Proteomic Analysis of Rat Brains Following Exposure to Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is one of the most effective treatments used in psychiatry to date. The mechanisms of ECT action, however, are the least understood and still unclear. As a tool to elucidate the mechanisms of action of ECT, we employed proteomic analysis based on the identification of differentially expressed proteins after exposure to repeated ECT in rat brains. The expression of proteins was visualized by silver stain after two-dimensional gel electrophoresis. Of 24 differentially expressed protein spots (p<0.05 by Student t-test), six different proteins from 7 spots were identified by matrix-assisted laser desorption/ionization time-of flight (MALDI-TOF)/mass spectrometry. Among the identified proteins, there were five dominantly expressed proteins in the ECT-treated rat brain tissues (p<0.05); S100 protein beta chain, 14-3-3 protein zeta/delta, similar to ubiquitin-like 1 (sentrin) activating enzyme subunit 1, suppressor of G2 allele of SKP1 homolog, and phosphatidylinositol transfer protein alpha. The expression of only one protein, ACY1 protein, was repressed (p<0.05). These findings likely serve for a better understanding of mechanisms involved in the therapeutic effects of ECT.

Body Weight and Plasma Levels of Ghrelin and Leptin during Treatment with Olanzapine

Although enhanced appetite and weight gain are potential side effects of treatment with antipsychotic agents, particularly olanzapine and clozapine, the mechanisms underlying these side effects are poorly understood. Leptin and ghrelin were recently identified as hormones that play crucial roles in the regulation of energy balance and glucose metabolism. To elucidate relationships between weight change and plasma levels of ghrelin and leptin, we investigated the circulating ghrelin and leptin levels and body weight during olanzapine treatment. Twenty-four patients with schizophrenia were examined during 6-month administration of olanzapine. Ghrelin, leptin, weight and body mass index (BMI) were measured before and after 2, 4, 8, 12, 16, and 24 weeks of olanzapine treatment. The concentration of glucose and various lipid metabolic parameters were measured at baseline and at 24 weeks. Significant increases in weight, BMI and leptin were observed at week 24. On the other hand, the serum levels of ghrelin decreased significantly after olanzapine treatment. In addition, the level of ghrelin was negatively correlated with the leptin level, BMI and weight. The leptin level was positively correlated with both BMI and weight. Ghrelin is associated with metabolic changes, in combination with leptin, during olanzapine treatment. However, further large-scale and longitudinal studies are warranted to elucidate the metabolic changes involving ghrelin, leptin and insulin during treatment with antipsychotics.

Multicenter Clinical Trials for Efficacy and Safety of Mirtazapine in Moderate-to-Severe Major Depressive Patients / 대한정신약물학회지

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of mirtazapine treatment in multicenter population consisting of Korean patients suffering from moderate-to-severe depression. METHODS: Total 163 of in and outpatients with a diagnosis of major depressive disorder (DSM-IV) and 18 or over scores of 17-items Hamilton Rating Scale for Depression (HAMD) received treatment with mirtazapine (15-45 mg/day) for 6 weeks. Efficacy was assessed by HAMD, Montgomery and Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI), and Clinical Global Impression (CGI) scales and statistical analyses were performed on the intent-to-treat sample (143 patients) using the last-observation-carried-forward method. In addition, reported adverse events, routine laboratory parameters, and vital signs were investigated to evaluate the safety of mirtazapine. RESULTS: Mean daily dose of mirtazapine was 28.4 mg. At the end of the study, the response rate (50% or more reduction from baseline in HAMD scores) was 75.5% and the remission rate (7 or less in HAMD score) was 42.7%. Mirtazapine treatment induced significant reduction in depressive symptoms at the 4(th) day and substantial reduction along the treatment period, as assessed by changes in HAMD, MADRS, BDI, and CGI scales. At the 4(th) day and first week of mirtazapine treatment, the mean HAMD-17 total score was significantly reduced compared that of the baseline and the response rates were 11.9% and 28.7%, respectively. Mirtazapine was well tolerated in general, and somnolence and sedation were the most common adverse events reported. In addition, there were no clinically relevant changes in laboratory parameters and vital signs, although body weight was increased. CONCLUSION: Although this trial had many limitations of open non-comparative study, mirtazapine was demonstrated to an effective treatment for moderate to severe major depressive disorder and was well tolerated. A potentially rapid onset of overall therapeutic efficacy of mirtazapine was suggested by significant changes in all major variables of efficacy after 4(th) day of treatment.

