Gender differences in 12-week antidepressant treatment outcomes for a naturalistic secondary care cohort: the CRESCEND study

This study aimed to determine whether men and women with depression differ in socio-demographic, treatment-related characteristics, and in their responses to treatment with antidepressants, as well as to explore differences in treatment outcomes by menopausal status. From a nationwide sample of 18 hospitals in South Korea, 723 depressive patients were recruited. After baseline evaluation, they received naturalistic clinician-determined antidepressant interventions. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and re-evaluated at 1, 2, 4, 8, and 12 weeks later. At baseline, women were older, less educated, less likely to be employed, had lower income, were more likely to be married, and had longer illness duration than men. There were no gender differences in the treatment-regime received. After adjustment for baseline status, women were more likely to achieve HAMD remission (OR=1.51), HAMD response (OR=1.64), and HAMA response (OR=1.61). Women also experienced shorter times to HAMD response, HAMA response, and CGI-s remission. Postmenopausal women showed higher HAMA response with newer dual action antidepressants than premenopausal women. Women were found to have better outcomes following antidepressant treatment than men, and postmenopausal women had a better response on anxiety symptoms with newer dual action antidepressants.

Improvement within 2 weeks and later treatment outcomes in patients with depressive disorders: the CRESCEND study

BACKGROUND

Although antidepressants are conventionally given for 4-6 weeks before deciding on response, several reports suggest that early improvement predicts later outcomes. In a naturalistic national cohort study, we sought to investigate the predictive value of early improvement on Hamilton Depression Rating Scale (HAMD) score for later outcomes (depression (HAMD), anxiety (HAMA), global severity (CGI-s) and functioning (SOFAS)), as well as socio-demographic and clinical correlates of early improvement.

METHODS

Participants were recruited from 18 hospitals across South Korea. All met DSM-IV criteria for depressive disorders, scored ≥14 on the HAMD and received antidepressant treatment for up to 12 weeks. Treatment was naturalistic in that each clinician freely decided the types, doses, and regimes of antidepressant and concomitant medications. Early improvement was defined as a reduction in HAMD score of ≥20% compared with baseline within 2 weeks of treatment. Later treatment outcomes were measured at 4, 8, and 12 weeks.

RESULTS

In a recruited sample of 568 patients, early improvement predicted 12 week treatment outcomes with high sensitivity and high negative predictive values. The predictive values for HAMD and HAMA 12-week responses were higher compared to CGI-s and SOFAS responses. Early improvement was associated with higher monthly income, baseline lower anxiety and higher functioning levels. The patients with early improvement more frequently received antidepressant monotherapy.

LIMITATIONS

The study was observational, and the treatment modality was naturalistic.

CONCLUSIONS

Early antidepressant improvement strongly predicted later outcomes, and was associated with higher income, lower anxiety, and higher function.

The clinical research center for depression study: baseline characteristics of a korean long-term hospital-based observational collaborative prospective cohort study

OBJECTIVE

The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort.

METHODS

Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Social and Occupational Functioning Assessment Scale, Beck Depression Inventory-Second Edition, Scale for Suicide Ideation, and World Health Organization Quality of Life assessment instruments-abbreviated version. Also, personal histories of medical and psychiatric illnesses and the range of socio-epidemiologic and clinical data were collected from each participant.

RESULTS

One thousand one hundred eighty three participants were recruited from 18 hospitals. The mean age of the participants was 47.9±15.9 year-old, 74.4% were female, 82.9% had been diagnosed of major depressive disorder, 40.9% were experiencing their first depressive episode, and 21.4% had a past history of suicide attempts. The majority (85.3%) of the participants were moderately to severely ill. The average HDRS-17 was 19.8±6.1. Significant gender differences at baseline were shown in age, education, marriage, employment, religion, and first depressive episode.

CONCLUSION

The baseline findings in the CRESCEND study showed some different characteristics of depression in Korea, suggesting a possibility of ethnic and cultural factors in depression.

Predictors of 12-week remission in a nationwide cohort of people with depressive disorders: the CRESCEND study

OBJECTIVE

To estimate the 12-week remission rate of patients with depressive disorders and predictors of this in a naturalistic clinical setting in South Korea.

METHODS

For people with DSM-IV depressive disorders about to receive treatment at 18 hospitals, data on sociodemographic and health status were obtained. A free choice of clinical interventions was allowed and naturalistic follow-up took place at 1, 2, 4, 8, and 12 weeks later. Remission was defined as a Hamilton Depression Rating Scale score of ≤7 sustained to 12 weeks or last follow-up, if earlier.

RESULTS

For 723 participants, the 12-week remission rate was 31.4%. Remission was more likely in women, and in patients without a prior history of suicide attempt, and those with lower baseline anxiety.

CONCLUSIONS

Remission associated with unrestricted clinical interventions was comparable to STAR*D estimates for citalopram alone. Comorbid anxiety and previous suicide attempt were markers of worse outcome.

Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting

OBJECTIVE

Antidepressants used to treat depression are frequently associated with sexual dysfunction. Sexual side effects affect the patient's quality of life and, in long-term treatment, can lead to non-compliance and relapse. However, studies covering many antidepressants with differing mechanisms of action were scarce. The present study assessed and compared the incidence of sexual dysfunction among different antidepressants in a naturalistic setting.

METHODS

Participants were married patients diagnosed with depression, per DSM-IV diagnostic criteria, who had been taking antidepressants for more than 1 month. We assessed the participants via the Arizona Sexual Experiences Scale (ASEX), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI), and assessed their demographic variables, types and dosages of antidepressants, and duration of antidepressant use via their medical records.

