Trajectories of self-rated health among community-dwelling individuals with depressive symptoms: A latent class growth analysis

BACKGROUND

This study identified differences between individuals with and without depression regarding demographic and socioeconomic variables, health behavior, health status, health care utilization, and self-rated health (SRH) to identify the depressed group's SRH trajectories.

METHODS

Data of individuals with (n = 589) and without (n = 6856) depression aged ≥20 from the 2013-2017 Korean Health Panel were analyzed. A chi-square test and t-tests examined differences in demographic and socioeconomic variables, health behaviors, health status, health care utilization, and the mean of SRH. Latent Growth Curve and Latent Class Growth Modeling identified SRH development trajectories and the most suitable latent classes explaining the trajectories, respectively. Multinomial logistic regression determined the predicting factors that classified latent classes.

RESULTS

The depressed group had a lower mean SRH than the non-depressed group among most variables. Three latent classes were identified, each showing different SRH trajectories. Body-mass index and pain/discomfort were predicting factors for the "poor" classes compared with the "moderate-stable" class; older age, less national health insurance, less physical activity, more pain/discomfort, and more hospitalization were predictors for the "poor-stable" class. The depressed group's mean SRH was "poor."

LIMITATIONS

Latent Class Growth Modeling in individuals with depression was based on experimental data; however, it needed to review other sample data to identify similar types of latent classes to those suggested in the current study.

CONCLUSIONS

Predictors of the "poor-stable" class that were identified in this study can contribute to the formulation of intervention plans for the health and welfare of individuals with depression.

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea

BACKGROUND

The healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcare-associated infection during the early spread of COVID-19.

METHODS

A real-time online survey was conducted between April 14-18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout Inventory-General Survey scale, and the Stress and Anxiety to Viral Epidemics-9.

RESULTS

The HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73; P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07-1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31-2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21-2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09-2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression.

CONCLUSION

The present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.

High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study

BACKGROUND

The COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics.

OBJECTIVE

We investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic.

METHODS

Respondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers' depression as outcome variables.

RESULTS

Among 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression.

CONCLUSIONS

Psychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores.

Hospital-Based Case Management for Suicide High-Risk Group Using Delphi Survey

OBJECTIVE

As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care.

METHODS

We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management.

RESULTS

The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions.

CONCLUSION

Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

Associations between suicidal ideation and health-related quality of life among community-dwelling stroke survivors: 2013-2017 Korea National Health and Nutrition Examination Survey

PURPOSE

The study aimed to identify differences between individuals with stroke and the general population regarding socioeconomic, mental health, and Health-related quality of life (HRQOL) factors, and associations among Suicidal ideation (SI), HRQOL, and mental health.

METHODS

Data of individuals with stroke (n = 592) and without stroke (n = 23,562) aged 20 or older from the 2013-2017 Korea National Health and Nutrition Examination Survey were analyzed. Chi-square tests examined differences in socioeconomic status, mental health, and HRQOL (EQ-5D) between groups. Independent associations between each EQ-5D dimension and SI were analyzed through multivariable logistic regression.

RESULTS

Individuals with stroke were more likely to have problems on all EQ-5D dimensions. Significant univariate associations were identified between four EQ-5D dimensions and SI among individuals with stroke. Pain/discomfort (odds ratio [OR] = 1.32; 95% confidence interval [CI], 1.01-1.75, p = 0.048) and anxiety/depression (OR = 4.66; 95% CI, 3.69-5.89, p < .0001) of the EQ-5D were associated with SI when adjusting for all socioeconomic variables; anxiety/depression (OR = 2.80; 95% CI, 2.18-3.60, p < .0001) was the only risk factor for SI after controlling for socioeconomic and mental health variables.

CONCLUSION

Individuals with stroke showed higher rates for problems on the EQ-5D, SI, and depression compared to the general population. They also demonstrated significant associations between SI and each EQ-5D dimension except physical activity, especially pain/discomfort and depression/anxiety. The study's findings can be referred to when predicting suicide risk in individuals with stroke by analyzing their EQ-5D scores.

