Kyung Joon Min

Changes in Cue-Induced, Prefrontal Cortex Activity with Video-Game Play

Brain responses, particularly within the orbitofrontal and cingulate cortices, to Internet video-game cues in college students are similar to those observed in patients with substance dependence in response to the substance-related cues. In this study, we report changes in brain activity between baseline and following 6 weeks of Internet video-game play. We hypothesized that subjects with high levels of self-reported craving for Internet video-game play would be associated with increased activity in the prefrontal cortex, particularly the orbitofrontal and anterior cingulate cortex. Twenty-one healthy university students were recruited. At baseline and after a 6-week period of Internet video-game play, brain activity during presentation of video-game cues was assessed using 3T blood oxygen level dependent functional magnetic resonance imaging. Craving for Internet video-game play was assessed by self-report on a 7-point visual analogue scale following cue presentation. During a standardized 6-week video-game play period, brain activity in the anterior cingulate and orbitofrontal cortex of the excessive Internet game-playing group (EIGP) increased in response to Internet video-game cues. In contrast, activity observed in the general player group (GP) was not changed or decreased. In addition, the change of craving for Internet video games was positively correlated with the change in activity of the anterior cingulate in all subjects. These changes in frontal-lobe activity with extended video-game play may be similar to those observed during the early stages of addiction.

Relationship between painful physical symptoms and severity of depressive symptomatology and suicidality.

We examined the prevalence of painful physical symptoms in patients with major depressive disorder (MDD), clinical correlations therewith, and associations between painful symptoms and depression severity, quality of life, and suicidality, in a clinical sample in Korea. A total of 414 psychiatric outpatients at least 18years of age, with a primary diagnosis of MDD based on the DSM-IV-TR, were enrolled at the discretion of their treating psychiatrist. Patients were assessed for the presence or absence of painful physical symptoms (PPS+ and PPS-, respectively), defined by a total score ≥5 on the pain subscale (PS) of the Depression and Somatic Symptoms Scale (DSSS). DSSS and the Clinical Global Impressions-Severity of Illness scale (CGI-S) determined depression severity, and the EuroQoL Questionnaire-5 dimensions (EQ-5D) determined perceived quality of life. Questions about suicidality during current depressive episode were also asked to the participants. Overall, 30.4% of patients were classified as PPS+. PPS+ patients were older, less educated, less frequently unmarried, and more frequently widowed/divorced/separated compared to PPS- patients. PPS+ patients showed a significantly greater depression severity (CGI-S mean difference 0.92; 95% CI=0.68 to 1.16; DSSS mean difference 18.39; 95% CI=16.28 to 20.50), a significantly lower quality of life (EQ-5D VAS mean difference -18.15; 95% CI=-22.68 to -13.62), and significantly higher suicidal ideation (OR 1.73; 95% CI 1.04-2.86) during the current depressive episode. This study suggests that assessment of depressive patients should include detailed questions about painful physical symptoms, and treatment of MDD should involve management targeting painful physical symptoms as well as emotional and non-painful physical symptoms.

The effect of dopamine partial agonists on the nicotine dependency in patients with schizophrenia

We compared the effects of haloperidol and three atypical antipsychotics (risperidone, olanzapine, and aripiprazole) on nicotine dependence in schizophrenic patients.

Correlation between gray matter volume in the temporal lobe and depressive symptoms in patients with Alzheimer's disease.

Recent studies have suggested that depression might be an aggravating factor in Alzheimers disease (AD). The aim of the study was to compare depressive symptoms and gray matter volume between AD patients with comorbid depression and patients with dementia only. Forty-nine patients with AD, 57 with mild cognitive impairment (MCI), and 50 healthy control subjects were assessed using the Consortium to Establish a Registry for Alzheimers disease (CERAD) and the Geriatric Depression Scale (GDS). All magnetic resonance imaging (MRI)s were analyzed using voxel-based morphometry (VBM). Seventeen AD patients with depression versus 32 patients with dementia only showed decreased immediate recall for a word list (8.7±1.1 vs. 10.1±1.5, z=3.6, p<0.01) and constructional praxis scores (3.7±0.9 vs. 5.3±2.1, z=2.5, p=0.01). Compared to 32 patients with dementia, seventeen AD patients with depression showed decreased gray matter volume in the left inferior temporal gyrus (-56, -19, -31; KE=578, t=3.80, Puncorr<0.001). The MCI group showed decreased gray matter volume in the right hippocampal gyrus compared to healthy control group. Our results suggest that depressive symptoms may be associated with the volume changes of frontal and temporal lobe in patients with AD.

