Amisulpride withdrawal akathisia responding to aripiprazole with propranolol in first-onset psychosis: a case report.

BACKGROUND: Akathisia tends to develop as an early complication of antipsychotic treatment in a dose-dependent manner. Although withdrawal akathisia has been reported after the discontinuation or dose reduction of typical antipsychotic drugs, akathisia following atypical antipsychotic drug withdrawal remains a rare phenomenon. CASE PRESENTATION: A 24-year-old woman with an acute psychotic episode was admitted and initially treated with aripiprazole. The aripiprazole dose was titrated up to 30 mg/day over 9 days and maintained for the next 3 days; however, her psychotic symptoms persisted without change. She was switched to amisulpride, with the dose increased over 2 weeks to 1000 mg/day. Subsequently, although the patient's psychotic episode subsided, her serum prolactin levels increased markedly. After discharge, the amisulpride dose was increased to 1200 mg/day owing to auditory hallucinations and was maintained with quetiapine (100-200 mg/day) and benztropine (1 mg/day) for 13 weeks. Given the potential for hyperprolactinemia as a side effect, the amisulpride dose was reduced to 800 mg/day concurrently with the discontinuation of benztropine; however, these changes resulted in severe restlessness without other extrapyramidal symptoms. The withdrawal akathisia disappeared over 2 weeks after switching to aripiprazole (10 mg/day) with propranolol (40 mg/day) and the patient's prolactin levels had normalized after 6 months of aripiprazole monotherapy. CONCLUSIONS: The present case highlights the potential for the development of withdrawal akathisia when the dose of amisulpride is tapered abruptly. Thus, a slow tapering and careful monitoring are recommended when switching from amisulpride to other antipsychotic drugs. Furthermore, this case suggests that changing the regimen to aripiprazole with propranolol may be a potential option for amisulpride withdrawal akathisia superimposed on pre-existing hyperprolactinemia.

Ego-resiliency moderates the risk of depression and social anxiety symptoms on suicidal ideation in medical students.

BACKGROUND: Little is known about the role of protective factors in suicidal ideation among medical students. This study aimed to examine the association between suicidal ideation and protective (self-esteem/ego-resiliency/social support) and risk (depression/social anxiety) factors. METHODS: Data on sociodemographic factors, depression, social anxiety, self-esteem, ego-resiliency, social support, and current suicidal ideation were collected from 408 medical students. A logistic regression model was constructed to identify the independent impact of potential influencing factors on suicidal ideation. Potential moderating effects were also explored. RESULTS: Thirty-eight participants (9.3%) reported experiencing suicidal ideation. Younger age, higher levels of depression, social anxiety, and lower levels of self-esteem, ego-resiliency, and social support were found to be significantly correlated with suicidal ideation. In the final model, higher levels of depression and social anxiety were associated with an increased risk of suicidal ideation, while higher levels of self-esteem and social support were associated with a decreased risk of suicidal ideation. Although the independent effect was not significant, the interactions of ego-resiliency with both depression and social anxiety on suicidal ideation were significant. Higher levels of ego-resiliency acted as a buffer against suicidal ideation among those with higher levels of depression or social anxiety. CONCLUSIONS: In addition to risk factors, this study revealed the underlying protective and moderating factors of suicidal ideation among medical students. Mental health programs focusing on enhancing ego-resiliency, self-esteem, and social support may contribute to suicide prevention in medical students.

The relationship between smartphone addiction and symptoms of depression, anxiety, and attention-deficit/hyperactivity in South Korean adolescents.

BACKGROUND: Excessive smartphone use has been associated with numerous psychiatric disorders. This study aimed to investigate the prevalence of smartphone addiction and its association with depression, anxiety, and attention-deficit hyperactivity disorder (ADHD) symptoms in a large sample of Korean adolescents. METHODS: A total of 4512 (2034 males and 2478 females) middle- and high-school students in South Korea were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Korean Smartphone Addiction Scale (SAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Conners-Wells' Adolescent Self-Report Scale (CASS). Smartphone addiction and non-addiction groups were defined using SAS score of 42 as a cut-off. The data were analyzed using multivariate logistic regression analyses. RESULTS: 338 subjects (7.5%) were categorized to the addiction group. Total SAS score was positively correlated with total CASS score, BDI score, BAI score, female sex, smoking, and alcohol use. Using multivariate logistic regression analyses, the odds ratio of ADHD group compared to the non-ADHD group for smartphone addiction was 6.43, the highest among all variables (95% CI 4.60-9.00). CONCLUSIONS: Our findings indicate that ADHD may be a significant risk factor for developing smartphone addiction. The neurobiological substrates subserving smartphone addiction may provide insights on to both shared and discrete mechanisms with other brain-based disorders.

