The Abnormality of Posterior Default Mode Network in Medication-Naive Attention-Deficit Hyperactivity Disorder Children : Resting State fMRI Study

OBJECTIVES: Characteristic symptoms, including hyperactivity and easy distractibility, in children with attention-deficit hyperactivity disorder (ADHD) suggest that their brain status, even at rest, might differ from that of healthy children. This study was conducted in order to determine whether resting state brain activity is compromised in medication-naive children with ADHD. METHODS: Twenty medication-naive children with ADHD (mean age 10.3+/-2.5) and 28 age- and gender-matched healthy volunteers (mean age 10.3+/-2.0) underwent measurements for resting state brain activity using functional magnetic resonance imaging (fMRI). Among resting state related-independent components (RSICs) extracted from fMRI data using independent component analysis, a significant difference in RSICs was observed between groups, using a mixed Gaussian/gamma model. RESULTS: Except for IQ, which was higher in the healthy control group, no demographic difference was observed between the two groups (p<.001). Significantly less activation of one RSIC, which includes the bilateral precuneus/posterior cingulate cortex, occipito-temporal junction, and anterior cingulate cortex, was observed in the ADHD group, compared with the control group (p<.05). CONCLUSION: An abnormal RSIC, posterior default mode network (DMN), was observed in the medication-naive ADHD group. Results of our study suggest that abnormality of posterior DMN is one of the main pathophysiologies of ADHD.

Occipito-Temporal Connectivity in Medication-Naive ADHD Children: Preliminary Diffusion Tensor Imaging Study / 신경정신의학

OBJECTIVES: Occipito-temporal connectivity was explored using diffuse tensor imaging (DTI) and its correlation to behavioral symptoms and neurocognitive functions in medication-naive attentiondeficit/hyperactivity disorder (ADHD) children and adolescents. METHODS: Eleven medication-naive children and adolescents with ADHD (mean age 11.5+/-.3) and 9 age- and gender-matched healthy volunteers (mean age 11.4+/-2.5) were measured for mean fractional anisotropy (FA) values with DTI and clinical assessments. The FA values for the region of interest (ROI) which contained both inferior longitudinal fasciculus (ILF) and inferior occipito-frontal fasciculus (IOFF), were compared in ADHD and gender- and age-matched healthy control groups and the relationship between clinical and neurocognitive variables was explored. RESULTS: The ADHD group exhibited significantly higher scores on the Korean ADHD Rating Scale (p<0.001), the Korean Conners Parent Rating Scale (p<0.001), the computerized Continuous Performance Test, and the Visual (omission error, commission error, mean time, and variability)(p<0.01), and significantly decreased scores on the Finger Window Test (p<0.01). Mean FA values from the left-side ROI were significantly lower in the ADHD group compared with healthy controls after controlling for age (p<0.05). In the ADHD group, FA values from the left-side of the ROI did not show significant correlation with clinical rating or neurocognitive tests. CONCLUSION: Our results suggest that one of the core pathophysiology hallmarks in child ADHD may be abnormal anatomical connectivity in the occipito-frontal and/or occipito-temporal pathway, both of which are related to visual information processing. To confirm such an anatomical deficit and its association with clinical or neurocognitive symptoms in ADHD, further studies using larger sample sizes are needed.

Illness Representation for Pathological Gambling / 신경정신의학

OBJECTIVES: In our studies, we have made efforts to compare illness representation among the pathological gamblers, social gamblers, the family members of gambler, the gambling industry employees, and general adults and to investigate what kinds of illness representation make an estimate of therapy intention. METHODS: 222 gambling users, 125 family members of gambler, 95 employees in gambling industry, and 1383 general adults were included in this study. Symptom representation, negative characteristic representation, negative consequence representation, internal and external attribution representation, spontaneous recovery representation, recovery representation through therapeutic help of speciality, time lapse representation were constructed and included for illness representation of pathological gambling. RESULTS: 1) Pathological gamblers had lower symptoms, negative characteristics, negative consequences and therapeutic help seeking representation than other groups, on the other hand higher external attribution representation and spontaneous recovery representation. 2) Families of problem gambler have inconsistent characteristics higher external attribution and negative consequences and lower therapeutic help seeking representation. 3) It was founded that negative consequences representation and external representation were low in gambling industry employees. 4) The more symptom representation increased and external attribution decreased, the more therapeutic intention increased in case of problem gamblers and their families. CONCLUSION: Pathological gamblers have the lowest awareness and acceptance on mental problem caused by excessive gambling. However, suggested that family members of gambler and gambling industry employees also have partially self defensive and contradicted representations. It was suggested that awareness on severity of symptom and internal attribution representation needs to be increased in order to participate therapeutic place.

