Jeong Ho Chae

Distinct processing of facial emotion of own-race versus other-race.

We investigated the neural basis underlying the effect of race on incidental facial emotional processing using functional MRI. Thirteen healthy Korean men underwent functional MRI while viewing photographs of Korean (own-race) and Caucasian (other-race) emotional faces while performing a sex discrimination task. Responses to other-race relative to own-race neutral faces replicated previous studies: activations were obtained in dorsolateral prefrontal cortex/medial frontal cortex. Direct contrasts between-race emotional faces (happy and sad) also showed differential effects: the contrast of own-race relative to other-race had more activations in limbic areas (amygdala and hippocampus), whereas the contrast of other-race relative to own-race had more activations in frontal, occipital, and parietal lobes. Our findings provide evidence for differential processing of emotional faces as a function of race.

Impact of early-life stress and resilience on patients with major depressive disorder

Purpose Early-life stress (ELS) has a long-lasting effect on affective function and may entail an increased risk for major depressive disorder (MDD). However, resilience can play a protective role against developing psychopathology. In this study, we investigated the relationships of depressive symptoms with ELS and resilience in MDD. Materials and Methods Twenty-six patients with MDD as well as age- and gender-matched healthy controls were included in this study. Each subject was assessed concerning ELS, resilience, and depressive symptom severity with self-report questionnaires. Independent samples t-test and Mann-Whitney test were performed to compare ELS and resilience between the patient and control groups. Spearman correlation analyses and linear regression analysis were conducted to investigate significant ELS and resilience factors associated with depressive symptoms. Results In the MDD patient group, subjects reported greater exposure to inter-parental violence, and five factor scores on the resilience scale were significantly lower in comparison to the control group. In linear regression analysis, in regards to resilience, depressive symptom score was significantly associated with self-confidence and self-control factors; however, ELS demonstrated no significant association with depressive symptoms. Conclusion Among resilience factors, self-confidence and self-control may ameliorate depressive symptoms in MDD. ELS, including inter-parental violence, physical abuse and emotional abuse, might be a risk factor for developing depression. Assessment of early-life stress and intervention programs for increasing resilience capacity would be helpful in treating MDD.

Gender-Specific Effects of Brain-Derived Neurotrophic Factor Val66Met Polymorphism and Childhood Maltreatment on Anxiety

Background: Although the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is thought to play an important role in the pathophysiology of anxiety, studies on the association between the BDNF polymorphism and anxiety have reported inconsistent results. As possible confounders in determining anxiety, childhood maltreatment and gender as well as their interactions with BDNF polymorphism have been suggested. This study examined the effect of BDNF genotype, childhood maltreatment, and their interaction on anxiety levels by gender. Methods: A total of 206 unrelated Korean healthy young adults (108 were male and the mean age was 23.1 ± 3.2 years) were genotyped for the BDNFVal66Met polymorphism. Measures for anxiety and childhood maltreatment were completed. The main and interaction effects of BDNF polymorphism and childhood maltreatment on anxiety were analyzed by general linear models in all subjects and then in gender-stratified groups. Results: Gender-specific analyses revealed that the interaction effect was significant only in males (p = 0.014). Interestingly, male subjects with the Val/Met genotype tended to be resilient against the increased anxiety after childhood maltreatment. In females, the main effects of both BDNF genotype and childhood maltreatment were significant (p = 0.024 and p = 0.009, respectively) and post-hoc analysis revealed that the Val/Val genotype was associated with a higher anxiety than the Met/Met genotype (p = 0.004). Conclusions: Our results support the interaction effect between the BDNFVal66Met polymorphism and childhood maltreatment in determining anxiety and further emphasize the possible moderating role of gender in this gene-environment interaction.

The neural substrates of affective face recognition in patients with Hwa-Byung and healthy individuals in Korea.

Hwa-Byung (HB) is a Korean culture-bound psychiatric syndrome caused by the suppression of anger. HB patients have various psychological and somatic symptoms, such as chest discomfort, a sensation of heat, and the sensation of having an epigastric mass. In this study, we measured brain activity in HB patients and healthy individuals in response to affective facial stimuli. Using functional magnetic resonance imaging (fMRI), the current study measured neural responses to neutral, sad, and angry facial stimuli in 12 healthy individuals and 12 patients with HB. In response to all types of facial stimuli, HB patients showed increased activations in the lingual gyrus and fusiform gyrus compared with healthy persons, but they showed relatively lower activation in the thalamus. We also found that patients with HB showed lower activity in response to the neutral condition in the right ACC than healthy controls. The current study indicates that the suppression of affect results in aberrant function of the brain regions of the visual pathway, and functional impairment in the ACC may contribute to the pathophysiology of HB.

Impairment of work productivity in panic disorder patients

BACKGROUND Panic disorder (PD) has a critical impact on productivity at the workplace. This study aimed to identify the lost productivity time (LPT) for patients with PD. It also assessed change in LPT for patients with PD after 12 weeks of treatment with Selective Serotonin Reuptake Inhibitors (SSRIs), compared with healthy controls. METHODS Working patients diagnosed with PD without other major medical or psychiatric illness were enrolled at outpatient psychiatric clinics (N=108). Age and sex-matched healthy controls were recruited through advertisement (N=108). Health and productivity, PD symptoms, and depressive symptoms were assessed using the Korean version of the World Health Organizations Health and Work Performance Questionnaire (HPQ), the Panic Disorder Severity Scale (PDSS), and the Hamilton Rating Scales for Depression (HAM-D), respectively at baseline, week 4, and week 12. RESULTS At baseline, the PD group showed significantly higher LPT compared to the control group (103.02 vs. 47.28h in the past 4 weeks). After 12 weeks of treatment, the PD group displayed significant clinical improvement as well as improved productivity with a marked reduction in LPT. Among the patients who completed the treatment, LPT due to PD was reduced from 104.38 to 55.15h in the past 4 weeks. LIMITATIONS There may be selection bias due to case-control study design. CONCLUSIONS These data suggest that, after the treatment, there was significant improvement in clinical symptoms, and that productivity loss due to PD was almost entirely recovered to the level of healthy controls after 12 weeks of psychiatric outpatient treatment.

