Effects of Depression and Anxiety Symptoms on Specific Cognitive Function by Evaluating Healthy Subjects / 정신신체의학

Objectives@#：Based on the fact that cognitive functions decline known as comorbid symptoms of depression can precede depression, this study seeks to observe the effects of depressive symptoms and anxiety symptoms on cognitive function in healthy subjects. @*Methods@#：To recruit 50 general populations to evaluate cognitive and clinical symptoms and to find out the effects of clinical symptoms on cognitive functions, Pearson correlation and multivariate regression were conducted. Correlation analysis of subdomain cognitive function was conducted for reliability analysis. @*Results@#：Trail making test-B that evaluates the execution function correlates with depressive symptoms (r=0.300, p=0.03) and age (r=0.323, p=0.02). Depressive symptoms (β=0.304, p=0.03) and age (β=0.335, p=0.01) were significantly related to Trail making test -B (Adjusted R2 =0.148). Subjective cognitive tests correlates with anxiety symptoms (r=0.434, p=0.002). In the correlation between cognitive functional items, Subjective cognitive tests was found to be correlated with other test except Spotter. @*Conclusions@#：In this study, depressive symptoms contribute independently to executive functions in addition to demographic characteristics such as age and duration of education. Given that cognitive decline is a common long-term clinical outcome in depression, we expect active early intervention and evaluation of cognitive function to be helpful.

Anxiety Hastened Depressive Recurrence in Bipolar Disorder :An Interim Analysis of Prospective Follow-Up Study

Objectives@#Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. @*Methods@#A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. @*Results@#Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). @*Conclusions@#This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course.Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.

Anxiety Hastened Depressive Recurrence in Bipolar Disorder :An Interim Analysis of Prospective Follow-Up Study

Objectives@#Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. @*Methods@#A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. @*Results@#Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). @*Conclusions@#This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course.Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.

Soybean Viromes in the Republic of Korea Revealed by RT-PCR and Next-Generation Sequencing.

Soybean (Glycine max L.) is one of the most important crop plants in the Republic of Korea. Here, we conducted a soybean virome study. We harvested a total of 172 soybean leaf samples showing disease symptoms from major soybean-growing regions in the Republic of Korea. Individual samples were examined for virus infection by RT-PCR. Moreover, we generated eight libraries representing eight provinces by pooling samples and four libraries from single samples. RNA-seq followed by bioinformatics analyses revealed 10 different RNA viruses infecting soybean. The proportion of viral reads in each transcriptome ranged from 0.2 to 31.7%. Coinfection of different viruses in soybean plants was very common. There was a single dominant virus in each province, and this geographical difference might be related to the soybean seeds that transmit viruses. In this study, 32 viral genome sequences were assembled and successfully used to analyze the phylogenetic relationships and quasispecies nature of the identified RNA viruses. Moreover, RT-PCR with newly developed primers confirmed infection of the identified viruses in each library. Taken together, our soybean virome study provides a comprehensive overview of viruses infecting soybean in eight geographical regions in the Republic of Korea and four single soybean plants in detail.

Operation Status and Improvement Plan of Continuing Hospitalization Judgement System in Mental Health Review Board / 보건행정학회지

BACKGROUND: The recent revision of South Korea's Mental Health Law emphasizes the role of the Mental Health Review Board. For this study, we examined the current status of continuing hospitalization judgement in Mental Health Review Board at the national level and aimed to determine the directions of improvement. METHODS: Using a qualitative case study as the research method, we interviewed 30 Mental Health Review Board members and analyzed the results. RESULTS: Each municipality had very different continuing hospitalization judgement methods. In our systematic review, which consisted of document inspection, we identified reliability problems due to limitations in Mental Health Review Board's operating systems, discharge orders, etc. Additionally, continuing hospitalization judgement needs to improve the objectivity, fairness, and effectiveness of their screening examinations. CONCLUSION: Based on the results of this study, we suggest policy proposals to improve these systems, such as standardizing examination processes, strengthening on-site inspections, increasing the independence and neutrality of judgment in Mental Health Review Board, building community mental health infrastructures, and establishing integrated management systems.

