Jun Soo Kwon

Seoul National University Hospital, Sŏul, Seoul, South Korea

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Publications (250)979.29 Total impact

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    ABSTRACT: Primary pharmacotherapy regimen for obsessive-compulsive disorder (OCD) named Serotonin reuptake inhibitors (SRIs) does not attain sufficient symptom improvement in 40-60% of OCD. We aimed to decode the differential profile of OCD-related brain pathology per subject in the context of cortical surface area (CSA) or thickness (CT)-based individualized structural covariance (ISC) and to demonstrate the potential of which as a biomarker of treatment response to SRI-based pharmacotherapy in OCD using the support vector machine (SVM). T1-weighted magnetic resonance imaging was obtained at 3T from 56 unmedicated OCD subjects and 75 healthy controls (HCs) at baseline. After 4months of SRI-based pharmacotherapy, the OCD subjects were classified as responders (OCD-R,N=25; ≥35% improvement) or nonresponders (OCD-NR,N=31; <35% improvement) according to the percentage change in the Yale-Brown Obsessive Compulsive Scale total score. Cortical ISCs sustaining between-group difference (p<.001) for every run of leave-one-out group-comparison were packaged as feature set for group classification using the SVM. An optimal feature set of the top 12 ISCs including a CT-ISC between the dorsolateral prefrontal cortex versus precuneus, a CSA-ISC between the anterior insula versus intraparietal sulcus, as well as perisylvian area-related ISCs predicted the initial prognosis of OCD as OCD-R or OCD-NR with an accuracy of 89.0% (sensitivity 88.4%, specificity 90.1%). Extended sets of ISCs distinguished the OCD subjects from the HCs with 90.7-95.6% accuracy (sensitivity 90.8-96.2%, specificity 91.1-95.0%). We showed the potential of cortical morphology-based ISCs, which reflect dysfunctional cortical maturation process, as a possible biomarker that predicts the clinical treatment response to SRI-based pharmacotherapy in OCD. Copyright © 2015. Published by Elsevier Inc.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 06/2015; DOI:10.1016/j.pnpbp.2015.06.009 · 4.03 Impact Factor
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    ABSTRACT: Many of previous neuroimaging studies on neuronal structures in patients with obsessive-compulsive disorder (OCD) used univariate statistical tests on unimodal imaging measurements. Although the univariate methods revealed important aberrance of local morphometry in OCD patients, the covariance structure of the anatomical alterations remains unclear. Motivated by recent developments of multivariate techniques in the neuroimaging field, we applied a fusion method called "mCCA+jICA" on multimodal structural data of T1-weighted magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of 30 unmedicated patients with OCD and 34 healthy controls. Amongst six highly correlated multimodal networks (p < 0.0001), we found significant alterations of the interrelated gray and white matter networks over occipital and parietal cortices, frontal interhemispheric connections and cerebella (False Discovery Rate q ≤ 0.05). In addition, we found white matter networks around basal ganglia that correlated with a subdimension of OC symptoms, namely 'harm/checking' (q ≤ 0.05). The present study not only agrees with the previous unimodal findings of OCD, but also quantifies the association of the altered networks across imaging modalities.
