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Objective@#Suicidal ideation is one of the strongest predictors of suicide, and its relevance to impulsivity in depressed patients has been accumulated. Furthermore, high impulsivity patients show the attenuation of the Nogo amplitude in the GoNogo event-related potential (ERP). The purpose of the current study is to determine the correlation of Nogo ERP to the suicidal ideation depending on the condition of its presence or absence in major depressive disorder (MDD) patients. @*Methods@#A total 162 participants (104 patients with suicidal ideation, 31 patients without suicidal ideation, and 27 healthy controls) were recruited, and performed GoNogo tasks during the electroencephalogram measurement. Depression, anxiety, suicidal ideation and impulsivity were assessed by self-rating scales. The clinical measures, behavioral data and Nogo ERP were compared among groups. @*Results@#The MDD with suicidal ideation (SI) group showed significantly decreased Nogo P3 amplitudes compared to MDD without SI (Fz and Cz electrodes) and control group (all electrodes). The MDD with SI group also had significantly low accuracy of both Go and Nogo trails, compared to the MDD without group. The Nogo P3 amplitudes showed the negative relation to the scores of impulsivity, depression, anxiety and SI. @*Conclusion@#Our results concluded that the Nogo P3 ERP amplitude was decreased in MDD patients with SI compared to MDD patients without SI and controls. These findings suggest that the decreased Nogo P3 amplitude is the one of the candidate biomarker for impulsivity in MDD patients to evaluating SI.
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Objectives@#Assessing the risks of youth suicide in educational and clinical settings is crucial.Therefore, this study developed a machine learning model to predict suicide attempts using the Korean Youth Risk Behavior Web-based Survey (KYRBWS). @*Methods@#KYRBWS is conducted annually on Korean middle and high school students to assess their health-related behaviors. The KYRBWS data for 2021, which showed 1206 adolescents reporting suicide attempts out of 54848, was split into the training (n=43878) and test (n=10970) datasets. Thirty-nine features were selected from the KYRBWS questionnaire. The balanced accuracy of the model was employed as a metric to select the best model. Independent validations were conducted with the test dataset of 2021 KYRBWS (n=10970) and the external dataset of 2020 KYRBWS (n=54948). The clinical implication of the prediction by the selected model was measured for sensitivity, specificity, true prediction rate (TPR), and false prediction rate (FPR). @*Results@#Balanced bag of histogram gradient boosting model has shown the best performance (balanced accuracy=0.803). This model shows 76.23% sensitivity, 83.08% specificity, 10.03% TPR, and 99.30% FPR for the test dataset as well as 77.25% sensitivity, 84.62% specificity, 9.31% TPR, and 99.45% FPR for the external dataset, respectively. @*Conclusion@#These results suggest that a specific machine learning model can predict suicide attempts among adolescents with high accuracy.
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Objective@#The loudness dependence of the auditory evoked potential (LDAEP) is a reliable indicator that is inversely related to central serotonergic activity, and recent studies have suggested an association between LDAEP and suicidal ideation. This study investigated differences in LDAEP between patients with major depressive disorder and high suicidality and those with major depressive disorder and low suicidality compared to healthy controls. @*Methods@#This study included 67 participants: 23 patients with major depressive disorder with high suicidality (9 males, mean age 29.3 ± 15.7 years, total score of SSI-BECK ≥ 15), 22 patients with major depressive disorder with low suicidality (9 males, mean age 42.2 ± 14.4 years, total score of SSI-BECK ≤ 14), and 22 healthy controls (11 males, mean age 31.6 ± 8.7 years). Participants completed the following assessments: Patient Health Questionnaire-9, Beck Depression Inventory-II, Beck Scale for Suicidal ideation, State Anxiety Scale of the State-Trait Anxiety Inventory, Beck Anxiety Inventory, and LDAEP (measured at electrode Cz). @*Results@#There were no sex-related differences among groups (p = 0.821). The high-suicidality group exhibited significantly higher LDAEP compared to the low-suicidality group (0.82 ± 0.79 vs. 0.26 ± 0.36, p = 0.014). No significant differences were found between the control and high-suicidality (p = 0.281) or the control and low-suicidality groups (p = 0.236). @*Conclusion@#LDAEP was applied to demonstrate the association between serotonergic activity and suicidal ideation and suicide risk in major depression and may be a candidate of biological marker for preventing suicide in this study.