Impulsivity and Sensation-seeking of Pathological Gambling: Comparison with Alcoholism / 신경정신의학

OBJECTIVES: We investigated impulsivity and sensation seeking of pathological gambling, comparing with alcoholism and normal group. METHODS: 36 pathological gamblers, who were diagnosed by DSM-IV criteria, were compared with 31 alcoholism group and 26 healthy normal group with Barratt impulsivity scale and Zuckerman sensation seeking scale. RESULTS: 1) Pathological gamblers appeared to have much more impulsivity than alcoholism group or normal group. In respect to sensation seeking, no significant differences were founded among three groups. 2) Pathological gamblers tend to have more non-planning impulsivity, cognitive impulsivity, and motor impulsivity than alcoholic group. Comparing with normal group, pathological gamblers tend to have more non-planning impulsivity and motor impulsivity, but not in cognitive impulsivity. 3) There were no differences in three sub-scales including of thrill seeking, experience seeking and disinhibition out of four sub-scales of sensation seeking scale, among three groups. However, Boredom susceptibility was higher in pathological gamblers than alcoholics and normal group. CONCLUSIONS: These results suggested that personality of pathological gambler is most impulsive and boredom susceptible, which indicates that pathological gamblers is more serious pathological clinical disorder than alcoholism.

The Changes of Cytokine Production during the Hangover State Induced by Experimental Alcohol Consumption / 신경정신의학

OBJECT: A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur 8-16hr after alcohol drinking. We evaluated the effects of experimentally induced alcohol hangover on immune functions by the measurement of cytokine production. METHODS: A total of 13 normal adults males participated in this study. They did not have any previous histories of psychiatric or medical disorder. We defined the experimentally induced hangover condition by 13 hours after drinking high doses of alcohol(1.5g/kg of body weight). Venous blood was taken before the alcohol drinking & during the experimental hangover conditions. Monocyte was separated and stimulated with phytohemagglutinin. Cytokine production was measured by ELISA for IL-1beta, IL-2, IL-4, IL-6, IL-10, IL-12, INF-gamma, TNF-alpha. RESULTS: The production of cytokines IL-10, IL-12 and INF-gamma were increased during hangover conditions. CONCLUSIONS: There is an changes in the production of cytokines IL-10, IL-12 and INF-gamma during hangover conditions. Thus, our results supported the hypothesis that acute alcohol treatment might affect Th1/Th2 immune balance by altering monocyte production of IL-12 and IL-10. These results suggested that elevated monocyte-derived IL-10 can contribute to the cellular immune abnormalities during hangover conditions.

A Naturalistic Study of Risperidone Treatment in Affiliated University Hospitals: Focus on Clinical Characteristics / 신경정신의학

OBJECTIVE: This retrospective naturalistic study was designed to compare the clinical characteristics including psychopathology of two groups of patients, long-term maintenance group and short-term drop-out group, who were taking risperidone. METHOD: Datas were collected for 210 schizophrenic patients with complete medical records among 580 patients who were enrolled with risperidone administration from January 1996 to December 1996 in 8 affiliated hospital of the Catholic University. The short-term drop-out patients group were assigned to whom treatment period was less than 6 month, and the long-term maintained patients group, treatment period was more than 2 years. We assessed demographics, psychopathology, and other variables related with medication based on past medical records. RESULTS: Among subjects of 210, short-term drop-out patients group were 67(31.9%) and long-term maintained patients group were 143(68.1%). Demographics and psychopathology were not significantly different between two groups. The starting and maximal dosage of risperidone was not significantly different between two groups but the maintenance dosage of risperidone was lower in long-term medicated patients group than short-term drop-out patients group(t=3.698, p<0.05). Additionally, the result of this study showed differences in experiences of past antipsychotic use as following. The number of no previous use of antipsychotic was 39(58.2%), the number of high potency antipsychotic use was 27(40.3%), and the number of low potency antipsychotic use was 1(1.5%) in short-term drop-out group. The number of no previous use of antipsychotic was 58(40.6%), the number of high potency antipsychotic use was 77(53.8%), the number of low potency antipsychotic use was 8(5.6%) in long-term maintained group(X 2=6.559, df=2, p<0.05). CONCLUSION: According to these results, administration of low therapeutic dosage should be recommended for long-term maintenance as if possible. Multi-center based retrospective naturalistic study like this would be useful for getting informations about efficacy and some other aspects of antipsychotic administration in practical field.

