White matter alterations in male patients with obsessive–compulsive disorder

Ha, Tae Hyon,Kang, Do-Hyung,Park, Jun Sung,Jang, Joon Hwan,Jung, Wi Hoon,Choi, Jung-Seok,Park, Ji-Young,Jung, Myung Hun,Choi, Chi-Hoon,Lee, Jong-Min,Ha, Kyooseob,Kwon, Jun Soo Lippincott Williams Wilkins, Inc. 2009 NEUROREPORT - Vol.20 No.7

To investigate white matter abnormalities in patients with obsessive–compulsive disorder and to clarify the relationship between discrete white matter alterations and obsessive–compulsive symptom dimensions, the fractional anisotropy obtained from 25 male patients and 25 matched normal controls were analyzed. The patients had a significantly lower fractional anisotropy in the left anterior cingulate white matter than the controls. When stratified by clinical symptom dimensions, patients with a predominant aggressive/checking symptom dimension exhibited a significantly lower fractional anisotropy in the left anterior cingulate white matter, whereas patients with a predominant contamination/cleaning symptom dimension showed a significantly higher fractional anisotropy in the bilateral prefrontal white matter. Our findings provide evidence that obsessive–compulsive disorder may be a heterogeneous disease with distinct white matter changes.

주의력결핍/과잉행동장애와 양극성장애 공존 환아군과 주의력결핍/과잉행동장애 환아군의 비교연구

정동선,하규섭,정희연,구훈정,황준원,김붕년,신민섭,조수철,홍강의 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.6

Objective : Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with a variety of psychiatric disorders. Among them, bipolar disorder (BPD) has especially attracted growing interest. This is partly due to the fact that early onset BPD has been frequently misdiagnosed as ADHD because of symptomatic overlap. The aim of the present study is to find the differences in demographic data and clinical features of ADHD+BPD and ADHD in children and adolescents. Method : Children and adolescents patients participating in the present study have been enrolled at the child psychiatric clinic since 2004. 14 patients meeting the DSM-IV chteria for ADHD+BPD and 19 patients meeting the criteria for ADHD and 15 healthy comparison subjects were recruited. All groups were evaluated through the Schedule for Affective disorders and Schizophrenia for School-Age Children-Present and Life Time version-Korean version (K-SADS-PL-K). Demographic data and clinical charactehstics of the subjects were also collected. Parents were asked to complete the Child Behavior Check List(CBCL) and the Toddler Temperamental Scale (TTS) clinical ratings were obtained using the Young Mania Rating Scale(YMRS), the Children's Depression Iventory (CDI) and the Dupaul ADHD scale. Clinical variables between ADHD+BPD and ADHD were analyzed using the Mann-Whitney U test. YMRS, CDI, Dupaul ADHD scale (inattention and hyperactivity), CBCL, and TTS among the three groups were analyzed using the Kruskal-Wallis test with post-hoc Mann-Whitney U test. Results : 1) ADHD+BPD group had an earlier onset age of ADHD than ADHD group 2) ADHD+BPD group had more co-morbid psychiathc disorders than ADHD group. 3) Compared to ADHD group, ADHD+BPD had more psychiathc family history, especially mood disorders. 4) ADHD+BPD group had prodromal symptoms such as irritability, anger dyscontrol and academic dysfunction, compared to ADHD group who rarely showed prodromal symptoms. 5) ADHD+BPD group had higher ADHD scores than the ADHD group in the Dupaul ADHD inattentive scale. 6) In global functions of CBCL, ADHD+BPD group showed more impaired functions at home and school than ADHD group. 7) In Attention diagnostic system (ADS), ADHD+BPD group had more omission and commission errors than ADHD group, especially in the visual system. 8) In the subtests of the IQ profile, ADHD+BPD group had lower arithmetic and block design scores than ADHD group. Conclusion : Clinicians have to rule out underlying bipolarity in children and adolescents with ADHD who show earlier age of onset and severe clinical features. Bipolarity should be explored intensively in ADHD children and adolescents who have early onset of symptoms and severe functional impairment.

Pattern of Pharmacotherapy by Episode Types for Patients With Bipolar Disorders and Its Concordance With Treatment Guidelines

Baek, Ji Hyun,Ha, Kyooseob,Yatham, Lakshimi N.,Chang, Jae Seung,Ha, Tae Hyon,Jeon, Hong Jin,Hong, Kyung Sue,Chang, Sung Man,Ahn, Yong Min,Cho, Hyun Sang,Moon, Eunsoo,Cha, Boseok,Choi, Jung Eun,Joo, Ye by Lippincott Williams Wilkins. 2014 JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Vol.34 No.5

ABSTRACT: This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%–48.7%) compared with that for depressive inpatients (18.6%–46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses.

