Transcranial direct current stimulation (tDCS) is an upcoming treatment modality for patients with schizophrenia. A series of recent observations have demonstrated improvement in clinical status of schizophrenia patients with tDCS. This review summarizes the research work that has examined the effects of tDCS in schizophrenia patients with respect to symptom amelioration, cognitive enhancement and neuroplasticity evaluation. tDCS is emerging as a safe, rapid and effective treatment for various aspects of schizophrenia symptoms ranging from auditory hallucinations-for which the effect is most marked, to negative symptoms and cognitive symptoms as well. An interesting line of investigation involves using tDCS for altering and examining neuroplasticity in patients and healthy subjects and is likely to lead to new insights into the neurological aberrations and pathophysiology of schizophrenia. The mechanistic aspects of the technique are discussed in brief. Future work should focus on establishing the clinical efficacy of this novel technique and on evaluating this modality as an adjunct to cognitive enhancement protocols. Understanding the mechanism of action of tDCS as well as the determinants and neurobiological correlates of clinical response to tDCS remains an important goal, which will help us expand the clinical applications of tDCS for the treatment of patients with schizophrenia.
Hallucinations ; Humans ; Neurobehavioral Manifestations ; Neuronal Plasticity ; Schizophrenia*

OBJECTIVE: Preliminary data indicate that predominant positive symptoms are predictive of subsequent treatment response, while negative and cognitive symptoms are associated with poor outcome. Purpose of the present study was to investigate the relation between the predominant clinical dimension, duration of illness and acute antipsychotic response in a sample of schizophrenic inpatients. METHODS: Fifty-one schizophrenic inpatients, receiving an antipsychotic mono-therapy, were dimensionally assessed at the admission in the Acute Psychiatric Unit of the University of Milan. Treatment response was selected as parameter of outcome and defined as a reduction >50% of baseline total The Positive and Negative Syndrome Scale (PANSS) score. Demographic and clinical variables between responders and non-responders were compared using one-way analysis of variance for continuous variables and chi2 test for dichotomous ones. Binary logistic regression was performed to find if dimensional scores and duration of illness were associated with acute antipsychotic response. RESULTS: A longer duration of illness was found in non-responders respect to responders (15.61 years vs. 8.28 years)(F=4.98, p=0.03). Higher scores on PANSS positive sub-scale (OR=1.3, p=0.03), lower scores on cognitive PANSS scores (OR=0.75, p=0.05) and shorter duration of illness (OR=0.93, p=0.04) were found to be predictive of acute antipsychotic response. CONCLUSION: These preliminary results show that a long duration of illness as well as a more severe cognitive impairment is predictive of treatment non-response, indicating a worse outcome for chronic patients with predominant cognitive symptoms.
Humans ; Inpatients ; Logistic Models ; Neurobehavioral Manifestations ; Schizophrenia

OBJECTIVES: Depression is a common disabling psychiatric illness in the workplace and is associated with high burden to both employer and employee. Little is known about the awareness, attitude, and impact of depression in the Korean workplace. This study investigates how workers perceive the symptomatology, disability, and management of depression. METHODS: This study is a cross-sectional web-based survey of 1000 workers recruited from online sites. Selected panel members were invited to participate in the survey through Ipsos MORI (www.ipsos-mori.com/) between 10th and 19th February 2014. The participants were Korean workers, aged 16-64, who are either currently working or had worked within the past year. Subjects were encouraged to respond to a 13-item questionnaire on the awareness, attitude, and impact of depression. RESULTS: According to the results, 7.4% of the subjects responded that they had ever been diagnosed as having depression from medical professionals. One third of workers with depression who had taken time off from work did not provide the actual reason to their employers, and the mean number of days off work was 9.8 days. The most common symptoms were depressed mood (76.7%), loss of interests (71.5%), sleep problem (69.8%), and cognitive dysfunction (47.0%). Cognitive symptoms (72.2%) were prominent among the workers who continued to work under the influence of depression. CONCLUSION: Korean workers reported a low rate of depression. Those who have been diagnosed with depression reported shorter number of days taken off from work compared to other countries. These results suggest that depression is poorly recognized and disclosed to employers in the Korean workplace. Presenteeism rather than absenteeism may be a major loss of productivity in Korea. An employee assistance program for depressed workers and new therapeutic strategies for treatment of cognitive symptoms of depression should be provided in Korea.
Absenteeism ; Depression* ; Depressive Disorder ; Efficiency ; Korea ; Neurobehavioral Manifestations ; Surveys and Questionnaires

