A prospective, open-label study to evaluate symptomatic remission in schizophrenia with risperidone long-acting injectable in Korea.

This study was designed to investigate long-term clinical outcomes of risperidone long-acting injectable (RLAI) in patients with schizophrenia or schizoaffective disorder. An open-label, 48-week, prospective study of RLAI treatment was carried out at 63 centers in South Korea. Initial and maintenance dosage of RLAI were adjusted according to clinical judgment. Efficacy was measured by the remission rate, continuation rate, and changes in the clinical measurements such as eight items of the Positive and Negative Symptom Scale (PANSS), the Clinical Global Impression - Severity, and the Schizophrenia Quality of Life Scale. In terms of the safety, Simpson-Angus rating Scale, adverse events (AEs), and BMI were investigated. Of the 522 patients who were enrolled, 472 patients who had been assessed on the eight items of PANSS at baseline and at least once during RLAI treatment were included in the intention-to-treat (ITT) population. The per-protocol (PP) population included 184 patients (39.0%), who completed all assessments during 48 weeks of the follow-up period. Total scores of eight items of PANSS, Clinical Global Impression - Severity, and Schizophrenia Quality of Life Scale were reduced significantly from baseline to endpoint in both ITT and PP populations. The mean dose (SD) of RLAI was 33.2 (7.6) mg. In the PP population, the number of patients who scored 1-3 on eight items of PANSS were 47 (25.5%) at baseline and 144 (78.3%) at 48 weeks. According to the remission defining as scores 1-3 on eight items of PANSS sustaining of at least 6 months' duration by Andreasen, the numbers of patients who achieved remission were 45 (24.5%) at 24 weeks and 120 (65.2%) at 48 weeks. A significant decrease in the mean score of Simpson-Angus rating Scale and a significant increase in BMI over time in last observation carried forward were observed, and patients who fulfilled the remission criteria during the study showed more weight gain than those who did not. During the study period, a total of 645 AEs were noted in 233 patients (49.3%) who were included in the ITT population. Sixty-nine serious AEs in 51 patients were reported, but all of them were not directly attributable to administration of RLAI. This prospective, open-label study showed improvements in symptom and AEs and a significant increase in BMI during 48 weeks of biweekly RLAI treatment. The rate of study completion was 39.0% and the remission rate among those who completed the study was 65.2%. None of the serious AEs were directly related to the administration of RLAI.

Association between glucocorticoid receptor methylation and hippocampal subfields in major depressive disorder.

BACKGROUND: DNA methylation in the promoter region of the glucocorticoid receptor gene (NR3C1) is closely associated with childhood adversity and suicide. However, few studies have examined NR3C1 methylation in relation to major depressive disorder (MDD) and hippocampal subfield volumes. We investigated the possible association between NR3C1 methylation and structural brain alterations in MDD in comparison with healthy controls. METHODS: We compared the degree of NR3C1 promoter methylation in the peripheral blood of non-psychotic outpatients with MDD and that of healthy controls. Correlations among NR3C1 promoter methylation, structural abnormalities in hippocampal subfield volumes and whole-brain cortical thickness, and clinical variables were also analyzed. RESULTS: In total, 117 participants (45 with MDD and 72 healthy controls) were recruited. Patients with MDD had significantly lower methylation than healthy controls at 2 CpG sites. In MDD, methylations had positive correlations with the bilateral cornu ammonis (CA) 2-3 and CA4-dentate gyrus (DG) subfields. However, in healthy controls, methylations had positive correlation with the subiculum and presubiculum. There were no differences in total and subfield volumes of the hippocampus between patients with MDD and healthy controls. Compared with healthy controls, patients with MDD had a significantly thinner cortex in the left rostromiddle frontal, right lateral orbitofrontal, and right pars triangularis areas. CONCLUSIONS: Lower methylation in the NR3C1 promoter, which might have compensatory effects relating to CA2-3 and CA4-DG, is a distinct epigenetic characteristic in non-psychotic outpatients with MDD. Future studies with a longitudinal design and a comprehensive neurobiological approach are warranted in order to elucidate the effects of NR3C1 methylation.

