OBJECTIVE: This study was designed to investigate the clinical characteristics of patients with major depressive disorder who were rehospitalized within a year in a naturalistic setting at a university hospital. METHODS: Inpatients with major depressive disorder patients were retrospectively investigated. Data on patients' demographic factors, clinical variables-age, sex, education year, socioeconomic state, marital state, illness duration, length of stay, severity of illness, presence of psychotic features, number of past depressive episodes and hospitalization, family history, comorbidity-were collected. Use of antidepressants, antipsychotics, mood stabilizers and hypnotics were investigated. RESULTS: A total of 238 patients participated in the study. No significant differences were observed between one-year rehospitalized group and the non-rehospitalized group in demographic factors and clinical variables except for the number of previous psychiatric hospitalizations. The mean number of previous psychiatric hospitalization was significantly higher in the one-year rehospitalized group than the non-rehospitalized group (0.41+/-0.83 times vs. 0.23+/-0.83 times) (p=0.048). No significant differences in rehospitalized rates were observed among the disparate treatment types. One-year rehospitalization rate was significantly higher in patients who discontinued antidepressants than the patients who continued the antidepressants (15.9% vs. 0%) (p=0.002). CONCLUSION: The present data suggest that the number of previous psychiatric hospitalizations is higher in patients who were rehospitalized within a year and the discontinuation of antidepressant might be an influencing factor. Further controlled studies are recommended to confirm our findings.
Antidepressive Agents ; Antipsychotic Agents ; Demography ; Depressive Disorder, Major* ; Education ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Inpatients ; Length of Stay ; Retrospective Studies*

OBJECTIVE: The aim of this study was to examine 1) public knowledge and perceptions about attention-deficit hyperactivity disorder (ADHD) and 2) factors influencing the public's decisions to adhere to ADHD pharmacotherapy. METHODS: In this study, 396 participants responded to the internet survey regarding their experiences, beliefs and treatment preferences about ADHD. RESULTS: 252 respondents (63.6%) were reluctant to pharmacological treatment of ADHD. The respondents chose the functional impairment of the brain as the main cause of ADHD were favorable to pharmacological treatment and scored significantly high on the ADHD Knowledge Questionnaire. On the other hand, the respondents who regarded ADHD as an overly active personality rather than a disease were skeptical to pharmacotherapy and scored significantly low. The respondents who were acquainted with someone who had been diagnosed with ADHD perceived themselves relatively well informed about ADHD. However, the subjective perception of the degree of knowledge of ADHD was not correlated with the objective score of the ADHD Knowledge Questionnaire. CONCLUSION: The public is not well informed about ADHD and its treatments. Culturally appropriate psychoeducational strategies based on the media and the internet are needed. Providing biomedical conceptualization of ADHD to the public may aid with treatment decisions and promote adherence to pharmacological treatment.
Brain ; Drug Therapy ; Hand ; Internet ; Surveys and Questionnaires

OBJECTIVE: Atypical antipsychotics and newly developed anticonvulsants have become increasingly popular medication for bipolar disorder. Especially, atypical antipsychotics have increasing importance in treatment of bipolar disorder and a number of treatment guideline recommend atypical antipsychotics for pharmacological treatment of bipolar manic and depressed episodes. This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics. METHODS: Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics. RESULTS: In 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity. CONCLUSION: The development of bipolar disorder's psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.
Anticonvulsants ; Antidepressive Agents ; Antipsychotic Agents* ; Bipolar Disorder* ; Comorbidity ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Lithium ; Outpatients* ; Prescriptions* ; Psychopharmacology ; Retrospective Studies

OBJECTIVE: The aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital. METHODS: A retrospective chart review was performed and data of 188 cases (2009-2012) and 118 cases (1998-2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed. RESULTS: The proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased. CONCLUSION: This study showed significant changes have occurred in the prescription patterns in patients with bipolar disorder in the last four years. These results seem to reflect the accumulating evidence-based data for the treatment of bipolar disorder, and will provide the useful information to clinicians in practical situations.
Antipsychotic Agents ; Bipolar Disorder* ; Diagnosis ; Hospitalization ; Humans ; Inpatients* ; Lithium ; Prescriptions ; Retrospective Studies ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: There is much research on risk factors of suicide, but studies about what can play a protective role on suicide are limited. This study was conducted to investigate the impact of depression and emotional intelligence on suicidal ideation of patients with depression. We focused more on the role of emotional intelligence as a protective factor. METHODS: The participants (n=100) underwent a psychiatric interview which included the Mini International Neuropsychiatric Interview and the Columbia University Suicide Severity Rating Scale (C-SSRS). Beck's Depression Inventory (BDI) was also completed. For measuring emotional intelligence, both a self-report questionnaire (the Adult Emotional Quotient Test, AEQT) and an objective measurement based on ability model (Emotional Literacy) were conducted. RESULTS: In linear regression analysis, depressive symptom score was significantly associated with suicidal ideation. It was also shown that 'emotional expression' of AEQT and 'emotion perception' of Emotional Literacy are significantly associated with suicidal ideation. CONCLUSION: Against our expectation that emotional intelligence would be a protective factor on suicidal ideation, emotional expression and emotion perception might rather be a risk factor for suicidal ideation. The limitations of this study and suggestions for further research are also discussed.
Adult ; Depression* ; Depressive Disorder, Major* ; Emotional Intelligence* ; Humans ; Linear Models ; Surveys and Questionnaires ; Risk Factors ; Suicidal Ideation* ; Suicide

