Psychiatric Implications of Nutritional Deficiencies in Alcoholism

ByungJoo Ham,IhnGeun Choi 대한신경정신의학회 2005 PSYCHIATRY INVESTIGATION Vol.2 No.2

Malnutrition is common in chronic alcoholics. Hypocalcemia, hyponatremia, hypokalemia and, hypophosphatemia have all been associated with chronic alcoholism. Alcohol intake is also associated with low serum magnesium, selenium and zinc levels. Water-soluble vitamins, such as vitamin B1, B2, B3, B6, B9 and C, and fat-soluble vitamins, such as vitamin A, D, E and K have also been reported to be deficient in alcoholics. General causes of malnutrition in alcoholics are inadequate nutrient, particularly lack of water-soluble vitamins in their diet, reduced uptake, impaired utilization, increased requirements of nutrients and genetic predisposition to nutrient deficiency. Nutrient deficiencies are, therefore, a virtually inevitable consequence of alcohol abuse, not only because alcohol displaces food, but also because alcohol directly interferes with the body s use of nutrients, making them ineffective even if they are present. Chronic alcoholics exhibit a number of neurological disorders which are related to nutritional deficiencies, in particular vitamin deficiencies that are essential for normal cerebral functioning. Specific vitamin and nutrient deficiencies arising in chronic alcoholics may result in severe functional impairment and tissue damage, mainly neuronal and vascular, in the brain. Nutritional deficiency in alcoholics also causes neurotransmitter dysfunction, ion channel dysfunction, oxidative stress and metabolic dysfunction in the brain. Nutritional deficiency in chronic alcoholics frequently leads to a mild to moderate cognitive impairment, including impairment in perceptual-motor skills, visual-spatial functions, learning/memory, and abstraction and problem solving. There are a number of nutritional deficiencies which need to be cared for but magnesium, thiamine, and other B vitamins need to be administered immediately. Nutritional therapy can aid in the recovery from alcoholism. Patients who have received nutritional therapy reported significantly less alcohol craving as well as significantly greater nutrient intakes, and a greater number abstained from alcohol. Although abstinence and proper nutrition remain the cornerstones of treatment, pharmacological modification of neurotransmitter function and/or enhancement of cerebral metabolism combined with behavioral methods may also be beneficial.

No Association between Serotonin Receptor 2C -759C/T Polymorphism and Weight Change or Treatment Response to Mirtazapine in Korean Depressive Patients

HwaYoung Lee,ChaeKeun Oh,ByungJoo Ham,HunSoo Chang,JongWoo Paik,EunSoo Won,SangWoo Hahn,SeHoon Shim,YoungJoon Kwon,HeeYeon Jung,MinSoo Lee 대한신경정신의학회 2013 PSYCHIATRY INVESTIGATION Vol.10 No.2

Objective-Activation of one or more serotonin (5-HT) receptors may play a role in mediating the antidepressant effects of serotonergic antidepressants. The serotonin 2C (5HT 2C) receptor is known to be associated with antidepressant action and weight gain. We sought to determine whether the 5-HTR 2C receptor -759C/T polymorphism was associated with weight gain and treatment response to mirtazapine in major depressive disorder (MDD) patients. Methods-The 5-HT 2C receptor -759C/T polymorphism was analyzed in 323 MDD patients. All patients were evaluated using the 21-item Hamilton Depression Rating Scale at the beginning of the study and at 1, 2, 4, and 8 weeks of mirtazapine treatment. Results-There was no significant difference in the 5-HT 2C receptor -759C/T genotype distribution between responder and non-responder groups. The 5-HT 2C receptor -759C/T polymorphism was not associated with weight change over time after mirtazapine administration. Conclusion-The 5-HT 2C receptor -759C/T polymorphism does not appear to be a predictor of treatment response to mirtazapine. This polymorphism was not associated with weight change after 8 weeks of mirtazapine treatment. Further investigation on other polymorphisms of the 5-HT 2C gene is required to determine whether the 5-HT 2C gene influences treatment response and weight change after mirtazapine administration in patients with major depressive disorder.

