Temperament Affects Sympathetic Nervous Function in a Normal Population

OBJECTIVE: Although specific temperaments have been known to be related to autonomic nervous function in some psychiatric disorders, there are few studies that have examined the relationship between temperaments and autonomic nervous function in a normal population. In this study, we examined the effect of temperament on the sympathetic nervous function in a normal population. METHODS: Sixty eight healthy subjects participated in the present study. Temperament was assessed using the Korean version of the Cloninger Temperament and Character Inventory (TCI). Autonomic nervous function was determined by measuring skin temperature in a resting state, which was recorded for 5 minutes from the palmar surface of the left 5th digit using a thermistor secured with a Velcro(R) band. Pearson's correlation analysis and multiple linear regression were used to examine the relationship between temperament and skin temperature. RESULTS: A higher harm avoidance score was correlated with a lower skin temperature (i.e. an increased sympathetic tone; r=-0.343, p=0.004) whereas a higher persistence score was correlated with a higher skin temperature (r=0.433, p=0.001). Hierarchical linear regression analysis revealed that harm avoidance was able to predict the variance of skin temperature independently, with a variance of 7.1% after controlling for sex, blood pressure and state anxiety and persistence was the factor predicting the variance of skin temperature with a variance of 5.0%. CONCLUSION: These results suggest that high harm avoidance is related to an increased sympathetic nervous function whereas high persistence is related to decreased sympathetic nervous function in a normal population.

Impact of Early-Life Stress and Resilience on Patients with Major Depressive Disorder

PURPOSE: Early-life stress (ELS) has a long-lasting effect on affective function and may entail an increased risk for major depressive disorder (MDD). However, resilience can play a protective role against developing psychopathology. In this study, we investigated the relationships of depressive symptoms with ELS and resilience in MDD. MATERIALS AND METHODS: Twenty-six patients with MDD as well as age- and gender-matched healthy controls were included in this study. Each subject was assessed concerning ELS, resilience, and depressive symptom severity with self-report questionnaires. Independent samples t-test and Mann-Whitney test were performed to compare ELS and resilience between the patient and control groups. Spearman correlation analyses and linear regression analysis were conducted to investigate significant ELS and resilience factors associated with depressive symptoms. RESULTS: In the MDD patient group, subjects reported greater exposure to inter-parental violence, and five factor scores on the resilience scale were significantly lower in comparison to the control group. In linear regression analysis, in regards to resilience, depressive symptom score was significantly associated with self-confidence and self-control factors; however, ELS demonstrated no significant association with depressive symptoms. CONCLUSION: Among resilience factors, self-confidence and self-control may ameliorate depressive symptoms in MDD. ELS, including inter-parental violence, physical abuse and emotional abuse, might be a risk factor for developing depression. Assessment of early-life stress and intervention programs for increasing resilience capacity would be helpful in treating MDD.

Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial

OBJECTIVE: Panic disorder is characterized by recurrent panic attacks, persistent concerns about additional attacks, and worry about the implications of the attack or significant changes in behavior related to the attacks. We examined the efficacy of 24-week naturalistic, open-label escitalopram treatment in terms of the response and remission rates and functional disability in 119 adult Korean patients with panic disorder from 6 clinical centers in South Korea. METHODS: Clinical severity and functional impairment were assessed at baseline and at 4, 12, and 24 weeks after the treatment using the Panic Disorder Severity Scale and Sheehan Disability Scale. Ninety-six patients (80.7%) showed a treatment response, and 87 patients (73.1%) had attained remission after 24 weeks of escitalopram treatment. RESULTS: Continuous improvement in the Panic Disorder Severity Scale and Sheehan Disability Scale scores was found over the 24 weeks of treatment. CONCLUSION: These findings suggest that escitalopram treatment is very effective for panic disorder in terms of both response and remission rates and that long-term pharmacotherapy with escitalopram continuously improved panic symptoms and functional disability in Korean patients with panic disorder.

