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Panic disorder may be associated with defective serotonin (5-HT) neurotransmission. This study was to investigate the association between the tryptophan hydroxylase (TPH) gene and a serotonin transporter gene promoter polymorphism (5-HTTLPR), with panic disorder in a Korean population. 244 Korean patients with panic disorder and the 227 controls were genotyped by a polymerase chain reaction-based method. The severity of panic disorders was assessed by number of panic attacks during the previous 1 month, as well as scores for anticipatory anxiety, panic distress, and agoraphobic distress, as determined by a visual analogue scale (VAS). All the subjects completed the assessment measures including Spielberger State-Trait Anxiety Inventory-State (STAI-S), Spielberger State-Trait Anxiety Inventory-Trait (STAI-T), Beck Depression Inventory (BDI), Symptom Checklist-90-Revised (SCL-90-R), Revised Anxiety Sensitivity Index (ASI-R), Clinical Global Impression Scale – Severity of Illness (CGI-S), Panic Disorder Severity Scale (PDSS), and the Hamilton Depression Rating Scale (HAMD). Responder analyses were conducted based on changes in CGI-I scores after 10 weeks of treatment. We found no significant differences in the genotype and allele frequencies in TPH A218C and 5-HTTLPR polymorphisms between the panic patients and the control group. Subgroup analyses in terms of comorbidities, response, and other primary clinical variables, indicated no differences in these polymorphisms. Our findings suggest that the TPH A218C polymorphism and 5-HTTLPR play no significant roles in the pathogenesis and clinical symptomatologies, at least in a Korean population.

A number of a disintegrin and metalloprotease (ADAM) family members are expressed in mammalian male reproductive organs such as testis and epididymis. These reproductive ADAMs are divided phylogenically into three major groups: ADAMs 1, 4, 6, 20, 21, 24, 25, 26, 29, 30, and 34 (the first group); ADAMs 2, 3, 5, 27, and 32 (the second group); and ADAMs 7 and 28 (the third group). Previous mouse knockout studies indicate that ADAM1, ADAM2, and ADAM3 have intricate expressional relationships, playing critical roles in fertilization. In the present study, we analyzed processing, biochemical characteristics, localization, and expressional relationship of the previously-unexplored, second-group ADAMs (ADAM5, ADAM27, and ADAM32). We found that all of the three ADAMs are made as precursors in the testis and processed during epididymal maturation, and that ADAM5 and ADAM32, but not ADAM27, are located on the sperm surface. Using sperm from Adam2(-/-) and Adam3(-/-) mice, we found that, among the three ADAMs, the level of ADAM5 is modestly and severely reduced in Adam3 and Adam2 knockout sperm, respectively. Further, we analyzed ADAM7, an epididymis-derived sperm surface ADAM from the separate phylogenetic group, in the knockout sperm. We found that the level of ADAM7 is also significantly reduced in both Adam2 and Adam3-null sperm. Taken together, our results suggest a novel expressional relationship of ADAM5 and ADAM7 with ADAM2 and ADAM3, which play critical roles in fertilization.

To elucidate the correlates of self-rated fatigue in Korean employees.The data for 10,176 (men, 7984; women, 2192; mean age, 34.2; SD: 8.8) employees recruited from a nation-wide sample were examined. A structured questionnaire was used to measure the participants' fatigue, sociodemographics (sex, age, education, and marital status), job-related characteristics (work duration, grade at work, work hours, shiftwork, employment type, and magnitude of workplace), and health-related habits (smoking, drinking, coffee intake, and exercise). Two types of measurement for fatigue were used to evaluate the magnitude of fatigue: self-rated question and a standardized measurement tool (Multidimensional Fatigue Scale: MFS).According to the self-rated fatigue, 32% of employees reported that they felt fatigue for the past two weeks, and 9.6% of males and 8.7% of females had experienced excessive fatigue (6 months or more). Hierarchical multiple regression analysis showed that fatigue measured by MFS was more common in women, younger, college or more graduated, single, and employees who do not regularly exercise. Fatigue was also associated with long work hours, and the size of the workplace (1000 employees).These results suggest that fatigue has been considered as a common complaint, and that it is affected by job-related factors like work hours and the workplace size as well as sociodemographics or health-related behaviors. Further research is needed to clarify the effects of fatigue on adverse health,outcomes, work performance, work disability, sick absence and medical utilization, and to examine the relationship of job characteristics (e.g.: work demand, decision latitude) to fatigue.