Survey of premenstrual symptom severity and impairment in Korean adolescents: premenstrual dysphoric disorder, subthreshold premenstrual dysphoric disorder and premenstrual syndrome.

INTRODUCTION: The aims of the study were to examine the prevalence of premenstrual dysphoric disorder (PMDD), subthreshold PMDD and premenstrual syndrome (PMS) among adolescents, and to assess the nature of symptoms and the impact on daily life functions, especially for PMDD and subthreshold PMDD. METHODS: A cross-sectional survey was conducted among adolescents from an urban area. Participants included 984 girls divided into the following four groups, using a premenstrual symptoms screening tool: PMDD, subthreshold PMDD, moderate/severe PMS and no/mild PMS. An Adolescent Mental Problem Questionnaire, Center for Epidemiological Studies-Depression Scale, revised Children's Manifest Anxiety Scale, and a menstrual information questionnaire were also used. RESULTS: Sixty-three (6.76%) of the subjects met the criteria for PMDD and 58 (6.2%) were subthreshold PMDD. The subthreshold PMDD group included 79.3% who met the symptom criteria for PMDD, but their impairment was moderate, and 21.7% who were falling short by the number of symptoms for PMDD diagnosis, though reporting severe impairment. The symptom intensity and frequency of the subthreshold PMDD subjects were similar to those in subjects with PMDD. In these two groups, 69% had moderate to severe physical symptoms. Psychiatric problems, including depression and anxiety, were higher in the PMDD and subthreshold PMDD groups than in the moderate/severe PMS and no/mild PMS group. DISCUSSION: In total, 20% of adolescents reported suffering from distressing premenstrual symptoms, and girls with PMDD and subthreshold PMDD were very similar in their symptom severity and characteristics. Prospective daily charting is needed to confirm the accurate diagnosis and management of PMDD.

Sensitivity of cognitive tests in four cognitive domains in discriminating MDD patients from healthy controls: a meta-analysis.

BACKGROUND: We performed a meta-analysis in order to determine which neuropsychological domains and tasks would be most sensitive for discriminating between patients with major depressive disorder (MDD) and healthy controls. METHODS: Relevant articles were identified through a literature search of the PubMed and Cochrane Library databases for the period between January 1997 and May 2011. A meta-analysis was conducted using the standardized means of individual cognitive tests in each domain. The heterogeneity was assessed, and subgroup analyses according to age and medication status were performed to explore the sources of heterogeneity. RESULTS: A total of 22 trials involving 955 MDD patients and 7,664 healthy participants were selected for our meta-analysis. MDD patients showed significantly impaired results compared with healthy participants on the Digit Span and Continuous Performance Test in the attention domain; the Trail Making Test A (TMT-A) and the Digit Symbol Test in the processing speed domain; the Stroop Test, the Wisconsin Card Sorting Test, and Verbal Fluency in the executive function domain; and immediate verbal memory in the memory domain. The Finger Tapping Task, TMT-B, delayed verbal memory, and immediate and delayed visual memory failed to separate MDD patients from healthy controls. The results of subgroup analysis showed that performance of Verbal Fluency was significantly impaired in younger depressed patients (<60 years), and immediate visual memory was significantly reduced in depressed patients using antidepressants. CONCLUSIONS: Our findings have inevitable limitations arising from methodological issues inherent in the meta-analysis and we could not explain high heterogeneity between studies. Despite such limitations, current study has the strength of being the first meta-analysis which tried to specify cognitive function of depressed patients compared with healthy participants. And our findings may provide clinicians with further evidences that some cognitive tests in specific cognitive domains have sensitivity to discriminate MDD patients from healthy controls.

The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support.

