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A Case of Marchiafava-Bignami Disease with Personality Change.

Hyoung Jun KIM ; Sang Yeol LEE ; Min Cheol PARK

Korean Journal of Psychopharmacology.2003;14(2):181-187.

Marchiafava-Bignami Disease is a rare disorder characterized pathologically by demyelination of the corpus callosum. This disease could be related with chronic alcoholism although a proven etiology has not been reported. Marchiafava-Bignami Disease (MBD) could cause the fatal acute phase symptoms (seizure, coma, and death), various neurological symptoms (tremor, dysarthria, gait disturbance, apraxia), and cognitive impairments (memory impairment, disorientation). It is also reported that MBD causes a dementia. Approximately 250 cases have been reported regarding the MBD since it was first reported in 1903. However, only 20 cases have revealed a favorable prognosis. We found a case of MBD with personality change and chronic alcoholism subsequent to the repeated improvement and aggravation for 4 years. This case is demonstrated a atrophy of splenium of corpus callosum by Magnetic Resonance Imaging. The case also is diagnosed the personality changes, such as emotional irritability, impulsivity, and indignation-expose due to general medical condition, as described in Diagnostic and Statistic Manual of Mental Disorder 4th edition (DSM-IV). However, in early phase this diagnosis did not revealed. The patient was improved in impulse control and behavior by treatment with the Carbamazepine. We investigate the etiology, pathogenesis, symptom &sign, and treatment regarding the MBD in neuropsychiatric aspect.
Alcoholism ; Atrophy ; Carbamazepine ; Coma ; Corpus Callosum ; Dementia ; Demyelinating Diseases ; Diagnosis ; Dysarthria ; Gait ; Humans ; Impulsive Behavior ; Magnetic Resonance Imaging ; Marchiafava-Bignami Disease* ; Mental Disorders ; Prognosis

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Genetic Association between Single Nucleotide Polymorphisms on COMT Gene and Schizophrenia in Korean Population.

Eun Jeong JOO ; Seong Hoon JEONG ; Se Chang YOON ; So Jin MAENG ; Kyung Sik YOON ; In Won CHUNG ; Kyu Young LEE ; Yong Min AHN ; Ung Gu KANG ; Yong Sik KIM

Korean Journal of Psychopharmacology.2003;14(2):172-180.

OBJECTIVE: This study aimed to explore genetic relation between schizophrenia and COMT gene which plays an important role in metabolizing dopamine, one of the most intriguing neuro-transmitters for schizophrenia. METHODS: 1) Single Nucleotide Polymorphism (SNP) on exons of COMT gene was searched by F-CSGE (Fluorescent-Conformation Sensitive Gel Electrophoresis) method with 50 patients with schizophrenia to look for any SNP unique to Korean patients with schizophrenia. 2) Genotyping was done for five SNPs on COMT gene for 218 patients with schizophrenia and 199 normal controls by SNaPShot method. Allele frequencies, genotype frequencies and simulated haplotype frequencies were compared between patients with schizophrenia and normal controls. RESULTS: 1) No unique SNPs for Koreans was found on exons of COMT gene and seven SNPs were found, all of them are already reported to be found in other ethnic groups. 2) No significant difference between patients with schizophrenia and normal controls in terms of allele frequencies, genotype frequencies and haplotype frequencies was found in our sample. CONCLUSION: Genetic association between five SNPs on COMT gene and DSM-IV diagnosis of schizophrenia among Koreans was not able to be found in this study.
Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dopamine ; Ethnic Groups ; Exons ; Gene Frequency ; Genotype ; Haplotypes ; Humans ; Polymorphism, Single Nucleotide* ; Schizophrenia*

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Clinical Characteristics and Courses in Patients with Early-Onset and Late-Onset Obsessive-Compulsive Disorder.