    PLoS ONE 06/2015; 10(6):e0127118. DOI:10.1371/journal.pone.0127118 · 3.53 Impact Factor
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    ABSTRACT: The aim of this study was to investigate whether P300 could predict the short-term prognosis of subjects at clinical high risk (CHR) for psychosis who do not convert to psychotic disorder (non-converters). CHR subjects were examined with auditory P300 at baseline, and their clinical state was regularly assessed up to 2years. 45 CHR non-converters were divided into remitter and non-remitter groups. Repeated-measures analysis of variance (ANOVA) was performed to compare baseline P300 between the two groups. Multiple regression analysis was used to identify factors predicting symptomatic or functional improvement in CHR subjects during the follow-up period. There were no group differences in P300 amplitude or latency between CHR remitters and non-remitters. In the multiple regression analysis, P300 amplitude at Pz (β=0.206, 95% confidence interval [95CI]=0.035 to 0.567, p=0.028) significantly predicted later amelioration of the Scale of Prodromal Symptoms (SOPS) negative symptoms. Improvement in SOPS general symptoms was significantly predicted by P300 amplitude at Pz (β=0.255, 95CI=0.065 to 0.455, p=0.010) and mood stabilizer use (β=0.199, 95CI=0.081 to 4.154, p=0.042). These results indicate that P300 may be a possible predictor of improvement in negative and general symptoms in CHR non-converters. Our findings support the recommendation that a broader concept of assessment guidelines is needed to forecast clinical outcome and provide appropriate interventions for CHR non-converters. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 05/2015; 165(2-3). DOI:10.1016/j.schres.2015.04.033 · 4.43 Impact Factor
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    Dataset: mmc1
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    ABSTRACT: The notion that schizophrenia patients' (SZ) sense of being detached from external reality is a core feature of the disorder has existed since the early days of its recognition and is still largely emphasized in first person accounts of SZs; however, its etiology, neurophysiological mechanism, and significance for clinical symptoms are unclear. Mind-wandering is a ubiquitous experience of being detached from reality, the underlying neural mechanism of which closely resembles the brain in a resting-state. The resting-state functional magnetic resonance imaging data of 33 SZs and 33 matched healthy controls (CNT) were acquired. All subjects answered the mind-wandering subscale of the Imaginal Processing Inventory Questionnaire. Functional connectivity maps were constructed using 82 regions of interest comprising default-mode, salience, and frontoparietal networks. SZs exhibit significantly higher mind-wandering frequency relative to CNT. The elevated mind-wandering frequency in SZs significantly correlated with positive and general symptom severity. The mind-wandering frequency was inversely correlated with connectivity degree in the right ventromedial prefrontal cortex, the brain region involved in self-experience in SZs. Our results suggest that self-disturbances in SZs can explain SZs' disconnection to the external world, leading to the manifestation of positive psychotic symptoms. This study demonstrates strong preliminary evidence that contributes significantly to resolve the complex relationship between self, world, and the brain of SZs, which may lie at the "core" of psychotic experiences. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 04/2015; 165(1). DOI:10.1016/j.schres.2015.03.021 · 4.43 Impact Factor
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    ABSTRACT: There is substantial evidence regarding a social cognitive deficit in schizophrenia, and it has been suggested to be a trait-marker of this disorder. However, a domain-by-domain analysis of social cognitive deficits in individuals at clinical high risk (CHR) for psychosis has not been performed. Electronic databases were searched for studies regarding social cognitive performance in individuals at CHR. The included social cognitive domains, which were classified based on the Social Cognition Psychometric Evaluation (SCOPE) initiative of the National Institute of Mental Health (NIMH), were as follows: theory of mind (ToM), social perception (SP), attributional bias (AB), and emotion processing (EP). Twenty studies that included 1229 individuals at CHR and 825 healthy controls met the inclusion criteria. The overall effect size for social cognition was medium (g=-0.477). The largest effect size was identified for AB (g=-0.708). A medium effect size was identified for EP (g=-0.446) and ToM (g=-0.425), and small effects were identified for SP (g=-0.383). This is the first quantitative domain-by-domain social cognitive meta-analysis regarding CHR individuals. The present study indicated that individuals at CHR exhibited significant impairments in all domains of social cognition compared with healthy controls, with the largest effect size identified for AB. The identification of social cognitive domains that reflect an increased risk for impending psychosis and of predictors of the conversion to psychosis via a longitudinal follow-up study is required. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 03/2015; 164(1-3):28-34. DOI:10.1016/j.schres.2015.02.008 · 4.43 Impact Factor
