• 생물정신의학
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• 제13권3호
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• pp.152-161
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• 2006

Objective : The relationship between the total daily dose of clozapine given and the plasma concentrations of clozapine and its metabolites(N-desmethylclozapine and clozapine N-oxide) and the effect of Glu158Lys (wild-type : Glu, 'H' ; variant : Lys, 'h') and Glu308Gly(wild-type : Glu, 'D' ; variant : Lys, 'd') variation in FMO3 gene on plasma concentrations of clozapine and its metabolites was studied in schizophrenic patients. Methods : Trough plasma concentrations of clozapine and its metabolites were measured in 34 schizophrenic patients receiving clozapine. The genetic variation of 'h' and 'd' in FMO3 were analyzed in 21 among 34 patients. Results : A linear relationship between the total daily dose of clozapine given(mg/kg body weight per day) and the plasma concentrations(nM) of clozapine was revealed by regression analysis(p<0.001) in the 23 patients receiving a constant daily dose of clozapine for 8 days. The plasma molar concentration ratios of clozapine N-oxide/clozapine in 8 subjects with 'hh' or 'Hh' alleles were not different from those in 6 subjects with 'HH' alleles and the plasma molar concentration ratios in 6 subjects with 'dd' or 'Dd' alleles were not different from those in 8 subjects with 'DD' alleles. Conclusion : The effect of Glu158Lys and Glu308Gly variation in FMO3 gene on clozapine metabolism could not be shown.

• 생물정신의학
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• 제12권2호
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• pp.151-158
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• 2005

Background:Clozapine is a unique atypical antipsychotic medication. It is considered to be superior, even amongst the newer agents, in treatment-resistant schizophrenia. However, de novo emergence or exacerbation of obsessive-compulsive(OC) symptoms during treatment with clozapine has been reported. We prospectively evaluated 19 cases which newly developed OC symptoms during clozapine treatment and discussed the treatment of OC symptoms induced by it. Methods:We recruited 19 patients(8 males, 11 females) with a DSM-IV diagnosis of schizophrenia and schizoaffective disorder who had developed OC symptoms during clozapine treatment. OC symptoms were assessed using the Padua-ICMA and YBOCS on a monthly basis over three months. Results:Eleven female and eight male patients were enrolled and the average age of patients was 32.8 years. At baseline, no patients showed OC symptoms. Moderate to severe OC symptoms appeared with mean daily dose of 298.68 mg of clozapine. There were no significant differences in improving OC symptoms between the clozapine dose reduction group and the OC treatment group. Conclusion:We noticed the possibility that the appearance of OC symptoms is connected with the effect of clozapine. The clozapine-induced OC symptoms were improved both by reducing clozapine daily doses, and by adding OC treatment drugs. With other atypical antipsychotics now available, to know and treat the side effects of clozapine would be of considerable value, offering clinical guidance in making a decision on treatment-resistant schizophrenia.

• 생물정신의학
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• 제1권1호
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• pp.67-78
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• 1994

The author examined the relationship of two markers, D5S39(p105-153Ra), D5S76(p105-599Ha) of chromosome 5 and $D_2$, $D_3$ receptor genes in a Korean schizophrenic pedigree using polymerase chain reaction(PCR). The results were as follows : 1) On D5S39 locus, 5 different alleles(224/226 bp : 4 cases, 218/226 bp : 3 cases, 222/226 bp : 3 cases, 218/230 bp : 1 case, 222/224 bp : 1 case) were produced. 2) On D5S76 locus, 5 different alleles(102/112 bp : 4 cases, 94/112 bp : 3 cases, 108/112 bp 3 cases, 94/94 bp : 1 case, 102/108 bp 1 case) were produced. 3) On $D_2$ receptor gene, 3 different alleles($A_1A_2$ : 8 cases, $A_1A_1$ : 2 cases, $A_2A_2$ : cases) were produced. 4) On $D_3$ receptor gene, 2 different alleles(1/2 : 7 cases, 1/1 : 5 cases) were produced. The author had not find any specific alleles on all four loci in all pedigree nor any specific alleles in the schizophrenic patients. Though the author has not found absolute relationship between the four loci and the onset of schizophrenia, there still remains the possibilities if the more detailed and elaborated pedigree studies are done.