A Study of the Current State of the Mental Health Service Delivery System Using the Focused-Group Interview / 신경정신의학

OBJECTIVES: To use focus-group interviews (FGI) to determine the current state of the Korean mental health service delivery system, inter-agency patient links, and identify associated problems. METHODS: The FGI were conducted by seven workers from psychiatric rehabilitation centers and community mental health centers and seven social workers from mental health hospitals. RESULTS: Within the mental health service delivery system, disconnection of the community network after discharge is considered a serious problem. The following improvement proposals are suggested : 1) the control tower should govern the community network after discharge, 2) consider insurance costs during activation of hospital links, and 3) expand information sharing related to community social facilities. With regard to non-voluntary admission and long-term hospitalization, most focus group members considered the revolving-door phenomenon to be more serious than non-voluntary admission. In order to prevent unnecessary long-term hospitalization, the FGI results indicated that the government should proactively intervene in the admission/discharge process. In addition, the following improvement proposals were suggested : 1) functional activation of the mental health review board via the reinforcement of workers' expertise, 2) expansion of local mental health centers, and 3) undertake institutional changes related to the family-related issue of preferring hospitalization over a stay at a secure facility. CONCLUSION: For the government to improve the efficiency of the mental health service delivery system, it is necessary to improve institutional linkages, expand mental health infrastructure, and develop an integrated management system.

Risperidone Monotherapy in Children and Adolescents with Autism Spectrum Disorders: A Naturalistic Study

OBJECTIVES: We retrospectively investigated the efficacy and tolerability of risperidone monotherapy in subjects with autism spectrum disorder (ASD). In addition, we did mixed effect model analysis of the effects of risperidone in patients with ASDs naturalistically treated in a routine clinical setting to determine whether the clinical effects were maintained and the side effects were tolerable. METHODS: This retrospective study assessed children and adolescents with ASD, who were on risperidone monotherapy from July 2010 to July 2011 at the Child and Adolescent ASD Clinic at Seoul National Hospital. Outcome measures included the Clinical Global Impression-Severity of Illness (CGI-S) and the CGI-Improvement (CGI-I) scales along with other clinical indices: dosage, target symptoms, and side effects. RESULTS: The mean dose of risperidone in 47 children and adolescents with ASD (40 males, 7 females; age range 5-19 years) who were on risperidone monotherapy was 1.6+/-0.8 mg/day, and the mean duration of the treatment period was 20.2+/-17.3 months. Aggressive behavior, stereotypic behavior, irritability, and self-injurious behavior were the most frequent target symptoms of risperidone. The most common side effects were weight gain followed by somnolence and extrapyramidal symptoms. In a mixed effects model analysis of CGI-I scores, the mean CGI-I score at the 1 month follow-up was significantly different from the mean CGI-I score of the 3-month follow-up (p=.046), and the CGI-I scores were equally maintained over 3 to 48 months [F(6, 28.9)=4.393, p=.003]. Of the 47 patients, 33 patients (70.2%) were identified as the response group, showing an end point CGI-I rating of 3 or under and having continued risperidone treatment for at least 6 months. The baseline CGI-S score showed significant association with clinical response to risperidone (p=.005), the mean baseline CGI-S was higher in the response group compared to the non-response group. CONCLUSION: In this study, clinical improvement of risperidone stabilized around 3 months and was equally maintained up to 48 months with tolerable side effects, supporting maintenance of risperidone treatment in children and adolescents with ASDs.

Outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet's disease.

OBJECTIVE: To evaluate the effectiveness of endovascular stent grafting for surgical management of aortic pseudoaneurysm in patients with Behcet's disease (BD). METHODS: We present a single-institution retrospective cohort of patients with aortic pseudoaneurysm and BD treated with aortic stent grafting. Computed tomography imaging was obtained preoperatively in all patients and once within 2 weeks postoperatively, and then annually. Clinical follow-up and erythrocyte sedimentation rate were used to follow BD activity. Immunosuppressant therapy was instituted prior to endovascular treatment unless a contraindication existed. RESULTS: From 1998 to 2012, 10 patients (eight male, two female; median age, 39) with BD and aortic pseudoaneurysm were treated with endovascular stent grafting at this institution. Ninety percent of these patients received immunosuppressive therapy before and after surgical treatment. The median follow-up period was 57 months (interquartile range, 43-72). The locations of the 12 pseudoaneurysms treated in this cohort were infrarenal abdominal aorta (seven), descending thoracic aorta (four), and aortic arch (one). Median pseudoaneurysm size was 4.5 cm (interquartile range, 3.4-5.9). At long-term follow-up, complete resolution of the aortic pseudoaneurysm was noted in all patients. No endoleaks occurred. Newly developed pseudoaneurysm at the distal margin of the stent graft was noted in one patient 17 months after the stent graft procedure. One patient required a subsequent stent graft placement for an expanding pseudoaneurysm of the subclavian artery. No patient deaths occurred during the follow-up period. CONCLUSIONS: Endovascular treatment of aortic pseudoaneurysm with stent-grafting in patients with BD is safe and effective with long-term durability.