Tuberculum sellae meningioma with possible tacrolimus neurotoxicity manifesting as manic-like psychosis after kidney transplantation.

BACKGROUND: Although kidney transplantation is the best treatment option for chronic kidney disease, the accompanying immunosuppressive treatment can induce severe neurotoxicity presenting, on rare occasions, as psychosis. However, a brain tumor synchronous with immunosuppressant neurotoxicity has never been reported in a kidney transplant recipient. Herein, we report the first case of possible tacrolimus neurotoxicity with a meningioma manifesting as manic-like psychosis after kidney transplantation. CASE PRESENTATION: A 63-year-old male presenting with acute psychotic mania was admitted to a psychiatric ward approximately 2 years after kidney transplantation. On brain magnetic resonance imaging, a tuberculum sellae meningioma was found, and hyperintense white matter lesions with possible tacrolimus-induced neurotoxicity were seen on fluid-attenuated inversion recovery images. Interestingly, the patient showed no visual field defects, and his blood tacrolimus concentration was within therapeutic ranges. After 3 weeks of adjunctive treatment with blonanserin, most of the symptoms had abated. CONCLUSIONS: The present case highlights the fact that neuroimaging studies are necessary to investigate underlying causes, as well as immunosuppressant neurotoxicity, which should all be considered when atypical psychiatric symptoms develop after organ transplantation. Further, this case suggests that the additional use of atypical antipsychotics while maintaining immunosuppressants may be effective for manic-like psychotic symptoms secondary to possible immunosuppressant neurotoxicity synchronous with a meningioma.

Life satisfaction and happiness associated with depressive symptoms among university students: a cross-sectional study in Korea.

BACKGROUND: This cross-sectional study investigated the impact of life satisfaction and happiness, as well as the prevalence and correlates of depressive symptoms in a large sample of university students. METHODS: We included 2338 students at 6 universities in 1 metropolitan city and 2 provinces of Korea. Depressive symptoms were assessed by the Beck Depression Inventory, and scores of 16 or higher were categorized as the presence of depression. Various sociodemographic, life satisfaction, happiness, and clinical factors (alcohol consumption and sleep quality) were measured. According to the presence of depression, sociodemographic, life satisfaction, happiness, and clinical characteristics were compared using statistical analyses. Further, a logistic regression model was constructed to examine the impact of life satisfaction, happiness, and clinical factors on depression. RESULTS: Among participants, 13.4% were identified as having depression. Life satisfaction and happiness were associated with a lower risk of depression, while hazardous alcohol drinking and poor sleep quality were related to a higher risk of depression. In addition, female gender, subjective body shape as obese, and insufficient pocket money were found to be significant correlates of depressive symptoms. CONCLUSIONS: This study demonstrated possible risk and protective factors of underlying depressive symptoms. Especially, our findings suggest that improvement in life satisfaction and happiness would be important in the prevention and management of depression. Our findings may contribute to developing specialized mental health programs for prevention, screening, and treatment of depression among university students.

Bullying Among South Korean Adolescents: Prevalence and Association With Psychological Adjustment.

This study assessed the prevalence rates of physical, verbal, relational, property, and cyber bullying among a sample of South Korean middle school students. Associations between bullying and a list of psychopathological symptoms were also examined. Finally, whether a link between bullying and psychopathological symptoms is modified by the level of parental attachment was examined. Results show that, contrary to Western studies, girls were more likely than boys to be involved in school bullying. Significant interaction effects between parental attachment and bully/victim status on depression were also discovered.

Suicidality is most centrally situated within network of depression symptom criteria in unipolar depression patients with mood stabilizer in Asia.

