OBJECTIVES: The purpose of this study was to investigate client satisfaction with mental health services across sociodemographical and service utilization characteristics and to identify the predictors for quality of life for schizophrenic patients who registered in community mental health center. METHODS: One hundred five schizophrenic patients who had received intensive or continuing care completed questionnaires, which included Consumer Satisfaction Scale and the Korean version of World Health Organization Quality of Life Assessment Instrument-Brief (WHOQOL-BREF). Subject's sociodemographic and service utilization characteristics were compared using t-test or one-way analysis of variance. To examine the influence of these variables on quality of life, stepwise multiple regression was conducted. RESULTS: Consumer satisfaction scores differed significantly depending on the length of contact with a current mental health staff. In a stepwise multiple regression model, service relevance and occupation together explained 20.5% of variance in quality of life. CONCLUSION: The results suggest that continuity in contact with a current mental health staff was important in consumer satisfaction. Service relevance and occupation had an impact on quality of life.
Consumer Satisfaction ; Humans ; Mental Health Services* ; Mental Health* ; Occupations ; Quality of Life* ; Surveys and Questionnaires ; Schizophrenia* ; World Health Organization

Animal models are useful tools to study the molecular basis of schizophrenia pathophysiology and efficacy of potential therapeutic agents. Schizophrenia animal models can be subdivided into three classes ; drug-induced models, genetic models, and environmental models and each model is designed based on specific traits corresponding to the characteristic symptoms of human schizophrenia patients. Psychomotor agitation and sensitivity to psychotomimetic drugs are often thought to reflect positive symptoms. Social interaction deficits and affective impairments are known to correspond to negative symptoms. Also, cognitive symptoms have been linked to the working memory impairments, attention deficits and related cognitive deficits in animals. To analyze such components in quantifiable manners, various behavioral paradigms have been developed and utilized. Here, we overview these animal models, focusing on underlying rationales for their use in the context of schizophrenia research.
Animals ; Behavior, Animal ; Humans ; Interpersonal Relations ; Memory, Short-Term ; Models, Animal* ; Models, Genetic ; Neurobehavioral Manifestations ; Psychomotor Agitation ; Schizophrenia*

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth version (DSM-5) finally introduced in 2013. Psychiatrists and researchers of neuroscience were looking forward that DSM-5 will introduce a new paradigm of diagnostic criteria. However, they have criticized on DSM-5 about not including of neurobiological criteria after DSM-5 published. Since schizophrenia spectrum disorder is heterogeneous and hard to diagnose correctly, we can guess that there might be a big affliction in preparation of DSM-5. Diagnostic criteria of schizophrenia spectrum disorder in DSM-5 changed in several points including changes of Criteria A of schizophrenia. The most outstanding change is the elimination of subtypes of schizophrenia, and introducing of Clinician-Rated Dimensions of Psychosis Symptom Severity for further division into homogenous subgroups depending on psychosis symptoms. Until now, the results of various neurobiological investigations are not consistent, so neurobiological criteria of schizophrenia spectrum disorder deserved no inclusion in DSM-5. Thinking comprehensively, DSM-5 might decide to choose stability rather than challenge. In the future, the diagnostic criteria of schizophrenia spectrum disorder in DSM will progress with inclusion of neurobiological criteria, and researches of schizophrenia spectrum disorder will make advance that match changes in progression of DSM.
Diagnostic and Statistical Manual of Mental Disorders ; Neurosciences ; Psychiatry ; Psychotic Disorders ; Schizophrenia* ; Thinking

OBJECTIVES: There are emerging evidences suggest that the development of tardive dyskinesia (TD) is related to the oxidative stress, excitotoxicity, and immune activation. The purpose of this study is to investigate whether single-nucleotide polymorphisms (SNPs) of tumor necrosis factor (TNF)-alpha genes are associated with the susceptibility of TD and schizophrenia. METHODS: We investigated two hundred and eighty Korean schizophrenic patients. The schizophrenic participants consisted of patients with (n=105) and without (n=175) TD who were matched for antipsychotic drug exposure and other relevant variables. The TNF-alpha gene -308G/A SNPs were analyzed by polymerase chain reaction (PCR)-based methods. RESULTS: The frequencies of genotype (chi2=0.33, p=0.848) of the TNF-alpha gene -308 G/A SNP did not differ significantly between schizophrenic patients with and without TD. The difference of allele frequencies (chi2=0.28, p=0.594) of the TNF-alpha gene between the schizophrenic patients with and without TD were not significant. CONCLUSION: These results suggest that the TNF-alpha gene -308 G/A SNPs are not associated with TD and schizophrenia in a Korean population. Further association studies of TD with other candidate genes for cytokines would help us understand the pathophysiological mechanisms of TD.
Cytokines ; Gene Frequency ; Genotype ; Humans ; Movement Disorders ; Oxidative Stress ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Schizophrenia ; Tumor Necrosis Factor-alpha