Association between BDNF Gene Polymorphisms and Serotonergic Activity Using Loudness Dependence of Auditory Evoked Potentials in Healthy Subjects

It has been proposed that the loudness dependence of auditory evoked potentials (LDAEP) would be a reliable indicator of central serotonin system activity in humans. Serotonin levels and turnover are also increased by brain-derived neurotrophic factor (BDNF). The aim of the present study was to determine whether there is an association between genetic polymorphisms of BDNF and the LDAEP in healthy Korean young adults. The cohort comprised 211 mentally and physically healthy subjects, all of whom were nonsmokers (111 males, 100 females; age: 20∼32 years). To avoid hormonal effects, the LDAEP was measured during days 2–5 after the beginning of menstruation for female subjects. In addition, BDNF polymorphisms (rs6265, rs2030324, and rs1491850) were genotyped. The strength of the LDAEP differed significantly among the BDNF genotype groups. Furthermore, the distribution of genotypic frequencies differed significantly between subjects with high and low LDAEPs. In particular, subjects with the Val/Met (A/G) genotype for rs6265, the T/T genotype for rs2030324, or the C/C genotype for rs1491850 had a higher LDAEP, indicating lower central serotonergic activity. A low LDAEP was more prevalent than a high LDAEP among those with the C-T haplotype (C genotype for rs2030424 and T genotype for rs1491850). Our results concur with previous findings on BDNF polymorphisms and serotonergic drug responses in psychiatric disorder patients. The present results suggest the possibility that BDNF polymorphisms and LDAEP patterns can predict altered serotonergic activity.

Psychometric properties of the Korean version of the Interpersonal Sensitivity Measure (IPSM-K)

The aim of this study was to investigate the psychometric properties of a Korean version of Interpersonal Sensitivity Measure (IPSM). A Korean version of the IPSM (IPSM-K) was produced through forward translation, reconciliation, and back translation. A total of 338 healthy, non-clinical participants were selected through screening and clinical interview, and they each were given a set of questionnaires including IPSM-K. All subscales, as well as a full-scale IPSM-K showed satisfactory internal consistency (Cronbachs alpha=0.73-0.83 and 0.94, respectively). Test-retest reliability at 2-week intervals was significant, with coefficient r ranging between .80 and .94. In terms of convergent validity, IPSM-K showed the significant positive correlation with sociotropy and autonomy subscale of Personal Style Inventory-II, as well as with neuroticism subscale of Neuroticism Extraversion Openness-Personality Inventory. IPSM-K had no correlation with Social Desirability Scale, thus demonstrated divergent validity with social desirability. A factor analysis of the scale was conducted and five factors emerged (low self-confidence, interpersonal awareness, lack of assertiveness/separation anxiety, interpersonal vulnerability, and need for approval). This study demonstrated that IPSM-K could be useful in assessing interpersonal sensitivity in Korean population.

The Diagnostic Stability of DSM-IV Diagnoses: An Examination of Major Depressive Disorder, Bipolar I Disorder, and Schizophrenia in Korean Patients.

Objective We examined the stability of diagnoses defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) (major depressive disorder [MDD], bipolar I disorder [BID], and schizophrenia [SPR]) by means of retrospective reviews of medical records. Methods Data from patients who met the DSM-IV criteria for the aforementioned disorders according to two psychiatrists and who were followed for at least 2 years were included in this study. We reviewed the medical records and compared the diagnosis given at the index admission with assessments made every 6 months for 2 years after discharge to determine diagnostic stability. Results A total of 138 patients with MDD, 56 patients with BID, and 107 patients with SPR who were followed for 2 years were included in the final analyses. The data showed that 84.8% of the sample retained their initial diagnosis of MDD during the first year; this figure decreased to 79.0% during the second year. During the first year, 93.5% retained their initial diagnosis of BID, and this figure decreased to 89.3% during the second year; 86.8% and 86.9% retained their diagnosis of SPR during the first and second years, respectively. Conclusion This study showed the instability of three major DSM-IV diagnoses among Korean patients. Additionally, the results demonstrated that accurate diagnosis using the current diagnostic system requires longitudinal observation.

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved family members of the Sewol ferry accident were recruited. Severity of complicated grief, post-traumatic stress disorder (PTSD) and depressive disorder was assessed through self-reporting questionnaire, inventory of complicated grief (ICG), PTSD Check List-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9). We also included demographic, socioeconomic, health-related variables, and Functional Social Support Questionnaire (FSSQ), which affect the ICG score. Participants were divided into 4 groups based on the experience of psychotherapy or psychiatry clinic service before the accident and mental health support after the disaster. In univariate analysis, these 4 groups showed a significant difference in the mean ICG score (P = 0.020). Participants who received mental health support only after the Sewol ferry accident (group 2) showed a lower mean ICG score than those who received neither psychotherapy or psychiatry clinic service before the disaster nor mental health support after the accident (group 4). There was no significant correlation between the ICG score and other variables except for subjective health status measured 1 month after the disaster (P = 0.005). There was no significant difference in PCL-5 (P = 0.140) and PHQ-9 scores (P = 0.603) among groups, respectively. In conclusion, mental health support significantly reduced the severity of grief only in those participants who had not received any psychotherapy or psychiatry clinic service before the accident.

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

Objective This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. Methods Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). Results Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. Conclusion The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.