Incidence and risk factors for psychiatric comorbidity among people newly diagnosed with cancer based on Korean national registry data.

OBJECTIVE: The present study investigates the incidence of psychiatric disorders, related risk factors, and the use of mental health services among people newly diagnosed with one of five major cancers (stomach, liver, colorectal, lung, and breast cancer) based on national registry data from the National Health Insurance Service (NHIS) in the Korean population. METHODS: We collected data on people newly diagnosed with one of the five major cancers between 2005 and 2008 using the nationwide claims data and cancer registration files of the NHIS. We analyzed the data of those diagnosed with psychiatric disorders over a 5-year period, from 2004 to 2009. RESULTS: Among 302,844 people with newly diagnosed cancer, we identified 31,579 patients (10.43%) who were also newly diagnosed with psychiatric disorders after their cancer diagnosis. Among psychiatric diagnoses, anxiety disorders and depression showed the highest incidences of 18.13 and 13.16 per 1000 person-years, respectively. Among major cancers, patients with lung cancer showed the highest incidence of psychiatric disorders. Older age and female gender were shown to be risk factors associated with psychiatric comorbidity, and no significant differences were found for region of residence. CONCLUSION: The present study showed a low incidence of psychiatric comorbidity and suggests that psychiatric disorders in cancer patients tend to be underrecognized in actual clinical practice. Greater risk for psychiatric comorbidity was associated with lung cancer, older age, and female gender. The present findings provide important information for establishing national policies to detect and manage mental health problems during cancer care.

The relationship between ambivalence, alexithymia, and salience network dysfunction in schizophrenia.

Ambivalence in schizophrenia is worth investigating its association with salience processing and alexithymia using functional MRI. Twenty-two patients with schizophrenia and 22 healthy controls were scanned during the ambivalence task of matching picture (ambivalent, positive and negative) and word (positive and negative) stimuli, and the Toronto Alexithymia Scale (TAS) was rated. Patients exhibited decreased activity in the anterior cingulate cortex (ACC) and insula compared to controls, and ACC activity in the ambivalent condition was negatively correlated with the TAS score in patients. Ambivalence in schizophrenia may be based on salience network dysfunction, and this disturbance may be related to alexithymia.

The Relationship between Neuropsychiatric Symptoms and Default-Mode Network Connectivity in Alzheimer's Disease.

OBJECTIVE: Neuropsychiatric symptoms of dementia are prevalent and extremely burdening for the patient and caregivers, but the underlying mechanism of these symptoms has not been investigated. This study aimed to investigate the relationship between neuropsychiatric symptoms and default-mode functional connectivity in Alzheimer's disease. METHODS: Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. Functional magnetic resonance imaging was conducted on seventy patients with Alzheimer's disease during rest. We conducted a seed-based functional connectivity analysis to identify anterior and posterior default-mode networks (DMN). Seeds were the medial prefrontal cortex (Montreal Neurological Institute 12, 51, 36; seed radius=3 mm) for the anterior DMN and the precuneus (Montreal Neurological Institute -6, -63, 27; seed radius=3 mm) for the posterior DMN We then correlated the scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective, and psychosis syndrome) with maps of connectivity in the default-mode network. RESULTS: There was a significant correlation between decreased connectivity in the medial prefrontal cortex of the anterior defaultmode network and hyperactivity (agitation, irritability, aberrant motor behavior, euphoria, and disinhibition) syndrome (p<0.05, family wise error cluster-level corrected). CONCLUSION: Our study demonstrated that hyperactivity syndrome is related to hypoconnected default-mode network in Alzheimer's disease. This finding suggests that specific network alterations are associated with certain neuropsychiatric syndromes.

Neural Basis of Ambivalence towards Ideal Self-Image in Schizophrenia.

OBJECTIVE: Little has been explored about a reflection towards self-image in schizophrenia, though it can be related to heterogeneous symptoms of the illness. We identified the neural basis of ambivalence towards ideal self-image in patients with schizophrenia. METHODS: 20 patients with schizophrenia and 20 healthy controls underwent functional MRI while the self-image reflection tasks of determining whether to agree with sentences describing their actual or ideal self-image that contained one of the adjective pairs with opposite valence. The interaction between the group and ideal ambivalence score was examined, and group differences in functional connectivity related to ambivalence towards ideal self-image were further studied. RESULTS: The interaction of group-by-ideal ambivalence score was shown in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, where activities were positively correlated with the level of ideal self-image ambivalence in patients, but not in controls. Task-related decrease in functional connectivity was shown between the orbitofrontal cortex and cerebellum in patients. CONCLUSION: The process of reflecting on ambivalent ideal self-image in schizophrenia may be related to aberrant prefrontal activity and connectivity. Abnormality in the prefrontal regions that take part in cognitive conflict monitoring and value judgment may underlie the pathophysiology of increased ambivalence towards ideal self-image.