RESULTS

One hundred and one patients (46 male, 55 female, age 42.2+/-7 years) completed the instruments. Thirteen were taking fluoxetine (mean dose 21.3+/-8.5 mg/day), 24 were taking paroxetine (mean dose 20.4+/-7.2 mg/day), 20 taking citalopram (mean dose 22.1+/-6.5 mg/day), 22, venlafaxine (mean dose 115.7+/-53.2 mg/day) and 22, mirtazapine (mean dose 18+/-8.7 mg/day). Mean ages, sex ratios, and BDI and STAI scores did not differ significantly across antidepressants. A substantial number of participants (46.5%, n=47) experienced sexual dysfunction. The prevalence of sexual dysfunction differed across drugs: citalopram 60% (n=12), venlafaxine 54.5% (n=12), paroxetine 54.2% (n=13), fluoxetine 46.2% (n=6), and mirtazapine 18.2% (n=4). Regression analyses revealed the significant factors for sexual dysfunction were being female, total scores on the BDI and SAI, and type of antidepressant (F=4.92, p<0.0001). Of the antidepressants, the mirtarzapine group's total ASEX score was significantly lower than the scores of the citalopram, fluoxetine, and paroxetine groups.

CONCLUSION

The incidence of sexual dysfunction was substantially high during antidepressant treatment. The incidence of sexual dysfunction differed among antidepressants having different mechanisms of action. Our study suggests the need for clinicians to consider the impact of pharmacotherapy on patients' sexual functioning in the course of treatment with antidepressants.

Epistasis between a set of variations located in the TAAR6 and HSP-70 genes toward schizophrenia and response to antipsychotic treatment

Suggestive associations have been reported between trace amines and heat shock proteins, and a disrupted pathophysiology that enhances the risk of psychosis and that modifies responses to antipsychotic treatments. Our group previously reported genetic studies on TAAR6 and HSP-70 separately in patients with schizophrenia. In the current study, we investigated possible epistasis between the same set of variations in a sample of 281 patients diagnosed with schizophrenia and 288 healthy controls. We applied the generalized multifactor dimensionality reduction (MDR) method and controlled covariates significantly associated with both diagnosis and treatment efficacy. To the best of our knowledge, epistasis between the present set of variations in schizophrenia has not been tested before. We found significant associations with both the risk of disease and response to treatment. However, the insufficiently balanced accuracy of the applied tests suggests that, despite significantly different genetic variations between cases and controls, these factors have a poor predictive value. Explanations for these findings and possible future directions are also discussed.

Efficacy and safety of quetiapine for depressive symptoms in patients with schizophrenia

OBJECTIVE

To investigate the efficacy and safety of quetiapine for depressive symptoms in patients with schizophrenia.

METHOD

Thirty-nine patients fulfilling DSM-IV-TR diagnostic criteria for schizophrenia and had depressive symptoms were studied in a prospective 6-week open-label design using quetiapine monotherapy. The brief psychiatric rating scale (BPRS), 17-item Hamilton depression rating scale (HAMD-17), Simpson-Angus rating scale, and the Barnes Akathisia rating scale (BARS) were used to assess patients at baseline, week 1, 2, 4, and 6.

RESULTS

Thirty patients (76.9%) completed this study. The dose of quetiapine at endpoint was 583 (+/-235 SD) mg/day. Treatment with Quetiapine was associated with significantly reduced depressive symptoms (HAMD-17 total score and BPRS depression/anxiety subscale) from the first week of treatment. Changes of mean score from baseline to endpoint were 7.8 +/- 6.2 for HAMD-17 total score and 3.4 +/- 3.6 for BPRS depression/anxiety subscale (LOCF, n = 39, p < 0.001). Quetiapine was well tolerated, with minimal extrapyramidal symptoms and non-significant increase in body weight (mean increase of 0.8 kg).

CONCLUSIONS

While the interpretation of findings from the open-label design of this study warrants appropriate caution, the results suggest that quetiapine may be an effective and tolerable treatment for depression in patients with schizophrenia.

Patterns of temperament and character in patients with posttraumatic stress disorder and their association with symptom severity

OBJECTIVES

The aim of this study was to identify the patterns of temperament and character of patients with posttraumatic stress disorder (PTSD) and to explore the relationship between the patterns of temperament and character and PTSD symptoms severity.

METHODS

Temperament and character features of 130 patients with PTSD (n = 65) and age and sex-matched healthy controls (n = 65) were evaluated using the Temperament and Character Inventory. Severity of PTSD symptoms and general anxiety symptoms was measured with the Impact of Events Scale-Revised (IES-R) and the Hamilton Anxiety Rating Scale (HARS).

RESULTS

Patients with PTSD showed significantly higher scores on subscales of harm avoidance and self-transcendence and lower scores on self-directedness and cooperativeness compared to controls. Harm avoidance and self-transcendence scores were significantly associated with PTSD symptom severity as measured by IES-R but not with general anxiety symptom severity as measured by HARS.

CONCLUSIONS

Patterns of temperament and character of patients with PTSD were significantly different from those of healthy controls. In addition, these patterns are specifically associated with the PTSD symptom severity.

