Hyperarousal-state of Insomnia Disorder in Wake-resting State Quantitative Electroencephalography.

Objective: : Insomnia is associated with elevated high-frequency electroencephalogram power in the waking state. Although affective symptoms (e.g., depression and anxiety) are commonly comorbid with insomnia, few reports distinguished objective sleep disturbance from affective symptoms. In this study, we investigated whether daytime electroencephalographic activity explains insomnia, even after controlling for the effects of affective symptoms. Methods: : A total of 107 participants were divided into the insomnia disorder (n = 58) and healthy control (n = 49) groups using the Mini-International Neuropsychiatric Interview and diagnostic criteria for insomnia disorder. The participants underwent daytime resting-state electroencephalography sessions (64 channels, eye-closed). Results: : The insomnia group showed higher levels of anxiety, depression, and insomnia than the healthy group, as well as increased beta [t(105) = -2.56, p = 0.012] and gamma [t(105) = -2.44, p = 0.016] spectra. Among all participants, insomnia symptoms positively correlated with the intensity of beta (r = 0.28, p ＜ 0.01) and gamma (r = 0.25, p ＜ 0.05) spectra. Through hierarchical multiple regression, the beta power showed the additional ability to predict insomnia symptoms beyond the effect of anxiety (ΔR2 = 0.041, p = 0.018). Conclusion: : Our results showed a significant relationship between beta electroencephalographic activity and insomnia symptoms, after adjusting for other clinical correlates, and serve as further evidence for the hyperarousal theory of insomnia. Moreover, resting-state quantitative electroencephalography may be a supplementary tool to assess insomnia.

Neuroablative Intervention for Refractory Obsessive-Compulsive Disorder.

OBJECTIVE: This review aims to investigate the progression of neuroablation, along with documented clinical efficacy and safety, in the management of treatment-resistant obsessive-compulsive disorder (OCD). METHODS: We searched and compiled clinical research results of neuroablation therapy reported to date. We extracted outcomes related to clinical efficacy, side effects, and surgical complications. Additionally, we summarized key claims and findings. RESULTS: Neuroablative intervention is a potential treatment approach for refractory OCD. Recent advancements, such as real-time magnetic resonance monitoring and minimally invasive techniques employing ultrasound and laser, offer distinct advantages in terms of safety and comparative efficacy when compared to conventional methods. However, the absence of randomized controlled trials and long-term outcome data underscores the need for cautious consideration when selecting neuroablation. CONCLUSION: Neuroablative intervention shows promise for refractory OCD, but vigilant consideration is essential in both patient selection and surgical method choices due to the potential for rare yet serious complications.

Clinical Advances in Treatment Strategies for Obsessive-compulsive Disorder in Adults.

In the present article, we provide a comprehensive review of the treatment strategies for obsessive-compulsive disorder (OCD), a common, chronic, and often debilitating disorder, characterized by overwhelming obsessions and compulsions. OCD typically starts in childhood or adolescence and persists throughout life, causing functional impairment across multiple domains. The article begins by describing the historical concepts of OCD from religious and guilt-based explanations to psychoanalytic perspectives, and then explores the changing understanding of OCD as a treatable condition. Recent advances include the development of evidence-based psychological treatments, such as exposure and response prevention, and pharmacological treatments, such as selective serotonin reuptake inhibitors. The latest version of the Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases, has removed OCD from the anxiety disorder grouping and regrouped it into obsessive-compulsive and related disorders. We conclude by highlighting the current state of knowledge and development in the clinical management of OCD, including recommendations for first- and second-line treatments, alternative, or augmentative strategies for and novel agents under investigation for OCD. In future, the latest advances in neuroimaging, electrophysiology, digital technology, and data-driven analysis will help elucidate the pathophysiology of OCD and develop personalized intervention strategies.

Vasomotion in human arteries and their regulations based on ion channel regulations: 10 years study.

