Jeewook Choi

Preliminary Evidence for White Matter Tract Abnormalities in Young Adults Exposed to Parental Verbal Abuse

BACKGROUND Psychiatric sequelae of exposure to parental verbal abuse (PVA) appear to be comparable with that of nonfamilial sexual abuse and witnessing domestic violence. Diffusion tensor imaging (DTI) was used to ascertain whether PVA was associated with abnormalities in white matter (WM) tract integrity. METHODS 1271 healthy young adults were screened for exposure to childhood adversity. Diffusion tensor imaging was collected on 16 unmedicated subjects with history of high-level exposure to PVA but no other form of maltreatment (4 male/12 female subjects, mean age 21.9 +/- 2.4 years) and 16 healthy control subjects (5 male/11 female subjects, 21.0 +/- 1.6 years). Group differences in fractional anisotropy (FA), covaried by parental education and income, were assessed using tract-based spatial statistics (TBSS). RESULTS Three WM tract regions had significantly reduced FA: 1) arcuate fasciculus in left superior temporal gyrus, 2) cingulum bundle by the posterior tail of the left hippocampus, and 3) the left body of the fornix. Fractional anisotropy in these areas was strongly associated with average PVA scores (r(s) = -.701, -.801, -.524, respectively) and levels of maternal verbal abuse. Across groups, FA in region 1 correlated with verbal IQ and verbal comprehension index. Fractional anisotropy in region 2 was inversely associated with ratings of depression, dissociation, and limbic irritability. Fractional anisotropy in region 3 was inversely correlated with ratings of somatization and anxiety. CONCLUSIONS Exposure to PVA may be associated with alteration in the integrity of neural pathways with implications for language development and psychopathology.

Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests

The potential relationship between Internet addiction and certain cognitive function problems has been suggested by several studies. However, few or no studies have examined the differences in cognitive functioning between persons addicted to the Internet and persons not addicted using a standard neuropsychological test. This study screened 253 middle school students and 389 high school students for Internet addiction and compared 59 Internet-addicted students with 43 non-addicted students using an IQ test. The Internet-addicted group had comprehension sub-item scores that were significantly lower than those of the non-addicted group. As the comprehension item reflects ethical judgement and reality testing, there may be a relationship between Internet addiction and weak social intelligence. Earlier onset of Internet addiction and longer addiction duration were associated with lower participant performance in areas related to attention. As this study is a cross-sectional study, it is not clear whether the persons who display weak cognitive functioning are susceptible to Internet addiction or if Internet addiction causes cognitive problems. However, as brain development remains active during adolescence, the possibility that Internet addiction adversely affects the cognitive functioning of adolescents cannot be ruled out.

Plasma Concentration of Prolactin, Testosterone Might Be Associated with Brain Response to Visual Erotic Stimuli in Healthy Heterosexual Males

Objective Many studies have showed that excess or lack of sexual hormones, such as prolactin and testosterone, induced the sexual dysfunction in humans. Little, however, is known about the role of sexual hormones showing normal range in, especially, the basal state unexposed to any sexual stimulation. We hypothesized sexual hormones in the basal state may affect sexual behavior. Methods We investigated the association of the sexual hormones level in the basal hormonal state before visual sexual stimulation with the sexual response-related brain activity during the stimulation. Twelve heterosexual men were recorded the functional MRI signals of their brain activation elicited by passive viewing erotic (ERO), happy-faced (HA) couple, food and nature pictures. Both plasma prolacitn and testosterone concentrations were measured before functional MR scanning. A voxel wise regression analyses were performed to investigate the relationship between the concentration of sexual hormones in basal state and brain activity elicited by ERO minus HA, not food minus nature, contrast. Results The plasma concentration of prolactin in basal state showed positive association with the activity of the brain involving cognitive component of sexual behavior including the left middle frontal gyrus, paracingulate/superior frontal/anterior cingulate gyri, bilateral parietal lobule, right angular, bilateral precuneus and right cerebellum. Testosterone in basal state was positively associated with the brain activity of the bilateral supplementary motor area which related with motivational component of sexual behavior. Conclusion Our results suggested sexual hormones in basal state may have their specific target regions or network associated with sexual response.

Aberrant function of frontoamygdala circuits in adolescents with previous verbal abuse experiences.