Pessimistically biased perception in panic disorder during risk learning

BACKGROUND

Despite the well-known association between anxiety and risk-avoidant decision making, it is unclear how pathological anxiety biases risk learning. We propose a Bayesian inference model with bias parameters of prior, learning, and perception during risk learning in individuals with pathological anxiety.

METHODS

Patients with panic disorder (PD, n = 40) and healthy control subjects (n = 84) completed the balloon analog risk task (BART). By fitting our computational model of three bias parameters (prior belief, learning rate, and perceptual bias) to the participants' behavior, we estimated the degree of bias in risk learning and its relationship with anxiety symptoms.

RESULTS

Relative to the healthy control subjects, the pathologically anxious participants exhibited a biased underestimation of perceptual evidence rather than differences in priors and learning rates. The degree of perceptual bias was correlated with the anxiety and depression symptom severity in the patients with PD. Furthermore, our proposed model was the winning model for BART data in an external data set from different patient groups.

CONCLUSIONS

Our results showed that individuals with pathological anxiety demonstrate perceptual bias in evidence accumulation, which may explain why patients with anxiety overestimate risk in their daily lives. This clarification highlights the importance of interventions focusing on perceptual bias, such as enhancing the clarity of favorable outcome probabilities.

Risk Factors for Serious Suicide Attempts with High Medical Severity

OBJECTIVES

his study investigated the risk factors leading to serious suicide attempts with high medical severity.

METHODS

Nine hundred and eighty-two patients who visited the emergency room after attempting suicide were divided into two groups: suicide attempters with high medical severity (25.3%) and those with low medical severity (74.7%). Demographic variables, clinical characteristics, and factors related to each suicide attempt were compared between the two groups. Multivariate logistic regression analysis was conducted to investigate risk factors for high medical severity in patients' current suicide attempts.

RESULTS

The results show that suicide attempters with high medical severity had more severe depression and psychological disturbances such as agitation, intense emotions, and self-reproach. Suicide attempters with high medical severity also had more serious risk factors for suicide such as repetitive/intense/continuous thoughts of suicide, suicidal planning, and a stronger wish to die. School/work problems and physical illnesses were related to high medical severity with more lethal methods. Logistic regression demonstrated that school/work problems, total risk rating, severity of suicidal ideation, and agitation were risks for more serious suicide attempts, whereas more frequent lifetime suicide attempts were a protective factor.

CONCLUSION

This study demonstrates that suicide attempters with high medical severity had more severe psychopathologies and risk factors related to suicidal behavior than those with low medical severity.

Deciphering reward-based decision-making in schizophrenia: A meta-analysis and behavioral modeling of the Iowa Gambling Task

BACKGROUND

Patients with schizophrenia (SZP) have been reported to exhibit impairments in reward-based decision-making, but results are heterogeneous with multiple potential confounds such as age, intelligence level, clinical symptoms or medication, making it difficult to evaluate the robustness of these impairments.

METHODS

We conducted a meta-analysis of studies comparing the performance of SZP and healthy controls (HC) in the Iowa Gambling Task (IGT) as well as comprehensive analyses based on subject-level data (n = 303 SZP, n = 188 HC) to investigate reward-based decision-making in SZP. To quantify differences in the influence of individual deck features (immediate gain, gain frequency, net loss) between SZP and HC, we additionally employed a least-squares model.

RESULTS

SZP showed statistically significant suboptimal decisions as indicated by disadvantageous deck choices (d from 0.51 to −0.62) and lower net scores (d from −0.35 to −1.03) in a meta-analysis of k = 29 samples (n = 1127 SZP, n = 1149 HC) and these results were confirmed in a complementary subject-level analysis. Moreover, decision-making in SZP was characterized by a relative overweighting of immediate gain and net losses and an underweighting of gain frequency. Moderator analyses revealed that in part, decision-making in the IGT was moderated by intelligence level, medication and general symptom scores.

CONCLUSION

Our results indicate robust impairments in reward-based decision-making in SZP and suggest that decreased cognitive resources, such as working memory, may contribute to these alterations.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE

The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea.

METHODS

We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis.

RESULTS

Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians.

