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A Comparative Study on the Cognitive and Clinical Characteristics of Childhood/Adolescent- and Adult-Onset of Bipolar Disorder

Hyeonmi KIM ; Sung-Young HUH ; Sung-Gon KIM ; Ji-Hoon KIM ; Woo-Young JUNG ; Eun-ra YU ; Bum-Sung CHOI ; Dae-Wook KIM ; Dong-Uk YOON

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):154-161.

Objectives: ：Childhood/adolescent-onset of bipolar disorder presents functional impairments on emotional, academic, and social aspects. These impairments could continue into adulthood. However, there are few studies comparing cognitive function between childhood/adolescent- and adult-onset using psychological test. This study aims to improve understanding of childhood/adolescent-onset of bipolar disorder by comparing differences in cognitive function, clinical and demographic features between the two groups. Methods: ：This study was conducted on 145 patients diagnosed with bipolar disorder type I, II, and other specified bipolar disorder by DSM 5 at the time of discharge from 2016 to 2019 at the Department of Psychiatry, Pusan National University Yangsan Hospital. Demographic information, clinical data, and results of psychological tests (K-WISC-IV, K-WAIS-IV) were collected and reviewed. Results: ：Childhood/adolescent-onset group was significantly low in total potential IQ and in language understanding than adult-onset group (p=0.008 and p=0.013). The childhood/adolescent group had significantly more psychiatric comorbidities than the adult group (p<0.001). The average number of prescribed antipsychotic agents was 1.18 (SD= ±0.64) in the childhood/adolescent group, and 1.78 (SD=±0.82) in the adult group. The difference was statistically significant (p<0.001). Conclusion ：Patients with childhood/adolescent-onset bipolar disorder have lower total potential IQ and language understanding comparing patients with adult-onset bipolar disorder. This highlights the importance of conducting a well-designed prospective study to find out more about the characteristics of childhood/adolescent-onset bipolar disorder.

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The Influence of School-Based Social Skills Training Program on the Social Decision-Making of Children and Adolescents : A Preliminary Study

Min-Seok KIM ; Sang-Soo SEO ; Yang-Tae KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):144-153.

Objectives: ：The purpose of this study is to evaluate the effect of a school-based social skills training program on the social decision-making of children and adolescents and to assess plan for effective school-based mental health services. Methods: ：It was performed school-based social skills training (n=46, 7 sessions) in elementary and middle school students. Evaluations were conducted before and after the application of the program using a ultimatum game and dictator game, in order to identify changes. Results: ：Before social skills training program (SSTP), the younger students showed higher acceptance rates of unfair offers than the older students in ultimatum game (UG) [at 9:1 offers 0.79±0.08>0.55±0.12 (p=0.001); at 8:2 offers 0.81±0.11>0.59±0.11 (p=0.001)]. the rejection rates of unfair offers in UG significantly increased after SSTP[at 9:1 offers 0.64±0.19→0.43±0.18 (p=0.001) ; at 8:2 offers 0.67±0.16→0.54±0.16 (p=0.046) ; at 7:3 offers 0.83± 0.20→0.65±0.12 (p=0.001)]. the rejection rates of unfair offers in UG significantly increased at happy and at neutral facial expression of proposers after SSTP[happy facial expression condition, at 9:1 offers 0.89±0.12→0.68±0.19 (p=0.001) ; at 8:2 offers 0.82±0.19→0.72±0.14 (p=0.001) ; at 7:3 offers 0.99±0.07→0.92±0.17 (p=0.040] [neutral facial expression condition, at 9:1 offers 0.71±0.20→0.54±0.13 (p=0.001) ; at 8:2 offers 0.61±0.18→0.52±0.06 (p=0.001) ; at 7:3 offers 0.91±0.13→0.83±0.12 (p=0.001)]. the amount of money offered as a proposer in dictator game significantly increased after SSTP [3989.1±1952.3→4742.5±371.1, (p=0.012)]. Conclusion ：The social skills training program positively influences the social decision-making. The school-based social skills training program can be expected to have positive results in school-based mental health services. Future investigation is needed to validate the long term effects of this program.

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e Prevalence of Psychotic Experiences in the Korean General Population and its Association with Psychiatric Disorders

Hyunjun KIM ; Hyerim KIM ; Jimin LEE ; Seoyoung JANG ; Sung Man CHANG ; Byung-Soo KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):134-143.

Objectives: ：The aim of this study was to investigate the lifetime prevalence of psychotic experiences (PEs) and the association of PEs with a range of psychiatric disorders in the Korean general population. Methods: ：Multi-stage cluster sampling was adopted in this study. Interviews were conducted face-to-face with 18-year-old and older people living in the community from June to November 2016. Korean version of Composite International Diagnostic Interview (K-CIDI) was applied to assess the prevalence of psychiatric disorders. Psychotic experiences were assessed with 21 items (15 items for hallucinations and 6 items for delusions) in the CIDI psychosis module. Results: ：Mean lifetime prevalence (standard error) of ever having a PEs was 3.3% (0.3) with 2.2% (0.2) of hallucinatory experiences and 1.7% (0.2) of delusional experiences. The lifetime prevalence of PEs was higher in young people and in persons with unemployment or part-time-job. PEs were associated with an increase in the lifetime prevalence of anxiety disorders [Adjusted odd ratio (AOR)=6.3 ; p<0.001], mood disorders (AOR=4.9 ; p<0.001), alcohol use disorders (AOR=2.4 ; p<0.001), and nicotine use disorders (AOR=2.4 ; p<0.001) after controlling for sociodemographic variables. Conclusion ：PEs are related to various non-psychotic disorders as well as psychotic disorders. Clinicians should pay more attention to the mental health of individuals with PEs.

