnerability). In contrast, BD II patients scored lower than BD I patients on the Extraversion dimension and its facet, Positive emotion. Competence and Achievement-striving facets within the Conscientiousness dimension were significantly lower for BD II than for BD I patients. There were no significant between-group differences in the Openness and Agreeableness dimensions. CONCLUSION: Disparities in personality traits were observed between BD I and BD II patients from the FFM perspective. BD II patients had higher Neuroticism and lower Extraversion than BD I patients, which are differentiating natures between the two subtypes based on the FFM.

Verbal Memory Test Performance In Patients With Bipolar I Disorder Attending A Psychiatric Clinic Of A University Hospital In Kuala Lumpur, Malaysia

Objective: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.

Differences in Clinical Manifestations between Bipolar I and Bipolar II Disorders in Korean Population / 신경정신의학

OBJECTIVES : Whether bipolar II disorder (BP-II) is simply a milder form of bipolar I disorder (BP-I) or a valid diagnostic category that could be separated from BP-I, is an issue still under consideration. Investigations exploring differential clinical and biological features of the two conditions are needed to resolve the controversies. This study aimed to obtain a comprehensive view of differences in clinical course and symptoms characteristics between BP-I and BP-II. METHODS : 44 BP-I and 26 BP-II patients were assessed using the Diagnostic Interview for Genetic Studies (DIGS), Korean version. Demographic data, age at onset, number of (hypo) manic/ depressive episodes, the duration of illness, polarity at onset, seasonality, rapid cycling, atypical depression and symptom profiles of each episode were evaluated. RESULTS : BP-II patients experienced depressive episodes more frequently than BP-I patients after illness onset (U=240.5, p=0.008). More BP-II patients showed seasonality (34.9% vs. 61.5%) and a rapid cycling course (4.5% vs. 18.2%). When comparing symptom profiles of manic/hypomanic episodes, irritable mood, decreased sleep need, inattention, reckless behavior, arrogant/provocative attitude and frequent outbursts of anger were less encountered in BP-II patients. In depressive episodes, leaden paralysis and psychomotor agitation were more frequently observed in BP-II patients. There was no significant difference between the two groups in psychotic symptoms of depressive episode. CONCLUSION : BP-I and BP-II disorders showed differences in clinical courses and symptom profiles. BP-II disorder seems to be less severe than BP-I disorder with regard to the intensity of manic symptoms, but more severe with respect to frequencies of depressive episodes. These results provide additional evidence supporting the distinction of BP-I and BP-II as separate diagnos-tic categories that might have different genetic profiles and/or biological mechanisms.

Differences in Clinical Manifestations between Bipolar I and Bipolar II Disorders in Korean Population / 신경정신의학

OBJECTIVES : Whether bipolar II disorder (BP-II) is simply a milder form of bipolar I disorder (BP-I) or a valid diagnostic category that could be separated from BP-I, is an issue still under consideration. Investigations exploring differential clinical and biological features of the two conditions are needed to resolve the controversies. This study aimed to obtain a comprehensive view of differences in clinical course and symptoms characteristics between BP-I and BP-II. METHODS : 44 BP-I and 26 BP-II patients were assessed using the Diagnostic Interview for Genetic Studies (DIGS), Korean version. Demographic data, age at onset, number of (hypo) manic/ depressive episodes, the duration of illness, polarity at onset, seasonality, rapid cycling, atypical depression and symptom profiles of each episode were evaluated. RESULTS : BP-II patients experienced depressive episodes more frequently than BP-I patients after illness onset (U=240.5, p=0.008). More BP-II patients showed seasonality (34.9% vs. 61.5%) and a rapid cycling course (4.5% vs. 18.2%). When comparing symptom profiles of manic/hypomanic episodes, irritable mood, decreased sleep need, inattention, reckless behavior, arrogant/provocative attitude and frequent outbursts of anger were less encountered in BP-II patients. In depressive episodes, leaden paralysis and psychomotor agitation were more frequently observed in BP-II patients. There was no significant difference between the two groups in psychotic symptoms of depressive episode. CONCLUSION : BP-I and BP-II disorders showed differences in clinical courses and symptom profiles. BP-II disorder seems to be less severe than BP-I disorder with regard to the intensity of manic symptoms, but more severe with respect to frequencies of depressive episodes. These results provide additional evidence supporting the distinction of BP-I and BP-II as separate diagnos-tic categories that might have different genetic profiles and/or biological mechanisms.

Subclinical Hypothyroidism during Quetiapine Treatment: A Case Report

Quetiapine is an atypical antipsychotic drug with a benign side effect profile. However, recent studies have reported that thyroid dysfunction is associated with quetiapine treatment. The authors report a patient with DSM-IV bipolar I disorder who developed subclinical hypothyroidism during quetiapine treatment. The patient showed no significant clinical symptoms, but only abnormal thyroid function test findings including antithyroglobulin antibody. The abnormal thyroid function test findings were normalized after discontinuation of quetiapine. The subclinical hypothyroidism developed during quetiapine treatment may be associated with autoimmune process.