Chan Hyung KIM ; Keun Ah CHEON ; Min Seong KOO ; Yoon Young NAM ; Chang Hyung HONG ; Hong Shick LEE

Korean Journal of Psychopharmacology.2003;14(2):163-171.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder with a bimodal pattern in age onset and treatment outcomes. This study attempted to ascertain the importance of the age factor for a better phenotypic precision. Therefore, the authors compared adult OCD patients with an early symptom onset to adult OCD patients with a later symptom onset. METHODS: One hundred sixty five patients with OCD were evaluated with semistructured interviews;79 with symptom onset before the age of 17 (early onset group) and 86 with symptom onset after the age of 17 (late onset group). The two groups were analyzed in terms of Y-BOCS (Yale-Brown Obsessive Compulsive Scale) scores and demographic data including clinical variables. RESULTS: Early onset group has more comorbidity of tic disorder and lesser of depression and anxiety disorder than late onset group. Early onset group showed more family history of tic disorder than late onset group. The treatment response to SSRI is relatively declined after 18 months of initiation in early onset group. CONCLUSION: The results indicate that age at onset may be an important factor in subtyping OCD. Early onset group may have more biological and familial tendency that might be differentiate the two groups.
Adult ; Age Factors ; Age of Onset ; Anxiety Disorders ; Comorbidity ; Depression ; Humans ; Obsessive-Compulsive Disorder* ; Tic Disorders

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Change of Cognitive Functions in Switching of Risperidone for Chronic Schizophrenic Patients.

Hyun Ju HONG ; Hae Gyung CHUNG ; Jin Hee CHOI ; Young An CHOI

Korean Journal of Psychopharmacology.2003;14(2):154-162.

OBJECTIVE: The aim of this study is to evaluate the effect of risperidone on cognitive functions in chronic schizophrenic patients after 8 weeks of treatments and determine whether any improvement on cognitive function relates to improvement in psychopathology. METHODS: The subjects were 20 chronic schizophrenic outpatients, who participated in eight-week crossover study from conventional antipsychotics to risperidone. Clinical symptoms were assessed by Positive and Negative Syndrome Scale, Clinical Global Impression and Extrapyramidal Symptom Rating Scale, while they were receiving conventional antipsychotic treatment. Cognitive functions were assessed by K-WAIS digit span and digit symbol substitution test, and vigilance, continuous attention, reaction unit, corsi-block-tapping test. Patients were then reassessed after changing to a new treatment of risperidone. RESULTS: After crossover from conventional antipsychotics to risperidone, positive and negative symptoms and the general psychopathology were significantly improved. The only item of Vienna tests significantly improved after risperidone treatment was corsi-block-tapping test. However, this improvement was not related to the improvement in psychopathology. Backward digit span score, digit span total score, digit symbol substitution score were significantly improved after risperidone treatment. But this improvement was not related to the improvement in psychopathology, except digit span total score. Digit span total score was related to the improvement in negative symptom score and PANNS total score. CONCLUSION: Treatment with risperidone appeared to exert a favorable effect on visuospatial memory and working memory, but long-term and larger sample replication study is necessary.
Antipsychotic Agents ; Cross-Over Studies ; Humans ; Memory ; Memory, Short-Term ; Outpatients ; Psychopathology ; Risperidone* ; Schizophrenia

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A Retrospective Pharmacoeconomic Study of Risperidone versus Olanzapine.

Guk Hee SUH ; Tae Jin LEE

Korean Journal of Psychopharmacology.2003;14(2):145-153.

OBJECTIVE: The study aims to compare daily treatment costs of risperidone and olanzapine in the Korean RODOS data. METHODS: Retrospective inpatient chart review yielded pharmacoeconomic data of 1096 patients with schizophrenia and schizoaffective disorder. RESULTS: The mean+/-SD daily effective dose of olanzapine treatment was 14.9+/-5.3 mg compared to 5.1+/-1.8 mg for risperidone. Use of concomittant neuroleptics was higher in olanzapine group (risperidone 29%;olanzapine 35%;p=0.034), while use of other concomitant drugs was higher in risperidone group (risperidone 97%;olanzapine 90%;p<0.001). The mean+/-SD total costs of all inpatient drugs was significantly higher (p<0.001) for olanzapine (338, 431 Korean Won+/-289, 884) than risperidone (114, 775 Korean Won+/-97, 835). Although this difference in the average total costs in part reflects the longer treatment duration for olanzapine compared to risperidone (52 day versus 43 day), the cost difference remained when looking at costs on a daily basis and when correcting the baseline differences. The mean+/-SD daily costs of all inpatient drugs was significantly higher (p<0.001) for olanzapine (9, 407 Korean Won+/-10, 767) than risperidone (4, 475 Korean Won+/-4, 312). CONCLUSION: When both olanzapine and risperidone are considered appropriate, it is desirable to choose risperidone first in terms of the pharmacoeconomic consideration of the cost of these drugs.
Antipsychotic Agents ; Economics, Pharmaceutical ; Health Care Costs ; Humans ; Inpatients ; Psychotic Disorders ; Retrospective Studies* ; Risperidone* ; Schizophrenia

