Ju-Yeon Lee

BDNF promoter methylation and suicidal behavior in depressive patients

INTRODUCTION Suicide is a major health problem, and depression is a major psychiatric cause of suicide. Suicide is influenced by the multifactorial interaction of many risk factors. Therefore, epigenetic research may lead to understandings that are applicable to suicide. This study investigated whether epigenetic changes are associated with suicidal behavior and evaluated the treatment outcome of suicidal ideation in depressive patients. METHODS In 108 patients with major depression, the promoter methylation of the gene encoding brain-derived neurotrophic factor (BDNF) was measured. Sociodemographic and clinical characteristics including a history of previous depressive episodes, age at onset, duration of illnesses, family history of depression, and number of stressful life events as well as subjective perception of stress and assessment scales for depression (HAMD), anxiety (HAMA), function (SOFAS), disability (WHODAS-12), and quality of life (WHOQOL-BREF) were evaluated at baseline. Suicidal behavior was ascertained using a semistructured clinical interview with questions about severity and intent. Beck Scale for Suicide Ideation (BSS) was administered during 12 weeks of treatment with antidepressants. RESULTS A higher BDNF promoter methylation status was significantly associated with a previous suicidal attempt history, suicidal ideation during treatment, and suicidal ideation at last evaluation as well as with higher BSS scores and poor treatment outcomes for suicidal ideation. LIMITATIONS Methylation status was investigated with limited area of the BDNF gene and sample size was relatively small. CONCLUSIONS BDNF methylation status could be a proxy marker for previous suicidal attempts and a clinical biomarker for poor treatment outcomes of suicidal ideation in depression.

Rapid spontaneous resolution of a traumatic cervical epidural haematoma

A 45-year-old man presented with weakness and radiating pain in the left arm after being injured when a heavy object was dropped on his head while at work. The neurological examination on admission revealed weakness of the left extremities: arm Grade II and leg Grade IVþ. Hypoaesthesia was observed below the C3 sensory dermatome on the left side. The magnetic resonance imaging (MRI) of the cervical spine showed two epidural space-occupying lesions, which were slightly low intensity on T1-weighted images and high intensity on T2-weighted images (Fig. 1). The lesions were diagnosed as acute epidural haematomas. One in the high cervical region was located in the ventral epidural space, while the other, in the mid-cervical portion, was dorsal, mainly on the left side. After the first examination, we decided to perform surgical evacuation of the dorsal epidural haematoma in the mid-cervical area, but the patient refused the operation vigorously and was managed conservatively on the first day. Interestingly, on the second day the patient showed clinical improvement. The left leg motor weakness disappeared, the left arm power improved to grade IV and the radicular pain reduced. Based on the clinical improvement, we began to reconsider our original plan of surgical intervention. The first follow-up MRI on the third day showed that the majority of the dorsal haematoma had disappeared while the ventral haematoma remained (Fig. 2). These results encouraged us to keep managing the patient conservatively. After 3 weeks, the patient showed good recovery with minimal radicular pain in the left arm, and the second follow-up MRI showed a complete resolution of both haematomas (Fig. 3). Discussion

Prevalence and Correlates of Problematic Internet Experiences and Computer-Using Time: A Two-Year Longitudinal Study in Korean School Children

Objective To measure the prevalence of and factors associated with online inappropriate sexual exposure, cyber-bullying victimisation, and computer-using time in early adolescence. Methods A two-year, prospective school survey was performed with 1,173 children aged 13 at baseline. Data collected included demographic factors, bullying experience, depression, anxiety, coping strategies, self-esteem, psychopathology, attention-deficit hyperactivity disorder symptoms, and school performance. These factors were investigated in relation to problematic Internet experiences and computer-using time at age 15. Results The prevalence of online inappropriate sexual exposure, cyber-bullying victimisation, academic-purpose computer overuse, and game-purpose computer overuse was 31.6%, 19.2%, 8.5%, and 21.8%, respectively, at age 15. Having older siblings, more weekly pocket money, depressive symptoms, anxiety symptoms, and passive coping strategy were associated with reported online sexual harassment. Male gender, depressive symptoms, and anxiety symptoms were associated with reported cyber-bullying victimisation. Female gender was associated with academic-purpose computer overuse, while male gender, lower academic level, increased height, and having older siblings were associated with game-purpose computer-overuse. Conclusion Different environmental and psychological factors predicted different aspects of problematic Internet experiences and computer-using time. This knowledge is important for framing public health interventions to educate adolescents about, and prevent, internet-derived problems.

Interactions between a serotonin transporter gene, life events and social support on suicidal ideation in Korean elders

INTRODUCTION The functional polymorphism in the serotonin transporter gene linked promoter region (5-HTTLPR) may modify associations between environmental stressors and suicidality in adolescents and working-age adults. We investigated whether the 5-HTTLPR s/l polymorphism interacts with stressful life events (SLEs) and social support deficits (SSDs) on late-life suicidal ideation. METHODS 732 Korean community residents aged 65+ were evaluated and, of 639 without suicidal ideation, 579 (90.6%) were followed two years later. Prevalence and incidence of suicidal ideation was ascertained. Information on SLEs and SSDs were gathered, and covariates included socio-demographic characteristics, depressive symptoms, cognitive function, and disability. RESULTS Significant interactions were observed between 5-HTTLPR genotype, SLEs and SSDs on both prevalence and incidence of suicidal ideation after adjustment for covariates. The associations of SLEs and SSDs with suicidal ideation were strengthened in combination with higher numbers of s alleles, and were only significant predictors in those with s/s genotype. A significant three-way interaction between 5-HTTLPR genotype, SLEs and SSDs was also found. LIMITATIONS The generalizability of suicidal ideation as a marker of suicidality should be considered. CONCLUSIONS Gene-environment interactions on suicidal behavior are therefore identifiable even in old age.

