Clinical Characteristics and Heart Rate Variability of Foreign Domestic Violence Victims in Korea / 수면정신생리

OBJECTIVES: Domestic violence is related to many psychiatric diseases, such as depression, anxiety disorder, and PTSD. Heart rate variability (HRV) is an index of autonomic control of the heart and is related to cardiovascular and emotional disorders. Although there have been some studies on the effects of domestic violence on women's mental health, relatively little information is available on HRV in this population. The aim of this study is to investigate demographic data, psychological features, and HRV in female victims of domestic violence and difference between Korean and foreign female victims. METHODS: A total of 210 female victims of domestic violence (166 Korean women and 44 foreign women) were recruited for this study. Psychological symptoms were measured using the Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), and Impact of Event Scale-Revised (IES-R). HRV measures were assessed by time-domain and frequency-domain analyses. RESULTS: The mean score of HAM-A was 13.81, that of HAM-D was 12.92, and that of IES-R was 33.61 ; there were no significant differences between Korean and foreign women in these measures. In HRV time domain analyses, approximate entropy (ApEn) was significantly increased in foreign women compared to the Korean women. The square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) was significantly decreased in foreign women compared to Korean women. There were no significant differences in the other HRV variables between Korean and foreign women. CONCLUSION: Female victims of domestic violence in Korea are associated with depression, anxiety, and PTSD symptoms. The physiologic factors of a female victim's nationality could be related to higher ApEn and lower RMSSD in foreign female victims. These findings have important implications for future study to study the relationships among ethnic and environmental factors and HRV variables.

Temperament and Character Traits, Heart Rate Variability and Occupational Stress in New Nursing Employees / 신경정신의학

OBJECTIVES: Nursing is a job with high stress. This study investigated the relationship between temperament and character traits, heart rate variability, and the severity of occupational stress in new nursing employees. METHODS: Ninety-seven nurses newly employed in a Seoul Medical Center from April 2014 to September 2015 were included to the study. Before beginning employment, all subjects were asked to complete a sociodemographic questionnaire and Temperament and Character Inventory (TCI). After they were employed for a month, we administered a heart rate variability test and Korean Occupational Stress Scale (KOSS). RESULTS: Harm avoidance (r=0.334, p=0.001), self-transcendence (r=0.224, p=0.028) and KOSS scores were positively correlated. Self-directedness (r=-0.278, p=0.006) and cooperativeness (r=-0.263, p=0.009) were negatively correlated with KOSS scores. In multiple regression analyses, harm avoidance and cooperativeness were risk factors for severe occupational stress. Physical parameters of total power (r=0.303, p=0.003), very low frequency (VLF ; r=0.318, p=0.002), and standard deviation of the NN interval (r=0.220, p=0.030) were significantly associated with higher KOSS scores. In multiple regression analysis, VLF was significant correlated with KOSS scores. CONCLUSION: Individual factors, such as personality trait or autonomic function, may affect the occupational stress vulnerability on this study. Harm avoidance, cooperativeness in TCI parameters are associated with severity of the occupational stress.

Linkage and Association Analyses of Schizophrenia with Genetic Variations on Chromosome 22q11 in Koreans

OBJECTIVE: Chromosome 22q11 has been implicated as a susceptibility locus of schizophrenia. It also contains various candidate genes for which evidence of association with schizophrenia has been reported. To determine whether genetic variations in chromosome 22q11 are associated with schizophrenia in Koreans, we performed a linkage analysis and case-control association study. METHODS: Three microsatellite markers within a region of 4.35 Mb on 22q11 were genotyped for 47 multiplex schizophrenia families, and a non-parametric linkage analysis was applied. The association analysis was done with 227 unrelated patients and 292 normal controls. For 39 single nucleotide polymorphisms (SNPs) spanning a 1.4 Mb region (33 kb interval) containing four candidate schizophrenia genes (DGCR, COMT, PRODH and ZDHHC8), allele frequencies were estimated in pooled DNA samples. RESULTS: No significant linkage was found at any of the three microsatellite markers in single and multi-point analyses. Five SNPs showed suggestive evidence of association (p<0.05) and two more SNPs showed a trend for association (p<0.1) in pooled DNA association analysis. Individual genotyping was performed for those seven SNPs and four more intragenic SNPs. In this second analysis, all of the 11 SNPs individually genotyped did not show significant association. CONCLUSION: The present study suggests that genetic variations on chromosome 22q11 may not play a major role in Korean schizophrenia patients. Inadequate sample size, densities of genetic markers and differences between location of genetic markers of linkage and association can contribute to an explanation of the negative results of this study.

