Prevalence and prescription of antidepressants in depression with somatic comorbidity in Asia: the Research on East Asian Psychotropic Prescription Patterns study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Depression is often comorbid with chronic somatic diseases. Few previous studies have investigated the prevalence of somatic diseases in depression or the prescription pattern of antidepressants in comorbidly depressed patients in Asia. This study aimed to investigate the prevalence of somatic comorbidity (SC) in depression and compared the prescriptions of antidepressants in depressed patients with and without SC.</p><p><b>METHODS</b>A total of 2320 patients treated with antidepressants in 8 Asian countries were examined, and a diagnosis was based on the International Classification of Disease, 10 th revision. We listed 17 common chronic somatic diseases. Patients' socio-demographic and clinical characteristics and psychotropic drug prescriptions were recorded using a standardized protocol and data collection procedure.</p><p><b>RESULTS</b>Of the patients examined, 1240 were diagnosed with depression and 30% of them (n = 375) had SC. The most common comorbid condition was diabetes (23.7%). The patients with SC were more likely to seek help at a general hospital (74.7% vs. 47.2%), and had a higher incidence of symptoms involving sadness, disturbed sleep, and poor appetite. Noradrenergic and specific serotonergic antidepressant was prescribed more for patients with SC than for those without SC (30.4% vs. 22.9%).</p><p><b>CONCLUSIONS</b>SC is common in depressed Asian patients. It is important to strengthen the recognition of depression, especially in general hospitals and when patients report some somatic discomfort. It is also a matter of urgency to establish evidence-based guidelines for the use of new antidepressants in depressed patients with SC.</p>

Prevalence, Correlates, and Comorbidity of 12-Month Tobacco Dependence among Ever-smokers in South Korea, During 1984-2001

The rate of dependence among ever-users of a drug indicates the risk of developing dependence once an individual has been exposed to the drug. This is the first study to investigate 12-month tobacco dependence (TD) among ever-smokers in a community-based population. Analyses were based on two national studies of representative samples aged 18-64 in 1984 (n=5,025) and in 2001 (n=6,275), conducted with household visits and face-to-face interviews. The rates of 12-month TD among ever-smokers in men showed no significant difference between 51.6% in 1984 and 50.6% in 2001. On the contrary, the rates in women significantly increased from 33.3% in 1984 to 52.8% in 2001. After adjusting for the sociodemographic variables, 'male gender' was significantly associated with 12-month TD among eversmokers in 1984, but not in 2001. 'Unmarried' was significantly associated in 2001 but not in 1984. 'Alcohol dependence' was the only psychiatric disorder associated with 12-month TD in both study years. In conclusion, 12-month TD was found in about 50% of ever-smokers, and gender differences between the rates of 12-month TD which was observed in 1984 disappeared in 2001. Individuals with 12-month TD showed higher comorbidity with alcohol dependence than ever-smokers without TD.

Impact of Age at Onset of Menarche on Subsequent Courses in Women with Schizophrenia / 신경정신의학

OBJECTIVES: The protective effects of estrogen against the development of schizophrenia have been investigated in various perspectives. Previous studies showed patients with earlier age of menarche had later onset of schizophrenia and less frequent admissions. This study was performed to evaluate the effect of the age of menarche on subsequent courses including hospitalizations, suicidal attempts, physical harm to others, and psychotic symptoms in women with schizophrenia. METHODS: Self-report menarche age, onset of psychotic symptoms, and clinical status were collected in a sample of 108 premenopausal women with the diagnosis of schizophrenia. RESULTS: There was significant correlation between the age of menarche and the frequency of admissions (r=.321, p=.006). Also, patients with history of physical harms to others showed later age of menarche than those without (t=2.025, df= 106, p=.045). CONCLUSION: In women with schizophrenia, the age of onset of menarche affects subsequent courses indicated by frequency of admissions and violent behaviors. It is suggested that identifying the age of menarche might be helpful to predict the courses in women with schizophrenia. Further investigations regarding the relationship between estrogen and the courses of schizophrenia in women are needed.

Impact of Age at Onset of Menarche on Subsequent Courses in Women with Schizophrenia / 신경정신의학

OBJECTIVES: The protective effects of estrogen against the development of schizophrenia have been investigated in various perspectives. Previous studies showed patients with earlier age of menarche had later onset of schizophrenia and less frequent admissions. This study was performed to evaluate the effect of the age of menarche on subsequent courses including hospitalizations, suicidal attempts, physical harm to others, and psychotic symptoms in women with schizophrenia. METHODS: Self-report menarche age, onset of psychotic symptoms, and clinical status were collected in a sample of 108 premenopausal women with the diagnosis of schizophrenia. RESULTS: There was significant correlation between the age of menarche and the frequency of admissions (r=.321, p=.006). Also, patients with history of physical harms to others showed later age of menarche than those without (t=2.025, df= 106, p=.045). CONCLUSION: In women with schizophrenia, the age of onset of menarche affects subsequent courses indicated by frequency of admissions and violent behaviors. It is suggested that identifying the age of menarche might be helpful to predict the courses in women with schizophrenia. Further investigations regarding the relationship between estrogen and the courses of schizophrenia in women are needed.

