OBJECTIVE: The definite causes of obsessive-compulsive disorder (OCD) are still unknown. Evidences from familial, twin and segregation studies support the role of a genetic component in the etiology of OCD. There are growing evidences that OCD has specific neurochemical and neuroanatomical basis. It has been shown that serotonergic neurons play the predominant pathophysiological role in OCD. Recently, it has also been proposed that neurotransmitters other than serotonin play a role in the pathophysiology of OCD, and a series of studies have provided evidence that dopamine is involved in some OCD patients. Therefore, the aims of this study were to investigate the association between dopamine receptor D4 (DRD4) and OCD. METHODS: One hundred and fifteen OCD patients and 160 normal controls participated in this study. Genomic DNA was extracted from their blood. The genotypes and allele frequencies of the DRD4 polymorphism between OCD group and control group were compared. OCD patients were classified into early onset group (age of onset <17) and late onset group (age of onset > or =17) according to their onset age and the genotype and allele frequency were compared between two groups. Using principal component analysis, we had already derived 4 factors from 13 main contents of YBOCS checklist in the previous study and in this study, we investigated the association between these three factors and DRD4 genotypes. RESULTS: In this case-control study, we could find that the L-genotype frequencies of DRD4 were significantly higher in OCD than in normal control groups (chi2 test, p=0.04). There were no difference in genotype frequencies between early onset OCD group and late onset OCD group. In OCD group, patients with L-genotype had higher scores for the religious/somatic factor than the other groups (t test, p=0.009). CONCLUSIONS: The L-genotype of DRD4 may have negative effects on the development of OCD and religious/somatic factor of the obsessive-compulsive symptoms.
Age of Onset ; Case-Control Studies ; Checklist ; DNA ; Dopamine Plasma Membrane Transport Proteins ; Dopamine* ; Gene Frequency ; Genotype ; Humans ; Neurotransmitter Agents ; Obsessive-Compulsive Disorder* ; Principal Component Analysis ; Receptors, Dopamine* ; Serotonergic Neurons ; Serotonin

OBJECTIVE: Stress and elevated levels of glucocorticoids in patients with major depressive disorder (MDD) have been hypothesized to be associated with damage to the hippocampus. However the relationship between depression and hippocampal structure is unconfirmed. We investigated whether the chemical changes will occurr in the hippocampus of patients with MDD by using 1H-magnetic resonance spectroscopy (MRS) and explored the clinical meanings of hippocampal metabolites. METHODS: Fourteen female, right-handed patients with major depressive disorder and 12 healthy controls (age, sex, education and their dextrality matched) were included. We measured variables of time course of illness, severity of illness, levels of NAA, Cho and Cr in both hippocampus using 1HMRS. In addition, we performed neuropsychological tests in depressed subjects. RESULTS: There were no significant difference in the NAA/Cr, Cho/Cr, Cho/NAA between depressed and control subjects. In depressed subjects, significant negative correlations were observed between hippocampal NAA/Cr and duration of illness, duration of unmedication, severity of illness, respectively. Right hippocampal NAA/Cr was correlated with RCFT scores. CONCLUSION: These findings indicate damage to the hippocampus may not be a common feature in all depressed patients. However the results suggest that the illness burden and past treatment may influence hippocampal neurons and neuronal network in patients with MDD. Also, chemical changes in hippocampus may be associated with severity of illness and memory function.
Cost of Illness ; Depression ; Depressive Disorder, Major* ; Education ; Female* ; Glucocorticoids ; Hippocampus ; Humans ; Magnetic Resonance Spectroscopy ; Memory ; Neurons ; Neuropsychological Tests ; Spectrum Analysis

OBJECTIVES: The reliability and validity of the Korean version of Hamilton Depression Rating Scale (K-HDRS) were examined in Korean patients depressive symptoms. METHODS: 33 inpatients and 70 outpatients diagnosed as major depressive disorder or depressive episode of bipolar I disorder according to the DSM-IV criteria were assessed with K-HDRS, Clinical Global Impression score(CGI), Beck Depression Inventory (BDI) and Montgomery-Aberg Depression Rating Scale (MADRS). RESULTS: Internal consistency (Cronhach's alpha coefficeint=0.76) and interrater reliability (r=0.94, p<0.001) were statistically significant. Principal axis factoring analysis revealed 4 factors that accounted for 50.4% of the total variance. The correlations of K-HDRS with CGI, BDI and MADRS were 0.84, 0.54, 0.58 respectively. CONCLUSION: These results showed that the K-HDRS could be a reliable and valid tool for the assessment of depressive Korean patients. The K-HDRS will be a useful tool for assessing depressive symptoms in Korea.
Axis, Cervical Vertebra ; Depression* ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Inpatients ; Korea ; Outpatients ; Reproducibility of Results*