OBJECTIVE: Depression during pregnancy can negatively affect both maternal and fetal health. The benefits of early detection and treatment for antenatal depression have been emphasized. Therefore, we investigated risk factors for antenatal depression with a focus on emotional support. METHODS: We conducted a cross-sectional study of pregnant women (n=1262) enrolled from the local division of a community mental health center. All subjects completed self-report questionnaires that assessed depressive mood, emotional support and other risk factors. Associations between antenatal depression and potential risk factors including emotional support were analyzed by logistic regression analysis. RESULTS: Antenatal depression was associated with various biopsychosocial correlates: unmarried state, low education, cigarette smoking, low income, familial history of depression, past history of depression, physical abuse history, sexual abuse history, premenstrual syndrome, primiparity and unplanned pregnancy. When the associations of emotional support with antenatal depression were specified by its resources, current emotional support from partner [odds ratio (OR)=2.26, 95% confidence interval (CI)=1.94-2.64] and mother (OR=1.43, 95% CI=1.26-1.62) and past experience for emotional support from mother (OR=1.52, 95% CI=1.32-1.74), but not from father significantly influenced depression during pregnancy. CONCLUSIONS: The multidimensional biopsychosocial approach would be needed to identify and assess antenatal depression. Promoting emotional support from the partner, family member and, possibly, the health provider could be a protective effect against the development of antenatal depression.

Neuropsychological correlates of the P300 in patients with Alzheimer's disease.

OBJECTIVES: The P300 is a useful psychophysiological index that reflects cognitive functions; however, the relationship between P300 indices and neuropsychological tests in Alzheimer's disease (AD) patients is unclear. METHODS: Thirty-one AD patients and 31 elderly normal control (NC) subjects were recruited. Age and education level were matched between the two groups. The relationship between the P300 and the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K) assessment packet (including 11 neuropsychological tests) was examined in AD patients. RESULTS: Compared to the NC subjects, the AD patients exhibited significantly decreased P300 amplitudes; however, there was no significant difference between the two groups in terms of P300 latency. After a permutation-based correction for multiple tests, P300 amplitudes at the Cz and Pz electrodes were significantly correlated with performance on the word list recognition, constructional praxis, and word fluency neuropsychological tests in the AD patients. Additionally, P300 latencies at the Pz and C6 electrodes were also significantly correlated with performance on the Mini-Mental State Examination, CERAD-K version (MMSE-K), and Trail Making Test part A (TMT-A) neuropsychological tests in the AD patients. CONCLUSIONS: The results suggest that the P300 is responsive to the deterioration of language, memory, and executive functions observed in AD patients. Although there was no significant difference between the AD patients and NC subjects in the P300 latency, P300 latency has been shown to reflect impaired global cognition and attention deficits associated with AD. Our results suggest that P300 indices could be used as biological markers that indicate impaired neuropsychological functions in AD patients.

Standardization of the korean version of the posttraumatic embitterment disorder self-rating scale.

OBJECTIVE: Embitterment is a persistent feeling of being let down or insulted, feeling like a "loser", or feeling revengeful but helpless. In South Korea, social injustice experienced during rapid industrial development and protracted unemployment during the Asian economic crisis may lead to strong feelings of embitterment. North Korean defectors and victims of industrial disasters may also experience humiliation and feelings of injustice. Posttraumatic Embitterment Disorder (PTED) is a recent conceptualization of a new psychiatric disorder. This study tested the reliability and validation of the Korean version of the PTED Scale. METHODS: Subjects aged 18 years or older were recruited from a psychiatric outpatient clinic. All subjects were diagnosed with a depressive disorder. Subjects completed the Korean version of the PTED Scale, the Patient Health Questionnaire (PHQ-9) and the Patient Health Questionnaire (PHQ-15) at baseline and two weeks later. RESULTS: Approximately 15.4% of subjects could be categorized as having PTED. The test-retest reliability of the PTED Scale was good (r=0.76) and the internal consistency was very high (Cronbach's alpha=0.962). Positive correlations were found between the PTED Scale, the PHQ-9 and the PHQ-15, indicating substantial convergent validity of the PTED Scale. CONCLUSION: The Korean version of the PTED Scale is a reliable and valid measurement of embitterment in Korean adults as an emotional reaction to a negative life event.

Adherence with electronic monitoring and symptoms in children with attention deficit hyperactivity disorder.

