Severity of Comorbidities among Suicidal Attempters Classified by the Forms of Psychiatric Follow-up / 정신신체의학

OBJECTIVES: Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. METHODS: One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. RESULTS: Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. CONCLUSIONS: Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

Association of Norepinephrine Transporter Gene and Side Effects of Osmotic-Release Oral System Methylphenidate in Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The aim of our study was to investigate association of norepinephrine transporter gene (SLC6A2) polymorphism and side effects of osmotic-release oral system methylphenidate (OROS MPH) in children with attention-deficit hyperactivity disorder (ADHD). METHODS: We recruited drug naive children with ADHD (N=97). We administered OROS MPH by tolerable dosage. At week 8 of treatment, parents completed the Barkley's side effect rating scale. We analyzed two SLC6A2 single nucleotide polymorphisms (SNPs), rs192303 and rs3785143, with blood of subjects. We compared the frequency and severity of each side effect among SLC6A2 genotypes of 2 SNPs. RESULTS: In the analysis of frequency of each side effect, irritability differed according to rs192303 and rs3785143 genotype. In comparisons of severity, talking less and disinterest differed according to rs192303 genotype. In the case of rs3785143, severities of disinterest and irritability were involved with genotype. CONCLUSION: Side effects of OROS MPH showed an association with SLC6A2 genotype.

Silicosis Caused by Chronic Inhalation of Snail Shell Powder

A 70-yr-old woman visited our hospital for shortness of breath. Chest CT showed ground glass opacity and traction bronchiectasis at right middle, lower lobe and left lingular division. Video-assisted thoracic surgical biopsy at right lower lobe and pathologic examination revealed mixed dust pneumoconiosis. Polarized optical microscopy showed lung lesions were consisted of silica and carbon materials. She was a housewife and never been exposed to silica dusts occupationally. She has taken freshwater snails as a health-promoting food for 40 yr and ground shell powder was piled up on her backyard where she spent day-time. Energy dispersive X-ray spectroscopy of snail shell and scanning electron microscopy with energy dispersive x-ray spectroscopy of lung lesion revealed that silica occupies important portion. Herein, we report the first known case of silicosis due to chronic inhalation of shell powder of freshwater snail.

Risk Factors Associated with the Development and the Course of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: The aim of this study was to analyze the clinical variables associated with the occurrence, duration, and severity of alcohol withdrawal delirium (AWD) in patients with alcohol dependence. METHODS: We conducted a retrospective case-control study in alcohol dependent inpatients admitted to the psychiatric department, between 2006 and 2012 (n=863). Multivariable logistic and linear regression models were used for analysis of risk factors associated with development of AWD and the duration of illness, respectively. And multivariable logistic regression models were applied for assessment of risk factors associated with seclusions or physical restraints, which reflect the severity of AWD. RESULTS: Significant predictors for the occurrence of AWD included higher body temperature, lower platelet count, lower serum potassium, higher drinking amount, history of AWD, and history of head trauma or structural brain lesion. Variables associated with prolongation of delirium included higher body temperature, higher drinking amount, and less use of benzodiazepine during the AWD episode. Significant predictors for severe AWD included higher systolic blood pressure, longer duration of harmful alcohol use, and higher drinking amount. CONCLUSION: Easily determinable parameters, such as vital signs and past history related to drinking are significantly associated with not only development of AWD, but also its severity and duration. Therefore, when initially assessing alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent occurrence of risky withdrawal delirium and behavioral problems.

H1N1 Influenza/A Associated ARDS Recovered without Mechanical Ventilatory Support: A Case Report / 대한구급학회지

An eighteen year-old female visited the ER in our hospital with fever of 38.5degrees C for 2 days. She also had cough, myalgia, and dyspnea. Chest PA and lung HRCT showed mild pulmonary edema at both hilar areas. However, she had severe hypoxia (PaO2; 58 mmHg in room air). RT-PCR for H1N1 influenza/A of pharyngeal swab was positive. Tamiflu (150 mg/d) with broad-spectrum antibiotics was prescribed. Two days later, her dyspnea aggravated and chest PA showed diffuse bilateral infiltration. PaO2 dropped to 70 mmHg (O2 10 L/min by face mask with reservoir bag). She was transferred to the MICU and the Tamiflu dose was doubled (300 mg/day). Mechanical ventilator was set aside to prepare respiratory failure. Fortunately, her symptoms and oxygenation improved and she was discharged with full recovery. Although, most cases of ARDS require mechanical ventilatory support, early and adequate dose of Tamiflu may avoid it in the case of ARDS developed by H1N1 influenza/A.

