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A Case of Galactorrhea Associated with Excitalopram.

Se Hoon SHIM ; Yeon Jeong LEE ; Eun Chan LEE

Psychiatry Investigation.2009;6(3):230-232.

Escitalopram is one of the most popular selective serotonin reuptake inhibitors (SSRIs) in current use as a first-line treatment for depression. Escitalopram is well-tolerated and rarely associated with serious side effects. Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is very rarely mentioned among SSRI-related side effects. Serotonin-enhancing antidepressants may result in a rise in prolactin levels through suppression of dopamine neurotransmission. In the present study, we report a case of hyperprolactinemic galactorrhea associated with escitalopram. A 36-year-old woman developed galactorrhea after initiation of escitalopram for depression and was found to have an elevated prolactin level. Escitalopram was discontinued with resolution of the patient's galactorrhea and normalization of her prolactin level.
Adult ; Antidepressive Agents ; Citalopram ; Depression ; Dopamine ; Female ; Galactorrhea ; Humans ; Pregnancy ; Prolactin ; Serotonin Uptake Inhibitors ; Synaptic Transmission

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Psychiatric Disorder in Two Siblings with Hallervorden-Spatz Disease.

Young Kyung SUNWOO ; Jeong Seop LEE ; Won Hyoung KIM ; Yong Bum SHIN ; Myung Ji LEE ; In Hee CHO ; Sun Myeong OCK

Psychiatry Investigation.2009;6(3):226-229.

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.
Adolescent ; Anxiety ; Delusions ; Depression ; Dysarthria ; Dystonia ; Gait Disorders, Neurologic ; Hallucinations ; Humans ; Neuroimaging ; Pantothenate Kinase-Associated Neurodegeneration ; Psychotic Disorders ; Rare Diseases ; Siblings ; Substance Withdrawal Syndrome ; Tics

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Genetic Polymorphisms in Dopamine- and Serotonin-Related Genes and Treatment Responses to Risperidone and Perospirone.

Atsushi TSUTSUMI ; Tetsufumi KANAZAWA ; Hiroki KIKUYAMA ; Gaku OKUGAWA ; Hiroyuki UENISHI ; Toshio MIYAMOTO ; Naoki MATSUMOTO ; Jun KOH ; Kazuhiro SHINOSAKI ; Toshifumi KISHIMOTO ; Hiroshi YONEDA ; Toshihiko KINOSHITA

Psychiatry Investigation.2009;6(3):222-225.

We investigated the possible association between genetic polymorphisms in the dopamine receptor and serotonin transporter genes and the responses of schizophrenic patients treated with either risperidone or perospirone. The subjects comprised 27 patients with schizophrenia who were clinically evaluated both before and after treatment. The genotyping of the polymorphisms of the dopamine D2 receptor gene (DRD2) (rs1801028 and rs6277), the dopamine D4 receptor gene (DRD4) (120-bp tandem repeats and rs1800955), and serotonin transporter gene (5HTT)(variable number of tandem repeats; VNTR) were performed using the real-time polymerase chain reaction and sequencing. In DRD2 and 5HTT-VNTR, there were no significant correlations between clinical response and polymorphism in the case of risperidone, and for perospirone treatment it was impossible to analyze the clinical evaluation due to the absence of genotype information. On the other hand, in DRD4 there were significant correlations in the two-factor interaction effect on the Positive and Negative Syndrome Scale (PANSS) between the two drugs [120-bp tandem repeat, p=0.003; rs1800955, p=0.043]. Although the small sample represents a serious limitation, these results suggest that variants in DRD4 are a predictor of whether treatment will be more effective with risperidone or with perospirone in individual patients.
Genotype ; Hand ; Humans ; Isoindoles ; Polymorphism, Genetic ; Real-Time Polymerase Chain Reaction ; Receptors, Dopamine ; Receptors, Dopamine D2 ; Receptors, Dopamine D4 ; Risperidone ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins ; Tandem Repeat Sequences ; Thiazoles

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Association between Dopamine D4 Receptor Gene Polymorphism and Scores on a Continuous Performance Test in Korean Children with Attention Deficit Hyperactivity Disorder.