Vasomotion is the oscillation of vascular tone which gives rise to flow motion of blood into an organ. As is well known, spontaneous contractile organs such as heart, GI, and genitourinary tract produce rhythmic contraction. It imposes or removes pressure on their vessels alternatively for exchange of many substances. It was first described over 150 years ago, however the physiological mechanism and pathophysiological implications are not well understood. This study aimed to elucidate underlying mechanisms and physiological function of vasomotion in human arteries. Conventional contractile force measurement, immunohistochemistry, and Western blot analysis were employed to study human left gastric artery (HLGA) and uterine arteries (HUA). RESULTS: Circular muscle of HLGA and/or HUA produced sustained tonic contraction by high K+ (50 mM) which was blocked by 2 µM nifedipine. Stepwise stretch and high K+ produced nerve-independent spontaneous contraction (vasomotion) (around 45% of tested tissues). Vasomotion was also produced by application of BayK 8644, 5-HT, prostagrandins, oxytocin. It was blocked by nifedipine (2 µM) and blockers of intracellular Ca2+ stores. Inhibitors of Ca2+ -activated Cl- channels (DIDS and/or niflumic acid) and ATP-sensitive K+ (KATP ) channels inhibited vasomotion reversibly. Metabolic inhibition by sodium cyanide (NaCN) and several neuropeptides also regulated vasomotion in KATP channel-sensitive and -insensitive manner. Finally, we identified TMEM16A Ca2+ -activated Cl- channels and subunits of KATP channels (Kir 6.1/6.2 and sulfonylurea receptor 2B [SUR2B]), and c-Kit positivity by Western blot analysis. We conclude that vasomotion is sensitive to TMEM16A Ca2+ -activated Cl- channels and metabolic changes in human gastric and uterine arteries. Vasomotion might play an important role in the regulation of microcirculation dynamics even in pacemaker-related autonomic contractile organs in humans.

Social Stigma and Discrimination Toward People With Drug Addiction: A National Survey in Korea.

OBJECTIVE: This study aims to understand the attitudes, stigma, and discrimination of the general adult population toward drug addiction. METHODS: We conducted a cross-sectional nationwide survey with 1,020 Korean adults using an Internet web-based panel. Self-reported data were collected on demographics, experience with substance abuse, perceptions of narcotic analgesic use, beliefs about the legalization of cannabis use, coping with substance abuse and addiction, and perceptions of drug risks. All statistical analysis in this study utilized the IBM SPSS Statistics 26 program. RESULTS: In this study, 1.6% of the participants reported abuse of opioid analgesics, 88.0% reported negative perceptions of drug addiction, and 76.9% reported agreeing to unfair treatment of drug addicts. Logistic regression analysis found that perceived stigma was more prevalent among women (odd ratio [OR]=2.087, p<0.01), old adults (OR=1.939, p<0.01), those with no personal experience of opioid misuse (OR=8.172, p<0.05), and those who were non-smoking (OR=2.011, p<0.01). In addition, the discriminatory attitude was more prevalent among participants with higher income (OR=1.989, p<0.001) and those who are non-smoking (OR=1.608, p<0.05). CONCLUSION: This study provides information and guidelines for public intervention in drug addiction by identifying factors influencing social stigma and discriminatory behaviors toward drug addiction. The findings suggest that education on drug addiction prevention for the general adult population is necessary, and this education should include knowledge on coping with drug addiction and reducing stigma and discrimination toward drug addicts.

Frontal EEG response to alcohol craving elicited by individually tailored video cues.

