Psychometric Properties of the Hypomania Checklist-32 in Korean Patients with Mood Disorders

OBJECTIVE: The aim of this study was to examine the validity of the Korean version of the Hypomania Checklist-32, second revision (HCL-32-R2) in mood disorder patients. METHODS: A total of 454 patients who diagnosed as mood disorder according to Structured Clinical Interview for DSM-IV Axis I Disorders, clinician version (SCID-CV) (bipolar disorder [BD] I, n=190; BD-II, n=72; and major depressive disorder [MDD], n=192) completed the Korean module of the HCL-32-R2 (KHCL-32-R2). RESULTS: The KHCL-32-R2 showed a three-factorial structure (eigenvalue >2) that accounted for 43.26% of the total variance. Factor 1 was labeled “active/elated” and included 16 items; factor 2, “irritable/distractible” and included 9 items; and factor 3 was labeled “risk-taking/indulging” and included 9 items. A score of 16 or more on the KHCL-32-R2 total scale score distinguished between BD and MDD, which yielded a sensitivity of 70% and a specificity of 70%. MDD and BD-II also could be differentiated at a cut-off of 15 with maximized sensitivity (0.67) and specificity (0.66). Cronbach’s alpha of KHCL-32-R2 and its subsets (factors 1, 2, and 3) were 0.91, 0.89, 0.81 and 0.79, respectively. Correlations between KHCL-32-R2 and Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale and Korean version of Mood Disorder Questionnaire were −0.66 (p=0.41), −0.14 (p=0.9), and 0.61 (p < 0.001), respectively. CONCLUSION: The KHCL-32-R2 may be a useful tool in distinguishing between bipolar and depressive patients in clinical settings.

Screening of Bipolar Disorders in High School Students / 신경정신의학

OBJECTIVES: This study aimed to assess the prevalence of bipolar spectrum disorders among Korean high school students (individuals in late adolescence) using the Korean version of the Mood Disorder Questionnaire (K-MDQ). METHODS: Two thousand male and female participants were proportionately selected from among high school students nationwide. From November 2007 through February 2008, we conducted an epidemiological survey of, and administered the K-MDQ to, these participants, assessed their psychometric properties, and compared characteristics between K-MDQ-positive and K-MDQ-negative participants. RESULTS: The K-MDQ's internal consistency (Cronbach's alpha) was 0.74. The item-total score correlations ranged from 0.35 to 0.57, and all were statistically significant (p<.001). Factor analysis with varimax rotation revealed 3 factors that explained 42.6% of total variance. We found the cutoff endorsement of the K-MDQ score (7 or more in criteria 1) in 1207 students (60.4%) and found 104 (5.2%) subjects were K-MDQ-positive, meeting all 3 K-MDQ criteria. The mean K-MDQ total score was 7.2+/-2.9 and total scores of K-MDQ-positives and K-MDQ-negatives were 9.9+/-1.7 and 7.0+/-2.9, respectively. K-MDQ-positives and K-MDQ-negatives showed no differences in the sociodemographic variables we assessed. Endorsement of items in total subject ranged from 15.7% to 77.7%. All items except item 8 (more energy) differed significantly in endorsement between K-MDQ-positives and K-MDQ-negatives. Items accounting for over 30% of the endorsement differences between K-MDQ-positives and K-MDQ-negatives were"feel so good," "so irritable," and"excessive, foolish, risky behavior." CONCLUSION: The K-MDQ was a relatively valid screening tool for Korean high school students. Per the result of the K-MDQ survey, suspected lifetime prevalence of bipolar spectrum disorders for those in late adolescence (high school students) seems to be 5.2%, suggesting that systemic screening for bipolar spectrum disorder should be required for this age group.

Genetic Polymorphism of Endothelial Nitric Oxide Synthase in Korean Schizophrenic Patients / 신경정신의학

OBJECTIVES: Although genotype of endothelial nitric oxide synthase has been investigated in many neuropsychiatric disorders, results were controversial and even contradictory. The purpose of this study was to investigate the nature of endothelial nitric oxide synthase in Korean schizophrenic patients, and compare it with healthy control group in terms of distribution of e genotype and allele frequency of endothelial nitric oxide synthase. METHODS: Using polymerase chain reaction and amplified refractory mutation system, endothelial nitric oxide synthase genotypes were identified in 77 schizophrenics and 121 healthy controls. RESULTS: 1) When genotypes of endothelial nitric oxide synthase were classified as a/a, a/b, b/b, there was no statistical difference in genotypes between the two groups. 2) In terms of allele frequency, there was also no statistical difference between the two groups. CONCLUSION: These results suggest that endothelial nitric oxide synthase gene seem to be unrelated to the pathogenesis of schizophrenia in Korean population.

A Case of Olanzapine Treatment in a Pregnant Woman with Bipolar Disorder / 대한정신약물학회지

Our report focuses on the case of a pregnant woman with bipolar disorder, manic episode. The patient was treated with olanzapine from the 24th gestational week until delivery and during breast feeding. No adverse events occurred during pregnancy, and the outcome was healthy.

A Case of Olanzapine Treatment in a Pregnant Woman with Bipolar Disorder / 대한정신약물학회지

Our report focuses on the case of a pregnant woman with bipolar disorder, manic episode. The patient was treated with olanzapine from the 24th gestational week until delivery and during breast feeding. No adverse events occurred during pregnancy, and the outcome was healthy.

Treatment of Obsessive Symptoms in Schizophrenic Patient with a Risperidone-Fluoxetine Combination / 대한정신약물학회지

Recent studies have reported that obsessive-compulsive (OC) symptoms are highly prevalent in schizophrenia, and schizophrenic patients with OC symptoms have a poorer clinical course compared to those without OC symptoms. In spite of many previous case reports, treatment of OC symptoms in schizophrenia has not been systematically studied. We report a patient with chronic schizophrenia who had obsessive symptoms such as bizarre, stereotyped behaviors. Treatment with olanzapine and risperidone, resulted in partial response for his psychotic symptoms, respectively. The obsessive symptoms, however, persisted and fluoxetine was added to the risperidone regimen. After 4 weeks of combination treatment, fluoxetine was titrated up to 80 mg/day and his obsessive symptoms became less in frequency and intensity. After 7 weeks on combination treatment of risperidone and fluoxetine, obsessive symptoms resulted in a significant reduction. On the 20 months of following, he remained in a recovered state and had been treated with risperidone 4 mg/day, and fluoxetine 20 mg/day.

A Case of Low dose Venlafaxine-Induced Hypertension / 대한정신약물학회지

Venlafaxine has a dose-dependant effect on blood pressure that is clinically significant at high dose. But the cases of hypertension associated with low dose venlafaxine have been rarely reported. We experienced a case of low dose venlafaxine-induced hypertension in a 53 year-old woman with major depressive disorder who has never been diagnosed as hypertension and other medical diseases. We started venlafaxine administration at a dose of 37.5 mg/day, and on the first day of venlafaxine administration, her blood pressure was abruptly elevated. Regardless of hypertension, venlafaxine was adjusted up to 112.5 mg/day for her depressive symptoms. Hypertension was continued, but not controlled by antihypertensive medication. We thought that she had a venlafaxine-induced hypertension, so we stopped this medication. Elevated blood pressure was normalized 2 days after stopping venlafaxine administration. Her blood pressure has been within normal range without antihypertensive medication for 9 months. So we report this case with the review of the literatures on the venlafaxine-induced hypertension.