Dysbindin gene (DTNBP1) and schizophrenia in Korean population

Dysbindin gene (DTNBP1) has been consistently reported to be associated with schizophrenia. However data from East Asian population has been sparse and inconsistent till today. This study tried to replicate the genetic association of DTNBP1 with schizophrenia in a large Korean sample, as well as analyzing the association of DTNBP1 with clinical variables. Nine hundred and eight (908) patients with schizophrenia and 601 controls were investigated. The high-throughput genotyping method using pyrosequencer (Biotage AB, Sweden) was used for genotyping 4 SNPs (rs3213207, rs1011313, rs760761, and rs2619522). Haplotype analyses revealed a significant association with schizophrenia (P < 0.0001) with the haplotypes A-C-C-C and A-C-T-A having an eminent protective effect toward schizophrenia. The major contribution to the difference in the haplotype distribution between patients and the controls was the rs760761 (C/T) and rs2619522 (A/C) haplotypes (P < 0.0001). No association of DTNBP1 with other clinical variables was found. In conclusion, the present study suggests a possible protective effect of rare DTNBP1 variants in schizophrenia, although subsequent studies in different ethnic groups are warranted.

Effect of augmented atypical antipsychotics on weight change in patients with major depressive disorder in a naturalistic setting

OBJECTIVE

The extent of weight changes in depressed patients who use atypical antipsychotics (AAP) as augmentation could not be easily predicted due to weight related symptoms of depression and the interaction with antidepressants which have weight reducing effects.

METHODS

Patients were treated with either antidepressants augmented with AAP for more than 2 weeks (AAP group, n = 100) or only with antidepressants (non-AAP group, n = 172) during the admission between 2002 and 2006, and the differences in weight were analyzed.

RESULTS

Mean weight gains of AAP group were significantly higher than those of non-AAP group (2.98 +/- 1.87 kg vs. 1.70 +/- 1.85 kg, p = 0.001). When stratified by antidepressants, the significant difference between the two groups was shown among the subjects who had taken serotonin reuptake inhibitors (SSRIs), but not mirtazapine and venlafaxine (3.42 +/- 2.01 kg vs. 1.48 +/- 1.79 kg, p < 0.001). Comparing among different combinations in AAP group showed that subjects treated with SSRIs and olanzapine had the greatest weight gain (4.21 +/- 1.90 kg), significantly higher than that of the other subgroups (p < 0.001).

CONCLUSIONS

Our findings suggest that AAP used in patients with depression could severely aggravate preexisting weight-related problems of antidepressants use and the possibility that the combined use with specific antidepressants could have a unique effect on weight by drug-drug interactions.

Association analysis of heat shock protein 70 gene polymorphisms in schizophrenia

OBJECTIVES

Heat shock proteins (HSPs) are a promising candidate gene in schizophrenia as they are believed to play a protective role in the central nervous system. An alteration in the titers of antibodies to the HSPs in schizophrenia patients has been suggested. Association between the three polymorphisms of HSP70-1 (HSPA1A), HSP70-hom (HSPA1L) and HSP70-2 (HSPA1B) and schizophrenia has been reported. Therefore, this study investigated the association between an enlarged set of SNPs at HSP70 gene and schizophrenia.

METHODS

Two hundred and ninety-four patients with schizophrenia and 287 controls were enrolled in the study. Genotypings of 5 SNPs of HSP70 were performed using pyrosequencing method. Haploview 3.2 was used to generate a linkage disequilibrium map and to test for Hardy-Weinberg equilibrium. Single locus and haplotype-based associations were tested. Tests for associations using and multi-marker haplotypes were performed by using a COCAPHASE v2.403. Association of SNP markers and clinical variables were analyzed by analysis of variance.

RESULTS

Significant association was detected at rs2075799 (allele A, X2 = 8.03, df = 1, P = 0.0046), but not at rs2227956 (P = 0.28), rs1043618 (P = 0.88), rs562047 (P = 0.47) or rs539689 (P = 0.32). In fact, the rs2075799*G/A genotype was more represented in patients with schizophrenia than in controls (X2 = 8.23, df= 1, P = 0.0041). Haplotype based associations were also detected (global P value 0.000003); the T-A-C-C-G haplotype was more prevalent among the patients (odds ratio, OR 5.95). Sliding windows analysis revealed a major contribution from rs2227956 and rs2075799 (global-P value 0.0075), with T-A haplotype significantly associated with schizophrenia. There was no evidence of an association between the clinical variables and schizophrenia across the genotypes.

CONCLUSION

Our results raise the possibility that HSP70 gene (i.e., haplotypes of rs2075799) might be implicated in the development of schizophrenia, although limited by rare haplotypic association with the disease. Hence further studies from different ethnics should be performed to confirm these results.

Is there protective haplotype of dysbindin gene (DTNBP1) 3 polymorphisms for major depressive disorder

Dysbindin gene has been repeatedly associated with psychiatric disorders and schizophrenia in particular. This study aimed to investigate the variants of dysbindin gene in major depressive disorder (MDD). One hundred and eighty eight patients with MDD and 350 controls were investigated for 4 variants within the dysbindin gene (rs3213207 A/G, rs1011313 C/T, rs760761 C/T, and rs2619522 A/C). Haplotype analyses revealed a significant association with MDD (p=0.0007, protective A-C-T-A and A-C-C-C haplotypes), in particular the effect was due to the rs760761 (C/T) and rs2619522 (A/C) haplotype (p=0.000026). These results suggest a protective effect of some dysbindin gene haplotypes on the development of MDD. Coupled with previous findings on schizophrenia, our finding suggests that dysbindin gene variants may have a role in the susceptibility to MDD. Adequately powered further studies in different ethnic groups are warranted.

