Association between chronic fatigue syndrome and suicidality among survivors of Middle East respiratory syndrome over a 2-year follow-up period.

Suicide is an important public health issue during the current pandemic of emerging infectious diseases (EIDs). In EIDs, various symptoms persist even after recovery, and chronic fatigue is among those that are commonly reported. The aim of this study was to examine the effects of chronic fatigue syndrome on suicidality during the recovery phase among survivors of Middle East respiratory syndrome (MERS). MERS survivors were recruited from five centers and prospectively followed up for 2 years. In total, 63 participants were registered at 12 months (T1), of whom 53 and 50 completed the assessments at 18 months (T2) and 24 months (T3), respectively. Suicidality and chronic fatigue were evaluated using the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Fatigue Severity Scale (FSS), respectively. We analyzed the relationship between chronic fatigue and suicidality during the follow-up period using the generalized estimating equation (GEE). The suicidality rates were 22.2% (n = 14), 15.1% (n = 8), and 10.0% (n = 5) at T1-T3, respectively. Of the 63 participants, 29 had chronic fatigue syndrome at T1. The group that reported chronic fatigue syndrome at T1 was more likely to experience suicidality during the 2-year follow-up than the group that reported otherwise (RR: 7.5, 95% CI: 2.4-23.1). This association was present even after adjusting for potential confounders (RR: 7.6, 95% CI: 2.2-26.0). Chronic fatigue syndrome and suicide risk among emerging infectious disease (EID) survivors should be acknowledged, and effective interventions must be developed.

Decreased cardiovascular death in schizophrenia patients treated with antipsychotics: A Korean national cohort study.

BACKGROUND: Patients with schizophrenia have a reduced life expectancy, but the association between antipsychotic usage and cause of death is uncertain. METHODS: The authors observed associations of antipsychotic usage with the mortality rate and cause of death in a population-based cohort of the Korean National Health Insurance Service database from 2003 to 2017. A total of 86,923 patients with schizophrenia were categorized by the total duration of antipsychotic prescription after schizophrenia diagnosis into treated (n = 77,139) and untreated (n = 9784) groups. The main outcome was all-cause mortality; causes of death included cardiovascular disease, pulmonary disease, diabetes, cancer, accident, suicide and homicide. RESULTS: The numbers of all-cause deaths and deaths from individual causes were significantly lower in the antipsychotic-treated group than in the untreated group (all cases, p < 10-4). When adjusted for covariates (age, sex, income, body mass index, alcohol consumption, hypertension, cancer and cerebral stroke), mortality rates due to ischemic heart disease (hazard ratio, HR, 0.38 [95% CI, 0.18-0.77]) and stroke (HR, 0.39 [95% CI, 0.19-0.80]) were significantly lower in the antipsychotic-treated group. Among 4 atypical antipsychotics (olanzapine, risperidone, aripiprazole and quetiapine), only aripiprazole was associated with a decreased mortality risk relative to olanzapine (HR, 0.55 [95% CI, 0.32-0.96]). CONCLUSIONS: Schizophrenia patients constantly prescribed antipsychotics had significantly lower rates of death from certain cardiovascular illnesses than untreated patients. Aripiprazole-treated schizophrenia was associated with a decreased risk of death compared with olanzapine-treated disease.

Anxiety and Depression of the Patients with Hematological Malignancies during Hospitalization for Hematopoietic Stem Cell Transplantation.

OBJECTIVE: This study aimed to assess the anxiety and depression in patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS: Eighty-seven adult patients with various hematologic diseases, who were scheduled to receive autologous or allogeneic HSCT, were enrolled. The M.D. Anderson Symptom Inventory and the Hospital Anxiety Depression Scale were applied prospectively at hospital admission (D-14), on the day of transplantation (D day), and at 7 (D7) and 14 days (D14) after transplantation. RESULTS: The severity of both anxiety and depressive symptoms increased over time, with a peak at D7, and then showed a downturn at D14. Physical distresses also started with mild intensity at base line, which were continuously aggravated until D7, and then a partial recovery afterwards. Approximately, 52% of the participants had significantly high anxiety or depression before the start of HSCT. The occurrence of aggravation of pain, nausea, shortness of breath, and lack of appetite was associated with the development of anxiety during isolation period. The patients with significant baseline anxiety had higher scores on fatigue and shortness of breath items at D7 compared to those without. CONCLUSION: Our finding suggests the importance of psychiatric approaches, including preventive measures, for the patients undergoing HSCT.