OBJECTIVE: Psychotropic drugs use in pregnant mothers with psychiatric disorders raises issues of safety not only with the mothers but also with fetal development and the postpartum prognosis of the neonate. Several studies have reported on the harmful effects of antenatal exposure to psychotropic drugs. However, debatable disregard of the psychiatric disorder itself and issues of necessary and useful pharmacotherapy clouds the results. Hence, the purpose of this study was to retrospectively examine the association between prenatal psychotropic exposure and clinically evident fetal adverse effects. METHODS: From January 1994 to December 2011, a retrospective chart review of patients diagnosed with a major psychiatric disorder from the department of psychiatry and who also had a history of giving birth at the department of obstetrics and gynecology at Ajou University Hospital was conducted. Participants were divided into two groups: those taking psychotropic drugs during pregnancy were designated to the case group and the control group consisted of those not on psychotropics during pregnancy. Psychotropics included antidepressants, antipsychotics and benzodiazepines used in clinical dosages. Then the two groups were compared on factors such as gestational age, the offspring's birth weight, bitemporal diameter, and Apgar scores. After then, we analyzed relatively risk potential to the preterm labor in such variables (old age pregnancy, gestational diabetes, gestational hypertension and exposure psychotropics in pregnancy). T-test and logistic regression analysis of the data was performed. RESULTS: Demographic and clinical characteristics did not differ significantly between the groups. Also, there was no significant difference in gestational age, birth weight, bitemporal diameter and Apgar scores between the exposure and non-exposure groups. There was no significant relationship between psychotropic exposure during pregnancy, old age pregnancy, gestational diabetes and preterm labor. However, the relationship between gestational hypertension and preterm labor was significant. CONCLUSION: Psychotropic drugs are considered as significant clinical treatment options to control symptoms of psychiatric disorders during pregnancy. In the clinical setting there was no statistically significant relationship between psychotropic exposure and gestational age on fetal development. However the retrospective nature of the study limits the interpretation of the data and constant close monitoring of pregnant patients in the clinical setting is advised.
Antidepressive Agents ; Antipsychotic Agents ; Benzodiazepines ; Birth Weight ; Diabetes, Gestational ; Drug Therapy ; Female ; Fetal Development ; Fetus* ; Gestational Age ; Gynecology ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Newborn ; Logistic Models ; Mothers ; Obstetric Labor, Premature* ; Obstetrics ; Parturition ; Postpartum Period ; Pregnancy ; Prognosis ; Psychotropic Drugs ; Retrospective Studies

Depression is a common mental illness with a high lifetime prevalence rate in the general population. However, the pathophysiology of depression is still poorly understood. Recent studies showed that environmental factors can affect gene expression by modifying epigenetic factors. Early life stress (ELS) is likely a risk factor of lifetime vulnerability to stress and development of depression. ELS or stressful lifetime can induce changes in gene expression through epigenetic mechanism, such as DNA methylation or histone modification. In this article, recent researches on the epigenetic mechanisms of depression will be discussed.
Depression* ; DNA Methylation ; Epigenomics* ; Gene Expression ; Histones ; Prevalence ; Risk Factors ; Stress, Psychological