BACKGROUND: Although physicians state that patients ideally should receive hospice palliative care for 3 months before death, the majority of patients survive less than one month in hospice palliative care. This is too short to do effective hospice palliative care. Therefore, we figured out the problems through the clinical considerations about terminally ill cancer patients who had died in hospice unit. METHODS: From July to December in 2003, 107 patients with terminally ill cancer who had died in Sam Anyang Hospice Unit were enrolled in this study. For getting the informations about patients characteristics, we reviewed the medical records and interviewed the patients on the first visit. RESULTS: There were 70 males (65%) and 37 females (35%), and median age of patients was 60 years (range 23-93). The most common cancer was stomach cancer (18 patients, 17%). Forty seven patients (44%) took analgesics, the others 60 (56%) not. The most common symptom was pain (75 patients, 70%) and the most prevalent reason for admission was also pain (60, 56%). The most prevalent physician specialty who transferred patients or referred to local hospital was other internal medicine (48 patients, 44%), followed by hemato-oncology (38, 36%), surgery (12, 11%) and others (9, 9%). The median duration between the day when the patients were diagnosed as terminally ill cancer patient and the day when they were referred to hospice center is 48 days. The median survival in hospice palliative care is 30 days. The median hospitalization is 19 days. CONCLUSION: We found that lack of recognition about hospice palliative care of physicians, patients and families made the length of hospice palliative care too short. To do effective hospice palliative care, it needs education and promotion for them constantly.
Analgesics ; Education ; Female ; Gyeonggi-do ; Hospices* ; Hospitalization ; Humans ; Internal Medicine ; Male ; Medical Records ; Palliative Care ; Stomach Neoplasms ; Terminally Ill*

OBJECTIVE: The aim of this study was to describe and evaluate the clinical data and short-term treatment response in patients with obsessive-compulsive disorder (OCD) based on an outpatient setting. METHODS: A group of patients with OCD underwent mean 12-weeks treatment with selective serotonin reuptake inhibitors. The patients were divided into two groups according to treatment response, defined as a reduction of the Yale-Brown Obsessive Compulsive Scale total score >35% and CGI of 1 or 2. RESULTS: 1) Among the 249 patients, 24.1% had checking type and 23.7% washing type. Among these two types, 31.9% had mood disorder, 15.0% had anxiety disorder and 24.5% personality disorder as co-morbidity. One hundred fourteen patients (45.8%) responded to the treatment and 135 (54.2%) did not. The responders decreased Y-BOCS scores from 27.9+/-7.2 at baseline to 21.3+/-6.4 and 19.3+/-3.8 at post-treatment 8 and 12 weeks, respectively (repeated measure ANOVA, p=0.039). There were no differences among the treatment responses to serotonin reuptake inhibitors. CONCLUSION: About half of the OCD patients showed a response to pharmacological treatment using SSRI in the outpatient clinic setting for 12 weeks. Long-term and contrast studies of OCD may elucidate further clinical aspects of this disorder in the future.
Ambulatory Care Facilities ; Anxiety Disorders ; Comorbidity ; Humans ; Mood Disorders ; Obsessive-Compulsive Disorder* ; Outpatients ; Personality Disorders ; Serotonin Uptake Inhibitors

