• Investigative Magnetic Resonance Imaging
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• 제19권1호
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• pp.10-18
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• 2015

Background and Purpose: The association between the low emotional regulation and the brain structural change of major depressive disorder (MDD) has been proposed, but the voxel-based morphometry (VBM) studies on female MDD are rare. The purpose of the present study was to show the regional volume changes of gray matter (GM) in female patients with MDD by optimized VBM. Methods: To control subjects homogeneity, twenty female MDD patients and age, sex matched 21 normal controls were included for the VBM analysis. To identify the change of regional gray matter volume (GMV), the optimized VBM was performed with T1 MRIs. The amounts of gray/white matter and intracranial cavity volumes (ICV) were measured. The analysis of covariance (ANCOVA) and partial correlation analyses covariate with age and ICV were applied for VBM. Results: The age and ICV distributions were similar between the two groups. In the ANCOVA, the total GMV of MDD was smaller than that of normal controls. In the VBM, regional GMV was relatively decreased in the limbic system (amygdalae, ambient gyri, hippocampi heads, subiculum, posterior parahippocampal gyri, pulvinar nuclei, dorsal posterior cingulate gyri, and left pregenual cingulate gyrus). The lingual gyri, short insular gyri, right fusiform gyrus, and right inferior frontal gyrus were also showed decreased regional GMV. Conclusion: The results of this study indicate that the female MDD is mainly associated with the structural deficits of the limbic system and limbic system related cortices, which were known to the center of emotions.

• 생물정신의학
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• 제25권4호
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• pp.89-100
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• 2018

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that delivers 1-2 mA of current to the scalp. Several clinical studies have been conducted to confirm the therapeutic effect of major depressive disorder (MDD) patients with tDCS. Some studies have shown tDCS's antidepressant effect, while the others showed conflicting results in antidepressant effects. Our aim of this review is to understand the biological bases of tDCS's antidepressant effect and review the results of studies on tDCS's antidepressant effect. For the review and search process of MDD treatment using tDCS, the US National Library of Medicine search engine PubMed was used. In this review, we discuss the biological mechanism of tDCS's antidepressant effect and the existing published literature including meta-analysis, systematic review, control trial, open studies, and case reports of antidepressant effects and cognitive function improvement in patients with MDD are reviewed. We also discuss the appropriate tDCS protocol for MDD patients, factors predictive of response to tDCS treatment, the disadvantages of tDCS in MDD treatment, and side effects.

• 생물정신의학
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• 제27권2호
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• pp.74-83
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• 2020

Objectives Psychological resilience plays a significant role in many aspects of mental health. The aim of this study was to find an association between childhood attention deficit hyperactivity disorder (ADHD) features and adulthood psychological resilience in patients with mood disorders. Methods A total of 213 patients with mood disorders including major depressive disorder or bipolar I, II disorder and 909 healthy controls were included. We assessed childhood ADHD features using the Wender Utah Rating Scale (WURS), adulthood psychological resilience using the Connor-Davidson Resilience Scale (CD-RISC), and current depressive mood using the Beck Depression Inventory (BDI). Pearson's correlation, multiple linear regression and a mediation analyses were performed to examine the relationships between three WURS factor (impulsivity, inattention, and mood instability) scores, the BDI score, and the CD-RISC score. Results The CD-RISC score was negatively correlated with the WURS childhood inattention factor score and current BDI score in patients with mood disorders. BDI score mediated the influence of the inattention factor score on CD-RISC score among patients with mood disorders. The CD-RISC score was significantly lower in patients with mood disorders than in controls even after controlling for age, WURS scores, and the BDI score. Conclusions An evaluation of psychological resilience is important for enhancing recovery and quality of life in patients with mood disorders. When assessing psychological resilience, current depression and ADHD features in childhood, particularly inattention, should be considered.

• 생물정신의학
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• 제21권1호
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• pp.14-20
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• 2014

Objectives The current study investigated the putative relationship between chronotype and suicidality or bipolarity in patients with major depressive disorder (MDD). Method Nineteen outpatients who met the criteria for MDD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders-text revision were recruited for the current study. The subjects were divided into two subgroups based on their Basic Language Morningness (BALM) scores (dichotomized according to the median BALM score). The Loudness Dependence of Auditory Evoked Potentials (LDAEP) was evaluated by measuring the auditory event-related potentials before beginning medication with serotonergic agents. In addition, K-Mood Disorder Questionaire (K-MDQ), Beck Scale for Suicidal Ideation (BSS), Beck Hopelessness Scale (BHS), Barratt Impulsiveness Scale (BIS) were applied. Results The K-MDQ, BSS, BHS, BIS score was higher for the eveningness group than for the morningness group. However, the LDAEP, Hamilton Depression Rating Scale, Hamilton Anxiety Scale scores did not differ significantly between them. There were negative correlations between the total BALM score and the total K-MDQ, BSS, and BHS scores (r=-0.64 and p=0.0033, r=-0.61 and p=0.0055, and r=-0.72 and p=0.00056, respectively). Conclusions Depressed patients with eveningness are more vulnerable to the suicidality than those with morningness. Eveningness is also associated with bipolarity.