OBJECTIVE: The primary aim of this study was to compare electronic monitoring with other measures of adherence to Osmotic-controlled Release Oral delivery System methylphenidate in children with attention-deficit hyperactivity disorder (ADHD). The secondary aim was to analyze the relationships between adherence and clinical factors, including ADHD symptoms. METHODS: Thirty-nine children diagnosed with ADHD were monitored for adherence to medication over the course of eight weeks. Medication adherence was assessed using the Medication Event Monitoring System (MEMS), which is a bottle cap with a microprocessor that records all instances and times that the bottle is opened; patient self-report; clinician rating; and pill count. Information, including demographic and clinical characteristics, symptom rating scale, and psychological test results, were also collected. The relationships between adherence and clinical factors, including ADHD rating scores of baseline and of the changes, were assessed. RESULTS: The rate of non-adherence measured by the MEMS was found to be 46.2%, which was considerably higher than those of the patient self-report (17.9%), clinician rating (31.7%), and pill count (12.8%) of non-adherence. The rate of adherence measured by the MEMS was not significantly associated with baseline symptom severity or symptom changes over the eight weeks, although non-adherent group showed more severe baseline symptoms and inferior improvement. CONCLUSION: Adherence as measured by the MEMS showed a discrepancy with other measures of adherence in patients with ADHD. The symptom severity and level of improvement were not related to adherence with MEMS. Further studies are needed to evaluate the variables that may impact medication adherence in children with ADHD.

Combination treatment with aripiprazole and valproic acid for acute mania: an 8-week, single-blind, randomized controlled trial.

OBJECTIVES: Despite the fact that combination treatment for patients with acute bipolar is prevalent in clinical practice, the outcomes of adjunct treatment with aripiprazole and a mood stabilizer have rarely been reported. The aim of this single-blind, randomized, controlled trial was to investigate treatment efficacy and safety of aripiprazole as an adjunct to valproic acid (Ari+Val), compared with haloperidol plus valproic acid (Hal+Val), in acute manic patients. METHODS: Treatment efficacy was prospectively assessed for 8 weeks in 42 patients with acute mania using the Young Mania Rating Scale and the Clinical Global Impression-Severity of illness scale. Emergent adverse events were assessed by the Drug-Induced Extrapyramidal Symptoms Scale and the Liverpool University Neuroleptic Side Effect Rating Scale. RESULTS: Both Ari+Val and Hal+Val produced a high rate of response (85.7% and 92.9%, respectively) and remission (82.1% and 85.7%, respectively) after the 8-week trial. Changes in the Young Mania Rating Scale and the Clinical Global Impression-Severity of illness scale over the study period and time to remission and response were not significantly different between the 2 groups. Patients treated with Ari+Val showed significantly fewer extrapyramidal adverse events than those treated with Hal+Val (t = -2.048, F = 40, P = 0.048). However, significant weight gain was more prevalent in the Ari+Val group than the Hal+Val group (t = 2.055, F = 40, P = 0.046). CONCLUSIONS: Our findings suggest that both combination strategies with Ari+Val and Hal+Val are beneficial for acute manic episode. Although patients receiving Ari+Val showed fewer extrapyramidal symptoms than those taking Hal+Val, careful consideration of adverse events such as weight gain and sedation is warranted.

Gray matter abnormalities in patients with premenstrual dysphoric disorder: an optimized voxel-based morphometry.

BACKGROUND: Although brain neurochemistry is thought to play a role in the development of premenstrual dysphoric disorder (PMDD), neuroimaging studies of PMDD are sparse. We examined the extent to which gray matter (GM) abnormalities were present in women with PMDD compared to healthy controls. METHODS: 3.0T magnetic resonance imaging scans of 15 women with PMDD and 15 healthy controls were compared using optimized voxel-based morphometry (VBM) analysis. A regression analysis was used to assess the relationship between GM density and PMDD-symptom severity. RESULTS: Our results showed significantly increased GM density in the hippocampal cortex and significantly decreased GM density in the parahippocampal cortex among women with PMDD compared to healthy controls. However, these GM abnormalities were not significantly associated with the severity of PMDD. LIMITATION: Our inferences of the relationships between structural alterations and PMDD are drawn from a small sample, which may have increased the likelihood of type I error. CONCLUSIONS: GM abnormalities in limbic and paralimbic cortices were found to be associated with the pathophysiology of PMDD. Etiology of PMDD is likely related to emotional processing and self-regulation. Our findings provide a basis of neurobiological model for PMDD.