A study of Disaster Survivors in Korea

MinSoo Lee,RheeHun Kang,ByungJoo Ham,YunKyeung Choi,ChangSu Han,HeonJeong Lee,SeungHwan Lee,SungMee Kim,HongSeock Lee 대한신경정신의학회 2004 PSYCHIATRY INVESTIGATION Vol.1 No.1

Objectives-The purpose of this study was to assess the clinical manifestation of psychiatric symptoms and Minnesota Multiphasic Personality Inventory (MMPI) profiles, and to examine the factors affecting the Degree of symptom severity, among survivors of a man-made disaster in Korea. Methods-Survivors of the Sampoong Department Store collapse were evaluated in October 1995, 5 months after the disaster occurred. Among the original 681 subjects, 624 were evaluated using the Psychiatric Evaluation Form, and the MMPI. Results-The primary complaint was sleep disturbance (54.2%), which was followed by headaches (31.8%) and intense distress over reminders of the event (24.2%). Most subjects (90.4%) showed a variety of psychiatric symptoms with certain factors further affecting the degree of severity. Another result showed that the severity of the subjects symptoms increased as their age increased and their educational level decreased. Divorced and widowed survivors had more severe symptoms, as did those who had experienced a loss of consciousness or who had waited a long time to be rescued. In the MMPI, the mean Welsh code profile configuration was 13726-0894/5: F-KL: and the most common two- and three- point code types were 1-3/3-1 (15.4%) and 1-3-7/1-7-3 (8.4%), respectively. Conclusions-The results indicate that it is possible to identify the specific psychiatric symptoms that resulted from this disaster, and that a substantial segment of the adult population exposed to similar events may experience symptoms of post traumatic stress. The psychiatric symptoms and the factors affecting the severity of the symptoms identified in this study may prove useful in the future screening of disaster victims for appropriate evaluation and treatment.

Frontoparietal Cortical Thinning in Respiratory-Type Panic Disorder: A Preliminary Report

HoKyoung Yoon,June Kang,DoYoung Kwon,ByungJoo Ham 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.1

Objective-Many evidences raise the possibility that the panic disorder (PD) patients with respiratory subtype (RS) may have characteristic structural abnormalities. We aimed to explore the structural differences between PD patients with and without the respiratory symptoms. Methods-Patients with PD were recruited from the Department of Psychiatry at Korea University Anam Hospital. Respiratory subtype (RS) was diagnosed when at least 4 out of 5 of the following respiratory symptoms were present during the panic attack: fear of dying, chest pain/discomfort, shortness of breath, paresthesias, and a choking sensation. We acquired high-resolution MRI scans and used FreeSurfer to obtain a measure of cortical thickness for each patient. Results-Cluster based analysis revealed significantly decreased cortical thickness in the left hemisphere in the caudal-middle-frontal, superior frontal, and posterior parietal areas in the RS group. No significant difference was observed in any of the limbic areas. Conclusion-Respiratory symptoms of panic disorder were associated with a reduction in cortical thickness in the left frontal and parietal areas. This finding leads to the assumption that the frontoparietal network is the crucial component in a larger cortical network underlying the perception of dyspnea in RS.

A Meta-Analysis Comparing Open-Label versus Placebo- Controlled Clinical Trials for Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: Lessons and Promises

ChiUn Pae,HoJun Seo,BoungChul Lee,JeongHo Seok,HongJin Jeon,JongWoo Paik,KyungPhil Kwak,ByungJoo Ham,Changsu Han,SooJung Lee 대한신경정신의학회 2014 PSYCHIATRY INVESTIGATION Vol.11 No.4

Objective-The present study is to provide whether open-label studies (OLS) may properly foresee the efficacy of randomized, placebo-controlled trials (RCTs) using OLSs and RCTs data for aripiprazole in the treatment of MDD, with the use of meta-analysis approach. Methods-A search of the studies used the key terms “depression and aripiprazole” from the databases of PubMed/PsychInfo from Jan 2005 through July 2013. The data were selected and verified for publication in English-based peer-reviewed journals based on rigorous inclusion criteria. Extracted data were delivered into and run by the Comprehensive Meta Analysis program v2. Results-The pooled SMDs for the primary efficacy measure was statistically significant, pointing out the significant reduction of depressive symptoms after aripiprazole augmentation (AA) to current antidepressant treatment in OLSs (pooled SMD=-2.114, z=-9.625, p<0.001); similar results were also found in RCTs (pooled SMD=-2.202, z=-6.862, p<0.001). The meta-regression analysis revealed no influence of the study design for treatment outcome. Conclusion-There was no difference in the treatment effects of aripiprazole as an augmentation therapy in both OLSs and RCTs, indicating that open-label design may be a potentially useful predictor for treatment outcomes of controlled-clinical trials. The proper conduction of OLSs may provide informative, useful and preliminary clinical data and factors to be involved in controlled-clinical trials, by which we may have better understanding on the role of AA (e.g., dosing issues, proper duration of treatment, specific population for AA) implicated in the treatment of MDD in clinical practice.