Beomwoo Nam

The Changes of Blood Glucose Control and Lipid Profiles after Short-Term Smoking Cessation in Healthy Males

Objective Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. Methods Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the β-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). Results The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA β-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). Conclusion During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.

Comparing the Effects of Bupropion and Escitalopram on Excessive Internet Game Play in Patients with Major Depressive Disorder

Objective Several studies have suggested the efficacy of bupropion and escitalopram on reducing the excessive internet game play. We hypothesized that both bupropion and escitalopram would be effective on reducing the severity of depressive symptoms and internet gaming disorder (IGD) symptoms in patients with both major depressive disorder and IGD. However, the changes in brain connectivity between the default mode network (DMN) and the salience network were different between bupropion and escitalopram due to their different pharmacodynamics. Methods This study was designed as a 12-week double blind prospective trial. Thirty patients were recruited for this research (15 bupropion group+15 escitalopram group). To assess the differential functional connectivity (FC) between the hubs of the DMN and the salience network, we selected 12 regions from the automated anatomical labeling in PickAtals software. Results After drug treatment, the depressive symptoms and IGD symptoms in both groups were improved. Impulsivity and attentional symptoms in the bupropion group were significantly decreased, compared to the escitalopram group. After treatment, FC within only the DMN in escitalopram decreased while FC between DMN and salience network in bupropion group decreased. Bupropion was associated with significantly decreased FC within the salience network and between the salience network and the DMN, compared to escitalopram. Conclusion Bupropion showed greater effects than escitalopram on reducing impulsivity and attentional symptoms. Decreased brain connectivity between the salience network and the DMN appears to be associated with improved excessive IGD symptoms and impulsivity in MDD patients with IGD.

Efficacy and Tolerability of Paliperidone Extended-release in the Treatment of First-episode Psychosis: An Eight-week, Open-label, Multicenter Trial

Objective We investigated the efficacy and tolerability of paliperidone extended-release (ER) tablets in patients with first-episode psychosis (n=75). Methods This was an 8-week, open-label, multicenter trial. The primary outcome variable was scores on the Positive and Negative Syndrome Scale (PANSS); secondary measures included the Scale for the Assessment of Negative Symptoms (SANS), the Cognitive Assessment Interview (CAI), and the Global Assessment of Functioning (GAF). To assess safety, we measured drug-related adverse events, weight, lipid-related variables, and prolactin and administered the Simpson–Angus Rating Scale (SARS), the Abnormal Involuntary Movement Scale (AIMS), the Barnes Akathisia Scale (BAS), the Arizona Sexual Experiences Scale (ASEX), and the Udvalg for Kliniske Undersogelser side effect rating scale (UKU). Results The administration of paliperidone ER resulted in significant improvement in the PANSS, SANS, CAI, and GAF scores (p<0.001) over time. This improvement was evident as early as 1 week. The most frequent adverse events were akathisia, somnolence, anxiety, and sedation, which were well tolerated. Modest increases in weight and lipid profiles were also noted. Prolactin levels were substantially increased at the endpoint in both male and female patients. Conclusion These results indicate that paliperidone ER is effective and is characterized by good tolerability in the treatment of positive and negative symptoms and cognitive functioning in first-episode psychosis.

The effects of care management on depression treatment in a psychiatric clinic: a randomized controlled trial.

This study aims to examine whether care management has an effect on adherence to depression treatment in a psychiatric clinic in Korea.

T230. DOSE TRENDS OF ARIPIPRAZOLE FROM 2004 TO 2014 IN PSYCHIATRIC INPATIENTS IN KOREA

Abstract Background The purpose of the present study was to evaluate the initial and maximum doses of aripiprazole over a decade to estimate appropriate dosage in clinical practice. We hypothesized that there was a measurable change in dosing patterns during 2004–2014 in Korean psychiatric inpatients. Methods In this retrospective study, we reviewed the medical records of patients who were hospitalized in the psychiatric ward of five university hospitals in Korea from March 2004 to December 2014. The patients were at least 18 years of age, prescribed aripiprazole during the index hospitalization and were given at least one prescription for oral aripiprazole. We compared baseline demographic variables among Waves 1 (2004–2006), 2 (2007–2010) and 3 (2011–2014) using univariate one-way analysis of variance (ANOVA) with Bonferroni correction for continuous variables and a chi-square test for categorical variables. Results There was a significant difference in mean age among waves (p = 0.012). The use of concomitant medications with aripiprazole was significantly different among waves, as well. The use of other atypical antipsychotics in Wave 1 was 27.0% (n = 20) and 27.4% (n = 55) in Wave 2 and increased to 36.5% (n = 129) in Wave 3, but the difference between Waves 1 and 3 (p = 0.118) and 2 and 3 (p = 0.027) did not reach statistical significance after Bonferroni’s correction. In total, the initial dose of aripiprazole was significantly lower in Wave 3 (7.0 ± 3.9 mg/day) when compared to Waves 1 (10.9 ± 4.6 mg/day, p<0.001) and 2 (10.7 ± 5.6 mg/day, p<0.001). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2. Discussion The results from the present study show that the initial doses of aripiprazole, and not the maximum doses, decreased in hospitalized psychiatric patients with the accumulation of clinical experience in aripiprazole use.

