G-protein beta3 Subunit Gene 825C/T Polymorphism Is Not Associated with Olanzapine-Induced Weight Gain in Korean Schizophrenic Patients

OBJECTIVE: Weight gain is a possible adverse effect of the use of antipsychotics, and is an important factor for long-term health and treatment compliance. Olanzapine is an atypical antipsychotic known to cause considerable weight gain. A relationship between weight gain and the G protein beta3 subunit gene (GNB3) 825C/T polymorphism has been reported. We therefore examined this possible association in a Korean schizophrenic patient group receiving olanzapine treatment. METHODS: Weight and height measurements were obtained prior to starting olanzapine and measured again after long-term treatment. Genotyping for the 825C/T polymorphism was performed using a PCR-based method. RESULTS: We found that long-term treatment with olanzapine resulted in mean gains in weight and body mass index (BMI) of 5.2 kg and 1.93 kg/m2, respectively. There was a no significant difference in the mean body weight change from baseline to the endpoint after olanzapine treatment between the genotype groups (p=0.796). There were also no significant differences in genotype or allele frequencies between the severe weight-gain (more than 10%) and minimal weight-gain (less than 10%) groups (chi-square=0.037, p=0.98; chi-square=0.020, p=0.89). CONCLUSION: The finding from this study thus does not support a relationship between the GNB3 825C/T polymorphism and weight gain in Korean schizophrenic patients receiving olanzapine treatment.

The Effect of Schizotypal Personality Trait on the Ability of Facial Affect Identification in Healthy Person

OBJECTIVES: The purpose of this study is to investigate whether the ability of facial affect perception is associated with schizotypal personality traits in healthy normal controls. METHODS: 241 normal subjects were recruited in this study. The age range of all subjects was from 19 to 63 years. The schizotypal personality questionnaire(SPQ) and facial affect identification test(FAIT), which were developed and standardized in Korea, were applied. Subjects from high 1 standard deviation(H group, N=40) and low 1 standard deviation(L group, N=26) on SPQ score were compared. RESULTS: We found that the H group showed significantly reduced ability on the correctness of sadness and neutral compared with the L group. But, no significant association between SPQ and intensity or reaction point was observed in all subjects. CONCLUSION: This study suggests the individuals with high schizotypal personality trait have impairments on the facial affect identification. Also, these findings may provide the reasonable explanation of social cognition deficit of schizotypal personality disorder.

Comparison of the Efficacy between Risperidone and Quetiapine in Elderly Patients with Delirium

OBJECTIVES: Many studies showed that risperidone and olanzapine in the treatment of delirium were similar to haloperidol, in side effects were superior to that. Quetiapine is frequently used in delirious patients. However, the studies of quetiapine in the treatment of delirium are very few. This study was designed to compare the efficacy of risperidone and quetiapine in elderly patients with delirium. METHODS: We divided 2 groups (risperidone and quetiapine) of elderly patients with delirium. We compared the two groups of elderly patients with delirium by Korean Version of Delirium Rating Scale (K-DRS) and Korean Mini-Mental State Examination (K-MMSE) at baseline and 1 week later. RESULTS: Our results showed that risperidone and quetiapine were efficacious in the treatment of elderly patients with delirium according to using K-DRS and K-MMSE. There were no significant differences in the degree of effects in both drugs. CONCLUSION: We compared the efficacy of risperidone and quetiapine in the treatment of delirium. Quetiapine was as efficacious as risperidone in the treatment of the elderly patients with delirium. In future, the sample size need to be increased in the studies of delirium. And the evaluation of long-term side effects related to quetiapine need to be performed.

P50 and Schizophrenia

One of the most widely recognized neurophysiologic endophenotypes for schizophrenia is deficient gating or inhibition of the P50 component of the auditory event-related potential(ERP). A deficit in P50 sensory gating refers to a dysfunction in the mechanism responsible for modulating the brain's sensitivity of filtering out irrelevant or background stimuli, perhaps as a result of dysfunction in inhibitory neural circuits. In this paper, we review the neuronal and genetic aspects as well as medication effects on P50 in schizophrenia.