An Open Label Multi-Center Prospective Observational Study of Paliperidone Extended Release to Assess the Medication Satisfaction and Treatment Response in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: The aim of this study was to demonstrate changes of subjective medication satisfaction and clinical benefit after once-daily paliperidone extended release (ER) in treatment of schizophrenia. METHODS: In an open-label, observational, and multicenter study, 374 patients with schizophrenia who switched to paliperidone ER due to any reason were recruited. Medication Satisfaction Questionnaire (MSQ), Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement and visual analogue scale for sleep (VAS) were assessed at baseline, 4 weeks and 8 weeks after treatment. We also examined the type, frequency, and severity of adverse events newly formed. RESULTS: Among 374 patients, 320 patients (76.5%) were included in the intent-to-treat analysis set. The mean dose of paliperidone ER was 5.33+/-2.31 mg/day at the initiation. At the endpoint, the mean dose of paliperidone ER was 6.68+/-3.13 mg/day. The percentages of patients satisfied with medication were changed from 40.9% at baseline to 67.8% at endpoint (p<0.001). Both CGI-S scores and VAS for daytime drowsiness were significantly decreased after 8 weeks (both p<0.0001) and mean scores of MSQ and VAS for sleep quality were improved after 8 weeks (both p<0.0001). CONCLUSION: After switching to paliperidone ER, 67.8% of patients with schizophrenia who had any reason to switch medication showed subjective satisfaction for medication and clinical improvement without significant adverse events. Regarding that medication satisfaction was associated with changes of clinical states, medication satisfaction can be used for measures for clinical scales in the treatment of schizophrenia.

Heart Rate Variability and Lipid Profile in Patients with Major Depressive Disorder / 수면정신생리

OBJECTIVES: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. METHODS: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. RESULTS: In serum lipid profile test, MDD group showed higher cholesterol (197.68+/-42.94 mg/dL vs. 176.85+/-34.68 mg/dL, p=0.044), TG (139.45+/-92.54 mg/dL vs. 91.4+/-65.68 mg/dL, p=0.018), LDL (130.03+/-33.18 vs. 106.62+/-27.08, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant (32.82+/-14.33 ms vs. 40.36+/-21.40ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group (1.13+/-0.11 vs. 0.91+/-0.18, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). CONCLUSION: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.

Internet Addiction in Adolescents and its Relation to Sleep and Depression / 수면정신생리

OBJECTIVES: "Internet-addiction" came into common use not only in clinical setting but also in everyday life. But, pathophysiology and diagnostic criteria of the internet addiction remain unknown. Because adolescents are in developing period, they might be vulnerable to the internet addiction, depression and sleep-related problem. The objectives of this study were to investigate the characteristics of internet addiction and its association with sleep pattern and depression in Korean adolescence. METHODS: Subjects were 799 middle and high school students in Seoul, Korea. We administered a self-reported questionnaire including socio-demographic data, Korean versions of Young's Internet Addiction Scale (YIAS), Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies for Depression Scale (CES-D) and questions about internet using patterns. Data of 696 subjects were included in analysis. Chi-square tests were used to analyze proportional differences, and ANOVA with post-hoc tests were used to analyze differences among groups. Partial correlation analyses were performed to analyze the correlation of internet addiction with other variables (two-tailed, p<0.05). RESULTS: Of the 696 participants (grade 2 of middle school;M2 135 vs. grade 1 of high school;H1 238 vs. grade 2 of high school;H2 323), 2.0% (n=14) were internet-addicted (IA), 27.7% (n=193) were over-using (OU) and 70.3% (n=489) were not-addicted (NA). The mean scores of YIAS, PSQI and CES-D scores were 35.24+/-12.78, 5.53+/-3.04 and 16.72+/-8.69, respectively. In higher grade students, average total sleep time was shorter (M2 426.20+/-67.68 min. vs. H1 380.47+/-62.57 min. vs. H2 354.67+/-73.37 min., F=51.909, p<0.001), and PSQI (4.69+/-3.14 vs. 5.42+/-3.15 vs. 5.97+/-2.83, F=8.871, p<0.001) CES-D (13.53+/-8.37 vs. 16.96+/-8.24 vs. 17.87+/-8.84, F=12.373, p<0.001) scores were higher than those of lower grade students. Comparing variables among IA, OU and NA groups, computer using time not for study (96.36+/-63.31 min. vs. 134.92+/-86.79 min. vs. 213.57+/-136.87 min., F=34.287, p<0.001) and portable device using time not for study (84.22+/-79.11 min. vs. 96.97+/-91.89 min. vs. 152.31+/- 93.64 min., F=5.400, p=0.005) were different among groups. PSQI (5.26+/-2.97 vs. 6.08+/-2.97 vs. 7.50+/-4.41, F=8.218, p<0.001) and CES-D scores (15.40+/-8.08 vs. 19.05+/-8.42 vs. 30.43+/-13.69, F=32.692, p<0.001) were also different among groups. YIAS score were correlated with computer using time not for study (r=0.356, p<0.001) and portable device using time not for study (r=0.136, p<0.001). PSQI score (r=0.237, p<0.001) and CES-D score (r=0.332, p<0.001). YIAS score and PSQI score (r=0.131, p=0.001), YIAS and CES-D score (r=0.265, p<0.001), PSQI score and CES-D score (r=0.357, p<0.001) were correlated each other. CONCLUSION: These results suggested that adolescents' internet-addiction was correlated with not only computer and portable device using time not for study but also depression and sleep-related problems. We should pay attention to depression and sleep-related problems, when evaluating internet-addiction in adolescents.

