• Korean Journal of Biological Psychiatry
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• v.25 no.2
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• pp.38-43
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• 2018

Objectives Dopamine dysregulation has been regarded as one of the core pathologies in patients with schizophrenia. Since dopamine synthesis capacity has found to be inconsistent in patients with schizophrenia, current classification of patients based on clinical symptoms cannot reflect the neurochemical heterogeneity of the disease. Here we performed new subtyping of patients with first-episode psychosis (FEP) through biotype-based cluster analysis. We specifically suggested basal ganglia structural changes as a biotype, which deeply involves in the dopaminergic circuit. Methods Forty FEP and 40 demographically matched healthy participants underwent 3T T1 MRI. Whole brain parcellation was conducted, and volumes of total 6 regions of basal ganglia have been extracted as features for cluster analysis. We used K-means clustering, and external validation was conducted with Positive and Negative Syndrome Scale (PANSS). Results K-means clustering divided 40 FEP subjects into 2 clusters. Cluster 1 (n = 25) showed substantial volume decrease in 4 regions of basal ganglia compared to Cluster 2 (n = 15). Cluster 1 showed higher positive scales of PANSS compared with Cluster 2 (F = 2.333, p = 0.025). Compared to healthy controls, Cluster 1 showed smaller volumes in 4 regions, whereas Cluster 2 showed larger volumes in 3 regions. Conclusions Two subgroups have been found by cluster analysis, which showed a distinct difference in volume patterns of basal ganglia structures and positive symptom severity. The result possibly reflects the neurobiological heterogeneity of schizophrenia. Thus, the current study supports the importance of paradigm shift toward biotype-based diagnosis, instead of phenotype, for future precision psychiatry.

• Korean Journal of Schizophrenia Research
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• v.20 no.1
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• pp.15-22
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• 2017

Objectives : It has been shown that early intervention is crucial for favorable outcome in patients with schizophrenia. However, development of biomarkers for predicting prognosis of psychotic disorder still requires more research. In this study, we aimed to investigate whether baseline mismatch negativity (MMN) predict prognosis in patients with first episode psychosis (FEP). Methods : Twenty-four patients with FEP and matched healthy controls (HCs) were examined with MMN at baseline, and their clinical status were re-assessed after 1 year. Repeated-measures analysis of variance was performed to compare baseline MMN between the two groups. Multiple regression analysis was used to identify factors predicting prognosis in FEP patients during the follow-up period. Results : MMN amplitudes at baseline were significantly reduced in patients with FEP compared to healthy controls. In the multiple regression analysis, baseline MMN amplitude significantly predicted later improvement of performances on digit span and delayed recall of California Verbal Learning Test. However, baseline MMN did not predicted improvement of clinical symptoms. Conclusion : These results indicate that MMN may be a possible predictor of improvement in cognitive functioning in patients with FEP. Future study with larger sample and longer follow-up period would be needed to confirm the findings of the current study.

• Korean Journal of Biological Psychiatry
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• v.8 no.1
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• pp.153-155
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• 2001

There had been few reports of arachnoid cyst accompanying psychiatric disturbance and no report treated with low-dose risperidone administration. We report a patient, developed first-transient psychotic episode considered to be provoked by an arachnoid cyst, responsive to risperidone, which was found in the middle cranial fossa as follows. A 57-year-old man was admitted by suddenly developed headache, auditory hallucination, delusion of persecution and, an arachnoid cyst in the anteromedial aspect of middle cranial fossa was found on MRI after admission. The psychotic episode was first to him and he was also negative to other clinical evaluation including endocrine abnormality, his psychotic symtom was suspected to be induced by arachnoid cyst and was well controlled to low-dose risperidone administration. He left hospital free from psychotic symptoms on 14 hospital days.

• BMB Reports
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• v.51 no.9
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• pp.427-428
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• 2018

Based on the piling reports of disruptions in the thalamus of patients with schizophrenia, the alteration in the thalamo-cortical system has been regarded as the core pathophysiology. As the thalamus is composed of distinctive nuclei with different cytoarchitecture and cortical connections, nuclei specific investigations have been actively conducted in post-mortem studies. In addition, the importance of early changes has been highlighted, which in turn has led to investigations of the thalamo-cortical system using non-invasive neuroimaging methods. From this perspective, the early structural changes in the thalamo-cortical system, such as the thalamo-cortical connection and nuclei specific microstructural changes (which are coherent with findings from post-mortem methods) will be briefly discussed. The main findings, which are the reduced thalamo-prefrontal connection and reduced microstructural complexity in the higher-order nuclei detected in first-episode psychosis patients, suggest the occurrence of early alterations within and between the communication hub of the brain and cortex. These findings suggest not only directions for further studies for unveiling the thalamo-cortical system related pathophysiology, but also the possibility of using the reduced microstructural complexity in the higher order nucleus as a biomarker for schizophrenia.