• 생물정신의학
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• 제10권1호
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• pp.54-61
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• 2003

Object : This cross-sectional study was performed in order to evaluate the prevalence of tardive dyskinesia among the hospitalized schizophrenic patients. Methods : Four hundred nineteen hospitalized schizophrenic patients(male=263, female=156) were recruited for this study. They were treated with antipsychotics for more than 3 months. The prevalence of tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale. Results : The prevalence of tardive dyskinesia was 35.6%(Male=36.9%, Female 33.3%). There were no significant differences in the prevalence of tardive dyskinesia among male and female schizophrenic patients. The prevalence of tardive dyskinesia among the patients over 30years old was much higher than those below 30years old. There were no significant correlations between the prevalence of tardive dyskinesia and the duration of hospitalization, the total amount of antipsychotics. The frequently involved parts of the body in the schizophrenic patients who have tardive dyskinesia were tongue, upper extremity, lips and perioral area, jaw, lower extremity, muscles of facial expression trunk, respectively. Conclusions : There was significant correlation between the age and the prevalence of tardive dyskinesia in the antipsychotic-treated schizophrenic patients. There were no correlations between the prevalence of tardive dyskinesia and gender difference, the duration of hospitalization, the total amount of antipsychotics.

• 생물정신의학
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• 제16권4호
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• pp.256-265
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• 2009

Objectives : The aims of this study were to assess a) the prevalence of trauma and posttraumatic stress disorder(PTSD) in schizophrenic patients and b) the differences in symptomatology and outcome after 1year treatment between those with and without PTSD. Methods : Twenty eight schizophrenia and schizoaffective disorder patients completed the Positive and Negative Syndrome Scale(PANSS), Life Stressor Checklist-Revised(LSCL-R), Clinician-Administered PTSD Scale(CAPS), Dissociative Experiences Scale(DES), Hamilton Psychiatry Rating Scale for Depression(HAM-D), and Rosenberg Self-Esteem Scale(RSE). Results : Twenty six patients(92.9%) had at least one trauma in their life time. Eleven patients(39.3%) were diagnosed with PTSD. PTSD group had significantly higher scores on HAM-D and DES but lower scores on RSE. PTSD group also had significantly lower score in the baseline PANSS Negative score. Higher CAPS scores were significantly correlated with lower baseline PANSS Negative score and greater change after 1year of PANSS Negative score. Conclusion : These results showed that the prevalences of trauma and PTSD are high in schizophrenic patients and suggested that PTSD and trauma-related symptoms affected the symptomatology and treatment outcome. More research is warranted to better understand the effects of PTSD in schizophrenic patients.

• 생물정신의학
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• 제15권3호
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• pp.211-218
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• 2008

Objectives : The purpose of this study is to compare the ability of facial affect perception among schizophrenia patients, their first degree relatives, and normal control subjects. Methods : Thirty five patients with schizophrenia, 22 first degree relatives, and 34 normal control subjects were recruited in this study. All three groups were matched for age and education levels. The facial affect identification test(FAIT), and neurocognitive test were applied. In the FAIT, the correct response rate, perceived intensity, and sensitivity for 6 kinds of affects were compared among three groups. Results : We found that correct response rate of sadness and anger were decreased in the schizophrenia patients compared with the normal control group. Also the schizophrenia patients showed reduced sensitivity for all six affects compared with the normal control group. The ability of facial affect perception in first degree relatives of schizophrenia patients was decreased but there were not any significant differences compared with normal control group. Conclusion : This study confirmed significantly reduced ability of facial affect perception in schizophrenia patients compared with normal control. Decreased ability of facial affect perception in first degree relatives suggests that affective sensitivity can be influenced by genetic predisposition.

• 생물정신의학
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• 제11권1호
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• pp.54-60
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• 2004

Objectives:Tardive dyskinesia(TD) is a serious side effect associated with long-term antipsychotic treatments. Some candidate genetic polymorphisms were reported to be associated with TD and possible involvement of serotonergic receptors in the pathophysiology of TD has been suggested. In the present study, we investigated the association between $5-HT_6$ receptor gene polymorphism and TD with schizophrenia. Methods:To investigate the relationship between $5-HT_6$ receptor gene polymorphism and TD, 60 patients with TD were compared with 60 patients without TD. The 267C/T allele of $5-HT_6$ receptor gene was genotyped by means of polymerase chain reaction method. TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). Results:The patients with the three 267C/T genotype showed no significant differences in age, gender, and duration of illness. No significant difference in genotype frequencies was observed between schizophrenic patients with and without TD. In addition, there was no difference in allele frequencies. Further analysis with an measure of AIMS scores showed that these scores were not significantly influenced by the $5-HT_6$ receptor gene polymorphism. Conclusion:These results suggest that 267C/T polymorphism of $5-HT_6$ receptor gene is not significantly associated with susceptibility to TD in schizophrenia.