Bora KIM ; Min Seong KOO ; Jin Yong JUN ; Il Ho PARK ; Dong Yul OH ; Keun Ah CHEON

Psychiatry Investigation.2009;6(3):216-221.

OBJECTIVE: The aim of this study was to evaluate the association between a variable number of tandem repeats polymorphism at the dopamine D4 receptor gene (DRD4) and the performance of children with attention deficit hyperactivity disorder (ADHD) in a continuous performance test (CPT). METHODS: This study included 72 ADHD children (mean age=9.39+/-2.05 years) who were recruited from one child psychiatric clinic. The omission errors, commission errors, reaction time and reaction standardization in the CPT were computed. The number of 48-base pairs tandem repeats in the exon III of DRD4 was analyzed in a blind manner. RESULTS: The homozygosity of the 4-repeat allele at DRD4 was significantly associated with fewer commission errors (t=2.364, df=28.685, p=0.025) and standard deviation of reaction time (t=2.351, df=24.648, p=0.027) even after adjusting for age. The results of analyses of CPT measured values among three groups showed that the group with higher frequency of the 4-repeat allele showed a lower mean score of commission errors (F=4.268, df=2, p=0.018). CONCLUSION: These results suggest a protective role of 4-repeat allele of the DRD4 polymorphisms on commission errors in the CPT in children with ADHD.
Alleles ; Attention Deficit Disorder with Hyperactivity ; Child ; Dopamine ; Exons ; Humans ; Minisatellite Repeats ; Reaction Time ; Receptors, Dopamine D4 ; Tandem Repeat Sequences

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Association between Antipsychotics-Induced Restless Legs Syndrome and Tyrosine Hydroxylase Gene Polymorphism.

Chul Hyun CHO ; Seung Gul KANG ; Jung Eun CHOI ; Young Min PARK ; Heon Jeong LEE ; Leen KIM

Psychiatry Investigation.2009;6(3):211-215.

OBJECTIVE: Restless legs syndrome (RLS) has been reported to be more prevalent in schizophrenic patients who take antipsychotics. The cause of RLS is unknown but associated with dopaminergic deficiency. Tyrosine hydroxylase (TH) is the enzyme responsible for catalyzing the conversion of L-tyrosine to DOPA. The purpose of this study is to determine whether the TH gene Val81Met polymorphism is associated with antipsychotic-induced RLS. METHODS: One hundred ninety Korean schizophrenic patients were evaluated by the diagnostic criteria of the International RLS Study Group (IRLSSG). The genotyping was performed by PCR-based methods. RESULTS: Of the one hundred ninety schizophrenic patients, 44 (23.2%) were found to have RLS. Although there were no significant associations between TH genotypes or allele frequencies and RLS, when separate analyses were performed by sex (male or female), we detected significant differences in the frequencies of the genotype (chi-square=6.15, p=0.046) and allele (chi-square=4.67, p=0.031) of the TH gene Val81Met polymorphism between those with and without RLS in the female patients. CONCLUSION: These findings suggest that the TH gene Val81Met SNP might be associated with antipsychotic-induced RLS in female schizophrenic patients.
Alleles ; Antipsychotic Agents ; Dihydroxyphenylalanine ; Female ; Gene Frequency ; Genotype ; Humans ; Restless Legs Syndrome ; Schizophrenia ; Tyrosine ; Tyrosine 3-Monooxygenase

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The Effects of Galantamine Hydrobromide Treatment on Dehydroepiandrosterone Sulfate and Cortisol Levels in Patients with Chronic Fatigue Syndrome.

Tayfun TURAN ; Hasan Basri IZGI ; Saliha OZSOY ; Fatih TANRIVERDI ; Mustafa BASTURK ; Akif ASDEMIR ; Asli BESIRLI ; Ertugrul ESEL ; Seher SOFUOGLU

Psychiatry Investigation.2009;6(3):204-210.