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Objective@#The loudness dependence of the auditory evoked potential (LDAEP) is a reliable indicator that is inversely related to central serotonergic activity, and recent studies have suggested an association between LDAEP and suicidal ideation. This study investigated differences in LDAEP between patients with major depressive disorder and high suicidality and those with major depressive disorder and low suicidality compared to healthy controls. @*Methods@#This study included 67 participants: 23 patients with major depressive disorder with high suicidality (9 males, mean age 29.3 ± 15.7 years, total score of SSI-BECK ≥ 15), 22 patients with major depressive disorder with low suicidality (9 males, mean age 42.2 ± 14.4 years, total score of SSI-BECK ≤ 14), and 22 healthy controls (11 males, mean age 31.6 ± 8.7 years). Participants completed the following assessments: Patient Health Questionnaire-9, Beck Depression Inventory-II, Beck Scale for Suicidal ideation, State Anxiety Scale of the State-Trait Anxiety Inventory, Beck Anxiety Inventory, and LDAEP (measured at electrode Cz). @*Results@#There were no sex-related differences among groups (p = 0.821). The high-suicidality group exhibited significantly higher LDAEP compared to the low-suicidality group (0.82 ± 0.79 vs. 0.26 ± 0.36, p = 0.014). No significant differences were found between the control and high-suicidality (p = 0.281) or the control and low-suicidality groups (p = 0.236). @*Conclusion@#LDAEP was applied to demonstrate the association between serotonergic activity and suicidal ideation and suicide risk in major depression and may be a candidate of biological marker for preventing suicide in this study.
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Objectives@#ZZThe aim was to find effective vectorization and classification models to predict a psychiatric diagnosis from text-basedmedical records. @*Methods@#ZZElectronic medical records (n = 494) of present illness were collected retrospectively in inpatient admission notes withthree diagnoses of major depressive disorder, type 1 bipolar disorder, and schizophrenia. Data were split into 400 training data and 94 independentvalidation data. Data were vectorized by two different models such as term frequency-inverse document frequency (TF-IDF)and Doc2vec. Machine learning models for classification including stochastic gradient descent, logistic regression, support vectorclassification, and deep learning (DL) were applied to predict three psychiatric diagnoses. Five-fold cross-validation was used to find aneffective model. Metrics such as accuracy, precision, recall, and F1-score were measured for comparison between the models. @*Results@#ZZFive-fold cross-validation in training data showed DL model with Doc2vec was the most effective model to predict the diagnosis(accuracy = 0.87, F1-score = 0.87). However, these metrics have been reduced in independent test data set with final workingDL models (accuracy = 0.79, F1-score = 0.79), while the model of logistic regression and support vector machine with Doc2vec showedslightly better performance (accuracy = 0.80, F1-score = 0.80) than the DL models with Doc2vec and others with TF-IDF. @*Conclusions@#ZZThe current results suggest that the vectorization may have more impact on the performance of classification thanthe machine learning model. However, data set had a number of limitations including small sample size, imbalance among the category,and its generalizability. With this regard, the need for research with multi-sites and large samples is suggested to improve the machinelearning models.