The Genetic Basis of Panic Disorder

Panic disorder is one of the chronic and disabling anxiety disorders. There has been evidence for either genetic heterogeneity or complex inheritance, with environmental factor interactions and multiple single genes, in panic disorder's etiology. Linkage studies have implicated several chromosomal regions, but no research has replicated evidence for major genes involved in panic disorder. Researchers have suggested several neurotransmitter systems are related to panic disorder. However, to date no candidate gene association studies have established specific loci. Recently, researchers have emphasized genome-wide association studies. Results of two genome-wide association studies on panic disorder failed to show significant associations. Evidence exists for differences regarding gender and ethnicity in panic disorder. Increasing evidence suggests genes underlying panic disorder overlap, transcending current diagnostic boundaries. In addition, an anxious temperament and anxiety-related personality traits may represent intermediate phenotypes that predispose to panic disorder. Future research should focus on broad phenotypes, defined by comorbidity or intermediate phenotypes. Genome-wide association studies in large samples, studies of gene-gene and gene-environment interactions, and pharmacogenetic studies are needed.

The Development of the 'Mental Fitness' Scale / 신경정신의학

OBJECTIVES: The purpose of this study was to develop and validate the 'Mental Fitness'Scale, which was designed to measure the characteristics of being mentally fit or positive mental health. METHODS: Interviews using open-ended questions were conducted on 105 healthy adults between 20 and 65 years of age to obtain the 25 candidate items of the 'Mental Fitness' Scale. To evaluate the validity of the new scale, these items and the Beck Depression Inventory (BDI), the Positive and Negative Affect Scale (PANAS), and the Epworth Sleepiness Scale(ESS) were administered to 212 healthy adults. To assess test-retest reliability, the preliminary 'Mental Fitness' Scale items were administered two weeks later to 47 healthy subjects selected by random sampling. A comparison was made between the 212 healthy subjects and 42 psychiatric patients with depressive or anxiety disorders. RESULTS: Factor analysis yielded four subscales (mental energy, empathic communication, flexibility, and self-assurance). Five items were excluded due to their low factor loadings. The test-retest reliability coefficients were significantly high, ranging between 0.57-0.76. Internal consistency was computed, and Cronbach's alpha for four subscales ranged between 0.66-0.88, and was 0.90 for the total score. Concurrent validity was assessed by correlating the four subscales and the total score with total scores on the BDI, PANAS, and ESS. The correlations were all at significant levels. CONCLUSION: These results indicate that the 'Mental Fitness' Scale is a reliable and valid instrument for assessing positive mental health.

Sleep Disorder and Socioeconomic Burden / 수면정신생리

Sleep disorders such as insomnia, obstructive sleep apnea (OSA), and restless legs syndrome (RLS) are very common disorders and may cause significant burden in terms of individual as well as societal aspects. Sleep insufficiency from such sleep disorders may cause deleterious effects on daily work life and may be associated with other major medical or psychiatric disorders including cardiovascular disease, diabetes mellitus, depression, and anxiety disorder. Various motor or occupational accident may result from the sleep problems. In addition, recent researches provide the method to evaluate the lost productivity time in terms of absenteeism and presenteeism. Moreover, several studies on cost-effectiveness of treatment of sleep disorders show that it is cost-effective.

Relationship between Personality and Insomnia in Panic Disorder Patients

OBJECTIVE: Panic disorder (PD) is frequently comorbid with insomnia, which could exacerbate panic symptoms and contribute to PD relapse. Research has suggested that characteristics are implicated in both PD and insomnia. However, there are no reports examining whether temperament and character affect insomnia in PD. Thus, we examined the relationship between insomnia and personality characteristics in PD patients. METHODS: Participants were 101 patients, recruited from 6 university hospitals in Korea, who met the DSM-IV-TR criteria for PD. We assessed sleep outcomes using the sleep items of 17-item Hamilton Depression Rating Scale (HAMD-17)(item 4=onset latency, item 5=middle awakening, and item 6=early awakening) and used the Cloninger's Temperament and Character Inventory-Revised-Short to assess personality characteristics. To examine the relationship between personality and insomnia, we used analysis of variance with age, sex, and severity of depression (total HAMD scores minus sum of the three sleep items) as the covariates. RESULTS: There were no statistical differences (p>0.1) in demographic and clinical data between patients with and without insomnia. Initial insomnia (delayed sleep onset) correlated to a high score on the temperamental dimension of novelty seeking 3 (NS3)(F1,96=6.93, p=0.03). There were no statistical differences (p>0.1) in NS3 between patients with and without middle or terminal insomnia. CONCLUSION: The present study suggests that higher NS3 is related to the development of initial insomnia in PD and that temperament and character should be considered when assessing sleep problems in PD patients.

