Jee In Kang

ATTRIBUTION BIAS IN ULTRA-HIGH RISK FOR PSYCHOSIS AND FIRST-EPISODE SCHIZOPHRENIA

BACKGROUND Attribution style bias, such as a greater tendency to perceive hostility, has been reported to be associated with paranoia in multi-episode, chronic schizophrenia patients. The aim of this study was to investigate whether young, first-episode schizophrenia patients exhibited a perceived hostility bias and if this bias was correlated with persecutory symptoms. This study also explored whether this attribution bias, associated with paranoid tendencies, also emerged in participants at ultra-high risk (UHR) for psychosis. METHODS Thirty-nine normal controls, 24 UHR participants, and 20 young, first-episode schizophrenia patients were asked to complete the Ambiguous Intentions Hostility Questionnaire (AIHQ) and other psychosocial measures. The AIHQ, specifically developed for paranoia, is a self-report questionnaire about negative outcomes that varied intentionality (i.e., intentional, accidental, and ambiguous intentions). The perceived hostility, composite blame, and aggression bias scores were calculated, in this study, from the ambiguous situations. RESULTS First-episode patients with schizophrenia were found to have a perceived hostility bias, which was associated with persecutory symptoms. The UHR participants also showed an attribution bias for perceiving hostility and blaming others, and this attribution bias was linked to the paranoia process. CONCLUSIONS These findings suggest that a biased attribution style linked with paranoid symptoms may not only be present in first-episode psychotic patients but may already have evolved prior to the onset of frank psychotic symptoms. A biased attribution style may play a pivotal role in the persecutory process during the prodromal phase as well as a patients first schizophrenic episode.

A randomized controlled study of sequentially applied repetitive transcranial magnetic stimulation in obsessive-compulsive disorder.

OBJECTIVE The present study investigated possible therapeutic effects and safety of sequentially combined low-frequency repetitive transcranial magnetic stimulation (rTMS) to the right dorsolateral prefrontal cortex and supplementary motor area in patients with treatment-resistant obsessive-compulsive disorder. METHOD Between February 2007 and January 2008, we carried out a study with a rater-blinded, sham-controlled design in which 20 patients with treatment-resistant obsessive-compulsive disorder, confirmed by a psychiatrist after use of the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version, were randomly assigned to either active rTMS (n = 10) or sham treatment (n = 10). Over 10 days, rTMS of 1 Hz was given at 110% of the motor threshold for 20 minutes over the right dorsolateral prefrontal cortex and sequentially at 1 Hz at 100% of the motor threshold for 20 minutes over the supplementary motor area. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS) score. RESULTS For the between-group analyses, there were no significant differences over 4 weeks between the active and sham groups on the YBOCS (F = 0.01, P = .92) and the Montgomery-Asberg Depression Rating Scale (MADRS; F = 0.39, P = .54). In repeated-measures analyses on all subjects, there was a significant effect of time on the YBOCS (F = 5.48, P = .009) and the MADRS (F = 6.55, P = .004). There were no significant group-by-time interactions for the YBOCS (F = 0.03, P = .94) or the MADRS (F = 0.09, P = .67). CONCLUSIONS These findings suggest that 10 sessions of sequential rTMS of the right dorsolateral prefrontal cortex and the supplementary motor area at low frequency had no therapeutic effect on obsessive-compulsive symptoms. However, rTMS was a safe method of treatment, and there was no significant change in cognitive function after rTMS. Further controlled studies using a more sophisticated sham system in larger samples are required to confirm the effect of rTMS in obsessive-compulsive disorder. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00932204.

Temperament and character in subjects with obsessive-compulsive disorder

BACKGROUND The aims of this study were to evaluate the differences between personality traits of patients with obsessive-compulsive disorder (OCD) and normal controls using the Temperament and Character Inventory (TCI) and to examine the relationship of personality traits and the severity of obsessive-compulsive (OC) symptoms. We also aimed to examine the influence a particular personality trait might have on the 5 factor-analyzed symptom dimension scores of OCD. METHOD We recruited 130 patients with OCD and 185 age- and sex-matched normal controls. All subjects completed the TCI. Patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale, and the factor-analyzed symptom dimension scores from the Y-BOCS checklist. RESULTS Patients with OCD had higher harm avoidance scores and lower self-directedness (SD), reward dependence (RD), and cooperativeness (C) scores than the controls. Lower SD scores and lower C scores were associated with OC symptom severity measured by the Y-BOCS after adjusting for age and depression severity. Hoarding dimension of OC symptoms was associated with lower SD scores and higher persistence (P) scores after adjusting for age, OC symptom severity, and depression severity. CONCLUSIONS There were significant differences in TCI subscales between patients with OCD and controls. Particular personality traits may have an influence on the severity and the dimensions of OC symptoms.