S110. THE CLINICAL IMPLICATION OF CLINICIAN-RATED DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY (CRDPSS) FOR DIAGNOSIS BY DSM-5

Abstract Background The most recently published the 5th edition of the DSM proposed a dimensional approach with continuous of schizophrenia and other psychoses. The newly proposed Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the DSM was recommended to be evaluated in all disorders with psychotic symptoms in eight dimensions; Hallucinations, Delusions, Disorganized speech, Abnormal psychomotor behavior, Negative symptoms, Impaired cognition, Depression, Mania. The purpose of this study is to examine if Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) can usefully be used for the Non-Affective Psychoses (NP) and Affective Psychoses (AP). Methods Participants in the study were 175 diagnosed with Schizophrenia, or Schizophreniform Disorder, Schizoaffective Disorder, mood disorder with psychotic symptoms (Major Depressive Disorder, Bipolar Disorder) based on DSM-5 diagnostic criteria and were assigned to either the NP (n = 154) or AP (n = 21) group. CRDPSS was performed jointly by a psychiatrist and a psychiatric resident to assess the severity of the psychotic symptoms of all the participants. And WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was responded to all participants. Independent T-test was conducted to determine whether there was a difference in CRDPSS profile and WHODAS 2.0 scores between the two groups. In addition, a linear discriminant analysis was performed to determine whether the CRDPSS profile can discriminate between the two groups. Results Demographics and WHODAS 2.0 had no statistically significant differences between the two groups. On the other hand, Patients in the NP group had higher Hallucination (p < .05) and Negative symptoms (p < .001), however, lower Mania (p < .001). As a result of constructing a linear discriminant function for NP and AP, the correct classification rate of CRDPSS to discriminate between two groups was 84%. Discussion The results of this study are the first to distinct effectively that Non-Affective psychoses and Affective psychoses by CRDPSS profile. There was no difference in the level of functional disability between groups NP and AP, but only CRDPSS profile could discriminate both groups. Hallucinations, Negative symptoms, and Mania were the major contributors to the distinction between the two groups. This is consistent with the previous studies that these are important in distinguishing Schizophrenia and Bipolar Disorder from each other. CRDPSS provides a new perspective that can be viewed from an integrated perspective, the NP and AP. Regarding the result of this study that it is more important to identify the score profile than the combined score of CRDPSS, because patients exhibit very heterogeneous profile of symptoms.

T116. CAFFEINE-INDUCED PSYCHIATRIC MANIFESTATIONS

Abstract Background The association between caffeine consumption and various psychiatric manifestations has long been observed. Methods We present two cases that show the ability of caffeine to induce psychotic and manic symptoms, and we also review the extant literature on caffeine-induced psychiatric manifestations. Results On the basis of our own and others’ findings, we suggest that caffeine may be related to not only de-novo psychotic or mood symptoms but also to aggravation of pre-existing psychotic or mood disorders. Discussion We therefore suggest that caffeine consumption among patients with mood or psychotic symptoms should be assessed carefully in clinical practice as part of routine psychiatric evaluations.

