Evidence for Association between the Brain-Derived Neurotrophic Factor Gene and Panic Disorder: A Novel Haplotype Analysis

OBJECTIVE: Panic disorder (PD) is a common psychiatric disorder with a complex etiology, and several studies have suggested that it has a genetic component. Brain-derived neurotrophic factor (BDNF) is the most abundant of the neurotrophins in the brain and is recognized for its important role in the survival, differentiation and growth of neurons. Several lines of research have suggested possible associations between the BDNF gene and PD. In this study, we investigated the BDNF 196G/A (rs6265), 11757G/C (rs16917204), and 270C/T (rs56164415) single nucleotide polymorphisms (SNPs) in order to determine an association with PD. We also identified the genetic sequence associations with PD via haplotype analysis. METHODS: Participants in this study included 136 PD patients and 263 healthy controls. Male and female subjects were analyzed separately. The genotype and allele frequencies of the PD patients and controls were analyzed using chi2 statistics. Frequencies and haplotype reconstructions were calculated using the SNP analyzer 2.0. RESULTS: We found no significant statistical differences in the genotype distributions or allele frequencies of the three tested polymorphisms between the PD and control groups. In addition, no differences were found between PD patients and the controls in either male or female subgroups. However, we found that, the frequency of the G-C haplotype for 196G/A and 11757G/C was significantly higher in PD patients than in the controls. CONCLUSION: Our result suggest that patients with the G-C haplotype for 196G/A and 11757G/C may be more susceptible to the development of PD. Further studies are needed to replicate the associations that we observed.

Environmental and Familial Risk Factors of Children and Adolescents with Attention Deficit/Hyperactivity Disorder / 신경정신의학

OBJECTIVES: The aim of this study was to analyze the environmental and familial variables associated with attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. METHODS: Children and adolescents aged 6-18 with in attention, hyperactivity, or impulsivity who visited the Department of Psychiatry at Soonchunhyang University Bucheon Hospital from April 2006 to April 2012, were interviewed for diagnosis of ADHD. Diagnostic and Statistical Manual of Mental Disorders, 4th edition symptom criteria for ADHD were assessed using a semi-structured interview, the schedule for affective disorders and schizophrenia for school-age children present and lifetime version (K-SADS-PL). Environmental and familial variables were obtained using questionnaires for parents. RESULTS: In total, 262 children and adolescents with ADHD (n=139) and control subjects (n=123) were recruited. In a multivariate logistic regression model, results of this study showed that maternal psychiatric problem during pregnancy, dystoia, forceps/vacuum use during delivery, and unplanned pregnancy were risk factors for ADHD. CONCLUSION: Findings of this study showed an association of some prenatal factors (such as unplanned pregnancy or maternal psychiatric problem during pregnancy) and some perinatal factors (dystocia and forceps/vacuum use during delivery) with increased risk of ADHD. The identified risk factors are environmental, and therefore potentially preventable. Conduct of further prospective studies is needed in order to clarify the potential role of these risk factors for ADHD.

The Trend of the Use of Neuropsychological Tests in the Korean Psychiatric Division for the Past 10 Years : Focused on Dementia Research / 신경정신의학

OBJECTIVES: The aim of this study is to investigate the proportion of dementia studies and the trends of the use of neuropsychological tests in dementia studies for the past 10 years. METHODS: The subjects of this study were 715 original articles published in Journal of Korean Neuropsychiatric Association and 72 original articles published in Journal of Korean Geriatric Psychiatry between January 1, 2000 and December 31, 2009. Among those, there were 78 articles of dementia study and 36 articles using the neuropsychological test used for the analysis. According to the published year, all articles were divided into two stages (between 2000-2004, between 2005-2009). The data were collected for what neuropsychological tests were used. RESULTS: The proportion of dementia studies increased from 8.2% to 12.4% and the proportion of dementia studies using the neuropsychological test decreased from 60.5% to 37.5%, when comparing the two stages. The use rate of screening tests, intelligence tests, and domain-specific cognitive tests decreased from 91.3% to 84.6%, 13.0% to 0%, 91.3% to 76.9% respectively, whereas the use rate of comprehensive assessment of dementia increased from 21.7% to 38.5%. CONCLUSION: These results show an increasing trend in dementia studies and decreasing rate of neuropsychological test use in Korea. However, the use rate of comprehensive assessment of dementia increased.