A Validation Study of the Suicide Probability Scale for Adolescents (SPS-A) / 신경정신의학

OBJECTIVES: We aimed to develope the Suicide Probability Scale for Adolescent (SPS-A) to evaluate the possibility of suicide behavior in adolescents. METHODS: SPS-A was adminstered to 792 middle and high school students for examining the reliability and validity. RESULTS: SPS-A was found to have significantly high internal consistency and total -subscale score correlations. Factor analysis yielded four factors of negative self-evaluation, hopelessness, suicide idea and hostility, which explained 53.28% of total variables. In the assessment of correlations with other suicide-related scales for the concurrent validity of SPS-A, Rosenberg self-esteem scale and Buss-Durkee hostility scale have significant correlations with SPS-A. However, Children's depression inventory and Hopelessness scale for adolescent did not have significant correlations with SPS-A. CONCLUSION: We concluded that SPS-A had high reliability and validity, which is usefull for evaluating suicide idea in adolescents. This study suggests that hopelessness and depressive symptoms are not for evaluating suicide risk in adolescents, unlike adult group.

The Change of Cytokines by Risperidone in Patients with Schizophrenia / 신경정신의학

OBJECT: This study was carried out to evaluate immunologic difference between baseline and after 4 weeks drug treatment with atypical antipsychotics (rispreidone) by measurement of serum concentration of 6 cytokines. METHODS: The subjets were composed of 25 patients who are admitted at Dajeon St's Marys hospital of psychiatry department and diagnosed as schizophrenia by DSM-IV diagnositc criteria. We measured serum IL-1beta, IL-2, IL-6, IL-12, INF-gamma, TNF-alpha concenatrations by quantitative ELISA method using ELISA kit (Endogen Inc., Woburn, MA, USA).The two psyciatrists performed PANSS examination between baseline and after 4 weeks risperidone treatments. RESULTS: The serum level of IL-12 was increased significantly after medication of 4 weeks and the serum concentration of IFN-gamma showed the tendency of decreasement but not significant. The serum level of the other cytokines showed no significant change. CONCLUSIONS: We spectulate that the increasement of IL-12 may contribute to role of activation of immune response by treatment of antipsychotic medication (risperidone). This study is first trial of IL-12 study in neuropsychiatric field and IL-12 which play important role of immune response becomes interesting subjects in immune research.

The Psychological and Behavioral Characteristics of the Pathological Gamblers in Horse Racing / 신경정신의학

OBJECTIVES: We investigated the socio-demographic, psychological and behavioral characteristics of the pathological gamblers in horse racing. METHODS: Among 61 horse-racing gamblers, 20 pathological gamblers were diagnosed by DSM-IV criteria, and compared with 18 healthy horse racing spectators. RESULTS: 1) The education level of the pathological gamblers was lower and the duraton of gambling history longer than the healthy horse racing spectators. 2) The number and the amount of the bet of pathological gamblers in one day were higher than those of the healthy horse racing spectator. Especially, the highest amount of money gained of the pathological gambler were significantly larger than that of the healthy horse racing spectators. 3) The pathological gamblers bet with the purpose of restoring loss sum, gaining money, and avoiding dysphoric and negative mood. To be opposed, the healthy horse racing spectator play for rest, pleasure and excitement seeking. 4) The healthy horse racing spectators enjoy pleasure and euphoric mood through horse racing more than the pathological gamblers. However, the pathological gamblers experience repentance after game, and irritable and unstable mood while they were betting. 5) The pathological gamblers could control impulse less than the healthy horse racing spectator because of being habituated to the game. CONCLUSIONS: Horse racing is one of the most popular and legitimate leisure and gambling activities in Korea. In such a legitimate gambling activity, serious pathological gamblers are found frequently and their psychological and societal problems are increasing. Therefore, the prevention and the therapeutic intervention for the pathological gambling would be urgent.

Spatio-Temporal Pattern Analysis in EEG of Alzheimer's Dementia: A Preliminary Report Using Karhunen-Loeve Method for Clinical Implication / 신경정신의학

OBJECTIVES: We introduce a novel analysis method of spatio-temporal pattern analysis of EEG. Using it, we presents a results discriminating severe Alzheimer's disease patients from normal subjects. METHOD: To the groups of 10 Alzheimer's disease patients and 10 normal aged subjects, we applied the Karhunen-Loeve decomposition method and observed their principal patterns and time-varying dynamics. RESULTS: First, there was a first primary pattern of the eigenvector in Alzheimer's disease patients that showed opposite polarities at the left and the right hemispheric regions. Second, the Alzheimer's disease patients had significantly different average values of the eigenvector at the left parieto-temporal area than the normal controls did. Third, some Alzheimer's disease patients had one, coherent frequency component in the Fourier amplitude spectrum of the first pattern expansion coefficient. CONCLUSION: Our results suggest that the pathophysiologic site of Alzheimer's dementia may be left temporo-parietal area in brain and further studies need to evaluate whether the spatio-temoral pattern analysis could be used to diagnose Alzheimer's dementia patients.