Low-Resolution Electromagnetic Tomography (LORETA) Source Imaging Compared with Structural Brain Imaging in Patients having Organic Brain Lesion / 신경정신의학

OBJECTIVES: Patients with organic brain lesion can produce unique slow waves (delta and theta) in the EEG. Basic assumption of this study was that the low resolution electro magnetic tomography (LORETA), an inverse source localization program, can provide functional images representing increased slow wave activity in these patients compared to normal subjects. METHODS: The current study was performed by 18 channels digital EEG for 10 patients whose organic deficit have been visually confirmed by CT or MRI. The source images of slow wave (1-7 Hz) frequency were produced by LORETA-key program. RESULTS: We found that in eight out of ten subjects, LORETA successfully found out the source regions which were very closely matched to their original brain lesions. However in two subjects whose organic brain lesions were too small (<1 cm) and located out of gray matter, we failed to find any increased slow wave activity compared with normal control. CONCLUSION: We can conclude that LORETA could be a useful method to provide functional imaging in patients with gray matter deficits in their brain. Its usefulness and limitations were discussed.

Association Study of the -36C>T Polymorphism in the Cholecystokinin Promoter Gene with the Diagnosis and the Response of Pharmacotherapy in Korean Patients with Panic Disorder / 대한정신약물학회지

OBJECTIVE: This study aimed to test the possible association between cholecystokinin (CCK) promoter gene and panic disorder. METHODS: 267 patients with panic disorder and 82 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Genotype and allele distribution of CCK promoter -36C>T polymorphism patients with panic disorder was not significantly different from those of the controls. In addition, after excluding panic disorder patients with major depressive disorder, we did not find out the association of CCK-36C>T with the panic disorder without comorbidities. CONCLUSION: This study suggested that the CCK promoter -36C>T polymorphism may have not a potential role for susceptibility to panic disorder in the Korean population. Thus calls for consecutive studies in order to pile up the data with larger different ethnic background.

Heart Rate Variability of Korean Generalized Anxiety Disorder Patients

OBJECTIVE: The purposes of this study were to investigate heart rate variability(HRV) in patients with generalized anxiety disorder(GAD) compared with major depressive disorder in Korea. METHODS: Fifty-six GAD patients(20 male and 36 female) was classified into their comorbid psychiatric illness. Among them, Twenty-five patients(10 male and 15 female) who do not have any psychiatric comorbidity were compared with 30 major depressive disorder patients(12 male and 18 female). Clinical symptoms, HRV and MMPI were analysed between two group. RESULTS: Comorbid psychiatric illnesses of GAD were ranked into no diagnosis(44.6%), MDD(32.1%), panic disorder(10.7%), social phobia(5.3%), PTSD(1.7%), OCD(1.7%), MDD+panic disorder(1.7%) and MDD+ specific phobia(1.7%). GAD patients showed low functioning in HRV, but degree of decreasing HRV is not so severe compared with MDD patient. Balance of sympathetic and parasympathetic nerve tone is more severely impaired in GAD patients compared with MDD patient. The score of MMPI did not reveal any differences between two groups. CONCLUSIONS: The result showed that HRV can differenciate GAD and MDD patients. GAD patients could show decreased HRV functioning, less than MDD patients. But autonomic imbalance could be more severe in GAD than MDD patients.

The 3 Cases of Patients with Behcet's Disease who have Depressive and Psychotic Symptoms / 신경정신의학

Behcet's disease is characterized by mucocutaneous-ocular symptoms, namely recurrent stomatitis aphthosis, genital ulcer and ocular symptoms. Organic mental changes can be often observed, as well as dementia, depression, visual hallucination and schizophrenia-like symptoms. A 46-year-old female was admitted due to visual and auditory hallucinations, paranoid delusion and disorientation which had continued for 3 weeks. The findings on brain MRI were compatible with neuro-Behcet's disease. Her psychiatric symptoms improved with antipsychotic medications. A 42-year-old female visited our clinic complaining short-term memory impairment, depressive mood, anxiety and insomnia. Her depressive mood, anxiety and insomnia improved with antidepressant and benzodiazepine treatment. However, memory impairment remained. A 40-year-old female visited ER due to a suicide attempt with drug overdose. Depressive mood continued a few weeks prior to the incident. During admission psychotic symptoms were observed. These symptoms improved with antipsychotics within a week. Also depressive mood was subsided with antidepressant. These three cases represent that Behcet's disease often accompanies with psychiatric symptoms. A variety of psychosocial stressors can influence the progress of Behcet's disease and psychiatric symptoms.