Productivity Time Lost by Sleep Disturbance among Workers in Korea / 신경정신의학

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.

Productivity Time Lost by Sleep Disturbance among Workers in Korea / 신경정신의학

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.

Platelet Serotonin Transporter Function and Heart Rate Variability in Patients with Panic Disorder

Many studies showed abnormal serotonin transporter (5-HTT) function and heart rate variability (HRV) in panic disorder patients. The present study investigated the relationship between HRV power spectral analysis findings and platelet serotonin uptake in panic disorder patients. Short-term HRV over 5 min and platelet serotonin transporter uptake parameters (V(max) and K(m)) were measured both in 45 patients with panic disorder and in 30 age-matched normal healthy control subjects. Low frequency power (LF) normalized unit (nu) and LF/high frequency power (HF) were significantly higher, whereas HF and HF nu were lower in the patient group than in the control group. V(max) and K(m) were all significantly lower (i.e., reflects decreased 5-HTT function) in patients with panic disorder than in normal controls. In the patient group, Km was negatively correlated with LF/HF and LF nu whereas no such correlations between them were found in the control group. By multivariate analysis based on multiple hierarchical linear regression, a low Km independently predicted an increased LF nu even after controlling for age, sex, and body mass index in the patient group. These results suggest that impaired 5-HTT function is closely related to dysregulation of autonomic nervous system in panic disorder.

Effect of Temperament and Character on Pharmacotherapy in Panic Disorder Patients / 대한정신약물학회지

OBJECTIVE: Temperament and character that represent personality trait are supposed to relate to panic disorder (PD). There are several studies that report a significant relationship among temperament, character and treatment outcome in PD. In this study, we examined whether temperament and character affect the long term outcome of escitalopram treatment in patients with PD. METHODS: Ninety-two patients with PD were recruited at the psychiatric outpatient clinics of 6 university hospitals in South Korea. All patients were treated with escitalopram for 6 months. The Temperament-Character Inventory-Revised-Short (TCI-RS) was administered to all patients at baseline. They were also assessed with the Panic Disorder Severity Scale (PDSS), Hamilton Rating Scale for Anxiety (HAM-A), 17-item Hamilton Rating Scale for Depression (HAMD-17), and Clinical Global Impression on-Severity (CGI-S) at both baseline and after 6 months of pharmacotherapy. RESULTS: There was a significant relationship between reward dependence (RD) and a remission rate in PD patients who were treated with escitalopram, and panic patients who had high RD showed a low remission rate after the treatment. CONCLUSION: This study suggests that high RD predicts a poor treatment response in patients with PD.

Changes in Cerebral Cortex and Limbic Brain Functions after Short-Term Paroxetine Treatment in Panic Disorder: An 18FFDG-PET Pilot Study

OBJECTIVE: Panic disorder (PD) is a common and often chronic psychiatric illness, and serotonin-specific reuptake inhibitors (SSRIs) are the drugs of choice for the treatment of PD. Previous studies suggested the cerebral cortex and limbic brain structures played a major role in the development of PD, but the therapeutic effect of SSRIs on specific brain structures remains unclear in PD. We examined the changes in PD patients' glucose metabolism using the [18F] Fluorodeoxy-glucose-positron emission tomography (FDG-PET) before and after 12 weeks of paroxetine treatment. METHODS: We assessed the brain glucose metabolism of 5 PD patients, using the [18F]FDG-PET, and treated them with paroxetine (12.5-37.5 mg/day) for 12 weeks. Then, we compared before and after treatment PET images of the patients, using voxel-based statistical analysis and a post hoc regions of interest analysis. Furthermore, we measured the patients' clinical variables, including information from the Panic Disorder Severity Scale (PDSS), Clinical Global Impression for Severity (CGI-S), and Hamilton Anxiety Rating Scale (HAMA). RESULTS: After 12 weeks of paroxetine treatment, the patients showed significant clinical improvement in terms of PDSS, CGI-S and HAMA scores (12.8+/-1.8 vs. 3.8+/-2.3, 4.6+/-0.5 vs. 2.0+/-1.4, and 15.2+/-4.0 vs. 5.0+/-1.2, respectively; all p values<0.05). After treatment, patients' glucose metabolism increased significantly in global brain areas: the right precentral gyrus, right middle frontal gyrus, right amygdala, right caudate body, right putamen, left middle frontal gyrus, left precentral gyrus, left insula, left parahippocampal gyrus, and left inferior frontal gyrus (All areas were significant at uncorrected p<0.001 and cluster level corrected p<0.05). CONCLUSION: In these PD patients, cerebral cortex and limbic brain functions changed after short-term treatment with paroxetine. The therapeutic action of paroxetine may be related to altered glucose metabolism at both the cerebral cortex and limbic brain areas.