Outcomes of endovascular management for complicated chronic type B aortic dissection: effect of the extent of stent graft coverage and anatomic properties of aortic dissection.

PURPOSE: To assess the effect of the extent of stent graft coverage and anatomic properties of aortic dissection on the outcomes of thoracic endovascular aortic repair (TEVAR) for complicated chronic type B aortic dissection (CCBAD) in terms of survival, reintervention, and false lumen thrombosis. MATERIALS AND METHODS: A retrospective analysis was performed of 71 patients who underwent TEVAR for CCBAD. Mean patient age was 54.7 years. Distal extent of stent graft coverage was categorized as short (≤ T7) or long (≥ T8) coverage. Indications of reintervention were categorized into three groups: proximal, alongside, and distal according to the anatomic relationship of the culprit lesion and the stent graft. Overall survival, reintervention-free survival, and extent of false lumen thrombosis were compared. RESULTS: The technical success rate was 97.2%. The 1-year, 3-year, and 5-year overall survival rates were 97.1%, 88.9%, and 88.9%, and 1-year, 3-year, and 5-year reintervention-free survival rates were 80.7%, 73.8%, and 60.6%. There were no differences in overall survival, reintervention-free survival rates, and extent of false lumen thrombosis between the groups. In the short coverage group, distal reintervention was more frequent in patients with an abdominal aortic diameter ≥ 37 mm compared with patients with an abdominal aortic diameter < 37 mm (P = .005). CONCLUSIONS: TEVAR was effective for CCBAD with a high technical success rate and low mortality. The extent of stent graft coverage did not make a difference in terms of survival and false lumen thrombosis. Reinterventions were more frequently performed in patients with a large baseline abdominal aortic diameter who were treated with short stent graft coverage, and so longer coverage is recommended in such patients.

One-step multiplex reverse transcription-polymerase chain reaction for the simultaneous detection of three rice viruses.

Rice stripe virus (RSV), Rice black-streaked dwarf virus (RBSDV), and Rice dwarf virus (RDV) are major rice-infecting viruses in Korea that can cause serious crop losses. A one-step multiplex reverse transcription-polymerase chain reaction (mRT-PCR) was developed for the simultaneous detection of these rice viruses. Three sets of specific primers targeted to the capsid protein coding genes of RSV, RBSDV, and RDV were used to amplify fragments that were 703 bp, 485 bp, and 252 bp, respectively. The one-step mRT-PCR assay proved to be a sensitive and rapid method for detecting the three rice viruses. This method could be used to facilitate better control of rice viruses.

Hybrid treatment for thoracic aortic aneurysm combined with aberrant right subclavian artery.

An aberrant right subclavian artery (ARSA) is the most common vascular abnormality of the aortic arch and is associated with development of aneurysms in 3-8% of these anomalies. In this case report, we describe an 84-year-old man with a symptomatic ARSA treated with staged hybrid procedure combining surgical replacement of the ascending aorta and bilateral carotid-to-subclavian artery bypass with implantation of a stent graft in the aortic arch and descending aorta. Our case suggests that a less invasive hybrid therapy can be performed successfully for the treatment of ARSA with aneurysmal change in patients at high surgical risk.

The Effect of Seed-borne Mycoflora from Sorghum and Foxtail Millet Seeds on Germination and Disease Transmission.

