This review briefly summarizes the relevant knowledge of psychoneuroimmunological basis for neuroimmunology, with particular emphasis on bidirectional neural-immune interactions. The immune system and the nervous system maintain extensive communication, including hardwiring of sympathetic and parasympathetic nerves to lymphoid organs. Immune system is modulated by various neurotransmitters such as acetylcholine, norepinephrine, substance P and histamine. Neuroendocrine hormones such as corticotrophin-releasing hormone(CRH) or substance P regulate cytokine balance. The immune system modulates brain activity including sleep and body temperature. Recent studies have revealed that psychological factors which influence immunity and immune-related disease may modulate brain-to -immune interaction. But, we still await the scientific research and evidences to prove whether or how behavioral or treatment intervention of stress can influence the development, progress or prevention of a specific disease.

There have been vast amount studies regarding immunologic dysregulation in schizophrenia. The mechanism of immune pathogenesis in schizophrenia still is unclear, even though various immune dysfunction have been reported. We endeavored to report on two major hypothesis on immunologic dysregulation in schizophrenia, the infection hypothesis and autoimmune hypothesis. We went on to focus on the autoimmune hypothesis, which has received the most attention over the years. We explored the accumulated data and the rational behind the autoimmune hypothesis and the implications of the autoimmune hypothesis for future research in the pathogenesis of schizophrenia.

Accumulating evidence has suggested the existence of reciprocal communication between immune, endocrine, and neurotransmitter system. Cytokine hypothesis of depression implies that increased pro-inflammatory cytokine such as -1, IL-6, IL-12, TNF-${\alpha}$, and IFN-${\gamma}$ in major depression, acting neuromodulators, play a key role in the mediation of behavioral, neuroendocrine, and neurochemical disturbances in depression. Concerning the relation between cytokines and serotonin metabolism, pro-inflammatory cytokines have profound effects on the metabolism of brain serotonin through the enzyme indoleamine-2,3-dioxygenase(IDO) that metabolizes tryptophan, the precursor of 5-HT to neurodegenerative quinolinate and neuroprotective kynurenate. The neurodegeneration process is reinforced by the neurotoxic effect of the hypercortisolemia during depression. From this perspective, it is possible that efficacy of antidepressants in the treatment of depression may, at least in part, rely on downregulation of pro-inflammatory cytokine synthesis. So, the use of cytokine synthesis inhibitors or cytokine antagonists may be a new treatment approach in depression. However, at present the question whether cytokines play a causal role in the onset of depression or are mere epiphenomena sustaining depressive symptoms remains to be elucidated. Nevertheless, cytokine hypothesis has created new perspectives in the study of psychological and pathophysiological mechanism that are associated with major depression, as well as the prospect for developing a new generation antidepressants.

Objectives : The authors tried to investigate the characteristics of Heart Rate Variability(HRV) among the subjects with metabolic syndrome for testing the possibility of clinical application of HRV in evaluating metabolic syndrome. Methods : We examined the difference of the means of HRV between 122 subjects of metabolic syndrome and 1057 healthy controls using T-test, and the change of means in HRV according to increasing risk factors of metabolic syndrome. Using multiple regression analysis, we examined the association of HRV with the risk factors of metabolic syndrome. Results : The HRV indices including SDNN(Standard Deviation of all normal NN intervals), RMSSD(the square Root of the Mean Squared Differences of successive all normal NN interval), TP(Total Power), LF(Low Freuency), and HF(High Frequency) were significantly lower in the metabolic syndrome group than in the normal control group, and the means of all HRV indices except LF/HF were decreased consistently according to increasing risk factors of metabolic syndrome. The fasting glucose, triglyceride, and waist circumference were dependent factors that contributed significantly to the change of HRV. Conclusion : These findings suggest metabolic syndrome adversely affects cardiac autonomic system and HRV could be a useful method for evaluating metabolic syndrome.

