Kee Jeong Park

Antidepressant-emergent mood switch in Korean adolescents with mood disorder.

ObjectivesThe objectives of this study were to compare clinical characteristics of children and adolescents who experienced antidepressant-emergent mood switch (AEMS) and those who did not, and to investigate the predictors of AEMS in a clinical sample of Korean children and adolescents. MethodsTwo psychiatrists retrospectively reviewed the medical records of 115 children and adolescents (age, 15.0 [2.0] years; 45 boys) that were prescribed antidepressants or lamotrigine for the treatment of a depressive episode of bipolar or depressive disorders from March 2010 to February 2012 at the Department of Psychiatry of Asan Medical Center. The diagnosis was reviewed and confirmed for each subject. Demographic information, clinical characteristics, family history, and psychiatric comorbidities were compared across subjects with and without AEMS. ResultsTwelve subjects (10.4%) experienced AEMS. The latency to AEMS was 25.9 (20.9) days (range, 2–56 days; median, 18 days). Antidepressant-emergent mood switch was more frequent in subjects with bipolar disorder (BD) than in subjects with depressive disorder (P < 0.001) and in subjects with high socioeconomic status (P < 0.001). Previous suicidal attempt (P = 0.001), previous antidepressant exposure (P = 0.001), number of previous antidepressant exposures (P < 0.001), family history of other psychiatric disorder (P = 0.001), and concomitant antipsychotics (P = 0.006) were more common in subjects with AEMS than in subjects without AEMS. In multivariate logistic regression, diagnosis of BD (odds ratio [95% confidence interval], 15.94 [1.83–139.16]), concomitant antipsychotics (26.90 [2.43–297.38]), and family history of other psychiatric disorder (39.55 [3.05–512.22]) were significant predictors of AEMS. ConclusionsChildren and adolescents who experienced AEMS had distinct profiles of clinical characteristics. Antidepressant-emergent mood switch may be more associated with BD than with depressive disorder.

Clinical and Neuropsychological Characteristics of ADHD According to DSM-5 Age-of-Onset Criterion in Korean Children and Adolescents:

Objective: The aim of this study was to compare the clinical features and neuropsychological profiles of children and adolescents with ADHD according to the age-of-onset defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Method: We compared the following three groups: early-onset ADHD group (onset before age 7, n = 86), late-onset ADHD group (onset between ages 7 and 12, n = 58), and the control group (n = 88). Results: Both early-onset and late-onset ADHD groups had more symptoms and functional impairments than the control group. Also, both ADHD groups scored higher on ADHD Rating Scale, Parent General Behavior Inventory, majority of the subscales of Social Responsiveness Scale, Hyperactivity subscale of Korean Personality Rating Scale for Children, and Omission Errors of Visual Continuous Performance Test compared with the control group. Conclusion: Our results support the extension of age-of-onset criterion made in DSM-5.

Child behavior checklist profiles in adolescents with bipolar and depressive disorders

OBJECTIVE We aimed to evaluate the Child Behavior Checklist (CBCL) profiles in youths with bipolar and depressive disorders. METHODS Seventy-four subjects with a mean age of 14.9±1.6years (36 boys) with mood disorders and their parents were recruited from September 2011 to June 2013 in the Department of Psychiatry, Asan Medical Center, Seoul, Korea. Diagnosis of mood disorder and comorbid psychiatric disorder was confirmed by child psychiatrists using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime version (K-SADS-PL). The parents of the subjects completed the Parent General Behavior Inventory-10-item Mania Scale (P-GBI-10M), Parent-version of Mood Disorder Questionnaire (P-MDQ), ADHD rating scale (ARS) and CBCL. The adolescents completed the 76-item Adolescent General Behavior Inventory (A-GBI), Beck Depression Inventory (BDI), and Adolescent-version of Mood Disorder Questionnaire (A-MDQ). RESULTS When adjusted for gender and the comorbidity with ADHD, the Withdrawn and Anxious/Depressed subscale scores of the CBCL were higher in subjects with bipolar disorder than in those with depressive disorder. Higher scores of A-GBI Depressive subscale, A-MDQ and BDI were shown in subjects with bipolar disorder than in those with depressive disorder. There was no significant difference on CBCL-DP, P-GBI-10M, P-MDQ, A-GBI Hypomanic/Biphasic subscale and ARS between two groups. All eight subscales of the CBCL positively correlated with the P-GBI-10M and P-MDQ scores, and seven of all eight subscales of the CBCL positively correlated with A-GBI Depressive and Hypomanic/Biphasic subscales. The BDI score was positively associated with the Withdrawn, Somatic Complaints, Anxious/Depressed, and Social Problems subscale scores. CBCL-DP score was strongly correlated with manic/hypomanic symptoms measured by P-GBI-10M and P-MDQ (r=0.771 and 0.826). CONCLUSIONS This study suggests that the CBCL could be used for measuring mood symptoms and combined psychopathology, especially internalizing symptoms, in youth with mood disorder. However, CBCL-DP had limited ability to differentiate bipolar from depressive disorder, at least in adolescents.