• 한국산림과학회지
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• 제101권4호
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• pp.677-685
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• 2012

본 연구의 목적은 숲 환경을 이용한 주요우울장애의 정신사회적 치료 프로그램을 개발하여, 그 효과를 대조군 비교 연구를 통해 확인하는 것이다. 정신과 전문의에 의해 주요우울장애로 진단 받고 현재 정신과 외래에서 항우울제 약물치료 중인 사람들이 연구에 참여하였다. 이들은 각각 네 집단으로 나뉘어 세 집단은 각각 산림에서 시행한 치유 프로그램, 병원에서 시행한 치유 프로그램, 단순 산림욕에 참여하였고, 나머지 한 집단은 프로그램을 시행하지 않고 일반 진료만 받은 대조군이었다. 이들은 모두 프로그램 전후의 우울증상 변화, 생리적 지표 변화를 관찰하기 위해 Hamilton Rating Scales for Depression(HRSD), Montgomery-Asberg Depressin Rating Scales(MADRS), Beck Depression Inventory(BDI), Short Form Health Survey Questionnaire(SF-36), Heart Rate Variability(HRV)검사를 받았다. 연구 결과, 산림치유 프로그램 집단의 HRSD 점수가 대조군에 비해 유의하게 감소하였고, MADRS 점수는 산림치유 프로그램 집단, 병원 프로그램 집단이 대조군에 비해서 유의미한 호전을 보였다. HRSD 7점 이하로 정의되는 관해율은 산림치유 프로그램 집단이 가장 높았다. 또한 SF-36결과, 산림치유 프로그램 집단에서만 건강 상태와 관련된 삶의 질 수준이 유의미하게 증가하였고, Heart Rate Variability(HRV)에서도 생리적 이완감을 나타내는 HF가 유의하게 높아지는 결과를 보였다. 이 결과를 통하여 산림환경을 이용한 심리치료 프로그램을 외래 치료 중인 우울증 환자에게 적용했을 때 우울증 증상 개선에 도움이 됨을 알 수 있었다. 또한 통계적으로 유의하진 않지만, 우울증상 감소와 관해율에 있어서 산림치유 프로그램 집단, 병원 프로그램 집단, 산림욕 집단, 대조군 순으로 좋은 결과를 보였다.

• 정신신체의학
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• 제29권1호
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• pp.1-10
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• 2021

연구목적 본 연구는 MMPI-2-RF를 통해 주요우울장애 환자군 중 자살 시도자들의 심리적 특성을 확인하고자 하였다. 방 법 본 연구는 한림대학교 성심병원 정신건강의학과를 방문한 입원 및 외래 환자 중 한국판 K-MINI-Plus 5.0을 통해 DSM-IV의 주요우울장애 진단적 준거를 충족시키는 자 107명을 대상으로 하였다. 이들을 C-SSRS를 사용하여 자살 시도군(n=43)과 비시도군(n=64)으로 분류하였고 ANOVA를 통해 두 집단 간 MMPI-2-RF 척도 점수에서의 차이를 조사하였다. 더불어 우울 증상의 심각도와 공존질환의 이환 여부가 자살 시도 여부에 영향을 주었을 가능성을 고려해 이를 공변인으로 하여 추가적으로 ANCOVA 분석을 수행하였다. 결 과 본 연구에서 자살 시도군이 비시도군에 비해 효능감 결여(NFC), 대인관계 수동성(IPP), 자살/죽음 사고(SUI) 척도에서 유의하게 높은 점수를 나타냈다(p<0.05). 다만 자살/죽음 사고(SUI) 척도의 경우 우울 증상과 공존질환의 이환 여부를 통제한 이후에는 두 집단 간 차이에서 통계적으로 유의한 경향성을 보여주었다(p<0.10). 결 론 본 연구의 결과를 통해 MMPI-2-RF가 중등도 이상의 증상 심각도를 지닌 주요우울장애 집단에서 실제 자살 시도로 이행될 위험이 있는 환자를 심리적 특성을 확인하는데 유용한 도구임을 확인하였다. 이러한 결과를 토대로 본 연구의 한계와 향후 연구 방향에 대해 논의하였다.

