Body Dysmorphic Disorder, Psychiatric Symptoms, and Quality of Life in Female Dermatological Patients.

PURPOSE: To examine the relationships of body dysmorphic disorder (BDD) with psychiatric symptoms and quality of life in dermatological patients. PATIENTS AND METHODS: A total of 154 female patients with dermatological disease underwent a comprehensive clinical assessment that included the Body Dysmorphic Disorder Examination-Self Report (BDDE-SR), Symptom Checklist 90-Revised (SCL-90-R), and Skindex-29. Dermatological disease was categorized as follows: inflammatory dermatoses (reference category), isolated lesions, and unclassified dermatoses. The BDDE-SR and SCL-90-R scores were used to evaluate BDD and psychiatric symptoms, respectively. Dermatological quality of life was measured with the Skindex-29. RESULTS: The BDDE-SR score was significantly associated with the SCL-90-R and Skindex-29 total and subscores, even after controlling for age, body mass index, and dermatological diagnosis. The variables that contributed most to the BDDE-SR score were the SCL-90-R depression score and Skindex-29 emotion scores. Additional analyses revealed that the BDDE-SR score was higher in participants with unclassified dermatoses, but neither the SCL-90-R score nor Skindex-29 score was related to any dermatological diagnosis. CONCLUSION: The BDD symptoms were especially prominent in the unclassified dermatoses group and were highly related to psychiatric symptoms and a poor quality of life in our dermatological patients. Further research including studies involving psychiatric interviews to confirm the BDD diagnosis and symptoms will improve our understanding of BDD in dermatological patients.

Efficacy and safety of oral SOCG in treatment of major depressive disorder: A protocol for a phase II, randomized, double-blind, placebo controlled, parallel-groups, dose finding exploratory study.

INTRODUCTION: Major depressive disorder (MDD) is a common condition worldwide, and leads to degradation in quality of life and large socioeconomic costs. There has been increasing demand for new therapies with fewer side effects. SOCG (SOCG tablet) is a modified prescription of So-ochim-tang, which is widely used in Traditional Korean Medicine to treat MDD. We aim to evaluate the efficacy of SOCG in treating MDD, and identify the optimum dose. DESIGN: The protocol we are following is that of a Phase II clinical trial with a randomized, double blinded, placebo controlled, and parallel design. One hundred forty-eight participants will be randomly divided into 4 groups and treated for 8 weeks. OUTCOME MEASURES: The primary outcome will be the score in the Korean Version of the Hamilton Depression Rating Scale. Scores in the Korean version of the Beck Depression Inventory-II Korean Symptom Check List-95 (KSCL-95), State Trait Anxiety Inventory-Korean version, State- Trait Anger Expression Inventory- Korean version (STAXI-K), Insomnia Severity Index (ISI), and the EuroQol-5 Dimension (EQ-5D) will be considered as secondary outcomes. DISCUSSION AND CONCLUSIONS: Demonstration of human safety and efficacy of SOCG in the present trial and identification of the appropriate dose will justify a New Drug Application and a phase III clinical trial. Further, we expect that this new antidepressant will be able to increase cure rates, and alleviate the burden of medical expenses. TRIAL REGISTRATION NUMBER: Clinical Research Information Service, Republic of Korea (KCT0002763).

Comparative Analysis of Emotional Symptoms in Elderly Koreans with Hwa-Byung and Depression.