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumor. They occur predominantly at premenopausal women and rarely at postmenopausal and prepubertal. Most common symptom is menstrual disorder including vaginal bleeding. This symptom is the results of excessive testosterone production of Leydig cell. Masculinization is occasionally accompanied by this symptom. but approximately 50% of patients with SLCT have no endocrine manifestations. Prognosis prove generally favorable with 5-year survival rate of 70-90%. Recurrence is rare.The majority of these tumors are benign and are unilaterally (97-98%) localized. Surgery varies with patient age, tumor stage, and differentiation from unilateral salpingo-oophorectomy to bilateral salpingo-oophorectomy and total hysterectomy concomitant with pelvic lymph node dissection. Herewith, we experienced a case of treatment advanced-stage Sertoli-Leydig cell tumor with poorly differentiation in that is ascitic and metastatic in a 53 years old menopause woman who has no virilizing symptom. After all the tumor has resulted in fatal outcome despite of surgery and aggressive chemotherapy. Therefore we present it with review of literature.
Drug Therapy ; Fatal Outcome ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Menopause ; Middle Aged ; Ovary ; Prognosis ; Recurrence ; Sertoli-Leydig Cell Tumor* ; Survival Rate ; Testosterone ; Uterine Hemorrhage

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumor. They occur predominantly at premenopausal women and rarely at postmenopausal and prepubertal. Most common symptom is menstrual disorder including vaginal bleeding. This symptom is the results of excessive testosterone production of Leydig cell. Masculinization is occasionally accompanied by this symptom. but approximately 50% of patients with SLCT have no endocrine manifestations. Prognosis prove generally favorable with 5-year survival rate of 70-90%. Recurrence is rare.The majority of these tumors are benign and are unilaterally (97-98%) localized. Surgery varies with patient age, tumor stage, and differentiation from unilateral salpingo-oophorectomy to bilateral salpingo-oophorectomy and total hysterectomy concomitant with pelvic lymph node dissection. Herewith, we experienced a case of treatment advanced-stage Sertoli-Leydig cell tumor with poorly differentiation in that is ascitic and metastatic in a 53 years old menopause woman who has no virilizing symptom. After all the tumor has resulted in fatal outcome despite of surgery and aggressive chemotherapy. Therefore we present it with review of literature.
Drug Therapy ; Fatal Outcome ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Menopause ; Middle Aged ; Ovary ; Prognosis ; Recurrence ; Sertoli-Leydig Cell Tumor* ; Survival Rate ; Testosterone ; Uterine Hemorrhage

BACKGROUND: The long-term survival in patients with non-Hodgkin's lymphoma (NHL) after conventional chemotherapy is about 35% and the rest of the patients tend to have relapse. So, in relapsed or refractory NHL, the outcome of patients undergoing high-dose chemotherapy and autologous peripheral stem cell transplantation (APBSCT) was evaluated, and the main prognostic factors were determined. METHODS: 17 patients with relapsed or resistant NHL (5 complete response group, 7 partial response group, 4 primary refractory group, 1 resistant relapse) underwent BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy and APBSCT between July 1997 and February 1999. RESULTS: The median follow-up duration was 17 months (range: 4-47). The response rate was 58.3% (complete response 33.3%, partial response 25.0%) in 12 patients in whom complete response group was not included. The 2-year, 3-year overall response rate were 41.2%, 27.5%, respectively. And 2-year progression free survival was 35.3%. The disease status before high-dose chemotherapy was the only significant prognostic factor in determining overall survival (univariate p=.024, multivariate p=.059) and progression free survival (univariate p=.013, multivariate p=.026). Patients with complete response to salvage regimen had better overall survival (p=.021) and progression free survival (p=.008) than patients with refractory response. WBC (> or = 1,000/uL) was recovered at the median 11 days (range; 8-24), and platelet (> or = 50,000/uL) was recovered at the median 18 days (range; 9-44). There was no treatment-related death and no grade 3 and 4 toxicity. Neutropenic infection was in 4 patients (1 Herpes zoster, 1 typhlitis, 1 perianal infection, 1 otitis externa). CONCLUSION: The pre-transplant disease status was the main prognostic factor. Patients with complete response to salvage regimen had the significant benefit in survival from high-dose chemotherapy and APBSCT, but patients with refractory or resistant relapsed NHL did not have any significant benefit.
Blood Platelets ; Cytarabine ; Disease-Free Survival ; Drug Therapy ; Etoposide ; Follow-Up Studies ; Herpes Zoster ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Otitis ; Peripheral Blood Stem Cell Transplantation* ; Recurrence ; Typhlitis