Symptom severity and attitudes toward medication: impacts on adherence in outpatients with schizophrenia.

OBJECTIVE: The primary aim of this study was to compare electronic monitoring with other measures of adherence to antipsychotic medication in outpatients with schizophrenia. The secondary aim of the study was to analyze the relationships between adherence and other clinical parameters. METHOD: Fifty-one patients diagnosed with schizophrenia were monitored over an eight-week period. Medication adherence was assessed using the Medication Event Monitoring System (MEMS), which is a bottle cap with a microprocessor that records the occurrence and times of bottle opening, patient self-reports, a clinician rating scale, and pill counts. Agreements among adherence measures and the relationships between adherence and other clinical factors were assessed. RESULTS: The rate of non-adherence according to the MEMS was 41.2%, considerably higher than those of pill counting (7.8%), clinician rating scale (7.8%), or self-reporting (25.5%). Excitement, impulse control, and preoccupation symptoms on the Positive and Negative Syndrome Scale (PANSS) were higher in the non-adherent patients than in the adherent patients. The full Drug Attitude Inventory (DAI) score was higher in adherent versus non-adherent patients and the significant other subscale of the Multidimensional Scale of Perceived Social Support score was lower in the adherent patients. The Clinical Global Impression-Severity score was negatively correlated with adherence as measured by the MEMS (r=-0.426, p<0.05) and DAI scores were positively correlated with adherence according to the MEMS and the clinician rating scale (r=0.498, p<0.01 and r=0.387, p<0.05). Multivariate analysis showed that PANSS and DAI scores significantly contributed to MEMS adherence. CONCLUSION: Adherence as measured by the MEMS showed a discrepancy with other measures of adherence in patients with schizophrenia. The severity of disease and attitudes toward medication were related to adherence. Further studies are needed to evaluate the impacts of medication adherence in schizophrenia.

Effects of long-term combination treatment with valproate and atypical antipsychotics on bone mineral density and bone metabolism in premenopausal patients with bipolar disorder: a preliminary study.

OBJECTIVE: We investigated bone mineral density (BMD) and bone metabolism in female bipolar patients who were undergoing long-term treatment with valproate combined with a low-dose atypical antipsychotic. METHODS: Nineteen premenopausal women with bipolar disorder who were treated with valproate combined with atypical antipsycho-tics for at least 2 years were evaluated. The BMD was measured at lumbar spine and femur sites using dual-energy X-ray absorptiometry (DE-XA). The biochemical markers of bone turnover and circulating levels of gonadal hormones were assessed. Subjects with abnormal DEXA scans were compared to those with normal scans. RESULTS: Nine (47%) of nineteen subjects showed osteopenia or osteoporosis. The T-score for subjects with abnormal DEXA scans was -1.988. Decreased BMD was more prominent in the proximal femur than in the lumbar spine. Subjects with abnormal DEXA scans had high phosphorus and low testosterone levels relative to subjects with normal scans (p=0.008 and p=0.028, respectively). There was a significant negative correlation between phosphorus, osteocalcin, and femur neck BMD (p<0.05). However, multivariate analysis did not show a significant association between femur and lumbar BMD and biochemical markers of bone turnover. CONCLUSION: Long-term treatment with valproate combined with low-dose atypical antipsychotics may adversely affect BMD in premenopausal women with bipolar disorder. A prospective, controlled-study with a larger population is warranted, and assessment of BMD and bone metabolism should be taken into consideration in long-term therapy with valproate and atypical antipsychotics.

DRD2/ANKK1 TaqI A polymorphism affects corticostriatal activity in response to negative affective facial stimuli.

