Changes of Plasma Adiponectin Levels after Smoking Cessation

OBJECTIVE: Cigarette smoking is associated with a variety of health problems including cardiovascular, pulmonary, neoplasms, endocrinopathies including diabetes, the metabolic syndrome, and chronic inflammation. Adiponectin is an adipocyte-derived plasma protein that is closely associated with insulin sensitivity and the metabolic syndrome. The aim of this study was to evaluate the changes of plasma adiponectin levels after smoking cessation. METHODS: Thirty seven smokers that wanted to stop smoking without any nicotine replacement therapy or medication were recruited for this study. Fifteen smokers succeeded in stopping smoking (validated by urine cotinine levels < or =50 ng/mL) and 22 smokers failed. Therefore, only the 15 that succeeded were included in the analysis. The plasma adiponectin levels were determined using a commercially available enzyme-linked immunosorbent assay. RESULTS: The mean age of the successful 15 was 35+/-9.3 years old. They were all males. The daily smoking habit was a mean of 13.5+/-5.4 cigarettes per day. The mean Nicotine Dependence Syndrome Scale (NDSS) and Fagerstrom Test for Nicotine Dependence (FTND) scores were 55.6+/-9.6 and 2.9+/-1.9. During the study period of three months, the mean body mass index (BMI), body fat mass (BFM), waist-hip ratio (WHR) and body weight increased by 1.1 kg/m2, 3.0%, 0.02%, and 2.9 kg, respectively. The baseline mean adiponectin level in the subjects was 11.9+/-5.2 mg/L. The mean adiponectin levels measured at one and three months were 16.0+/-5.1 mg/L and 14.7+/-4.5 mg/L respectively. The mean plasma adiponectin levels of the successful group was significantly increased after four weeks when compared to the baseline (z=-2.401, p=0.016). However, the decrease in plasma adiponectin levels at one and three months was not statistically significant. CONCLUSION: Even though the decrease over the next two months was not significant, these findings, the increase of plasma level of adiponectin after smoking cessation, provide preliminary data for future research on the possible mechanisms associated with smoking cessation and changes in body metabolism.

Genetic Association of CHRNB3 and CHRNA6 Gene Polymorphisms with Nicotine Dependence Syndrome Scale in Korean Population

OBJECTIVE: Cholinergic nicotinic receptor (CHRN) gene family has been known to mediate the highly additive effects of nicotine in the body, and implicated nicotine dependence (ND) and related phenotypes. Previous studies have found that CHRNA6-CHRNB3 cluster polymorphisms were significantly associated with the risk of ND and various tobacco behaviors. The aim of study was to evaluate the genetic association of CHRNB3 and CHRNA6 polymorphisms with the risk of ND based on the Fagerstrom Test for Nicotine Dependence (FTND) score and five subscales of nicotine dependence syndrome scale (NDSS) in Korean population. METHODS: Six SNPs in CHRNA6-CHRNB3 cluster were analyzed in 576 Korean subjects. Association analysis using logistic models and regression analysis with NDSS were performed. RESULTS: There was no association in the case-control analysis, whereas all six SNPs were significantly associated with drive factor among NDSS in subgroup based on the FTND score. CHRNB3 rs4954 and CHRNA6 rs16891604 showed significant associations with NDSSF1 (drive) in dominant models among moderate to severe ND among smokers after correction (p(corr)=0.02 and 0.001, respectively), whereas other four SNPs showed significant associations among mild ND after correction (p(corr)=0.03-0.02 in dominant model). CONCLUSION: This study showed that the genetic influence of CHRNB3-CHRNA6 cluster polymorphisms are found in a ND endophenotype (drive) using NDSS subscales, rather than the risk of ND in Korean population. Our findings might be the first report for the association of CHRNB3-CHRNA6 cluster with ND-related phenotypes in Korean and might offer an approach to elucidating the molecular mechanisms of ND and ND-related phenotypes.

Clinical Characteristics of Vascular Depression in Korean Elderly People / 신경정신의학

OBJECTIVES: This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. METHODS: A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. RESULTS: Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. CONCLUSION: Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group.

Screening for Depression in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review / 대한내과학회지

BACKGROUND/AIMS: Chronic obstructive pulmonary disease (COPD) often coexists with co-morbid conditions that significantly affect the prognosis. Although depression frequently coexists with COPD, little about how to screen for depression in COPD patients is known. We report the effectiveness of depression screening in patients with COPD and of the instruments used for this purpose. METHODS: We performed a systematic literature review of the domestic (Research Information Sharing Service, KoreaMed, and Kmbase) and international (Medline, Embase, Cochrane library) databases using "COPD AND depression AND screening tools" as key words. RESULTS: No study directly evaluated the effectiveness of screening for depression in COPD patients. However, depression was present more frequently in patients with COPD. COPD patients with depression were also more likely to be in poor health. A total of eight screening instruments for depression were translated into Korean. All had similar reliabilities and internal consistencies. CONCLUSIONS: Screening of COPD patients for depression is necessary because individuals with this condition are more likely to suffer from depression, which has a negative impact on health. The choice of depression screening instruments may need to be based on considerations of simplicity.