Aripiprazole augmentation for treatment of patients with inadequate antidepressants response

This study evaluated whether or not augmentation with aripiprzazole is beneficial and tolerable to patients with an inadequate response to antidepressants (ADs). Thirteen patients with nonpsychotic major depression, who had failed to respond to an adequate trial of at least one AD, were prescribed aripiprazole (dose, 5-30 mg) for 8 weeks. The dose of their preexisting ADs was not changed. The treatment response was defined as the mean changes in the scores of the Hamilton Depression Rating Scale (HAM-D) from the baseline to the end of treatment. Eleven (84.6%) patients returned for at least one follow-up visit, and 7 (53.8%) patients completed the study. The HAM-D and Clinical Global Impression-Severity (CGI-S) scores decreased significantly from the baseline to the end of treatment by 53.8% and 56.0%, respectively (Z = -2.937, P =.003; Z = -2.961, P =.003). Seven (63.6%) patients showed a > or = 50% reduction in the HAM-D score at the end of treatment. Three (27.3%) patients met the remission criteria at the end of treatment. There were no serious side effects. Despite the high dropout rate in this open study, aripiprazole appears to be reasonably effective and tolerated as an augmentation strategy in conjunction with conventional ADs treatment in patients with an inadequate AD response. These results highlight the potential benefits of aripiprazole for these patients. However, adequately powered, randomized, controlled trials are needed to confirm these results.

Association of the trace amine associated receptor 6 (TAAR6) gene with schizophrenia and bipolar disorder in a Korean case control sample

Trace amines and their receptors may be implicated in the pathogenesis of psychiatric disorders. Previous studies have reported association of the trace amine associated receptor 6 (TAAR6) gene with susceptibility to schizophrenia and bipolar disorder but results have not been consistent. The purpose of this study was to examine these associations in Korean patients and also to test for association of TAAR6 with susceptibility to major depressive disorder (MDD). A case control sample consisting of 281 patients with schizophrenia, 190 patients with bipolar disorder, 187 patients with MDD and 288 psychiatrically healthy control subjects, was examined. Patients with schizoaffective disorder were not included in any of the psychiatric samples. Five single nucleotide polymorphisms (SNPs: rs4305745; rs8192625; rs7452939; rs6903874 and rs6937506) were genotyped in the TAAR6 gene and in the 3' regulatory region, using pyrosequencing. SNP rs6903874 was significantly associated with schizophrenia (p = 0.012) and bipolar disorder (p = 0.004). A three SNP haplotype consisting of alleles GCT from SNPs rs7452939, rs6903874 and rs6937506, respectively, was significantly over-represented in patients with schizophrenia (p = 0.0003) and bipolar disorder (p = 0.00002). A second three SNP haplotype (GTT) derived from the same SNPs was significantly under-represented in patients with bipolar disorder (p = 0.001). The GTT haplotype associations withstand the most rigorous corrections for multiple testing. These findings strongly support association of the TAAR6 gene with susceptibility to both schizophrenia and bipolar disorder in Korean patients. Further studies are needed to confirm these findings in this and other populations and to identify functional variants in TAAR6 that may be implicated in pathogenesis.

The bipolar diathesis of treatment-resistant major depressive disorder

Objective. In this study, we determined the prevalence of bipolarity in patients with treatment-resistant depression (TRD) by investigating demographic and clinical characteristics, diagnostic subtypes and illness outcome of patients with resistant depression. Methods. A medical record review of patients who were admitted to a university hospital with the diagnosis of major depressive disorder (MDD) was conducted. DSM-IV diagnoses at the index hospitalization and 6 months after discharge and detailed clinical information were obtained. We categorized subjects into a TRD group or a non-TRD group and re-evaluated the patients using the criteria for bipolar spectrum disorders. Results. There were 281 patients diagnosed with MDD. At discharge, the number of patients who fulfilled the criteria for BSD was higher in the TRD group (47.1%) than in the non-TRD group (3.8%) (P<0.001). At the end of the 6-month follow-up period, the diagnoses of 38 patients were changed; 18 (26.5%) of the TRD group were subsequently classified as having a bipolar disorder, as were seven (3.3%) in the non-TRD group (P<0.001). There was no difference between these two groups for other clinical and demographic variables. Conclusion. The findings of this study suggest that many patients with TRD have a bipolar diathesis.

Manganese superoxide dismutase (MnSOD: Ala-9Val) gene polymorphism may not be associated with schizophrenia and tardive dyskinesia

There has been increasing evidence that the alteration of antioxidant enzymes such as manganese superoxide dismutase (MnSOD) might be implicated in the development of schizophrenia and/or tardive dyskinesia (TD). This study investigated the association of a MnSOD gene (MnSOD) polymorphism (Ala-9Val) with schizophrenia as well as its involvement in TD. Patients with schizophrenia (n=262) and healthy controls (n=263) were enrolled in this study and genotyped by a polymerase chain reaction-based method. The distribution of the MnSOD genotypes and alleles was not significantly different between patients and controls. Logistic regression analysis also failed to reveal any association between MnSOD genotypes and TD. Taken together, these results suggest that the MnSOD polymorphism does not contribute to the development of schizophrenia and/or TD, at least in the Korean population.

Effect of 5-haplotype of dysbindin gene (DTNBP1) polymorphisms for the susceptibility to bipolar I disorder

We investigated a possible association between dysbindin gene (DTNBP1) variants and bipolar I disorder (BID). Five SNPs within DTNBP1 (rs3213207, rs1011313, rs2005976, rs760761, and rs2619522) were genotyped for 151 patients with BID and 478 controls. We observed a significant protective association of the haplotype A-C-G-T-A (all SNPs, P = 0.00016) and particularly G-T-A (the last three SNP, P = 0.00007) within DTNBP1 variants investigated. Single marker and subgroup (e.g., psychotic features, age at onset, family history, etc.) analyses showed no significant association. Although the association was due to a small number of subjects, specific DTNBP1 haplotypes, previously associated with schizophrenia, may be also associated with BID. Adequately powered studies from different ethnicities will be necessary to confirm our findings.

