Brain Network Connectivity and Association with Catechol-O-Methyltransferase Gene Polymorphism in Korean Attention-Deficit Hyperactivity Disorder Children

Objective@#We sought to determine if the links between and within the default mode network (DMN) and dorsal attention network (DAT) exhibited different conditions according to catechol-O-methyltransferase (COMT) gene polymorphism in relationship to attention-deficit hyperactivity disorder (ADHD) symptoms. @*Methods@#Fifty-seven children with ADHD and 48 healthy controls (HCs) were administered an intelligence test, the Children’s Depression Inventory, the Korean ADHD rating scale, and continuous performance test. Resting-state brain functional MRI scans were obtained, and COMT genotyping was performed to distinguish valine carriers and methionine homozygotes. @*Results@#Compared to controls, children with ADHD showed increased ADHD scale scores, increased visual commission errors, and increased functional connectivity (FC) within the DMN and DAT. Compared to all children with ADHD, children with the methionine homozygote and those who were valine carriers showed increased FC within the DMN and DAT and decreased FC between the DMN and DAT. FC within the DMN was also increased in HC valine carriers compared to HC children with the methionine homozygote, and in children with ADHD who were valine carriers compared to HC valine carriers. @*Conclusion@#We observed increased brain connectivity within the DMN and DAT and altered brain connectivity within and between the DMN and DAT associated with COMT polymorphism in children with ADHD.

Effects of Amisulpride Adjunctive Therapy on Working Memory and Brain Metabolism in the Frontal Cortex of Patients with Schizophrenia: A Preliminary Positron Emission Tomography/Computerized Tomography Investigation

OBJECTIVE: Dopamine plays a significant role in working memory by acting as a key neuromodulator between brain networks. Additionally, treatment of patients with schizophrenia using amisulpride, a pure dopamine class 2/3 receptor antagonist, improves their clinical symptoms with fewer side effects. We hypothesized that patients with schizophrenia treated with amisulpride and aripiprazole show increased working memory and glucose metabolism compared with those treated with cognitive behavioral therapy (CBT) and aripiprazole instead. METHODS: Sixteen patients with schizophrenia (eight in the amisulpride group [aripiprazole+amisulpride] and eight in the CBT group [aripiprazole+CBT]) and 15 age- and sex-matched healthy control subjects were recruited for a 12-week-long prospective trial. An [18F]-fluorodeoxyglucose-positron emission tomography/computerized tomography scanner was used to acquire the images. RESULTS: After 12 weeks of treatment, the amisulpride group showed greater improvement in the Letter-Number Span scores than the CBT group. Additionally, although brain metabolism in the left middle frontal gyrus, left occipital lingual gyrus, and right inferior parietal lobe was increased in all patients with schizophrenia, the amisulpride group exhibited a greater increase in metabolism in both the right superior frontal gyrus and right frontal precentral gyrus than the CBT group. CONCLUSION: This study suggests that a small dose of amisulpride improves the general psychopathology, working memory performance, and brain glucose metabolism of patients with schizophrenia treated with aripiprazole.

Comparison of QEEG Findings between Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) without Comorbidity and ADHD Comorbid with Internet Gaming Disorder