Lithium and mood stabilizers are considered effective augmentation agents of antidepressants for treatment-resistant depression. Thus, this study aimed to estimate the network structure of depression symptom criteria among unipolar depression patients with mood stabilizers, using data from the Research on Asian Psychotropic Prescription Patterns for mood stabilizers (REAP-MS). We estimated a network of the 9 depression symptom criteria among 411 unipolar depression patients in Asia. Each of the depression symptom criteria was considered to be a dichotomous categorical variable. Suicidality (suicidal ideation or attempt) was the most centrally situated within the network of depression symptoms, followed by depressed mood, loss of energy, anhedonia and weight loss or gain. Contrastingly, concentration problem was the least interconnected. The depression symptom criteria were organized into 4 clusters by the community detection method. The findings suggest that suicidality may be one of the significant therapeutic target symptoms in unipolar depression patients with mood stabilizers.

Quantitative visualization of a gas diffusion layer in a polymer electrolyte fuel cell using synchrotron X-ray imaging techniques.

A gas diffusion layer (GDL) in a polymer electrolyte fuel cell (PEFC) is quantitatively visualized using synchrotron X-ray micro-computed tomography. For three-dimensional reconstruction, an adaptive threshold method is used. This method is compared with the conventional method, i.e. Otsu's method. Additionally, the spatial and temporal variations of the porosity distribution of the GDL under freeze-and-thaw cycles are investigated experimentally. The freeze-and-thaw cycles are established simply using a CRYO system and light source illumination, respectively. Structural defects are found to largely affect the porosity of the GDL. In addition, a cyclic porosity variation is observed in the GDL under freeze-and-thaw cycles. The heterogeneous porosity is irreversibly decreased with the progress of repetitive cycles.

Successful Early Lamotrigine and Aripiprazole Augmentation of Clomipramine in Severe Obsessive-compulsive Disorder.

Lamotrigine and aripiprazole have shown efficacy as augmentation agents of serotonin reuptake inhibitors for treatment-resistant obsessive-compulsive disorder (OCD). To date, the efficacy of lamotrigine/aripiprazole augmentation has not been reported in OCD treatment. Herein, we report the case of a 37-year-old male with severe OCD and comorbid depression whose symptoms markedly improved after low-dose lamotrigine/aripiprazole augmentation to clomipramine. Our report suggests that early glutamatergic/antipsychotic augmentation contributes to rapid remission of OCD symptoms.

Psychosocial Factors Influencing Quality of Life Among Medical Students.

OBJECTIVE: This study investigated the influence of psychosocial factors on medical students' quality of life (QOL). METHODS: A total of 408 medical students participated in this study. We collected data on participants' sociodemographic details, symptoms of depression and Internet addiction, self-esteem, social support, and QOL. QOL was assessed using the World Health Organization Quality of Life-Abbreviated form, which has four domains (physical health, psychological health, social relationships, and environment). A stepwise multiple linear regression model was constructed to identify factors' independent impact on QOL. RESULTS: Higher levels of depression and Internet addiction were associated with lower scores in all domains of QOL, whereas higher levels of self-esteem and social support were associated with higher scores. Being in third-year versus first-year was associated with higher scores in the physical health and environment domains. Living alone or in dormitories, low or middle socioeconomic status, and insufficient or moderate pocket money were associated with lower scores in the environment domain. Additionally, female students displayed significantly lower scores for physical health, psychological health, and environment than male students, but not for social relationships. There were significant differences in certain domains of QOL due to sociodemographic factors. CONCLUSION: This study demonstrates the psychosocial factors influencing medical students' QOL. Educational strategies focusing on strengthening self-esteem and social support as well as preventing depression and Internet addiction may contribute to improving medical students' QOL.

Internet Addiction and Its Associations with Clinical and Psychosocial Factors in Medical Students.