Development of New Drug for Cognitive Enhancement of Schizophrenia: Introduction of Measurement And Treatment Research to Improve Cognition in Schizophrenia(MATRICS) / 대한정신약물학회지

Antipsychotic drugs have focused on treatment of positive and negative symptoms of schizophrenia. While these drugs resulted in improvements of these symptoms, they did not yield the expected recovery to pre-morbid level of functioning. Recently, a growing number of publications have shown that the cognitive deficits are a core feature of schizophrenia and they are critical determinants of poor functional outcome. Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) is a NIMH initiative that is designed to stimulate development of drugs to improve cognition in schizophrenia. MATRICS has four main goals: 1) to promote development of novel compounds to enhance cognition in schizophrenia, 2) to increase acceptance of cognition in schizophrenia as a valid target for drug approval from the US Food and Drug Administration, 3) to help focus the economic research power of industry on this important, but neglected, clinical target, and 4) to identify promising compounds and support proof of concept trials for cognition-enhancers in schizophrenia. In this article, we reviewed the contents of MATRICS and its progress.

Neurocognitive Function and Clinical Characteristic in Schizophrenia Patients with Treatment-Resistant Auditory Hallucination / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and neurocognitive functions in schizophrenia patients with treatment-resistant auditory hallucination. METHODS: The 30 patients with treatment-resistant hallucination (hallucinating patients) were compared with 31 patients without hallucination (non-hallucinating patients) and 30 normal controls. The hallucinating patients included the schizophrenic patients who reported not-remitting hallucinations for 2 years in spite of appropriate treatments. The non-hallucinating patients included schizophrenic patients who had chronic illness course, and not reporting hallucination within 2 years. The hallucination characteristics and neurocognitive were measured by self report questionnaires on hallucination: functions Wisconsin card sorting test (WCST), Continuous performance test (CPT) and Sentence repetition test (SRT) among three groups. Psychopathology, depressive symptomps and extrapyramidal symtomps were measured by Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Beck depression Inventory (BDI) and Extrapyramidal Symptom Rating Scale (ESRS), separately. RESULTS: The auditory hallucinations 1 or 2 times a day (33%), with the contents of criticising and cursing (26%) were most frequent. Hallucinating patients did not feel uncomfortable with their hallucinations. WCST performances were significantly decreased in hallucinating patients than non-hallucinating patients, especially on total error (35.2+/-7.6 vs 25.3+/-10.0), perseverative error (54.8+/-14.9 vs 38.5+/-13.0). In CPT, hallucinating patients showed more error response (11.9+/-8.1 vs 8.9+/-7.5) and more prolonged reaction time to incorrect answers (552.4+/-433.2 ms vs 492.7+/-358.5 ms). CONCLUSION: Integrating these observations, it can be said that schizophrenic patients with treatment-resistant auditory hallucination have more neurocogntive functional deficits implying frontal lobe dysfunction than non-hallucinating schizophrenic patients.

Autonomic Neurocardiac Function in Patients with Major Depressive Disorder: Using a Heart Rate Variability Test Battery / 수면정신생리

OBJECTIVES: Major depression is associated with an increased risk of cardiovascular mortality. One possible explanation for this association is that major depression influences autonomic neurocardiac regulation. However, previous studies on the relationship between heart rate variability (HRV) and major depression have revealed conflicting results. The purpose of this study is to clarify that major depressive patients compared to healthy controls show a reduction in HRV as an expression of reduced modulation of vagal activity to the heart. METHODS: According to DSM-IV, the time and frequency domain HRV indices (5-min resting study) of 30 patients with major de-pressive disorder were compared with those of 30 healthy controls. Standardized HRV tests enable quantitative estimation of auto-nomic nervous system function. RESULTS: After controlling for age and gender, subjects with major depression showed a higher heart rate and significantly lower modulation of cardiovagal activity compared to controls. The total power (TP) band, very low frequency (VLF: 0.003-0.04 Hz) band, low frequency (LF: 0.04-0.15 Hz) band, and high frequency (HF: 0.15-0.4 Hz) band were significantly reduced in subjects with major depression compared to control subjects. CONCLUSION: Patients with major depression may suffer from functional disturbances in the interaction between the sympathetic and parasympathetic autonomic systems.