F35. PRESCRIPTION PATTERN OF ANTIPSYCHOTICS FOR CHILDREN AND ADOLESCENTS WITH SCHIZOPHRENIA IN KOREA BASED ON NATIONWIDE DATA

Abstract Background This study aimed to analyze the extent and pattern of antipsychotic prescription for Korean children and adolescents with schizophrenia using population-based data. Methods Our data was retrieved from the Korean National Health Insurance Review & Assessment Service-National Sample for 2013, which was a stratified sampling from the entire population under the Korean national health insurance program. Among 0.2 million children and adolescents aged 6–18 years from data, subjects who had received any antipsychotic medication in the year were investigated for the prescribed medication and concomitant psychotropic medication. Results A total of 91 children and adolescents (mean age 16.2 ± 2.2 years, 53 boys) received antipsychotic medication. Among the prescriptions, risperidone (n = 59, 35.3%) and aripiprazole (n = 34, 20.4%) were the two most frequently prescribed antipsychotics. Of 91 patients, 80 (87.9%) have prescribed with antipsychotic monopharmacy (mean 134.9 ± 11.1 day), 33 (36.3%) with bipharmacy (mean 136.9 ± 20.2 days), and 12 (13.2%) with polypharmacy (more than three antipsychotics) (mean 32.5 ± 7.3 days) in the year. Mood stabilizers (n=48, 52.7%), and antidepressants (n=35, 38.5%) were co-medicated in the year. Discussion Our study shows the prescription pattern of antipsychotics for children and adolescents with schizophrenia in Korea.

Effects of Atomoxetine on Height and Weight in Korean Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Retrospective Chart Review

Objective We aimed to investigate the long-term effects of atomoxetine on growth in Korean children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods The medical records of 82 subjects (mean age, 9.0±2.0 years; 64 boys) with ADHD treated with atomoxetine for at least 1 year at the Department of Psychiatry at Asan Medical Center were retrospectively reviewed. Height and weight data were prospectively obtained and retrospectively gathered and converted to age- and gender-corrected z scores using norms from Korean youths. Growth changes were analyzed using random coefficients models with changes in height or weight z scores as the dependent variables. Results Height z scores significantly decreased during the treatment period (β=-0.054, p=0.024). Height z scores decreased during the 1st year of treatment (β=-0.086, p=0.003), but did not change after the 1st year. Weight z scores did not change significantly during treatment (β=0.004, p=0.925). Conclusion Our results suggest that long-term atomoxetine treatment may be associated with deficits in height growth in Korean youths, although this effect was minor and tended to be attenuated over the first year. Because of the limitations of this study such as retrospective design and selection bias, further prospective studies are needed.

Altered white matter connectivity in patients with schizophrenia: An investigation using public neuroimaging data from SchizConnect

Several studies have produced extensive evidence on white matter abnormalities in schizophrenia (SZ). However, optimum consistency and reproducibility have not been achieved, and reported low white matter tract integrity in patients with SZ varies between studies. A whole-brain imaging study with a large sample size is needed. This study aimed to investigate white matter integrity in the corpus callosum and connections between regions of interests (ROIs) in the same hemisphere in 122 patients with SZ and 129 healthy controls with public neuroimaging data from SchizConnect. For each diffusion-weighted image (DWI), two-tensor full-brain tractography was performed; DWIs were parcellated by processing and registering T1 images with FreeSurfer and Advanced Normalization Tools. White matter query language was used to extract white matter fiber tracts. We evaluated group differences in means of diffusion measures between the patients and controls, and correlations of diffusion measures with the severity of clinical symptoms and cognitive impairment in the patients using the Positive and Negative Syndrome Scale (PANSS), a letter-number sequencing (LNS) test, vocabulary test, letter fluency test, category fluency test, and trail-making test, part A. To correct for multiple comparisons, a false discovery rate of q < 0.05 was applied. In patients with SZ, we observed significant radial diffusivity (RD) and trace (TR) increases in left thalamo-occipital tracts and the right uncinate fascicle, and a significant RD increase in the right middle longitudinal fascicle (MDLF) and the right superior longitudinal fascicle ii. Correlations were present between TR of left thalamo-occipital tracts, and the letter fluency test and the LNS test, and RD in the right MDLF and PANSS positive subscale score. However, these correlations were not significant after correction for multiple comparisons. These results indicated widespread white matter fiber tract abnormalities in patients with SZ, contributing to SZ pathophysiology.