OBJECTIVE: Excessive internet use has been associated with various psychiatric symptoms and psychosocial factors. This study aimed to investigate the prevalence of internet addiction (IA) and its associations with clinical (depression/social anxiety) and psychosocial (self-esteem/perceived social support) factors in medical students. METHODS: In total, 408 medical students at one university in Korea were included in this study. IA symptoms were assessed with Young's Internet Addiction Test, and scores of 50 or higher were considered to indicate IA. Participants were asked to complete the Beck Depression Inventory, Social Phobia Inventory, Rosenberg Self-Esteem Scale, and Duke-University of North Carolina Functional Social Support Questionnaire. A logistic regression model was constructed to examine the impact of clinical and psychosocial factors on IA. RESULTS: Forty-seven participants (11.5%) were identified as having IA. Self-esteem was associated with a lower risk of IA, whereas depression and social anxiety were associated with a higher risk of IA. Depression, social anxiety, low self-esteem, and low perceived social support were found to be significant correlates of IA. Young's Internet Addiction Test score positively correlated with Beck Depression Inventory and Social Phobia Inventory scores, but negatively correlated with Rosenberg Self-Esteem Scale and Duke-University of North Carolina Functional Social Support Questionnaire scores. Furthermore, the prevalence of IA was highest in first-year medical students. CONCLUSION: This study revealed the possible risk and protective factors of IA. Our findings indicate that strengthening self-esteem and reducing depression and social anxiety may contribute to the prevention and management of IA in medical students.

Associations between Brain Reserve Proxies and Clinical Progression in Alzheimer's Disease Dementia.

The purpose of this study was to investigate whether brain and cognitive reserves were associated with the clinical progression of AD dementia. We included participants with AD dementia from the Alzheimer's Disease Neuroimaging Initiative, provided they were followed up at least once, and candidate proxies for cognitive (education for early-life reserve and Adult Reading Test for late-life reserve) or brain reserve (intracranial volume [ICV] for early-life reserve and the composite value of [18F] fluorodeoxyglucose positron emission tomography regions of interest (FDG-ROIs) for late-life reserve) were available. The final analysis included 120 participants. Cox proportional hazards model revealed that FDG-ROIs were the only significant predictor of clinical progression. Subgroup analysis revealed a significant association between FDG-ROIs and clinical progression only in the larger ICV group (HR = 0.388, p = 0.028, 95% CI 0.167-0.902). Our preliminary findings suggest that relatively preserved cerebral glucose metabolism might delay further clinical progression in AD dementia, particularly in the greater ICV group. In addition to ICV, cerebral glucose metabolism could play an important role as a late-life brain reserve in the process of neurodegeneration. Distinguishing between early- and late-life reserves, and considering both proxies simultaneously, would provide a wider range of factors associated with the prognosis of AD dementia.

Feasibility of regenerative adsorption of a hydrofluorocarbon (HFC-134a) using activated carbon fiber studied by the gaseous flow method.

The adsorption and desorption behavior of the refrigerant HFC-134a on pitch-based activated carbon fibers (ACFs) with various Brunauer-Emmett-Teller surface areas was investigated by the flow method. Fixed-bed adsorption experiments performed at 20, 5, -15, -20, and -25 °C showed that the use of lower temperatures resulted in an increase in the adsorption capacity of the ACF. In particular, the complete adsorption time was dramatically increased at -25 °C. Crucially, even after five cycles of adsorption at -20 °C and desorption at 30 °C of HFC-134a in a electrothermal swing adsorption apparatus, significant decreases in the adsorption capability were not observed. The desorption of HFC-134a from saturated ACF was carried out using electric power directly applied to the ACF itself. The electric heating increased the ACF temperature, causing desorption within several minutes. The results of this study show that the regenerative adsorption of HFC-134a by ACF coupled with electric power is possible.

A Literature Review on the Efficacy and Related Neural Effects of Pharmacological and Psychosocial Treatments in Individuals With Internet Gaming Disorder.

OBJECTIVE: Internet gaming disorder (IGD) has attracted considerable attention as a serious mental and public health issue worldwide. Currently, there are no established treatment guidelines for IGD. Herein, we review the latest findings on the efficacy and related neural effects of pharmacological and psychosocial treatments for individuals with IGD. METHODS: A database search of relevant studies published between 2007 and 2020 was conducted using PubMed and Google Scholar. Twenty-seven studies were reviewed for current evidence related to the efficacy and neural effects of pharmacological and psychosocial IGD treatments. RESULTS: Pharmacological studies suggest that bupropion may play a significant role in IGD. Additionally, nuclear imaging studies on IGD have demonstrated functional impairment of the dopamine system, providing a neurobiological basis for the efficacy of dopamineenhancing drugs. Among the various psychosocial interventions, current evidence suggests that cognitive behavioral therapy may be an effective intervention for IGD. Cognitive behavioral therapy and bupropion were found to influence resting-state functional connectivity within the cortico-subcortical circuit and default mode network, suggesting a possible neural mechanism. Innovative approaches, including virtual reality treatment, residential camps, voluntary abstinence, and transcranial direct current stimulation, have shown promising results. However, methodological limitations, such as the absence of proper controls, small sample sizes, short duration, inconsistency of inclusion criteria across studies, and self-report measures of outcome, hamper conclusions regarding the efficacy of treatments. CONCLUSION: Ongoing basic research and clinical trials overcoming these limitations could add to the existing knowledge on IGD and contribute to the development of evidence-based treatments.

