• Korean Journal of Biological Psychiatry
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• v.25 no.1
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• pp.9-15
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• 2018

Objectives This study intended to identify the deficits of cognitive control among patients with bipolar I disorder and their first-degree relatives, and identify the possibility of cognitive control as an endophenotype of bipolar disorder. Methods The study included three groups: euthymic states patients with bipolar I disorder (n = 55), unaffected first-degree relatives of probands with bipolar I disorder (n = 30), and a healthy control group (n = 51), that was matched on age, sex, and years of education. The AX version of the continuous performance test (CPT) was used to examine cognitive control. Error rate, correct response times of each subsets (AX, BX, AY, BY), and d' as an indication of accuracy sensitivity index were calculated. Psychopathology, intelligence, and psychomotor speed were also assessed. Results Patients with bipolar I disorder showed significantly worse error rates in the AX (p = 0.01) and BX (p = 0.02) subsets and d' (p = 0.05) than the others. They also showed more delayed correct response times than the healthy control group and first-degree relatives in all subsets (p < 0.01). But first-degree relatives showed neither high error rates nor delayed correct response times than healthy control group. Conclusions These findings suggest that cognitive control is impaired in bipolar I disorder but less likely to be an endophynotype of bipolar I disorder.

• Korean Journal of Biological Psychiatry
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• v.19 no.3
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• pp.134-139
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• 2012

Objectives : Proinflammatory process has been implicated as an underlying mechanism of bipolar disorder and schizophrenia. Previous studies have suggested a possible role of lymphotoxin alpha (LTA) gene in the development of schizophrenia and have prompted further investigation in bipolar patients. Association of the LTA +252A/G polymorphism with susceptibility to bipolar I disorder itself as well as with vulnerability among a subset of psychotic bipolar patients were tested. Methods : DNA extraction was done by a standard method and genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 114 Korean patients with bipolar I disorder and 202 healthy controls. SPSS v18.0 was used for statistical analysis. Comparisons of the genotype and allele distributions in LTA +252A/G polymorphism were made using a chi-square test. The genotype and allele associations were also evaluated using odds ratio (OR) and 95% confidence interval (CI). Statistical significance was accepted when p was < 0.05. Results : No significant association was found between the LTA +252A/G polymorphism and bipolar disorder. However, LTA +252G allele was present with significantly higher frequency among bipolar patients with psychotic features compared to those without (${\chi}^2$ = 4.69, p = 0.034, OR = 2.495, 95% CI = 1.069-5.827). Conclusion : The results suggest that the allele LTA +252G of the polymorphism may be associated with the psychotic subset of bipolar disorder but not with bipolar I disorder itself. Adequately powered subsequent studies should be conducted.

• Psychiatry investigation
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• v.15 no.12
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• pp.1135-1143
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• 2018

Objective The aim of this study was to evaluate differences in psychopathology between offspring of parents with bipolar I disorder (BP-I) and those with bipolar II disorder (BP-II). Methods The sample included 201 offspring between 6 and 17 years of age who had at least one parent with BP-I or BP-II. The offspring were diagnostically evaluated using the Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Psychopathology and Clinical characteristics were evaluated, including lifetime DSM-5 diagnoses, depression, and childhood trauma. Lifetime DSM-5 diagnoses were also compared between schoolchildren aged 6 to 11 years and adolescents aged 12 to 17 years. Results In lifetime DSM-5 diagnoses, offspring of parents with BP-I had significantly increased risk of developing MDD and BP-I than those with BP-II. Regarding clinical characteristics, ADHD rating scale and childhood trauma scale were significantly higher in offspring of parents with BP-I than that in those with BP-II. Conclusion The present study supports that BP-I may be etiologically distinct from BP-II by a possible genetic liability. Our findings indicate that additional research related to bipolar offspring is needed to enhance understanding of differences between BP-I and BP-II.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.18 no.1
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• pp.66-71
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• 2007

