Diagnostic Validity of an Automated Probabilistic Tractography in Amnestic Mild Cognitive Impairment

Won Sang Jung,엄유현,강동우,Chang-Uk Lee,Young Sup Woo,Won-Myong Bahk,Hyun Kook Lim 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.2

Objective: Although several prior works showed the white matter (WM) integrity changes in amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease, it is still unclear the diagnostic accuracy of the WM integrity measurements using diffusion tensor imaging (DTI) in discriminating aMCI from normal controls. The aim of this study is to explore diagnostic validity of whole brain automated probabilistic tractography in discriminating aMCI from normal controls. Methods: One hundred-two subjects (50 aMCI and 52 normal controls) were included and underwent DTI scans. Whole brain WM tracts were reconstructed with automated probabilistic tractography. Fractional anisotropy (FA) and mean diffusivity (MD) values of the memory related WM tracts were measured and compared between the aMCI and the normal control groups. In addition, the diagnostic validities of these WM tracts were evaluated. Results: Decreased FA and increased MD values of memory related WM tracts were observed in the aMCI group compared with the control group. Among FA and MD value of each tract, the FA value of left cingulum angular bundle showed the highest area under the curve (AUC) of 0.85 with a sensitivity of 88.2%, a specificity of 76.9% in differentiating MCI patients from control subjects. Furthermore, the combination FA values of WM integrity measures of memory related WM tracts showed AUC value of 0.98, a sensitivity of 96%, a specificity of 94.2%. Conclusion: Our results with good diagnostic validity of WM integrity measurements suggest DTI might be promising neuroimaging tool for early detection of aMCI and AD patients.

The Diagnostic Stability of DSM-IV Diagnoses: An Examination of Major Depressive Disorder, Bipolar I Disorder, and Schizophrenia in Korean Patients

Kim, Won,Woo, Young Sup,Chae, Jeong-Ho,Bahk, Won-Myong Korean College of Neuropsychopharmacology 2011 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.9 No.3

<P><B>Objective</B></P><P>We examined the stability of diagnoses defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) (major depressive disorder [MDD], bipolar I disorder [BID], and schizophrenia [SPR]) by means of retrospective reviews of medical records.</P><P><B>Methods</B></P><P>Data from patients who met the DSM-IV criteria for the aforementioned disorders according to two psychiatrists and who were followed for at least 2 years were included in this study. We reviewed the medical records and compared the diagnosis given at the index admission with assessments made every 6 months for 2 years after discharge to determine diagnostic stability.</P><P><B>Results</B></P><P>A total of 138 patients with MDD, 56 patients with BID, and 107 patients with SPR who were followed for 2 years were included in the final analyses. The data showed that 84.8% of the sample retained their initial diagnosis of MDD during the first year; this figure decreased to 79.0% during the second year. During the first year, 93.5% retained their initial diagnosis of BID, and this figure decreased to 89.3% during the second year; 86.8% and 86.9% retained their diagnosis of SPR during the first and second years, respectively.</P><P><B>Conclusion</B></P><P>This study showed the instability of three major DSM-IV diagnoses among Korean patients. Additionally, the results demonstrated that accurate diagnosis using the current diagnostic system requires longitudinal observation.</P>

인터넷 시대와 정신과

박원명(Won-Myong Bahk),배치운(Chi-Un Pae) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.1

1999년도의 인터넷 사용자는 1억 6천만 명, 연간 e-mail 사용 회선은 2조 7천만번, 건강 관련 websites는 10만개에 달하였으며, 2002년에는 인터넷 사용자가 전세계적으로 3억 명에 달할 것으로 추산될 정도로 computer를 이용한 정보의 공급과 소비는 더욱 늘어날 전망이다. 정신과 영역에서도 인터넷의 보급은 확산 일로에 있지만 정신과 영역에서 장점과 위험성 등 그 잠재성은 정확하게 알려져 있지 않다. 또한, 인터넷은 수많은 환자와 정신과 의사가 무한의 정보를 교류할 수 있는 영역이며 동시에 비밀 유지(confidentiality), 환자와의 소통방법 변화, 임상적 적용과 관련된 적절한 software의 개발 필요성 등 변화에 적절히 대응해야할 요소가 많으므로 본고에서는 Internet communication의 model, 정신과 영역에서 최근 대두되고 있는 인터넷으로 인한 부정적인 영향, 정신과적 적용과 한계, 그리고 미래 등을 문헌과 online 검색을 통하여 소개하려고 한다. In 1999, the internet had 160 million users world wide, the number of websites related to health is 100000, and with 2.7 trillion e-mail messages sent annually. By the year 2002 it is anticipated that there will be 300 million internet users. At present, with increasing the internet services, but there is no accurate information and knowledge of internet application in psychiatry. Additionally, internet is the communicative field of many psychiatrists and patients, and has some problems including confidentiality, change of communication with patients, need of software related to clinical practice, and so on. According to recent trends, in this article authors want to introduce potential risks and adverse events, model of internet communication, the drawbacks and application to psychiatric area, and the future by journal review and online search.