OBJECTIVE: Cognitive symptoms are an important component of depression and the Perceived Deficits Questionnaire-Depression is one of only a few instruments available for the subjective assessment of cognitive dysfunction in depression. Thus, the present study aimed to validate a Korean version of the PDQ-D (K-PDQ-D) using patients with major depressive disorder (MDD). METHODS: This study included 128 MDD patients who were assessed at study entry and 86 of these patients were then completed 12 weeks of antidepressant monotherapy. All subjects were assessed with the K-PDQ-D, the Montgomery-Asberg Depression Rating Scale (MADRS), the Sheehan Disability Scale (SDS), the EuroQol-5 dimensions questionnaire (EQ-5D), and the number of sick leave days taken in the previous week. The internal consistency, Guttman's split-half and test-retest reliabilities, factorial analyses, and concurrent and predictive validities of the K-PDQ-D were investigated. RESULTS: The K-PDQ-D exhibited excellent internal consistency and reliabilities, and was composed of four factors with high coefficients of determination. The concurrent validity analyses revealed that the K-PDQ-D scores were significantly correlated with the MADRS, SDS, and EQ-5D scores and the number of sick leave days taken. The K-PDQ-D scores at study entry significantly predicted changes in sick leave days and EQ-5D score from study entry to the 12-week endpoint. CONCLUSION: The newly developed K-PDQ-D is a reliable and valid instrument for the evaluation of subjective cognitive symptoms in MDD patients. The K-PDQ-D may assist in the gathering of unique information regarding subjective cognitive complaints, which is important for the comprehensive evaluation of patients with MDD.
Depression ; Depressive Disorder, Major* ; Humans ; Neurobehavioral Manifestations ; Sick Leave

Secondary mania is closely linked to neurocircuitry defects. Frontal-subcortical circuits, in particular, play a major role in the affective, motor and cognitive symptoms of secondary mania. In this paper, we present the three main frontal-subcortical circuits : the dorsolateral prefrontal circuit, which mediates executive functions (i.e., the organization of information to facilitate a response) ; the anterior cingulate circuit, which is involved in motivated behavior ; the orbitofrontal circuit, which has medial (i.e., integration of visceral-amygdalar functions with the internal state of the organism) and lateral divisions (i.e., integration of limbic and emotional information into contextually appropriate behavioral responses). Impaired executive functions, apathy, disinhibition and impulsivity are hallmarks of frontal-subcortical circuit dysfunction. The various neuropsychiatric manifestations of secondary mania may result from disturbances that have a direct or indirect impact on the integrity or functioning of these loops.
Apathy ; Bipolar Disorder* ; Executive Function ; Impulsive Behavior ; Neurobehavioral Manifestations

Atypical antipsychotics have more beneficial effects than conventional antipsychotics, particularly with regard to negative symptoms, cognitive functions, and also have a superior side effect profile. Although with such advantages, the use of the atypical antipsychotics cause numerous complications such as hypertension, increase of insuline, diabetes mellitus due to gain in weight, hyperprolactinemia, sexual dysfunctions, cardiovascular symptoms as well as noncompliance due to the previously mentioned side effects and high medical expenses which burden individual and governments. Now is the time to consider both advantages and disadvantages to balance out gains and losses in using the atypical antipsychotics. Blind trust or exclusive decision in using the atypical antipsychotics are unsuitableness. The decision on the use of the medicine must be the one that balances out its general advantages and disadvantages and its appropriateness must be decided upon a full consideration of its pharmacology, efficacies and side effects.
Antipsychotic Agents* ; Diabetes Mellitus ; Hyperprolactinemia ; Hypertension ; Insulin ; Neurobehavioral Manifestations ; Pharmacology

OBJECTIVES: Donepezil is a widely used drug for the treatment of patients with Alzheimer's disease(AD). The aim of the present study was to clarify the efficacy and the characteristics of responders to donepezil. METHODS: Patients with probable AD(n=80 ; 75.7 years) and small vessel dementia(SVD)(n=18 ; 77.8 years) who received donepezil were retrospectively analyzed using Alzheimer's registry, and three questions were asked: 1) Does donepezil therapy improves cognitive symptoms in patients with dementia? 2) If donepezil improves cognitive symptoms, which items of the K-MMSE are improved? 3) What are the characteristics of responder to donepezil medication? RESULTS: 1) After donepezil medication, cognitive function measured by the K-MMSE was significantly improved in both types of dementia(AD and SVD), However, statistical differences were not found between these groups. 2) In a clinical trial of donepezil, the patients performed better than before mediation on K-MMSE items assessing orientation, recall, construction, concentration, calculation. 3) In AD, the K-MMSE score before medication was closely related with response of donepezil. CONCLUSION: This study suggests that donepezil improves various cognitive functions in both types of dementia, and the responsive group had significantly lower K-MMSE scores than the non-responsive group before medication.
Alzheimer Disease* ; Dementia* ; Humans ; Negotiating ; Neurobehavioral Manifestations ; Retrospective Studies