The seed-borne mycoflora of sorghum and foxtail millet collected from different growing areas in South Korea were isolated and taxonomically identified using dry inspection, standard blotter and the agar plate method. We investigated the in vitro and in vivo germination rates of disinfected and non-disinfected seeds of sorghum and foxtail millet using sterilized and unsterilized soil. The percent recovery of seed-borne mycoflora from the seed components of sorghum and foxtail millet seeds was determined and an infection experiment using the dominant species was evaluated for seedling emergence and mortality. A higher number of seed-borne fungi was observed in sorghum compared to that of foxtail millet. Eighteen fungal genera with 34 fungal species were identified from the seeds of sorghum and 13 genera with 22 species were identified from the seeds of foxtail millet. Five dominant species such as Alternaria alternata, Aspergillus flavus, Curvularia lunata, Fusarium moniliforme and Phoma sp. were recorded as seed-borne mycoflora in sorghum and 4 dominant species (Alternaria alternata, Aspergillus flavus, Curvularia lunata, Fusarium moniliforme) were observed in foxtail millet. The in vitro and in vivo germination rates were higher using disinfected seeds and sterilized soil. More seed-borne fungi were recovered from the pericarp compared to the endosperm and seed embryo. The percent recovery of seed-borne fungi ranged from 2.22% to 60.0%, and Alternaria alternata, Curvularia lunata and 4 species of Fusarium were isolated from the endosperm and embryo of sorghum and foxtail millet. Inoculation of the dominant seed-borne fungi showed considerable mortality of seedlings. All the transmitted seed-borne fungi might well be a primary source of infection of sorghum and foxtail millet crops.

Effects of pericardiectomy on early diastolic mitral annular velocity in patients with constrictive pericarditis.

BACKGROUND: In patients with constrictive pericarditis (CP), early diastolic mitral annular velocity (E') is usually normal or exaggerated due to limitation of lateral expansion by the constricting pericardium. Although pericardiectomy is the treatment of choice for CP, it is difficult to evaluate its effectiveness. Theoretically, E' may decrease after successful pericardiectomy. However, little data are available regarding the effect of pericardiectomy on E'. The purpose of this study was to assess the change in E' after pericardiectomy in patients with CP. METHODS: We studied 16 patients (12 males, mean age 62.3+/-7.0 years) with surgically confirmed CP for changes in pre-discharge Doppler parameters following pericardiectomy. CP was secondary to previous cardiac surgery in 4 patients, tuberculosis in 4 patients, radiation-induced in 1 patient, and idiopathic in 7 patients. Ten patients underwent complete pericardiectomy (62.5%). E' was measured at the septal annulus before pericardiectomy and a mean duration of 10 (+/-6) days after. RESULTS: E' significantly decreased from 9.2+/-2.7 cm/s to 7.4+/-2.6 after pericardiectomy (p=0.013). The mean percent change of E' after pericardiectomy was 17.9+/-25.9%. The decrement of E' was significantly higher in patients with complete pericardiectomy than in patients who underwent a partial pericardiectomy (2.7+/-2.3 vs. 0.4+/-2.1, p=0.042). Also, more than 15% decrease of E' was significantly higher in patients with improvement of symptom after pericardiectomy (9 (100.0%) vs. 3 (42.9%), p=0.019). CONCLUSION: E' decreased following pericardiectomy in most of the patients with CP. The change of E' after pericardiectomy may be useful in evaluating the effectiveness of pericardiectomy.

The Characteristics of Suicide Attempts and Psychosocial Risk Factors in Correctional Institutions / 신경정신의학

OBJECTIVES: Suicide is one of the most common causes of deaths in correctional institutions. This study aimed to examine the characteristics of suicide attempts and its related psycho-social factors in correctional institutions. METHODS: This study examined the characteristics of 101 suicide attempts from 2006 to 2007 in the two regional correctional headquarters. Thirty-seven male inmates (43 suicide attempts) and 40 matched controls were included in interviews and reviews of personal records. Psychiatric illnesses were examined using the Structured Clinical Interview for DSM-IV and medical outcomes of their suicide attempts with the Lethality Scale of Diagnostic Interview for Genetic Studies. RESULTS: Over a half of suicide attempts occurred in solitary cells and the most common method was hanging. Medically, 70% of the suicide attempts were more than severe. Poor social support, a lifetime history of suicide attempts, and incarceration were associated with suicide attempts. Additionally, psychiatric illnesses were more likely to increase the risk of suicide. CONCLUSION: This study implies that mental health issues and monitoring systems are important to reduce suicides in the correctional system. Regular checks and management of suicide risk and mental illness are crucial to prevent suicide in correctional institutions.