Feasibility of Psychosocial Distress Screening and Management Program for Hospitalized Cancer Patients.

OBJECTIVE: Although the diagnosis and treatment of cancer is associated with psychosocial distress, routine distress screening is difficult in hospitalized oncology settings. We developed a consecutive screening program for psychosocial distress to promote psychiatric treatment of cancer patients and evaluated the feasibility of our program by Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). METHODS: Among 777 cancer inpatients recruited from the Catholic Comprehensive Institute of Seoul St. Mary's Hospital, 499 agreed to complete primary distress screening through DT. We conducted secondary distress screening through HADS in 229 patients who had high scores of DT. RESULTS: Of the 499 participants, 270 patients with low scores of DT were included in the distress education program. 229 patients with high scores of DT received secondary distress screening through HADS. Among 115 patients with low scores of HADS, 111 patients received distress management. Among 114 patients with high scores in the secondary distress screening, 38 patients received psychiatric consultation service whereas 76 patients refused psychiatric consultation. CONCLUSION: Using consecutive screening for psychosocial distress appeared to be feasible in an inpatient oncology setting. Nevertheless, the low participation rate of psychiatric consultation service in cancer patients with high distress level should be improved.

Changes of plasma adiponectin levels after smoking cessation.

OBJECTIVE: Cigarette smoking is associated with a variety of health problems including cardiovascular, pulmonary, neoplasms, endocrinopathies including diabetes, the metabolic syndrome, and chronic inflammation. Adiponectin is an adipocyte-derived plasma protein that is closely associated with insulin sensitivity and the metabolic syndrome. The aim of this study was to evaluate the changes of plasma adiponectin levels after smoking cessation. METHODS: Thirty seven smokers that wanted to stop smoking without any nicotine replacement therapy or medication were recruited for this study. Fifteen smokers succeeded in stopping smoking (validated by urine cotinine levels ≤50 ng/mL) and 22 smokers failed. Therefore, only the 15 that succeeded were included in the analysis. The plasma adiponectin levels were determined using a commercially available enzyme-linked immunosorbent assay. RESULTS: The mean age of the successful 15 was 35±9.3 years old. They were all males. The daily smoking habit was a mean of 13.5±5.4 cigarettes per day. The mean Nicotine Dependence Syndrome Scale (NDSS) and Fagerstrom Test for Nicotine Dependence (FTND) scores were 55.6±9.6 and 2.9±1.9. During the study period of three months, the mean body mass index (BMI), body fat mass (BFM), waist-hip ratio (WHR) and body weight increased by 1.1 kg/m(2), 3.0%, 0.02%, and 2.9 kg, respectively. The baseline mean adiponectin level in the subjects was 11.9±5.2 mg/L. The mean adiponectin levels measured at one and three months were 16.0±5.1 mg/L and 14.7±4.5 mg/L respectively. The mean plasma adiponectin levels of the successful group was significantly increased after four weeks when compared to the baseline (z=-2.401, p=0.016). However, the decrease in plasma adiponectin levels at one and three months was not statistically significant. CONCLUSION: Even though the decrease over the next two months was not significant, these findings, the increase of plasma level of adiponectin after smoking cessation, provide preliminary data for future research on the possible mechanisms associated with smoking cessation and changes in body metabolism.

Psychological resilience contributes to low emotional distress in cancer patients.

