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The Normalization of Brain ¹⁸F-fluorodeoxy-D-glucose Positron Emission Tomography Hypometabolism following Electroconvulsive Therapy in a 55-year-old Woman with Treatment-resistant Late Onset Depression: A Case Report.

Jeongjae BAK ; Sang Mi LEE ; Young Joon KWON ; Se Hoon SHIM ; Joong Il KIM

Clinical Psychopharmacology and Neuroscience.2017;15(1):82-86. doi:10.9758/cpn.2017.15.1.82

Major depressive disorder, especially in later life, has heterogeneous clinical characteristics and treatment responses. Symptomatically, psychomotor retardation, lack of energy, and apathy tends to be more common in people with late-onset depression (LOD). Despite recent advances in psychopharmacologic treatments, 20% to 30% of patients with mood disorders experience inadequate responses to medication, often resulting in a trial of electroconvulsive therapy (ECT). However, the therapeutic mechanism of ECT is still unclear. By using ¹⁸F-fluorodeoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET/CT), we can obtain the status of brain metabolism in patients with neuropsychiatric disorders and changes during psychiatric treatment course. The object of this case report is evaluating the effect of ECT on brain metabolism in treatment-refractory LOD by PET/CT and understanding the mode of action of ECT. In this case report, we presented a 55-year-old female patient who suffered psychotic depression that was resistant to pharmacological treatment. Several antidepressants and atypical anti-psychotics were applied but there was no improvement in her symptoms. The patient presented not only depressed mood and behaviors but also deficit in cognitive functions. We found decreased diffuse cerebral metabolism in her brain ¹⁸F-FDG PET/CT image. ECT resulted in amelioration of the patients' symptoms and another brain PET imaging 7 weeks after the last ECT course showed that her brain metabolism was normalized.
Antidepressive Agents ; Apathy ; Brain* ; Cognition ; Depression* ; Depressive Disorder, Major ; Electroconvulsive Therapy* ; Electrons* ; Female ; Fluorodeoxyglucose F18 ; Humans ; Metabolism ; Middle Aged* ; Mood Disorders ; Positron-Emission Tomography and Computed Tomography ; Positron-Emission Tomography*

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Measurement-based Treatment of Residual Symptoms Using Clinically Useful Depression Outcome Scale: Korean Validation Study.

Sang Won JEON ; Changsu HAN ; Young Hoon KO ; Seo Young YOON ; Chi Un PAE ; Joonho CHOI ; Yong Chon PARK ; Jong Woo KIM ; Ho Kyoung YOON ; Seung Duk KO ; Ashwin A PATKAR ; Mark ZIMMERMAN

Clinical Psychopharmacology and Neuroscience.2017;15(1):28-34. doi:10.9758/cpn.2017.15.1.28

OBJECTIVE: This study was aimed at evaluating the diagnostic validity of the Korean version of the Clinically Useful Depression Outcome Scale (CUDOS) with varying follow-up in a typical clinical setting in multiple centers. METHODS: In total, 891 psychiatric outpatients were enrolled at the time of their intake appointment. Current diagnostic characteristics were examined using the Structured Clinical Interview for DSM-IV (41% major depressive disorder). The CUDOS was measured and compared with three clinician rating scales and four self-report scales. RESULTS: The CUDOS showed excellent results for internal consistency (Cronbach's α, 0.91), test-retest reliability (patients at intake, r=0.81; depressed patients in ongoing treatment, r=0.89), and convergent and discriminant validity (measures of depression, r=0.80; measures of anxiety and somatization, r=0.42). The CUDOS had a high ability to discriminate between different levels of depression severity based on the rating of Clinical Global Impression for depression severity and the diagnostic classification of major depression, minor depression, and non-depression. The ability of the CUDOS to identify patients with major depression was high (area under the receiver operating characteristic curve=0.867). A score of 20 as the optimal cutoff point was suggested when screening for major depression using the CUDOS (sensitivity=89.9%, specificity=69.5%). The CUDOS was sensitive to change after antidepressant treatment: patients with greater improvement showed a greater decrease in CUDOS scores (p<0.001). CONCLUSION: The results of this multi-site outpatient study found that the Korean version of the CUDOS is a very useful measurement for research and for clinical practice.
Anxiety ; Classification ; Depression* ; Diagnostic and Statistical Manual of Mental Disorders ; Follow-Up Studies ; Humans ; Mass Screening ; Outpatients ; Psychometrics ; Reproducibility of Results ; ROC Curve ; Weights and Measures

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Teratogenicity of Antiepileptic Drugs.