OBJECTIVES: The purpose of this study was to make empirical evidence of community based detection, assessment and allocation system for early psychosis. METHODS: We analysed 222 youths who were referred to Seoul Early Management and Improvement Services (SEMIS) for early psychosis during six years from 2007 to 2012. RESULTS: 44% of referrals were from suicide hotline, 23% from web-based SEMIS assessment program, 20% from other service areas such as military services and 11% were self referred. Among 222 youths, 139 (62.6%) were completed Structured Interview for Prodromal Syndrome (SIPS). After SIPS, 23% had untreated or early psychosis, another 17% were found to be at high risk of psychosis and 18% of completed SIPS were found to have other mental illness such as depression, yielding an efficiency ratio of 58%. 70% of youths who were categorized as psychosis or high risk of psychosis or other mental illness were referred to psychiatric hospital or case management services. CONCLUSION: This study shows the effectiveness and limitations of community-based assessment and intervention system for early psychosis. Integrated community program is necessary to improve the efficiency of early intervention and for the better outcomes.
Adolescent ; Case Management ; Depression ; Early Intervention (Education) ; Hospitals, Psychiatric ; Hotlines ; Humans ; Military Personnel ; Prodromal Symptoms ; Psychotic Disorders ; Referral and Consultation ; Suicide

OBJECTIVES: Patients with schizophrenia often have a concrete thinking or an impairment in abstract thinking, but there has been a limitation in quantitatively measuring this cognitive function. The aim of the current study was to investigate a deficit in abstract thinking in patients with schizophrenia using the theme identification task. METHODS: Twenty subjects with schizophrenia and 20 healthy volunteers participated in the behavioral study for theme identification. The visual stimuli were composed of a series of pictures, which contained positive or negative emotional situations. Three words, indicating a main theme of the picture, a theme-related item and a theme-unrelated item, respectively, were presented in the bottom of the pictures, and participants had to select a theme. RESULTS: The patient group selected theme words at significantly lower rate in both emotional conditions than the control group (positive, p=0.002 ; negative, p=0.001). Especially, in the negative condition, the patient group more selected theme-unrelated items than the control group (p=0.001). The rates of theme identification were inversely correlated with scores of the Social Anhedonia Scale (positive, r=-0.440, p=0.007 ; negative, r=-0.366, p=0.028). CONCLUSION: Patients with schizophrenia exhibited an impairment in abstract thinking, and it was remarkable in the negative condition. The ability to think abstractly was associated with the severity of social anhedonia. The impairment of abstract thinking may become one of the reasons for poor social functioning in socially anhedonic patients.
Anhedonia ; Humans ; Schizophrenia ; Thinking

OBJECTIVE: The prescription rates of long-acting injectable (LAI) antipsychotics are very low around 1% in Korea. This study was aimed to explore the preference of LAIs in patients with schizophrenia, who are currently living in community, and their caregivers. METHODS: The patients, diagnosed with schizophrenia by DSM-IV TR and were registered in the 31 mental health centers of Gyeonggi province and their caregivers were inquired the knowledge of the LAIs. The questionnaires contained information such as demographic characteristics, history of psychiatric treatment, and so on. RESULTS: About 5,318 were registered in 31 community mental health centers of Gyeonggi province in February 2012. The questionnaires of 614 patients and 365 caregivers were gathered from 20 community mental health centers. The mean ages (+/-SD) of patients and caregivers were 41.9 (+/-10.2) and 62.2 (+/-13.4) years old, respectively. 272 patients (44.6%) had experienced the discontinuation of medications without doctor's consent. 217 patients (35.9%) and 97 caregivers (27.1%) knew about the LAIs. The preference rates for LAIs were 35.2% and 46.8% for the patients and caregivers, respectively. CONCLUSION: There is still huge discrepancy between the preference and the real prescriptions of LAIs in community-dwelling patients and their caregivers, much higher than in those of hospital settings. This study suggests that both patients and caregivers registered in the community mental health centers have a strong commitment to live in the community. The obstacles against the benefits of LAIs need to be resolved.
Antipsychotic Agents ; Caregivers ; Community Mental Health Centers ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Mental Health ; Prescriptions ; Surveys and Questionnaires ; Schizophrenia