Correlation between fluorodeoxyglucose positron emission tomography and magnetic resonance imaging findings of non-suppurative meningoencephalitis in 5 dogs.

This study characterized the [(18)F]2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) findings of encephalitis in dogs and assessed the role of FDG-PET in the diagnosis of meningoencephalitis. The medical records, magnetic resonance (MR), and FDG-PET images of 3 dogs with necrotizing meningoencephalitis (NME), 1 dog with granulomatous meningoencephalitis (GME), and 1 dog with meningoencephalitis of unknown etiology (MUE) were reviewed. On the FDG-PET, glucose hypometabolism was identified in the dog with NME, whereas hypermetabolism was noted in the dog with GME. The T2-weighted images (WI) and fluid attenuated inversion recovery (FLAIR) images were characterized by hyperintensity, whereas the signal intensity of the lesions on the T1-WI images was variable. The metabolic changes on the brain FDG-PET corresponded well to the hyper- and hypointense lesions seen on the MR imaging. This type of tomography (FDG-PET) aided in the differentiation of different types of inflammatory meningoencephalitis when the metabolic data was combined with clinical and MR findings.

Distinct Neural Correlates of Executive Function by Amyloid Positivity and Associations with Clinical Progression in Mild Cognitive Impairment.

PURPOSE: This study aimed to identify the neural basis of executive function (EF) in amnestic mild cognitive impairment (aMCI) according to beta-amyloid (Aß) positivity. Furthermore, we explored if the identified brain areas could serve as predictors for clinical progression. MATERIALS AND METHODS: We included individuals with aMCI using data from [18F]-florbetapir-positron emission tomography (PET), fluorodeoxyglucose-PET, and EF scores, as well as follow-up clinical severity scores at 1 and 5 years from baseline from the Alzheimer's Disease Neuroimaging Initiative database. The correlations between EF score and regional cerebral glucose metabolism (rCMglc) were analyzed separately for aMCI with low Aß burden (aMCI Aß-, n=230) and aMCI with high Aß burden (aMCI Aß+, n=268). Multiple linear regression analysis was conducted to investigate the associations between rCMglc and clinical progression. RESULTS: Longitudinal courses differed between aMCI Aß- and aMCI Aß+ groups. On average, aMCI Aß- subjects maintained their level of clinical severity, whereas aMCI Aß+ subjects showed progression. EF impairment in aMCI Aß- was related to the anterior cingulate cortex (ACC), whereas that in aMCI Aß+ was related to Alzheimer's Disease-vulnerable brain regions. ACC and the posterior cingulate cortex were associated with clinical progression in aMCI Aß- and aMCI Aß+, respectively. CONCLUSION: Our findings suggest that although MCI subjects showed similar behavioral phenotypes at the time of diagnosis, EF and further progression were associated with different brain regions according to Aß burden. Clarification of the etiologies and nature of EF impairment in aMCI are critical for disease prognosis and management.

Clinical Characteristics and Psychotropic Drug Prescription Patterns of Bipolar Disorder Patients with a History of Suicidal Attempts: Findings from the REAP-BD, Korea.