DRD2/ANKK1 TaqI A polymorphism has been suggested to be involved in a reward-related psychiatric disorders. However, the effect of Dopamine receptor D2 (DRD2) on emotional processing has not been investigated yet. We investigated the possible relationship between DRD2/ANKK1 TaqI A polymorphism and corticostriatal response to negative facial stimuli using functional magnetic resonance imaging. All participants were genotyped with regard to the DRD2/ANKK1 TaqI A polymorphism. Our results suggest an association between the DRD2/ANKK1 TaqI A polymorphism and activations in the putamen, the anterior cingulate cortex, and amygdala in response to negative facial stimuli. Furthermore, molecular heterosis at the TaqI polymorphism of DRD2/ANKK1 may play an important role in affective regulation by corticostriatal pathway.

Neural substrates of affective face recognition in alexithymia: a functional magnetic resonance imaging study.

BACKGROUND: Alexithymia is a condition characterized by deficits in cognitive processing and the regulation of emotions. Several theories have been proposed for the underlying neurobiology, but the etiology of alexithymia remains unclear. METHODS: Using functional magnetic resonance imaging, we investigated brain activation measured on the scale of alexithymia in 38 individuals who were presented with neutral, sad, or angry affective facial stimuli. RESULTS: We found significant inverse correlations between the degree of alexithymia represented by the Korean version of the Toronto Alexithymia Scale (TAS-20K) and the intensity of the neural response to angry facial stimuli over neutral facial stimuli in the right caudate. This result was mainly due to the activations in factor 2 (difficulty describing feelings) in TAS-20K scale. CONCLUSIONS: The results suggest that functional impairments in the caudate of the fronto-striatal circuitry may play important roles in the pathophysiology of alexithymia.

Association between tryptophan hydroxylase 2 polymorphism and anger-related personality traits among young Korean women.

BACKGROUND/AIMS: It has been suggested that the serotonergic systems are associated with anger and aggressive behaviors. We investigated the association between several single nucleotide polymorphisms in the serotonergic genes and anger-related personality traits. METHODS: A total of 228 healthy female Korean women participated in this study. All subjects were assessed with the State-Trait Anger Expression Inventory (STAXI) and were genotyped for 3 polymorphisms: serotonin transporter (5-HTT) gene-linked polymorphic region (5-HTTLPR), tryptophan hydroxylase 1 (TPH1) A218C, and TPH2 G-703T. RESULTS: The Anger Expression-Out (AX-Out) subscale scores of the STAXI differed significantly between the genotypes for the TPH2 G-703T polymorphism (F = 4.825, p = 0.009). G/G homozygous subjects scored significantly higher on the AX-Out subscale than those with the G/T genotype. However, no significant differences were observed in the relationships between the STAXI subscale scores of subjects with other polymorphisms. CONCLUSIONS: This study suggests that the TPH2 G-703T polymorphism might contribute to anger-related traits, especially to the expression of anger.

Effect of bromocriptine on antipsychotic drug-induced hyperprolactinemia: eight-week randomized, single-blind, placebo-controlled, multicenter study.

AIM: The objective of the present study was to assess the efficacy and safety of bromocriptine treatment for patients with antipsychotic-drug-induced hyperprolactinemia in clinical practice. METHODS: This was an 8-week randomized, single-blind, placebo-controlled, multicenter study. Sixty female schizophrenia patients were enrolled and were randomly assigned to one of four treatment groups: bromocriptine 2.5 mg/day, 5 mg/day, 10 mg/day, and placebo. Serum levels of prolactin, estradiol (E2), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were evaluated on three occasions (baseline, and 4 and 8 weeks after commencement of the treatment paradigm). Extrapyramidal symptoms (EPS) and clinical symptoms were assessed using the Simpson-Angus scale and the Positive and Negative Syndrome Scale (PANSS), respectively. RESULTS: Of the 60 subjects who were enrolled, 48 completed the study (n = 14, 13, 11, and 10 in the bromocriptine 2.5 mg/day, 5 mg/day, and 10 mg/day, and placebo groups, respectively). Four patients in the 10-mg/day group, two in the 5-mg/day group, and one in the placebo group resumed menses during the study. The mean level of prolactin significantly decreased from baseline to week 4, and then plateaued, showing no significant change for the remaining 4 weeks of the study. No significant changes in LH, FSH, or E2 levels were observed throughout the 8-week study period, either within or between groups. CONCLUSION: Administration of bromocriptine is a safe method for treating antipsychotic-drug-induced hyperprolactinemia without exacerbating either psychotic symptoms or EPS.