A determinant of insulin resistance in patients with schizophrenia / 대한내과학회지

BACKGROUND/AIMS: As compared with the general population, patients with schizophrenia have a higher risk of obesity and glucose metabolism impairment. Moreover, some antipsychotic drugs add to this risk owing to side effects such as weight gain. However, few reports exist regarding the pathophysiology of insulin resistance in drug-naive or drug-free schizophrenic patients. Therefore, the aim of the present study was to investigate the factors that contribute to insulin resistance in antipsychotic drug-naive and drug-free schizophrenic patients. METHODS: Nineteen (4 men, 15 women) drug-naive or drug-free subjects with schizophrenia and nineteen age- and sex-matched controls were recruited for participation in this study. We measured weight, height, waist circumference, biochemical profiles, body fat percentage, and calculated body mass indices (BMI) in all patients. Furthermore, we correlated HOMA-IR, a marker for insulin resistance, with anthropometric measures and clinical characteristics. RESULTS: There were no significant differences in BMI, waist circumference, or body fat percentage between the two groups. In addition, there were no differences in blood pressure, glucose, HbA1c, insulin, HOMA-IR, total cholesterol, HDL-cholesterol, or LDL-cholesterol; however, triglyceride levels and 24 hr urine free cortisol levels were higher in schizophrenic patients. There was also a significant correlation between HOMA-IR and both age and waist circumference in the control group. Additionally, HOMA-IR was significantly correlated with 24 hr urine free cortisol levels in schizophrenic patients. CONCLUSIONS: The study shows that risk factors for insulin resistance in drug-naive or drug-free schizophrenic patients do not differ from those of the control group; however, the major determinant of insulin resistance in schizophrenia patients was that of increased cortisol levels.

Assessment of Abdominal Fat and Mid-Thigh Low-Density Muscle Areas in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: Patients with schizophrenia are at a higher risk for developing insulin resistance and type 2 diabetes mellitus (T2DM). However, few studies have examined abdominal fat and mid-thigh low-density muscle areas, which are known risk factors for insulin resistance and T2DM, in patients with schizophrenia. Therefore, we measured the abdominal fat and mid-thigh low-density muscle areas of schizophrenics and compared them with normal controls. METHODS: Nineteen (four men and 15 women) drug-naive or -free subjects who met the DSM IV criteria for schizophrenia and 19 age- and sex-matched controls were recruited. We measured weight, height, waist circumference, and percent body fat, and calculated the body mass index (BMI). Abdominal fat and mid-thigh low-density muscle areas were evaluated using computed tomography. RESULTS: There was no significant difference in terms of age and BMI between the two groups. The areas of abdominal fat (262.4+/-101.8 vs. 257.1+/-93.8 cm2 ; p=0.919), subcutaneous fat (182.4+/-72.8 vs. 180.5+/-75.1 cm2 ; p=0.988), visceral fat (79.9+/-47.2 vs. 76.6+/-49.3 cm2 ; p=0.872), and mid-thigh low-density muscle (15.0+/-9.9 vs. 15.4+/-5.2 cm2, p=0.373) did not differ between schizophrenics and controls. CONCLUSION: Abdominal obesity is a well-recognized risk factor for developing certain medical conditions such as insulin resistance and T2DM. We demonstrated that drug-naive or- free patients with schizophrenia do not have increased visceral fat or mid-thigh low-density muscle areas, which might have explained the higher prevalence of insulin resistance and T2DM in these patients.