Objectives : This study was aimed at evaluating the relationship between somatic symptoms, depression, anxiety and cognitive function in the patients with Mild Traumatic Brain Injury(MTBI). Methods : Thirty seven patients with MTBI were selected from those patients who had visited the Department of Neuropsychiatry of Wonkwang University Hospital from 2003 to 2007. To assess and quantify the somatic symptoms, depression and anxiety, Personality Assessment Inventory(PAI) was used. Assessment of cognitive function was carried out by using Korean Wechsler Adult Intelligence Scale(K-WAIS), Rey-Kim Memory Test, and Kims Executive Function Test. The effects of somatic symptoms, depression, and anxiety on the cognitive function were evaluated by Pearson correlation test. Results : Somatic symptoms, depression, and anxiety, all showed inverse correlation to cognitive function. Specifically, 1) an increase in somatic symptoms was associated with a decrease in attention, verbal short term memory, verbal recall and recognition, and visual memory. 2) An increase in anxiety was associated with a decrease in verbal recall and recognition. 3) An increase in depression was associated with a decrease in cognitive function that requires high attention and verbal memory. Conclusion : The patients with MTBI displayed diverse symptoms ranging from cognitive impairment to somatic symptoms, depression, and anxiety. Somatic and emotional symptoms were correlated with cognitive function(especially executive function). Importantly, this study raises the possibility of treating the cognitive impairment associated with MTBI by treating somatic symptoms, depression, and anxiety.

Objectives : The Alcohol Urge Questionnaire(AUQ) has been used in alcohol dependence treatment and research. The goal of this study is to develop of the Korean Alcohol Urge Questionnaire(AUQ-K). Methods : To examine the AUQ-K's psychometric properties, responses from 104 patients admitted in alcohol dependence treatment facility were investigated. Results : The internal consistency of the 8-item AUQ-K, measured by coefficient ${\alpha}$, was high(Cronbach's ${\alpha}$=0.78). AUQ-K scores showed significant correlation when the retest interval was 1 day(p<0.01). The AUQ-K's validity was investigated using correlational analyses with two other craving scales[the Obsessive Compulsive Drinking Scale(OCDS) and the Visual Analogue Scale(VAS)]. The high correlations were obtained between total AUQ-K scores and total OCDS scores, and between total AUQ-K scores and the VAS scores(p<0.01, respectively). Conclusion : The AUQ-K is a reliable and valid short scale for measurement of self-reported alcohol craving. This scale may offer significant advantages over existing single-item measures of alcohol craving in the fields of alcohol dependence treatment and research.

Objectives : The purpose of this study is to compare the ability of facial affect perception among schizophrenia patients, their first degree relatives, and normal control subjects. Methods : Thirty five patients with schizophrenia, 22 first degree relatives, and 34 normal control subjects were recruited in this study. All three groups were matched for age and education levels. The facial affect identification test(FAIT), and neurocognitive test were applied. In the FAIT, the correct response rate, perceived intensity, and sensitivity for 6 kinds of affects were compared among three groups. Results : We found that correct response rate of sadness and anger were decreased in the schizophrenia patients compared with the normal control group. Also the schizophrenia patients showed reduced sensitivity for all six affects compared with the normal control group. The ability of facial affect perception in first degree relatives of schizophrenia patients was decreased but there were not any significant differences compared with normal control group. Conclusion : This study confirmed significantly reduced ability of facial affect perception in schizophrenia patients compared with normal control. Decreased ability of facial affect perception in first degree relatives suggests that affective sensitivity can be influenced by genetic predisposition.

Refeeding syndrome is a life-threatening but treatable condition occurring in any patients with starvation. Electrolyte imbalance, especially hypophosphatemia and fluid shift result in metabolic changes in various systems. The authors reported a case of refeeding syndrome associated with prolonged starvation due to delusion and hallucination in a 38-year-old schizophrenia patient. Hypophosphatemia, hypokalemia, edema and elevation of liver enzyme was occurred despite careful treatment. The symptoms were improved after consistent electrolyte supplement. Close observation and repetitive monitoring are important to prevent refeeding syndrome.