Previous studies reported an association of depressive disorder and structural alteration of frontolimbic brain regions in subjects with emotional abuse experiences during childhood and adolescence. The results suggest that aberrant function of the frontolimbic circuit and its relation with psychiatric symptoms can be found in adolescents with preclinical status. We investigated functional changes of frontolimbic networks during implicit negative emotional face processing and their relationships with depressive symptoms in adolescents with previous verbal abuse experiences. We designed a gender discrimination task using emotional faces to induce an implicit level of emotional exposure, and was completed by 31 preclinical male adolescents during an fMRI scan. The right amygdala activity and its functional connectivity with the rostral anterior cingulate cortex (ACC) during implicit processing of negative emotional faces showed a significant relationship with previous verbal abuse experiences. The hierarchical regression analyses showed that their current depressive symptoms were associated with aberrant functional interaction between the right amygdala activity and right amygdala-rostral ACC connectivity. Our findings of verbal abuse-related functional changes in the right frontoamygdala circuit may be related to vulnerability to future mood disorder.

Effect of osmotic-release oral system methylphenidate on learning skills in adolescents with attention-deficit/hyperactivity disorder: an open-label study.

We evaluated the effect of osmotic-release oral system (OROS) methylphenidate on learning skills in adolescents with attention-deficit/hyperactivity disorder (ADHD). In an open-label study, 121 adolescents with ADHD were administered flexible doses of OROS methylphenidate for 12 weeks. The efficacy of methylphenidate on ADHD symptoms was evaluated by ADHD Rating Scale (ARS) and Clinical Global Impression Scale (CGI). Learning Skills Test (LST) was used to measure the learning skills of the participants at the baseline and the endpoint. Continuous performance test, visuospatial and verbal working memory, verbal fluency, and inhibition were evaluated before and after the 12 weeks of treatment. The mean total and subscores of LST were significantly increased after the 12-week treatment with OROS methylphenidate. Executive functions were also improved during the trial, with the exception of inhibition measured by the Stroop Test. To the best of our knowledge, this is the first study to examine the influence of OROS methylphenidate on learning skill. As a result, OROS methylphenidate was effective in enhancing learning skills in adolescents with ADHD.

School refusal behavior in South Korean first graders: A prospective observational community-based study

Refusing to attend school is a serious problem that could lead to psychopathology. We aimed to: (1) prospectively observe the actual development of school refusal behavior according to a history of separation anxiety symptoms (SAS) and (2) explore factors for predicting school refusal behavior in children who were just beginning primary school. The participants were 277 children, aged 6-7 years, who were expected to enter primary school in 2 months. The parents were surveyed about the child׳s history of SAS and their behavior. The children were questioned about anxiety symptoms. The children were surveyed about whether school refusal behavior developed or not after they entered primary school. Of the 248 children who responded to the follow-up survey, 7.66% of children met the criteria for school refusal behavior during the 3 months after entering school. We found no significant differences in the occurrence of school refusal behavior according to the children׳s SAS history. Familial risk factors for school refusal behavior included low parental educational level and a working mother. School refusal behavior by first graders cannot be fully explained by the expression of SAS and could be implicated in a more complex psychopathology.

The psychometric properties of the Korean version of the Verbal Abuse Questionnaire in university students

Objective The aim of the present study was to examine the psychometric properties of the Korean Verbal Abuse Questionnaire (K-VAQ) that consists of 15 items related with life-time verbal aggression exposure. Methods A total of 5814 university students who agreed to take part in the study completed the K-VAQ, the Korean version of the Life Event CheckList (LEC-K) and Impact of Event Scale-Revised (K-IES-R). Internal consistency was checked by using item-total item correlation and Cronbachs alpha coefficient. Exploratory and confirmatory factor analyses were performed, and convergent and concurrent validity levels were examined. Finally, a cluster analysis was conducted to verify the validity of the cutoff point of the K-VAQ. Results The Cronbachs alpha correlation coefficient was 0.9. The K-VAQ showed a single factor structure which explained 55.34% of the total variance. The K-VAQ was significantly associated with the LEC-K (r=0.24) and K-IES-R (r=0.28), indicating good convergent validity and concurrent validity. The cluster analysis provided four clusters of trauma experiences: high, moderate, low, and minimal, with K-VAQ ranges of 43-81, 20-42, 7-19, and 0-6, respectively. In a further investigation, a K-VAQ score of 40 was found to be the appropriate cutoff point to delineate the highly verbally abused group, as used in the previous studies. A sum of 36.5% of the highly verbally abused group reported to show substantial symptoms of PTSD (K-IES-R score >22). Conclusion The present findings suggest that the K-VAQ has good psychometric properties for assessing verbal aggression among the Korean population.