Emotional Priming With Facial Exposures in Euthymic Patients With Bipolar Disorder

Su Kim, Taek,Young Lee, Su,Yeon Ha, Ra,Kim, Eosu,Kyoon, Suk,Ha, Kyooseob,Cho, Hyun-Sang Lippincott Williams Wilkins, Inc. 2011 The Journal of nervous and mental disease Vol.199 No.12

ABSTRACT: People with bipolar disorder have abnormal emotional processing. We investigated the automatic and controlled emotional processing via a priming paradigm with subliminal and supraliminal facial exposure. We compared 20 euthymic bipolar patients and 20 healthy subjects on their performance in subliminal and supraliminal tasks. Priming tasks consisted of three different primes according to facial emotions (happy, sad, and neutral) followed by a neutral face as a target stimulus. The prime stimuli were presented subliminally (17 msec) or supraliminally (1000 msec). In subliminal tasks, both patients and controls judged the neutral target face as significantly more unpleasant (negative judgment shift) when presented with negative emotion primes compared with positive primes. In supraliminal tasks, bipolar subjects showed significant negative judgment shift, whereas healthy subjects did not. There was a significant group × emotion interaction for the judgment rate in supraliminal tasks. Our finding of persistent affective priming even at conscious awareness may suggest that bipolar patients have impaired cognitive control on emotional processing rather than automatically spreading activation of emotion.

환자용 기분기록지 개발 및 타당도 연구

차보석,최정은,장재승,김정현,하태현,유희정,최승원,하규섭 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.3

Objectives The aim of this study was to report the developmental process of the patient mood chart (named the Patient Mood Chart, PMC), and to test its validity and utility. Methods One hundred twenty nine subjects with bipolar disorder, as diagnosed using DSM-IV Criteria, completed the PMC. A trained clinician administered the Hamilton Depression Rating Scale (HDRS) the Montgomery Asberg Depression Rating Scale (MADRS), the Inventory of Depressive Symptomatology (IDS), the Young Mania Rating Scale (YMRS) and the Global Assessment of Functioning (GAF). Mood ratings on the PMC were compared with clinician-rated measures taken at initial visits and 6-month follow-ups. To examine the utility of the PMC, a patient questionnaire-type survey was done Results Depressive symptom ratings on the PMC were highly correlated with the HAMD MADRS and IDS scores. Manic symptom ratings on the PMC were correlated with the YMRS scores. Similarly a strong correlation was found between mood chart scores and the GAF scores. Most patients Considered the PMC to be useful and helpful. Conclusion These findings support the validity and utility of the PMC. The PMC can be used for Prospective assessment of symptom changes, treatment response, and long-term course for subjects with bipolar disorder.

임상연구의 설계 및 연구윤리

장재승,이선이,하태현,윤인영,하규섭,Chang, Jae Seung,Lee, Sunny,Ha, Tae Hyon,Yoon, In-Young,Ha, Kyooseob 대한생물정신의학회 2012 생물정신의학 Vol.19 No.4

Data from clinical studies are needed for psychiatrists to make quick and scientific decisions based on the best available evidence in clinical settings. Various methods of clinical studies are useful for clinicians to have reliable answers to unmet clinical needs. Although randomized controlled trials may provide high-quality information about major issues, well-designed, naturalistic and observational studies often give us unbiased explanation for real-world phenomena. Adequate selection of clinical variables and appropriate number of participants are key factors of well-designed clinical studies. Statistical methods can add an extra dimension to initial design of clinical studies. Given ethical issues in clinical studies on psychiatric disorders, special regards should be paid to participants' ability to provide informed consents. New strategies of clinical studies need to be developed to meet clinical needs and protect the rights and welfare of study participants.

A Comparative Study of Permissive Attitudes Toward Suicide : An Analysis of Cross-National Survey in South Korea, Japan, and the United States

Park, C. Hyung Keun,Kim, Bora,Lee, Sang Sin,Ha, Kyooseob,Baek, Chang-Jae,Shin, Min-Sup,Ahn, Yong-Min The Korean Society of Biological Psychiatry 2016 생물정신의학 Vol.23 No.4

Objectives There were previous studies which indicated that attitude toward suicide is able to influence the suicide outcome in both individual and group levels. In regard to the highest suicide rate in Korea, our study aims to explore the influence that attitude toward suicide has on suicide by comparing the national attitude towards suicide with a representative sample of the general population. Methods The target population was 20- to 59-year-old adults from South Korea, Japan, and the United States. The panel data were divided according to gender, age, and residential area of individuals, and an email with a hyperlink to our web survey was sent to the randomly selected participants in each stratum. To measure the perceptual differences about suicide in different cultures, this study adopted the Attitudes Toward Suicide questionnaire. Results A total of 2247 subjects in three countries participated in this study. According to results from factor analysis, there were different structure of factors and included items within factors in the three countries : five factors with nineteen items in South Korea, five factors with nineteen items in the United States, and five factors with twenty-five items in Japan. With regard to permissive attitude toward suicide, the mean value of permissiveness was not significantly different among countries, but permissiveness according to education level, gender, and marital status was different in each country. Conclusions This study is the first nationwide comparative study about attitude toward suicide with a representative sample. Our findings suggest that permissive attitude toward suicide influence the suicide phenomenon in each country ; however, its impact is not a mean score of permissiveness, but the detailed difference by various demographics.