Schizophrenia is a devastating mental illness that can lead to deterioration in the social and occupational functioning of affected individuals with a major cost to society. A wide range of studies suggest a genetic component to the inheritance of schizophrenia. The molecular genetic studies on schizophrenia have been actively performed since late 1980s. In linkage studies, no loci were replicated across studies and there were no loci surpassing genome-wide significance. Candidate gene association studies showed generally inconsistent results and there were no enrichment of smaller P-values. In the GWAS era, the community has coalesced into large international consortia. The largest schizophrenia GWAS to date is 50,000 samples and efforts are ongoing to accumulate 50,000 cases and 50,000 controls as part of 'PGC2' collaboration. With the limitation of GWAS results, several alternatives are being explored. In genotyping, the concepts of allelic spectrum including from common polygenic to rare penetrant variation are emerging. Phenotypes include all phenomena beyond DNA. The developments in transcriptomic & proteomic approach and intensive research on endophenotype will bring crucial insights into the nature of schizophrenia in the future. But there still remains our task about research on many factors including environment that influence gene expression (epigenetics), age, and gender.
Cooperative Behavior ; DNA ; Endophenotypes ; Epigenomics ; Gene Expression ; Genetic Association Studies ; Molecular Biology ; Phenotype ; Schizophrenia ; Wills

We report a case of a young female patient with catatonic features who later turned out to be suffering from an anti-NMDA (N-methyl-D-aspartate)-receptor-antibody encephalitis. A previously healthy 21-year-old woman was admitted to psychiatric inpatient care presenting with acute psychotic behavior with catatonic features. Laboratory tests of serum and CSF (Cerebrospinal fluid), EEG (Electroencephalogram), brain MRI (Magnetic Resonance Imaging) were unremarkable except vague slow wave on EEG. However, subtle cognitive impairment at the bedside examination suggested further imaging studies to rule out possible organic etiology like autoimmune encephalitis. Brain PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computed Tomography) suggested probable inflammation in the brain. In case of autoimmune encephalitis, given the severity of symptoms and worsening course, steroid pulse therapy was initiated promptly even though the diagnosis was not confirmed but presumed at that time. She recovered completely with steroid therapy. Later her disease turned out to be anti-NMDA-receptor-antibody encephalitis by the antibody test which was not available at the time of admission. Psychiatrists need to be aware of autoimmune encephalitis like anti-NMDA-receptor-antibody encephalitis in the differential diagnosis of acute psychosis with catatonic features. Subtle cognitive impairment which tends to be overlooked due to catatonic features might be a clue to suspect the organic etiology.
Brain ; Catatonia* ; Cognition Disorders ; Diagnosis ; Diagnosis, Differential ; Electroencephalography ; Encephalitis* ; Female ; Glycogen Storage Disease Type VI ; Humans ; Inflammation ; Inpatients ; Magnetic Resonance Imaging ; N-Methylaspartate* ; Psychiatry ; Psychotic Disorders ; Tomography, Emission-Computed, Single-Photon ; Young Adult

OBJECTIVES: It has been shown that early intervention is crucial for favorable outcome in patients with schizophrenia. However, development of biomarkers for predicting prognosis of psychotic disorder still requires more research. In this study, we aimed to investigate whether baseline mismatch negativity (MMN) predict prognosis in patients with first episode psychosis (FEP). METHODS: Twenty-four patients with FEP and matched healthy controls (HCs) were examined with MMN at baseline, and their clinical status were re-assessed after 1 year. Repeated-measures analysis of variance was performed to compare baseline MMN between the two groups. Multiple regression analysis was used to identify factors predicting prognosis in FEP patients during the follow-up period. RESULTS: MMN amplitudes at baseline were significantly reduced in patients with FEP compared to healthy controls. In the multiple regression analysis, baseline MMN amplitude significantly predicted later improvement of performances on digit span and delayed recall of California Verbal Learning Test. However, baseline MMN did not predicted improvement of clinical symptoms. CONCLUSION: These results indicate that MMN may be a possible predictor of improvement in cognitive functioning in patients with FEP. Future study with larger sample and longer follow-up period would be needed to confirm the findings of the current study.
Biomarkers ; California ; Cognition ; Early Intervention (Education) ; Follow-Up Studies* ; Humans ; Polytetrafluoroethylene ; Prognosis* ; Psychotic Disorders* ; Schizophrenia ; Verbal Learning