OBJECTIVE: This study compared the symptomatic emotional traits of elderly South Korean patients with hwa-byung and those with depression. METHODS: We enrolled 58 patients with hwa-byung, 180 patients with depression, and 181 healthy control subjects. All participants completed the Hwa-byung Scale, Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS), State Trait Anger Expression Inventory (STAXI), Reaction Inventory (RI), and Aggression Questionnaire (AQ). Chi-square tests and a one-way analysis of variance with Games-Howell post-hoc tests were used to compare demographic variables and scores. RESULTS: A binary logistic regression analysis was used to examine risk factors for hwa-byung. Scores in the hwa-byung group were higher than those in the depression group for the HDRS; BDI; GDS; trait anger STAXI subscale (trait anger temperament and trait anger reaction); state anger and anger expression STAXI subscales (anger-in, anger-out, and anger control); physical and verbal aggression as well as anger and hostility AQ subscales; and disturbance, embarrassing circumstances, personal disrespect, and unpleasant encounters RI subscales. A binary logistic regression analysis demonstrated that the state anger STAXI subscale, verbal aggression and anger AQ subscales, and unpleasant encounters RI subscale were significantly associated with hwa-byung. CONCLUSION: Elderly patients with hwa-byung had more severe anger traits and states as well as higher depression severity compared to those diagnosed with clinical depression. Excessive anger and anger reactivity to unpleasant factors may be risk factors for hwa-byung, whereas the appropriate expression (rather than suppression) of anger may decrease the risk of hwa-byung.

Polymorphism of the SNAP25 gene is associated with symptom improvement in schizophrenic patients treated with amisulpride.

Synaptosomal-associated protein 25kDa (SNAP25) is a promising candidate gene related to the treatment response to antipsychotics. Thus, the present study investigated the associations between polymorphisms of SNAP25 and the treatment response to amisulpride in patients with schizophrenia. This study enrolled 154 schizophrenic patients from six university hospitals in South Korea. All patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity (CGI-S) scale at baseline and week 6 of treatment. Additionally, 101 subjects were genotyped for the rs8636 and rs3746544 single nucleotide polymorphisms (SNPs) of SNAP25. The genotype frequencies of rs8636 SNP significantly differed between responders and non-responders, measured by PANSS total score, in additive, recessive, and overdominant models. These findings suggest that SNAP25 might be a useful marker for predicting the response to antipsychotics. Future studies should include a larger number of subjects, a comprehensive array of SNAP25 SNPs, and functional analyses.

Clinical Dementia Rating Orientation Score as an Excellent Predictor of the Progression to Alzheimer's Disease in Mild Cognitive Impairment.

OBJECTIVE: This study aimed to examine the usefulness of each subscale score of the Clinical Dementia Rating (CDR) for predicting Alzheimer's disease (AD) dementia progression in amnestic mild cognitive impairment (MCI) elderly subjects. METHODS: Fifty-nine elderly MCI individuals were recruited from a university dementia and memory disorder clinic. Standardized clinical and neuropsychological tests were performed both at baseline and at the time of 2 years follow-up. Logistic regression analyses were conducted to examine the ability of various clinical measures or their combinations to predict progression to AD dementia in MCI individuals. RESULTS: MCIp individuals showed significantly higher CDR Orientation subscale and CDR sum-of-boxes (SOB) score than MCInp ones, while there were no significant differences in other CDR subscale scores between the two. MCIp individuals also showed marginally higher MMSE scores than MCInp ones. A series of logistic regression analyses demonstrated that the model including CDR Orientation subscale had better AD dementia prediction accuracy than either the model with either MMSE or CDR-SOB. CONCLUSION: Our findings suggest that CDR Orientation subscale score, a simple and easily available clinical measure, could provide very useful information to predict AD dementia progression in amnestic MCI individuals in real clinical settings.

rs7968606 polymorphism of ANKS1B is associated with improvement in the PANSS general score of schizophrenia caused by amisulpride.