BACKGROUND: Most findings on the pathophysiology of alcoholism are based on studies using resting-state electroencephalography (EEG). There are few studies on cue-induced craving and on its utility as an electrophysiological index. We examined quantitative EEG (qEEG) activities in alcoholics and social drinkers exposed to video cues and compared their association with subjective alcohol craving and other related psychiatric symptoms, including anxiety and depression. METHODS: This is a between-subjects design. Adult male alcoholics (n = 34) and healthy social drinkers (n = 33) participated. In a laboratory, EEGs were recorded while the participants were presented with craving-inducing video stimuli. Measures used were the Visual Analog Scale (VAS) for subjective alcohol craving, Alcohol Urge Questionnaire (AUQ), Michigan Alcoholism Screening Test (MAST), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) scores. RESULTS: One-way analysis of covariance with age showed that alcoholics had significantly increased beta activity in the right DLPFC region (F4) (F = 4.029, p = 0.049), compared to social drinkers when craving-inducing stimuli were presented. Beta activity at the F4 electrode was positively correlated with AUQ (r = .284, p = 0.021), BAI (r = .398, p = 0.001), BDI (r = .291, p = 0.018), and changes in VAS (r = .292, p = 0.017) scores in both alcoholics and social drinkers. In alcoholics, beta activity was significantly correlated with BAI (r = .392, p = 0.024). CONCLUSIONS: These findings imply functional importance of hyperarousal and negative emotions upon exposure to craving-inducing cues. Frontal EEG indices with beta power could serve as an objective electrophysiological index of craving induced by individually tailored video cues in alcohol consumption behavior.

Evaluation of changes in neural oscillation after bilateral capsulotomy in treatment refractory obsessive-compulsive disorder using magnetoencephalogram.

Bilateral thermal capsulotomy with magnetic resonance-guided focused ultrasound (MRgFUS-capsulotomy) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Herein, we investigated the effects of bilateral thermal capsulotomy with MRgFUS on neural oscillations in treatment-refractory OCD patients. Eight patients underwent resting-state MEG with repeated recordings before and 1 and 6 months after MRgFUS-capsulotomy, and the oscillatory power and phase coherence over the entire cortical sensor area were measured. After MRgFUS-capsulotomy, the high beta band power in the fronto-central and temporal areas decreased at 1 month and remained stable for 6 months. Cortical connectivity of the high beta band gradually decreased over the entire cortical area during the following 6 months. At 1 month, improvement in anxiety and depression symptoms was significantly correlated with changes in high beta band power in both the frontotemporal and temporal areas. The treatment effect of MRgFUS-capsulotomy may be attributed to the cortical high beta band. Our results provide an advanced understanding of the neural mechanisms underlying MRgFUS-capsulotomy and other neuromodulatory interventions for treatment-refractory OCD.

Examining the Psychometric Properties and Clinical Correlates of the Korean Version of the Family Accommodation Scale-Self-Rated Version for Obsessive-Compulsive Disorder.

OBJECTIVE: We aimed to develop a Korean version of the Family Accommodation Scale-Self-Rated (FAS-SR), to investigate its reliability and validity and to study the clinical correlates of family accommodation in families with obsessive compulsive disorder (OCD) patient. METHODS: The FAS-SR was translated into Korean under the original author's supervision. Forty-two patients with OCD and their closest relatives participated. The internal consistency was estimated using Cronbach's alpha and the split half method. Convergent and divergent validity were identified by measuring with other clinical variables. Test-retest reliability was also calculated. RESULTS: The reliability analyses showed that Korean version of the FAS-SR demonstrated excellent internal consistency (Cronbach's alpha=0.91) and test-retest reliability (Intraclass correlation coefficient=0.93). It showed good convergent validity when simultaneously assessed OCD symptom severity, global functioning and relative's psychological distress. CONCLUSION: The findings suggest that Korean version of the FAS-SR is a reliable and valid tool for assessing family accommodation in Korean patients with OCD in both research and clinical settings.

Effects of cranial electrotherapy stimulation with novel in-ear electrodes on anxiety and resting-state brain activity: A randomized double-blind placebo-controlled trial.