OBJECTIVE: Mental fatigue, cognitive disorders, and sleep disturbances seen in chronic fatigue syndrome (CFS) may be attributed to cholinergic deficit. A functional deficiency of cholinergic neurotransmission may cause the hypothalamic-pituitary-adrenal axis hypoactivity seen in CFS. Therefore, we investigated the alterations in stress hormones such as cortisol and dehydroepiandrosterone sulfate (DHEAS) in CFS patients before and after 4-week administration of galantamine hydrobromide, a selective acetylcholinesterase inhibitor, and aimed to investigate whether there are any relationships between the probable hormonal changes and cholinergic treatment. METHODS: Basal levels of cortisol and DHEAS were measured in 29 untreated CFS patients who were diagnosed according to Centers for Disease Control (CDC) criteria and in 20 healthy controls. In the patient group, four weeks after 8 mg/d galantamine hydrobromide treatment, cortisol and DHEAS levels were measured again. After the treatment 22 patients who stayed in study were divided into two subgroups as responders and nonresponders according to the reduction in their Newcastle Research Group ME/CFS Score Card (NRG) scores. RESULTS: Important findings of this study are lower pre-and post-treatment cortisol levels and in all CFS patients compared to controls (F=4.129, p=0.049; F=4.803, p=0.035, respectively); higher basal DHEAS values and higher DHEAS/cortisol molar ratios which were normalized following four weeks' treatment with 8 mg/d galantamine hydrobromide in the treatment-respondent group (F=5.382, p=0.029; F=5.722, p=0.025, respectively). CONCLUSION: The findings of the decrease in basal DHEAS levels and DHEAS/cortisol molar ratios normalizing with galantamine treatment may give some support to the cholinergic deficit hypothesis in CFS.
Acetylcholinesterase ; Axis, Cervical Vertebra ; Centers for Disease Control and Prevention (U.S.) ; Dehydroepiandrosterone ; Dehydroepiandrosterone Sulfate ; Fatigue Syndrome, Chronic ; Galantamine ; Humans ; Hydrocortisone ; Mental Fatigue ; Molar ; Synaptic Transmission

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Plasma Concentration of Prolactin, Testosterone Might Be Associated with Brain Response to Visual Erotic Stimuli in Healthy Heterosexual Males.

Younghee SEO ; Bumseok JEONG ; Ji Woong KIM ; Jeewook CHOI

Psychiatry Investigation.2009;6(3):194-203.

OBJECTIVE: Many studies have showed that excess or lack of sexual hormones, such as prolactin and testosterone, induced the sexual dysfunction in humans. Little, however, is known about the role of sexual hormones showing normal range in, especially, the basal state unexposed to any sexual stimulation. We hypothesized sexual hormones in the basal state may affect sexual behavior. METHODS: We investigated the association of the sexual hormones level in the basal hormonal state before visual sexual stimulation with the sexual response-related brain activity during the stimulation. Twelve heterosexual men were recorded the functional MRI signals of their brain activation elicited by passive viewing erotic (ERO), happy-faced (HA) couple, food and nature pictures. Both plasma prolacitn and testosterone concentrations were measured before functional MR scanning. A voxel wise regression analyses were performed to investigate the relationship between the concentration of sexual hormones in basal state and brain activity elicited by ERO minus HA, not food minus nature, contrast. RESULTS: The plasma concentration of prolactin in basal state showed positive association with the activity of the brain involving cognitive component of sexual behavior including the left middle frontal gyrus, paracingulate/superior frontal/anterior cingulate gyri, bilateral parietal lobule, right angular, bilateral precuneus and right cerebellum. Testosterone in basal state was positively associated with the brain activity of the bilateral supplementary motor area which related with motivational component of sexual behavior. CONCLUSION: Our results suggested sexual hormones in basal state may have their specific target regions or network associated with sexual response.
Brain ; Cerebellum ; Dopamine ; Heterosexuality ; Humans ; Magnetic Resonance Imaging ; Male ; Plasma ; Prolactin ; Reference Values ; Sexual Behavior ; Testosterone

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Economic Evaluation of Add-on Levetiracetam for the Treatment of Refractory Partial Epilepsy in Korea.

Guk Hee SUH ; Sang Keol LEE

Psychiatry Investigation.2009;6(3):185-193.