A recent genome-wide pharmacogenomics study showed that the rs7968606 single-nucleotide polymorphism (SNP) of the ankyrin repeat and sterile alpha motif domain-containing protein 1B (ANKS1B) gene approached the threshold of statistical significance. The aim of this study was to determine the association between the rs7968606 SNP of ANKS1B and the treatment response to amisulpride in schizophrenia patients. In total, 154 participants were enrolled from six university hospitals in Korea. All the subjects were interviewed before and after 6 weeks of amisulpride treatment with the aid of the positive and negative syndrome scale and the clinical global impression-severity scale. Genotyping for the rs7968606 SNP of ANKS1B was performed in 101 subjects. Both the decrease (t = -2.067, p = 0.041) and improvement rate (t = -1.990, p = 0.049) in the positive and negative syndrome scale general score differed significantly between T-allele carriers and noncarriers of this polymorphism after 6 weeks of amisulpride treatment. To the best of our knowledge, this is the first genetic association study of the relationship between the rs7968606 SNP of ANKS1B and the response of schizophrenia patients to treatment with amisulpride. Future larger-scale studies involving more SNPs of ANKS1B will improve the understanding of the pharmacogenetics underlying the treatment responses to amisulpride.

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study.

OBJECTIVE: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. METHODS: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). RESULTS: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. CONCLUSION: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

DRD2 genotypic and haplotype variation is associated with improvements in negative symptoms after 6 weeks' amisulpride treatment.

The aim of this study was to identify the association between the rs1079597 and rs1800497 genetic polymorphisms of the gene encoding the dopamine D2 receptor (DRD2) protein and the treatment response to the selective dopamine receptor antagonist amisulpride. After 6 weeks of treatment with amisulpride, 125 schizophrenia patients were interviewed based on the Positive and Negative Syndrome Scale and the Clinical Global Impression-Severity Scale. Genotyping for rs1079597 and rs1800497 was performed using the TaqMan single nucleotide polymorphism genotyping assay. There were significant differences in the genotype frequency of the recessive model (χ = 5.73, P = 0.017) and allele frequency (χ = 5.16, P = 0.023) of rs1079597 between the responders and nonresponders based on the Positive and Negative Syndrome Scale negative symptoms scores. There was no significant finding in this regard for the rs1800497 polymorphism. The T-C and C-C haplotype of rs1079597-rs1800497 were associated with the negative symptom treatment response to amisulpride after permutation test. To the best of our knowledge, this is the first report of the positive finding in the association study between rs1079597 polymorphism and the treatment response to amisulpride in schizophrenic patients. A larger scale study involving more single nucleotide polymorphisms of DRD2 will progress the research into the pharmacogenetics of the treatment response to amisulpride.

No Effect on Body Dissatisfaction of an Interaction between 5-HTTLPR Genotype and Neuroticism in a Young Adult Korean Population.

OBJECTIVE: Many studies suggest an association between the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and anxiety-related personality traits (e.g., neuroticism) in healthy subjects. This study investigated the interaction of 5-HTTLPR genotype on body dissatisfaction by neuroticism and to evaluate the interaction of 5-HTTLPR genotype on self-esteem by body dissatisfaction in a young adult Korean population. METHODS: Two hundred and eighty three subjects were included in this study. The Eysenck Personality Questionnaire-Korean version was used to evaluate neuroticism, the Body Dysmorphic Disorder Examination-Self Report (BDDE-SR)-Korean version was used to evaluate body dissatisfaction, and the Self-Esteem Scale (SES)-Korean version was used to evaluate self-esteem. The 5-HTTLPR genotype by neuroticism (high : low) interaction was assessed according to the total BDDE-SR score, and 5-HTTLPR genotype by BDDE-SR (high : low) interaction was assessed according to the total SES score. RESULTS: The analysis of 5-HTTLPR genotype and neuroticism (high : low) with respect to body dissatisfaction showed no main effects of genotype whereas neuroticism did influence the BDDE-SR score and no interaction of the genotype with neuroticism. The analysis of 5-HTTLPR genotype and BDDE-SR (high : low) with respect to self-esteem score showed no main effects of genotype whereas BDDE-SR did influence the self-esteem score and no interaction of the genotype with body dissatisfaction. CONCLUSION: These results suggest that an interaction between 5-HTTPLR genotype and neuroticism does not affect body dissatisfaction and an interaction between 5-HTTPLR genotype and body dissatisfaction does not affect self-esteem in a young adult Korean population.