BACKGROUND: Cranial Electrotherapy Stimulation (CES) is a promising non-invasive brain stimulation technique with the potential to alleviate anxiety. We examined the effectiveness of home-based CES with novel, headphone-like, in-ear electrodes on anxiety-related symptoms and resting-state brain activity. METHODS: This study spanned 3-weeks, with randomized, double blind, and active-controlled design. Nonclinical volunteers experiencing daily anxiety were randomly assigned to either the active or the sham groups. CES provides an alternating current (10 Hz frequency, 500 µA intensity), connected to smartphone recording treatment logs. Participants treated themselves with 20 trials of CES at home. We evaluated the effectiveness using State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Wisconsin Card Sort Test (WCST), and resting-state electroencephalography (EEG). RESULTS: The active group showed a significant improvement in state-anxiety compared to sham, while there was a statistical trend in the WCST-Category Completed (p = .061) and no change in depression. In EEG analysis, the active group showed significantly increased relative power for theta in the left frontal region compared with the sham, and this significantly correlated with the changes in state-anxiety. The active group exhibited significantly increased high-beta source activity in cuneus and middle occipital gyrus after intervention compared with the baseline. LIMITATIONS: This study had a relatively short treatment period and small sample size. CONCLUSIONS: Our findings provide the first electrophysiological evidence for CES for novel in-ear electrodes to improve anxiety. The modulatory effects of CES on resting-state oscillations of EEG imply that CES could beneficially affect functional brain activity.

Baloxavir-oseltamivir combination therapy inhibits the emergence of resistant substitutions in influenza A virus PA gene in a mouse model.

Baloxavir marboxil (BXM) treatment-emergent polymerase acid (PA) I38X amino acid substitution (AAS) in the resistant variants of influenza viruses raise concerns regarding their emergence and spread. This study investigated the impact of 1 or 5 mg/kg BXM and 25 mg/kg oseltamivir phosphate (OS) (single or combination therapy) on the occurrence of resistance-related substitutions during the sequential lung-to-lung passages of AH1N1)pdm09 virus in mice. Deep sequencing analysis revealed that 67% (n = 4/6) of the population treated with BXM single therapy (1 or 5 mg/kg) possessed the treatment-emergent PA-I38X AAS variants (I38T, I38S, and I38V). Notably, BXM-OS combination therapy impeded PA-I38X AAS emergence. Although the doses utilized in the mouse model may not be directly translated into the clinically equivalent doses of each drugs, these findings offer insights toward alternative therapies to mitigate the emergence of influenza antiviral resistance.

Association of Depression With Functional Mobility in Schizophrenia.

BACKGROUND: Functional immobility can cause functional disability in patients with schizophrenia and has been linked to prognosis and mortality. Although depression might be a barrier for physical activity engagement, scarce data are present on the relationship between depression and functional mobility (FM) in schizophrenia. Thus, we aimed to investigate the associations among FM, depression, and other clinical correlates in individuals with schizophrenia. METHODS: FM was evaluated by the pedometer-assessed daily steps and Timed Up-and-Go (TUG) test in the daily-living and clinical settings, respectively. Psychiatric symptoms were assessed using the Beck Depression Inventory, Brief Psychiatric Rating Scale (BPRS), and State-Trait Anxiety Inventory. Cognitive function was evaluated using the Sternberg Working Memory (SWM) Task. Multiple regression analyses were performed to identify predictive factors associated with FM, with adjustment for relevant covariates. RESULTS: Sixty patients were enrolled in this study. Depression was the most consistent explanatory variable for both pedometer (ß = -0.34, p = 0.011) and TUG time (ß = 0.32, p = 0.018). Additionally, SWM accuracy (ß = -0.29, p = 0.018), BPRS-Withdrawal (ß = 0.19, p = 0.139), and fasting blood sugar (ß = 0.34, p = 0.008) were associated with TUG time. However, psychotic symptoms and anxiety were not associated with pedometer and TUG. CONCLUSIONS: We identified an association between depression and FM after adjusting for other disorder-related correlates in schizophrenia. Since the intervention goal is functional recovery, improving FM by treating depression may have considerable therapeutic value.

Korean Medication Algorithm for Schizophrenia 2019, Second Revision: Treatment of Psychotic Symptoms.