Reliability and Validity of the Korean Version of the Cornell Scale for Depression in Dementia

OBJECTIVE: The aim of this study was to explore the reliability and validity of the Korean version of the Cornell Scale for Depression in Dementia (CSDD-K), a scale for assessment of depression in dementia. METHODS: The original CSDD was translated into Korean and the content was verified through back-translation procedures. This study included 59 depressive patients with Alzheimer's disease (AD), 62 non-depressive patients with AD and 36 healthy elderly controls. The subjects were assessed using CSDD-K, the 17-item Hamilton Depression Rating Scale (HAM-D17), the 15-item Korean version of Geriatric Depression Scale (GDS15) and the Korean version of Mini-mental Status Examination (MMSE-K). RESULTS: In the reliability test, Cronbach's alpha coefficient and test-retest reliabilities were 0.92 and 0.91, respectively, indicating that the CSDD-K has good internal consistency. There were significant differences in CSDD-K total scores between AD patients with depression and AD patients without depression (p<0.001). In the analysis of the concurrent validity of the CSDD-K, there were significant correlations between the CSDD-K and HAM-D17 (r=0.91, p<0.001) and between the CSDD-K and GDS15 (r=0.75, p<0.001). ROC curve analysis identified a cut-off score of 7 for the CSDD-K, where the sensitivity was 87.5% and the specificity was 100%. Factor analysis resulted in a four-factor solution accounting for 63.8% of the common variance. CONCLUSION: The CSDD-K showed good reliability and validity for the assessment of depressive symptom severity in AD patients. The CSDD-K is a useful instrument for assessing AD patients with depressive symptoms in Korean ethnic population.

Biomarkers for Alzheimer's Dementia : Focus on Neuroimaging

Recent advances in brain imaging research are remarkable. Among them, many results from a variety of neuroimaging modalities in Alzheimer's dementia accompanied by the development and growing of imaging techniques have been presented in the research field. In this review we are focused on the imaging biomarkers for the Alzheimer's dementia to investigate the pathophysiologic mechanism. Future research on biomarkers for Alzheimer's dementia will provide more diverse and complex mechanisms or hypotheses than have been proposed in the current hypothesis about the pathogenesis of Alzheimer's dementia.

Effects of Smoking Cessation on Plasma Levels of Leptin, Ghrelin, Glucagon-Like Peptide 1, and Nerve Growth Factor

OBJECTIVES: It is well-known that tobacco smoking is related to various disease entities including chronic obstructive pulmonary disease, inflammation, cardiovascular disease, and neoplasms. The prohibition of smoking is important for the protection of these health problems. Regarding leptin, ghrelin, glucagon-like peptide 1 (GLP-1), and nerve growth factor (NGF) levels, correlations with the smoking are suggested but the reports on the effects after smoking cessation are not sufficient. METHOD: The changes of plasma levels of leptin, ghrelin, GLP-1, and NGF levels were analyzed after quitting smoking in Korean adults. Eleven participants succeeding in quitting smoking among 37 male smokers were included in the final analysis. The plasma levels of NGF, leptin, ghrelin, and GLP-1 were measured before and after 8-weeks period of smoking cessation. RESULTS: The plasma level of leptin increased after 4 weeks of smoking cessation. In addition, the plasma level of NGF increased after 8 weeks of smoking cessation (p < 0.05). CONCLUSION: Our results suggested that smoking cessation induces increases in leptin and the NGF level after smoking cessation. Many toxic materials including nicotine in the cigarette may be related to these changes of plasma level of leptin and NGF, playing a key role in neurogenesis and synaptic plasticity.

The Changes of Blood Glucose Control and Lipid Profiles after Short-Term Smoking Cessation in Healthy Males

OBJECTIVE: Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. METHODS: Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the beta-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). RESULTS: The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA beta-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). CONCLUSION: During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.

Psychiatric Evaluation and Intervention in a Weight Loss Surgery Program: A Review / 신경정신의학

OBJECTIVES: Weight loss surgery (WLS) is an effective treatment for morbidly obese patients. A pre- and postoperative multimodal team-based approach is essential for maximizing the efficacy of WLS. Although there is currently no standard psychiatric approach in WLS programs, this paper summarizes the value and methods of assessment and intervention suggested in the literature. METHODS: A Pubmed search of English-language reports (1985 to 2010) and a manual search of bibliographies of related papers were reviewed. Relevant clinical information was extracted. RESULTS: Patients receiving WLS show a substantial prevalence of psychopathology, including depression, anxiety, and eating disorders, and also impaired quality of life. Most psychiatric symptoms and impaired psychosocial functioning tend to be improved after WLS, and this improvement is one of the important goals of WLS besides weight loss. However, outcomes are not promising in all patients, and the literature suggests that some psychiatric variables have prognostic value. One of the most widely researched poor prognostic factors is postoperative binge eating disorder. The identification of vulnerable patients and the offer of an appropriate intervention may be critical for their future full recovery. CONCLUSION: There are several reasons why psychiatric evaluation and intervention are worthwhile in a WLS program. Further researches will be required for the establishment of prognostic psychological factors, their biological mechanisms, and clinical guidelines for psychiatric assessment and intervention.