Autism Spectrum Disorder Diagnosis in Diagnostic and Statistical Manual of Mental Disorders-5 Compared to Diagnostic and Statistical Manual of Mental Disorders-IV

Objectives: The objective of this study was to investigate the concordance of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5) diagnostic criteria for autism spectrum disorder (ASD). Methods: We retrospectively reviewed the medical records of 170 subjects (age range: 3–23, 140 boys) with developmental delay or social deficit from January 2011 to July 2016 at the Department of Psychiatry of Asan Medical Center. The Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and intelligence tests were performed for each subject. Diagnosis was reviewed and confirmed for each subject with DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 ASD criteria, respectively. Results: Fifty-eight of 145 subjects (34.1%) who were previously diagnosed as having PDD in DSM-IV did not meet DSM-5 ASD criteria. Among them, 28 (48.3%) had Asperger’s disorder based on DSM-IV. Most algorithm scores on ADOS and all algorithm scores on ADI-R were highest in subjects who met both DSM-IV PDD criteria and DSM-5 ASD criteria (the Convergent group), followed by subjects with a DSM-IV PDD diagnosis who did not have a DSM-5 ASD diagnosis (the Divergent group), and subjects who did not meet either DSM-IV PDD or DSM-5 ASD criteria (the non-PDD group). Intelligence quotient was lower in the Convergent group than in the Divergent group. Conclusion: The results of our study suggest that ASD prevalence estimates could be lower under DSM-5 than DSM-IV diagnostic criteria. Further prospective study on the impact of new DSM-5 ASD diagnoses in Koreans with ASD is needed.

Genome-Wide Analysis Reveals Four Novel Loci for Attention-Deficit Hyperactivity Disorder in Korean Youths

Objectives: The molecular mechanisms underlying attention-deficit hyperactivity disorder (ADHD) remain unclear. Therefore, this study aimed to identify the genetic susceptibility loci for ADHD in Korean children with ADHD. We performed a case-control and a family-based genome-wide association study (GWAS), as well as genome-wide quantitative trait locus (QTL) analyses, for two symptom traits. Methods: A total of 135 subjects (71 cases and 64 controls), for the case-control analysis, and 54 subjects (27 probands and 27 unaffected siblings), for the family-based analysis, were included. Results: The genome-wide QTL analysis identified four single nucleotide polymorphisms (SNPs) (rs7684645 near APELA, rs12538843 near YAE1D1 and POU6F2, rs11074258 near MCTP2, and rs34396552 near CIDEA) that were significantly associated with the number of inattention symptoms in ADHD. These SNPs showed possible association with ADHD in the family-based GWAS, and with hyperactivity-impulsivity in genome-wide QTL analyses. Moreover, association signals in the family-based QTL analysis for the number of inattention symptoms were clustered near genes IL10, IL19, SCL5A9, and SKINTL. Conclusion: We have identified four QTLs with genome-wide significance and several promising candidates that could potentially be associated with ADHD (CXCR4, UPF1, SETD5, NALCN-AS1, ERC1, SOX2-OT, FGFR2, ANO4, and TBL1XR1). Further replication studies with larger sample sizes are needed.

Medical and Psychiatric Comorbidities in Korean Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Objective Attention-deficit/hyperactivity disorder (ADHD) is associated with a high rate of comorbid disorders. We aimed to investigate the medical and psychiatric comorbidities of Korean children and adolescents with ADHD. Methods Data were obtained from Korean National Health Insurance Review and Assessment Service-National Patient Sample (HI-RA-NPS) for 2011. We included 2,140 (mean age, 10.9±3.1 years; boys, 1,710) and 219,410 (non-ADHD; mean age, 12.4±3.7 years; boys, 113,704) children and adolescents with and without ADHD, respectively. We compared medical and psychiatric comorbidities between the groups, and performed weighted logistic regression analyses to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results Most medical comorbidities were more likely in patients with ADHD and included nervous system disease (OR, 2.59; 95% CI, 2.52–2.66); endocrine, nutritional, and metabolic disease (OR, 2.09; 95% CI, 2.04–2.15); and congenital malformations, deformations, and chromosomal abnormalities (OR, 2.00; 95% CI, 1.90–2.11). Oppositional defiant disorder and conduct disorder were more prevalent in patients with ADHD (OR, 81.88; 95% CI, 79.00–84.86), followed by learning (OR, 75.61; 95% CI, 69.69–82.04), and depressive disorders (OR, 55.76; 95% CI, 54.44–57.11). Conclusion Our results suggest that Korean children and adolescents with ADHD are more likely to suffer medical and psychiatric comorbidities than those without ADHD.

Latent Class Analysis of ADHD Symptoms in Korean Children and Adolescents

Objective: The objective of this study was to conduct latent class analysis (LCA) of ADHD symptoms to characterize the underlying structure of ADHD. Method: Participants were recruited from September 2012 to January 2015 from the Department of Psychiatry of Asan Medical Center, Seoul, Korea. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie–Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version (K-SADS-PL). We performed LCA of ADHD symptoms in those who had (n = 141, age = 8.1 ± 2.3 years, 106 boys) and did not have (n = 82, age = 9.1 ± 2.5 years, 40 boys) ADHD. Results: A three-class solution was found to be the best model, revealing classes of children with mostly combined and hyperactive/impulsive subtypes of ADHD (Class 1), non-ADHD (Class 2), and inattentive subtype of ADHD (Class 3). Conclusion: The three-class solution with LCA supports a two-factor two-class structure of ADHD symptoms.