Neurocognitive Functions in Posttraumatic Stress Disorder

OBJECTIVE: The differences of various neurocognitive functions, including attention, memory, motor function, and higher cognitive function were compared between PTSD patients and normal control subjects. Also, correlation with PTSD symptom severity and neurocognitive functions were evaluated between PTSD patients and normal control subjects. METHOD: We assessed the neurocognitive functions by computerized neurocognitive test(CNT) batteries. The visual continuous performance test(CPT) and digit span test, finger tapping test and Wisconsin card sorting test(WCST) were executed. The Impact of Event Scale-Revised(IES-R) was used in the evaluation of the severity of PTSD. RESULT: The PTSD patients showed significantly impaired neurocognitive performance in all of the items, compared with normal control subjects. The relation between impairment in neurocognitive functions and symptom severity showed significant correlations. CONCLUSION: These results imply that PTSD patients have impaired neurocognitive functions concerning with specific brain areas, especially the frontal area. For the thorough evaluation of further neurocognitive functions, more detailed evaluation items of neurocognitive functions and brain imaging studies are necessary in the future study.

Antianxiety Treatment Guidelines for Non-psychiatric Clinicians

The anxiety disorders make up one of the most common groups of psychiatric disorders. Anxiety is an alerting signal ; it warns of impending danger and enables a person to take measures to deal with a threat. Three major schools of psychological theory-psychoanalytic, behavioral, and existential-have contributed theories about the causes of anxiety. Many drugs are effective in managing distressing signs and symptoms associated with anxiety disorders. As the symptoms are controlled by medication, patients are reassured and develop confidence that they will not be incapacitated by the disorder. Benzodiazepines are useful in panic disorder, phobias, and agitation. In general, benzodiazepines act as hypnotics at high doses and as anxiolytics or sedatives at low doses. The benzodiazepines have become the sedative-hypnotic drugs of first choice because they have a higher therapeutic index and significantly less abuse potential than do many of other sedative-hypnotics. The most common adverse effect of benzodiazepines is drowsiness. Some patients also experience dizziness and ataxia. The most serious adverse effects of benzodiazepines occur when other sedative substances are taken concurrently. When benzodiazepines are used for long periods, they usually cause significant tolerance, dependence, or withdrawal effects. Overdoses with benzodiazepines alone have a predictably favorable outcome. The benzodiazepines should be started at a low dosage, and the patient should be informed about the drug’s sedative properties and abuse potential. Serotonin-specific reuptake inhibitors (SSRIs) have a much more favorable profile of adverse effects and have significantly broadened the horizon for pharmacological treatment of anxiety disorder. Three fourths of patients experience no adverse effects at low starting doses, and doses may be increased relatively rapidly in these patients. In the remaining one fourth of patients, most of the SSRIs’ adverse effects appear within the first 1 to 2 weeks, and they generally subside or resolve spontaneously if the drugs are continued at the same dose.

Speech Perception Ability of Schizophrenics: A Comparative Study with Depressives & Normal Control

OBJECT: This study was to investigate the difference of speech perception ability in schizophrenic patients, and depression patients in order to explore trait-dependent speech perception ability of each disorder. METHODS: The speech perception ability was assessed with masked speech tracking test(MST) in schizophrenic patients(N=31), depression patients(N=25), and normal controls(N=21). The continuous performance test(CPT) and sentence repetition test(SRT) were also used for assessment of attention and working memory. RESULTS: The schizophrenic patients showed significant impaired MST performance, compared with depressive patients and normal controls. The performances of CPT and SRT were also more impaired in schizophrenic patients. The difference of MST performances between two patient group was cancelled out after consideration of differences in CPT & SRT performances. CONCLUSIONS: These results imply that schizophrenic patients have the impaired speech perception ability compared with depressive patients and normal controls. But speech perception ability was significantly influenced with CPT and SRT. For evaluation of pure speech perception ability, the more elaborate controlled study that excluded factors such as attention, working memory and intelligence is needed.

Mental Problems from the Economic Depression

No abstract available.