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No Association between Negative Symptoms of Schizophrenia and 5-HTTLPR.

Suk Joo CHOI ; Bo Geum KONG ; Sung Woo PARK ; Tae Min HA ; Young Hoon KIM

Korean Journal of Psychopharmacology.2003;14(2):138-144.

OBJECTIVE: 5-HTTLPR (5-HT transporter-linked polymorphic region), located in the promoter region of 5-HT transporter gene, was reported to be associated with several neuropsychiatric illnesses. In this study, we investigated the genotype distribution and allele frequency of serotonin transporter gene 5-HTTLPR in schizophrenic patients and normal controls using an independent Korean sample. METHODS: Subjects were 156 schizophrenic patients fulfilling the DSM-IV criteria for schizophrenia who had taken antipsychotics for at least 6 months and 96 normal controls who had no past and family history of psychiatric illnesses. Two negative symptoms of PANSS, blunted affect and emotional withdrawal, were rated in all patients by two experienced psychiatrists. We examined the genotype distribution and allele frequency of the serotonin transporter gene 5-HTTLPR in all subjects, using polymerase chain reaction (PCR) of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Between-group comparisons of the genotype distribution and allele frequency were performed by using score test for trend, Fisher's exact test, and chi-square test. RESULTS: There was no significant difference in 5-HTTLPR genotype distribution and allele frequency between schizophrenic patients and normal controls. There was also no significant difference in 5-HTTLPR genotype distribution and allele frequency between schizophrenic patients with and without the two negative symptoms, blunted affect or emotional withdrawal, respectively. CONCLUSION: These results suggest that 5-HTTLPR polymorphism had no significant association with schizophrenia and negative symptoms in a Korean sample.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Gene Frequency ; Genotype ; Humans ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Psychiatry ; Schizophrenia* ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

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Effects of Donepezil on Behavioral and Psychological Symptoms in Patients with Alzheimer's Disease.

Jin Sang YOON ; Jae Min KIM ; Hoon LEE ; Il Seon SHIN ; Yo Han LEE ; Hyung Yung LEE

Korean Journal of Psychopharmacology.2003;14(2):129-137.

OBJECTIVE: The primary purpose of this study was to investigate the effects of donepezil on the behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD). Additionally, its effects on cognitive function, activities of daily living (ADL) and global severity were investigated, and its safety was evaluated. METHODS: This was a 24 week prospective, open-labeled study with donepezil. The primary efficacy was measured by Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD);additional efficacies were assessed by Korean version of Mini-Mental State Examination (MMSE-K), Barthel Activities of Daily Living (BADL), Blessed Dementia Rating Scale (BDRS), and Global Deterioration Scale (GDS). Efficacy measurements were conducted at baseline and at weeks 4, 8, 12, and 24. Adverse events were rated using the UKU side effect rating scale at each time point and were monitored as well at the time of development. RESULTS: Of 40 patients recruited, 20 (50%) patients completed the study. The main reason for drop-out (N=14, 70%) was loss of follow-up. In the completers, scores on BEHAVE-AD were reduced significantly, particularly in subscales of `Activity Disturbances', `Diurnal Rhythm Disturbances', and `Affective Disturbances', while no significant changes were found in subscales of `Hallucinations' and `Anxieties &Phobias'. There were no significant changes in the scores on MMSE-K, BADL, BDRS, and GDS. Neither change was found in the scores on the UKU side effect rating scale. Although there were a few adverse events potentially associated with donepezil, they were tolerable and transient. CONCLUSIONS: Donepezil treatment was effective in some aspects of BPSD, and delayed the decline of cognitive function, ADL, and global severity in patients with AD. In addition, it was generally well tolerated in terms of adverse events.
Activities of Daily Living ; Alzheimer Disease* ; Dementia ; Follow-Up Studies ; Humans ; Pathology ; Prospective Studies

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Child and Adolescent Onset Obsessive Compulsive Disorder.