Posttraumatic Embitterment Disorder and Hwa-byung in the General Korean Population

Soohyun Joe,JungSun Lee,SeongYoon Kim,Seunghee Won,JongSeok Lim,KyooSeob Ha 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.4

Objective-Posttraumatic embitterment disorder (PTED) is characterized by states of “embitterment”, characteristically similar to “Hwa-byung”, which is a Korean culture-bound syndrome. The present study aimed to assess diagnostic relationships between PTED and Hwa-byung. Methods-A total of 290 participants completed our survey. PTED and Hwa-byung were diagnosed using a diagnostic interview and scale. Scales for depression, suicide ideation, and anger were used for evaluation. Fisher’s exact tests and Mann-Whitney U tests were performed to evaluate diagnostic overlap between PTED and Hwa-byung, and associations of scale scores for depression, suicide ideation, and anger between the PTED, Hwa-byung, and non-diagnosed groups. Associations of these scales between the depressive and non-depressive groups, and suicidal and non-suicidal groups were also evaluated. Results-Among the participants, 1.7% of the sample fit the diagnostic criteria for PTED and 2.1% fit the criteria for Hwa-byung. No individual fit the criteria for both. Anger scores were significantly higher in the Hwa-byung group than in the non-diagnostic group. There were not any significant differences in anger scores between the PTED and non-diagnostic groups. Depression scores were significantly higher in the PTED than in the non-diagnostic groups. In contrast, no significant differences were observed between depression scores in the Hwa-byung and non-diagnostic groups. Conclusion-These results suggest that PTED may be a disorder category that is distinct from Hwa-byung.

리튬 및 발프로에이트 병용 처치가 PC12 세포에서 ERK1/2 인산화와 ELK1 및 C-FOS 전사활성에 미치는 영향

차승근,김세현,하규섭,신순영,강웅구,Cha, Seung Keun,Kim, Se Hyun,Ha, Kyooseob,Shin, Soon Young,Kang, Ung Gu 대한생물정신의학회 2013 생물정신의학 Vol.20 No.4

Objectives Mechanisms of clinical synergistic effects, induced by co-treatments of lithium and valproate, are unclear. Extracellular signal-regulated kinase (ERK) has been suggested to play important roles in mechanisms of the action of mood stabilizers. In this study, effects of co-treatments of lithium and valproate on the ERK1/2 signal pathway and its down-stream transcription factors, ELK1 and C-FOS, were investigated in vitro. Methods PC12 cells, human pheochromocytoma cells, were treated with lithium chloride (30 mM), valproate (1 mM) or lithium chloride + valproate. The phosphorylation of ERK1/2 was analyzed with immunoblot analysis. Transcriptional activities of ELK1 and C-FOS were analyzed with reporter gene assay. Results Single treatment of lithium and valproate increased the phosphorylation of ERK and transcriptional activities of ELK1 and C-FOS, respectively. Combined treatments of lithium and valproate induced more robust increase in the phosphorylation of ERK1/2 and transcriptional activities of ELK1 and C-FOS, compared to those in response to single treatment of lithium or valproate. Conclusions Co-treatments of lithium and valproate induced synergistic increase in the phosphorylation of ERK1/2 and transcriptional activities of its down-stream transcription factors, ELK1 and C-FOS, compared to effects of single treatment. The findings might suggest potentiating effects of lithium and valproate augmentation treatment strategy.

Reliability and validity of the Korean version of UKU-SERS-Pat in patients with bipolar disorder.

Kim, Jeong-Hyun,Choi, Sung-Won,Joe, Soo Hyun,Ha, Tae Hyon,Yoo, Hee Jeong,Choi, Jung Eun,Cha, Boseok,Ha, Kyooseob Scandinavian University Press 2008 Nordic journal of psychiatry Vol.62 No.6

<P>Poor drug compliance caused by side effects is an important factor affecting clinical outcomes. Thus reliable and valid rating scales to accurately evaluate the side effects of medications in their early stages are needed. This study aimed to develop the Korean version of the Udvalg for Kliniske Undersøgelser (UKU) Side Effects Rating Scale for Patients (K-UKU-SERS-Pat) to comprehensively measure side effects of psychotropic medications by the self-report method and to examine reliability and validity in patients with bipolar disorder (BD). Ninety-three patients diagnosed with BD by DSM-IV criteria were recruited in this study. The patients completed the K-UKU-SERS-Pat. The Side Effects Rating Scale for Clinicians was administered simultaneously. In 19 patients, the K-UKU-SERS-Pat was conducted twice on a 3-day interval to examine the test-retest reliability. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale-17 and (hypo)manic symptoms with the Young Mania Rating Scale. The test-retest reliability (rho=0.89, P<0.01) and the concurrent validity (rho=0.80, P<0.01) of K-UKU-SERS-Pat were good. However, patients had a tendency to report their side effects more frequently and severely than clinicians. The K-UKU-SERS-Pat is proved to be a reliable and valid tool to comprehensively and practically monitor the side effects of psychotropics.</P>