There has been increasing recognition of pediatric bipolar disorder in the psychiatric field during the past 10 years. The clinical presentation of this disorder in preadolescent is greatly debated and few studies have been conducted in Korea. The authors report 3 cases of children with bipolar I disorder whose clinical symptoms were improved after pharmacotherapy. The authors also review current concepts, debates and treatment of pediatric bipolar disorder.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.23 no.1
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• pp.3-7
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• 2012

Objectives : The early onset of mood symptoms in bipolar disorder has been associated with poor outcomes in many studies. However, aspects of the clinical course of bipolar disorder in children and adolescents are controversial. The goal of this article is to review the clinical characteristics and longitudinal course of children and adolescents with bipolar disorders. Methods : Searches were conducted in MedLine, PsycINFO, KISS, and RISS using the terms phenomenology, clinical course, outcome, BPD, pediatric, children and adolescents. Twenty-one reports were selected : either original articles reporting symptoms and clinical characteristics of subjects (ages 5-18 years), or published articles in reviewed journals about bipolar disorder in children and adolescents. Results : Approximately 70% of subjects with bipolar disorder recovered from their index episode, and 50% had at least 1 syndromal recurrence, particularly depressive episodes. For 60% of the follow-up time, subjects had syndromal or subsyndromal symptoms with numerous changes in symptoms and shifts of polarity. Approximately 20% of BP-II subjects converted BP-I. Conclusion : Bipolar disorders in children and adolescents are characterized by episodic illness with subsyndromal and syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes. Extensive follow-up time is needed to evaluate the continuity of bipolar disorder symptoms from childhood to adulthood.

• Korean Journal of Biological Psychiatry
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• v.1 no.1
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• pp.79-87
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• 1994

For the purpose of evaluating the human leukocyte antigen(HLA) disease-association with bipolar disorder, HLA class I and class II allelic frequencies were assessed in 37 bipolar patients and were compared to the data from normal population. HLA class 1 typing was performed with microlymphocytotoxicity method while class II(DRB1) genotyping with reverse dot blot hybridization and sandwich method. Statistical analysis consisted of relative risk, Haldane's modified relative risk, Fisher's exact test and Bonferoni's corrected P. The results were as follows : 1) Bipolar patients showed increased allelic frequency of HLA A3 which has statistical significance. 2) Allelic frequencies of HLA B7, B14 and B54 were higher, while those of B51 and B55 were lower in bipolar patients, but they were not statistically significant. 3) Both of increased frequencies of DR2 in bipolar patients and DR15 in normal controls had statistical significance. The results of the present study suggested that some of HLA allelic types might be associated with bipolar disorder. To clarify the genetic influence of HLA to bipolar disorder, we should do consecutive study of bipolar disorder with new information about HLA system including alleles.

• Korean Journal of Biological Psychiatry
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• v.16 no.3
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• pp.205-211
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• 2009

Objectives : Serum and plasma BDNF levels have been shown to be decreased in patients with mood disorder such as major depressive disorder and bipolar disorder. We investigated whether platelet BDNF levels would be lower in patients with acute bipolar manic episode compared with those of normal controls. Methods : BDNF levels were examined in platelet-rich plasma(PRP) and platelet-poor plasma(PPP) in 20 healthy controls and 20 hospitalized patients who were diagnosed as bipolar I disorder, most recent episode manic using a Structured Clinical Interview for DSM-IV. And severity of manic symptoms was measured using Young Mania Rating Scale(YMRS). Platelet BDNF level was calculated by subtracting PPP BDNF from PRP BDNF level, and dividing the result by the total platelet count, and it was expressed as pg/$10^6$ platelet. Results : Platelet BDNF levels were significantly lower in patients with acute bipolar manic episode(4.55${\pm}$3.36pg/$10^6$ platelet) than in normal controls(6.84${\pm}$2.32pg/$10^6$ platelet)(p=0.008). However we failed to reveal the significant negative correlation between platelet BDNF levels and YMRS scores in patients with acute bipolar episode. Conclusion : Our finding suggests that there is a decrease in the platelet BDNF of patients with acute bipolar manic episode.