Boong Nyun KIM

Korean Journal of Psychopharmacology.2003;14(2):119-128.

Obsessive compulsive disorder with child & adolescent onset (C-OCD) is not a rare disorder. Though OCD patients with prepubertal onset is scarce, the prevalence of OCD with postpubertal, adolescent onset reach nearly that of adult OCD. In clinical features, C-OCD resemble adult OCD. However, the other features of pediatric OCD are different from those of adult OCD. The sex ratio of pediatric OCD is male dominant and C-OCD show high comorbid rate with tic disorder, which is not prevailing in adult OCD. Family data analysis of tic disorder and C-OCD reveal the close genetic linkage between two disorders. Neuroimaging studies of C-OCD indicate very consistent findings in basal ganglia volume change (usually reduction of striatum) that may not be so consistent in adult OCD. SSRIs are less effective in C-OCD and combined therapy with antipsychotics is more frequently needed than adult OCD. In conclusion, child and adolescent OCD can be a distinctive subtype of OCD that is different from adult OCD in many ways.
Adolescent* ; Adult ; Antipsychotic Agents ; Basal Ganglia ; Child* ; Epidemiology ; Genetic Linkage ; Humans ; Male ; Neurobiology ; Neuroimaging ; Obsessive-Compulsive Disorder* ; Prevalence ; Sex Ratio ; Statistics as Topic ; Tic Disorders

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Designs and Methods for the Development of Korean Medication Algorithm for Schizophrenic Patients.

Yong Min AHN ; Dae Yeob KANG ; Seung Hyun KIM ; Chang Yoon KIM ; Joo Cheol SHIM ; Suk Kyoon AN ; Jung Seo YI ; Hyun Sang CHO ; Won Myong BAHK ; Jun Soo KWON

Korean Journal of Psychopharmacology.2003;14(2):108-118.

As a solution about many problems of pharmacotherapy for Korean patients with major psychiatric disorders, Korean Medication Algorithm Project for Major Psychiatric Disorders (KMAP) was launched. Recently, a medication algorithm for schizophrenic patients was developed and distributed. This review article showed the designs, processes and methods for developing this algorithm. Also we compared the development of Korean algorithm for schizophrenics with other foreign representative algorithms or clinical practice guidelines. We hope that this review elicit the productive criticism about the rigour, the system of development and the objectivity of content. The limitations and problems of Korean algorithm are also discussed in this review.
Drug Therapy ; Hope ; Humans ; Schizophrenia

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Functional Neurosurgery for Psychiatric Disease.

Yoon HA ; Chan Hyung KIM ; Jong Hee CHANG ; Yong Gou PARK ; Sang Sup CHUNG ; Jin Woo CHANG

Korean Journal of Psychopharmacology.2003;14(2):99-107.

Despite a long and controversial history, psychosurgery has persisted as a modern treatment option for some severe, medically intractable psychiatric disorders. The empirical basis of psychosurgery is weak because of the lack of well-designed investigations. Several carefully conducted studies in which independent evaluation has been made, however, show convincingly that highly selective stereotactic operations on the brain can benefit some carefully selected, chronically ill psychiatric patients with a low rate of unwanted side effects. The goal of this article is to review the current state of psychosurgery. In this review, the definition of psychosurgery, patient selection criteria, and anatomical and physiological rationales for anterior cingulotomy, subcaudate tractotomy, anterior capsulotomy, limbic leukotomy, vagus nerve stimulation and deep brain stimulation are discussed.
Brain ; Chronic Disease ; Deep Brain Stimulation ; Humans ; Neurosurgery* ; Patient Selection ; Psychosurgery ; Vagus Nerve Stimulation

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