• 생물정신의학
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• 제11권1호
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• pp.40-48
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• 2004

Objective:Event-related potentials(ERPs) are electrical changes recorded at the surface of the scalp in response to stimulus presentation, and their latency and amplitude change according to cognitive processes. Through past studies of the auditory ERP in schizophrenia, the P300 has been reported to be statistically smaller and delayed in schizophrenia than comparison groups. However, studies of the visual ERP have not been systematically examined. The present study was designed to investigate the visual P300 in patients with schizophrenia and normal controls and to compare the pattern of P300 between them. Methods:The subjects were composed of patients(N=22) with schizophrenia by DSM-IV and normal controls(N=22). The visual ERPs were measured by the visual continuous performance test. P300 amplitude and latency measured on 5 scalp electrodes(Fz, Cz, Pz, $T_7$, $T_8$) were compared between patients and controls. Results:The P300 latencies measured on Fz, Cz, Pz, and $T_7$ electrodes were significantly longer in patients than controls(p<0.05). The P300 amplitudes in patients were smaller than controls. However, the difference between them was not statistically significant. Conclusion:Analysis of the visual ERPs showed that the P300 latency is significantly delayed and the P300 amplitude is slightly smaller in patients than controls. These results are similar to established studies of the auditory P300 in schizophrenia.

• 생물정신의학
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• 제13권2호
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• pp.82-94
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• 2006

Objectives : In order to explore effects of board-game therapy for cognitive rehabilitation in patients with schizophrenia, we investigated the change of executive cognitive function over a 2-month period of board-game therapy in patients with schizophrenia. Methods : Two groups of chronic schizophrenic inpatients were participated in this study. One group(n=21) were treated with board-game therapy for 2 months and the other control group(n=19) were not treated. For the evaluation of the executive cognitive function, a Wisconsin Card Sorting Test(WCST) was administered before and after the introduction of the board-game therapy. PANSS score change was also evaluated. Result : At the beginning of this study, there was no significant difference in performance of cognitive function tests, demographical data or clinical severity between both patient groups. After 2 months of treatment with the board-game therapy, the board-game therapy group showed significant improvements of executive cognitive function without any significant change of their schizophrenic symptoms. On the contrary, there was no change in control group. Conclusion : This study showed that a board-game therapy is effective for the enhancement of executive cognitive function in patients with chronic schizophrenia. A board-game therapy could be introduced with ease into psychiatric fields, such as inpatients' or outpatients' clinic wards and day hospital. Our result indicates that the board-game therapy is a promising tool for the enhancement of cognitive function, especially executive cognitive function and helpful for cognitive rehabilitation for schizophrenic patients.

• 생물정신의학
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• 제16권3호
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• pp.170-180
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• 2009

Objectives : To assess clinical improvement and change in plasma brain-derived neurotrophic factor(BDNF) level after repetitive transcranial magnetic stimulation(rTMS) in patients with treatment-resistant schizophrenia. Methods : Seven patients with DSM-IV schizophrenia, who were proven to be treatment-resistant, were treated with 15 sessions of rTMS for three weeks as an adjuvant therapy to antipsychotic treatment. Clinical improvement and change in plasma BDNF level were measured after the treatment period. The symptom severity was assessed with the Positive and Negative Syndrome Scale(PANSS) and the Korean Version of Calgary Depression Scale for Schizophrenia(K-CDSS) at baseline and 7 days after the treatment. Plasma BDNF level was measured by enzyme-linked immunosorbent assay(ELISA) at baseline and 7 days after the treatment. Results : After the rTMS treatment, there was no significant improvement in PANSS total score(Z=-1.693, p=0.090) and no significant change in plasma BDNF was found(Z=-1.183, p=0.237). Negative correlations were found between percentage change in PANSS positive subscale score and duration of illness(rho=-0.991, N=7, p<0.0005, two-tailed), and PANSS negative subscale score at baseline and percentage change in plasma BDNF level(rho=-0.821, N=7, p=0.023, two-tailed). Conclusion : This preliminary study suggests that rTMS didn't make a significant change in clinical symptoms nor in plasma BDNF level in treatment-resistant schizophrenia. Percentage change in plasma BDNF, however, might be correlated with treatment resistance in schizophrenic patients. This is a pilot study with a small sample size, therefore, a further study with a larger sample size is needed.