CONCLUSION

This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Research on potential biomarker correlates for suicidal behavior: A review

Suicide is a world health priority. Studies over the last few decades have revealed the complexity underlying the neurobiological mechanisms of suicide. Researchers have found dysregulations in the serotonergic system, the stress system, neural plasticity, lipid metabolism, and cell signaling pathways in relation to suicidal behaviors. These findings have provided more insight into the final path leading to suicide, at which medical intervention should be applied to prevent the action. However, because these molecular mechanisms have been implicated in both depression and suicide, the specificity of the mechanisms has been obscured. In this review, we summarize the main findings of studies on molecular mechanisms of suicidal behavior from the last 2 decades, with particular emphasis on the potential, independent role of each mechanism that is not contingent upon an underlying psychopathology, such as depression. The act of suicide is multifactorial; no single molecular mechanism is sufficient to fully account for the act. Knowledge of the reciprocal interactions among these molecular mechanisms and studying them in the context of brain circuitry by using neuroimaging techniques will provide a better understanding of the neurobiology of suicide.

Different alterations in brain functional networks according to direct and indirect topological connections in patients with schizophrenia

Schizophrenia displays connectivity deficits in the brain, but the literature has shown inconsistent findings about alterations in global efficiency of brain functional networks. We supposed that such inconsistency at the whole brain level may be due to a mixture of different portions of global efficiency at sub-brain levels. Accordingly, we considered measuring portions of global efficiency in two aspects: spatial portions by considering sub-brain networks and topological portions by considering contributions to global efficiency according to direct and indirect topological connections. We proposed adjacency and indirect adjacency as new network parameters attributable to direct and indirect topological connections, respectively, and applied them to graph-theoretical analysis of brain functional networks constructed from resting state fMRI data of 22 patients with schizophrenia and 22 healthy controls. Group differences in the network parameters were observed not for whole brain and hemispheric networks, but for regional networks. Alterations in adjacency and indirect adjacency were in opposite directions, such that adjacency increased, but indirect adjacency decreased in patients with schizophrenia. Furthermore, over connections in frontal and parietal regions, increased adjacency was associated with more severe negative symptoms, while decreased adjacency was associated with more severe positive symptoms of schizophrenia. This finding indicates that connectivity deficits associated with positive and negative symptoms of schizophrenia may involve topologically different paths in the brain. In patients with schizophrenia, although changes in global efficiency may not be clearly shown, different alterations in brain functional networks according to direct and indirect topological connections could be revealed at the regional level.

Tardive Dystonia Related with Aripiprazole

Tardive dystonia is characterized by sustained, generally slow involuntary twisting movements. It is estimated to occur at a frequency of 1% to 4% among patients who are taking an antipsychotic agent. Unlike the first generation antipsychotics, the second generation antipsychotics are less likely to cause neuroleptic-induced movement disorder. For aripiprazole, only a few cases have been reported for tardive dystonia. We present a young male, who developed a severe tardive dystonia after taking aripiprazole for 5 years. The patient was admitted to for the treatment of both hisdystonic and psychotic symptoms. Olanzapine was administered instead of aripiprazole and while his psychotic symptoms improved, the dystonic symptoms were continued. Therefore, olanzapine was switched to clozapine while augmenting with benzodiazepine, anti-cholinergic, and ginko biloba to control his tardive dystonia. After 2 weeks of treatment, the dystonic movement decreased remarkably.

Higher prevalence of dementia in patients with schizophrenia: A nationwide population-based study

INTRODUCTION

This study investigates the prevalence of dementia in patients with and without schizophrenia, with a particular focus on age-specific and sex-specific differences.

METHODS

We conducted a population-based study using the National Health Insurance claims database from 2010 to 2013. Using a 10:1 matching ratio, 248,919 patients without schizophrenia and 26,591 patients with schizophrenia were identified based on the ICD-10 code. Patients with dementia were extracted by diagnosis or use of anti-dementia drugs. Conditional logistic regression analyses were performed to evaluate the association between schizophrenia and dementia.