• Psychiatry investigation
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• 제15권11호
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• pp.1009-1010
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• 2018

• 생물정신의학
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• 제21권2호
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• pp.74-80
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• 2014

Objectives More than half of the elders suffer from chronic sleep disturbances. Moreover, sleep disturbances are more prevalent in patients with depressive disorder than in community dwelling elderly. In this study, we aim to estimate the risk factors of poor sleep quality and its effect on quality of life in patients with late life depression. Methods This study included 159 depressive patients aged 65 years or older who completed Pittsburgh Sleep Quality Index (PSQI). A global PSQI score of 5 or greater indicates a poor sleeper. Structural diagnostic interviews were performed using the Korean version of Mini International Neuropsychiatric Interview (MINI). Depression was evaluated by the Korean form of Geriatric Depression Scale (KGDS). Global cognition was assessed by Mini-Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease assessment packet. Quality of life was evaluated by the Korean version of Short-Form 36-Item Health Survey (SF-36). Results The frequencies of poor sleepers were 90.5% in major depressive disorder, 71.8% in minor depressive disorder, 47.1% in subsyndromal depressive disorder, and 73.0% in all types of depressive disorders. Multivariate logistic regression analysis indicated that female [odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.20-6.67] and higher KGDS score (OR = 1.13, 95% CI = 1.05-1.21) were risk factors of poor sleep quality in patients with late life depression. In the analysis of ANCOVA adjusted for age, gender, education and KGDS score, the mean scores of vitality mental health and mental component summary of SF-36 were lower in poor sleepers than in good sleepers. Conclusions Poor sleepers among patients with late life depression are very common and are associated with female and higher KGDS scores. Poor sleep quality causes a significant negative effect on mental health quality. So researchers and clinicians should be more vigilant in the evaluation and treatment of sleep disturbances in patients with late life depression.

• 대한불안의학회지
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• 제9권2호
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• pp.140-146
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• 2013

Objective : There have been few comprehensive studies on the analysis of 24-hour HRV of major depressive disorder (MDD). The purpose of this study was to compare the autonomic nerve system of patients with a MDD with healthy patients and to examine the physiologic and clinical effects of 24-hour HRV by analyzing whether the HRV demonstrates the level of depressive symptoms after improving the symptoms in patients with a MDD. Methods : The 24-hour HRV was measured in patient groups with a MDD (n=16) and control groups (n=16). The patients with a MDD received the follow up test for two months after the treatment. Results : There were significant differences among the indexes (SDNN, rMSSD, SDNN index, and pNN50) of time-domain analysis and the indexes (TP, VLF, LF, HF, and ULF) of frequency-domain analysis of HRV between patient and control groups. The means of RR, SDNN, SDANN, and TP increased after two month of the treatment, comparing them with before the treatment, but there were no statistical significance. Conclusion : The results of 24-hour HRV analysis indicated significant decrease of HRV indexes among MDD patients which may suggest decrease of parasympathetic nervous functions.

• 약학회지
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• 제57권2호
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• pp.101-109
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• 2013

Depressive disorders are the most common psychiatric problem in the elderly. Most depression treatment guidelines emphasize treatment with antidepressant medication and recommend that benzodiazepine use be minimized for limited period, particularly to elderly patients. In order to evaluate appropriate use of antidepressants and benzodiazepine, retrospective review of prescriptions was performed. The study population are older than 65 years who had been newly diagnosed with major depressive disorder in specialty mental health at a community general hospital from January $1^{st}$, 2007 to October $31^{th}$, 2012 (N=373). Initial antidepressant accounted for 89.5% with SSRI, and escitalopram accounted for 60.9% of SSRI group. 79% or more of the patients were prescribed the recommended dosage. The maintenance rate for 4 weeks of initial antidepressant was 48% and 6 weeks was 39%. Treatment-discontinuation rate was 68% at 3 month. Alprazolam (short acting benzodiazepine) was prescribed the most, followed by clonazepam (long acting benzodiazepine) and then diazepam. 55% of patients received a duplicated prescription for short acting plus long acting benzodiazepine. 61% of patients used long acting benzodiazepines. Prescribed dosages of benzodiazepines were commonly within a recommended range, while no one was prescribed a appropriate period (up to 2 weeks) except for the early discontinued patients. Appropriate use of zolpidem was only 16.2%. The depressed elderly treated in specialty mental health mostly received long-term treatment with benzodiazepines in combination with antidepressants, guideline recommendations was not followed. Multidisciplinary interventions like audit and feedback of benzodiazepine use are needed and education for the elderly is needed to properly maintain antidepressant treatment.