Neurobiology of Alzheimer's Disease

Alzheimer's disease(AD) is associated with a characteristic neuropathology. The major hallmarks of AD are senile plaques(SPs) and neurofibrillary tangles(NFTs). beta-amyloid protein(Abeta) is derived from the proteolysis of amyloid precursor protein(APP) and then converted to SPs. Mature SPs produce cytotoxicity through direct toxic effects and activation of microglia and complement. NFTs are composed of paired helical filaments(PHFs) including abnormally phosphorylated form of the microtubule-associated protein(MAP) tau and increased tau level in cerebrospinal fluid may be observed in most AD. The aggregation of Abeta and tau formation are thought to be a final common pathway of AD. Acetycholine, dopamine, serotonin, GABA and their receptors are associated with AD. Especially, decreased nicotinic acetylcholine receptors(nAChRs) in AD are reported. Genetic lesions associated with AD are mutations in the structural genes for the APP located on chromosome 21, presenilin(PSN)1 located on chromosome 14 and PSN2 located on chromosome 1. Also, trisomy 21, Apo-E gene located on chromosome 19, PMF locus, low density lipoprotein receptor-related protein and alpha-macroglobulin increase risk of AD. In this article, we will review about the neurobioloby of AD and some newly developed research areas.

Three Cases of Mirtazapine Induced Akathisia

The mirtazapine is a relatively new antidepressant that has noradrenergic and specific serotonin antagonist action(NaSSAs). This has been known as one of the most safest drugs because of its few side effects. Until now, there have been only one case report that mirtazapine causes a EPS side effect(restless leg syndrome). But the peculiar mechanism of this drug makes it impossible to explain the exact reasons why the mirtazapine could induce EPS symptoms. Authors obseved three cases of mirtazapine indeced akathisia. We could not explain the phenomenon the other way except akathisia. So here we presents the three case of mirtazapine induced akathisia and a few possible hypothesis of this phenomenon.

Depression Encountered at Primary Physician's Clinic

No abstract available.

Somatization

No abstract available.

The Relationship among Eating Traits, Personality Characteristics, and Other Psychopathology in the Korean General Population / 신경정신의학

OBJECTIVE: The purposes of this study were to clarify the roles of personality characteristics and general psychopathology, including depression and hypochondriasis, in individuals with eating disorders, and to test a continuum hypothesis of eating disorders. METHODS: Using a multi-stage questionnaire sampling method including area sampling, proportionated stratified sampling, and quota sampling, we surveyed 3,062 subjects(1249 males and 1813 females) from a target of 4,400 Korean adults over the age of 18 in a nationwide area(9 ku's, 10 middle or small cities, and 17 kun's). We used the questionnaire which consisted of three parts:general information, scales for eating traits, and scales for personality characteristics and other general psychopathology. RESULTS: Psychoticism was the only personality characteristics which had a significant relationship with various eating traits including 'eating habits'(r=-0.3195), 'the Eating Attitudes Test'(EAT, r=0.3657), and 'preference for vegetables and fish, and dislike for sweet,tasting foods'(r=-0.2740). Lie scale also had a significant relationship with 'preference for snacks and instant foods'(r=-0.2117). These results were consistent in examining the relationships across genders. In female, there was a significant relationship between 'preference for the traditional Korean foods' and 'psychoticism'(r=-0.2103) in addtion to above relationships. However, there were no significant relationships between any of the eating traits and other psychopathology. Relative to the relationship between personality characteristics and general psychopathology, there were significant correlations between 'depression' and 'interoversion-extraversion'(r=-0.2174), 'depression' and 'neuroticism'(r=0.4510>, and 'hypochondriasis' and 'neuroticism'(r=0.3432). These correlations in female was the same as those of the total group, while among males, 'depression' was significantly correlated with all four personality characteristics, and 'hypochondriasis' was significantly correlated with 'interoversion-extraversion'(r=-0.2265) and 'neuroticism'(r=0.3762). CONCLUSION: These results suggest that psychoticism is the only personaltiy characteristics related to eating-specific psychopathology, while general psychopathology, such as depression and hypochondriasis is not related to eating pathology but may influence eating disorders by their interaction with other personality characteristics, such as interoversion-extraversion and neuroticism. Considering the results of previous studies in the patients with eating disorders and high risk groups, which are similar with our results in the general population, our results support a continuum hypothesis of eating disorders. Our results also suggest that gender differences in the pathology of eating disorders are the result not of difference in eating-specific pathology itself but through difference in influences of concurrent general psychopathology, such as depression and hypochondriasis.