PURPOSE: Although a considerable number of cancer patients suffer from emotional distress which may have an impact on their quality of life, it still remains poorly understood which psychosocial factors contribute to individual vulnerabilities to emotional distress of cancer patients. Recently, resilience has been suggested as the capacity to cope with adversities like cancer. In this study, we investigated the relationships between resilience and emotional distress in cancer patients. METHODS: One hundred fifty-two cancer patients who were consecutively hospitalized for their scheduled treatments at the Seoul St. Mary's Hospital were enrolled and completed the Connor-Davidson Resilience Scale and Hospital Anxiety Depression Scale to measure resilience and emotional distress. The relationships between the levels of psychological resilience and emotional distress were evaluated using univariate and multivariate logistic regression analyses. RESULTS: Psychological resilience levels were negatively associated with emotional distress after controlling for relevant covariates. The highest quartile of resilience level was associated with a 90% (adjusted odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.03-0.34, P < 0.001) reduction in the risk for emotional distress compared to the lowest quartile. Among metastatic cancer patients, resilience was also found to be a significant protective factor for emotional distress (adjusted OR = 0.14, 95% CI = 0.02-0.79, P = 0.02). CONCLUSION: The present study suggests that psychological resilience may independently contribute to low emotional distress in cancer patients. The relationship between resilience and emotional distress was also significant in the subgroup of metastatic cancer patients. Psychosocial interventions to enhance resilience might provide useful approaches to overcome cancer-related emotional distress.

Clinical characteristics associated with different strengths of loudness dependence of auditory evoked potentials (LDAEP) in major depressive disorder.

Loudness dependence of auditory evoked potentials (LDAEP), also called as intensity dependence of auditory evoked potentials (IDAP), has been proposed as a potential marker for central serotonergic tone and has been noticed for its possible clinical implications in depression. However, its distributions in major depressive disorder (MDD) and factors affecting it are largely unknown. In this study, we examined its distribution and relationships with various demographic and clinical variables in MDD patients. In 143 MDD patients, the LDAEP was measured using five intensities of auditory stimulus. The influences of ten independent variables (age, gender, education years, marital status, psychiatric family history, age of onset, suicide attempt history, depression severity, later augmentation of mood stabilizer, and smoking status) on the LDAEP strength were examined using univariate analyses and data mining method. The mean (±S.D.) LDAEP was 0.90 (±0.73)µV/10dB (-0.78-3.83µV/10dB). Female gender, smoking, and being married were consistently associated with a weaker LDAEP. In the pathway model, sequential combination of being male, living alone, and older age predicted the strongest LDAEP, whereas female gender, older age, and smoking predicted the weakest LDAEP. These variables need to be considered when interpreting the LDAEP.

The changes of blood glucose control and lipid profiles after short-term smoking cessation in healthy males.

OBJECTIVE: Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. METHODS: Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the ß-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). RESULTS: The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA ß-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). CONCLUSION: During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.

Symptoms of posttraumatic stress disorder and mental health in women who escaped prostitution and helping activists in shelters.

PURPOSE: This study compared the mental symptoms, especially symptoms of posttraumatic stress disorder (PTSD), of women who escaped prostitution, helping activists at shelters, and matched control subjects. MATERIALS AND METHODS: We assessed 113 female ex-prostitutes who had been living at a shelter, 81 helping activists, and 65 control subjects using self-reporting questionnaires on demographic data, symptoms related to trauma and PTSD, stress-related reactions, and other mental health factors. RESULTS: Female ex-prostitutes had significantly higher stress response, somatization, depression, fatigue, frustration, sleep, smoking and alcohol problems, and more frequent and serious PTSD symptoms than the other 2 groups. Helping activists also had significantly higher tension, sleep and smoking problems, and more frequent and serious PTSD symptoms than control subjects. CONCLUSION: These findings show that engagement in prostitution may increase the risks of exposure to violence, which may psychologically traumatize not only the prostitutes themselves but also the people who help them, and that the effects of the trauma last for a long time. Future research is needed to develop a method to assess specific factors that may contribute to vicarious trauma of prostitution, and protect field workers of prostitute victims from vicarious trauma.

Serial vagus nerve stimulation functional MRI in treatment-resistant depression.