Discrimination of Mentally Ill Persons in Korean Legislative System / 신경정신의학

OBJECTIVES: The review of Korean legislative system may contribute to minimize the stigma and prejudice related to mental illness. We tried to search and revise the sentences that dicriminate against the mentally ill or are incompatible to contemporary concept of psychiatry in all Korean laws. METHODS: While screening 5,626 laws which were promulgated till August 30th, 2002, we singled out the statutes including the stigma and prejudice related to mental illness in the homepage of the Ministry of Legislation. RESULTS: There were thirty-nine statutes discriminating against mental disorder. The number of statutes related to confering the certificate was 23. Nine laws stipulated to violate the right of psychiatric patients. Seven miscellaneous ones were judged for further evaluation. The most frequent terms used in legislation were 'mental illness' and 'psychosis'. 'Odd persons', 'impairment in mental function', and 'schizophrenia' followed in decreasing orders. Two delphi survey leaded to a tentative conclusion that terminology of 'psychosis' should be replaced by 'psychotic disorder with impaired reality testing'. Most of experts recommended to delete unnecessary clauses of laws to reduce misunderstanding about mentally ill. CONCLUSION: There exists the terms and expressions stipulating discrimination against mentally ill in Korean legislation. It is an urgent issue to revise the laws with experts' opinions in order to reduce prejudice and discrimination against mentally ill.

Korean Epidemiologic Catchment Area(KECA) Study for Psychiatric Disorderscc: Prevalence of Specific Psychiatric Disorders / 신경정신의학

OBJECTIVES: This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). METHODS: Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November 30, 2001. RESULTS: Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major depressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. CONCLUSION: The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed.

A Validation Study of Korean-version of Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS): Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) / 신경정신의학

OBJECTIVES: This study was conducted to develop the Korean version of Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS) for measuring neuroleptic side effects by self-rating method and to examine the reliability and validity in the schizophrenic patients medicated by neuroleptics and normal controls. METHODS: We made 51-item, 4-point scale of Korean version LUNSERS through translation, reverse translation and supervision by specialists. Sixty two schizophrenics diagnosed by DSM-IV criteria and medicated with neuroleptics completed LUNSERS twice with one week interval. Second LUNSERS and UKU side effect rating scale (UKU) by psychiatrist were administered to the schizophrenics at the same time. Normal controls also completed LUNSERS. RESULTS: The test-retest reliability (r=0.86, p<0.01) of LUNSERS and the concurrent validity (r=0.81, p<0.001) against UKU were good. But the neuroleptic doses and total scores of side effect items didn't show significant correlation. By the ROC curve analysis, the total scores of side effect items differentiated the medicated patients from non-medicated controls but not for the red herring items. CONCLUSION: Korean-version of LUNSERS has good reliability and validity. And it was also proved to be an useful assessment tool for measuring the extent of neuroleptic side effects systematically instead of UKU in clinical trials.

How Risperidone affect the Quality of Life in Schizophrenic Patients on Their Maintenance Treatment?: Single Open Long-Term Clinical Trial / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to evaluate how risperidone, a new atypical antipsychotics, affect the quality of life in schizophrenics on their maintenance treatment. METHODS: The authors selected 39 schizophrenic patients diagnosed by the criteria of DSM-IV. We investigated their sociodemographic data, clinical characteristics, laboratory examination, PANSS for psychopathology evaluation, and UKU side effect rating scale. Also the subjects were asked the KmSWN scale, which consists of 18 items and a 6-point score, three times for studying the effect on the quality of life in schizophrenics over 26-week period. For the assessment, the authors conducted repeated measures ANOVA to evaluate the differences of mean dose of risperidone, vital sign, weight, PANSS scores, and UKU side effect rating scores at period of baseline, 2-week, 14-week, and 26-week respectively. Also We used Pearson correlation coefficients to assess the relationship between KmSWN and PANSS scores, KmSWN and UKU side effect rating scores. RESULTS: The results were shown as follows : first, in clinical evaluation, we observed mild systolic pressure diminution and 2.3 kg of mean weight gain at 26-week period but did not detected abnormal blood glucose level ; second, we observed the significant reduction in PANSS and UKU side effect rating scores on risperidone treatment, but the change of subjective evaluation on quality of life did not reported ; third, the schizophrenic symptoms, particularly negative and general psychopathology symptoms, and side effects were correlated negatively with the subjective evaluation on quality of life in schizophrenic patients at 26-week period after risperidone treatment in the Pearson correlation analysis. CONCLUSION: The authors observed the significant reduction in PANSS and UKU side effect rating scores at 26-week compared to baseline period. As the negative and general psychopathology symptoms, and the side effects reduced, the subjective evaluation on the quality of life improved in schizophrenic patients.