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Objectives@#ZZThe aim was to find effective vectorization and classification models to predict a psychiatric diagnosis from text-basedmedical records. @*Methods@#ZZElectronic medical records (n = 494) of present illness were collected retrospectively in inpatient admission notes withthree diagnoses of major depressive disorder, type 1 bipolar disorder, and schizophrenia. Data were split into 400 training data and 94 independentvalidation data. Data were vectorized by two different models such as term frequency-inverse document frequency (TF-IDF)and Doc2vec. Machine learning models for classification including stochastic gradient descent, logistic regression, support vectorclassification, and deep learning (DL) were applied to predict three psychiatric diagnoses. Five-fold cross-validation was used to find aneffective model. Metrics such as accuracy, precision, recall, and F1-score were measured for comparison between the models. @*Results@#ZZFive-fold cross-validation in training data showed DL model with Doc2vec was the most effective model to predict the diagnosis(accuracy = 0.87, F1-score = 0.87). However, these metrics have been reduced in independent test data set with final workingDL models (accuracy = 0.79, F1-score = 0.79), while the model of logistic regression and support vector machine with Doc2vec showedslightly better performance (accuracy = 0.80, F1-score = 0.80) than the DL models with Doc2vec and others with TF-IDF. @*Conclusions@#ZZThe current results suggest that the vectorization may have more impact on the performance of classification thanthe machine learning model. However, data set had a number of limitations including small sample size, imbalance among the category,and its generalizability. With this regard, the need for research with multi-sites and large samples is suggested to improve the machinelearning models.
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Objective@#This study investigated the treatment response and cognitive enhancement effects of buspirone augmentation of escitalopram in patients with major depressive disorder (MDD), according to atypical feature subtypes of MDD. @*Methods@#An 8 week, randomized, parallel-controlled, open-label study was conducted. The Columbia Atypical Depression Diagnostic Scale was administered to evaluate atypical features. Patients were assigned randomly to the buspirone augmentation or non-buspirone groups. Symptom severity and cognitive function were evaluated using the 17-item Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Beck Depression Inventory, Beck Anxiety Inventory, digit span test, word fluency test, and Trail Making Tests A and B. @*Results@#A total of 89 patients were recruited. There were no significant differences in the measures between the groups; however, among the MDD patients without atypical features, the digit span and word fluency tests were improved by treatment. In the MDD patients without atypical features, the buspirone augmentation group showed a significant improvement on the digit span test compared to the non-buspirone group. @*Conclusion@#Buspirone augmentation did not demonstrate significant benefits in MDD patients; however, buspirone augmentation showed greater efficacy for the improvement of cognitive function in MDD patients without atypical features. Our study suggests that atypical features are an important factor for cognitive enhancement in buspirone augmentation treatment in patients with MDD.
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OBJECTIVES: According to previous studies, the Chromogranin B (CHGB) gene could be an important candidate gene for schizophrenia which is located on chromosome 20p12.3. Some studies have linked the polymorphism in CHGB gene with the risk of schizophrenia. Meanwhile, smooth pursuit eye movement (SPEM) abnormality has been regarded as one of the most consistent endophenotype of schizophrenia. In this study, we investigated the association between the polymorphisms in CHGB gene and SPEM abnormality in Korean patients with schizophrenia. METHODS: We measured SPEM function in 24 Korean patients with schizophrenia (16 male, 8 female) and they were divided according to SPEM function into two groups, good and poor SPEM function groups. We also investigated genotypes of polymorphisms in CHGB gene in each group. A logistic regression analysis was performed to find the association between SPEM abnormality and the number of polymorphism. RESULTS: The natural logarithm value of signal/noise ratio (Ln S/N ratio) of good SPEM function group was 4.19 ± 0.19 and that of poor SPEM function group was 3.17 ± 0.65. In total, 15 single nucleotide polymorphisms of CHGB were identified and the genotypes were divided into C/C, C/R, and R/R. Statistical analysis revealed that two genetic variants (rs16991480, rs76791154) were associated with SPEM abnormality in schizophrenia (p = 0.004). CONCLUSIONS: Despite the limitations including a small number of samples and lack of functional study, our results suggest that genetic variants of CHGB may be associated with SPEM abnormality and provide useful preliminary information for further study.