Dysbindin associated with selective serotonin reuptake inhibitor antidepressant efficacy

OBJECTIVE

Antidepressant drug efficacy is partially under genetic control and a number of gene variants have been associated with antidepressants efficacy over the last few years. In the search for further genes influencing antidepressant response we focused on the dysbindin gene (dystrobrevin-binding-protein 1, DTNBP1).

BASIC METHODS

One hundred and four Korean inpatients affected by major depressive disorder were treated with various antidepressants at standard therapeutic daily doses and rated with the 10-items Montgomery-Asberg Depression rating scale (MADRS) at baseline and discharge. Five DTNBP1 variants (rs3213207 A/G, rs1011313 C/T, rs2005976 G/A, rs760761 C/T and rs2619522 A/C) were analysed for all patients.

RESULTS

Rs2005976 was found to be significantly associated with final MADRS scores, with the rarest A allele associated with higher final scores (P=0.00055), rs760761 also showed a significant association (P=0.0058) and rs2619522 showed a positive trend (P=0.025). Markers were not significantly associated with Clinical Global Impression Scale scores. Five marker haplotypes were mildly associated with MADRS final scores but when considering the block composed of the three single nucleotide polymorphisms individually associated with response (rs2005976, rs760761 and rs2619522), results were more marked (P=0.0096), with the more frequent G-C-A haplotype associated with a positive outcome.

CONCLUSIONS

Despite limitations due to the sample size and the mild antidepressant response, we observed a significant association between DTNBP1 variants and antidepressant response.

Comparison of venlafaxine extended release versus paroxetine for treatment of patients with generalized anxiety disorder

This trial was to evaluate the efficacy and tolerability of venlafaxine extended release (XR) and paroxetine for treatment of patients with generalized anxiety disorder (GAD). Sixty patients who met DSM-IV criteria for GAD were randomly assigned to either venlafaxine XR or paroxetine for 8 weeks. Efficacy was assessed with the Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression-Severity of Illness (CGI-S) scale at the baseline, week 1, week 4, and week 8. The side-effects were collected with reported adverse events and laboratory tests throughout the study period. Repeated measures analysis of variance (ANOVA) on the HAM-A and CGI-S scores showed a significant decrease over time in both treatment groups without significant group difference or time x group interaction effect. There were no serious adverse events in both groups. This open trial demonstrated that either venlafaxine XR or paroxetine would be effective and tolerable for the treatment of patients with GAD. Double blind, placebo-controlled head-to-head comparison studies are needed to draw a definite conclusion.

The effectiveness of mirtazapine in the treatment of post-traumatic stress disorder: a 24-week continuation therapy

Few studies for the long-term effects of antidepressants on post-traumatic stress disorder (PTSD) have been conducted. The aim of the present study was to investigate the effectiveness of mirtazapine during the 24-week continuation treatment in patients with PTSD. Out of 15 patients who participated in the previous 8-week short-term study, 12 patients completed 24-week continuation treatment with mirtazapine. The effectiveness was evaluated at week 12 and week 24 using Impact of Event Scale-Revised (IES-R), Short PTSD Rating Interview (SPRINT), Interviewer-Administered Structured Interview for PTSD (SIP) and Montgomery-Asberg Depression Rating Scale (MADRS). The tolerability of continuation treatment was also reported. The scores on the IES-R, SPRINT, SIP and MADRS were significantly reduced over time from baseline to week 24, the end-point (F=36.1, d.f.=4, P<0.001; F=106.3, d.f.=4, P<0.001; F=121.1, d.f.=4, P<0.001; F=198.9, d.f.=4, P<0.001). On post-hoc analysis, the scores of all four measures were significantly reduced at the end point since week 8. However, after Bonferroni's correction, that was statistically significant in SPRINT only. The number of patients whose scores were reduced over 50% in all four scales had a tendency of incremental increase from three at week 8 to eight at the end point (P=0.063). No serious drug-related side-effects occurred. These results suggest that the mirtazapine may be effective in the continuation treatment of PTSD as well as short-term treatment. Further and better-designed studies are necessary.

The merlin tumor suppressor interacts with Ral guanine nucleotide dissociation stimulator and inhibits its activity

Neurofibromatosis type 2 (NF2) is the most commonly mutated gene in benign tumors of the human nervous system such as schwannomas and meningiomas. The NF2 gene encodes a protein called schwannomin or merlin, which is involved in regulating cell growth and proliferation through protein-protein interactions with various cellular proteins. In order to better understand the mechanism by which merlin exerts its function, yeast two-hybrid screening was performed and Ral guanine nucleotide dissociation stimulator (RalGDS), a downstream molecule of Ras, was identified as a merlin-binding protein. The direct interaction between merlin and RalGDS was confirmed both in vitro and in the NIH3T3 cells. The domain analyses revealed that the broad C-terminal region of merlin (aa 141-595) is necessary for the interaction with the C-terminal Ras-binding domain (RBD) of RalGDS. Functional studies showed that merlin inhibits the RalGDS-induced RalA activation, the colony formation and the cell migration in mammalian cells. These results suggest that merlin can function as a tumor suppressor by inhibiting the RalGDS-mediated oncogenic signals.