Symptoms of dementia vary widely according to the etiology, nature, progression of the causative disease. Not only various cognitive and non-cognitive features are present in any given point of evaluation, but also it is very common to note the ups and downs of such symptoms in an individual patient as the disease progress. Although cortical degenerative dementia such as Dementia of Alzheimer's Type typically show cognitive deficit in language, memory, praxis etc. in its early stage, it is unwise to confine such symptoms to be characteristic only in cortical dementias. Likewise, neurologic symptoms or changes in affect, personality and behavior, frequently seen in vascular dementia or other subcortical degenerative dementias should be understood as a part of whole cognitive and behavioral symptomatic gamut. As a logical conclusion, when evaluating the symptoms of a dementic patient, all the physical, neurologic, and neuropsychiatric evaluation must be applied as well as neuropsychological assessments. In addition, attention must be paid on the patients' functionality of daily living, reversibility, and appropriateness of services by family members or caregivers.
Caregivers ; Dementia* ; Dementia, Vascular ; Humans ; Logic ; Memory ; Neurobehavioral Manifestations ; Neurologic Manifestations

OBJECTIVE: This study explored the phenomenology of delirium in cancer patients, and evaluated the severity of delirium according to the cancer treatment method and the use of sedative-hypnotics, including zolpidem. METHODS: This was a retrospective chart review study. Cancer patients with delirium, who were referred to the Department of Psychiatry at a National University hospital, were included in the analysis. In all subjects, the severity of delirium was assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98). RESULTS: The analysis included 112 patients with delirium. Among the neuropsychiatric and behavioral symptoms, the most frequent ones were sleep-wake cycle disturbance (100.0%) and perceptual disturbances and hallucinations (95.5%). Among the cognitive symptoms, inattention (98.2%) was the most frequent. The older the patients were, the higher the DRS-R-98 total scores were. There was no significant difference in the DRS-R-98 scores among cancer treatment methods (operation, chemotherapy, or radiation therapy). However, the total DRS-R-98 scores in the zolpidem use group were higher than in control group, and the difference was significant after adjusting for age, sex, and type of cancer treatment. CONCLUSION: Sleep-wake cycle disturbance, inattention, and perceptual disturbances were the most common delirium symptoms in cancer patients. The severity of delirium in patients taking zolpidem was significantly greater.
Behavioral Symptoms ; Benzodiazepines ; Delirium ; Hallucinations ; Humans ; Neurobehavioral Manifestations ; Pyridines ; Retrospective Studies

OBJECTIVES: We aimed to investigate the prevalence of Extrapyramidal signs (EPS) and the associations between EPS and cognitive subdomains in patients with Alzheimer disease (AD). METHODS: We recruited 1,324 patients with AD from the Clinical Research of Dementia of South Korea (CREDOS), a hospital based cohort study with fifty-six participating hospitals. We estimated cognitive subdomain using the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D). Dementia severity was measured by Clinical Dementia Rating Sum of Boxes (CDR-SB) and Korean version of Mini-Mental Status Examination (K-MMSE). The EPS group was defined by the presence of at least one EPS based on a focused neurologic examination. RESULTS: The prevalence of patients with EPS was 11%. These had higher CDR-SB scores than non-EPS group. After controlling for demographic, radiological, and dementia severity (CDR-SB) factors, EPS group showed lower cognitive ability in the subdomains for visuospatial and frontal-executive function than non-EPS group. The patients with EPS were showed significantly higher scores in the subdomain for memory function. CONCLUSION: The presence of EPSs in patients with AD was associated with lower visuospatial, frontal-executive function and higher memory function.
Alzheimer Disease ; Cohort Studies ; Dementia ; Humans ; Mass Screening ; Memory ; Neurobehavioral Manifestations ; Prevalence ; Republic of Korea