A Preliminary Study for the Validation of the Korean Version of Psychogeriatric Assessment Scale / 신경정신의학

OBJECTIVES: This study was designed to develop the Korean version of the Psychogeriatric Assessment Scale(PAS-K), a multidimensional screening tool for the dementia and depression. METHODS: Through three times preliminary trials, the authors translated PAS into Korean. The PAS-K, Geriatric Depression Scale, Hamilton Depression Rating Scale, Hachinski Ischemic Scale and Mini-Mental State Examination-Korean version were administered to 291 subjects over the age of 60 and the same number of their informants(67 subjects were institutionalized, 168 subjects were in community, 58 subjects were psychiatric hospital patients). And the Diagnostic Interview Schedule (DIS-III-R) was independently administered to exactly diagnose dementia and depression. The reliability and validity test, optimal cut-off point estimation for six each scale and ROC curve analyses were done to investigate the diagnostic validity of PAS-K. RESULTS: Internal consistency and interrater reliability of the PAS-K were high. Concurrent validity of each scales of PAS-K was good in being measured with other standardized scales. The optimal cut-off points of each scale of the PAS-K were estimated as follows: 1) Stroke Scale of subject interview: 1, 2) Cognitive Impairment Scale of subject interview: 10, 3) Depression Scale of subject interview: 5, 4) Stroke Scale of informant interview: 1, 5) Cognitive Decline Scale of informant interview: 3, and 6) Behavioral Change Scale of informant: 2. CONCLUSIONS: The PAS-K was valid and reliable screening tools for detecting dementia and depression. Therefore the PAS-K could be widely and extensively used in psychogeriatric epidemiological research or clinical setting of primary screening for dementia and depression.

Neuroimaging of Vascular Dementia

Neuroimaging is a vascular and became an essential method to detecting and evaluating brain pathology. It is also important in evaluation of dementia, especially of vascular dementia. This article review characteristic features of methodological problems of CT and MRI, and of various dementias, especially vascular dementia.

An Association Study of D9S158 Polymorphism(VNTR Marker Linked to the NMDA Receptor Gene) with korean Schizophrenics / 신경정신의학

An association study with Korean schizophrenic patients(N=75) and normal controls(N=87) was performed to find the relationship between D9S158 polymorphism and schizophrenia using polymerase chain reaction. Eight different alleles of a dinucleotide polymorphism on D9S158 locus were observed in both group. When we compared the frequencies of alleles between schizophrenics and normal controls, there was no significant difference between two groups. To increase homogeneity of schizophrenic group, we divided schizophrenic group by clinical phenotypes such as family history, negative and positive symptoms(PANSS), soft neurologic signs(NES-K) and DSM-lV diagnostic subtypes. Then we compared the frequencies of alleles among subgroups of clinical phenotypes, and there were no significant differences between subgroups(p>.05). Although our findings fail to provide an evidence of association between schizophrenia and D9S158 locus, further investigation of other loci that are linked to NMDA receptor gene may be needed in genetically homogeneous subgroups of schizophrenia.

The apolipoprotein E genotyping using the PCR-RFLP was useful to linkage analysis of Alzheimer's disease families

Apolipoprotein E (ape E) has three common alleles (ape epsilon 2, epsilon 3 and epsilon 4) that code for three major isoforms E2, E3 and E4. The isoforms differ from each other by a single amino acid substitutions at two positions and also differ in their binding affinity for the apo E receptors. Moreover, recently a strong association between the apo epsilon 4 allele and late-onset Alzheimer disease (AD) was demonstrated. In this study, were analyzed the apo E genotypes using the Hhal digestion of PCR amplified samples, and the apo epsilon 4 allele frequency from 70 AD patients and 106 normal population in Korea. The results suggested that the frequency of epsilon 4 allele among the AD patients (35.7%) was 3 times higher than that among the control population (13.7%). The data, which are in agreement with recent reports, suggests that the apo epsilon 4 allele is associated with AD in Korea.

Evaluation of the cognitive function of the elderly residing in nursing homes / 신경정신의학

No abstract available.