The Relationship between Late-Onset Depression and Alzheimer's Disease

OBJECTIVES: With the elderly population rising sharply, there is a rising interest in dementia, and recently researches on risk factors for dementia, particularly of Alzheimer's disease have been actively conducted. The purpose of this research is to examine the effect of the late-onset depression as a risk factor for Alzheimer's disease. METHODS: The subjects were divided into the group of the patients who were diagnosed with depression in the National Health Insurance Corporation Ilsan Hospital from March 1, 2000 to December 31, 2009 and the corresponding control group, which was the group of the patients who were diagnosed with osteoarthritis for the same period. Of the above patients, the following cases were excluded from the final analysis. The excluded cases were those who were first diagnosed with either of the two diseases at the age of less than 50, and those who were diagnosed with major psychiatric disorder or neurologic disorder. As a result, a total of 5,347 people, made up of 1,697 depression patients and 3,650 osteoarthritis patients, were selected. Two groups were compared through survival analysis. RESULTS: Form the Log-Rank tests, it could be confirmed that there were significant differences (p<0.01) among the two groups. Even when many confounding factors including age and gender were controlled, the degree of occurrence of Alzheimer's disease was found to be higher in the group of late-onset depression patients than in the group of osteoarthritis patients (HR : 2.53-2.80). CONCLUSION: The late-onset depression can become independently the risk factor for Alzheimer's disease. Therefore it can be expected that the rate of occurrence of Alzheimer's disease may be reduced through active medical treatment of depression.

Cell Differentiation Might Predict the Recurrence in Surgically Resected Non-Small Cell Lung Carcinoma / 결핵및호흡기질환

BACKGROUND: Lung cancer is the most common cause of cancer mortality in Korea. The TNM stage at presentation in patients with non-small cell lung cancer (NSCLC) has the greatest impact on prognosis. Patients who undergo a complete resection for NSCLC are likely to develop recurrent and/or metastatic disease. There are several factors influencing the development of recurrence. We explored risk factors of recurrence in patients with stages I and II NSCLC, who had undergone curative resection. METHODS: We reviewed patients who had complete surgical resection as definitive treatment for stage I or II. Patients followed up for more than 36 months. We evaluated several factors which might have relationship with recurrence, such as patient's demographic factors, TNM staging, pathologic finding, tumor markers and surgical technique. RESULTS: A total of 75 patients were enrolled for analysis, of whom 58 were men and 17 were women with mean age of 61 (range, 37 to 76) years. The average size of tumors was 3.9 cm (0.7 to 10 cm). There were 64 patients with stage I NSCLC and 11 with stage II NSCLC. Among 64 patients with stage I NSCLC, 35 patients showed recurrences whereas 8 patients have recurred in stage II NSCLC. Grade of differentiation of tumor was closely related to the recurrence. Seventy-five percent of patients who had poor tumor differentiation experienced a recurrence. In contrast, 3 patients of twelve had recurrences, who revealed differentiation in their tissue (p<0.05). CONCLUSION: Tumor differentiation could be a predictive factor for tumor recurrence in patients who have undergone curative resection for stage I or II NSCLC.

The Effect of Epigallocatechin-3-gallate on HIF-1alpha and VEGF in Human Lung Cancer Cell Line / 결핵및호흡기질환

BACKGROUND: Epigallocatechin-3-gallate (EGCG) is the major catechin in green tea, and has shown antiproliferative, antiangiogenic, antimetastatic and cell cycle pertubation activity in various tumor models. Hypoxia can be induced because angiogenesis is insufficient for highly proliferating cancer. Hypoxia-inducible factor-1alpha (HIF-1alpha) and its downstream target, vascular endothelial growth factor (VEGF), are important for angiogenesis, tumor growth and metastasis. The aim of this study was to determine how hypoxia could cause changes in the cellular phenomena and microenvironment in a non-small cell culture system and to examine the effects of EGCG on a HIF-1alpha and VEGF in A549 cell line. METHODS: A549 cells, a non-small cell lung cancer cell line, were cultured with DMEM and 10% fetal bovine serum. A decrease in oxygen tension was induced using a hypoxia microchamber and a CO2-N2 gas mixture. Gas analysis and a MTT assay were performed. The A549 cells were treated with EGCG (0, 12.5, 25, 50 micromol/L), and then examined by real-time-PCR analysis of HIF-1alpha, VEGF, and beta-actin mRNA. RESULTS: Hypoxia reduced the proliferation of A549 cells from normoxic conditions. EGCG inhibited HIF-1alpha transcription in A549 cells in a dose-dependent manner. Compared to HIF-1alpha, VEGF was not inhibited by EGCG. CONCLUSION: HIF-1alpha can be inhibited by EGCG. This suggests that targeting HIF-1alpha with a EGCG treatment may have therapeutic potential in non-small cell lung cancers.