OBJECTIVE: This study estimated the expected cost-effectiveness ratio expressed as the incremental cost per seizure-free day (SFD) gained and the incremental cost per quality adjusted life year (QALY) gained when using levetiracetam (LEV) as add-on therapy from a third-party payer perspective. METHODS: A 1-year dose-escalation decision-tree model comparing LEV plus standard therapy (ST) with ST alone was designed to combine transition probabilities, costs and outcomes. The short-term outcomes and probabilities were derived from a prospective, open-label clinical trial with 100 Korean adults with refractory partial epilepsy. All data for the direct medical costs were derived from Korean cost data extracted from reports published by the National Health Insurance Corporation. RESULTS: The average gain in SFDs attributed to LEV add-on was 18.3 days per patient per year and the incremental cost-effectiveness ratios (ICERs) for LEV add-on were US$ 44 per SFD per patient and US$ 11,084 per QALY gained. All sensitivity analyses showed that the model was robust to the assumptions made. CONCLUSION: The economic evaluation indicates that, given a wide range of assumptions, the increased cost of treating patients having refractory partial epilepsy with LEV may be partially offset by a reduction in other direct medical costs. This reduction is a consequence of an increase in the number of SFDs and improved quality of life.
Adult ; Epilepsies, Partial ; Epilepsy ; Humans ; Insurance, Health, Reimbursement ; Korea ; National Health Programs ; Piracetam ; Prospective Studies ; Quality of Life ; Quality-Adjusted Life Years

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Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment.

Inn Sook AHN ; Ji Hae KIM ; Seonwoo KIM ; Jae Won CHUNG ; Hyeran KIM ; Hyo Shin KANG ; Doh Kwan KIM

Psychiatry Investigation.2009;6(3):180-184.

OBJECTIVE: This study was conducted to examine the following: whether patients with mild cognitive impairment (MCI) show impairments in instrumental activities of daily living (IADL) as compared to controls; to identify the functional sub-domains of instrumental activities of daily living (IADL) that are affected in MCI and, finally, to identify the Seoul-Instrumental Activities of Daily Living (S-IADL) scale cut-off score that best differentiated between MCI and controls. METHODS: This study was carried out at the geropsychiatry clinic, university hospital. The study participants included 66 patients with MCI and 61 normal elderly. The S-IADL and Seoul-Activities of Daily Living (S-ADL) scales were administered to the main caregivers of all participants in order to assess everyday functioning. RESULTS: The total S-IADL score was significantly higher in the patients with MCI [mean (SD) score=4.47 (2.06)] than in the controls [mean (SD) score=1.44 (1.65)] (p<0.001). The patients with MCI performed significantly worse on IADLs, such as the ability to use the telephone, prepare meals, take medication, manage belongings, keep appointments, talk about recent events, and perform leisure activities/hobbies (p<0.05). The S-IADL scale discriminated well between patients with MCI and controls (Area Under Curve=87%). CONCLUSION: The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLs related to memory and frontal/executive functioning were particularly affected in MCI.
Activities of Daily Living ; Aged ; Appointments and Schedules ; Caregivers ; Humans ; Leisure Activities ; Meals ; Memory ; Mild Cognitive Impairment ; Telephone ; Weights and Measures

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Reliability and Validity of the 20-Item Toronto Alexithymia Scale in Korean Adolescents.

Sang Soo SEO ; Un Sun CHUNG ; Hyo Deog RIM ; Sung Hoon JEONG

Psychiatry Investigation.2009;6(3):173-179.

OBJECTIVE: Adolescence is a period of developing emotional regulation. However, alexithymia has rarely been examined during this period. The objective of this study is to examine the factor structure and internal consistency of the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K) in normal adolescents in South Korea. METHODS: The TAS-20K was administered to a sample of 290 adolescents aged from 12 to 16 years old. Internal reliability, test-retest reliability, and factorial validity were evaluated. RESULTS: The three factors of the TAS-20K were confirmed by confirmatory factor analysis. The internal consistency, measured using Cronbach's alpha coefficient was acceptable for difficulty in identifying feelings, good for difficulty in describing feelings, and acceptable for externally oriented thinking. CONCLUSION: Our study indicates that the TAS-20K is an appropriate instrument to assess alexithymia in Korean adolescents.
Adolescent ; Affective Symptoms ; Aged ; Humans ; Reproducibility of Results ; Republic of Korea ; Thinking

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