Subject(s)
Humans , Male , Chromogranin B , Endophenotypes , Eye Movements , Genetic Variation , Genotype , Logistic Models , Polymorphism, Single Nucleotide , Pursuit, Smooth , SchizophreniaABSTRACT
OBJECTIVE: We aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9). METHODS: Two hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea. RESULTS: Greater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, p<0.001], reduced/increased sleep (aOR=3.269, p<0.001), psychomotor retardation/agitation (aOR=2.243, p=0.004), and concentration problem (aOR=16.116, p<0.001) were independently associated with increased likelihood of having depressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, p<0.001]. CONCLUSION: Our findings suggested that the diagnostic weighting of little interest, reduced/increased sleep, psychomotor retardation/agitation, and concentration problem is needed to detect depressive disorder among the elderly patients with chronic physical diseases.
Subject(s)
Aged , Humans , Coronary Artery Disease , Depression , Depressive Disorder , Hospitals, General , Korea , Logistic Models , Mass Screening , Odds Ratio , ROC Curve , Sensitivity and SpecificityABSTRACT
OBJECTIVE: This study aimed to analyze psychological characteristics of elderly patients. METHODS: The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) data of 110 elderly patients who visited the department of psychiatry was analyzed. We examined differences of MMPI-2 score according to sex and age. The elderly were classified into four clusters with similar characteristics. RESULTS: Depression, suicidal ideation, low motivation score was high in total sample. Depression, subjective depression, mental dullness, lassitude-malaise, psychasthenia, and fears score was higher among females than males. Through the cluster analysis, elderly were classified into four types of ‘high profile’, ‘1-2-7 profile’, ‘6-7-8-0 profile’, and ‘low profile’. CONCLUSION: The elderly patients who visited the department of psychiatry complain depression and helplessness. Females complained depression and anxiety more than males. Elderly were classified into four types of patients with high somatic complaints ‘high profile’, patients with high depression and helplessness ‘1-2-7 profile’, patients who were dissatisfied and could blame others ‘6-7-8-0 profile’, and patients who needed additional interview and projective test ‘low profile’.
Subject(s)
Aged , Female , Humans , Male , Anxiety , Cluster Analysis , Depression , Minnesota , Motivation , Suicidal IdeationABSTRACT
OBJECTIVES: According to previous studies, the cannabinoid receptor 1 (CNR1) gene could be an important candidate gene for schizophrenia. Some studies have linked the (AAT)n trinucleotide repeat polymorphism in CNR1 gene with the risk of schizophrenia. Meanwhile, smooth pursuit eye movement (SPEM) has been regarded as one of the most consistent endophenotypes of schizophrenia. In this study, we investigated the association between the (AAT)n trinucleotide repeats in CNR1 gene and SPEM abnormality in Korean patients with schizophrenia. METHODS: We measured SPEM function in 167 Korean patients with schizophrenia (84 male, 83 female) and they were divided according to SPEM function into two groups, good and poor SPEM function groups. We also investigated allele frequencies of (AAT)n repeat polymorphisms on CNR1 gene in each group. A logistic regression analysis was performed to find the association between SPEM abnormality and the number of (AAT)n trinucleotide repeats. RESULTS: The natural logarithm value of signal/noise ratio (Ln S/N ratio) of the good SPEM function group was 4.34 ± 0.29 and that of the poor SPEM function group was 3.21 ± 0.70. In total, 7 types of trinucleotide repeats were identified, each containing 7, 10, 11, 12, 13, 14, and 15 repeats, respectively. In the patients with (AAT)₇ allele, the distributions of the good and poor SPEM function groups were 18 (11.1%) and 19 (11.0%) respectively. In the patients with (AAT)₁₀ allele, (AAT)₁₁ allele, (AAT)₁₂ allele, (AAT)₁₃ allele, (AAT)₁₄ allele and (AAT)₁₅ allele, the distributions of good and poor SPEM function groups were 13 (8.0%) and 12 (7.0%), 4 (2.5%) and 6 (3.5%), 31 (19.8%) and 35 (20.3%), 51 (31.5%) and 51 (29.7%), 36 (22.2%) and 45 (26.2%), 9 (5.6%) and 4 (2.3%) respectively. As the number of (AAT) n repeat increased, there was no aggravation of abnormality of SPEM function. CONCLUSIONS: There was no significant aggravation of SPEM abnormality along with the increase of number of (AAT)n trinucleotide repeats in the CNR1 gene in Korean patients with schizophrenia.