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    ABSTRACT: Impaired facial emotion recognition is a core deficit in schizophrenia. Oxytocin has been shown to improve social perception in patients with schizophrenia; however, the effect of oxytocin on the neural activity underlying facial emotion recognition has not been investigated. This study was aimed to assess the effect of a single dose of intranasal oxytocin on brain activity in patients with schizophrenia using an implicit facial emotion recognition paradigm. Sixteen male patients with schizophrenia and 16 age-matched healthy male control subjects participated in a randomized, double blind, placebo-controlled crossover trial at Seoul National University Hospital. Delivery of a single dose of 40 IU intranasal oxytocin and the placebo was separated by 1 week. Drug conditions were compared by performing a region of interest (ROI) analysis of the bilateral amygdala on responses to the emotion recognition test. It was found that nasal spray decreased amygdala activity for fearful emotion and increased activity for happy faces. Further, oxytocin elicited differential effects between the patient and control groups. Intranasal oxytocin attenuated amygdala activity for emotional faces in patients with schizophrenia, whereas intranasal oxytocin significantly increased amygdala activity in healthy controls. Oxytocin-induced BOLD signal changes in amygdala in response to happy faces was related to attachment style in the control group. Our result provides new evidence of a modulatory effect of oxytocin on neural response to emotional faces for patients with schizophrenia. Future studies are needed to investigate the effectiveness of long-term treatment with intranasal oxytocin on neural activity in patients with schizophrenia.Neuropsychopharmacology accepted article preview online, 10 February 2015. doi:10.1038/npp.2015.41.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 02/2015; 40(8). DOI:10.1038/npp.2015.41 · 7.83 Impact Factor
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    ABSTRACT: Individuals at ultra-high risk (UHR) for psychosis experience a considerable delay before appropriate clinical attention is provided. Therefore, we investigated the correlates of this delay by examining clinical, socio-demographic and neuropsychological contributors to the duration of untreated prodromal positive symptoms (DUPP) in them (n=73). The slowly progressive mode of functional decline, defined as a small percentage drop in the Global Assessment of Functioning (GAF) score within the past year, and male gender, explained a considerable portion of the DUPP in the multivariate regression model (F=9.269, p<0.001). Slower functional decline may be correlated with delayed care during the UHR period. Copyright © 2015. Published by Elsevier B.V.
    Schizophrenia Research 01/2015; 162(1-3). DOI:10.1016/j.schres.2015.01.013 · 4.43 Impact Factor
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    ABSTRACT: This study investigates the clinical nature, prevalence rates, and associated factors of second-generation antipsychotic (SGA)-related tardive dyskinesia and tardive dystonia. To date, these subjects have not been thoroughly investigated.The subjects were 80 non-elderly schizophrenic patients who received SGAs for more than 1 year without any previous exposure to first-generation antipsychotics. Multiple (≥2) direct assessments of movement symptoms were performed. Hospital records longer than 1 recent year describing any observed tardive movement symptoms were reviewed.A current or history of tardive dyskinesia and/or tardive dystonia associated with SGA was identified in 28 (35%) subjects. These patients were being treated with risperidone (n = 15), amisulpride, olanzapine, aripiprazole, ziprasidone, or clozapine at the time of the onset of the movement symptoms. Tardive dyskinesia was mostly in the orolingual area, and the most frequently observed tardive dystonia was torticollis. The median interval between the first exposure to the SGA and the movement syndrome onset was 15 months for tardive dyskinesia and 43 months for tardive dystonia. A history of acute dystonia was significantly associated with tardive dystonia, and comorbid obsessive-compulsive syndrome was related to both tardive movement syndromes.This study indicates that more clinical attention and research efforts are needed regarding SGA-associated tardive movement syndromes, including a larger-scale prevalence assessment. This study is the first to indicate that a comorbid obsessive-compulsive syndrome might be an associated factor of tardive movement syndrome. The association warrants further investigation.
    Journal of Clinical Psychopharmacology 12/2014; 35(1). DOI:10.1097/JCP.0000000000000250 · 3.76 Impact Factor
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    ABSTRACT: Objective Although the executive function subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) have been used to assess cognitive function in diverse psychiatric illnesses, few studies have verified the validity of this battery for Korean psychiatric patients. Therefore, this preliminary study evaluated the construct and concurrent validity of the executive function subtests of the CANTAB for Korean psychiatric patients by comparing it with subtests of the Computerized Neuropsychological Test (CNT). Methods Three subtests of the CANTAB and three subtests of the CNT were administered to 36 patients diagnosed with either schizophrenia or bipolar disorder. Subtests of the CANTAB included the Intra/Extra-Dimensional Set Shift (IED), Stockings of Cambridge (SOC), and Spatial Working Memory (SWM). Differences between groups on each subtest as well as correlations between the subtests of the CANTAB and the CNT were assessed. Results The schizophrenia group performed significantly more poorly on the IED and the Wisconsin Card Sorting Test (WCST) compared with the bipolar disorder group. Additionally, correlation analyses revealed a significant correlation between the IED and the WCST; a positive correlation between the SOC and the Trail Making Test, Part B and the Stroop test; and a significant correlation between the SWM and the Stroop test. Conclusion This study verified the construct and concurrent validity of the executive function subtests of the CANTAB for Korean psychiatric patients and suggests that the subtests of this battery would be useful and appropriate for assessing deficits in executive function in Korean clinical settings.