Monocyte chemoattractant protein-1 promoter -2518 polymorphism and schizophrenia in the Korean population

The purpose of the present study was to investigate the association between the monocyte chemoattractant protein-1 (MCP-1) promoter -2518 polymorphism and schizophrenia. One hundred and twenty-three schizophrenic inpatients and 114 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. Genotype and allele distributions in patients with schizophrenia were not significantly different from those of the controls. However, distributions of genotypes and alleles were marginally different when considering subjects with positive and negative symptomatology. The present study therefore calls for further studies on the potential role of the MCP-1 promoter -2518 polymorphism in clinical heterogeneity of schizophrenia.

Glutathione S-transferase M1 polymorphism may contribute to schizophrenia in the Korean population

The association between Glutathione S-Transferase M1 gene (GSTM1) polymorphism and schizophrenia was examined. One hundred and eleven in-patients with schizophrenia and 130 healthy controls were enrolled in this study. Genotyping was performed using a polymerase chain reaction-based method. The GSTM1 null genotype was significantly more frequent in the schizophrenia patients than in the controls (P=0.014, odds ratio=1.93, 95% confidence interval=1.115-3.351). On the other hand, the GSTM1 genotype variants were not associated with tardive dyskinesia or total abnormal involuntary movement scale scores. This study suggests that, at least in the Korean population, the GSTM1 polymorphism may confer susceptibility to the development of schizophrenia but not to tardive dyskinesia.

MAP, a protein interacting with a tumor suppressor, merlin, through the run domain

Merlin (or schwannomin) is a tumor suppressor encoded by the neurofibromatosis type 2 gene. Many studies have suggested that merlin is involved in the regulation of cell growth and proliferation through interactions with various cellular proteins. To better understand the function of merlin, we tried to identify the proteins that bind to merlin using the yeast two-hybrid screening. Characterization of the positive clones revealed a protein of 749 amino acids named merlin-associated protein (MAP), which showed wide tissue distribution in Northern blot analysis. Sequence analysis revealed that MAP is a potential homologue of a yeast check-point protein, BUB2, and contains TBC, SH3, and RUN domains, thereby implicating its role in the Ras-like GTPase signal pathways. MAP and merlin were directly associated in vitro and in vivo, and colocalized in NIH3T3 cells. The RUN domain of MAP and the C-terminus of merlin appeared to be responsible for their interaction. MAP decreased the AP-1-dependent promoter activity additively with merlin in NIH3T3 cells. In addition, merlin and MAP synergistically reduced the colony formation of NIH3T3 cells. These results suggest that MAP may play a cooperative role in the merlin-mediated growth suppression of cells.

Quinone oxidoreductase (NQO1) gene polymorphism (609C/T) may be associated with tardive dyskinesia, but not with the development of schizophrenia

The association between the quinone oxidoreductase gene (NQO1) polymorphism (609C/T) and schizophrenia was examined to replicate and extend the findings of a previous study (Hori et al., 2003). The study sample was 107 schizophrenia in-patients and 106 healthy controls. The distributions of the NQO1 genotypes and alleles were not different between the schizophrenia patients and the controls. However, the frequency of the variant genotype was significantly higher in the subgroup with tardive dyskinesia (TD) than in the subgroup without (p=0.019). The subjects with allele T were significantly more frequent in the TD patients than in those without (odds ratio 2.256, 95% confidence interval 1.235-4.133). In addition, the Abnormal Involuntary Movement Scale (AIMS) score was significantly higher in the variant genotype group (T/T) than in other genotypic groups (C/C and C/T) (p=0.004). This study suggests that the NQO1 gene polymorphism (609C/T) may confer susceptibility to the development of TD in schizophrenia, at least in the Korean population.

No association of TAP2 polymorphisms in Korean patients with schizophrenia

OBJECTIVES

Polymorphisms of transporters associated with antigen-processing (TAP) genes might influence the susceptibility to schizophrenia by altering the antigen-processing pathway. The aim of this study was to verify the relationship between schizophrenia and the polymorphisms of TAP2 genes.

METHOD

Two hundred and fifty-seven Korean patients diagnosed with schizophrenia according to DSM-IV and 184 normal controls participated in this study. TAP2 polymorphic residues at positions 379, 565 and 665 were typed using amplification refractory mutation system-polymerase chain reaction single-strand conformation polymorphism.

RESULTS

Distribution of the alleles and genotypes in patients with schizophrenia was not significantly different from those of controls.

CONCLUSIONS

This study did not show the association of the TAP2 gene with schizophrenia in the Korean population.

Monocyte chemoattractant protein-1 (MCP1) promoter -2518 polymorphism may confer a susceptibility to major depressive disorder in the Korean population

We conducted a case-control association study of the monocyte chemoattractant protein-1 (MCP1) gene -2518 polymorphism in 90 patients with major depressive disorder. Genotyping was performed by polymerase chain reaction methods. We found significant differences in genotype and allele frequencies. The present study suggests that this polymorphism may confer a susceptibility to major depressive disorder in the Korean population.

BanI polymorphism of the cytosolic phospholipase A2 gene and mood disorders in the Korean population

Membrane phospholipid abnormalities have been proposed to be involved in the pathogenesis of mood disorders, and in signal transduction and neurotransmitter uptake. Cytosolic phospholipase A2 (cPLA2) is not only an essential enzyme in the metabolism of fatty acids but also in signaling process. Therefore, we examined the association between the BanI polymorphism of the cPLA2 gene and mood disorders. Sixty-two patients with major depressive disorder (MDD), 50 patients with bipolar I disorder (BID) and 117 healthy controls participated in this study. Genotyping was performed by using PCR-based methods. Genotype and allele distributions in MDD patients were significantly different from those of the controls. In particular, the A2 allele was associated with increased risk of MDD development (p = 0.007, odds ratio = 1.827; confidence interval = 1.141-2.927). However, the polymorphism was not different between BID patients and controls in genotype and allele distribution. This preliminary study indicates the need for further studies on the potential role of the cPLA2 gene polymorphism in the susceptibility to mood disorders.