Subject(s)
Humans , Male , Alleles , Endophenotypes , Eye Movements , Gene Frequency , Logistic Models , Pursuit, Smooth , Receptors, Cannabinoid , Schizophrenia , Trinucleotide RepeatsABSTRACT
OBJECTIVE: We investigated the efficacy and tolerability of paliperidone extended-release (ER) tablets in patients with first-episode psychosis (n=75). METHODS: This was an 8-week, open-label, multicenter trial. The primary outcome variable was scores on the Positive and Negative Syndrome Scale (PANSS); secondary measures included the Scale for the Assessment of Negative Symptoms (SANS), the Cognitive Assessment Interview (CAI), and the Global Assessment of Functioning (GAF). To assess safety, we measured drug-related adverse events, weight, lipid-related variables, and prolactin and administered the Simpson–Angus Rating Scale (SARS), the Abnormal Involuntary Movement Scale (AIMS), the Barnes Akathisia Scale (BAS), the Arizona Sexual Experiences Scale (ASEX), and the Udvalg for Kliniske Undersogelser side effect rating scale (UKU). RESULTS: The administration of paliperidone ER resulted in significant improvement in the PANSS, SANS, CAI, and GAF scores (p<0.001) over time. This improvement was evident as early as 1 week. The most frequent adverse events were akathisia, somnolence, anxiety, and sedation, which were well tolerated. Modest increases in weight and lipid profiles were also noted. Prolactin levels were substantially increased at the endpoint in both male and female patients. CONCLUSION: These results indicate that paliperidone ER is effective and is characterized by good tolerability in the treatment of positive and negative symptoms and cognitive functioning in first-episode psychosis.
Subject(s)
Female , Humans , Male , Abnormal Involuntary Movement Scale , Anxiety , Arizona , Multicenter Studies as Topic , Paliperidone Palmitate , Prolactin , Psychomotor Agitation , Psychotic Disorders , TabletsABSTRACT
OBJECTIVES: This study investigated the effects of the grade of residents, sociodemographic variables, and clinical experience with suicidal patients on the knowledge and attitudes toward suicide among psychiatric residents in Korea. METHODS: A self-reporting survey including 30 questions was conducted together with an investigation of the sociodemographic background of the research subjects. The questionnaire was composed of general knowledge questions on suicide, suicide-related personal experience, attitudes toward suicide, and the treatment experience of suicide attempt patients. Chi-square test and binary logistic regression analysis were used to determine the differences and associations among the attitudes toward suicide, clinical experience of suicide, and sociodemographic characteristics. RESULTS: A significantly higher response rate was presented in the 4th grade on general knowledge of suicide and treatment experience with suicide attempt patients than in the 1st grade. Residents with previous history of psychiatric treatment suicide plans, or attempts presented a significantly higher level of permissive attitude toward suicide. Residents who had a previous history of suicide attempt among their own patients were more likely to think that they were more capable to prevent suicide of patients. CONCLUSION: Effective clinical practices are essential considering the fact that the highest suicide risk groups will inevitably be referred to psychiatric clinical services. The authors expect that the study results regarding suicide-related knowledge, attitudes, and the experience of psychiatric residents will contribute to the development of effective resident training programs for suicide-related clinical practice in Korea.