The Relationships between Online Game Player Biogenetic Traits, Playing Time, and the Genre of the Game Being Played

Objective Psychobiological traits may be associated with excessive Internet use. This study assessed the relationships between biogenetic traits, the amount of time spent in online game playing, and the genre of the online game being played. Methods Five hundred sixty five students who enjoyed one of the four types of games included in this study were recruited. The types of games examined included role playing games (RPG), real-time strategy games (RTS), first person shooting games (FPS), and sports games. Behavioral patterns of game play, academic performance, and player biogenetic characteristics were assessed. Results The amount of time that the participants spent playing online games was significantly greater on weekends than on weekdays. On weekends, the types of games with the largest numbers of participants who played games for more than three hours were ranked as follows: RPG and FPS, RTS, and sports games. The Youngs Internet Addiction Scale (YIAS)score for the RPG group was the highest among the groups of the four types of game players. The time that participants spent playing games on weekdays was negatively associated with academic performance, especially for the RPG and FPS groups. Compared with the other groups, the RPG and RTS groups had higher novelty seeking (NS) scores and self-directedness (SD) scores, respectively. Additionally, the sports game group had higher reward dependency scores than the other groups. Conclusion These results suggest that RPGs may have specific factors that are attractive to latent game addicts with higher NS scores. Additionally, excessive playing of online games is related to impaired academic performance.

Exposure to Environmental Toxins in Mothers of Children with Autism Spectrum Disorder

Objective Environmental pollutants, especially environmental toxins (ET), may have the potential to disrupt neurodevelopmental pathways during early brain development. This study was designed to test our hypothesis that mothers with autism spectrum disorder (ASD) children would have less knowledge about ET and more chance to be exposed to ET than mothers with healthy children (MHC). Methods One hundred and six biologic mothers with ASD children (MASD) and three hundred twenty four biologic mothers with healthy children MHC were assessed using two questionnaires asking about ET. Results The total score in response to questions related to knowledge about ET in MHC was higher than that in MASD. The possibility of exposure to ET was higher in MASD than MHC. MASD showed higher sub-scale scores in terms of exposures to canned food, plastics, waste incinerators, old electronics, microwavable food, and textiles. Conclusion The current results show that reduced knowledge about ET and greater exposure to ET may be associated with autism spectrum disorder.

Diagnostic utility of quantitative EEG in un-medicated schizophrenia

The aim of the current study was to evaluate the quantitative electroencephalography (QEEG) characteristics of patients with un-medicated schizophrenia (SPR) and to investigate the diagnostic utility of QEEG in assessing such patients during resting conditions. The subjects included 90 patients with schizophrenia and 90 normal controls. Spectral analysis was performed on the absolute power of all of the electrodes across five frequency bands following artifact removal. We conducted a repeated-measures ANOVA to examine group differences within the five frequency bands across several brain regions and receiver operator characteristic (ROC) analyses to examine the discrimination ability of each frequency band. Compared with controls, patients with schizophrenia showed increased delta and theta activity and decreased alpha 2 activity, particularly in the frontocentral area. There were no significant differences in the alpha 1 and beta activity. The ROC analysis performed on the delta frequency band generated the best result, with an overall classification accuracy of 62.2%. The results of this study confirmed the characteristics of the QEEG power in un-medicated schizophrenia patients compared with normal controls. These findings suggest that a resting EEG test can be a supportive tool for evaluating patients with schizophrenia.