Objective: In 2001, the Korean College of Neuropsychopharmacology and the Korean Society for Schizophrenia Research developed the Korean Medication Algorithm Project for Schizophrenia (KMAP-SPR 2001, revised 2006) through a consensus of expert opinion. The present study was carried out to support the second revision of the KMAP-SPR. Methods: Based on clinical guidelines and studies on the treatment of psychotic symptoms in schizophrenia, the Executive committee completed a draft of KMAP-SPR 2019. To obtain an expert consensus, a Review committee of 100 Korean psychiatrists was formed and 69 responded to a 30-item questionnaire. Based on their responses, the KMAP-SPR 2019 was finalized. Results: The revised schizophrenia algorithm now consists of 5 stages. At Stage 1, monotherapy with atypical antipsychotics was recommended by expert reviewers as the first-line strategy. At Stage 2, most reviewers recommended the use of typical or atypical antipsychotic drugs not used at Stage 1. At Stage 3, many reviewers agreed with the administration of clozapine. At Stage 4, a combination of clozapine and other agents such as antipsychotics, mood stabilizers, antidepressants, or electroconvulsive therapy was recommended. At Stage 5, most reviewers recommended combined treatment with an antipsychotic other than clozapine; and a mood stabilizer, antidepressant, or electroconvulsive therapy. At any stage, prescribing long-acting injectable antipsychotics at the discretion of the clinician was recommended. Conclusion: Compared with previous versions, the KMAP-SPR 2019 now recommends using clozapine earlier in treatment- refractory schizophrenia. In addition, the use of long-acting injectable antipsychotics is now considered to be available at any stage.

Physiological function and molecular composition of ATP-sensitive K+ channels in human gastric smooth muscle.

Gastric motility is controlled by slow waves. In general, the activation of the ATP-sensitive K+ (KATP) channels in the smooth muscle opposes the membrane excitability and produces relaxation. Since metabolic inhibition and/or diabetes mellitus are accompanied by dysfunctions of gastric smooth muscle, we examined the possible roles of KATP channels in human gastric motility. We used human gastric corpus and antrum smooth muscle preparations and recorded the mechanical activities with a conventional contractile measuring system. We also identified the subunits of the KATP channels using Western blot. Pinacidil (10 µM), a KATP channel opener, suppressed contractions to 30% (basal tone to -0.2 g) of the control. The inhibitory effect of pinacidil on contraction was reversed to 59% of the control by glibenclamide (20 µM), a KATP channel blocker. The relaxation by pinacidil was not affected by a pretreatment with L-arginine methyl ester, tetraethylammonium, or 4-aminopyridine. Pinacidil also inhibited the acetylcholine (ACh)-induced tonic and phasic contractions in a glibenclamide-sensitive manner (42% and 6% of the control, respectively). Other KATP channel openers such as diazoxide, cromakalim and nicorandil also inhibited the spontaneous and ACh-induced contractions. Calcitonin gene-related peptide (CGRP), a gastric neuropeptide, induced muscle relaxation by the activation of KATP channels in human gastric smooth muscle. Finally, we have found with Western blot studies, that human gastric smooth muscle expressed KATP channels which were composed of Kir 6.2 and SUR2B subunits.

Alpha B-Crystallin Overexpression Protects Oligodendrocyte Precursor Cells Against Oxidative Stress-Induced Apoptosis Through the Akt Pathway.

Alpha B-crystallin (aBC), a member of the small heat shock protein family, is expressed in mature oligodendrocytes (mOLs), but not in oligodendrocyte precursor cells (OPCs). Our previous study found that the survival rate of OPCs was lower than that of mOLs under oxidative stress, suggesting that aBC may play a protective role in mOLs. In the present study, we investigated the effects of aBC overexpression on oxidative stress-induced cell injury in OPCs and examined the underlying mechanisms. We observed that the survival rates of aBC-overexpressed OPCs were significantly higher than those of control cells under oxidative stress induced by hydrogen peroxide. Akt activities were significantly suppressed by oxidative stress in control OPCs, but not in aBC-overexpressed OPCs. The expressions of Bax and cleaved caspase-3 were decreased, whereas Bcl-2 expression was increased in aBC-overexpressed OPCs under oxidative stress. These findings suggest that low Akt activity in OPCs due to aBC deficiency may cause high susceptibility of OPCs to oxidative stress. The findings may provide new insights into the implication of OPCs in demyelinating diseases.