No Evidence for Linkage of Chromosome 6p24-22, The Locus of Dysbindin Gene, to Schizophrenia in Korean Families / 신경정신의학

OBJECTIVES: Chromosome 6p24-22 has been identified as a disease locus with a high probability for schizophrenia based on several genomewide linkage scans with Caucasian families. The recent association studies suggest that the dysbindin gene located at chromosome 6p22.3 may be a candidate gene of schizophrenia. The purpose of this study was to investigate the linkage of chromosome 6p24.3-22.3 locus to schizophrenia in Korean families. METHODS: We recruited one hundred fifty-seven family members from forty-six multiplex schizophrenia families. One hundred three of them were affected individuals. four microsatellite markers with 4.8 cM intervals on 6p24.3-22.3 were genotyped. Nonparametric linkage analysis was performed by evaluating the levels of allele sharing between the affected relative pairs. RESULTS: In the single point analysis, no markers on chromosome 6p24.3-22.3 locus showed statistical evidence for linkage. Significant evidence for linkage was not found in the multi-point analysis. CONCLUSION: These results do not support the previous evidence from Caucasian families for a locus predisposing to schizophrenia at 6p24.3-22.3, the locus of dysbindin gene. We conclude that if there is a susceptibility locus for schizophrenia in this region then its effect size is so small as to render our study insufficiently powerful to detect it and schizophrenia susceptibility loci in Korean families likey have different ethnicity-specific effects from Caucasian families.

Association of Genetic Variations within 5' end of Neuregulin 1 with Schizophrenia in Korean Population / 신경정신의학

OBJECTIVES: The authors recently found a suggestive evidence of linkage of chromosome 8p21-12 to schizophrenia in Korean multiplex families. Neuregulin 1 (NRG1) was identified in this locus as a positional and functional candidate gene for schizophrenia, through several independent studies with European and Chinese populations. The purpose of this study is to determine whether NRG1 is associated with schizophrenia in Korean population. METHODS: Three SNPs (SNP8NRG221533, SNP8NRG241930, SNP8NRG243177) and two microsatellites markers (478B14-848, 420M9-1395) located at the 5' end of NRG1 were genotyped for 242 unrelated schizophrenia patients and the same number of normal controls. Genetic association was tested by chi2-test (df=1). Not only for the whole patients group but also for a subgroup of patients with auditory hallucination. This subtype showed stronger linkage with chromosome 8p12 in the prior study of the authors with multiplex families. RESULTS: G allele of SNP8NRG241930 was significantly in excess in the subgroup of patients with auditory hallucination compared to the control group (p=0.03, OR=1.76). We also found that 3 SNPs haplotype TTC (p=0.04, OR=0.58) and five markers haplotype TTC53 (p=0.01, OR=0.49) were associated with schziophrenia with a protective effect. Three SNPs haplotype CGT which is a part of the at-risk haplotype of the Icelandic schizophrenia families was found in excess in the patients group but no significant association was observed. CONCLUSION: NRG1 might either play a role in the predisposition to schizophrenia or be in linkage disequilibrium with a causal locus of this illness.

Intra-familial Correlations of Symptoms and Clinical Characteristics in Multiplex Korean Families with Schizophrenia / 신경정신의학

