• The Korean Journal of Applied Statistics
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• v.20 no.3
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• pp.449-458
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• 2007

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in person's mood, energy, and ability to function. Compared with manic episode, the depression episode causes more serious results such as restless, loss of interest or pleasure, or thoughts of death or suicide and the cure rate of depression episode is lower than that of manic episode. Furthermore, a long term use of antidepressants in bipolar patients may result in manic episode. Our interest is to investigate the effect of antidepressant on switch of moods of bipolar patients and to estimate the transition probabilities of switch between moods, depression and (hypo) manic. In this study, three approaches are applied in terms of multi state model. Parametric model is applied using left censoring data and nonparametric model is implemented under illness-death model with counting process. In order to estimate the effect of covariates, a multiplicative model is used. These all methods have similar results.

• Korean Journal of Psychosomatic Medicine
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• v.6 no.1
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• pp.79-84
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• 1998

Authors report a case of poststroke bipolar disorder that occurs much less frequently than poststroke depression(PSD). A MRI study performed to identify the etiology of a secondary manic episode in a patient with preceded PSD after left basal ganglia infarction revealed newly developed right basal ganglia infarction associated with poststroke bipolar disorder. It is interesting to note that (1) the temporal relationship was found between the occurrence of PSD after left hemisphere stroke and the occurrence of poststroke bipolar disorder following right hemisphere stroke, and that (2) the occurrence of PSD and the occurrence of poststroke bipolar disorder are associated with lesion location respectively. It has been reported that bipolar disorders were associated with subcortical lesions of the right hemisphere, whereas right-cortical lesions led to unipolar mania and that risk factors for mania included a family history of psychiatric disorders and mild subcortical atrophy. In this case, MR image shows subcortical lesions of the right hemisphere and mild subcortical atrophy. The investigation of the relationships among stroke lesion locations and potstroke mood disorders and risk factors for poststroke bipolar disorder may contribute to understanding the neurobiology of primary mood disorder. A clinical implication is that the risk of secondary bipolar disorder after cerebral infarction should be highlighted.

• Korean Journal of Biological Psychiatry
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• v.8 no.1
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• pp.96-105
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• 2001

Objective : Lithium inhibits the action of inositol monophosphatase(IMPase) in phosphoinositide(PI) signal transduction system at therapeutically relevant concentration. The depletion of inositol by lithium itself cannot explain the lithium's therapeutic effect. However, attention has focused on the abnormality of PI signal transduction system as the pathophysiology of bipolar affective disorder(BPD). We investigated whether IMPase mRNA levels of lymphocytes would be different between BPD patients(n=16) and age, sex-matched normal controls(n=16). We also investigated the change of IMPase mRNA level by lithium during 4 weeks to probe the possibility that IMPase mRNA levels could predict the therapeutic response to lithium and clinical course. Method : Relative IMPase mRNA levels in lymphocyte were quantified by reverse transcriptase(RT)-PCR in sixteen drug-free BPD patients and sex, age-matched normal controls. The psychopathology of patients were measured using YMRS (Young Mania Rating Scale) and CGI(Clinical Global Impression). Results : There was no significant difference in IMPase mRNA levels between BPD patients and normal controls. And the IMPase mRNA levels were not significantly changed by 4 week treatment with lithium. However, the basal IMPase mRNA levels were negatively correlated with the changes of CGI after 4 weeks. Furthermore, the patients with relatively high basal IMPase mRNA levels showed much more improvement during 4 weeks. Conclusions : BPD patients and normal controls were not distinguished by lymphocyte IMPase mRNA level. Although we do not support the hypothesis that lymphocyte IMPase activity would be related with the pathogenesis of BPD and the action of lithium, these data raise the possibility that lymphocyte IMPase mRNA levels could function as a predictor of therapeutic response and clinical course of BPD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.1
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• pp.124-131
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• 2005