Efficacy and Tolerability of Blonanserin in the Patients With Schizophrenia: A Randomized, Double-blind, Risperidone-Compared Trial

Yang, Jaewon,Bahk, Won-Myong,Cho, Hyun-Sang,Jeon, Yang-Whan,Jon, Duk-In,Jung, Hee-Yeon,Kim, Chan-Hyung,Kim, Hee-Cheol,Kim, Yong-Ku,Kim, Young-Hoon,Kwon, Jun-Soo,Lee, Sang-Yeol,Lee, Seung-Hwan,Yi, Jung Lippincott Williams Wilkins, Inc. 2010 Clinical neuropharmacology Vol.33 No.4

OBJECTIVES:: The objective of this study was to evaluate the efficacy and tolerability of blonanserin for the treatment of Korean patients with schizophrenia using a double-blind risperidone-compared design. METHODS:: Patients aged 18 to 65 years with schizophrenia were randomly assigned to blonanserin or risperidone treatment for 8 weeks. The efficacy was assessed using the mean change in Positive and Negative Syndrome Scale score total scores from baseline to week 8. Safety assessments included monitoring of vital signs, a physical examination, laboratory tests, and adverse events. RESULTS:: Of 206 randomly enrolled patients, 103 receiving blonanserin and 103 receiving risperidone were included in the analysis. In this study, noninferiority between blonanserin and risperidone was demonstrated. The mean change in the Positive and Negative Syndrome Scale total score at the final evaluation time point was −23.48 ± 19.73 for the blonanserin group and −25.40 ± 18.38 for the risperidone group. Adverse events, which occurred less frequently in the blonanserin than in the risperidone group, included dysarthria (P = 0.0288), dizziness (P = 0.0139), increased alanine aminotransferase and aspartate aminotransferase (P = 0.0095 and P = 0.0032, respectively), and increased level blood prolactin (P = 0.0012). On the other hand, the adverse events that occurred more frequently in the blonanserin than in the risperidone group was hand tremor (P = 0.0006). CONCLUSIONS:: Blonanserin was effective in the treatment of Korean patients with schizophrenia compared with risperidone and was more tolerable with a better safety profile, particularly with respect to prolactin elevation. These findings suggest that blonanserin is useful in the treatment of schizophrenia.

Improving the Screening Instrument of Bipolar Spectrum Disorders: Weighted Korean Version of the Mood Disorder Questionnaire

Narei Hong,Won-Myong Bahk,Bo-Hyun Yoon,Kyung Joon Min,Young Chul Shin,Duk-In Jon 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.3

Objective: It is not easy to diagnose bipolar disorders accurately in the clinical setting. Although Korean version of the Mood Disorder Questionnaire (K-MDQ) is easily administered, it still has weakness regarding case finding. In this study, we suggest a new weighted version of the K-MDQ to increase its screening power. Methods: Ninety-five patients with bipolar disorders and 346 controls (patients with schizophrenia, patients with depressive disorders, patients with anxiety disorders, and subjects without any psychiatric disease) were enrolled in this study. The subjects received brief information on the K-MDQ, and then independently completed the questionnaire. Results: Using odds ratios, we constructed a new weighted K-MDQ (W-K-MDQ). Item 1 (feel so good or hyper) was weighted 7 times and item 4 (less sleep) 3.5 times. Item 7 (easily distracted) and item 11 (more interested in sex) were excluded. Part 2 (simultaneity) and 3 (functional impairment) were also excluded as in the original K-MDQ. The sensitivity of the W-K-MDQ with a cutoff value of 10 was enhanced to 0.789. The area under the receiver operating characteristic curve was increased to 0.837. Conclusion: We suggested a new formula for K-MDQ using 11 of its items. The W-K-MDQ can be easily applied with good sensitivity to screen for bipolar disorders in clinical settings in Korea. Further evaluations with larger samples are needed to establish the usefulness of the W-K-MDQ.