To estimate the magnitude of psychosocial distress and examine eligible factors associated with the development of psychosocial distress in Korean employees, using a nationwide sample.A total of 6977 workers were recruited from 245 companies. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, social support at work, personality traits (locus of control, type A behavior pattern), self-esteem, and psychosocial distress.The results showed that 23% of workers were categorized as high stress, 73% as moderate, and 5% as normal. Hierarchical multiple regression analysis showed that psychosocial distress was more common in younger workers, both male and female. Regular exercise was negatively associated with increase of psychosocial distress. In job characteristics, as expected, low decision latitude, high job insecurity, and low social support at work were related to high psychosocial distress. Personality traits such as locus of control and type A behavior pattern, and self-esteem were more powerful predictors of psychosocial distress than general characteristics, health-related behavior, and job characteristics. There were some gender differences. While men who are less educated and single (unmarried, divorced, and separated) experienced higher levels of psychosocial distress than those who are educated and married, women who feel high job demand experienced higher levels of psychosocial distress than those who feel low job demand.The proportion of the high stress group was higher than expected, and psychosocial factors like social support and personality characteristics (e.g. locus of control, type A behavior pattern and self-esteem) were more significant factors for psychosocial distress than other variables. This finding suggests that some psychosocial factors, especially inadequate social support, low self-esteem and lack of internal locus of control for the development of psychosocial distress, will also operate as an intervention strategy in the worksite stress reduction program. It is strongly required that worksite stress reduction programs should be established in at both occupational and level as well as in individual levels.

Mammalian spermatogenesis is a highly ordered process that occurs in mitotic, meiotic, and postmeiotic phases. The unique mechanisms responsible for this tightly regulated developmental process suggest the presence of an intrinsic genetic program composed of spermatogenic cell-specific genes. In this study, we analyzed the mouse round spermatid UniGene library currently containing 2124 gene-oriented transcript clusters, predicting that 467 of them are testis-specific genes, and systematically identified 28 novel genes with evident testis-specific expression by in silico and in vitro approaches. We analyzed these genes by Northern blot hybridization and cDNA cloning, demonstrating the presence of additional transcript sequences in five genes and multiple transcript isoforms in six genes. Genomic analysis revealed lack of human orthologues for 10 genes, implying a relationship between these genes and male reproduction unique to mouse. We found that all of the novel genes are expressed in developmentally regulated and stage-specific patterns, suggesting that they are primary regulators of male germ cell development. Using computational bioinformatics tools, we found that 20 gene products are potentially involved in various processes during spermatogenesis or fertilization. Taken together, we predict that over 20% of the genes from the round spermatid library are testis-specific, have discovered the 28 authentic, novel genes with probable spermatogenic cell-specific expression by the integrative approach, and provide new and thorough information about the novel genes by various in vitro and in silico analyses. Thus, the study establishes on a comprehensive scale a new basis for studies to uncover molecular mechanisms underlying the reproductive process.