Seizure and Thyroid Dysfunction Associated with High Dose of Quetiapine: Case Report / 신경정신의학

We report a case of seizure and thyroid dysfunction in a patient receiving quetiapine. A 31-year-old Korean woman with bipolar I disorder was observed to have a seizure attack after reduction of quetiapine from 1,200 mg/day to 1,000 mg/day and discontinuance of clonazepam 1 mg/day. Her thyroid function test also showed hyperthyroidism after quetiapine use. She had no known risk factors of seizure, and no known history of lithium ingestion. The patient was taking high dose quetiapine due to her manic symptoms. Using high dose of quetiapine may have resulted in a seizure attack in our patient with bipolar I disorder. Also, in this patient, quetiapine was probably associated with hyperthyroidism. It is not common that seizure occur with atypical antipsychotics, such as quetiapine, except clozapine, but special attention is required using high dose of atypical antipsychotics.

Polymorphism of Tumor Necrosis Factor-beta Gene in Bipolar I disorder / 신경정신의학

OBJECTIVES: Bipolar disorder is known to have a high genetic predisposition. Recently, the main focus of etiologic studies in bipolar disorder has been concentrated on molecular genetic approach including gene polymorphism analysis. The present study was conducted to investigate whether TNFB polymorphism is associated with bipolar I disorder in the Korean population. METHODS: 89 bipolar I disorder patients diagnosed by DSM-IV criteria were assigned as the patient group and 202 normal population, matched on age and sex from Catholic hemopoietic stem cell bank (Seoul, Korea), were enrolled as the control group in this study. Genotyping was performed by a polymerase chain reaction-restriction fragment length polymorphism method. All data was analyzed by chi2 test. RESULTS: There were no significant differences in frequency of TNFB*1/1, TNFB*1/2 and TNFB*2/2 between bipolar I disorder patient group and normal control group. The frequency of TNFB*2 and TNFB*1 was not statistically different between bipolar I disorder patient group and normal control group. CONCLUSION: The difference of frequency in TNFB*1/TNFB*2 gene between the bipolar I disorder gropup and the normal control could not be verified. The present result suggested that the gene polymorphism of TNFB may not play a significant role in susceptibility to bipolar I disorder. Studies with a larger number of subjects from different ethnic backgrounds, considering clinical phenotype and controlling various factors, should be launched to further determine the role of TNFB in bipolar I disorder.

A Naturalistic Study of Atypical Antipsychotic Use in Inpatients with Bipolar I Disorder / 신경정신의학

OBJECTIVES: This study was conducted to evaluate the prescription patterns, overall efficacy, and safety of atypical antipsychotics for inpatients with bipolar I disorder. METHODS: Inpatients with bipolar I disorder, who had received adjunctive treatment with olanzapine or risperidone, beyond 1 month, along with mood stabilizers were selected for a retrospective study. The charts of those patients(N=56) were reviewed for the details of efficacy, safety, and other pharmacological variables of the two drugs. RESULTS: Olanzapine and risperidone showed equivalent efficacy by the evaluation in accordance with clinical global impression scale (CGI) and global assessment of functioning scale(GAF) score. Different side effect profiles were noted between two drugs. CONCLUSION: These limited results suggested that the efficacy and safety of risperidone and olanzapine were similar for the treatment of inpatients with bipolar I disorder. Prospective controlled study for efficacy and safety of risperidone and olanzapine in the treatment of bipolar I disorder should be conducted in future.

Seasonsits of the First Onset in Schizophrenia and Mood Disorder: Mainly in Paranoid Schizophrenia and Bipolar I Disorder / 신경정신의학

This study aimed 1) at determining the seasonal pattern of the first onset and 2) at examining different demographic and clinical factors by the seasonality of first onset, for shizophrenia, mood disorder and subtypes of each diagnosis. Finally, the 52 subjects with paranoid schizophrenia were selected from all patients who fulfilled DSM-IV criteria far schizophrenia who had been admitted to the National Seoul Mental Hospital from March 1994 to February 1995. And the 44 subjects with bipolar I disorder were selected from all patients who fulfilled DSM-IV criteria for mood disorder who had been admitted to the hospital from March 1994 to February 1996. This study was done by reviewing the hospital records about season of the first outset, demographic factors(sex, age, occupation, educated period, religion, marital status, residence and socioeconomic status) and clinical factors(age at the first onset, duration of illness, family history, length of admission, frequency of admission and treatment result). The seasonal pattern of the first onset and the different demographic and clinical factors by the season of the first onset in paranoid shizophrenia and I disorder were analyzed. The results were as follows: 1) There was no significant seasonal variation of the first onset for paranoid schizophrenia. 2) There was a significant seasonal variation of the first onset with a maximum in spring for bipolar I disorder. 3) There was no significant seasonal variation of the first onset in case of bipolar I disorder that began with the manic episode. 4) There was nonsignificant seasonal tendency to peak in spring/summer in the case of the first manic episode for bipolar I disorder. 5) There were no significant differences in demographic and clinical factors by the season of the first onset for paranoid schizophrenia and bipolar I disorder.