The Usefulness of Whole-blood Interferon-gamma Release Assay for the Diagnosis of Extra-pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). METHODS: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. RESULTS: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. CONCLUSION: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.

Efficacy and Safety of Long-term Aripiprazole Therapy in Patients with Schizophrenia, Schizophreniform Disorder, and Schizoaffective Disorder: A 52-week, Prospective, Open-label Study / 대한정신약물학회지

OBJECTIVE: We investigated the long-term efficacy, safety, and tolerability of aripiprazole in a large number of patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder in Korea. METHODS: This was an open-label, multi-center, single-arm, 52-week study of patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder. Korean patients (N=300) experiencing either a first episode or recurrence participated in this study. The primary efficacy measure was the Positive and Negative Syndrome Scale (PANSS) total score. Secondary efficacy measures included the PANSS positive and negative subscales, and the Clinical Global Impression-Severity of Illness (CGI-S). Safety was evaluated prospectively by recording treatmentemergent adverse events; measuring extrapyramidal symptoms (EPS), vital signs, and body weight; and performing laboratory tests. RESULTS: Overall, 55 (18.33%) of the patients completed the entire 52-week study. Treatment with aripiprazole provided rapid and significant improvement in all of the efficacy measures. Comparing PANSS total scores, PANSS positive subscale scores, and CGI-S scores, first-episode patients showed significant improvement than the patients who had experienced at least one recurrence. There were no significant differences in the mean change of EPS during the study, except for akathisia at week 8 and a significant decrease in serum prolactin level in patients experiencing first and recurrent episodes. At the end of the study, the mean weight gain was 2.40 kg. CONCLUSION: Aripiprazole is effective and safe for patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder during a long-term, 52-week treatment. The result may be associated with the unique mechanism of aripiprazole. We have extended the findings of previous studies in the United States and other countries and demonstrated a similar effectiveness of aripiprazole for Korean patients.

A Study on Relapse Predictors in Korean Alcohol-Dependent Patients: A 24 Weeks Follow up Study

OBJECTIVES: The aim of this prospective study is to investigate predictors estimating relapse in Korean alcohol-dependent patients using variables like alcohol history, drinking craving, treatment motivation and insight. METHODS: Alcohol dependent patients(N=48) who completed questionnaires about sociodemographic variables and drinking history, Timeline Follow-Back(TLFB), Obsessive-Compulsive Drinking Scale(OCSD), Alcohol Urge Questionnaire(AUQ), Pennsylvania Alcohol Craving Scale(PACS), University of Rhode Island Change Assessment(URICA), Hanil Alcohol Insight Scale(HAIS) were followed-up for 24weeks. Subjects who drank heavily(5 standard drinking or more/day) or were not followed up anymore were classified as the relapse group. We used logistic regression analysis with backward elimination of SPSS PC+11.5 to investigate relapse estimate predictors. RESULTS: Average drinking amount per drinking day for last 1 year and HAIS score were predictors of relapse in alcohol-dependent patients. CONCLUSIONS: Our findings suggest that therapist should give more attention to alcohol-dependent patients who had more drinks per drinking day for last 1 year and had lower insight level.