Internet gaming disorder (IGD) is often comorbid with attention deficit hyperactivity disorder (ADHD). In this study, we compared the neurobiological differences between ADHD comorbid with IGD (ADHD+IGD group) and ADHD without comorbidity (ADHD-only group) by analyzing quantitative electroencephalogram (QEEG) findings. We recruited 16 male ADHD+IGD, 15 male ADHD-only adolescent patients, and 15 male healthy controls (HC group). Participants were assessed using Young's Internet Addiction Scale and ADHD Rating Scale. Relative power and inter- and intra-hemispheric coherences of brain waves were measured using a digital electroencephalography (EEG) system. Compared to the ADHD-only group, the ADHD+IGD group showed lower relative delta power and greater relative beta power in temporal regions. The relative theta power in frontal regions were higher in ADHD-only group compared to HC group. Inter-hemispheric coherence values for the theta band between F3–F4 and C3–C4 electrodes were higher in ADHD-only group compared to HC group. Intra-hemispheric coherence values for the delta, theta, alpha, and beta bands between P4–O2 electrodes and intra-hemispheric coherence values for the theta band between Fz–Cz and T4–T6 electrodes were higher in ADHD+IGD group compared to ADHD-only group. Adolescents who show greater vulnerability to ADHD seem to continuously play Internet games to unconsciously enhance attentional ability. In turn, relative beta power in attention deficit in ADHD+IGD group may become similar to that in HC group. Repetitive activation of brain reward and working memory systems during continuous gaming may result in an increase in neuronal connectivity within the parieto-occipital and temporal regions for the ADHD+IGD group.

Clinical Practice Guidelines for Major Comorbid Disorders with Attention-Deficit Hyperactivity Disorder / 신경정신의학

Attention-deficit hyperactivity disorder (ADHD) occurs with a high prevalence of comorbid disorders, and these comorbid disorders can affect assessment, clinical symptoms, prognosis, and treatment strategies for children with ADHD. The goal of this study was to develop a clinical practice guideline for ADHD and its specific comorbid disorders. Due to limited numbers of previous clinical studies, current recommendations are based on literature review and expert consensus among Korean child and adolescent psychiatrists. We suggest the use of multidisciplinary evaluations, interview techniques, and assessment tools in order to differentiate major comorbid disorders from ADHD. Specific ADHD comorbid disorders (e.g., medical comorbidity, oppositional defiant disorder, conduct disorder, bipolar disorder, major depressive disorder, anxiety disorder, specific learning disorder, tic disorder, and substance use disorder) have suggested treatment protocols that include pharmacological and behavioral treatments. Children and adolescents with ADHD may have comorbid disorders. The use of current clinical practice guidelines will be helpful when treating ADHD children with comorbid disorders.

Correlations among Social Anxiety, Self-Esteem, Impulsivity, and Game Genre in Patients with Problematic Online Game Playing

OBJECTIVE: Recent studies of online game addiction have suggested that social interaction and impulsivity are critical factors for the etiology and progress of online game addiction. We hypothesized that the genre of the online game is associated with impulsivity and sociality in individuals with online game addictions. METHODS: In total, 212 patients with problematic online game playing were divided into four groups by game genre: 1) massive multiplayer online role playing game (MMORPG), 2) real-time strategy (RTS), 3) first-person shooter (FPS), and 4) other. Their symptoms and characteristics were assessed using 8 scales and 2 tests to estimate self-esteem, impulsiveness, comorbidity, social interaction status, and cognitive function. RESULTS: The mean social anxiety score was highest in the MMORPG group and lowest in the FPS group. The mean self-esteem score was highest in the RTS group. Social anxiety score was positively correlated with Internet addiction score in the MMORPG group, and the self-esteem score was positively correlated with Internet addiction score in the RTS group. CONCLUSION: The genre of online game was not associated with impulsivity, but social anxiety status varied significantly with game genre, and differences in social anxiety were especially pronounced in patients playing the MMORPG (highest social anxiety) and FPS (lowest social anxiety) game genres. In addition, self-esteem was highest in the RTS game genre.

Internet Gaming Disorder Treatment Options in the Hospital Setting

Internet gaming disorder (IGD), one of the common subtypes of internet addiction, is now classified in Section 3 of DSM-5 and is increasingly regarded as a growing health concern in many parts of the world. Consequently, many psychotherapeutic and psychopharmacological approaches have been considered and some research regarding therapeutic strategies has been conducted. However, treatment of IGD is in its early stages and therefore is not yet well established. This article reviews multiple therapeutic modalities including our own treatment model for IGD according to clinical and biological effects, thus providing suggestions for standard treatment strategies. The two main streams are psychopharmacological treatment and cognitive-behavior treatment, and the cognitive-behavior approach includes cognitive reconstruction, psychoeducation, and parenting coach. Many other non-pharmacological treatments are also recommended for personalized treatment of IGD.