Vagus nerve stimulation (VNS) therapy has shown antidepressant effects in open acute and long-term studies of treatment-resistant major depression. Mechanisms of action are not fully understood, although clinical data suggest slower onset therapeutic benefit than conventional psychotropic interventions. We set out to map brain systems activated by VNS and to identify serial brain functional correlates of antidepressant treatment and symptomatic response. Nine adults, satisfying DSM-IV criteria for unipolar or bipolar disorder, severe depressed type, were implanted with adjunctive VNS therapy (MRI-compatible technique) and enrolled in a 3-month, double-blind, placebo-controlled, serial-interleaved VNS/functional MRI (fMRI) study and open 20-month follow-up. A multiple regression mixed model with blood oxygenation level dependent (BOLD) signal as the dependent variable revealed that over time, VNS therapy was associated with ventro-medial prefrontal cortex deactivation. Controlling for other variables, acute VNS produced greater right insula activation among the participants with a greater degree of depression. These results suggest that similar to other antidepressant treatments, BOLD deactivation in the ventro-medial prefrontal cortex correlates with the antidepressant response to VNS therapy. The increased acute VNS insula effects among actively depressed participants may also account for the lower dosing observed in VNS clinical trials of depression compared with epilepsy. Future interleaved VNS/fMRI studies to confirm these findings and further clarify the regional neurobiological effects of VNS.

No evidence for an association of the CTLA4 gene with bipolar I disorder.

The purpose of the present paper was to investigate the relationship between the first exon at position +49 (A/G) polymorphism of the cytotoxic T lymphocyte antigen 4 (CTLA4) gene and bipolar disorder. Among the Korean patients diagnosed with bipolar disorder according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV), 90 patients without serious medical illness, neurologic illness, hormonal disorder, or concomitant mental illness were selected. The normal control group consisted of 149 age- and sex-matched subjects without current or past history of autoimmune diseases or mental disorder. DNA was extracted from peripheral blood using proteinase K; and the exon 1 region of the CTLA4 gene was amplified by polymerase chain reaction. Gene typing was performed using single strand conformation polymorphism. There were no significant differences in genotype frequencies of CTLA4*G/G, CTLA4*G/A, and CTLA4*A/A between the patients with bipolar disorder and the control group (48.9% vs 46.3%, 44.4% vs 39.6%, and 6.7% vs 14.1%, respectively). There were no significant differences in allelic frequencies of CTLA4*G and CTLA4*A between the patients with bipolar disorder and the control group (71.1% vs 66.1%; 28.9% vs 33.9%, respectively). In the present study an association was not found of exon 1 (+49) polymorphism of CTLA4 gene with bipolar disorder in the Korean population.

Possible association between -G308A tumour necrosis factor-alpha gene polymorphism and major depressive disorder in the Korean population.

OBJECTIVE: The present study was aimed at examining the association between the -G308A tumour necrosis factor-alpha gene polymorphism and major depressive disorder (MDD) in the Korean population. METHODS: One hundred and eight in-patients with MDD and 125 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Genotype and allele distributions in patients with MDD (P=0.024 and P=0.0125, respectively), were significantly different from those of the controls. In particular, subjects with MDD had an increased frequency of the TNF2 (A) allele. CONCLUSION: The present study suggests that the -G308A tumour necrosis factor-alpha gene polymorphism may have a potential role for susceptibility to MDD in the Korean population.

Tumor necrosis factor-alpha gene polymorphism at position -308 and schizophrenia in the Korean population.

The purpose of the present study was to examine the association between the tumor necrosis factor (TNF)-alpha gene (A) polymorphism and schizophrenia in a Korean sample of schizophrenic patients and control subjects. Genotyping for the TNFA polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism. Genotype and allele distributions of the TNFA polymorphism between schizophrenic patients and controls were not significantly different. In the light of these results, the TNFA polymorphism seems not to confer susceptibility to the pathogenesis of schizophrenia, at least in the Korean population.

TNFB polymorphism may be associated with schizophrenia in the Korean population.