Non-Relapse Rate in a 24 Week Follow-up Clinical Study with Korean Male Alcohol-Dependent Patients / 신경정신의학

OBJECTIVES: In order to provide useful data for the further clinical studies with Korean alcohol-dependent patients, enrollment and non-relapse rates were investigated while alcohol-dependent patients were followed up for 24 weeks. METHODS: The subjects of this study were alcohol-dependent male patients who, for the first time, visited a hospital among 3 groups of hospitals, University Hospital, General Hospital or Mental Hospital, or those who needed to be followed up after discharge from those hospitals. After assigning 12 subjects to each hospital, we investigated enrollment and non-relapse rates while cognitive-behavioral therapy and pharmacotherapy were provided. RESULTS: 1) Forty-eight patients were enrolled and the rate of enrollment was 36.4%. The enrollment rate in the University Hospital group was 52.1%, in the General Hospital group 50.0%, and in the Mental Hospital group 10.4%. 2) In 48 patients, non-relapse rate was 27.1% at 12 week and 18.8% at 24 weeks after starting follow-up. It was 24.4% and 20.0% at 12 and 24 weeks, repectively, in the University Hospital group while the General Hospital group showed 33.3% and 16.7%, respectively, and the Mental Hospital Group showed 20.0% at both 12 and 24 weeks. CONCLUSION: These results provide important data for further clinical studies of Korean alcohol-dependent patients.

The Biology of Alcohol Dependence

Alcohol dependence (AD) is a chronically relapsing disease and has various biological etiologies. Neither genetics nor neurobiology explains the pathogenesis of AD exclusively. AD is a multifactorial disease. This article reviews the genetic and biological aspects of AD. Many candidate genes and neurotransmitters play important roles in AD. Further studies are needed to elucidate the biological mechanisms of AD. Also the treatment of AD should be individualized according to the patients's biological characteristics.

Differences of Photographs Inducing Craving Between Alcoholics and Non-alcoholics

Many researchers have used cue reactivity paradigm to study alcohol craving. But the difference of craving response to drinks between alcoholic patients and social drinkers was little evaluated. To investigate characteristics of alcohol-related visual cues which induce alcohol craving in alcoholism, we examined the response of subjects to alcohol-related cues considering qualitative aspects. The authors developed 27 photographs related to alcohol as candidate visual cues. Thirty five patients with alcohol dependence, 35 heavy drinkers and 35 social drinkers were shown these pictures and asked to rate these 6 pictures in order of inducing alcohol craving the most. 'A glass of Soju' and 'A Party scene' were chosen as the alcohol-related visual cues which induced craving the most in the patients and heavy drinkers, respectively. The results suggest that the patients with alcohol dependence are more absorbed by alcohol without drinking context such as an atmosphere or situation involving drinking. Heavy drinkers may experience craving in anticipation of being in a drinking situation.

Neuroimaging in Alcohol use Disorder / 신경정신의학

With the structural and functional neuroimaging studies on alcohol use disorders, the neurobiology of alcohol use disorder can now be directly measured in vivo. This article reviews the findings of structural and functional neuroimaging studies related to alcohol use disorder. Issues about intoxication, dependence, withdrawal, abstinence, organic change induced by chronic alcohol use, neurochemistry and craving are discussed and its clinical implications and future direction of neuroimaging studies are also suggested.

Neurophysiological Measurement of Alcohol Craving Using Visual Event-Related Potential / 신경정신의학

OBJECTIVES: Alcohol craving, is not only the most common symptom but the key element in alcohol dependence. The aim of this study is to measure ERPs, especially P3 elicted by alcohol related photographs in order to assess the craving in alcohol dependent patients. METHODS: Based on the result of previous study, 6 alcohol related photographs and 6 control photographs were chosen as visual stimuli. Each stimuli set consisted of alcohol related or control photographs as target stimuli and the same sized checkerboards as non-targets. Stimuli were presented using oddball paradigm for 300 msec with an inter-stimulus interval of 1000 msec in 12 normal controls and 16 abstinent alcohol dependent patients. One session consisted of three blocks; exercise block, control block, alcohol craving block. RESULTS: The amplitudes of P3 elicited by alcohol related visual stimuli were significantly larger than those of P3 elicited by control stimuli in alcohol dependent patients while there was no significant difference in normal controls. CONCLUSION: Consistent with the hypothesis, only alcohol-dependent patients were characterized by increased P3 amplitude associated with alcohol-realted visual stimuli compared with control stimuli. The results suggest the ERPs can be used as a neurophysiological correlate of alcohol craving in alcohol dependent patients. Future investigations will be needed to assess the relapse in the patients included in this study in order to elucidate the meaning of the increased P3 amplitude.