BanI polymorphism of the cytosolic phospholipase A2 gene may confer susceptibility to the development of schizophrenia

Membrane phospholipid abnormalities have been proposed to be involved in the pathogenesis of schizophrenia. Cytosolic phospholipase A2 (cPLA2) plays a major role in the metabolism of fatty acids but is also found in abnormalities in patients with schizophrenia. This study examined the association between the cPLA2 gene BanI polymorphism and schizophrenia. Ninety-seven Korean schizophrenia patients and 117 healthy controls participated in this study. Genotyping was performed by using polymerase chain reaction (PCR)-based methods. Genotype and allele distributions were significantly different between the schizophrenia patients and controls. In particular, the A2 allele was associated with an increased risk of schizophrenia (p = 0.003; odds ratio (OR) = 1.799; confidence interval (CI) = 1.192-2.716). However, the polymorphism was not different when the patient group was subdivided by the presence or absence of family history and by positive and negative subgroups according to the positive and negative syndrome scale (PANSS) score on schizophrenia. The results of this study replicated those of previous findings from Western countries and indicates the need for further studies on the potential role of the cPLA2 gene polymorphism in the susceptibility to schizophrenia.

Dimensional complexity of the EEG in patients with posttraumatic stress disorder

Recent electrophysiological studies have reported evidence of information processing abnormalities in patients with posttraumatic stress disorder (PTSD). The aim of this study is to examine dynamical complexity of the EEG in PTSD patients, which is thought to reflect information processing of the brain. Resting EEG recordings (32,800 data points acquired continuously from 82 s of an EEG record) were obtained in 16 channels of 27 patients with PTSD from a mixed civilian trauma population and 14 healthy subjects. The correlation dimension (D2) of the EEG was used to quantify the complexity of the cortical dynamics underlying the EEG signal. The PTSD patients were found to have lower D2 values than those of the healthy subjects in most channels (Fp1, F8, C4, P4, T3, T4, T5, T6, and O1), indicating that PTSD patients have globally reduced complexity in their EEG waveforms. This study supports the hypotheses that PTSD patients exhibit disturbed cortical information processing, and that non-linear dynamical analysis of the EEG can be a tool for detecting changes in neurodynamics of the brain in PTSD.

Monocyte chemoattractant protein-1 promoter -2518 polymorphism may have an influence on clinical heterogeneity of bipolar I disorder in the Korean population

The aim of this study was to investigate the association between monocyte chemoattractant protein-1 (MCP1) promoter -2518 polymorphism and DSM-IV-based bipolar I disorder (BID) in Korea. Ninety-two patients with BID and 114 healthy controls participated in this study. A polymerase chain reaction-based method was used for genotyping. Genotype and allele distributions in patients with BID were not different from those of the controls, nor were they different according to clinical factors in the patient group. However, the frequency of the A allele (p = 0.028) was significantly different when subdividing the patient group into patients with manic episode versus depressed and mixed episode. The present study suggests that the MCP1 promoter -2518 polymorphism may not confer susceptibility to BID itself, but could have an influence on the clinical heterogeneity of BID, at least in the Korean population.

Merlin, a tumor suppressor, interacts with transactivation-responsive RNA-binding protein and inhibits its oncogenic activity

The neurofibromatosis type 2 gene-encoded protein, merlin, is related to the ERM (ezrin, radixin, and moesin) family of membrane-cytoskeleton-associated proteins. Recent studies suggest that the loss of neurofibromatosis type 2 function contributes to tumor development and metastasis. Although the cellular functions of merlin as a tumor suppressor are relatively well characterized, the cellular mechanism whereby merlin controls cell proliferation from membrane locations is still poorly understood. During our efforts to find potential merlin modulators through protein-protein interactions, we identified transactivation-responsive RNA-binding protein (TRBP) as a merlin-binding protein in a yeast two-hybrid screen. The interaction between TRBP and merlin was confirmed by glutathione S-transferase pull-down assays, co-immunoprecipitation, and co-localization experiments. The carboxyl-terminal regions of each protein were responsible for their interaction. Cells overexpressing TRBP showed enhanced cell growth in cell proliferation assays and also exhibited transformed phenotypes, such as anchorage-independent cell growth and tumor development in mouse xenografts. Merlin efficiently inhibited these oncogenic activities of TRBP in our experiments. These results provide the first clue to the functional interaction between TRBP and merlin and suggest a novel mechanism for the tumor suppressor function of merlin both in vitro and in vivo.

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.

Polymorphisms of interleukin-4 promoter and receptor gene for schizophrenia in the Korean population

The purpose of the present paper was to investigate the interleukin (IL)-4 promoter gene -590 and receptor alpha (Ralpha) gene 1902 polymorphism in Korean schizophrenic patients. A total of 222 Korean patients diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and 165 normal healthy controls participated in the present study. The DNA was extracted from whole blood using proteinase K, and the IL-4 promoter and receptor gene were amplified by polymerase chain reaction. The genotype was determined using single-strand conformation polymorphism (SSCP) analysis. The distribution of the alleles and genotypes in patients with schizophrenia was not significantly different from those of controls. In conclusion, these results suggest that the polymorphisms in IL-4 promoter gene -590 and IL-4 Ralpha gene 1902 are not involved in the pathophysiology of schizophrenia 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.