OBJECTIVE: This study was conducted to evaluate the impairment of cognitive functions, which include verbal and visual memory, visuospatial function, and executive function, and also to investigate if there is improvement of cognitive impairment after antidepressant treatment in patients with major depressive disorder (MDD). METHODS: Fifteen female patients with non-psychotic MDD in mild to moderate severity and 25 age-matched female normal control subjects participated in this study. Clinical severity of depression was measured by Beck Depression Inventory (BDI), Zung's Self-Rating Depression Scale (Zung), and Hamilton Rating Scale for Depression (HAMD). Cognitive functions were tested using Ray Complex Figure Test (RCFT) to evaluate visuospatial function and visual memory, Stroop test to evaluate conflict monitoring, Wisconsin Card Sorting Test (WCST) to evaluate executive function, and Seoul Verbal Learning Test (SVLT) to evaluate verbal memory. Both clinical depression scales and cognitive function tests were conducted at baseline and after 12 months of antidepressant treatment. RESULTS: At baseline, there were deficits in immediate and delayed recall of SVLT in patients with MDD compared to normal control subjects, while the impairment in visuospatial function, visual memory, and executive function was not clear. After antidepressant treatment, improvement of executive function, i.e. percent of error response and perseverative response of WCST in MDD patients was greater than that in normal control subjects. Improvement of executive function, however, did not show a significant correlation with the change of clinical severity of depression. CONCLUSION: The verbal memory was the most prominent domain of cognitive dysfunction in non-psychotic depression with mild to moderate severity. Of further note, differential improvement in executive function was observed in MDD patients after antidepressant treatment, although the improvement in executive function was not directly associated with the improvement of clinical depression.
Depression ; Depressive Disorder, Major ; Executive Function ; Female ; Humans ; Memory ; Prospective Studies ; Stroop Test ; Verbal Learning ; Weights and Measures ; Wisconsin

OBJECTIVE: Lamotrigine's possible efficacy in the treatment of depressive disorders has been suggested. This naturalistic study investigated clinical response to lamotrigine augmentation in patients with treatment-resistant depression. Characteristics of the lamotrigine-responders were also explored. METHODS: Clinical data from 40 lamotrigine- treated patients with treatment-resistant unipolar depression were analyzed. The subjects were diagnosed with DSM-IV major depressive disorder and resistant to at least 2 antidepressants. Efficacy of lamotrigine treatment was measured by the changes in mean scores of the Clinical Global Impression Severity subscale (CGI-S), which were extracted from the prospective mood chart and structured interviews. Response was defined as a decrease of at least 2 or more from baseline on the CGI-S. Untoward effects associated with lamotrigine treatment were also assessed through medical records. RESULTS: Significant reduction in the CGI-S mean score was observed from baseline through 8 week lamotrigine augmentation in 40 patients with treatment-resistant unipolar depression (t=5.7, df=39, p<.01), and the magnitude of treatment effect was large (r(effect size)=0.68). Drop-outs were mainly attributable to lamotrigine-associated rash (N=5). Greater rate of improvement was associated with responder group (N=14) compared to non-responder group (N=17) from week 3 onward. CONCLUSION: The results of current study lend support to the potential benefit of lamotrigine augmentation in a subpopulation of patients with treatmentresistant unipolar depression. Continuation of lamotrigine add-on for more than 3 weeks may be needed to assess clinical outcome. Lamotrigine augmentation was generally well-tolerated. Large scale, double-blind studies are necessary to confirm its use as an augmentation agent.
Antidepressive Agents ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Double-Blind Method ; Exanthema ; Humans ; Medical Records ; Triazines

OBJECTIVE: Genetic differences may contribute to the inter-individual differences in treatment response to antidepressants among patients suffering from major depression. This study investigated a possible association of various monoamine transporter genetic polymorphisms with treatment response to mirtazapine in major depressive patients in elderly. METHODS: In this study, three genetic polymorphisms were selected: serotonin transporter 5- HTTLPR, serotonin transporter 5-HTT intron 2 VNTR, and norepinephrine transporter NET (G1287A). The patients with major depression diagnosed by DSM-IV were recruited to a 6 week naturalistic mirtazapine treatment study in Samsung Medical Center. Treatment response to mirtazapine was defined as > or =50% decrease in HAMD-17 scores at 6 weeks, and the genotypes in the patients were determined using the polymerase chain reaction. RESULTS: Our results showed that ss allele carriers were included more in responder group (ss allele in responder vs. non responder group; 69.4% vs. 40.0%). In addition, l-allele (sl/ll) carriers were included less in responder group (sl/ll allele in responder vs. non responder group; 30.6% vs. 60.0%). Multiple logistic regression analyses showed the 5-HTTLPR polymorphism as an predictor of the mirtazapine response (5HTTLPR ss allele carrier vs. l-allele (sl/ll) carrier; odds ratio: 3.81; 95% confidence interval [CI], 1.32-11.0; p=0.013). However, 5-HTT intron 2 VNTR l/s (p=0.33 by multiple logistic regression; [OR], 0.53; 95% [CI], 0.15-1.88), and NET (G1287A) G/A (p=0.68 by multiple logistic regression; [OR], 1.25; 95% [CI], 0.44-3.53) showed no statistical significant influences on response rate. CONCLUSION: In conclusion, 5HTTLPR polymorphism may predict treatment response to mirtazapine in major depressive patients in elderly.
Aged ; Alleles ; Antidepressive Agents ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Humans ; Introns ; Logistic Models ; Mianserin ; Norepinephrine Plasma Membrane Transport Proteins ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Serotonin Plasma Membrane Transport Proteins ; Stress, Psychological