Verbal and Visuo-Spatial Working Memory Impairments in Patients with Alcohol Dependence / 대한정신약물학회지

OBJECTIVE: Although alcohol dependence is associated with a wide range of cognitive impairment, working memory function of alcohol dependence has not been well studied. The aim of this study was the assessment of working memory in alcohol dependence, the comparison of verbal and visuo-spatial working memory, and the examination of the correlations between working memory and clinical parameters. METHODS: A sample of 18 sober alcohol-dependent participants was compared with a sample of 19 controls on verbal and visuo-spatial working memory test using "2-back" system. RESULTS: Alcohol dependent participants showed the increased errors of verbal working memory. The amount of alcohol consumption during problem alcohol drinking period was correlated significantly with false positive error of verbal working memory. CONCLUSION: These results demonstrated that alcohol dependence impairs verbal working memory despite no impairment of intelligence. This study suggested the relationship between verbal working memory impairment and the amount of alcohol consumption.

Development of the Alcohol-Related Visual Stimuli Inducing Alcohol Craving / 신경정신의학

OBJECTIVES: Craving is the subjectively experienced motivational states inducing ongoing drug use in addicts. It also proceeds or precipitates relapse episode in drug addicts. Alcohol craving may be triggered by exposure to an object, environment, or emotion that a person has come to associate with alcohol consumption. Such stimuli are called alcohol-related cues. Among alcohol-related cues, alcohol-related visual stimuli are simple and reliable methods in inducing alcohol craving. The object of this study is to develop alcohol-related visual stimuli which induce alcohol craving reliably and to investigate the characteristics of alcohol-related visual stimuli in alcoholics. METHODS: First, the authors developed 27 alcohol and drinking color photos as candidate stimuli. Then, 3 photos which induce alcohol craving most were chosen as alcohol-related visual stimuli respectively by alcoholics, alcoholism high risk group and normal control group. The authors compared characteristics, situation and complexity of selected alcohol-related visual stimuli among three groups. RESULTS: 1) 'A glass of Soju', 'Drinking together' and 'A glass of beer, a bottle of beer and a sidedish' were chosen as alcohol-related visual stimuli which induce most craving in alcoholics, alcoholism high risk group and normal control group respectively. 2) Alcohol photo(stationary object) induced craving most in alcoholics in contrast with drinking photo(situation) in social drinkers. Alcoholics clung to alcohol per se, not to atmosphere or situation of drinking, and alcoholism high risk group felt craving by the expectation of drinking situation. Normal control group showed no consistent finding in choosing alcohol-related visual stimuli. CONCLUSION: With these results, the author suggests classical conditioning as psychopathological model of alcohol craving with alcoholics. In contrast with alcoholics, alcohol craving of alcoholism high risk group may be related to alcohol specific memory or positive expectancies about alcohol use. These finding may support different neurobiological mechanisms of alcohol craving between alcoholics and social drinkers.

Short-term Plan of Journal of Korean Neuropsychiatric Association / 신경정신의학

No abstract available.

The Study on Reliability and Validity of Korean Versions of Obsessive Compulsive Drinking Scale for Outpatient of Alcohol Dependence / 신경정신의학

OBJECTIVES: This study is to examine the efficacy and the limitation of translated Korean version of the Obsessive-compulsive Drinking Scale. The Korean version of the scale is to be used for treatment and research on alcoholism. METHODS: This study was carried out to examine reliability and validity of the translated Korean version of the Obsessive-compulsive Drinking Scale. One hundred forty two out-patient alcohol dependence subjects were measured of their cognitive and behavioral aspects of craving with this scale. RESULTS: For 142 tested alcoholic subjects, internal consistency among 14 items of the Obsessive-compulsive Drinking Scale was 0.8947(Crohnbach's alpha). For 40 detoxified alcoholics, test-retest reliability of total score of the Korean version of the Obsessive-compulsive Drinking Scale was 0.76 (correlation coefficient, p<0.01). In 131 alcoholic subjects, validity of total score of the Korean version of the Obsessive-compulsive Drinking Scale was examined by correlation analysis with visual analogue scale (VAS). Correlation coefficient was 0.52 with VAS. Especially, correlation coefficient of compulsive subscale of the Korean version of the Obsessive-compulsive Drinking Scale was 0.61 with VAS. The total score of the Korean version of the Obsessive-compulsive Drinking Scale which was analyzed by repeated measure analyses of variance during 8 weeks was significantly different between the relapse group and the abstinence group. CONCLUSION: The Korean version of the Obsessive-compulsive Drinking Scale shows very similar psychometric performance to the original Obsessive-compulsive Drinking Scale developed by Anton. The Korean version, therefore, is an useful instrument that reflects characteristic drinking behaviors of alcoholics.