A growing body of literature has documented that job stress is associated with the development of cardiovascular disease. Nevertheless, the pathophysiological mechanism of this association remains unclear. The purpose of this study is to elucidate the relationship between job stress, heart rate variability, and metabolic syndrome. The study design was cross-sectional, and a total of 169 industrial workers were recruited. A structured-questionnaire was used to assess the general characteristics and job characteristics (work demand, decision latitude). Heart rate variability (HRV) was recorded using SA-2000 (medi-core), and was assessed by time-domain and by frequency-domain analyses. Time domain analysis was performed using SDNN (Standard Deviation of normal to normal interval), and spectral analysis using low-frequency (LF), high-frequency (HF), and total frequency power. Metabolic syndrome was defined on the basis of risk factors being clustered when three or more of the following cardiovascular risk factors were included in the fifth quintile: glucose, systolic blood pressure, high-density lipoprotein cholesterol (bottom quintile), triglyceride, and waist-hip ratio. The results showed that job characteristics were not associated with cardiovascular risk factors. Compared to the lower strain group (low strain+passive+active group), the high strain group had a less favorable cardiovascular risk profile with higher levels of blood pressure, glucose, homocysteine, and clotting factor, but the difference was not statistically significant. The SDNN of HRV was significantly lower in the high strain group than in the low strain group. The prevalence of metabolic syndrome in the lower strain group and high strain group was 13.2% and 23.8%, respectively. In the high strain group, the metabolic syndrome was significantly related to a decreased SDNN. However, we could not find a significant association in LF/HF ratio. This result suggests that decreased HRV found in the high-strain group are not a direct indicator of disease. However, it can induce cardiovascular abnormalities or dysfunctions related to the onset of heart disease among high risk groups.

A protein complex present at the junctional sarcoplasmic reticulum (SR) membrane is implicated in the Ca(2+) release process during muscle contraction. The histidine-rich Ca(2+)-binding protein (HRC) is an emerging component associated into the SR protein complex. We cloned cDNAs for rat and monkey HRCs, showing a conserved sequence organization in common with other mammalian HRCs. Genomic analysis revealed that each mammalian HRC gene is present as a single copy in the genome, consisting of 6 exons and 5 introns. Developmental expression analysis using mouse embryos and postnatal hearts demonstrated that Hrc transcription begins at 12.5 days postcoitum and its level increases gradually, reaching an adult level in the range 5-20 days after birth. Comparing the Hrc gene and other SR genes, we found that the timing and pattern of gene expression vary among the SR genes and the full-level expression of these genes is achieved in the heart after postnatal day 20. Collectively, our study provides comprehensive information about the structure and expression of the mammalian HRC gene, together with the comparative expression data of the related SR genes.

Members of the ADAM (A Disintegrin And Metalloprotease) family of cell surface proteins have been discovered in a variety of tissues and species. We have cloned and sequenced a mouse cDNA encoding a novel member of the ADAM family. This mouse ADAM gene was named ADAM32 after an human homologue previously sequenced but not characterized. The cDNA sequence of ADAM32 has an open reading frame which encodes 750 (mouse ADAM32) and 787 (human ADAM32) amino acids, sharing 69% homology between the two species. The deduced amino acid sequences of mouse and human ADAM32 cDNAs contain all of the domains common to ADAM family members. Comparison of amino acid sequences showed that ADAM32 is highly homologous to ADAM2 and ADAM3, sperm surface proteins required for fertilization. We found that the ADAM32 gene is expressed predominantly in the testis. Examination of transcription in pre-pubertal and adult mouse testes revealed that expression of ADAM32 begins during meiotic prophase, in pachytene spermatocytes. These results suggest a potential role for ADAM32 in sperm development or fertilization. Genome database searches revealed that the mouse and human ADAM32 genes are located on chromosomes 8 and 8q11, respectively. The ADAM32 gene covers a relatively large region of the genome (120 kb for mouse ADAM32 and 180 kb for human ADAM32) and consists of multiple small exons (at least 22 exons in mouse ADAM32 and 25 exons in human ADAM32).