Association between Alcoholism and the Genetic Polymorphisms of the GABA(A) Receptor Genes on Chromosome 5q33-34 in Korean Population

Family, twin, and adoption studies have demonstrated that genes play an important role in the development of alcoholism. We investigated the association between alcoholism and the genetic polymorphisms of the GABA(A) receptor genes on chromosome 5q33-34 in Korean population. The genotype of the GABA(A) receptor gene polymorphisms were determined by performing polymerase chain reaction genotyping for 172 normal controls and 162 male alcoholics who are hospitalized in alcoholism treatment institute. We found a significant association between the genetic polymorphisms of the GABA(A) alpha1 and GABA(A) alpha6 receptor gene and alcoholism. The GG genotype of the GABA(A) alpha1 receptor gene was associated with the onset age of alcoholism and alcohol withdrawal symptoms, and a high score on the Korean version of the ADS. However, there was no association between the genetic polymorphisms of the GABA(A) beta2 and gamma2 receptor gene and alcoholisms. Our finding suggest that genetic polymorphisms of the GABA(A) alpha1 and GABA(A) alpha6 receptor gene may be associated with the development of alcoholism and that the GG genotype of the GABA(A) alpha1 receptor gene play an important role in the development of the early onset and the severe type of alcoholism.

The Relationship of Insight Level with Temperament and Character Pattern in Patients with Chronic Male Schizophrenia / 신경정신의학

OBJECTIVES: This study was conducted to investigate the relationship of insight level with temperament and character pattern in chronic male schizophrenics. In addition, we tried to examine demographic variables and illness-related variables which may affect the level of insight. METHODS: To assess insight level by psychiatrists, Insight and Treatment Attitudes Question-naire(ITAQ), Scale to Assess Unawareness of Mental Disorder(SUMD) were applied. Temperament and character patterns were evaluated by the Korean version of Cloninger's self-rated Temperament and Character Inventory(TCI). The authors investigated the correlations between insight level, and scores of temperament and character dimensions. Data on the demographic and illness-related variabres for the subjects were gathered from hospital records and clinical interviews. A total of 113 patients with schizophrenia according to DSM-IV criteria was analyzed. The insight level was dichotomized into good(median value of 11) and poor insight group(<11). RESULTS: 1) There was a significant difference between good insightgroup and poor insight group in novelty seeking dimension in TCI. 2) There was a significant negative correlation between novelty seeking scores by TCI and insight scores by ITAQ(rs:Spearman correlation coefficient=-0.20, p<0.05). There was a positive correlation between harm avoidance scores by TCI and insight scores by ITAQ(rs=0.22, p<0.05). 3) Significant differences between good and poor insight groups were identified in diverse clinical variables such as age at onset of illness, mode of hospitalization, duration of illness, current length of stay, and dosage of drug. CONCLUSION: The results suggest that high scores in the temperament dimension of novelty seeking and low scores in the temperament dimension of harm avoidance may influence poor insight in patients with chronic male schizophrenia. Therefore it is clinically valuable for us to assess the pattern of temperament at the stage of insight evaluation. The authors suggest that further studies on temperament and character in schizophrenia is needed.

No Association of CYP2D6*4 and CYP2D6*10 Polymorphisms with Tardive Dyskinesia in Korean Schizophrenics

P450 CYP2D6 enzyme(debrisoquine hydroxylase) is known to metabolize many neuroleptics and some genetic polymorphisms in the CYP2D6 gene were reported to be associated with tardive dyskinesia(TD). We investigeted the association of two genetic polymorphisms in the CYP2D6 gene, CYP2D6*4 and CYP2D6*10, with TD in Korean schizophrenic subjects. Subjects consisted of 71 Korean schizophrenics and TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). There were no statistically significant differences in the demographic variables of age, male to female percentage and the current antipsychotic(CPZ equivalent) dose between the grup with TD and the group without TD. But the duration of antipsychotic drug exposure was siginificantly higher in the group without TD(p=0.000, by independent t-test). The mean AIMS score in the group with TD was 11.2+/-6.6(S.D.). Genotypings ofr the presence of CYP2D6*4 and CYP2D6*10 wee done using PCR amplifications and endonuclease digestions. There were no statistically significant genotypic and alleleic associations between TD and CYP2D6*4(by chi-square tests), and between TD and CYP2D6*10(by chi-square tests). These results indicate that the CYP2D6*4 and CYP2D6*10 polymorphisms have no significant roles in the causation of TD.

Efficacy and Safety Profile of Risperidone in Schizophrenia: Open Multicenter Clinical Trial / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Prevalence, Cause of Insomnia and Drug Medication of Newly Admitted Patients to a University Hospital / 수면정신생리