    Psychiatry investigation 10/2014; 11(4):394-401. DOI:10.4306/pi.2014.11.4.394 · 1.15 Impact Factor
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    ABSTRACT: The default mode network (DMN) represents neuronal activity that is intrinsically generated during a resting state. The present study used resting-state fMRI to investigate whether functional connectivity is altered in pathological gambling (PG). Fifteen drug-naive male patients with PG and fifteen age-matched male control subjects participated in the present study. The pathological gambling modification of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS), the Beck Depression Inventory, and the Beck Anxiety Inventory were used to determine symptom severity in all participants. Participants were instructed to keep their eyes closed and not to focus on any particular thoughts during the 4.68-minute resting-state functional scan. The patients with PG displayed decreased default mode connectivity in the left superior frontal gyrus, right middle temporal gyrus, and precuneus compared with healthy controls. The severity of PG symptoms in patients with PG was negatively associated with connectivity between the posterior cingulate cortex seed region and the precuneus (r=-0.599, p=0.018). Decreased functional connectivity within DMN suggests that PG may share similar neurobiological abnormalities with other addictive disorders. Moreover, the severity of PG symptoms was correlated with decreased connectivity in the precuneus, which may be important in the response to treatment in patients with PG.
    Neuroscience Letters 09/2014; DOI:10.1016/j.neulet.2014.09.025 · 2.06 Impact Factor
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    ABSTRACT: As the main input hub of the basal ganglia, the striatum receives projections from the cerebral cortex. Many studies have provided evidence for multiple parallel corticostriatal loops based on the structural and functional connectivity profiles of the human striatum. A recent resting-state fMRI study revealed the topography of striatum by assigning each voxel in the striatum to its most strongly correlated cortical network among the cognitive, affective, and motor networks. However, it remains unclear what patterns of striatal parcellation would result from performing the clustering without subsequent assignment to cortical networks. Thus, we applied unsupervised clustering algorithms to parcellate the human striatum based on its functional connectivity patterns to other brain regions without any anatomically or functionally defined cortical targets. Functional connectivity maps of striatal subdivisions, identified through clustering analyses, were also computed. Our findings were consistent with recent accounts of the functional distinctions of the striatum as well as with recent studies about its functional and anatomical connectivity. For example, we found functional connections between dorsal and ventral striatal clusters and the areas involved in cognitive and affective processes, respectively, and between rostral and caudal putamen clusters and the areas involved in cognitive and motor processes, respectively. This study confirms prior findings, showing similar striatal parcellation patterns between the present and prior studies. Given such striking similarity, it is suggested that striatal subregions are functionally linked to cortical networks involving specific functions rather than discrete portions of cortical regions. Our findings also demonstrate that the clustering of functional connectivity patterns is a reliable feature in parcellating the striatum into anatomically and functionally meaningful subdivisions. The striatal subdivisions identified here may have important implications for understanding the relationship between corticostriatal dysfunction and various neurodegenerative and psychiatric disorders.
    PLoS ONE 09/2014; 9(9):e106768. DOI:10.1371/journal.pone.0106768 · 3.53 Impact Factor
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    ABSTRACT: Symptoms of schizophrenia are related to deficits in self-monitoring function, which may be a consequence of irregularity in aspects of the default mode network (DMN). Schizophrenia can also be characterized by a functional abnormality of the brain activity that is reflected in the resting state. Oscillatory analysis provides an important understanding of resting brain activity. However, conventional methods using electroencephalography are restricted because of low spatial resolution, despite their excellent temporal resolution.The aim of this study was to investigate resting brain oscillation and the default mode network based on a source space in various frequency bands such as theta, alpha, beta, and gamma using magnetoencephalography. In addition, we investigated whether these resting and DMN activities could distinguish schizophrenia patients from normal controls. To do this, the power spectral density of each frequency band at rest was imaged and compared on a spatially normalized brain template in 20 patients and 20 controls.
    BMC Neuroscience 09/2014; 15(1):104. DOI:10.1186/1471-2202-15-104 · 2.85 Impact Factor
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    Schizophrenia Research 09/2014; 159(1):254-255.. DOI:10.1016/j.schres.2014.08.002 · 4.43 Impact Factor
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    ABSTRACT: Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N = 96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.