Craving for Alcohol and Food During Treatment for Alcohol Dependence: Modulation by T Allele of 1519T>C GABAAα6

BACKGROUND Craving for alcohol and food has been studied in association with alcohol dependence and eating disorders, respectively. One subclass of the gamma-aminobutyric acid (GABA) receptor, 1519T>C GABA(A)alpha6 has been reported to be associated with both alcohol dependence and weight gain. In this study, we hypothesized that patients being treated for alcohol dependence would report decreased craving for alcohol, but an increased craving for food during a 4-week treatment period. We further hypothesized that the T allele of the 1519T>C GABA(A)alpha6 gene would modulate the extent of changes in craving for alcohol and food. METHODS This study included 98 male inpatients being treated for alcohol dependence. A 7-point visual analog scale was applied to evaluate relative levels of alcohol and food craving at baseline and again 4 weeks later. Body weight was also checked at the same periods. Genotyping of the 1519T>C SNP in GABA(A)alpha6 was carried out by restriction fragment length polymorphism. RESULTS There were significant changes in craving for alcohol and food in all patients with alcohol dependence. During the treatment period, body weight increased in all patients with alcohol dependence. Changes in alcohol and food craving in T-allele carriers (CT + TT) of 1519T>C GABA(A)alpha6 were greater than those observed in CC homozygotes. In T-allele carriers, body weight significantly increased and the changes in weight showed a negative correlation with the change in the craving for alcohol and a positive correlation with the changes in craving for food. DISCUSSION The current results suggest that in T-allele carriers the change in craving for alcohol during treatment for alcohol dependence is negatively associated with changes in craving for food. The T allele of the 1519T>C GABA(A)alpha6 gene may be one of the modulating factors associated with changes in craving for alcohol and food during treatment of patients with alcohol dependence.

Adjunctive aripiprazole therapy with escitalopram in patients with co-morbid major depressive disorder and alcohol dependence: Clinical and neuroimaging evidence

The effective treatment of depression has been reported to reduce the severity of alcohol use, potentially reflecting improvements in common brain reward circuits. We hypothesized that augmentation therapy of escitalopram with aripiprazole would improve depressive symptoms as well as reduce craving for alcohol and cue-induced brain activity in patients with co-morbid alcohol dependence and major depressive disorder, compared with treatment with escitalopram alone. Thirty-five subjects with major depressive disorder and alcohol dependence were recruited and randomly assigned into 17 aripiprazole + escitalopram and 18 escitalopram only groups. At baseline and following six weeks of treatment, symptoms of depression, craving for alcohol and brain activity were evaluated. During the six week treatment period, Beck Depression Inventory and clinical global index-severity (CGI-S) scores decreased in both the aripiprazole + escitalopram and escitalopram only groups. In addition, following the treatment period, the Korean alcohol urge questionnaire scores in the aripiprazole + escitalopram group were reduced from 23.3±8.4 to 14.3±4.9, compared with those of the escitalopram group of from 21.6±8.4 to 19.3±7.1 (F=13.1, p<0.01). The activity within the anterior cingulate was increased in response to the presentation of alcohol drinking scenes following treatment in the aripiprazole + escitalopram group. The change of brain activity within the left anterior cingulate gyrus in all patients with co-morbid alcohol dependence and major depressive disorder was negatively correlated with the change in craving for alcohol. These findings suggest that the effects of aripiprazole on anterior cingulate cortex might mediate the successful treatment of alcohol dependence in patients with major depressive disorder.

Rash in adult patients receiving lamotrigine to treat bipolar I disorder in Korea: a multicenter, prospective, naturalistic, open-label trial.

The goal of this study was to assess the incidence of rash occurring in patients received lamotrigine to treat bipolar I disorder in a real world setting in Korea. We included a heterogeneous sample with multiple medications and medical comorbidities. Lamotrigine was added to the current therapy regime for DSM-IV bipolar I patients on an open-label basis for 12 weeks. The incidences of rash and other adverse events were assessed. The primary outcome measure was the incidence of rash. A total of 237 adult patients were included in the present study and 173 patients (73.0%) completed the 12 weeks of treatment. Thirty patients (12.7%) developed a rash, of whom 2 (0.8%) developed a serious rash. There were no patients who developed Stevens-Johnson syndrome or toxic epidermal necrolysis. The median time of rash onset was 16 days. As a group, patients who did not experience rash were significantly heavier than those who did. Our findings suggest that the incidence of serious rash associated with lamotrigine is low. The prescription of lamotrigine should be undertaken with appropriate consideration of the potential risk of adverse events including rash to the patient in relation to potential benefit from improvement of bipolar disorder.