• Korean Journal of Biological Psychiatry
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• v.10 no.2
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• pp.121-125
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• 2003

Objective:Recently, many experimental evidences have been reported that psychiatric diseases are closely related with neurodevelopmental abnormalities and this can be properly explained by apoptosis. It is known that Apo-1/Fas is one of the genes in charge of apoptosis related with neurodevelopmental abnormalities. In this study, the association between bipolar disorder and functional polymorphism in Apo-1/Fas promoter gene has been investigated. Method:For 81 bipolar disorder patients and 217 healthy control subjects, MvaI restriction fragment length polymorphism(RFLP) of Apo-1/Fas promoter gene was analyzed after polymerase chain reaction(PCR) amplification. Result:There was a statistical significant difference in genotypic distribution(${\chi}^2$=16.656, df=2, p=0.0002) and allelic frequencies(${\chi}^2$=14.225, df=1, p=0.0002) between bipolar disorder patients and healthy control subjects. Conclusion:Our results suggest an association between functional polymorphism in Apo-1/Fas promoter gene and bipolar disorder and provide the important genetic information related with the pathogenesis of the disease. Further studies employing larger samples are required to clarify the present results.

• Korean Journal of Biological Psychiatry
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• v.23 no.4
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• pp.185-192
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• 2016

Objectives Treatment response of bipolar disorders (BDs) to long-term mood stabilizers maintenance has not been well explored because of complicated clinical and treatment courses. This study aims at investigating long-term clinical response of BDs to lithium and/or valproate in a naturalistic setting of a tertiary-care university-affiliated hospital. Methods Subjects were 65 patients with bipolar I (BD-I) disorders who had been treated with lithium and/or valproate for more than two years at single bipolar disorder clinic. Long-term response to the best treatment based on treatment algorithms and the current clinical standard of care was retrospectively evaluated using the Alda Scale and the Clinical Global Impression Scale for use in bi-polar illness (CGI-BP). Patients were classified into full responder and partial/non responder groups based on the total score of the Alda Scale with the cut-off score generated from the frequentist mixture analysis of the authors' previous study. Results The mean duration of treatment with the index medication was 69.2 months. Baseline demographic and clinical characteristics were not different among three mood stabilizer groups (valproate, lithium, and combination groups). Twenty-one subjects were classified into full responder group (32.3%). Treatment response assessed by the Alda Scale and CGI-BP scores was not different between lithium and valproate groups. The Alda Scale scores were well correlated with the CGI-BP scores (p < 0.05). Conclusions One third of the patients showed a full response to the long-term lithium and/or valproate treatment in BD-I. The degree of response was similar between lithium and valproate groups.

• Korean Journal of Biological Psychiatry
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• v.24 no.4
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• pp.225-234
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• 2017

Objectives Local gyrification reflects the early neural development of cortical connectivity, and is regarded as a potential neural endophenotype in psychiatric disorders. Several studies have suggested altered local gyrification in patients with bipolar I disorder (BD-I). The purpose of the present study was to investigate the alterations in the cortical gyrification of whole brain cortices in patients with BD-I. Methods Twenty-two patients with BD-I and age and sex-matched 22 healthy controls (HC) were included in this study. All participants underwent T1-weighted structural magnetic resonance imaging (MRI). The local gyrification index (LGI) of 66 cortical regions were analyzed using the FreeSurfer (Athinoula A. Martinos Center for Biomedical Imaging). One-way analysis of covariance (ANCOVA) was used to analyze the difference of LGI values between two groups adjusting for age and sex as covariates. Results The patients with BD-I showed significant hypogyria in the left pars opercularis (uncorrected-p = 0.049), the left rostral anterior cingulate gyrus (uncorrected-p = 0.012), the left caudal anterior cingulate gyrus (uncorrected-p = 0.033). However, these findings were not significant after applying the multiple comparison correction. Severity or duration of illness were not significantly correlated with LGI in the patients with BD-I. Conclusions Our results of lower LGI in the anterior cingulate cortex and the ventrolateral prefrontal cortex in the BD-I group implicate that altered cortical gyrification in neural circuits involved in emotion-processing may contribute to pathophysiology of BD-I.