Exercise Effect in Children with Attention-Deficit Hyperactivity Disorder : Meta-Analysis of Domestic Study / 신경정신의학

The aim of this meta-analysis study was to examine the effectiveness of exercise interventions on attention-deficit hyperactivity disorder (ADHD) pertaining to cognitive function such as attention and impulsivity in children.ZA comprehensive literature search was conducted using databases including Korean Information Service System, DBpia, Research Information Sharing Service, and National Assembly Library from 1995 to 2014. Search terms included 'ADHD', 'children', 'exercise', 'physical activity', and 'sports'. Standardized mean difference and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Q statistic. That is, these results revealed that effectiveness of exercise groups was higher by approximately 32% compared with control groups.ZEight studies (n=150) satisfied the inclusion criteria. The meta-analysis suggested that exercise has a moderate to large effect on core symptoms involved in attention [effect size (ES)=0.93] and impulsivity (ES=0.92) in children with ADHD. The main findings indicate that exercise, based on several types of exercise intervention, appears to be effective for mitigating symptoms such as attention, impulsivity in children with ADHD. From this perspective, exercise might be an effective adjunctive therapy for enhancing the effects of medication in children with ADHD. Future study related to exercise effect on ADHD symptoms is required in order to understand the specific evidence of relationship between exercise and core symptoms.

A Case of Rheumatoid Arthritis with Chronic Eosinophilic Pneumonia Associated with Eosinophilic Pleural Effusion

We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.

A Case of Dermatomyositis Presenting with Rhabdomyolysis

Rhabdomyolysis is caused by injury to skeletal muscle and it involves leakage of intracellular contents into the plasma. Rhabdomyolysis is an extremely rare manifestation of dermatomyositis. Dermatomyositis is a rare idiopathic inflammatory myopathy that is characterized by chronic inflammation of skeletal muscles and skin, resulting in muscle weakness. A 20 year old Korean male soldier presented with acute muscle pain, weakness and skin rashes over the face, neck and anterior chest. He received military training with carrying a radio set one week previouslyago. The patient was treated for rhabdomyolysis. However, the patient's symptoms did not improve. Muscle biopsy results suggested the diagnosis of rhabdomyolysis. Nevertheless, the features of skin and muscle inflammation raised the possibility of dermatomyositis. High dose steroid treatment was started, and then the symptoms and signs of muscle inflammation were improved. Rhabdomyolysis as the presenting sign of dermatomyositis has not been reported in Korea. Thus, we report on this case with a literature review.

A Case of Recurrent Intestinal Pseudo-obstruction in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Intestinal pseudo-obstruction (IpO) is a rare, poorly understood and recently recognized gastrointestinal manifestation of SLE. We report a 26-year-old female with SLE for 3 years. 10 months ago, IpO was diagnosed first, and it was responded well to high-dose steroid therapy. After then, oral prednisolone and azathioprine were administered, but the patient had been lost to follow up until recurrence of IpO. She was admitted with diffuse abdominal pain, distension, frequent vomiting, and intermittent dysuria due to recurrent IpO accompanied with bilateral ureterohydronephrosis. Despite of high dose steroid therapy, her symptom and imaging findings were not improved. The patient was treated with pulses of cyclophosphamide, and then the patient's symptoms and signs were gradually subsided. Three weeks following cyclophosphamide therapy, she was able to eat without vomiting and following abdominal CT showed nearly complete resolution of diffuse intestinal distension and bilateral ureterohydronephrosis. High level of awareness of IpO in SLE and appropriate medical treatment is needed to prevent unnecessary surgical treatment. And if this complication is refractory to corticosteroid, active immunosuppressive therapy, such as cyclophosphamide, should be considered.