The effect of paliperidone extended release on subjective well-being and responses in patients with schizophrenia.

OBJECTIVE: This study aimed to evaluate the subjective well-being and attitudes toward antipsychotic medication of patients with schizophrenia who had switched to paliperidone extended release (ER). METHODS: A total of 291 patients with schizophrenia treated with antipsychotics participated in this open-label, 24-week switching study. The primary outcome measures were the Subjective Well-Being under Neuroleptic Treatment Scale-short version (SWN-K) and the Drug Attitude Inventory (DAI). The Krawiecka scale, Clinical Global Impression-Schizophrenia (CGI-SCH), Personal and Social Performance scale (PSP) were used to evaluate psychopathology and psychosocial functioning, respectively. RESULTS: Data from a total of 243 subjects who received the study medication and had at least one follow-up assessment without a major protocol violation were analyzed. Scores on the DAI and SWN-K showed significant improvement between baseline and end-point measurements beginning during the second week. Scores on the Krawiecka scale, all five subscales of the CGI-SCH scale, and the PSP scale were also significantly improved at the end point compared with the baseline. Significant predictors of improvements in the SWN-K and DAI after a switch to paliperidone ER were baseline scores, reductions in scores on the Krawiecka scale, and previous risperidone use. A clinically relevant increase in body weight (≥7% weight gain) occurred in one-fourth of the participants who completed the 24-week study. CONCLUSION: Switching to paliperidone ER improved the subjective well-being and attitudes towards antipsychotic medication in patients with schizophrenia. Exploratory analyses revealed that these improvements were particularly pronounced in patients who had been treated with risperidone before treatment with paliperidone ER.

Anger in elderly patients with depressive disorders.

OBJECTIVE: This study was conducted to investigate anger in elderly patients with depressive disorders. METHODS: The subjects included 216 elderly patients with depression and 198 controls. All subjects were assessed by the State and Trait Anger Inventory (STAXI), Aggression Questionnaire (AQ), Reaction Inventory (RI). RESULTS: Elderly patients with depressive disorder showed lower levels of trait anger and anger expression on the STAXI, lower levels of verbal aggression and hostility on the AQ, and lower levels of anger reaction to the unpredictable disruption and disturbances factor, the embarrassing circumstances factor, and the personal disrespect factor on the RI than the controls. In the depression group, the severity of their depression was positively correlated with the trait anger, state anger, anger expression (except 'anger control') scores on the STAXI; the physical aggression, anger, and hostility scores on the AQ; and the anger reaction to unpredictable disruption and disturbances factor, the embarrassing circumstances factor, and the personal disrespect factor scores on the RI. However, the severity of depression negatively correlated with only anger control on the STAXI. In the linear logistic regression analysis, as there were higher levels of state anger seen in the STAXI, anger on the AQ, anger reaction to unpleasant factors on the RI, and therefore the likelihood of depression would be higher. CONCLUSION: Elderly depressive patients are less likely to have anger traits and to express anger than normal elderly. However, in elderly depressive patients, the higher they have severity of depressive symptoms, the higher they reported anger experience and anger expression.

A validation study of the Korean version of SPAN.