Psychiatric Evaluation and Intervention in a Weight Loss Surgery Program: A Review / 신경정신의학

OBJECTIVES: Weight loss surgery (WLS) is an effective treatment for morbidly obese patients. A pre- and postoperative multimodal team-based approach is essential for maximizing the efficacy of WLS. Although there is currently no standard psychiatric approach in WLS programs, this paper summarizes the value and methods of assessment and intervention suggested in the literature. METHODS: A Pubmed search of English-language reports (1985 to 2010) and a manual search of bibliographies of related papers were reviewed. Relevant clinical information was extracted. RESULTS: Patients receiving WLS show a substantial prevalence of psychopathology, including depression, anxiety, and eating disorders, and also impaired quality of life. Most psychiatric symptoms and impaired psychosocial functioning tend to be improved after WLS, and this improvement is one of the important goals of WLS besides weight loss. However, outcomes are not promising in all patients, and the literature suggests that some psychiatric variables have prognostic value. One of the most widely researched poor prognostic factors is postoperative binge eating disorder. The identification of vulnerable patients and the offer of an appropriate intervention may be critical for their future full recovery. CONCLUSION: There are several reasons why psychiatric evaluation and intervention are worthwhile in a WLS program. Further researches will be required for the establishment of prognostic psychological factors, their biological mechanisms, and clinical guidelines for psychiatric assessment and intervention.

Pharmacological treatment of psychiatric disorders of the elderly

Psychiatric disturbances in the elderly are complicated. Dementia and depression are serious causes of global impairment in the elderly. Aging is characterized by a progressive functional impairment of multiple organs, a reduction of homeostatic mechanisms, and a changed sensitivity or capacity of neurotransmitter receptors. Understanding the influence of age-dependent changes in the composition and function of the body on the pharmacokinetics and pharmacodynamics of drugs is important before prescribing drugs to elderly patients. However, there is little clinical pharmacological information available to guide pharmacotherapy for late-life psychiatric disorders. Treatment of dementia is based on the cognitive decline and behavioral symptoms that accompany dementia. Currently prescribed antidepressants have similar efficacies but the side effect profiles vary. Comprehension of the normal aging process and understanding the characteristics of each of the psychotropics are essential in geriatric psychopharmacology. Up to the present, most studies are confirmations or reproductions of previous results on efficacy or safety. Future directions for psychopharmacological research should include discovering newer drugs, treatment of resistance or nonresponders, and combination or adjunctive therapies. This review focused on the geriatric pharmacokinetic/pharmacodynamic changes and clinical information regarding currently prescribed psychotropic medications.

Agreement between Self-Report on Smoking Cessation and Urinary Cotinine Test / 대한정신약물학회지

OBJECTIVE: Self-report is being used in most of studies investigating the therapeutic effect of smoking cessation clinics of public health centers in Korea instead of cotinine or other chemical markers of nicotine exposure. This study was conducted to evaluate the agreement between self-report and urinary cotinine test after smoking cessation program. METHODS: The study subjects were 333 adult male who visited public health center and participated in 12-week scheduled smoking cessation program. Questionnaires including demographic data and information about cigarette use, blood test, and urinary cotinine test were performed to all subjects during initial evaluation. At the end of the program, smoking status of subjects was assessed by an oral self-report and additional blood and urinary cotinine tests were done to the subjects who agreed. RESULTS: 52 participants who gave both self-report on smoking status and urine sample were included in the final analysis. The overall percentage agreement was 67.3%, and the overall Kappa index was 0.367. The sensitivity, specificity, positive predictive value, and negative predictive value of self-report in detecting smoking state were 46.43%, 91.67%, 86.67%, and 59.46%, respectively. CONCLUSION: The agreement between self-report and urinary cotinine test in detecting smoking status after smoking cessation program was relatively low on account of participants who failed to quit smoking but reported their smoking status incorrectly. Therefore, the use of objective measures such as urine cotinine should be considered in evaluation of successful smoking cessation.

An Optimized Voxel-Based Morphometry of Gray Matter Reduction in Patients with Alzheimer's Disease

OBJECTIVE:Optimized voxel based morphometry (VBM) has been increasingly applied to investigate differences in brain morphology between a group of Alzheimer's Disease (AD) patients and control subjects. Optimized VBM permits comparison of gray matter (GM) volume at voxel-level from the entire brain. The purpose of this study was to assess the regional GM volume loss measured by optimized VBM in AD compared to controls METHODS:Twenty-three AD patients and 20 cognitively normal elderly control subjects included in this study. To improve the VBM performance, the study specific template and the probability maps were generated from the control subjects. RESULTS:Optimized VBM analysis revealed GM loss, including hippocampus, amygdala, anterior cingulate, posterior cingulate, insula, frontal lobe and middle temporal complex in the AD group as compared to normal control group CONCLUSION:The VBM results confirmed previous findings of temporal lobe and limbic lobe atrophic changes in AD, and suggest that these abnormalities may be confined to specific sites within that lobe, rather than showing a widespread distribution.