Effect of Korean Red Ginseng on Stress Responses and beta-Adrenergic Receptor Function in a Normal Population / 대한정신약물학회지

OBJECTIVE : There have been few studies to examine the effect of Korean red-ginseng on autonomic nervous system. The aim of this study is to examine the effect of Korean red-ginseng on beta-adrenergic receptor function in a normal population. METHODS : Thirty four healthy normal subjects who were 20-40 years old were recruited for the study. They were randomized into the two groups ; red-ginseng group (n=19) and placebo group (n=15). Three gram of red-ginseng or placebo per day was administered to the study subjects for 3 weeks. Before and after the medications, we measured the lymphocyte beta-adrenergic receptor function (Bmax, cAMP, and Kd), and psychological scales such as the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), and Spielberger State and Trait Anxiety Inventory (STAI). This study was a double-blind, placebo-controlled, randomized, comparative study. RESULTS : There were no significant differences in the changes of beta-adrenergic receptor density (Bmax) and sensitivity (cAMP) and psychological assessments between the two groups according to the medications. However, we found significant (group x time) effects for Kd, and beta-adrenergic receptor affinity (1/Kd) was increased significantly in the Korean red-ginseng group. CONCLUSION : In a normal population, Korean red-ginseng showed a potential effects on the beta-adrenergic receptor function, which may play an important role in the regulation of stress responses

Effect of Korean Red Ginseng on Stress Responses and beta-Adrenergic Receptor Function in a Normal Population / 대한정신약물학회지

OBJECTIVE : There have been few studies to examine the effect of Korean red-ginseng on autonomic nervous system. The aim of this study is to examine the effect of Korean red-ginseng on beta-adrenergic receptor function in a normal population. METHODS : Thirty four healthy normal subjects who were 20-40 years old were recruited for the study. They were randomized into the two groups ; red-ginseng group (n=19) and placebo group (n=15). Three gram of red-ginseng or placebo per day was administered to the study subjects for 3 weeks. Before and after the medications, we measured the lymphocyte beta-adrenergic receptor function (Bmax, cAMP, and Kd), and psychological scales such as the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), and Spielberger State and Trait Anxiety Inventory (STAI). This study was a double-blind, placebo-controlled, randomized, comparative study. RESULTS : There were no significant differences in the changes of beta-adrenergic receptor density (Bmax) and sensitivity (cAMP) and psychological assessments between the two groups according to the medications. However, we found significant (group x time) effects for Kd, and beta-adrenergic receptor affinity (1/Kd) was increased significantly in the Korean red-ginseng group. CONCLUSION : In a normal population, Korean red-ginseng showed a potential effects on the beta-adrenergic receptor function, which may play an important role in the regulation of stress responses

Difference in Anxiety Sensitivity Among Anxiety Disorder Groups / 신경정신의학

OBJECTIVES : The present study aimed to compare anxiety sensitivity among anxiety disorder groups, and to examine the relationships between lower-order factors of anxiety sensitivity and each anxiety disorder. METHODS : Three hundred and twenty four normal control subjects and 212 patients with anxiety disorders were enrolled in this study. All subjects completed a psychometric assessment package including the Korean Anxiety Sensitivity Index-Revised (ASI-R) test. Statistical analysis of the two groups was performed using the Mann-Whitney U test, and comparison of anxiety sensitivity amongthe anxiety-disorder groups (panic disorder-PD, general anxiety disorder-GAD, social phobia- SP, obsessive-compulsive disorder-OCD) was investigated using Kruskal-Wallis test. RESULTS : All anxiety disorder groups showed higher total scores of the ASI-R than did the normal control group (Z=-13.724, pSP,OCD), fear of respiratory symptoms (PD>GAD, SP,OCD), and fear of publicly observable anxiety reactions (SP>PD,OCD) among the anxiety disorder groups. CONCLUSION : These results suggest that anxiety sensitivity reflects vulnerability to anxiety disorders, and that lower-order factors of the ASI-R may help in the differential diagnosis of anxiety disorders.