Outdoor cycling improves clinical symptoms, cognition and objectively measured physical activity in patients with schizophrenia: A randomized controlled trial.

PURPOSE: The therapeutic effects of outdoor cycling (OC) and its benefits on physical activity (PA) were investigated in people with schizophrenia. METHODS: Sixty patients with schizophrenia were randomly assigned to 16-weeks of Outdoor Cycling (OC) (n = 30, 50% male; mean age, 38.7 ±â€¯10.1) or Occupational Therapy (OT) (n = 30, 50% male; mean age, 39.0 ±â€¯8.6). OC and OT involved one 90-min group session per week. OC consisted of structured exercise programs and OT addressed daily living skills. Primary outcome measurements were mental health variables, such as Brief Psychiatric Rating Scale, Beck's Depression Inventory, State and Trait Anxiety Inventory, Rosenberg Self-Esteem Scale, Global Assessment of Functioning and executive function (Wisconsin Card Sorting Test, WCST). Secondary measures were the adherence and PA. PA was measured by responding to the Physical Activity Scale (K-PASE) and wearing a pedometer for 2 days. RESULTS: Repeated measures ANOVA revealed improved psychotic symptoms (p = .014), depression (p = .007), state (p = .031) and trait anxiety (p = .002) and global functions (p = .024) in the OC group compared with OT group. The OC group showed increased correct rates (p = .022) and categories completed (p = .033) in the WCST. There was no difference in total K-PASE score between groups; however, there was a significant improvement in the number of daily steps in the OC group compared with the OT group (p = .030). CONCLUSION: OC significantly improved mental health and executive function in individuals with schizophrenia. Further, OC significantly increased PA measured by the pedometers. These findings suggest that OC offers a safe and attrition-lowering intervention promoting mental health and PA. TRIAL REGISTRATION: cris.nih.go.kr identifier: KCT-0000873.

Physical performance is more strongly associated with cognition in schizophrenia than psychiatric symptoms.

BACKGROUND: Although neurocognitive dysfunction and physical performance are known to be impaired in patients with schizophrenia, evidence regarding the relationship between these two domains remains insufficient. Thus, we aimed to investigate the relationship between various physical performance domains and cognitive domains in individuals with schizophrenia, while considering other disorder-related clinical symptoms. METHODS: Sixty patients with schizophrenia participated in the study. Cardiorespiratory fitness and functional mobility were evaluated using the step test and supine-to-standing (STS) test, respectively. Executive function and working memory were assessed using the Stroop task and Sternberg working memory (SWM) task, respectively. Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Multivariate analyses were performed to adjust for relevant covariates and identify predictive factors associated with neurocognition. RESULTS: Multiple regression analysis revealed that the step test index was most strongly associated with reaction time in the Stroop task (ß = 0.434, p = 0.001) and SWM task (ß = 0.331, p = 0.026), while STS test time was most strongly associated with accuracy on the Stoop task (ß=-0.418, p = 0.001) and SWM task (ß=-0.383, p = 0.007). Total cholesterol levels were positively associated with Stroop task accuracy (ß=-0.307, p = 0.018) after controlling for other clinical correlates. However, clinical symptoms were not associated with any variables in Stroop or SWM task. CONCLUSIONS: The present findings demonstrate the relationship between physical performance and neurocognition in patients with schizophrenia. Considering that these factors are modifiable, exercise intervention may help to improve cognitive symptoms in patients with schizophrenia, thereby leading to improvements in function and prognosis.

Iron is Responsible for Production of Reactive Oxygen Species Regulating Vasopressin Expression in the Mouse Paraventricular Nucleus.