• Korean Journal of Schizophrenia Research
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• v.15 no.2
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• pp.66-72
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• 2012

Objectives : The aim of this study was to investigate whether verbal and spatial working memory functions were impaired not only in patients with schizophrenia but also in people at ultra-high risk for first-episode psychosis. Methods : Twenty-five patients (M 13, F 12) with schizophrenia (SPR), 21 people at ultra-high risk for psychosis (UHR)(M 10, F 11) and 19 normal controls (NC)(M 10, F 9) were recruited. The working memory was assessed by using the verbal and spatial n-back test. The working memory load increased incrementally from the 0-back to the 3-back condition. Results : SPR performed significantly lower than NC and UHR in terms of hit rates of verbal and spatial n-back test. UHR subjects conducted significantly lower than NC and higher in trend-level than SPR in terms of hit rates of verbal and spatial n-back test. These differences were derived from the high working memory load (2-back and 3-back), not from the low working memory load (0-back and 1-back). There was no significant difference between the verbal and spatial n-back test across the three groups. Conclusion : These findings suggest that verbal and spatial working memory dysfunction may be general rather than differential in terms of stimuli modality, and this working memory deficit may be an important trait factor in schizophrenia.

• Korean Journal of Biological Psychiatry
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• v.20 no.4
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• pp.179-186
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• 2013

Objectives This study is designed to compare the clinical characteristics of patients with early onset schizophrenia to those of adult onset schizophrenia patients in first episode. Methods Authors reviewed medical records of 16 early-onset schizophrenia patients and 22 adult-onset schizophrenia patients who had been admitted in the psychiatric ward and diagnosed as schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, fourth Edition (DSM-IV) at Eulji University Hospital during 2004-2008. Socio-demographic data and clinical characteristics such as duration between onset and active phase, number of significant positive and negative symptoms, positive and negative symptom scores of Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S) scores, duration from onset to admission, duration of admission, and equivalent dose of antipsychotics were reviewed. These clinical characteristics of early-onset group were compared to those of adult-onset group. Correlation between age of onset and other clinical characteristics was also analyzed. Results Early-onset group showed more insidious onset pattern and had longer duration of hospitalization than adult-onset group. Early onset group also exhibited more negative symptoms, higher negative symptom scores, and higher CGI-S scores than adult-onset group after treatment. However, there were no significant differences in family history of psychosis, positive symptom frequency at discharge and equivalent dose of antipsychotics between two groups. Conclusions This study revealed that patients with early-onset schizophrenia exhibited more insidious onset, more negative symptoms, and more severe symptoms than those with adult-onset schizophrenia after treatment.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.2
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• pp.192-217
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• 2001

Object：This study was carried out to classify adolescents in runaway shelters by evaluating their psychopathology. And the ultimate purpose is to offer basic data for preventing adolescents‘ runaway and for diversifying runaway shelters suitable for the problem of individual adolescent. Method：128 adolescents who stay in the runaway shelters were asked to complete self-report qeustionnaires including basic sociodemographic data, Child Behavior Check List(CBCL), Minnesota Multiphasic Personality Inventory(MMPI), and Symptom Check List-90-Revised(SCL-90-R). Korean Wechsler Adult Intelligence Scale(K-WAIS)[or Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children(KEDI-WISC)] and Bender-Gestalt test(BGT) were also done by clinical psychologists. Results：The most common age of the subjects were 15-year-old, and they dropped out their schools in the middle school most commonly. Mostly they were from middle class family and their parents' educational level were high school graduates. The first runaway episode was most common in the middleschool period, and their runaways were repeated. The most common frequency of runaways were more than 10 times. About 10% of them abused drugs and about 80% of them abused alcohol. One third of them had experiences of illegal problems and 10% of them engaged in sexual activity for money. 95 adolescents(83%) in CBCL, 42 adolescents(36%) in SCL-90-R, and 70 adolescents(69.3%) in MMPI showed clinical significance. In intelligence test, 22 adolescents(22%) were mentally retarded. In BGT, 35 adolescents(39.4%) manifested brain dysfunction signs. Conclusion：Runaway adolescents in the shelters have variable and severe psychopathology. Their psychopathology is classified as follows；The behavior disorder group, the mood disorder group with anxiety/depression, the somatic disorder group with somatic symptoms, and the psychosis group with possibility of severe psychopathology. Therefore it is very important to evaluate psychiatric problems of runaway adolescents, and specific therapeutic interventions according to their problems are required.