This study was conducted to test the association between the tumor necrosis factor (TNF)-beta gene (B) polymorphism and schizophrenia in the Korean population. 127 patients with schizophrenia according to the DSM-IV criteria and 202 healthy controls were enrolled in this study. Patients and controls were biologically unrelated age and sex-matched native Koreans. Genotyping for the TNFB polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism. Genotype and allele distributions of the TNFB polymorphism in patients with schizophrenia were significantly different from those of the controls. Subjects with the TNFB*2 allele had an increased risk for schizophrenia (Odds Ratio=1.76, 95% CI=1.27-2.45). The present study suggests that the TNFB polymorphism may confer susceptibility to schizophrenia in the Korean population.

Tumor necrosis factor-beta gene polymorphism may not be associated with major depressive disorder in the Korean population.

Tumor necrosis factor (TNF)-beta has been implicated in the regulation of immune system. Alterations of the immune system in patients with major depressive disorder (MDD) have been also proposed to date. The present study was undertaken to investigate whether TNF-beta gene polymorphism is associated with MDD in the Korean population. Ninety-five patients with MDD who met the criteria of DSM-IV and 202 gender- and age-matched unrelated volunteers participated in the study. Genotyping for TNF-beta gene was performed by a polymerase chain reaction-restriction fragment length polymorphism method. The genotype and allele distribution in patients with MDD was similar to that of the controls. This study suggests that the TNF-beta gene polymorphism does not confer a susceptibility to MDD in the Korean population. A larger scaled study to examine different races is necessary to determine a role in the pathogenesis of MDD.

Polymorphism of CTLA-4 gene at position 49 of exon 1 may be associated with schizophrenia in the Korean population.

This study was carried out to investigate the association of a polymorphism of the CTLA-4 gene, at position 49 of exon 1, with schizophrenia in the Korean population. Among Korean patients diagnosed with schizophrenia according to DSM-IV, 116 patients who met the selection criteria were recruited for the study. One hundred and forty-nine normal healthy Koreans from the Catholic Hemopoietic Stem Cell Information Bank, were used as a normal control group. DNA was extracted from whole blood using proteinase K and the CTLA-4 gene region was amplified by polymerase chain reaction. Geneo typing was performed by single strand conformation polymorphism (SSCP). The genotype and allele distribution in patients with schizophrenia was significantly different from that seen in the control group. This study suggests a putative role of the CTLA-4 gene polymorphism at position 49 of exon 1 for schizophrenia in the Korean population, although the detailed mechanisms remained to be elucidated.

A case of brief psychosis associated with an arachnoid cyst.

Little is known about the arachnoid cyst and there have been few reports of it accompanying psychiatric disturbances. A 57-year-old patient was admitted due to sudden headache, auditory hallucination, and delusion of persecution. An arachnoid cyst was found in the anteromedial aspect of middle cranial fossa on his magnetic resonance image. This was his first psychotic episode and he was also negative to other clinical evaluations including endocrine system. His psychotic symptoms were suspected to be induced by the arachnoid cyst and it was well controlled by low-dose risperidone administration. He left hospital free from psychotic symptoms on 14th hospital day.

A review of the new minimally invasive brain stimulation techniques in psychiatry

O conhecimento acerca de regiões específicas do cérebro envolvidas em transtornos psiquiátricos está em franca expansäo como resultado dos avanços recentes em técnicas de neuroimagem funcional. A capacidade de estimular o cérebro em adultos despertos em estado de alerta, sem necessidade de neurocirurgia, é um avanço real sonhado havia muito pelos neurocientistas. Recentemente, desenvolveram-se várias novas técnicas minimamente invasivas para estimular o cérebro. Entre essas novas intervenções somáticas, a estimulaçäo transcraniana magnética (ETM), a estimulaçäo do nervo vago (ENV) e a estimulaçäo cerebral profunda (ECP) revelam-se promissoras ferramentas terapêuticas no tratamento de transtornos neuropsiquiátricos. Neste artigo se faz uma revisäo da história, da metodologia e das perspectivas futuras das técnicas minimamente invasivas de estimulaçäo cerebral (ECMI) e das pesquisas e aplicações terapêuticas em psiquiatria