Objectives:Functional magnetic resonance imaging(fMRI) is one of the most useful techniques for assessing localized changes in cerebral blood flow and oxygenation using diverse challenge paradigms. This review presents the results of fMRI studies relating to schizophrenia. Methods:Several fMRI articles on this subject in psychiatric journals were surveyed. Results:Even with some methodological limitations, most studies showed activity differences between schizophrenics and control subjects. Conclusion:fMRI extends our understanding of the pathophysiological basis of schizophrenia and offer an opportunity for the assessment and management of its pathology.

The current understanding of the mechanisms of pharmacotherapy for depression is characterized by an emphasis on increasing synaptic availability of serotonin, noradrenaline, and possibly dopamine, while minimizing side effects. The acute effects of current available effective antidepressants include blocking selective serotonin or noradrenaline reuptake, alpha2 autoreceptors or monoamine oxidase. Although efficacious, current treatments often produce partial or limited symptomatic improvement rather than remission. While current pharmacotherapies target monoaminergic systems, distinct neurobiological underpinnings and other systems are likely involved in the pathogenesis of depression. Recently, several promising hypotheses of depression and antidepressant action have been formulated. These hypotheses are largely based on dsyregulation of neural plasticity, CREB, BDNF, corticotropin-releasing factor, glucocorticoid, hypothalamic-pituitary adrenal axis and cytokines. Based on these new theories and hypotheses of depression, a number of new and novel agents, including corticotropin-releasing factor antagonists, antiglucocorticoids, and substance P antagonists show a considerable promise for refining treatment options for depression. In this article, the current available pharmacotherapies, current understanding of neurobiology and pathogenesis of depression and new and promising directions in pharmacological research on depression will be discussed.

Background:The dopaminergic genes have been implicated with some personality traits. Many recent studies indicated that there is a correlation between D2 dopamine receptor gene(DRD2) polymorphisms and the personality traits. The purpose of this study is to investigate a possible association between DRD2 gene (TaqI A, TaqI B) polymorphism and personality traits. Methods:The subjects were consisted of 173 blood-unrelated young female Koreans with a mean age(${\pm}SD$) of 13.88(${\pm}0.29$) years. These volunteers were recruited from one of the junior high schools in Seoul and were tested by the Korean version of the Temperament and Character Inventory(TCI). Genotyping of the DRD2 polymorphisms by PCR methods were carried out. Two DRD2 gene polymorphisms were classified and individually assessed as follows:TaqI A1+ vs A1-, TaqI B1+ vs B-. The associations between the TCI scores and TaqI A, TaqI B polymorphisms were assessed by Student's t-test. Results:In the 173 subjects, the allele frequencies of the DRD2 TaqI A1, TaqI B1 alleles ranged from 0.42 to 0.43, and these results are quite different from the ranges of 0.15-0.20 in the case of a Caucasian population. The genotype frequencies of DRD2(TaqI A1, TaqI B1) variants showed no significant deviation from the Hardy-Weinberg equilibrium. RD4(dependence vs. independence) of Cloninger's TCI, a sub-dimension of Reward Dependence, was significantly higher in the subjects having DRD2 less frequent alleles than those without these alleles. Conclusion:This study suggests that the female subjects carrying the less frequent DRD2 alleles exhibited higher reward-dependent personality trait compared to those without these alleles.

Objective:Nitric oxide(NO) has been known to be associated with tolerance and preference to alcohol. It has also been known to affect various alcohol drinking behavior, alcohol withdrawal symptoms and alcohol- induced brain damage. The purpose of this study was to determine the difference, among alcohol dependence group, alcohol drinking group and abstinence group, in serum concentration of nitrite, a stable metabolite of NO, and it's relationship to clinical and biochemical markers of alcoholism. Methods:Forty subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated for the clinical characteristics and biochemical markers of alcohol dependence including nitrite with their CIWA-Ar scores checked just after admission. Thirty-nine healthy controls were also evaluated, divided into twenty-three alcohol drinking group and sixteen abstinence group. Clinical characteristics were evaluated by CIWA-Ar, CAGE and AUDIT questionnaires. Aspartate aminotransferase(AST), alanine aminotransferase (ALT), gamma glutamyltransferase(GGT) and mean corpuscular volume(MCV) were used as the biochemical markers of alcohol dependence. Serum nitrite concentrations were measured by Griess reaction. Results:1) The concentrations of nitrite in alcohol dependence patients were not different from those in the control subjects. 2) There were no significant association between the nitrite concentrations and the CIWA-Ar scores in alcohol dependence patients. 3) Nitrites are significantly increased in alcohol dependence group and alcohol drinking group compared with abstinence group. Conclusions:These findings suggest that serum nitrite concentration has no relation with alcohol withdrawal symptoms, but alcohol drinking increases serum nitrite concentration influenced by general condition of the body.