Betül Tekin GÜVELI ; Rasim Özgür ROSTI ; Alper GÜZELTAŞ ; Elif Bahar TUNA ; Dilek ATAKLI ; Serra SENCER ; Ensar YEKELER ; Hülya KAYSERILI ; Ahmet DIRICAN ; Nerses BEBEK ; Betül BAYKAN ; Ayşen GÖKYIĞIT ; Candan GÜRSES

Clinical Psychopharmacology and Neuroscience.2017;15(1):19-27. doi:10.9758/cpn.2017.15.1.19

OBJECTIVE: Antiepileptic drugs (AED) have chronic teratogenic effects, the most common of which are congenital heart disease, cleft lip/palate, urogenital and neural tube defects. The aim of our study is to examine teratogenic effects of AED and the correlation between these malformations and AED in single or multiple pregnancies. METHODS: This is a retrospective study of malformations in children born to mothers currently followed up by our outpatient clinics who used or discontinued AED during their pregnancy. Their children were then investigated using echocardiography, urinary ultrasound, cranial magnetic resonance image, and examined by geneticists and pediatric dentists. RESULTS: One hundred and seventeen children were included in the study. Ninety one of these children were exposed to AED during pregnancy. The most commonly used AED were valproic acid and carbamazepine in monotherapy. The percentage of major anomaly was 6.8% in all children. Dysmorphic features and dental anomalies were observed more in children exposed especially to valproic acid. There were 26 mothers with two and four mothers with three pregnancies from the same fathers. No correlation was found between the distribution of malformations in recurring pregnancies and AED usage. CONCLUSION: Our study has the highest number of dysmorphism examined in literature, found in all the children exposed to valproic acid, which may account for the higher rate of facial dysmorphism and dental anomalies. On lower doses of valproic acid, major malformations are not seen, although the risk increases with polytherapy. Our data also indicate possible effects of genetic and environmental factors on malformations.
Ambulatory Care Facilities ; Anticonvulsants* ; Carbamazepine ; Child ; Dentists ; Echocardiography ; Fathers ; Female ; Heart Defects, Congenital ; Humans ; Mothers ; Neural Tube Defects ; Pregnancy ; Pregnancy, Multiple ; Retrospective Studies ; Teratogenesis ; Ultrasonography ; Valproic Acid

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Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment.

Yoo Hyun UM ; Seung Chul HONG ; Jong Hyun JEONG

Clinical Psychopharmacology and Neuroscience.2017;15(1):9-18. doi:10.9758/cpn.2017.15.1.9

Attention-deficit hyperactivity disorder (ADHD) is notorious for its debilitating consequences and early age of onset. The need for early diagnosis and intervention has frequently been underscored. Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. Genetic-phenotypic differences across individuals regarding the aforementioned sleep problems have been elucidated along with the possible use of these characteristics for early prediction of ADHD. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD, with novel treatment approaches ranging from melatonin and light therapy to myofunctional therapy and adjustments of the time point at which school starts.
Age of Onset ; Circadian Rhythm ; Early Diagnosis ; Early Intervention (Education) ; Humans ; Melatonin ; Myofunctional Therapy ; Obesity ; Phototherapy ; Sleep Apnea Syndromes ; Sleep Deprivation

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Mechanisms of Alzheimer's Disease Pathogenesis and Prevention: The Brain, Neural Pathology, N-methyl-D-aspartate Receptors, Tau Protein and Other Risk Factors.