Adjunctive Risperidone and Olanzapine in the Treatment of Patients with Bipolar I Disorder :A Retrospective Study

Chi-Un Pae,Won-Myong Bahk,Keun-Young Hong,Young Sup Woo,Jeong-Ho Chae,Tae-Youn Jun,Kwang-Soo Kim,이철 대한정신약물학회 2005 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.3 No.1

This study was conducted to evaluate the overall efficacy and safety of atypical antipsychotics (risperidone vs. olanzapine) in the treatment of inpatients with bipolar I disorder in Korea. Ninety six consecutive inpatients with bipolar I disorder at St. Mary’s Hospital in Seoul, Korea, were given olanzapine or risperidone as adjuncts to mood stabilizers for at least 1 month, in the absence of other antipsychotics. Details of the adverse effects, tolerability, and efficacy were reviewed on the basis of the treatment records on admission and after 4 weeks of hospitalization. The overall results showed that the two atypical antipsychotics had equivalent efficacies based on the Clinical Global Impression (CGI) and Global Assessment Functioning(GAF) scores. The frequencies of the extrapyramidal symptom-related side effects were higher in the risperidone-treated group than in the olanzapine-treated group. This small study suggests that the efficacies of risperidone and olanzapine are similar in inpatients with bipolar I disorder in a naturalistic setting and that the present data from a North-East Asian setting replicated and extended the findings of previous Western studies. This study was conducted to evaluate the overall efficacy and safety of atypical antipsychotics (risperidone vs. olanzapine) in the treatment of inpatients with bipolar I disorder in Korea. Ninety six consecutive inpatients with bipolar I disorder at St. Mary’s Hospital in Seoul, Korea, were given olanzapine or risperidone as adjuncts to mood stabilizers for at least 1 month, in the absence of other antipsychotics. Details of the adverse effects, tolerability, and efficacy were reviewed on the basis of the treatment records on admission and after 4 weeks of hospitalization. The overall results showed that the two atypical antipsychotics had equivalent efficacies based on the Clinical Global Impression (CGI) and Global Assessment Functioning(GAF) scores. The frequencies of the extrapyramidal symptom-related side effects were higher in the risperidone-treated group than in the olanzapine-treated group. This small study suggests that the efficacies of risperidone and olanzapine are similar in inpatients with bipolar I disorder in a naturalistic setting and that the present data from a North-East Asian setting replicated and extended the findings of previous Western studies.

Pharmacological Treatment of Major Depressive Episodes with Mixed Features: A Systematic Review

In Hee Shim,Won-Myong Bahk,Young Sup Woo,Bo-Hyun Yoon 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.4

We reviewed clinical studies investigating the pharmacological treatment of major depressive episodes (MDEs) with mixed features diagnosed according to the dimensional criteria (more than two or three [hypo]manic symptoms+principle depressive symptoms). We systematically reviewed published randomized controlled trials on the pharmacological treatment of MDEs with mixed features associated with mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). We searched the PubMed, Cochrane Library, and ClinicalTrials.gov databases through December 2017 with the following key word combinations linked with the word OR: (a) mixed or mixed state, mixed features, DMX, mixed depression; (b) depressive, major depressive, MDE, MDD, bipolar, bipolar depression; and (c) antidepressant, antipsychotic, mood stabilizer, anticonvulsant, treatment, medication, algorithm, guideline, pharmacological. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found few randomized trials on pharmacological treatments for MDEs with mixed features. Of the 36 articles assessed for eligibility, 11 investigated MDEs with mixed features in mood disorders: six assessed the efficacy of antipsychotic drugs (lurasidone and ziprasidone) in the acute phase of MDD with mixed features, although four of these were post hoc analyses based on large randomized controlled trials. Four studies compared antipsychotic drugs (olanzapine, lurasidone, and ziprasidone) with placebo, and one study assessed the efficacy of combination therapy (olanzapine+fluoxetine) in the acute phase of BD with mixed features. Pharmacological treatments for MDEs with mixed features have focused on antipsychotics, although evidence of their efficacy is lacking. Additional well-designed clinical trials are needed.

Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018): Fourth Revision

Young Sup Woo,Won-Myong Bahk,Jung Goo Lee,Jong Hyun Jeong,Moon Doo Kim,Inki Sohn,Se-Hoon Shim,Duk-In Jon,Jeong Seok Seo,Kyung Joon Min,Won Kim,송후림,Bo-Hyun Yoon 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.4

Objective: The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was first published in 2002 through an expert consensus of opinion, and updated in 2006, 2010, and 2014. This study constitutes the fourth revision of the KMAP-BP. Methods: A 50-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of adult bipolar disorder and six items for pediatric bipolar disorder. The review committee included 84 Korean psychiatrists and 43 child and adolescent psychiatry experts. Results: The preferred first-step strategies for acute mania were the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. A combination of a MS and an AAP, and AAP monotherapy were preferred for psychotic mania. The first-step strategies for mild to moderate bipolar depression were monotherapy with MS, AAP, or lamotrigine (LMT), and the combination of a MS and an AAP or LMT, or a combination of an AAP and LMT. The combination of two among a MS, AAP, and LMT were preferred for non-psychotic severe depression. A combination of a MS and an AAP or the combination of an AAP with an antidepressant or LMT were the first-line options for psychotic severe depression. Conclusion: The recommendations of the KMAP-BP 2018 have changed from the previous version by reflecting recent developments in pharmacotherapy for bipolar disorder. KMAP-BP 2018 provides clinicians with a wealth of information regarding appropriate strategies for treating patients with bipolar disorder.

A Practical Utility and Benefit of Pharmacogenetic-based Antidepressant Treatment Strategy for Major Depressive Disorder Patients with Difficult-to-treat

Kyung Ho Lee,Won-Myong Bahk,Soo-Jung Lee,Alessandro Serretti,Chi-Un Pae 대한정신약물학회 2021 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.19 No.1

Objective: We report the results of pharmacogenomics-based antidepressant treatment (PGXt) results in treating treatment- resistant major depressive disorder (TRD) patients in real practice. Methods: Nine patients were prescribed NeuropharmagenⓇ for selection of antidepressants for individual patient and their clinical outcomes were followed. Results: After treatment by PGXt results from current antidepressants, substantial reduction of depressive symptoms was observed at some point and maintained during observation period in six patients. Conclusion: Our case series potentially shows the clinical utility and benefit of PGXt for treatment of TRD patients.

The Effects of Antipsychotics on c-fos Expression in Rat Brain

Kim, Kwang-Soo,Bahk, Won-Myong,Jeon, Yang-Whan,Lee, Chung Tai,Lew, Tae-Yul CATHOLIC MEDICAL CENTER 1995 Bulletin of the Clinical Research Institute Vol.23 No.2

The authors studied potential differences in the neuroanatomical sites of actions of typical antipsychotics like chlorpromazine and haloperidol, atypical antipsychotics such as clozapine and risperidone, and selective dopamine Di receptor antagonist (SCH 23390) by comparing their effects on c-fos expression in the rat brains. Fifty-two rats, weighing 300-450g, were divided into 13 groups according to injection agents(distilled water, vehicle, chlorpromazine, haloperidol, clozapine, risperidone, and SCH 23390), and their doses. After postfixative period, brain sections, cut from the regions of the medical prefrontal cortex, nucleus accumbens, medial and lateral striata, and lateral septal nucleus, were stained by Fos-immunohistochemistry. Results were as follows; 1. Chlorpromazine(50㎎/㎏), clozapine(20㎎/㎏, 30㎎/㎏), and risperidone increased the number of Fos-positive neurons in the medial prefrontal cortex, compared with the vehicle(P<.01). 2. Chlorpromazine, haloperidol, clozapine, and risperidone(1㎎/㎏) increased the number of Fos-positive neurons in the nucleus accumbens, compared with the vehicle, but SCH 23390 decreased it, in comparison with the distilled water(P<.01). 3. Chlorpromazine, haloperidol, and risperidone increased the number of Fos-positive neurons in the striatum, especially in the lateral striatum, compared with the vehicle(P<.01), but clozapine increased it much less than chlorpromazine, haloperidol, and risperidone did. SCH 23390 decreased the number of Fos-positive neurons in the medial striatum, in comparison with the distilled water(P<.05). 4. Chlorpromazine, haloperidol, clozapine, and risperidone increased the number of Fos-positive neurons in the lateral septal nucleus, compared with the vehicle(P<.01). These results support that clozapine and risperidone's unique therapeutic actions on negative symptoms of schizophrenia, and the low incidence of extrapyramidal side effects on their use in schizophrenics may be related to their distinctive effects in the regions, such as the medial prefrontal cortex and the lateral striatum.