Relationship between Suicidality and Low Self-esteem in Patients with Schizophrenia.

Objective Low self-esteem is associated with suicide risk in the general psychiatric population. The aim of this study was to examine associations between suicidality and self-esteem in patients with schizophrenia. Methods Subjects meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria for schizophrenia were enrolled. Sociodemographic and clinical variables, including previous suicide attempt history, were assessed. Psychopathology, self-esteem, and self-perceived stigma were also measured using the Positive and Negative Syndrome Scale, the Rosenberg Self-Esteem Scale (SES), the Beck Depression Inventory (BDI), the Beck Hopelessness Scale, and the Korean version of the Internalized Stigma of Mental Illness scale (K-ISMI). Results Of the total of 87 participants, 20 (23.0%) had attempted suicide. Patients with a history of suicide attempts had significantly higher scores on the BDI (p=0.036) and K-ISMI (p=0.009), and significantly lower scores on the SES (p=0.001). Analysis of covariance revealed that the SES scores were significantly lower in patients with a history of previous suicide attempts than in those with no history, after controlling for K-ISMI and BDI scores (p=0.039). Conclusion Low self-esteem appears to represent a psychological dimension that is closely related to suicide risk. Therefore, clinical attention should be paid to the evaluation and enhancement of low self-esteem in schizophrenia patients with suicidality. A longitudinal prospective study is required to ascertain whether low self-esteem leads suicide attempts.

Gender-specific Associations of the Brain-derived Neurotrophic Factor Val66Met Polymorphism with Neurocognitive and Clinical Features in Schizophrenia.

Objective To explore associations of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism with cognitive functioning and psychopathology in patients with schizophrenia. Methods We included 133 subjects meeting the DSM-IV criteria for schizophrenia who were in the post-acute stage of the disease. BDNF Val66Met genotypes were identified via polymerase chain reaction. The computerized neurocognitive function battery, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Scale (SOFAS), and the Subjective Well-being under Neuroleptic Treatment (SWN-K) were administered. Gender-stratified sub-analysis was also conducted to identify gender-specific patterns in the findings. Results In male patients, no significant difference in any measure by BDNF genotype was evident. In female patients, scores on the CDSS and total PANSS and all subscales were significantly higher in valine (Val) carriers. In addition, scores on the SOFAS and SWN-K were significantly lower in Val carriers. In terms of neurocognitive measures, female patients with the Val allele had significantly poorer reaction times and fewer correct responses on the Continuous Performance Test (CPT) and the Trail Making Test (Parts A and B). After adjustment of PANSS total scores and log-transformed CDSS scores, CPT outcomes were significantly poorer in female patients with than in those without the Val allele. Conclusion Gender-specific associations of the Val allele with poor neurocognitive function and more severe psychopathology were evident. Further studies are required to explore the mechanisms of these differences and the potential utility of the BDNF genotype as a predictor of outcome in patients with schizophrenia.

Factors associated with self‐rated sexual function in Korean patients with schizophrenia receiving risperidone monotherapy

This study aims to investigate the factors associated with sexual function in Korean patients with schizophrenia.

Association Between Vitamin D Insufficiency and Metabolic Syndrome in Patients With Psychotic Disorders

Objective This study examined the association between vitamin D and metabolic syndrome in patients with psychotic disorders. Methods The study enrolled 302 community-dwelling patients with psychotic disorders. Sociodemographic and clinical characteristics, including blood pressure, physical activity, and dietary habit were gathered. Laboratory examinations included vitamin D, lipid profile, fasting plasma glucose, HbA1c, liver function, and renal function. Vitamin D insufficiency was defined as <20 ng/mL. Clinical characteristics associated with vitamin D insufficiency were identified. Results Among the 302 participants, 236 patients (78.1%) had a vitamin D insufficiency and 97 (32.1%) had metabolic syndrome. Vitamin D insufficiency was significantly associated with the presence of metabolic syndrome (p=0.006) and hypertension (p=0.017). Significant increases in triglycerides and alanine transaminase were observed in the group with a vitamin D insufficiency (p=0.002 and 0.011, respectively). After adjusting for physical activity and dietary habit scores, vitamin D insufficiency remained significantly associated with metabolic syndrome and hypertension. Conclusion Vitamin D insufficiency was associated with metabolic syndrome and was particularly associated with high blood pressure, although the nature, direction and implications of this association are unclear.

Relationship between Problematic Internet Use and Post-Traumatic Stress Disorder Symptoms among Students Following the Sewol Ferry Disaster in South Korea

We investigated the association between problematic internet use (PIU) and post-traumatic stress disorder (PTSD) symptoms in children and adolescents in South Korea. A cross-sectional survey was administered to community students who attended primary, secondary, and high schools in the Jindo area 1–2.5 months after the Sewol ferry disaster. Of the 1,744 respondents, 392 students who were exposed to the disaster, witnessing the rescue work directly, were evaluated. PTSD symptoms were measured using the University of California Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD-RI). The severity of impairment caused by excessive internet use was evaluated using Youngs Internet Addiction Test. The Center for Epidemiological Studies Depression Scale (CES-D) and State Anxiety Inventory for Children (SAIC) were also used. Logistic regression analysis revealed that PIU was significantly and independently associated with a high level of PTSD symptoms. Our findings suggest that children and adolescents with PIU require intensive follow-up and special care to prevent the development of PTSD symptoms following a disaster.

Development and feasibility of smartphone application for cognitive-behavioural case management of individuals with early psychosis

This article describes the development of the smartphone application for cognitive‐behavioural case management of young individuals with early psychosis and examines the acceptance and potential clinical benefits of this application through a pilot survey.