Zonisamide-induced weight loss in schizophrenia: case series.

Weight gain and metabolic disturbances constitute bothersome problems in schizophrenic patients treated with atypical antipsychotics. Several medications, exercise regimens, and lifestyle changes have been used in attempts to ameliorate these problems. We describe 3 patients with schizophrenia who manifested distinct weight loss and reduction in waist circumference during medication with zonisamide. This report suggests that zonisamide might be associated with weight loss in patients with schizophrenia.

Variables influencing antidepressant medication adherence for treating outpatients with depressive disorders.

OBJECTIVE: Medication adherence is associated with the treatment outcomes. The reported consequences of non-adherence for patients with depressive disorders include chronification, poor psychosocial outcomes and increased suicide rates. The aim of this study is to determine whether insight is directly associated with the medication-taking adherence of patients with depressive disorders. In addition, we compared the various kinds of adherence measures for the depressive patients. METHOD: Consecutively 76 patients with depressive disorders were recruited from the outpatient clinic of our center. All patients were on mono-antidepressant therapy during at least 4-weeks' evaluation period, and evaluated with 17 item Hamilton Rating Scale for Depression (HRSD), Multidimensional Scale of Perceived Social Support (MSPSS) and Mood Disorders Insight Scale (MDIS). Medication adherence was assessed by using medication event monitoring system (MEMS), clinician rating scale of antidepressant adherence, pill count and patient's self-report. Agreement among the three continuous adherence measures was evaluated. The relationship between the adherence variables and the other clinical scale scores was assessed by using partial correlation correcting for age. RESULTS: The patients perceived poor social support from other people in relation to increasing severity of depression. The adherence rates for the MEMS, the pill count, the clinician rating scale of compliance and self-report were 51.9%, 71.4%, 79.2% and 75.3%, respectively. The HRSD scale score negatively correlated with the MDIS scores. No correlation was found between the adherence variables and the clinical scale scores (MDIS, HRSD and MSPSS). CONCLUSION: Patients with more severe depression tend to have greater insight. However, the increased insight of depressive patients was not associated with an increase in treatment adherence.

Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients.

BACKGROUND: About 2% to 5% of all primary-care patients have a somatization disorder, and somatic symptoms are strongly associated with comorbid depression and anxiety disorders. OBJECTIVE: The authors evaluated the validity of the 15-item Somatization module of the Patient Health Questionnaire (PHQ-15) among psychiatric outpatients. METHOD: The PHQ-15 was administered to patients with somatic complaints; it was compared with the Beck Depression Inventory (BDI) and the General Health Questionnaire-12 (GHQ-12). Fifty-seven Korean subjects completed the survey. RESULTS: The PHQ-15 exhibited significant internal consistency, and test-retest reliability. Convergent validity with the BDI and GHQ-12 were positive. CONCLUSION: These results indicate that the Korean version of the PHQ-15 is appropriate for measuring the severity of somatic symptoms in a psychiatric outpatient setting.

Manganese superoxide dismutase gene Ala-9Val polymorphism might be related to the severity of abnormal involuntary movements in Korean schizophrenic patients.

OBJECTIVE: This study examined whether the manganese superoxide dismutase (MnSOD) gene Ala-9Val single-nucleotide polymorphism (SNP) is associated with neuroleptic-induced tardive dyskinesia (TD) and the severity of the abnormal involuntary movements in Korean schizophrenic patients. METHOD: We investigated whether the MnSOD gene Ala-9Val SNP is associated with TD in Korean schizophrenic patients with (n=83) and without (n=126) TD who were matched for exposure to antipsychotics and other relevant variables. RESULTS: Logistic regression analysis revealed that being older (p=0.026) was a risk factor for TD, but that there was no significant association between MnSOD gene and TD. Abnormal involuntary movements were more severe in carriers of the Ala allele than in noncarriers (p=0.044). CONCLUSION: These findings do not support that the MnSOD gene Ala-9Val SNP is associated with TD in Korean schizophrenic patients. However, this polymorphism might be related to the severity of abnormal involuntary movements in this population.