OBJECTIVES: This study aims at examining familial associations of symptoms and clinical characteristics in affected sibling or relative pairs of schizophrenia as an effort to identify genetically homogeneous phenotypes. METHODS: Forty-seven relative pairs with DSM-IV diagnosis of schizophrenia from thirty-five Korean families multiply affected with schizophrenia were ascertained. Direct interviews were done using the Korean version of Diagnostic Interview for Genetic Studies (DIGS). The Krawieka Rating Scale and the Schedule for the Deficit Syndrome were also applied for further evaluation of psychopathologies. Intra-familial concordances and correlations of clinical characteristics and symptoms were tested using chi-squared-test and Spearman's correlation. RESULTS: Significantly high concordance rate within relative pairs was found for the diagnosis of paranoid vs. non-paranoid subtype (chi-squared=7.623, p=0.006, df=1). Deficit vs. non-deficit syndrome also showed significant concordance (chi-squared=3.850, p= 0.0497, df=1). Among single symptom items in DIGS, only 'auditory hallucination' showed significant concordance rate (chi-squared= 5.503, p=0.019, df=1). Factor analysis for symptoms items in the Krawiecka Rating Scale indicated three symptom dimensions; negative, psychotic and affective. Psychotic (rho=0.442, p=0.003) and affective dimension scores (rho=0.427, p=0.004) showed significant intra-familial correlations. Age at onset of recognized psychotic symptoms showed significant correlation only within the male sibling pairs. CONCLUSION: Familial factors, possibly genetic factor contribute to the phenotypic characteristics of paranoid vs. non-paranoid subtype, deficit vs. non-deficit syndrome, auditory hallucination, and affective syndrome. It supports their use in the delineation of homogeneous subgroups for future genetic studies

Genetic and Clinical Characteristics of Multiplex Schizophrenia Families / 신경정신의학

OBJECTIVES: This study aims at exploring genetic and clinical characteristics of multiplex Korean families with schizophrenia. METHODS: Thirty-three families having two or more schizophrenics by DSM-IV criteria within the second degree relatives were obtained from the clinics of general hospitals and mental hospitals. Sixty-nine affected and forty-five unaffected subjects from these families were interviewed using Korean version of Diagnostic Interview for Genetic Studies. Krawieka Rating Scale and The Schedule for the Deficit Syndrome were also applied for further evaluation of psychopathologies of the patients. Patterns of inheritances of the disease were analyzed by the inspection of the pedigrees. Parent-of-origin effect was evaluated by the comparison of the occurrence rate and the clinical characteristics between the subgroups of maternal and paternal origins. RESULTS: There were similar rates of maternal and paternal transmission in the families for which unilineal transmission of the disease was estimated. Only one family showed bilineal transmission. Observed patterns of transmission were not compatible with the recessive single locus model or sex-linked model. The most frequently observed non-schizophrenic disorders in these families were personality disorders/traits of schizophrenia spectrum. We could not find any clinical characteristics which might be unique to the patients from multiplex families. Parent-of-origin effect was not suggested. CONCLUSION: This study provides preliminary clinical and genetic data on the multiplex schizophrenia families which could be used for the determination of the genetic parameters and the boundaries of the phenotype in the linkage analyses.

A Pilot Study for Genetic Polymorphism of Catechol-O-Methyltransferase (COMT) in Panic Disorder / 신경정신의학

OBJECTIVES: Catecholamine metabolism has been thought to be related to the pathophysiology of panic disorder. There are two human COMT alleles, coding for a low activity enzyme, COMT L(L), and a high activity enzyme, COMT H(H), respectively. We examined the distribution of COMT genotypes and the relationship between COMT genetic polymorphism and some clinical characteristics in patients with panic disorder. METHOD: We recruited 51 patients who met the DSM-IV criteria for panic disorder, and 45 normal control subjects who had neither medical nor psychiatric illnesses. Genetic polymorphism of COMT was identified in all subjects using PCR-based restriction fragment length polymorphism(RFLP) analysis. We assessed some clinical variables including treatment responses in panic patients and measured anxiety and depression levels in normal control subjects using Spielberger State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). RESULT: The frequency of the homozygous LL genotype was higher in panic patients than that in control subjects (19.6% vs. 2.2%). We found that panic disorder was significantly associated with L allele (x2=8.66, p=0.003) and LL genotype(x2=8.45, p=0.015). Panic patients with LL genotype showed poorer treatment response than those with other genotypes (F=4.98, p=0.011). CONCLUSION: These results suggest that LL genotype of the COMT gene may be related to the pathophysiology and clinical courses in some patients with panic disorder.

Three Cases of Frontotemporal Dementia / 신경정신의학

Frontotemporal dementia is a common cause of dementia and distinguished from Alzheimer's disease. Because its clinical symptoms are characterized by slow progressive social breakdown and change of personality before cognitive impairments become prominent, it may be diagosed as other psychiatric disease. We have presented three cases of frontotemporal dementia. They had typical clinical histories and symptoms which deserve to be considered frontotemporal dementia. They showed appropriate findings of frontotemporal dementia in the neuropsychological tests and brain imaging study with brain magnetic resonance imaging and 18F-FDG positron emission tomography. Their clinical histories and findings are thought to be helpful for clinician to give attention to and diagnose frontotemporal dementia.