Future of Clinical Practice in Psychiatry Jong-Min Woo, MD, MPH, PhD, Myoung Ha Son, MD, Gyung-Mee Kim, MD, PhD, and Kyu-Chang Chae, BA Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea Stress Research Institute, Inje University, Seoul, Korea Department of Psychiatry, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea Department of Neuropsychiatry, Seife Hospital, Seoul, Korea

·Young-Sun Lee, PhD·In-Hee Cho, MD·Myung-Min Choi, PhD·Myoung-Ho Hyun, PhD Offices of Research Planning and Health Services Research, National Evidence-based Healthcare Collaborating Agency, Department of Psychiatry, Seoul National University College of Medicine, Office of Planning & Evaluation, Korea Youth Counseling & Welfare Institute, Seoul, Department of Psychiatry, Inje University College of Medicine, Busan, Division of Mental Health Policy, Ministry of Health & Welfare, Department of Psychiatry, Sungkyunkwan University School of Medicine, Seoul, Department of Psychiatry, Jeju National University School of Medicine, Jeju, Department of Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Goyang Community Mental Health Center, Goyang, Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Office of Students and Parents Research, Korean Educational Development Institute, Department of Preventive Medicine, The Catholic University of Korea School of Medicine, Students Health Management Division, Ministry of Education, Science and Technology, Central Church of Korea Evangelical Holiness Church, Seoul, Department of Nursing, Inje University, Busan, Office of Counseling & Welfare, Korea Youth Counseling & Welfare Institute, Department of Psychology, Ewha Womans University, Seoul, Department of Psychiatry, Gil Hospital, Gachon University, Incheon, Department of Social Welfare, Baekseok University, Cheonan, Department of

93 c Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Focused Issue of This Month·한국 청소년 자살 J Korean Med Assoc 2013 February; 56(2): 93-99 http://dx.doi.org/10.5124/jkma.2013.56.2.93 pISSN: 1975-8456 eISSN: 2093-5951 http://jkma.org

Even though suicide ranks as the fourth cause of death and is causing a significant loss in Korea, it seems that the conventional notion regarding suicide as a feasible way of solving a troublesome life situation hinders early recognition and proper management of suicide. This article reviews suicide prevention strategies recommended based on robust experience and scientific understanding of the characteristics of the suicide problem. In the UK, a suicide prevention strategy was formed at the national level suggesting significant goals to reduce the rate of suicide. In the US, the Institute of Medicine study committee examined the state of the science base, gaps in knowledge, strategies for prevention, and research designs for the study of suicide. This recommendation includes more science-based, coherent and well-coordinated multidisciplinary approaches, and thus suggests important practical recommendations for a suicide prevention strategy of Korea. The author concludes that suicide should be defined as a treatable and even preventable medical condition. Constructing a national network of suicide research, data surveillance, developing tools for suicide prevention including early detection and safety planning, and comprehensive insurance coverage are recommended.

ObjectiveaaPsychotherapeutic intervention combined with pharmacotherapy is helpful for achieving remission of depressive disorder. We developed and tested the effect of cognitive behavior therapy (CBT)-based psychotherapy applied in a forest environment on major depressive disorder. MethodsaaWe performed 4 sessions during 4 weeks (3 hours/session) in patients with major depressive disorder during pharmacotherapy. For the forest group, sessions were performed in the forest; for the hospital group, sessions were performed in the hospital. The control group was treated with the usual outpatient management. ResultsaaA total of 63 patients completed the study: 23 in the forest group, 19 in the hospital group, and 21 in the control group. Hamilton Rating Scales for Depression (HRSD) scores of the forest group were significantly decreased after 4 sessions compared with controls. Montgomery-Asberg Depression Rating Scales (MADRS) scores of the forest group were significantly decreased compared with both the hospital group and the controls. The remission rate (7 and below in HRSD) of the forest group was 61% (14/23), significantly higher than both the hospital group (21%, 4/19) and the controls (5%, 1/21). In heart rate variability (HRV) analysis, some measurements representing HRV and parasympathetic nerve tone were increased in the forest group after 4 sessions. The salivary cortisol levels of the forest group were significantly decreased. ConclusionaaCBT-based psychotherapy applied in the forest environment was helpful in the achievement of depression remission, and its effect was superior to that of psychotherapy performed in the hospital and the usual outpatient management. A good environment such as a forest helps improve the effect of psychotherapeutic intervention because it includes various natural instruments and facilitators in the treatment of depression. Psychiatry Invest 2009;6:245-254