The relationship between psychosocial functioning and resilience and negative symptoms in individuals at ultra-high risk for psychosis

Objective: Decline in psychosocial functioning seems to be a core feature in schizophrenia across various phases of the disorder. Little is known about the relationship between psychosocial functioning and protective factors or psychopathologies in individuals in the prodrome phase of psychosis. We aimed to investigate whether psychosocial functioning is impaired in individuals in the putative prodromal phase of schizophrenia, and, if so, to identify factors associated with compromised psychosocial functioning. Method: Sixty participants at ultra-high risk (UHR) for psychosis and 47 healthy controls were recruited. All subjects were assessed in terms of psychosocial functioning using the Quality of Life Scale. A clinical assessment of psychopathology and protective factors, including resilience and coping style, was also conducted. Results: Psychosocial functioning in UHR participants was found to be compromised; this dysfunction was associated with negative symptoms, adaptive coping, and resilience. In addition, baseline resilience was lower among those in the UHR group who converted to frank psychosis than among those who did not. Conclusions: These findings imply that treatment strategies for individuals at UHR for psychosis should be comprehensive, promoting resilience as well as targeting the reduction of positive and negative symptoms to foster social reintegration and recovery.

Abnormalities of emotional awareness and perception in patients with obsessive–compulsive disorder

BACKGROUND Emotional awareness deficit may play a critical role in the production and maintenance of obsessive-compulsive symptoms and social dysfunction in patients with obsessive-compulsive disorder (OCD). The aim of this study was to investigate characteristics of emotional awareness such as empathy and alexithymia in OCD patients. In addition, we examined whether impaired emotional awareness measured by self-assessment questionnaires was associated with emotional facial recognition ability in OCD patients. METHODS Study participants included 107 patients with OCD and 130 healthy age- and sex-matched volunteers. The Interpersonal Reactivity Index (IRI) and Toronto Alexithymia Scale-20 were applied as measures of empathy and alexithymia. A subset of 56 patients with OCD additionally performed the emotional perception task of face expression. RESULTS Patients with OCD scored significantly lower for perspective taking, and significantly higher for personal distress of IRI, and significantly higher for alexithymia compared to normal controls. Impaired emotional awareness such as lower perspective taking and fantasy seeking had a perception bias towards disgust in response to ambiguous facial expressions in OCD patients. LIMITATIONS The OCD group consisted of patients in different stages of the illness and with different degrees of severity. CONCLUSIONS OCD involves the impairment of emotional awareness and perception and it may relate to social dysfunction and to impairments in the ability to shift naturally from obsessive thoughts to other thoughts in response to social situations in patients with OCD.

Coping strategies and their relationship to psychopathologies in people at ultra high-risk for psychosis and with schizophrenia.

This studys aim was to investigate coping strategies and their relationship to symptoms in people at ultra high risk (UHR) for psychosis compared with recent-onset schizophrenia (SPR) and healthy controls. Thirty-three UHR participants, 22 SPR patients, and 33 healthy controls completed the Ways of Coping Questionnaire and other clinical measures. People at UHR for psychosis showed significantly more reliance on tension-reduction and less reliance on problem-focused coping than healthy controls. The SPR group showed more reliance on tension-reduction coping than healthy controls at a trend level. Maladaptive coping patterns were associated with higher levels of negative symptoms, depression, and anxiety in both the UHR and SPR groups. These findings suggest that maladaptive coping strategies might have already emerged in the (putative) prodromal stage and could influence symptom severities.

The association of 5-HTTLPR and DRD4 VNTR polymorphisms with affective temperamental traits in healthy volunteers

BACKGROUND There has been growing evidence that temperamental traits, including affective temperaments, are heritable and associated with genetic polymorphisms. The purpose of the present study was to investigate the possible relationship between affective temperaments and the triallelic serotonin transporter gene-linked polymorphic region (5-HTTLPR) and dopamine receptor D4 (DRD4) polymorphisms in healthy Korean subjects. METHODS Three hundred thirty-five healthy college students were recruited, and 290 participants with a complete data set (172 males, 118 females) were included in the data analysis. The DNA of the subjects was isolated from whole blood cells, and the 5-HTTLPR and DRD4 variable number of tandem repeats polymorphisms were genotyped using polymerase chain reaction. Participants performed the 110-item version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire (TEMPS-A) measuring five affective temperamental traits. RESULTS A significant association was found between the DRD4 polymorphism and the cyclothymic and irritable temperaments in male subjects. No significant association was shown between the 5-HTTLPR gene polymorphisms and affective temperaments. LIMITATION Our data were collected from a specific group of college students and cannot be generalized easily to other non-clinical populations. In addition, Korean version of the TEMPS-A used in this study has not yet been validated in Korean population. CONCLUSIONS This study showed a possible association between the DRD4 polymorphism and certain affective temperaments in the Korean male population. The clarification of the biological basis of predisposing temperaments such as cyclothymic temperament might help to understand the pathophysiology and mechanisms of mood disorders.