The purpose of this study was to investigate the prevalence, primary causes, and management of insomnia newly admitted patients in a university hospital. Subjects consisted of 168 adult patients (95 men and 73 women, 88 medical and 94 surgical patients) newly admitted to Gyeongsang National University Hospital from September 7 through September 27, 1996. Sleep patterns of all subjects in the usual nights before admission(UN), the previous night to admission(PN), the night on admission(ON), and the 5th night after admission(5N) were investigated using the Korean version of the St. Mary's Hospital Sleep Questionaire. In addition, all insomnia patients and their doctors and nurses in charge were interviewed by psychiatric residents. Additionally, their medical records were reviewed. Prevalence of insomnia were 22.6% in the UN, 42.9% in PN, 51.8% in ON, and 43.5% in 5N. The prevalence of insomnia was significantly increased immediately before and after admission. There were no significant differences in the prevalence of insomnia by age and sex. The most ammon primary causes of insomnia were somatic symptoms and psychological factors in PN, somatic syptoms and noise in ON and 5n. Only 17 (10.1%) of insomnia patients took medicstions for insomnia control(analgesics in 15, hypnotics in 2). These results shorred that the prevalence of insomnia was significantly increased on hospitalization due to somatic symptoms, environmental factors, and psychological factors, but nearly none were adequately managed.

A Comparative Study on the Characteristics of Demographic Data, Clinical Features, and Personality in Hospitalized Male and Female Alcoholics / 신경정신의학

OBJECTIVE: This study was designed to compare the characteristics of demographic data, clinical features, and personality in male and female alcoholics and to identify the clinically meaningful differences in the etiologies and the clinical features between the two groups. METHODS: The study group was composed of 30 males and 21 females who were recruited into the inpatient treatment. The researchers used self-reporting questionnaire composed of demographic data and drinking patterns, Michigan alcoholism screening test(MAST), self-rating anxiety scale(SAS) and self-rating depression scale(SDS) of Zung, Minnesota Multiphasic Personality Inventory(MMPI), symptom Checklist-90-revision(SCL-90-R), and Eysenck personality questionnaire(EPQ) . The differences between the two groups were tested by chi-square test and independent-samples t-test. RESULTS: 1) Education level of female alcoholics was significantly less than that of male alcoholics(p<0.05) and the birth order of female alcoholics was significantly higher than that of male alcoholics(p<0.05). 2) The level of socioeconomic status of female alcoholics was significantly lower than that of male alcoholics(p<0.01). 3) The initial motivations of female alcoholics were mainly due to social, psychological, and intrafamilial problems while those of male alcoholics were due to social problems. There were significant differences between the two groups(p<0.05). 4) The onset of initial drinking in female alcoholics was significantly earlier than that of male alcoholics(p<0.001). 5) The average amount of daily drinking in female alcoholics was significantly less than that of male alcoholics(p<0.01). 6) Withdrawal symptoms, physical disorders, and social or legal problems induced by alcohol drinking in female alcoholics were significantly less than those of male alcoholics(p<0.05) 7) The mean scores of PY scale of SCL90R and of L scale of EPQ in female alcoholics were significantly higher than those of male alcoholics(p<0.05). CONCLUSION: Demographic and psychosocial factors differed to a significant degree between male and female alcoholism. We suggest that these factors are more important in female alcoholism than in male one in the etiologies and the clinical features. These differences are due to more complex factors rather than simple ones, thus the further evaluations are needed to elucidate the differences in the etiologies between male and female alcoholism.

Combined Dexamethasone/Insulin-induced Hypoglyeemic Test in Manic and Schizophrenic Patients

Many investigators are trying to elucidate the pathogenesis of psychiatric disorders on the basis of neuroendocrine responses to stimulation or perturbation. Dexamethasone(DEX) suppression has been the most widely utilized as the prototypical challenge test. Dexamethasone suppression test(DST) has proven to be valuable in diagnosing the depressive spectrum disorder. Reported specificity of diagnosis of depression is relatively high, but sensitivity is limited. Some researchers used the combination of dexamethasone and corticotropin releasing hormone(CRH) in order to improve the sensitivity. They reported that combined DEX/CRH test, i.e., we administered the insulin instead of CRH. Total subjects were 28(7 normal controls, 10 manic patients, 11 schizophrenic, patients). Subject were token DEX(1.5mg p.o.) at 11 p.m., insulin 16 hours later(0.1 unit/kg i.v.). Five blood samples for the determination of cortisol and ACTH were serially drawn at 15 minute interval. The results are as following : 1) The cortisol an ACTH levels of manic subjects increased following insulin administration. Manic subjects showed higher levels of cortisol and ACTH than schizophrenic and normal control subjects. The cortisol and ACTH levels of schizophrenic and normal control subjects did not show gross changes. 2) The sensitivity of the test was lower than that of reported DEX/CRH test.

The psychopathology and personalistis characteristics of Korean shamanistic practitioners in Chinju Area / 신경정신의학

No abstract available.

Religious beliefs, practices, and experiences of psychiatric patients / 신경정신의학

No abstract available.

Psychiatric study on demon possession alleged by prostant clergymen / 신경정신의학

No abstract available.

Electroencephalographic sleep findings and dexamethasone suppression test in major psychotic disorders / 신경정신의학

No abstract available.

A psychiatric study of King Saul / 신경정신의학

No abstract available.