Our study aimed to analyze the clinical characteristics and psychotropic prescription patterns of a history of suicide attempts in South Koreans with bipolar disorder (BD), by using only Korean data from the Research on Asian Psychotropic Prescription Pattern for Bipolar disorder. The patterns of clinical characteristics and psychotropic drug use were compared among 53 patients with a history of suicide attempts and 297 without this history; the potential effects of confounding variables were adjusted with binary logistic analyses for discrete variables and analyses of covariance for continuous variables. After adjusting the effects of age, sex, duration of illness, and enrollment as an outpatient, patients with a history of suicide attempts were characterized by a significantly more prevalent depressive episode, lower prevalent remission state, lower levels of hemoglobin, and more use of antidepressants, anxiolytics, and hypnotics compared to those without lifetime suicide attempt. The inability to plan goal-directed behavior may be an intervening factor in the relationship between suicide attempts and depression in BD. Relatively low hemoglobin levels can be associated with manic episodes in patients with a history of suicide attempts and the use of antidepressants, anxiolytics, or hypnotics can be associated with suicide attempts in BD patients.

Polymorphism in the serotonin transporter protein gene in Maltese dogs with degenerative mitral valve disease.

Degenerative mitral valve disease (DMVD) is the most commonly acquired cardiac disease in dogs. This study evaluated the relationship between genetic variations in the serotonin transporter (SERT) gene of Maltese dogs and DMVD. Genomic DNA was extracted from blood samples collected from 20 client-owned DMVD Maltese dogs and 10 healthy control dogs, and each exon of the SERT gene was amplified via polymerase chain reaction. The resulting genetic sequences were aligned and analyzed for variations by comparing with reference sequences; the predicted secondary structures of these variations were modeled and cross-verified by applying computational methods. Genetic variations, including five nonsynonymous genetic variations, were detected in five exons. Protein structure and function of the five nonsynonymous genetic variations were predicted. Three of the five polymorphisms were predicted to be probable causes of damage to protein function and confirmed by protein structure model verification. This study identified six polymorphisms of the SERT gene in Maltese dogs with DMVD, suggesting an association between the SERT gene and canine DMVD. This is the first study of SERT mutation in Maltese dogs with DMVD and is considered a pilot study into clinical genetic examination for early DMVD diagnosis.

Correlation between serum homocysteine concentration and severity of mitral valve disease in dogs.

OBJECTIVE To measure serum homocysteine concentrations in dogs with myxomatous mitral valve disease (MMVD) and identify any association between this variable and stage of MMVD. ANIMALS 53 client-owned dogs with MMVD and 10 healthy control Beagles. PROCEDURES Dogs with MMVD were allocated to 3 groups in accordance with the staging system for chronic valvular heart disease in dogs and cats of the American College of Veterinary Internal Medicine. Blood samples were collected from all dogs, and serum homocysteine and cardiac troponin 1 concentrations were measured by enzyme immunoassay and chemiluminescence immunoassay, respectively. Analyte values were tested for associations with each other and with stage of MMVD. RESULTS A significant correlation was identified between serum homocysteine concentration and stage of MMVD. Mean ± SD concentrations were 6.72 ± 1.65 µmol/L for control dogs, 13.37 ± 4.16 µmol/L for dogs with stage B MMVD, 18.86 ± 6.73 µmol/L for dogs with stage C disease, and 28.26 ± 4.48 µmol/L for dogs with stage D disease. In addition, serum homocysteine concentration was correlated with serum cardiac troponin 1 (r = 0.34) and creatinine (r = 0.46) concentrations, systolic blood pressure (r = 0.57), and left atrium-to-aortic root ratio (r = 0.28), all of which were positively correlated with stage of MMVD. CONCLUSIONS AND CLINICAL RELEVANCE Serum homocysteine concentrations of dogs with MMVD were significantly higher than those of control dogs, and significant correlations were identified between these values and several risk factors for heart failure. Measurement of serum homocysteine concentration may be useful in the prediction of severity of disease in dogs with MMVD.

Low Self-Control Among South Korean Adolescents: A Test of Gottfredson and Hirschi's Generality Hypothesis.

Theoretical propositions and empirical tests of Gottfredson and Hirschi's general theory continue to permeate the criminological literature. Nevertheless, the vast majority of studies have been conducted in North America and some European countries. Only a handful of empirical works have been conducted in East Asia. To further test the generality assertion of Gottfredson and Hirschi, the current study examines low self-control's efficacy in predicting the involvement of South Korean adolescents in typical delinquency, drinking, smoking, Internet addiction, and smartphone addiction. The presented findings largely support the generality hypothesis, although the theorists' assertion seems to be somewhat overstated.