Difference in Anxiety Sensitivity Among Anxiety Disorder Groups / 신경정신의학

OBJECTIVES : The present study aimed to compare anxiety sensitivity among anxiety disorder groups, and to examine the relationships between lower-order factors of anxiety sensitivity and each anxiety disorder. METHODS : Three hundred and twenty four normal control subjects and 212 patients with anxiety disorders were enrolled in this study. All subjects completed a psychometric assessment package including the Korean Anxiety Sensitivity Index-Revised (ASI-R) test. Statistical analysis of the two groups was performed using the Mann-Whitney U test, and comparison of anxiety sensitivity amongthe anxiety-disorder groups (panic disorder-PD, general anxiety disorder-GAD, social phobia- SP, obsessive-compulsive disorder-OCD) was investigated using Kruskal-Wallis test. RESULTS : All anxiety disorder groups showed higher total scores of the ASI-R than did the normal control group (Z=-13.724, pSP,OCD), fear of respiratory symptoms (PD>GAD, SP,OCD), and fear of publicly observable anxiety reactions (SP>PD,OCD) among the anxiety disorder groups. CONCLUSION : These results suggest that anxiety sensitivity reflects vulnerability to anxiety disorders, and that lower-order factors of the ASI-R may help in the differential diagnosis of anxiety disorders.

Neurobiology of Panic Disorder / 신경정신의학

Panic disorder is a common mental disorder that causes considerable disability. However, the etiology of panic disorder remains unclear. Preclinical neuroanatomical and neurophysiological studies have provided clues to the neurobiological basis of panic disorder, and recent developments in neurobiological techniques in neurochemical research, brain imaging, and genetic research provide a further understanding of anxiety, fear, and panic disorder. In this article, we introduce a functional neuroanatomic model of fear and anxiety, and consider the implications of recent developments and debates in neurobiological findings with respect to panic disorder.

Neurobiology of Panic Disorder / 신경정신의학

Panic disorder is a common mental disorder that causes considerable disability. However, the etiology of panic disorder remains unclear. Preclinical neuroanatomical and neurophysiological studies have provided clues to the neurobiological basis of panic disorder, and recent developments in neurobiological techniques in neurochemical research, brain imaging, and genetic research provide a further understanding of anxiety, fear, and panic disorder. In this article, we introduce a functional neuroanatomic model of fear and anxiety, and consider the implications of recent developments and debates in neurobiological findings with respect to panic disorder.

Effect of Biofeedback-assisted Autogenic Training on Headache Activity and Mood States in Korean Female Migraine Patients

Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine. This study aimed to examine the effect of biofeedback treatment on headache activity, anxiety, and depression in Korean female patients with migraine headache. Patients were randomized into the treatment group (n=17) and monitoring group (n=15). Mood states including anxiety and depression, and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls (n=21). We found greater treatment response rate (defined as > or =50% reduction in headache index) in patients with biofeedback-assisted autogenic training than in monitoring group. The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment. Moreover, the decrease in their anxiety levels was significantly related to the treatment outcome. This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level.

A Case of Paraneoplastic Stiff-Person Syndrome Presenting Multiple Somatic Symptoms / 신경정신의학

Stiff-person syndrome (SPS) is an unusual autoimmune neurological disease. We report a woman who developed stiff-person syndrome associated with thymoma. A 42-year-old woman visited a general hospital complaining of progressive rigidity in her neck and both lower legs. She also had other symptoms including whole body pruritus, dysphargia, dysarthria, diplopia, and a visual hallucination-like symptom. Emotional distress preceded her symptoms. After a extensive neurologic workup, she was transferred from the neurologic ward to the psychiatric ward under the impression of conversion or somatoform disorder. During her psychiatric admission, we found a prolonged involuntary MUAP discharge on her electromyograph, and positive anti-GAD and anti-GQ1b antibodies. In addition, a chest CT scan revealed a thymic epithelial tumor. We report a case of stiff-person syndrome presenting multiple unexplained somatic symptoms, which was initially diagnosed as a conversion or somatoform disorder.