A case of familial primary pulmonary hypertension / 대한내과학회지

Primary Pulmonary Hypertension (PPH) predominantly affects women frequently in the prime of life and usually leads to death from right ventricular failure within a few years after diagnosis. The prevalence and etiology of familial PPH are uncertain. The age of onset is variable and penetrance is incomplete. Although its occurrence in families was reported within a few years after the original clinical report, PPH was formely believed rarely to have a gene basis. Recent progress has not only clarified a basic molecular mechanism for PPH in familise, but also identified mutations of the same gene in many sporadic PPH patients, suggestion that its basis is commonly genetic. We report a case of familial PPH in a 20-year-old male with exetional dyspnea, who has a family history of PPH in his mother. We report this case with a brief review of recent literatures.

A case of primary esophageal T-cell malignant lymphoma / 대한내과학회지

Gastrointestinal tract (GIT) lymphomas usually originate from B-lymphocytes but rarely from T-lymphocytes. The stomach is the most common site for extranodal GIT lymphoma but the esophagus is a rare site. In addition, a primary esophageal T-cell lymphoma is an uncommon disorder. We encountered a case of a primary esophageal T-cell lymphoma in a 60-year-old man, who had swallowing difficulties and multiple ulcers in the upper and lower esophageal mucosa on gastroscopy. Immunohistochemical staining for the biopsy material from the multiple esophageal ulcers tested positive for LCA and CD45RO (pan T-cell marker) and negative for cytokeratin and CD20 reactivity, respectively. No other abnormal lesions were observed on a computed tomography scan of the neck, chest, abdomen and pelvis. After six cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristin, prednisolone, etoposide and gemcitabine, the multiple esophageal ulcers had completely disappeared suggesting a complete clinical response. We report this case with a review of the relevant literature.

Drug-induced MR Urography: The effects of Furosemide and Intravenous Saline Injection on MR Urography of Obstructed and Non-obstructed Urinary Tract

PURPOSE: To determine the usefulness of MR urography technique for the evaluation of urinary systems in patients with obstructed urinary tract and normal volunteers with non-obstructed urinary tract after intravenous normal saline and diuretic injection. MATERIALS AND METHODS: Three normal volunteers and 12 patients with urinary tract obstruction [ureteral calculi(n=8), extraurinary mass(n=1), ureteral tumor invasion(n=3)] underwent MR urography using a 1.0T scanner and a 2D non-breath-hold heavily T2-weighted fast spin-echo sequence. These acquisition were postprocessed with a maximum intensity projection (MIP) algorithm. Two acquisitions were performed, the first prior to saline solution infusion following standard MR urography procedures, and the second, within 2-3 minutes of the infusion of 250 ml saline solution followed by 20 mg of Lasix administered intravenously. For this latter, drug-induced MR urography procedures were followed. RESULTS: In healthy volunteers (n=3) and those experiencing partial obstruction (n=4) by a urinary stone, drug-induced MR urography provided better images of the urinary tract than did standard MR urography. In those in whom a urinary stone or tumor had caused complete obstruction (n=8), standard MR urography provided good images, as did drug-induced MR urography. CONCLUSION: In patients with a partially or non-obstructed urinary tract, drug-induced MR urography provided better anatomic and functional details of the kidney and urinary tract than did standard MR urography. In those experiencing complete obstruction of the urinary tract, however, standard or drug-induced MR urography permitted very adequate evaluation of the tract, and drug-induced MR urography was unnecessary.

Solitary Cerebellar Metastasis from Primary Uterine Cervical Carcinoma: A Case Report

Brain metastasis from primary uterine cervical carcinoma have been described but are extremely rare and usually occur in the presence of widely disseminated diseases. The authors report a case of solitary cerebellar metastasis from uterine cervical carcinoma, which was confirmed by histopathological examination. The patient has shown no evidence of metastatic lesions elsewhere, thus far, but had undergone a radical hysterectomy under the diagnosis of uterine cervical carcinoma 52 months prior to the surgical excision of the cerebellar metastasis.