    Journal of Anxiety Disorders 08/2014; DOI:10.1016/j.janxdis.2014.06.003 · 2.96 Impact Factor
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    ABSTRACT: Background The aim of this study was to assess the frequency and predictors of symptomatic and functional remission in individuals at clinical high risk (CHR) for psychosis at 1–2 years of follow-up. Methods Help-seeking CHR individuals with symptomatic (Scale of Prodromal Symptoms (SOPS) positive scores < 3) and functional (Global Assessment of Functioning (GAF) score > 60) (CHR-R) remission at 12–24 months were compared to non-remitted individuals (CHR-NR) regarding baseline and treatment characteristics, symptom changes and predictors. Time to full remission was compared with that of symptomatic remission only. Results Of 73 individuals, 29 (39.7%) achieved full remission; 44 (60.3%) did not. Compared to CHR-NR individuals, CHR-R individuals had lower baseline SOPS positive symptoms (p = 0.017), antipsychotic use (p = 0.004), antipsychotic chlorpromazine dose equivalents (p = 0.001) and anxiolytic use (p = 0.004). In survival analyses, the estimated full remission rate was 48.3% (95% confidence interval (CI) = 36.2–61.9) and symptomatic remission rate was 67.5% (CI95 = 55.4–79.2). Time to full remission was longer than time to symptomatic remission (p = 0.017). Linear mixed-effect models revealed significantly greater improvements from 6 months onward in CHR-R subjects compared to CHR-NR subjects regarding SOPS positive symptoms (p = 0.003), highest SOPS positive symptom (p < 0.001) and GAF scores (p = 0.004). Examining baseline predictors, time to full remission was significantly longer in patients with higher SOPS positive scores (p = 0.017). Conclusions More stringent remission criteria that include functional status in addition to attenuated positive symptom severity should be applied to CHR subjects. Furthermore, more attention should be given to CHR individuals with highly positive prodromal symptoms at baseline.
    Schizophrenia Research 07/2014; DOI:10.1016/j.schres.2014.04.002 · 4.43 Impact Factor
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    ABSTRACT: The term schizophrenia, which comes from the Greek roots “skhizein” and “phren,” was translated as “Jungshinbunyeolbyung” in East Asian Countries, including Japan, Korea, and China. The term literally means “mind-splitting disease.” This term has generated a misconception of the disorder as an untreatable chaotic personality, thus instilling stigma and causing suffering in patients and their families. This socio-cultural connotation has impeded medical treatment of schizophrenia. Recent neuroscience research has suggested neural network dysfunction in schizophrenia. Accordingly, a new term, “Johyeonbyung (attunement disorder)”, was coined in South Korea. This term literally refers to tuning a string instrument, and metaphorically it describes schizophrenia as a disorder caused by mistuning of the brain’s neural network. We expect that the term Johyeonbyung will incite less prejudice and that its metaphoric description of the disorder may help patients to access medical treatment in the early phase. The name of a psychiatric disorder can influence others’ attitudes toward patients; thus, discretion is crucial in naming psychiatric disorders.
    Asian Journal of Psychiatry 04/2014; 8:118-120. DOI:10.1016/j.ajp.2014.01.008
  • Schizophrenia Research 04/2014; 153:S244. DOI:10.1016/S0920-9964(14)70698-X · 4.43 Impact Factor

Publication Stats

5k Citations
979.29 Total Impact Points

Institutions

  • 2002–2015
    • Seoul National University Hospital
      • Department of Neuropsychiatry
      Sŏul, Seoul, South Korea
    • Seoul National University
      • • Brain and Cognitive Sciences
      • • College of Medicine
      Sŏul, Seoul, South Korea
  • 2014
    • University of Seoul
      Sŏul, Seoul, South Korea
  • 2006–2010
    • Rowe Neuroscience Institute
      Lenexa, Kansas, United States
    • Robert Wood Johnson University Hospital
      New Brunswick, New Jersey, United States
  • 2004–2008
    • Hanyang University
      • Department of Biomedical Engineering
      Seoul, Seoul, South Korea
  • 2004–2005
    • Yonsei University
      • Department of Psychiatry
      Sŏul, Seoul, South Korea
  • 1999
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1998–1999
    • Harvard Medical School
      • Department of Psychiatry
      Boston, MA, United States