Venlafaxine-Induced Acute Toxic Hepatitis

Venlafaxine is among the most widely prescribed antidepressants. It is extensively metabolized to O-desmethylvenlafaxine via cytochrome P450 (CYP) 2D6. We report a case of acute toxic hepatitis resulting from venlafaxine in a 54-year-old woman with pain disorder. During venlafaxine treatment, laboratory tests revealed elevated liver enzymes with a maximum of 169 IU/L for aspartate transaminase (AST) and 166 IU/L for alanine transaminase (ALT). AST and ALT levels returned to normal after 6 days of discontinuation of venlafaxine. The patient was finally diagnosed with acute toxic hepatitis through liver biopsy. This case indicates the importance that clinicians should be aware of the hepatotoxicity of venlafaxine in practice.

A Case of Transient Psychosis after Sustained Release Bupropion Overdose / 대한정신약물학회지

Bupropion is a unique antidepressant with enhancing both noradrenergic and dopaminergic neurotransmission without altering serotonergic system. Given its pharmacodynamics and structural similarity to amphetamine, the possibility of bupropionrelated psychosis has been reported. The authors describe a 22-year-old woman who presented psychotic symptoms after taking 10 tablets of sustained release bupropion (bupropion SR) 150 mg (total 1,500 mg) and lorazepam 0.5 mg (total 5 mg). Visual hallucinations developed at 17 hours after overdose, while paranoid ideation and aggressive behaviors developed at 24 hours after overdose. The psychotic symptoms remitted on the fifth day of antipsychotics treatment. She remained psychiatrically stable without any clinically significant symptoms during 3-month follow-up. This case raises issue about the possible relationship between bupropion overdose and transient psychosis.

Subclinical Hypothyroidism during Quetiapine Treatment: A Case Report

Quetiapine is an atypical antipsychotic drug with a benign side effect profile. However, recent studies have reported that thyroid dysfunction is associated with quetiapine treatment. The authors report a patient with DSM-IV bipolar I disorder who developed subclinical hypothyroidism during quetiapine treatment. The patient showed no significant clinical symptoms, but only abnormal thyroid function test findings including antithyroglobulin antibody. The abnormal thyroid function test findings were normalized after discontinuation of quetiapine. The subclinical hypothyroidism developed during quetiapine treatment may be associated with autoimmune process.

Clinical Features and Prognosis Related to Age at Onset in Bipolar Disorder: A Prospective 1 Year Follow-Up / 신경정신의학

OBJECTIVES: There have been several studies demonstrating that age at onset is associated with clinical and functional outcome in bipolar disorder. The purpose of this study was to investigate whether age at onset would influence on the prognosis of patients with bipolar I disorder in a Korean sample. METHODS: Thirty-one patients with bipolar I disorder (DSM-IV) were recruited. Age at onset was split at age 30 years into early onset (n=15) and late onset (n=16) groups. These patients were followed at 1 year to assess re-hospitalization, psychiatric symptoms (Brief Psychiatric Rating Scale, Young Mania Rating Scale), and social functioning (Korean version of the Social Adjustment Scale II revised version : KSAS II-RV). The subgroups were compared by Mann-Whitney U test and chi-square test. RESULTS: Early onset group had more psychotic symptoms at hospitalization (chi-square=5.743, p=.029) and had more KSAS IIRV score after 1 year (U=49.000, p=.004). Other psychiatric symptoms except psychosis were not significantly different between early onset and late onset group. KSAS II-RV score was not significantly correlated with BPRS and YMRS score. CONCLUSION: Our data suggest that early onset group may have poorer social functioning than late onset group in bipolar I disorder.