Subject(s)
Humans , Cross-Sectional Studies , Education , Korea , Logistic Models , Research Subjects , SuicideABSTRACT
Our study aimed to examine the knowledge and attitude of nursing personnel toward depression in general hospitals of Korea. A total of 851 nursing personnel enrolled at four university-affiliated general hospitals completed self-report questionnaires. Chi-square tests were used to compare the knowledge and attitude of registered or assistant nurses toward depression. In addition, binary logistic regression analysis was used to adjust for the following confounders: age-group and workplace. Registered and assistant nurses differed in their knowledge and attitude toward depression. The proportion of rational and/or correct responses were higher in registered nurses than assistant nurses for the following: constellation of depressive symptoms defined by DSM-IV (adjusted odds ratio [aOR], 3.876; P<0.001); suicide risk in depression recovery (aOR, 3.223; P=0.001) and psychological stress as a cause of depression (aOR, 4.370; P<0.001); the relationship between chronic physical disease and depression (aOR, 8.984; P<0.001); and other items. Our results suggest that in terms of the biological model of depression, the understanding of registered nurses is greater than that of assistant nurses. Moreover, specific psychiatric education programs for nursing personnel need to be developed in Korea. Our findings can contribute to the development of a general hospital-based model for early detection of depression in patients with chronic medical diseases.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Attitude of Health Personnel , Depression/diagnosis , Health Knowledge, Attitudes, Practice , Hospitals, General , Nurses/psychology , Nursing Staff, Hospital/psychology , Republic of Korea , Surveys and QuestionnairesABSTRACT
OBJECTIVES: We aimed to explore the influence of depression on working memory in patients with mild cognitive impairment (MCI) and dementia. METHODS: Clinical and neuropsychological data of 43 subjects with mild cognitive impairment (MCI) (n=17) and dementia (n=26) who had visited Department of Psychiatry at Soonchunhyang University Seoul Hospital, were collected. The subjects were divided into depressed (n=18) and non-depressed (n=25) groups based on the Korean version of Short Geriatric Depression Scale. Two-way analysis of variance test was conducted to evaluate the influence of diagnosis (MCI and dementia), the presence of depression and their interaction on working memory which was measured by digit forward and backward span test. RESULTS: Among the patients with MCI, test score of digit backward span test in depressed group was significantly lower than in non-depressed group. However, among the patients with dementia, there was no significant difference in digit backward span test between depressed and non-depressed groups. CONCLUSION: This study suggests that the depression could deteriorate working memory measured by digit backward span test in patients with MCI, relative to in patients with dementia and it also implicates the diagnostic assessment for depression has clinically importance in patients with MCI.
Subject(s)
Humans , Dementia , Depression , Diagnosis , Memory, Short-Term , Cognitive Dysfunction , SeoulABSTRACT
This paper aims to introduce, summarize, and emphasize the importance of the 'Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition'. The guideline broadly covers most aspects of the pharmacological treatment of patients in Korea diagnosed with moderate to severe major depression according to the DSM-IV TR. The guideline establishment process involved determining and answering a number of key questions, searching and selecting publications, evaluating recommendations, preparing guideline drafts, undergoing external expert reviews, and obtaining approval. A guideline adaptation process was conducted for the revised edition. The guideline strongly recommends pharmacological treatment considered appropriate to the current clinical situation in Korea, and should be considered helpful when selecting the appropriate pharmacological treatment of patients diagnosed with major depressive disorder. Therefore, the wide distribution of this guideline is recommended.