Relationships between chronotypes and affective temperaments in healthy young adults

BACKGROUND Chronotype, an individual׳s preferred time for activity and sleep, has been known to be associated with affective disorders. Affective temperaments may be subclinical manifestations that represent a biological diathesis for affective disorders. Therefore, the aim of this study is to investigate the relationships between circadian preferences and affective temperaments. METHODS Six hundred and forty one healthy young adults (376 male, 265 female) completed the Korean Translation of Composite Scale of Morningness to measure diurnal preferences and the Temperament Scale of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A) to measure cyclothymic, depressive, hyperthymic, irritable, and anxious affective temperaments. Multivariate analyses of covariance were computed with the five affective temperaments as dependent variables, chronotype and gender as an independent variable, and age as a covariate. RESULTS One hundred and sixteen subjects were classified as having morning-type (18.1%), 402 as intermediate-type (62.7%), and 123 as evening-type (19.2%) circadian preferences. Evening-type was significantly associated with greater depressive, cyclothymic, irritable, and anxious temperaments, while morning-type was significantly associated with hyperthymic temperament. LIMITATIONS The present study only used self-report questionnaires to measure diurnal preference. CONCLUSIONS Evening-type subjects were more likely to have depressive, cyclothymic, irritable and anxious temperaments, whereas morning-types were more likely to have hyperthymic temperament. This relationship between chronotype and affective temperament might be important for vulnerability to affective disorders.

Multidimensional Measures of Impulsivity in Obsessive-Compulsive Disorder: Cannot Wait and Stop

Objective Although the relationship between obsessive compulsive disorder (OCD) and impulsivity has long been debated, impulsivity has not been systematically examined in clinical samples of OCD. Meanwhile, recent findings suggest that impulsivity is multi-dimensional construct that can be examined through several constructs. Therefore, this study is aimed to evaluate multiple facets of impulsivity in OCD. Method The recruitment includes 80 OCD and 76 healthy control participants. Participants completed a test battery comprising three behavioral tasks of stop signal task (SST), delay discounting task (DDT) and balloon analog risk test (BART), and one self-report measure of the Barratt Impulsiveness scale (BIS-11). Results OCD subjects showed significantly lower stop signal reaction time of SST reflecting higher action impulsivity and higher delay discounting parameter of DDT suggesting increased choice impulsivity but significantly lower adjusted mean pump of BART implying lower risk taking propensity of BART than healthy control. Conclusion Increased Action and choice impulsivity, and decreased risk taking propensities were found in OCD. These findings seem to be consistent with clinical characteristics of OCD such as greater preference for or avoid risky situations (avoidance), inability to wait tension relief may provoke safety behaviors (compulsion) and inability to stop already started behaviors (repetition).

Abnormal brain response during the auditory emotional processing in schizophrenic patients with chronic auditory hallucinations

OBJECTIVE Few neuroimaging studies have been conducted regarding clinical associations between auditory hallucinations (AHs) and affective disturbances in patients with schizophrenia. This study aimed to elucidate the neurobiological basis of emotional disturbances in schizophrenic patients with persisting AHs. METHODS Using functional magnetic resonance imaging (fMRI), the cortical responsiveness during the processing of laughing and crying sounds was measured and compared between 14 hallucinating schizophrenic patients, 14 nonhallucinating schizophrenic patients and 28 normal controls. RESULTS The hallucinating patients showed differential neural activities in various areas including the amygdala, the hippocampus, the cingulate, the prefrontal cortex, and the parietal cortex, compared with the nonhallucinating patients and the normal controls. In particular, compared with the nonhallucinators, the hallucinators revealed reduced activation in the left amygdala and the bilateral hippocampus during the processing of crying sounds. CONCLUSION Our findings suggest that the persistence of AHs in schizophrenia may induce functional disturbances of the emotion-related interconnected neural networks, including reduced responsiveness in the amygdala and hippocampus to negative stimuli.