Effects of Total Sleep Deprivation on the Cognitive Function in the Normal Adult Male Subjects / 신경정신의학

OBJECTIVES: This study was carried out to evaluate the effect of acute sleep deprivation of 36 hours on cognitive functions, and investigate which region of brain would dysfunction by sleep deprivation. METHODS: We carried out sleep deprivation in the 18 healthy and right handed males in their 20's. We also administered to them Luria-Nebraska Neuropsychological Battery and Calculation and Digit Span task of K-WAIS in order to examine cognitive functions before and after sleep deprivations. RESULTS: There were no differences in freedom from distractability, tactile function, visual function, reading, writing, calculation, and intellectual process function. However, motor function, rhythm, receptive speech, expressive speech, memory, and complex verbal arithmetic function decreased after sleep deprivation. In motor function, delayed speed and high fail rate in complex forms of praxis and selectivity of motor acts were observed. In area of receptive speech and expressive speech, understanding of logical and grammatical structure, spontaneous speech, sequencing and filling in items which are grammatically accurate decreased. All these functions related with dysfunction in right hemisphere anterior region. Also in localization scales, the fail rates of right frontal dysfunction scale and right temporal dysfunction scale increased after sleep deprivation. CONCLUSIONS: From these results, we suggest that sleep deprivation has negative effect on the cognitive functions. Especially, sleep deprivation might be associated with dysfunction of anterior region in right hemisphere or subcortical dysfunction.

Results of 1998 Korean Depression Screening Day and Sociodemographic Characteristics of Participants / 신경정신의학

OBJECTIVES: This study was performed to analyze the sociodemographic characteristics of participants in '1998 Korean Depression Screening Day' and to evaluate the results of the screening test. METHODS: By using the survey results of 619 volunteers from 8 hospitals, the authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and the psychiatric treatment history of respondents. The assessment measure was the Zung Self-Rating Depression Scale. RESULTS: The mean depression score of all participants was 57.5+/-13.8 and it came under mild depression. Of all participants, 69.5% (N=430)had at least mild depressive symptoms, 43.1% (N=267)had at least moderate symptoms, and 18.4% (N=114)had severe symptoms. Never have 56.8% of respondents in the severely depressed range and 63.9% of those in the moderately depressed range had psychiatric treatment. The results suggest that the age group of 29-year-old or younger (relative to 60-year-old or older group)and full-time employment status (relative to unemployment)are protective factors of depression. CONCLUSIONS: By '1998 Korean Depression Screening Day', many depressed patients were detected and their depressive symptoms had statistically significant relationships with some sociodemographic characteristics. The results suggest that the education and screening test programs for depressive illness facilitated by Depression Screening Day are useful to the patients regardless of being under current treatment or not.

Nonlinear Dynamic Analysis Using Lyapunov Exponent of EEG in Patients with Schizophrenia / 대한정신약물학회지

OBJECT: It seemed worthwhile to estimate nonlinear measures of the electroencephalogram (EEG) in schizophrenic patients, because nonlinear measures might serve as indicators of the specific brain function in schizophrenia. METHOD: Previous studies which estimated the chaoticity in the brain of schizophrenia with nonlinear methods recorded the EEGs at limited electrodes, so we tried to record EEGs from 16 channels for nonlinear analysis in 19 patients with Schizophrenia and 8 healthy control subjects. We employed a new method to calculate the nonlinear invariant measures. For limited noisy data, this algorithm was strikingly faster and more accurate than previous ones. RESULTS: Our results showed that the schizophrenic patients had lower values of the largest positive Lyapunov exponent at the left inferior frontal and anterior temporal head regions compared with normal controls. CONCLUSIONS: These results suggest that the nonlinear analysis of the EEGs such as the estimation of the largest positive Lyapunov exponent seems to be a useful tool in analyzing EEG data to explore the neurodynamics of the brain of schizophrenic patients.

Nonlinear Dynamic Analysis in EEG of Alzheimer's Dementia: A Preliminary Report Using Correlation Dimension

The changes of electroencephalogram(EEG) in patients with dementia are most commonly studied by analyzing power or magnitude in certain traditionally defined frequency bands. However because of the absence of on identified metric which quantifies the complex amount of information, there are many limitations in using such a linear method. According to chaos theory, irregular signals of EEG cal also result from low dimensional deterministic chaos. Chaotic nonlinear dynamics in the EEG can be studied by calculating the correlation dimension. The authors have analyzed EEG epochs from three patients with dementia of Alzheimer type and three matched control subject. The result showed that patients with dementia of Alzheimer type had significantly lower correlation dimension than non-demented controls on 12 channels. Topographic analysis showed that the correlation dimensions were significantly lower in patients with Alzheimer's disease on frontal, temporal, central, and occipital head regions. These results show that brains of patients with dementia with dementia of Alzheimer type have a decreased complexity of electrophysiological behavior. We conclude that the nonlinear analysis such as calculating correlation dimension can be a promising tool for detecting changes in the complexity of brain dynamics.