RESULTS

The prevalence of dementia was significantly higher in schizophrenia patients compared with that in matched non-schizophrenia patients (9.9% versus 2.2%, P < 0.0001). After adjusting for Charlson comorbidity index and underlying comorbidities, conditional logistic regression showed that schizophrenia was associated with dementia (adjusted odds ratio [AOR], 4.7; 95% confidence interval [CI], 4.4-5.1). When stratified by sex, the AOR was 5.6 (95% CI, 5.0-6.2) among women and 4.0 (95% CI, 3.6-4.5) among men. Moreover, the association between dementia and schizophrenia was strong in elderly patients. The AOR of dementia prevalence was 6.6 (95% CI, 6.1-7.2) in patients aged ≥65 years and 3.4 (95% CI, 3.0-3.8) in patients aged <65 years.

DISCUSSION

Schizophrenia patients were more likely to have dementia compared with non-schizophrenia patients. This association seems greater in higher prevalence groups such as women and patients aged ≥65 years. Further investigation on the mechanism is required.

Effect of emotion regulation training in patients with panic disorder: Evidenced by heart rate variability measures

OBJECTIVE

We aimed to examine the effect of emotion regulation training in patients with panic disorder (PD) by measuring heart rate variability (HRV).

METHODS

Forty-eight patients with PD were randomly divided into emotion regulation group (n=25) and no-regulation group (n=23). Three five-minute ECG recordings were taken in the following states: 1) baseline, 2) while subjects viewed 15 aversive pictures (active stimulus), 3) resting state after aversive pictures (post-stimulus). The emotion regulation group briefly received acceptance technique training for five minutes before performing the experimental task. Spectral analysis measures included a high-frequency (HF; 0.15-0.4 HZ) component, a low-frequency (LF; 0.04-0.15Hz) component, and an LF/HF ratio.

RESULTS

The mean change in LF/HF ratio from baseline to active stimulus was significantly lower in the emotion regulation group than in the no-regulation group (emotion regulation group, 0.13; no-regulation group, 2.31; t=-2.67; P<.05).

CONCLUSION

This suggests that brief emotion acceptance training could decrease aversive stimulus-induced sympathetic hyperactivity in patients with PD.

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

Objective

This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders.

Methods

Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep).

Results

Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively.

Conclusion

The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

Modulation of prefrontal-cingulate connectivity in affective processing of children with experiences of ostracism

BACKGROUND

The anterior cingulate cortex (ACC) has been shown to be involved in emotional distress induced by social exclusion and the ventrolateral prefrontal cortex (VLPFC) in the regulation or inhibition of the distress. Here, we examined modulation of effective connectivity between the regions in response to emotional feedback in children with experiences of ostracism in their everyday life.

METHODS

In functional magnetic resonance imaging experiments, 10 ostracized children and 11 control children were provided emotional feedback inducing negative or positive affective states. We employed effective connectivity analysis to explore connectivity models comprising the VLPFC and ACC, and to estimate connectivity parameters over the models.

RESULTS

In spite of psychological impacts on the ostracized children, behavioral data showed that their emotional responses did not deviate from the control children in response to the emotional feedback. The VLPFC to ACC connectivity was modulated only in the ostracized children, such that the modulation may help them regulate their emotional responses.

CONCLUSIONS

The findings suggest that the effects of ostracism experiences on affective processing can be revealed in terms of modulation of prefrontal-cingulate connectivity.

Characteristics of methods of suicide attempts in Korea: Korea National Suicide Survey (KNSS)

BACKGROUND

Because the method used for a suicide attempt is an important determinant of outcome, these methods should be explored. The present study was a nationwide investigation of suicide attempts and the characteristics of suicidal behavior.

AIMS

To compare the suicide methods used in attempted suicides with those used in completed suicides and to examine the factors associated with each phenomenon.

METHODS

The present study reviewed the medical charts of subjects who had attempted suicide and subsequently visited the emergency rooms of 17 medical centers from May 1, 2013 to November 7, 2013. All subjects completed a full psychiatric interview conducted by trained psychiatric residents. Suicide-attempt methods were divided into the following six categories: drug poisoning, pesticide poisoning, gassing, cutting, hanging, and others. The associations among demographic variables, related psychiatric variables, and suicide-attempt methods were analyzed using a multinomial regression analysis.