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Factors Influencing on Internet Game Addiction among Adolescents*

Hae-Jung YANG ; Seung-Gon KIM ; Sang-Hoon KIM ; Sang-Hag PARK ; Hyung-Jun YOON ; Eun-Hyun SEO

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):127-133.

Objectives: ：This study aimed to investigate the prevalence of internet game addiction and its association with environmental characteristics such as parent supervision, gaming hour (time spent on gaming) and attention-deficit hyperactivity disorder (ADHD) symptoms among middle school students. Methods: ：A total of 596 (416 males and 180 females) first grade middle-school students in Gwang-ju metropolitan city were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Internet Gaming Use-Elicited Symptom Screen (IGUESS), Attention deficit hyperactivity disorder (ADHD) symptom, environmental factor such as parent supervision, and game related factor like game hours. Internet Game addiction and non-addiction group were defined using IGUESS score of 10 as a cut-off. The data were analyzed using hierarchical regression analyses. Results: ：Internet Game addiction group was fifty-two subjects (8.7%). Male students were significantly higher than female students (OR 25.01). IGUESS score was statistically negatively correlated with parent attachment and parent supervision, while IGUESS score was positively correlated with time spent on gaming per day, the longest time spent on gaming per day and violent game and ADHD score. Among variables, IGUESS score showed the highest correlation with the longest time spent on gaming per day (r=0.373, p<0.01). Using hierarchical regression analyses, the longest time spent on gaming per day was also the highest predicting factor affecting internet game addiction among variables. Conclusion ：Our findings indicate that parent supervision, parent attachment and game related characteristics such as gaming per day, the longest time spent on gaming per day and violent game and ADHD were associated with internet game addiction.

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A Review on Neural Mechanisms of Transcranial Direct Current Stimulation on Cognitive Enhancement : Focused on Functional Magnetic Resonance Imaging Studies

Haejin HONG ; Jinsol KIM ; Hyangwon LEE ; Shinhye KIM ; Ilhyang KANG ; Gahae HONG ; Jungyoon KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):116-126.

Transcranial direct current stimulation (tDCS) is a non-invasive and effective neuromodulatory technique to modulate cortical activities by applying 1 to 2 milliamps electric current. The use of tDCS to enhance cognitive function such as executive function and memory has attracted much attention in recent years, and a lot of studies have been carried out to identify neural mechanisms underlying cognitive enhancement effects of tDCS. In this review, we discussed the previous neuroimaging studies on applications of tDCS for cognitive enhancement using functional magnetic resonance imaging (fMRI). Previous tDCS studies for neurological or psychiatric conditions and elderly individuals suggested that cognitive enhancement effects of tDCS were associated with normalizing aberrant brain networks and activities related to pathophysiology. Moreover, tDCS-induced cognitive enhancement in healthy individuals was associated with functional changes in brain activations and network connectivity. Furthermore, cognitive enhancement effects of tDCS were varied depending on the neurological structure and functional characteristics between individuals. The current review may provide critical insights into functional activity and connectivity of the brain regarding cognitive enhancement effects of tDCS, which could give direction for further studies on identifying the specific neural mechanisms and clinical strategies of tDCS.

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A Review on Neuronavigated Repetitive Transcranial Magnetic Stimulation and Its Antidepressant Effect

Myeongju KIM ; Yumi SONG ; Chaewon SUH ; Jiyoung MA ; Gahae HONG ; Jungyoon KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):101-115.

Repetitive transcranial magnetic stimulation (rTMS) is widely recognized as an effective and noninvasive neuromodulation for treating depression, and has been applied in a wide range of clinical settings. However, previous studies often reported inconsistent antidepressant effects that may be due to differences in the rTMS protocols such as coil placement. The typical simulation site for rTMS depression protocol is the left dorsolateral prefrontal cortex (DLPFC). Targeting the exact site of the left DLPFC while considering individual brain structure has been challenging due to the non-invasive nature of rTMS. Several researchers have applied various targeting methods to overcome the abovementioned issue. Most of the previous studies have applied the “5-cm rule” or the “international 10-20 system,” which is easily applicable. Recently, researchers started to apply a neuronavigation system that targets the stimulation site based on neuroimaging of each individual. Pros and cons of targeting methods have been discussed in terms of validity and reliability of targeting stimulation sites, differences in treatment responses, as well as considerations of individual characteristics. Therefore, the current review focuses on the targeting methods of stimulation site and the treatment effects of depression in previous studies. For discussion, we divided neuronavigation methods into using fixed coordinates and using individualized targets. Furthermore, the limitations of each targeting method are discussed that may potentially contribute to the development of the optimal rTMS protocol for depression treatment.