F194. ASSOCIATION STUDY BETWEEN TREATMENT RESPONSE OF AMISULPRIDE AND DOPAMINE D3 RECEPTOR GENE POLYMORPHISMS

Abstract Background The aim of this study is to evaluate the association between rs6280 and rs905568 genetic polymorphism of DRD3 gene and the treatment response of amisulpride. Methods After six weeks treatment of amisulpride, 125 schizophrenia patients were interviewed based on the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity (CGI-S). The genotyping for rs6280 and rs905568 was performed using TaqMan single nucleotide polymorphism (SNP) genotyping assay. Results There was no significant difference in the frequency of genotype and allele of rs6280 between the responders and non-responders based on the total, positive, and general score of PANSS and CGI-S score. However, there was a significant association between this SNP and treatment response in the negative score of PANSS (χ2 = 5.23, p = 0.022). There was no significant association between rs905568 and the response in positive, negative, general, and total PANSS score and CGI-S score. Discussion This is the first positive association study between DRD3 gene and the treatment response of negative symptoms to amisulpride in Korean schizophrenia patients. A larger scale research on more SNP of the DRD3 gene will make a progress in the study of pharmacogenetics on the treatment response of the amisulpride.

T251. THE STUDY OF QUALITY OF LIFE AND A GLOBAL FUNCTIONING FOR THE SCHIZOPHRENIA PATIENTS IN COMMUNITY BY THEIR RESIDENTIAL ENVIRONMENT

Abstract Background Mental health is so deeply related to our residential environment that the difficulties of residence could worsen it for schizophrenia patients. Moreover, patients with schizophrenia might induce severe residential problems such as poverty, discrimination, failure to education, frequent migration, homeless, and etc. This study investigated the quality of life and a global functioning for schizophrenia patients in community by their residential environment. Methods Total 648 patients with schizophrenia living in Jeollabukdo(province) were tested demographic and clinical characteristics. Housing and residential satisfaction were measured by the questionnaires established by Ministry of Land, Transport and Maritime Affairs and modified for this study. Psychiatric and psychological variables were assessed by Global Assessment Function (GAF) and World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL - BREF). Correlations among variables were analyzed using frequency analysis and Pearson’s product moment correlation coefficient. Results As the results of correlations between quality of life and housing satisfaction, correlations were shown at a global quality of life (r=0.312, p<.01), physical health (r=0.227, p<.01), psychological domain (r=0.215, p<.01), social relation domain (r=0.170, p<.01), and environmental domain (r=0.372, p<.01). For the correlation between quality of life and residential area satisfaction, a general quality of life (r=0.307, p<.01), physical health (r=0.242, p<.01), psychological domain (r=0.243, p<.01), social relation domain (r=0.169, p<.01), and environmental domain (r=0.306, p<.01) were correlated. Discussion The correlations among residential environment, quality of life, and a global functioning were significant. Consequently, it is necessary for the government policy that can improve housing and residential environment for the mentally disordered and ultimately contribute to enhance their welfare.

F115. INSIGHT AND MANIC SYMPTOMS IN PATIENTS WITH CHRONIC SCHIZOPHRENIA IN THE KOREAN COMMUNITY

Abstract Background Many studies have highlighted the similarity of the symptoms between bipolar disorders and schizophrenia. Moreover, there are no pathognomonic symptoms that can differentiate these two disorders, and 9% of schizophrenia patients have experienced a manic syndrome in their lifetime. Insight about their symptoms and illness is very important factor for the differential diagnosis and the management in schizophrenia. To examine the relationship among the insight, the psychotic and manic symptoms, and clinical variables in patients with chronic schizophrenia. Methods Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities have been evaluated with the Scale to assess Unawareness of Mental Disorder (SUMD), the Mood Disorder Questionnaire (MDQ), and the Brief Psychiatric Rating Scale (BPRS). Results The mean number of previous admission was 3.85. Their drug adherence was favorable (6.73 day/week). Mean CGI-S score was 3.8. Thirty-five percent of subject were MDQ positive (cutoff point = 7 or more). Among SUMD, “awareness of effect of medication” showed significant negative correlation (r = -0.33) with total MDQ score not with total BPRS score. The negative correlation was more obvious in participants with negative MDQ (total MDQ score 6 or less, r = -0.31). Several MDQ items (irritability, r = -0.25; decreased sleep, r = -0.27; thought racing, r = -0.28; and easy distractibility, r = -0.40) negatively correlated with “awareness of effect of medication”. In contrast, only one item (guilt feeling, r = -0.27) of BPRS revealed this correlation. Individual items in MDQ and BPRS rarely correlated with each other. Total MDQ score was not correlated with duration of illness and medication adherence. Discussion Manic symptoms were frequently detected even in schizophrenia as reported in previous studies. This made it difficult to differentially diagnose the disorder using only the total MDQ score. There was possible relationship between these manic symptoms and their insight. Identifying manic symptoms in schizophrenia would be considerable in clinical setting.