PURPOSE: The SPAN, which is acronym standing for its four components: Startle, Physiological arousal, Anger, and Numbness, is a short post-traumatic stress disorder (PTSD) screening scale. This study sought to develop and validate a Korean version of the SPAN (SPAN-K). MATERIALS AND METHODS: Ninety-three PTSD patients (PTSD group), 73 patients with non-psychotic psychiatric disorders (psychiatric control group), and 88 healthy participants (normal control group) were recruited for this study. Participants completed a variety of psychiatric assessments including the SPAN-K, the Davidson Trauma Scale (DTS), the Clinician-Administered PTSD Scale (CAPS), and the State-Trait Anxiety Inventory (STAI). RESULTS: Cronbach's α and test-retest reliability values for the SPAN-K were both 0.80. Mean SPAN-K scores were 10.06 for the PTSD group, 4.94 for the psychiatric control group, and 1.42 for the normal control group. With respect to concurrent validity, correlation coefficients were 0.87 for SPAN-K vs. CAPS total scores (p<0.001) and 0.86 for SPAN-K vs. DTS scores (p<0.001). Additionally, correlation coefficients were 0.31 and 0.42 for SPAN-K vs. STAI-S and STAI-T, respectively. Receiver operating characteristic analysis of SPAN-K showed good diagnostic accuracy with an area under the curve (AUC) of 0.87. The SPAN-K showed the highest efficiency at a cutoff score of 7, with a sensitivity of 0.83, a specificity of 0.81, positive predictive value (PPV) of 0.88, and negative predictive value (NPV) of 0.73. CONCLUSION: These results suggest that the SPAN-K had good psychometric properties and may be a useful instrument for rapid screening of PTSD patients.

Early assessment of delirium in elderly patients after hip surgery.

OBJECTIVE: This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. METHODS: This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98) was used to assess prodromal symptoms daily before the onset of delirium. RESULTS: Almost 28% (n=18) of the 65 patients developed delirium after surgery. Delirium in elderly patients after hip surgery was observed more often in older patients and those with acute admission, hip fracture, higher APACHE III score, lower MMSE score, and higher CRP levels within early days after the operation. Sleep-wake cycle disturbances, thought process abnormalities, orientation, and long-term memory in symptom items of K-DRS-98 were showed significant difference on 4 days before delirium, lability of affect on 3 days before, perceptual disturbances and hallucination, and visuo-spatial ability on 2 days before, and delusion, motor agitation, and short-term memory on the day before the occurrence of delirium. CRP levels within 24 hours and 72 hours after hospitalization were significantly higher in the delirium group. CONCLUSION: Medical professionals must pay attention to behavioral, cognitive changes and risk factors in elderly patients undergoing hip surgery and to the prodromal phase of delirium. K-DRS-98 may help in identifying the prodromal symptoms of delirium in elderly patients after hip surgery.

A gene conversion hotspot in the human growth hormone (GH1) gene promoter.

To assess the evolutionary importance of nonallelic (or interlocus) gene conversion for the highly polymorphic human growth hormone (GH1) gene promoter, sequence variation in this region was studied in four different ethnic groups. For 14 SNPs in the proximal GH1 promoter (535 bp), 60 different haplotypes were observed in 577 individuals (156 Britons, 116 Spaniards, 163 West-Africans, 142 Asians). Using a novel coalescence-based statistical test, significant evidence was found in the British, Spanish, and African groups for GH1 having acted as an acceptor of gene conversion, with at least one of the four paralogous GH gene promoters serving as the donor (and specifically GH2 in the Britons and Spaniards). The average gene conversion tract length was estimated to be 84 bp. A gene conversion hotspot was identified, spanning the GH1 transcriptional initiation site (positions -6 to +25). Although these findings serve to highlight the importance of gene conversion for the recent evolution of the human GH1 promoter, its relative frequency does not appear to be related simply to the presence of specific DNA sequence motifs or secondary structures, the degree of homology between GH paralogs, the distance between them, or their transcriptional orientation. The GH1 promoter was also found to be highly polymorphic in chimpanzee but not in macaque. This may reflect the lower degree of pair-wise similarity between the GH1 promoter and its paralogs in macaque (mean, 92.0%) as compared to chimpanzee (93.5%) and human (94.0%), and hence provides further support for the idea of a threshold (perhaps around 92%) below which gene conversion is reduced or abolished.

Reliability and validity of the Korean version of the Davidson Trauma Scale.