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A Review of Clinical Applications of Hyperbaric Oxygen Therapy in Psychiatric Disorders

Yoonji JOO ; Ryeyoung KIM ; Eunji HA ; Eun NAMGUNG ; Jungyoon KIM ; Gahae HONG

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):88-100.

Hyperbaric oxygen therapy (HBOT) is a noninvasive method that supplies pure oxygen under a pressure greater than normal atmospheric pressure to increase the partial pressure of oxygen in the plasma and tissue. Based on the potential mechanisms of HBOT, including neuroprotection and neurological recovery, HBOT has been suggested as a promising therapeutic option for neurological and psychiatric disorders. This review specifically focused on the clinical trials applying HBOT for psychiatric disorders published during the recent decade. We critically reviewed the efficacy and safety of HBOT in psychiatric disorders, and cautiously suggested the future directions for further research.

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The Antidepressant Effects and Clinical Implication of Ketamine

Byung-Soo KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(2):79-87.

Major depressive disorder is a highly prevalent psychiatric condition that causes serious health concern and psychosocial consequences. Nevertheless, about one third of the patients with major depressive disorder have treatmentresistant depression (i.e., a failure to respond to two or more antidepressant drugs). In addition, it takes at least two weeks to several months before the antidepressants have an effect. In the field of emergency psychiatry, this time lag has always been a serious obstacle in the treatment of suicidal patients. Since 2000, the ketamine has emerged as a novel therapeutic agent for major depressive disorder and suicidality with rapid onset and robust response rates. In 2019, the U.S. Food and Drug Administration (U.S. FDA) approved the S-enantiomer of ketamine, esketamine as a drug for treatment-resistant depression. However, the U.S. FDA approved it with a Risk Evaluation and Mitigation Strategy (REMS) to mitigate the risk of serious adverse effects resulting from sedation, dissociation, cardiovascular instability, and potential abuse. Although we still do not have enough experience about the efficacy and safety of this new medication, the interests of clinicians and patients are rapidly growing. In this narrative review, the pharmacological characteristics, the mechanism of action, the psychiatric effects and side effects, and a consensus statement on the use of ketamine were provided.

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Chlorpromazine-induced Exfoliative Photoallergic Reaction

Young Hoon KIM ; Gwang Bog LEE

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(3):269-273.

Despite the availability of second-generation antipsychotic drugs, chlorpromazine is still commonly used in Korea and many other countries due to its cost effectiveness, particularly for patients experiencing psychomotor excitement. Adverse effects of chlorpromazine include photosensitivity and phototoxic and photoallergic skin reactions. We present a case of severe photoallergic skin reactions to chlorpromazine that developed 3 days after use of the drug. The skin lesions resolved completely within one week after stopping the drug. A previous history of exposure to chlorpromazine was unknown and the patient had never previously experienced any form of drug-induced photosensitivity. This case highlights the need for awareness of the cutaneous adverse effects of chlorpromazine and the importance of educating patients.

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Atrophy of Thalamic Nuclei in Patients with Alcohol Dependence

Jeonghwan LEE ; Seungwon CHUNG ; Hyemi PARK ; Gawon JU ; Jung-Woo SON ; Chul-Jin SHIN ; Sang Ick LEE ; Siekyeong KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(3):259-268.

Objectives: ：Chronic alcohol ingestion is associated with structural alterations in the brain. In patients with alcohol dependence, thalamic volume is frequently diminished, commensurate with the amount of alcohol consumption, duration of illness, and cognitive impairment. Since the thalamus is composed of histologically and functionally distinct nuclei, we aimed to investigate volumetric changes of these nuclei in patients with alcohol dependence. Methods: ：Twenty-three participants with alcohol dependence who had abstained from drinking for at least 3 months (alcohol group) and 21 age-matched healthy controls (control group) underwent 3T magnetic resonance imaging. The volumes of 50 individual thalamic nuclei were reconstructed using FreeSurfer 6.0.0. We compared normalized volumes of thalamic nuclei between the two groups using analysis of covariance, controlling for age. The p-values were corrected using False Discovery Rate (p<0.05). Results: ：The alcohol group demonstrated atrophy of the whole thalamus and nuclei in the anterior, ventral, intralaminar, and medial thalamus. However, the volumes of bilateral lateral geniculate, medial geniculate, suprageniculatelimitans, pulvinar lateral, and right pulvinar inferior nuclei which are included in posterior thalamus, were not significantly different between the two groups. Conclusion ：In the alcohol group, atrophy of most thalamic nuclei which are associated with language processing, visuospatial memory, autobiographical memory, executive function and attention were not normalized after 3 months of sobriety. Furthermore, thalamic nuclei volumes, which are associated with visual and auditory information processing, were not significantly different compared to controls. We suggest that this could be microstructural evidence of relatively preserved visual attention and auditory startle response in patients with alcohol dependence.

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