Childhood and adolescent onset-bipolar disorders have higher rate of comorbidity with anxiety disorders as well as attention deficit hyperactivity disorder and conduct disorder. Obsessive compulsive disorder, social phobia, panic disorder, and separational anxiety disorder are common comorbid anxiety disorders with bipolar disorders in child and adolescent. Prospective and reliable data on temporal and causal relationship between the onset of bipolar disorders and the onset of comorbid anxiety disorders are still in debate. The authors report 2 adolescent cases with antidepressant induced-manic episodes with preceding anxiety symptoms. The authors suggest careful prescription of antidepressants for anxiety disorders, even for those who do not have definite past history or family history of bipolar disorders. Further comprehensive and prospective studies are requested for the temporal relationship and pharmacological guideline for comorbid bipolar disorders and anxiety disorder in child and adolescent.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.115-121
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• 2002

Objectives: Although sleep paralysis (SP) has been known as one of the symptoms of narcolepsy, recently it has become recognized as occurring frequently in the general population. However, the prevalence of SP and its associated factors in patients with major psychiatric disorders remain unknown. This study investigated the prevalence of SP and a variety of associated experiences in those patients. Methods: The subjects were 160 psychiatric patients and 143 age- and sex-matched controls. The Korean version SP questionnaire as well as the Sleep-Wake Schedule, Epworth Sleepiness Scale and Insomnia Severity Index were administered to all the subjects. The patients were referred from Dong-A University Hospital and consisted of 74 diagnosed as schizophrenia (47.7%), 26 as bipolar disorder (16.8%) and 55 as major depression (35.5%). Results: Nearly 42% of the patient group and 39% of the control group had experienced at least one episode of SP in their lifetime, with no significant difference between the groups. However, the patient group had experienced SP more frequently than the control group. Among all subjects, no gender difference in SP incidence was found. The peak age of onset was in the range of 16-25 years for both groups. Over eight tenths of both groups reported hallucinations and over seven tenths of both groups experienced fear accompanying SP. Conclusion: This study shows that there is no difference in the lifetime prevalence of SP between psychiatric patients and the general population, whereas frequency of SP experience is higher in psychiatric patients. Terrifying hallucinations and fearful feelings frequently accompany SP in both groups.

• Korean Journal of Psychosomatic Medicine
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• v.22 no.2
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• pp.112-120
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• 2014

Objectives : The aim of this study is to evaluate the clinical characteristics of night eating syndrome(NES) in bipolar disorder outpatients. Methods : The 14 items of self-reported night eating questionnaire(NEQ) was administered to 84 bipolar patients in psychiatric outpatient clinic. We examined demographic and clinical characteristics, body mass index(BMI), subjective measures of mood, sleep, binge eating & weight-related quality of life using Beck's Depression Inventory (BDI), Pittsburgh Sleep Quality Index(PSQI), Binge Eating Scale(BES) and Korean version of Obesity-Related Quality of Life Scale(KOQoL), respectively. Results : The prevalence of night eating syndrome in bipolar outpatients was 14.3%(12 of 84). Comparisons between NES group and non-NES group revealed no significant differences in demographic characteristics, BMI and clinical status except economic status and comorbid medical illnesses. However, compared to non-NES, patients with NES was more likely to have binge eating pattern and poorer weight-related quality of life. Conclusions : This study is to be the first to describe the clinical correlates of night eaters in bipolar outpatients. Although there were few significant correlates of NES in bipolar outpatients, relatively high prevalence of NES suggest that clinicians should be aware to assess the patients with bipolar disorder on NES, regardless of obesity status of patients.