Two different solicitation methods for obtaining information on adverse events associated with methylphenidate in adolescents: A 12-week multicenter, open-label study

OBJECTIVE We explored two different methods of determining adverse events (AEs) among methylphenidate (MPH)-treated adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS We performed a 12-week open label study of osmotic-release oral system (OROS) MPH in adolescents with ADHD who were recruited from four child and adolescent psychiatric outpatient clinics. The AEs were evaluated via a two-step procedure at weeks 1, 3, 6, and 12. The first step was to ask a general question to subjects and their parents regarding AEs. The second step included an AE evaluation process by the investigators, which was performed using a drug-specific checklist. One-way repeated measures ANOVA were used to compare the number of AEs reported by patients and their parents compared with the number reported by clinicians. This statistical technique was also used to compare the number of AEs reported by various sources (i.e., patients, parents, and clinicians) at weeks 1, 3, 6, and 12. RESULTS Of the 55 participants (43 males, 12 females) between the ages of 12 and 18 enrolled in this study, 47 participants completed the trial. When the number of AEs reported by patients, parents and clinicians were compared, there were no statistically significant differences. When the numbers of AEs obtained from the three different information sources at each study visit were compared, we noted differences. At week 6, the number of AEs evaluated by clinical investigators was higher than those reported by patients and their parents (p=0.003). Although the results did not reach statistical significance, the number of AEs reported by clinical investigators appeared to be greater than those obtained from patients or parents at weeks 3 and 12. The number of AEs reported by patients and their parents were similar at every visit. There were some differences in the pattern of AEs reported between patients and their parents. CONCLUSIONS Clinicians should supplement the subjective report on AEs from patients or their parents with a more drug-specific checklist to obtain drug side effects more effectively. As there are some differences in the pattern of AEs reported by patients and their parents, it is generally recommended that clinicians obtain information from both parties when possible.

Formative Experiences: Ontogenetic Perspectives on the Neurobiological Basis of Psychopathology Following Abuse and Neglect

INTRODUCTION The US Federal Child Abuse Prevention and Treatment Act defines child abuse and neglect as the recent act or failure of parents and caretakers resulting in physical or emotional injury, sexual exploitation, and/or death. According to national statistics on the prevalence of childhood abuse and neglect in the United States, 905,000 people under 18 years of age were victimized during 2006. Of these, 64.1% were neglected; 16.0% were physically abused; and 15.1% suffered abandonment, threats of harm, congenital drug addiction, or other forms of maltreatment. Furthermore, 8.8% were sexually abused; 6.6% were either emotionally or psychologically maltreated; and 2.2% were medically neglected. Childhood maltreatment is a major risk factor for the development of depression, drug and alcohol abuse, posttraumatic stress disorder (PTSD), bipolar disorder (BPD), personality disorders, and aggression. Depending on an individuals sex, genetic makeup, and age at insult, chronic childhood traumatic stress (CTS) alters the endocrine profile and gene-expression pattern, as well as the functional activity, hemispheric integration, and morphology of the brain. In this chapter, we offer a holistic portrayal of the pathways between maltreatment and adverse psychiatric outcomes, arguing that the impact of abuse and neglect is best understood in the context of normal ontogenetic processes relating to trajectories of brain development. NEUROPSYCHIATRIC EFFECTS OF TRAUMA Several studies have documented the consequences of exposure to CTS. One of the most compelling is the Adverse Childhood Experience (ACE) Study, led by Vincent Felitti and Robert Anda (Felitti et al., 1998).

Hippocampal Subfields Volume Reduction in High Schoolers with Previous Verbal Abuse Experiences

Objective Reduced hippocampal volume and alterations in white matter tracts have been frequently reported in adults having the history of emotional maltreatment. We investigated whether these structural change occur in adolescents with previous verbal abuse (VA) experiences. Methods Hippocampal subfield volume and white matter structural connectivity measures were assessed in 31 first year male high school students with various degrees of exposure to parental and peer VA. Results The high VA group showed significant volume reduction in the left cornu ammonis (CA) 1 and left subiculum compared to the low VA group (p<0.05). Volumes of left hippocampal subfields CA1 and subiculum were negatively correlated with previous VA experiences (p<0.05). Increased mean diffusivity (MD) of the splenium of the corpus callosum was related to high VA score across all subjects (p<0.05). There was an inverse relationship between volume of the CA1 and subiculum and MD of the splenium (p<0.05). Conclusion Exposure to parental and peer VA may affect development of the left hippocampal subfields and the splenium of corpus callosum. These structural alterations can be discernible during adolescence.