Sayad KOCAHAN ; Zumrut DOĞAN

Clinical Psychopharmacology and Neuroscience.2017;15(1):1-8. doi:10.9758/cpn.2017.15.1.1

The characteristic features of Alzheimer's disease (AD) are the appearance of extracellular amyloid-beta (Aβ) plaques and neurofibrillary tangles in the intracellular environment, neuronal death and the loss of synapses, all of which contribute to cognitive decline in a progressive manner. A number of hypotheses have been advanced to explain AD. Abnormal tau phosphorylation may contribute to the formation of abnormal neurofibrillary structures. Many different structures are susceptible to AD, including the reticular formation, the nuclei in the brain stem (e.g., raphe nucleus), thalamus, hypothalamus, locus ceruleus, amygdala, substantia nigra, striatum, and claustrum. Excitotoxicity results from continuous, low-level activation of N-methyl-D-aspartate (NMDA) receptors. Premature synaptotoxicity, changes in neurotransmitter expression, neurophils loss, accumulation of amyloid β-protein deposits (amyloid/senile plaques), and neuronal loss and brain atrophy are all associated with stages of AD progression. Several recent studies have examined the relationship between Aβ and NMDA receptors. Aβ-induced spine loss is associated with a decrease in glutamate receptors and is dependent upon the calcium-dependent phosphatase calcineurin, which has also been linked to long-term depression.
Alzheimer Disease* ; Amygdala ; Amyloid ; Animals, Genetically Modified ; Atrophy ; Basal Ganglia ; Brain Stem ; Brain* ; Calcineurin ; Depression ; Hypothalamus ; Locus Coeruleus ; N-Methylaspartate* ; Neurofibrillary Tangles ; Neurons ; Neurotransmitter Agents ; Pathology* ; Phosphorylation ; Receptors, Glutamate ; Receptors, N-Methyl-D-Aspartate* ; Reticular Formation ; Risk Factors* ; Spine ; Substantia Nigra ; Synapses ; tau Proteins* ; Thalamus

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The R-Stereoisomer of Ketamine as an Alternative for Ketamine for Treatment-resistant Major Depression.

Kenji HASHIMOTO

Clinical Psychopharmacology and Neuroscience.2014;12(1):72-73.

No abstract available.
Depression* ; Ketamine*

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A Case of Aripiprazole Induced Tardive Dyskinesia in a Neuroleptic-Naive Patient with Two Years of Follow Up.

Rakesh GOYAL ; Salam Hemabati DEVI

Clinical Psychopharmacology and Neuroscience.2014;12(1):69-71.

Tardive dyskinesia (TD) is arguably the most serious and potential irreversible side effect of antipsychotic medication. Traditionally first generation antipsychotics are the neuroleptics considered to have higher risk of TD as compared to second and third generation antipsychotics. Aripiprazole is a third-generation antipsychotic with a novel mechanism of action. Risk of developing TD with use of aripiprazole has been unknown. Recently many cases of aripiprazole associated TD have been reported. A case of 52 year old Caucasian woman is discussed who presented to us with first manic episode. Patient had never been treated with any antipsychotic medication in her life before. During current episode, she was treated with aripiprazole 30 mg/day. During follow up, patient was found to have developed dyskinetic oro-facial movements within 2 months of starting aripiprazole. She was not taking any other antipsychotic/anti-dopaminergic medication at that time. Patient's abnormal oro-facial movements could not be reversed in spite of immediate discontinuation of aripiprazole. Multiple medications are tried over the next 2 years but her movement disorder never remitted. Above case (along with other recent reports) suggest that risk of movement disorder with aripiprazole use could be higher than previously thought. Further studies are required to find out incidence of movement disorder with aripiprazole. Aripiprazole use should be preferably restricted to FDA approved indications. Clinician needs to be very vigilant about emergence of any movement disorder while using aripiprazole, especially in patients with risk factors for TD.
Antipsychotic Agents ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Movement Disorders* ; Risk Factors ; Aripiprazole

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A Case of Acute Pancreatitis Associated with Risperidone Treatment.

Kentaro KAWABE ; Shu Ichi UENO

Clinical Psychopharmacology and Neuroscience.2014;12(1):67-68.