Subject(s)
Humans , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Databases, Factual , Depression/complications , Drug Tolerance , Evidence-Based Practice , Monoamine Oxidase Inhibitors/therapeutic use , Neurotransmitter Uptake Inhibitors/therapeutic use , Placebo Effect , Psychotic Disorders/complications , Republic of Korea , Severity of Illness IndexABSTRACT
PURPOSE: The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients. MATERIALS AND METHODS: We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages <18), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late onset (ages 60+). Using analysis of covariance (ANCOVA) and ordinal logistic regression analysis with adjusting the effect of age, the relationships between clinical features and age at onset of MDD were evaluated. RESULTS: There was an apparent, but inconsistent correlation between clinical features and age at onset. Earlier onset MDD was significantly associated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001). CONCLUSION: Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Age Distribution , Age of Onset , Depression/epidemiology , Depressive Disorder, Major/classification , Life Change Events , Odds Ratio , Psychiatric Status Rating Scales , Regression Analysis , Republic of Korea , Suicide, Attempted/psychologyABSTRACT
OBJECTIVE: Activation of one or more serotonin (5-HT) receptors may play a role in mediating the antidepressant effects of serotonergic antidepressants. The serotonin 2C (5HT 2C) receptor is known to be associated with antidepressant action and weight gain. We sought to determine whether the 5-HTR 2C receptor -759C/T polymorphism was associated with weight gain and treatment response to mirtazapine in major depressive disorder (MDD) patients. METHODS: The 5-HT 2C receptor -759C/T polymorphism was analyzed in 323 MDD patients. All patients were evaluated using the 21-item Hamilton Depression Rating Scale at the beginning of the study and at 1, 2, 4, and 8 weeks of mirtazapine treatment. RESULTS: There was no significant difference in the 5-HT 2C receptor -759C/T genotype distribution between responder and non-responder groups. The 5-HT 2C receptor -759C/T polymorphism was not associated with weight change over time after mirtazapine administration. CONCLUSION: The 5-HT 2C receptor -759C/T polymorphism does not appear to be a predictor of treatment response to mirtazapine. This polymorphism was not associated with weight change after 8 weeks of mirtazapine treatment. Further investigation on other polymorphisms of the 5-HT 2C gene is required to determine whether the 5-HT 2C gene influences treatment response and weight change after mirtazapine administration in patients with major depressive disorder.
Subject(s)
Humans , Antidepressive Agents , Depression , Depressive Disorder, Major , Genotype , Mianserin , Negotiating , Receptor, Serotonin, 5-HT2C , Serotonin , Weight GainABSTRACT
OBJECTIVES: The aim of this study is to establish Korean pharmacological treatment guidelines for the initial choice of antidepressant for treatment of moderate or severe depression. METHODS: The process for establishment of guidelines involved determination of important key questions, selection of 12 international and domestic clinical practice guidelines for depression, drawing of recommendation drafts, and peer review. RESULTS: Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRI), and noradrenergic and specific serotonergic antidepressants (NaSSA) were strongly recommended as the first-line antidepressants for treatment of moderate or severe depression. SSRIs were weakly recommended for patients who had problems with tolerability. Consideration of not only efficacy but also provisional adverse effects, drug-drug interactions, history of treatment response, preference, acceptability, cost, comorbid illnesses, and other factors in the choice of first-line antidepressants was strongly recommended. The treatment recommendations for specific clinical features of depression were as follows. SSRIs were weakly recommended for atypical depression. Augmented use of antipsychotics to antidepressants was strongly recommended for psychotic depression. Bupropion and SSRIs were weakly recommended for seasonal depression. CONCLUSION: The results of this study may contribute toward improving the quality of depression treatment by providing clear and definite recommendations for the initial choice of antidepressant for treatment of moderate or severe depression.
Subject(s)
Humans , Antidepressive Agents , Antipsychotic Agents , Bupropion , Depression , Seasons , Selective Serotonin Reuptake InhibitorsABSTRACT
As the government has a plan to terminate medical internships and to start the New Resident program, postgraduate medical students should encounter the new residency training program without the internship from 2015. To keep pace with this significant change, the Korean Neuropsychiatry association launched the task force team to manage this problem. The task force team has examined the psychiatry residency training programs from major countries, including England, Japan, Germany, Australia, New Zealand, and the Unites States. In addition, we conducted a survey for teaching psychiatrists and psychiatry residents who just finished the Psychiatry Board Examination in 2013 using a premade questionnaire on the expected problems that might occur if the internship program were abolished, and some significant issues regarding resident rotation schedule to other departments. In this paper, we summarized the results of our examination and survey. Establishment of a new residency training program based on these surveys would be desirable.