Interleukin-10 gene promoter polymorphism is not associated with schizophrenia in the Korean population

The present study was aimed at examining the interleukin (IL)-10 gene promoter region polymorphic variants in patients with schizophrenia in the Korean population. Two hundred and thirty-three Korean patients diagnosed to have schizophrenia on the basis of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and 181 normal healthy controls participated in the present study. The DNA was extracted from whole blood using proteinase K and the IL-10 gene promoter region was amplified by polymerase chain reaction. Gene typing was performed by restriction fragment length polymorphism and single-strand conformation polymorphism. Distribution of the alleles and haplotypes in patients with schizophrenia was not significantly different from those of controls. The present study suggests that IL-10 gene promoter polymorphism is not associated with the development of 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.

A naturalistic study of risperidone treatment in seven affiliated university hospitals in Korea

This retrospective naturalistic study, conducted on patients with schizophrenia, was undertaken to examine the differences in the clinical characteristics of subjects who were treated with risperidone, but who were discontinued soon after administration, and those who were maintained on the drug for a long-term period. Data on 210 of 580 inpatients with schizophrenia who were treated with risperidone and whose complete medical records were available, were analyzed. Patients maintained on risperidone for at least 2 years were assigned to a 'long-term maintenance' (LTM) group and those who were discontinued within 6 months of risperidone administration were assigned to an 'early drop-out' (ED) group. The parameters used for comparisons included the patients' demographic characteristics, the presence/absence of physical or psychiatric comorbidities, the severity of the psychopathology, the typology of the schizophrenia, the nature and subjects' responses to previous antipsychotic treatments (if any) and dosages of risperidone treatment. Of the 210 subjects, 67 (31.9%) belonged to the ED group, whereas 143 (68.1%) were maintained on risperidone at 2 years. There were no significant differences in the demographics, nor in the severity of the psychopathology, nor were there significant differences in the starting or maximal dosages of risperidone administered between the two groups. Exposure to any previous antipsychotic and the longest maintained final dosage of risperidone were significantly different in the two groups. We believed that a multicenter-based retrospective naturalistic study would provide useful information about the efficacy and other practical aspects of antipsychotic administration.

Effects of mirtazapine in patients with post-traumatic stress disorder in Korea: a pilot study

This study was aimed at testing the efficacy and tolerability of mirtazapine in the treatment of Korean patients with chronic post-traumatic stress disorder (PTSD). Mirtazapine was administered for 8 weeks using a flexible-dose regime in 15 Korean patients with PTSD based on the DSM-IV criteria. We evaluated the patients at baseline and at weeks 4 and 8 after treatment with the interviewer-administered structured interview for PTSD (SIP), short PTSD rating interview (SPRINT), impact of event scale-revised (IES-R) and the Montgomery Asberg depression rating scale (MADRS). Scores on the SIP, SPRINT, IES-R and MADRS had significantly reduced after 8 weeks treatment. In this pilot study, mirtazapine was found to be effective and well tolerated in the treatment of patients with PTSD. This calls for further evaluation of the effect of this drug on subjects with PTSD with randomized placebo-controlled studies.

Effect of risperidone on serum cytokines

A variety of cytokines are dysregulated in schizophrenia, and some antipsychotic drugs effect cytokines. In order to examine the effect of risperidone on plasma cytokines, we measured the serum level of IL-1b, IL-2, IL-6, IL-12, and INF-g during acute states of illness, and after 4 weeks of treatment with risperidone in 19 schizophrenic patients. The patients' psychopathology was assessed by PANSS. Plasma IL-12 levels increased significantly after 4 weeks of treatment (p = .002). Plasma IL-b, IL-2, IL-6, and INF-g levels were not significantly different before and after treatment. There were no significant correlations between the changes in cytokine levels and the changes in PANSS scores. Increased IL-12 may contribute to activation of immune responses during treatment with risperidone. IL-12 may play an important role in immune responses related to neuropsychiatry.

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.

Effects of olanzapine on prolactin levels of female patients with schizophrenia treated with risperidone

BACKGROUND

This study was conducted to prospectively examine the effect of switching from risperidone to olanzapine on female schizophrenia patients who experienced menstrual disturbances, galactorrhea, and/or sexual dysfunction.

METHOD

Twenty female patients with DSM-IV schizophrenia who were taking risperidone and were suffering from menstrual disturbances, galactorrhea, and/or sexual dysfunction were enrolled. Patients were switched from risperidone to olanzapine over a 2-week period, then treated with olanzapine for 8 additional weeks. The serum prolactin concentrations were examined every 2 weeks. The Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Scale for Extrapyramidal Symptoms (SAS), and questions from the Dickson-Glazer Sexual Functioning Scale were administered to evaluate efficacy, extrapyramidal side effects, and sexual and reproductive functioning at baseline and the endpoint of 10 weeks.

RESULTS

Serum prolactin levels decreased significantly (p < .01) following the switch from risperidone to olanzapine. Scores of PANSS, AIMS, and SAS at the endpoint were also significantly decreased (p < .01) compared to those of baseline. Patients experienced improvements in menstrual functioning and perceptions of sexual side effects.

CONCLUSION

Olanzapine reversed hyperprolactinemia in risperidone-treated female schizophrenic patients. This was associated with a decrease in amenorrhea, improved cycle regularity, and a decrease in sexual side effects that the women attributed to antipsychotic medication. This study suggests that switching to olanzapine is a safe and effective alternative method for patients with antipsychotic-induced hyperprolactinemia associated sexual and/or reproductive dysfunction. Long-term follow-up studies are warranted, with particular attention to the course of sexual and reproductive dysfunction.

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.