The Davidson Trauma Scale (DTS) is a validated, 17-item, brief global assessment scale for posttraumatic stress disorder (PTSD). The purposes of this study were to develop a Korean version of the DTS (DTS-K) while maintaining its basic structure and to evaluate its reliability and validity for the Korean population. Participants of this study included 93 patients with PTSD (PTSD group), 73 patients with nonpsychotic mood or other anxiety disorders (psychiatric control group), and 88 healthy controls (normal control group). Subjects completed psychometric assessments, including the DTS-K and the Korean version of the Clinician-Administered PTSD Scale and the State Trait Anxiety Inventory. The DTS-K showed good internal consistency (Cronbach alpha = .97) and test-retest reliability (r = .93). The DTS-K showed a significantly positive correlation with Clinician-Administered PTSD Scale (r = .94). The highest diagnostic efficiency of DTS-K was at a total score of 47, with sensitivity and specificity of 0.87 and 0.84, respectively. Our findings suggest that the DTS-K is composed of good psychometric properties and is a valid and reliable tool for assessing the frequency and severity of PTSD symptoms regardless of ethnicity.

Comparison of efficacy and safety of milnacipran and fluoxetine in Korean patients with major depression.

OBJECT: To compare efficacy and safety of milnacipran and fluoxetine in a population of Korean patients with major depression. RESEARCH DESIGN AND METHODS: The design was a multi-centre, randomised, comparative clinical study. Patients with major depression (DSM-IV diagnostic criteria) scoring over 17 points on the 17-item Hamilton Depression Scale (HAM-D) and over 21 points on the Montgomery-Asberg Depression Rating Scale (MADRS) were recruited and randomised to receive milnacipran (50 mg/day increasing after 1 week to 100 mg/day) or fluoxetine (20 mg/day) for 6 weeks. All previous medication was stopped at least 7 days before entry into the study. Patients were evaluated (HAM-D, MADRS and clinical global impression scale, CGI) at baseline and after 1, 2, 4 and 6 weeks of treatment. All adverse events which developed during the study period were recorded. RESULTS: 70 patients (milnacipran 39; fluoxetine 31) were included in the study. Total score on both HAM-D, MADRS and CGI decreased significantly in both groups after 1 week and continued to decrease throughout the study. There was no significant difference between the two groups for any measurement at any time point. Both antidepressants were well tolerated. In the milnacipran group, 13 patients reported 28 adverse reactions, and in the fluoxetine group 11 patients reported 18 adverse reactions. Two patients discontinued due to adverse events in the milnacipran group and three in the fluoxetine group. There were no clinically significant modifications in vital signs, routine blood laboratory tests, biochemistry or ECG throughout the study. Nausea and headache were the most frequently reported adverse events with milnacipran while digestive disturbances, diarrhoea and insomnia were more common with fluoxetine. CONCLUSION: Milnacipran, like fluoxetine, was found to be effective and well tolerated for the treatment of major depression in this population of depressed Korean patients. Principal limitations of the study were its open design, its small sample size and its relatively short duration.

Influence of the serotonin transporter promoter gene polymorphism on susceptibility to posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder marked by behavioral, physiologic, and hormonal alterations. The etiology of PTSD is unknown, although exposure to a traumatic event constitutes a necessary, but not sufficient, factor. Serotonergic dysfunction has been implicated in PTSD. The present study examined the possible association between the serotonin-transporter-linked polymorphic region (SERTPR) and PTSD. The genotype and allele frequencies of the SERTPR were analyzed in 100 PTSD patients and 197 unrelated healthy controls using a case-control design. The frequency of the s/s genotype was significantly higher in PTSD patients than in normal controls. These findings suggest that the SERTPR s/s genotype is one of the genetic factors for the susceptibility to PTSD. Further investigations are required into the influence of gene polymorphisms on the biological mechanisms of PTSD, its clinical expression, and its response to treatment.