Reactive oxygen species (ROS) act as signaling molecules for maintaining homeostasis, particularly in the regulation of body-fluid balance in the paraventricular nucleus (PVN) of the hypothalamus. However, there has been little discussion regarding the source of ROS generation in this hypothalamic region. Because iron is the most abundant metal in the brain, we hypothesized that iron may act as a source of ROS, which regulate vasopressin (VP) expression. In the present study, we compared the amount of iron in the PVN to that in other forebrain regions of normal ICR mice, and examined the relationship among iron, ROS, and VP in the PVN of the iron-overloaded with iron dextran and iron-chelated mice with deferoxamine. The amount of iron in the PVN was significantly higher than in any of the forebrain regions we examined. The amount of iron in the PVN was significantly increased in iron-overloaded mice, although not in iron-chelated mice. These results suggest that the PVN exhibits high iron affinity. Both ROS production and VP expression in the PVN of iron-overloaded mice were significantly increased relative to levels observed in control mice. VP concentration in blood of iron-overloaded mice was also significantly higher than that of control mice. Interestingly, iron overload did not alter the expression of nitric oxide synthase, another modulator of VP expression. Taken together, our results suggest that high levels of iron in the PVN induce the production of ROS, which regulate VP expression, independent of nitric oxide signaling.

Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients.

OBJECTIVE: Although various clinical factors that affect medication adherence in schizophrenia have been studied, the role of the therapeutic alliance has not been studied in detail. Accordingly, we investigated the association between medication adherence and therapeutic alliance in patients with schizophrenia treated in a community outpatient clinic in Korea. METHODS: In this cross-sectional study, 81 outpatients who met the DSM-IV-TR criteria for schizophrenia were analyzed. Therapeutic alliance was measured via patient-self-report questionnaires consisting of 12 questions, which evaluate both “affective bond” and “collaborative bond” of alliance. We investigated the relationship between medication adherence and therapeutic alliance through correlation and regression analyses. RESULTS: Overall therapeutic alliance was weakly associated with medication adherence (r=0.268, p＜0.05). Among two factors of therapeutic alliance, “affective bond” was associated with adherence (r=0.302, p＜0.05), but collaborative was not. Regression analysis showed that therapeutic alliance significantly predicted medication adherence even after adjustment for duration of treatment, insight, and symptom severity. CONCLUSION: Maintaining a favorable therapeutic alliance is associated with medication adherence in schizophrenia. Further, treating patients in a frank and genuine manner might be important to improve adherence.

Changes of motor cortical excitability and response inhibition in patients with obsessive­compulsive disorder

Background: Deficits in cortical inhibitory processes have been suggested as underlying pathophysiological mechanisms of obsessive­compulsive disorder (OCD). We examined whether patients with OCD have altered cortical excitability using paired-pulse transcranial magnetic stimulation (TMS). We also tested associations between TMS indices and OCD-related characteristics, including age of onset and response inhibition in the go/no-go paradigm, to examine whether altered cortical excitability contributes to symptom formation and behavioural inhibition deficit in patients with OCD. Methods: We assessed motor cortex excitability using paired-pulse TMS in 51 patients with OCD and 39 age-matched healthy controls. We also assessed clinical symptoms and response inhibition in the go/nogo task. All patients were undergoing treatment with serotonin reuptake inhibitors. We performed repeated-measures multivariate analysis of covariance to compare TMS indices between patients with OCD and controls. Results: Compared to controls, patients with OCD showed a shorter cortical silent period and decreased intracortical facilitation. However, we found no significant difference between groups for resting motor threshold or short-interval intracortical inhibition. In the OCD group, the shortened cortical silent period was associated with a prompt reaction time in the go/no-go task and with early onset of OCD. Limitations: We could not exclude the influence of medications on motor cortex excitability. Conclusion: These findings suggest abnormal cortical excitability in patients with OCD. The associations between cortical silent period and response inhibition and age of onset further indicate that altered cortical excitability may play an important role in the development of OCD.