Clinical Correlates of Metabolic Syndrome in Patients with Chronic Schizophrenia / 대한정신약물학회지

OBJECTSIVE: This study investigated the frequency of metabolic syndrome, associated factors and its risk for cardiovascular morbidity in schizophrenic patients. METHODS: In this cross-sectional study, nineteen-six patients with schizophrenia defined by DSM-IV criteria were included. All subjects were assessed for the presence of metabolic syndrome by means of the criteria of the National Cholesterol Education Program-Adult Treatment Panel III. In addition, we compared clinical characteristics, laboratory variables and risk for cardiovascular morbidity between patients with and without metabolic syndrome. RESULTS: Of patients, 43% had metabolic syndrome. Metabolic syndrome was associated with illness chronicity and current status of antipsychotic agents use, total duration of atypical agents used, but not with daily chlorpromazine equivalent dose. Compared with the patients without metabolic syndrome, patients with metabolic syndrome had higher risk for cardiovascular morbidity. CONCLUSION: This study suggests that metabolic syndrome is common among patients with chronic schizophrenia. Clinicians should be cautious to aware the increased risk for the metabolic syndrome and intervene actively to prevent and treat metabolic morbidity among chronic patients with schizophrenia.

Association Study between Obsessive-Compulsive Disorder and Val-158-Met Catechol-O-Methyltransferase Gene Polymorphism in Korea / 신경정신의학

OBJECTIVES: The definite cause of obsessive-compulsive disorder (OCD) is still unknown. Evidences from familial, twin and segregation studies support the role of a genetic factor. There are also growing evidence indicating that OCD has specific neurochemical and neuroanatomical basis. Derived from the effectiveness of treatment with dopamine receptor blocker in certain part of OCD patients (eg. SSRI treatment-resistant OCD), several candidate genes related to dopamine dysregulation have been hypothesized to play an important role in the development of OCD. One of them is the Catechol-O-Methyltransferase (COMT) gene. The aim of this study was to investigate the association between COMT and OCD in Korean population. METHODS: 124 OCD patients and 170 normal controls participated in this study. Genomic DNA was extracted from their blood. The genotypes and allele frequencies of the COMT polymorphism between OCD group and control group were compared. We investigated the association between severity of OCD assessed by Yale-Brown obsessive compulsive symptom scale (YBOCS) and Hamilton depression rating scale (HDRS) scores and COMT polymorphism. RESULTS: In this case-control study, we could not find any association between COMT gene polymorphism and development of OCD. In OCD group, patients with H/H genotype had significantly higher scores for the HDRS than those with H/L or L/L genotype. CONCLUSION: In this study, there was no difference in genotype distributions of COMT between OCD and control groups. However, H/H genotype of COMT gene polymorphism might be related to depressive symptoms in OCD patients.

Effects of Mirtazapine on Hippocampal Metabolites of Female Patients with Major Depression / 대한정신약물학회지

OBJECTIVE: Recent studies suggested that the neurotrophic effects might be a major therapeutic mechanism of antidepressants. However, these effects have not been confirmed yet in depressed patients. We investigated whether mirtazapine treatment has the neurotrophic effects in depressed patient by using (1)H-MRS and explored the relationship between these effects and clinical improvements and neuropsychological functions. METHODS: Fourteen female, right-handed patients with major depressive disorder and 12 healthy controls participated in the study. Before the treatment with mirtazapine, we measured severity of illness, neuropsychological functions, and the levels of NAA, Cho and Cr in both hippocampi using (1)H-MRS in the depressed subjects. After the treatment with mirtazapine for 6 weeks, we repeated the measures of the pretreatment condition in the depressed subjects. We also measured variables of severity of illness and hippocampal metabolites with (1)H-MRS in the control group. RESULTS: There were no significant differences in NAA/Cr, Cho/Cr, and Cho/NAA between the depressed subjects and the control group. However, after the treatment with mirtazapine, there were significant improvements in severity of illness, immediate memory, and delayed memory. The posttreatment ratio of the total hippocampal Cho/Cr was significantly lowered than the ratio of the pretreatment Cho/Cr. However, the percent changes of the hippocampal Cho/Cr from the pretreatment Cho/Cr ratio were not correlated with the changes of severity of illness or neuropsychological functions from the pretreatment condition. CONCLUSIONS: These findings indicate that mirtazapine may reduce the level of choline metabolites by stabilizing the effect on the cholinergic neurons, reducing turnover or metabolism of neuronal membranes, or modulating the neuroendocrine systems in the depressed patients. However, this effect is not necessarily related to clinical improvements. Further studies on the therapeutic action of mirtazapine are needed.