Objective:Event-related potentials(ERPs) are electrical changes recorded at the surface of the scalp in response to stimulus presentation, and their latency and amplitude change according to cognitive processes. Through past studies of the auditory ERP in schizophrenia, the P300 has been reported to be statistically smaller and delayed in schizophrenia than comparison groups. However, studies of the visual ERP have not been systematically examined. The present study was designed to investigate the visual P300 in patients with schizophrenia and normal controls and to compare the pattern of P300 between them. Methods:The subjects were composed of patients(N=22) with schizophrenia by DSM-IV and normal controls(N=22). The visual ERPs were measured by the visual continuous performance test. P300 amplitude and latency measured on 5 scalp electrodes(Fz, Cz, Pz, $T_7$, $T_8$) were compared between patients and controls. Results:The P300 latencies measured on Fz, Cz, Pz, and $T_7$ electrodes were significantly longer in patients than controls(p<0.05). The P300 amplitudes in patients were smaller than controls. However, the difference between them was not statistically significant. Conclusion:Analysis of the visual ERPs showed that the P300 latency is significantly delayed and the P300 amplitude is slightly smaller in patients than controls. These results are similar to established studies of the auditory P300 in schizophrenia.

Objective:A Comparison of QTc prolongation for various antipsychotics and an analysis of QTc prolongation for the various types of serotonin transporter polymorphism were performed. Method:EKG was checked, followed by QTc measurement as Bazett's correction, and the serotonin transporter polymorphism was examined in 110 chronic schizophrenia patients were performed EKG before 24 weeks ago. We defiened QTc prolongation as over 450ms. The risk factor of sudden cardiac death were defiend as QTc prolongation and or 60ms in delta value. Result:The prevalence of QTc prolongation in this study was 7.3%, and the prevalence of over 60ms was 4.5%. Patients who had the risk factors were 10(9.1%). 6/52 who prescribed atypical antipsychotics and 2/58 who prescribed haloperidol showed QTc prolongation. The prevalence who had the risk factor of sudden cardiac death were 16% in atypical antipsychotics group, 3.4% in haloperidol group. QTc prolongation were observed more frequently in l/l type than s/s type. l allele frequency were 50% in QTc prolongated group, 19% in not prolongated group. l allele had an association with QTc prolongation(p<0.01). Conclusion:The prevalence of QTc prolongatin was frequent in chronic schizophrenia patients who were prescribed atypical antipsychotics. It has strong association with l allele of 5-HTTLPR.

Objectives:Tardive dyskinesia(TD) is a serious side effect associated with long-term antipsychotic treatments. Some candidate genetic polymorphisms were reported to be associated with TD and possible involvement of serotonergic receptors in the pathophysiology of TD has been suggested. In the present study, we investigated the association between $5-HT_6$ receptor gene polymorphism and TD with schizophrenia. Methods:To investigate the relationship between $5-HT_6$ receptor gene polymorphism and TD, 60 patients with TD were compared with 60 patients without TD. The 267C/T allele of $5-HT_6$ receptor gene was genotyped by means of polymerase chain reaction method. TD was evaluated using the Abnormal Involuntary Movement Scale(AIMS). Results:The patients with the three 267C/T genotype showed no significant differences in age, gender, and duration of illness. No significant difference in genotype frequencies was observed between schizophrenic patients with and without TD. In addition, there was no difference in allele frequencies. Further analysis with an measure of AIMS scores showed that these scores were not significantly influenced by the $5-HT_6$ receptor gene polymorphism. Conclusion:These results suggest that 267C/T polymorphism of $5-HT_6$ receptor gene is not significantly associated with susceptibility to TD in schizophrenia.

We describe the case of a 73 year-old female patient, YSG, who initially presented with a manic episode without any previous psychiatric history and was later diagnosed as having a meningioma in the left frontal lobe. YSG's symptoms were characterized by hyperactivity, insomnia, aggressive behavior with an auditory hallucination. She showed no abnormal signs on a complete neurologic examination. A gadolinium-enhanced MRI study showed a huge, extra-axial mass with homogenous enhancement in the left high convexity of the frontal lobe. Her manic symptoms subsided after administration of risperidone 1mg and valproic acid 500mg daily, for three weeks without surgical resection of the tumor. These findings suggest that YSG's mania might have resulted from the left-sided frontal tumor, and that her symptoms were treated rapidly by small doses of risperidone combined with valproic acid. Medical staff who care for manic patients should be aware of this possibility of a organic lesion without evidence of neurologic disease.