Disrupted salience processing involved in motivational deficits for real-life activities in patients with schizophrenia.

Motivational deficits in patients with schizophrenia adversely affect various domains of daily living. This symptom in everyday life situations manifests in a complex behavioral pattern whose root cannot be simplified to an impaired reward-motivation scheme. This study aimed to identify impairment of the salience network that underlies motivational deficits seen in patients with schizophrenia in real-life situations. During the functional magnetic resonance imaging scan, 20 patients with schizophrenia and 20 normal controls performed a task mimicking real-life situations, in which an avatar proposed participation in a daily activity with either an intrinsic or extrinsic reward. Group and type-of-reward effects were evaluated with respect to brain activity. Further, psychophysiological interactions were analyzed for the dorsal anterior cingulate cortex (dACC) and insula, which are the key nodes of the salience network. The acceptance of the proposal was significantly higher for intrinsic than for extrinsic rewards in controls, whereas patients showed no difference. The imaging results showed a group effect in the dACC, right insula, thalamus, and lingual gyrus. The dACC showed negative contrast interaction with regions of the left dorsolateral prefrontal cortex, and the right insula showed positive contrast interaction with the occipital gyrus and precentral gyrus. These results suggest that patients exhibit no different participation behavior between activities with intrinsic and extrinsic rewards, which can be explained by the floor effect. Disrupted salience processing in schizophrenia including aberrant salience network and a disconnection of the salience and reward networks may account for the lack of motivation for daily activities.

Comparing the Effectiveness and Safety of the Addition of and Switching to Aripiprazole for Resolving Antipsychotic-Induced Hyperprolactinemia: A Multicenter, Open-Label, Prospective Study.

OBJECTIVES: Hyperprolactinemia is an important but often overlooked adverse effect of antipsychotics. Several studies have shown that switching to or adding aripiprazole normalizes antipsychotic-induced hyperprolactinemia. However, no study has directly compared the effectiveness and safety of the 2 strategies. METHODS: A total of 52 patients with antipsychotic-induced hyperprolactinemia were recruited. Aripiprazole was administered to patients with mild hyperprolactinemia (serum prolactin level < 50 ng/mL). Patients with severe hyperprolactinemia (serum prolactin level > 50 ng/mL) were randomized to an aripiprazole-addition group (adding aripiprazole to previous antipsychotics) or a switching group (switching previous antipsychotics to aripiprazole). Serum prolactin level, menstrual disturbances, sexual dysfunction, psychopathologies, and quality of life were measured at weeks 0, 1, 2, 4, 6, and 8. RESULTS: Both the addition and switching groups showed significantly reduced serum prolactin level and menstrual disturbances and improved sexual dysfunction. In patients with severe hyperprolactinemia, the numbers of patients with hyperprolactinemia and menstrual disturbance in the switching group were significantly lower than those in the addition group at week 8. CONCLUSIONS: Both the addition and switching strategies were effective in resolving antipsychotic-induced hyperprolactinemia and hyperprolactinemia-related adverse events, including menstrual disturbances and sexual dysfunction. In addition, these findings suggest that switching to aripiprazole may be more effective than addition of aripiprazole for normalizing hyperprolactinemia and improving hyperprolactinemia-related adverse events in patients with schizophrenia.

Abnormal neural processing during emotional salience attribution of affective asymmetry in patients with schizophrenia.

Aberrant emotional salience attribution has been reported to be an important clinical feature in patients with schizophrenia. Real life stimuli that incorporate both positive and negative emotional traits lead to affective asymmetry such as negativity bias and positivity offset. In this study, we investigated the neural correlates of emotional salience attribution in patients with schizophrenia when affective asymmetry was processed. Fifteen patients with schizophrenia and 14 healthy controls were scanned using functional magnetic resonance imaging (fMRI) while performing an emotion judgment task in which two pictures were juxtaposed. The task consisted of responding to affective asymmetry condition (ambivalent and neutral) and affective symmetry conditions (positive and negative), and group comparisons were performed for each condition. Significantly higher activity in the medial prefrontal cortex and inferior frontal gyrus was observed for the ambivalent condition than for the other conditions in controls, but not in patients. Compared with controls, patients showed decreased activities in the dorsolateral prefrontal cortex, dorsal anterior cingulate cortex, insula, and putamen for the ambivalent condition, but no changes were observed for the neutral condition. Multiple prefrontal hypoactivities during salience attribution of negativity bias in schizophrenia may underlie deficits in the integrative processing of emotional information. Regional abnormalities in the salience network may be the basis of defective emotional salience attribution in schizophrenia, which is likely involved in symptom formation and social dysfunction.