• Korean Journal of Psychosomatic Medicine
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• v.18 no.1
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• pp.19-29
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• 2010

Objectives：Authors hypothesized that bipolar tendency of non-psychiatric person would be associated with stress vulnerability. To test the hypothesis, we compared perceived stress level, Type A Behavioral Pattern (TABP) and unhealthy lifestyle between person with and without bipolar tendency. Methods：The study cohort consisted of 1987 subjects without past and current psychiatric history. In this study, bipolar tendency was determined by MDQ response which requires endorsement of at least 7 of the 13 "yes or no" questions. We compared the scores of Perceived Stress Scale, A/B lifestyle questionnaire, and unhealthy lifestyle(alcohol, smoking, lack of exercise, irregular meal) between MDQ positive and negative respondents. Results：We identified the bipolar tendency group determined by the MDQ positive response were 329 subjects(16.6%). The overall score of the bipolar tendency group was significantly high on the A/B lifestyle questionnaire compared to the non-bipolar tendency group(125.4 vs. 115.9, p<0.001), and the rate of the subjects defined as TABP was also significantly high(41.3% vs. 30.1%, p<0.001). In comparison of subjectively perceived stress level, the bipolar tendency group was observed to be significantly higher than the non-bipolar tendency group (18.5% vs. 16.5%, p<0.001). The bipolar tendency group was significantly higher than the non-bipolar tendency group on the rate of answering：'irregular eating habit' (20.1% vs. 14.3%, p=0.002), '4-or-more-times alcohol intake per week' (29.8% vs. 16.5%, p<0.001), 'currently smoking' (41.9% vs. 23.0%, p<0.001), '2-or-less-times physical exercises per week' (63.2% vs. 55.1%, p=0.007). Conclusion：By clinical diagnosis, even a person who does not meet the criteria of bipolar disorder has a high risk of stress-related behavioral pattern, and perceived stress when possessing bipolar tendencies such as the (hypo) maniac tendency or affective instability. Such individual has significantly higher risk of having unhealthy life-style such as smoking, drinking, irregular eating habit and lack of exercise compared to non-bipolar tendency group. Since these risk factors lead to increase the risk of obesity, metabolic syndrome, diabetes, and cardiovascular diseases, the individual with the bipolar tendency requires a more effort to manage stress and to maintain healthy lifestyle.

• Korean Journal of Biological Psychiatry
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• v.18 no.1
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• pp.15-24
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• 2011

Mood disorder is unlikely to be a disease of a single brain region or a neurotransmitter system. Rather, it is now generally viewed as a multidimensional disorder that affects many neural pathways. Growing neuroimaging evidence suggests the anterior cingulate-pallidostriatal-thalamic-amygdala circuit as a putative cortico-limbic mood regulating circuit that may be dysfunctional in mood disorders. Brain-imaging techniques have shown increased activation of mood-generating limbic areas and decreased activation of cortical areas in major depressive disorder(MDD). Furthermore, the combination of functional abnormalities in limbic subcortical neural regions implicated in emotion processing together with functional abnormalities of prefrontal cortical neural regions probably result in the emotional lability and impaired ability to regulate emotion in bipolar disorder. Here we review the biological correlates of MDD and bipolar disorder as evidenced by neuroimaging paradigms, and interpret these data from the perspective of endophenotype. Despite possible limitations, we believe that the integration of neuroimaging research findings will significantly advance our understanding of affective neuroscience and provide novel insights into mood disorders.

• Sleep Medicine and Psychophysiology
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• v.22 no.1
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• pp.5-10
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• 2015

The secretion of melatonin exhibits a circadian rhythm entrained with the sleep-wake cycle. An alteration of this secretory rhythm has been found in various psychiatric disorders. This review summarizes the regulation of melatonin and its relationship to the circadian rhythm, major depressive disorder, bipolar disorder, seasonal affective disorder, Alzheimer's disease and autism. The review also looks at the effect of melatonin and melatonin agonist on sleep and symptoms of depression, bipolar disorder and seasonal affective disorder. In Alzheimer's disease, the circadian rhythm alterations are associated with the change of melatonin levels and melatonin receptors. It has been reported that melatonin and melatonin synthetic enzyme levels decrease in autism spectrum disorder.

• Korean Journal of Biological Psychiatry
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• v.28 no.1
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• pp.13-22
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• 2021

Objectives Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. Methods A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. Results Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). Conclusions This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course. Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.