Background Spermatogenesis and fertilization are highly unique processes. Discovery and characterization of germ cell-specific genes are important for the understanding of these reproductive processes. We investigated eight proteins encoded by novel spermatogenic cell-specific genes previously identified from the mouse round spermatid UniGene library. Methods Polyclonal antibodies were generated against the novel proteins and western blot analysis was performed with various protein samples. Germ cell specificity was investigated using testes from germ cell-less mutant mice. Developmental expression pattern was examined in testicular germ cells, testicular sperm and mature sperm. Subcellular localization was assessed by cell surface biotin labeling and trypsinization. Protein localization and properties in sperm were investigated by separation of head and tail fractions, and extractabilities by a non-ionic detergent and urea. Results The authenticity of the eight novel proteins and their specificity to spermatogenic cells were confirmed. In examining the developmental expression patterns, we found the presence of four proteins only in testicular germ cells, a single protein in testicular germ cells and testicular sperm, and three proteins in the testicular stages and mature sperm from the epididymis. Further analysis of the three proteins present in sperm disclosed that one is located at the surface of the acrosomal region and the other two are associated with cytoskeletal structures in the sperm flagellum. We name the genes for these sperm proteins Shsp1 (Sperm head surface protein 1), Sfap1 (Sperm flagellum associated protein 1) and Sfap2 (Sperm flagellum associated protein 2). Conclusion We analyzed eight novel germ cell-specific proteins, providing new and inclusive information about their developmental and cellular characteristics. Our findings will facilitate future investigation into the biological roles of these novel proteins in spermatogenesis and sperm functions.

3 ) Objective: A growing body of literature has documented that job stress is associated with the development of cardiovascular disease. Nevertheless, the pathophysiological mechanism of this association remains unclear. Therefore, we tried to elucidate the relationship between job stress, heart rate variability and metabolic syndrome. Method: The study design was cross-sectional, and 169 industrial workers were recruited. A structured-questionnaire was used to assess the general characteristics and job characteristics (work demand, decision latitude). Heart rate variability (HRV) was recorded using SA-2000 (medi-core). HRV was assessed by time-domain and by frequency-domain analyses. Time domain analysis was performed for SDNN (Standard Deviation of NN interval), and spectral analysis for low-frequency (LF), high-frequency (HF) and total frequency power. Metabolic syndrome was defined on the basis of clustering of risk factors, when three or more of the fol - lowing cardiovascular risk factors were included in the fifth quintile: glucose, systolic blood pressure, HDL-cholesterol (bottom quintile), triglyceride and waist-hip ratio. Results: The results showed that job characteristics were not associated with cardiovascular risk factors. The high strain group had a less favorable cardiovascular risk profile with higher levels of blood pressure, glucose, homocysteine, and clotting factor than the lower strain group (low strain+passive+active group), but the difference was not statistically significant. The SDNN of HRV was significantly lower in the high strain group than in the low strain group. The prevalence of metabolic syndrome in the low strain, passive, active and high strain groups was 9.7%, 13.9%, 14.9% and 23.8%, respectively. In the high strain group, the metabolic syn - drome was significantly related to a decreased SDNN. However, we could not find a significant association in LF/HF ratio. Conclusion: This result suggests that decreased HRV does not play a role in the development of disease; however, it can induce cardiovascular abnormalities or dysfunctions related to the onset of heart disease among high risk groups.

Background: Recently, social concern about occupational stress and disputes, which are surrounded with judgements of work relatedness for various psychiatric sequels, is increasing. Objective: We present a case of work-related, illness judgement in which panic disorder and adjustment disorder with conversion symptoms were associated with work stress due to job reallocation. M e t h o d s: We performed psychiatric assessment including mental status examination and neuropsychological test batteries. We also assessed job stress profiles using the Korean version of the Occupational Stress Inventory (K-OSI). Results: The patient showed no specific psychological or physical problems and had previously demonstrated suitable coping skills. However, the patient, who was sensitive to emotional stress, suffered chronic stress symptoms after a role change from a car mechanic to office manager which required continuous interaction with customers and a strong emotional burden. Panic attack and conversion symptoms were judged to be associated with disharmony between individual characteristics and environmental needs. Conclusion: It is noteworthy that this is the first reported case considered as a psychiatric illness related with psychological work stress. A further study will be attempted to assign standards of judgment for similar cases through systematic source collection and tool development.