Acute pancreatitis with antipsychotic treatment is rare but sometimes causes a fatal adverse effect. Most cases of acute pancreatitis due to atypical antipsychotic agents are reported to occur within six months of starting antipsychotic administration. Acute pancreatitis caused by risperidone is rare. The patient had a high fever, stomachache and vomiting. The results of the abdominal computed tomograhpy scan were negative. The results of the abdominal ultrasonography were positive for gallstones in gallbladder and distention of the common bile duct. She had been fasting and received antibiotic intravenous injections. Amylase and lipase titers were high. After risperidone discontinuation, both the levels of the amylase and the lipase were gradually decreased. Three months later, the patient still maintains a good clinical balance. Although atypical antipsychotic-induced pancreatitis has been reported in conjunction with hyperglycemia, the pathophysiologic mechanism of these adverse events remains unclear. This case got pancreatitis 6 month after risperidone treatment. Using the antipsychotic agents, it is necessary to monitor pancreas function.
Amylases ; Antipsychotic Agents ; Common Bile Duct ; Fasting ; Fever ; Gallbladder ; Gallstones ; Humans ; Hyperglycemia ; Injections, Intravenous ; Lipase ; Pancreas ; Pancreatitis* ; Risperidone* ; Schizophrenia ; Ultrasonography ; Vomiting ; Aripiprazole

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Successful Treatment of Anorexia Nervosa in a 10-year-old Boy with Risperidone Long-acting Injection.

Hidehiro UMEHARA ; Junichi IGA ; Tetsuro OHMORI

Clinical Psychopharmacology and Neuroscience.2014;12(1):65-66.

Although the effectiveness of medication in the treatment of anorexia nervosa is uncertain, atypical antipsychotics such as olanzapine and risperidone have been used empirically for decades. we describe the case of a 10-year-old boy with anorexia nervosa in whom remarkable improvement was seen following the administration of risperidone or risperidone long-acting injection and deterioration when these agents were ceased. Because this is, to the best of our knowledge, the first report describing the usefulness of risperidone long-acting injection for adolescent anorexia nervosa.
Adolescent ; Anorexia Nervosa* ; Antipsychotic Agents ; Child* ; Feeding and Eating Disorders ; Humans ; Male ; Risperidone*

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A Pilot Study for Discovering Candidate Genes of Chromosome 18q21 in Methamphetamine Abusers: Case-control Association Study.

Byung Dae LEE ; Je Min PARK ; Young Min LEE ; Eun Soo MOON ; Hee Jeong JEONG ; Young In CHUNG ; Hyo Deog RIM

Clinical Psychopharmacology and Neuroscience.2014;12(1):54-64.

OBJECTIVE: It was previously suggested that the malic enzyme 2 (ME2) as the candidate gene for psychosis in fine mapping of chromosome 18q21. Chromosome 18q21 is also one of the possible regions that can contribute to addiction. METHODS: We performed a pilot study for discovering candidate gene of chromosome 18q21 in the methamphetamine abusers for elucidating the candidate gene for methamphetamine addiction leading to psychosis. We have selected 30 unrelated controls (16 males, 14 females; age=59.8+/-10.4) and 37 male methamphetamine abusers (age=43.3+/-7.8). We analyzed 20 single nucleotide polymorphisms (SNPs) of 7 neuronal genes in chromosome 18q21 for DNA samples that was checked for the data quality and genotype error. The association between the case-control status and each individual SNP was measured using multiple logistic regression models (adjusting for age and sex as covariates). And we controlled false discovery rate (FDR) to deal with multiple testing problem. RESULTS: We found 3 significant SNPs of 2 genes in chromosome 18q21 (p-value<0.05; adjusting for age as covariate) in methamphetamine abusers compared to controls. We also found 2 significant SNPs of 1 gene (p-value<0.05; adjusting for age and sex as covariates) (rs3794899, rs3794901:MAPK4). Two SNPs in MAPK4 gene were significant in both statistical groups. CONCLUSION: MAPK4, the gene for mitogen-activated protein kinase 4, is one of the final 6 candidate genes including ME2 in 18q12-21 in our previous finemapping for psychosis. Our results suggest that MAPK4 can be a candidate gene that contribute to the methamphetamine addiction leading to psychosis.
Case-Control Studies* ; Comorbidity ; DNA ; Female ; Genotype ; Humans ; Logistic Models ; Male ; Methamphetamine* ; Neurons ; Pilot Projects* ; Polymorphism, Single Nucleotide ; Protein Kinases ; Psychotic Disorders ; Data Accuracy ; Substance-Related Disorders

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