BACKGROUND: Patients with non-Hodgkin's lymphoma who do not respond to first-line chemotherapy or those who relapse after obtaining a complete response have a poor prognosis and are rarely cured with usual salvage chemotherapy. We investigated the treatment responses, toxicities, prognostic factors and mobilization efficacy of peripheral blood stem cells (PBSC) used as salvage chemotherapy. METHODS: 55 patients with refractory (36) or relapsed (19) NHL were treated from Novembr 1997 to October 1999 with IVAM (ifosfamide, etoposide, cytarabine, methotrexate) regimen. Each patients was scheduled to receive one to three cycles of chemotherapy. When the leukocyte count reached 5x109/L after chemotherapy, PBSC collection was performed. The treatment was repeated every 4 weeks. RESULTS: The median age was 48 years (range, 19-76). Median 2.1 cycles of chemotherapy were administered. 15 patients (27.3%) achieved complete response and 29 (52.7%) partial response, with an overall response rate of 80.0%. Myelosuppression was the major toxicity, with 98.2% of grade 3, 4 neutropenia and thrombocytopenia, but there was no serious hemorragic event. Neutropenic fever occurred in 25.5% of the patients with one treatment-related death due to sepsis. Non-hematologic toxicity was modest. PBSC was collected in 36 patients for high dose chemotherapy and autologous stem cell transplantation. The median number of mononuclear cells collected was 9.9x108/kg and the median number of CD34(+) cells collected was 11.9x106/kg. After a median follow-up of 13 months (range, 3-26), median progression free survival were 12 months and median overall survival has not been reached yet. 1-year overall survival and progression free survival were 61.9% and 46.1%, respectively. In univariate analyses, unfavorable prognosis was associated with poor performance status (p=0.001), high LDH (p=0.041), stage III,IV (p=0.04), extralymphatic lesion (p=0.027), B sx (p=0.034), bone marrow involvement (p=0.039) and performing high dose chemotherapy (p=0.005). Multivariate analysis showed that performance status(p=0.0042), B sx(p=0.049) was a significant independent risk factors for death. CONCLUSION: These results suggest that IVAM is an effective salvage chemotherapy for refractory or relapsed NHL and allow effective PBSC collection for high dose chemotherapy and autologous PBSCT.
Bone Marrow ; Cytarabine ; Disease-Free Survival ; Drug Therapy* ; Etoposide ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Lymphoma, Non-Hodgkin* ; Multivariate Analysis ; Neutropenia ; Prognosis ; Recurrence ; Risk Factors ; Sepsis ; Stem Cell Transplantation ; Stem Cells ; Thrombocytopenia

OBJECTIVE: The purpose of this study was to examine the relative blood flow differences of brain regions between first-episode schizophrenic patients and normal controls and the relationships between these regions and the changes of psychopathology scores, the treatment response, after serotonin dopamine antagonist (SDA) risperidone treatment. Another purpose of this study was to investigate SPECT relative blood flow index as the treatment response predictor of SDA treatment under control of the influences of homovanillic acid (HVA). We hypothesize that there is differences in the brain blood flows examined by SPECT between first-episode schizophrenic patients and normal controls. Relative blood flow index examined by SPECT will be the response predictors of SDA treatment of schizophrenia under control of influences of metabolites. METHODS: The relative blood flows of seventeen first-episode schizophrenic patients and ten normal controls were examined by 99m-Tc ECD SPECT before drug treatment. The patients group was treated for 6 weeks with SDA. The psychopathology was assessed at baseline just before SDA trial and then at 2 weeks and 6 weeks after SDA treatment. At the same time plasma HVA was evaluated by HPLC (high performance liquid chromatography). RESULTS: The cerebral blood flow of first-episode schizophrenic patients was decreased in thalamus and left basal ganglia and the relative blood flow index of schizophrenic patient's left thalamus was significant therapeutic predictor of SDA treatment of positive symptoms under control of the HVA influnences. CONCLUSION: These results suggest that the relative blood flow examined by SPECT will be a therapeutic index of SDA treatment in schizophrenia.
Basal Ganglia ; Brain ; Chromatography, High Pressure Liquid ; Dopamine ; Homovanillic Acid* ; Humans ; Plasma* ; Psychopathology* ; Risperidone ; Schizophrenia ; Serotonin ; Thalamus ; Tomography, Emission-Computed, Single-Photon*