PURPOSE Blood pressure variability (BPV) is emerging as an important cardiovascular prognostic factor in addition to average blood pressure level. While there have been some suggestions for the determinants of the blood pressure variability, little is known about the relationship between the blood pressure variability and health-related quality of life (QOL). MATERIALS AND METHODS Fifty-six men and women with mild hypertension were enrolled from local health centers in Republic of Korea, from April to October 2009. They self-monitored their blood pressure twice daily for 8 weeks. Pharmacological treatment was not changed during the period. Standard deviation and coefficient of variation of blood pressure measurements were calculated as indices of BPV. Measurements of QOL were done at initial and at 8-week follow-up visits. RESULTS Study subjects had gender ratio of 39:41 (male:female) and the mean age was 64±10 years. The mean home blood pressure's at week 4 and 8 did not differ from baseline. Total score of QOL at follow-up visit and change of QOL among two measurements were negatively correlated to BPV indices, i.e., higher QOL was associated with lower BPV. This finding persisted after adjustment for age, gender and the number of antihypertensive agents. Among dimensions of QOL, physical, mental and hypertension-related dimensions were associated particularly with BPV. CONCLUSION QOL may be a significant determinant of BPV. Improvement of QOL may lead to favorable changes in BPV.

Objective We examined the association between the tryptophan hydroxylase 1 (TPH1) gene and eating disorders focusing on obsessionality. Methods The sample included 62 women with a lifetime diagnosis of anorexia nervosa (AN) as well as 50 women with a lifetime diagnosis of bulimia nervosa (BN) recruited from specialist clinics for eating disorders and 131 healthy women in Korea. Blood samples were collected from all participants for the TPH1 genotyping. The patients were ad ministered the Korean version of the Eating Disorders Examination and obsessionality was conceptualized using measures of persistence, harm avoidance, and obsessive-compulsive symptoms. Results In the case-control comparisons, the frequency of the A/A genotype was increased in the patients with BN, but this difference was not significant after correcting for multiple testing. We found no effect of the TPH A218C polymorphism on obsessionality in the patients with AN or BN. Conclusion Although the present findings should be regarded as preliminary because of the small size of our sample, they suggest that the TPH1 gene may contribute to the genetic susceptibility to BN and be associated with the other unexplored traits of bulimic case status.

ObjectivesZZThe purpose of this study was to correct the statistical errors in the previous article on “The Development of the ‘Mental Fitness’ Scale” (MFS) and to confirm the validity of factor structure via confirmatory factor analysis. MethodsZZBased on re-analysis of the factor structure of 25 preliminary items using the original dataset, we identified 22 items of the MFS and assessed test-retest reliability. Concurrent validity was assessed by correlating the new set of MFS with total scores of the Beck Depression Inventory and Positive and Negative Affect Schedule. We also performed confirmatory factor analysis (CFA) in order to verify the factor structure resulting from the exploratory factor analysis. ResultsZZRe-analysis yielded five factors of 22 items, which is different from four factors of 20 items in the previous paper. ‘Self-understanding’ was added as one of the five factors. The testretest reliability coefficients were significantly high, ranging between 0.57-0.73. Internal consistency was computed, and Cronbach’s α for five factors ranged between 0.67-0.86, and was 0.91 for the total score. Concurrent validity and discriminant validity were both significant. The validity of five factor structure based on CFA was verified as root mean square error of approximation was significant. ConclusionZZBased on results of confirmatory factor analysis, the validity and utility of the re vised MFS was increased. J Kor ean Neuropsychiatr Assoc 2013;52:431-441