RESULTS

Of the 1359 suicide attempts or instrumental suicide-related behaviors with/without injuries and the 14,160 completed suicides, drug poisoning and cutting were the most common suicidal behaviors with/without injuries, but they were the least frequent method of completed suicides. In contrast, hanging and jumping from a height were less common among failed suicide attempts but resulted in a higher percentage of fatalities. Being male, age, and area of residence were associated with pesticide poisoning, whereas previous suicide attempts were associated with cutting, pesticide poisoning, and gassing.

CONCLUSION

A previous suicide attempt is a risk factor for suicide; thus, assessing the characteristics of suicide attempts or instrumental suicide-related behaviors with/without injuries is necessary to prevent these attempts. The present findings showed that the methods of suicide used by individuals who only attempted suicide differed from those used by individuals who completed. Of the suicide methods, pesticide poisoning was related to age, residential area (urban), and a history of previous suicide attempts.

High Prevalence of Psychotropics Overdose among Suicide Attempters in Korea

Objective

The availability of suicide methods affects the risk of suicide attempts. This study examined the patterns of substances ingested by suicide attempters (SAs) and the characteristics of SAs using psychotropic overdoses.

Methods

Data for 384 of the 462 eligible SAs who used self-poisoning were analyzed. Demographic variables, clinical characteristics, and factors related to the suicide attempts were examined.

Results

There were 256 (66.7%) females and 128 (33.3%) males. Roughly half the SAs ingested psychotropics (n=179, 46.6%). Agricultural chemicals (n=84, 21.9%) were the second most frequently ingested substances, followed by analgesics (n=62, 16.1%), household products (n=27, 7.0%), and other prescribed medications (n=23, 6.0%). Among psychotropics, the most frequently overdosed drugs were sedative-hypnotics, including hypnotics (n=104) and benzodiazepines (n=78). SAs favored Z-drugs and alprazolam. When compared with SAs with non-psychotropic overdoses, significantly more SAs with psychotropic overdoses were female (76% vs. 58.5%, p<0.001) and had a psychiatric history (59.8% vs. 29.8%, p<0.001). They had significantly more previous suicide attempts (0.52±1.02 vs. 0.32±0.80, p<0.05) and lower risk (7.96±1.49 vs. 8.44±1.99, p<0.01) and medical severity (3.06±0.81 vs. 3.37±0.93, p<0.005) scores.

Conclusion

Psychotropic overdose, especially with sedative-hypnotics, was a major method in suicide attempts. It is important that psychiatric patients are carefully evaluated and monitored for suicidality when prescribing psychotropics.

Characteristic Risk Factors Associated with Planned versus Impulsive Suicide Attempters

OBJECTIVE

The present study aimed to investigate predictors for planned suicide attempters.

METHODS

This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared.

RESULTS

Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs.

CONCLUSION

The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.

Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program

Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.

Overactive Bladder Successfully Treated with Duloxetine in a Female Adolescent

Overactive bladder (OAB) is defined as urgency, usually with frequency and nocturia, and with or without urge incontinence. Duloxetine, an antidepressant that inhibits reuptake of serotonin and norepinephrine, is indicated for the treatment of stress urinary incontinence in Europe. In this paper, we present a case of a 17-year-old female patient with OAB and depressive symptoms who was successfully treated with duloxetine. This case suggests duloxetine can be an option for patient with OAB, and it also highlights the need for further studies of duloxetine’s use in the treatment of OAB.

Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

OBJECTIVE

Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide.

METHODS

We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients' severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed.

RESULTS

Many factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation.

CONCLUSION

Psychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.

Neural changes associated with emotion processing in children experiencing peer rejection: a functional MRI study

This study was performed to investigate differences between children who did and did not experience peer rejection in psychological state through surveys and in emotion processing during an interpersonal stress challenge task to reflect naturalistic interpersonal face-to-face relationships. A total of 20 right-handed children, 10 to 12 yr of age, completed self-rating questionnaires inquiring about peer rejection in school, depression, and anxiety. They then underwent an interpersonal stress challenge task simulating conditions of emotional stress, in reaction to positive, negative and neutral facial expression stimuli, using interpersonal feedbacks, and functional magnetic resonance imaging (FMRI) for an analysis of neural correlates during the task. Ten were the peer-rejection group, whereas the remainder were the control group. Based on the behavioral results, the peer-rejection group exhibited elevated levels of depression, state anxiety, trait anxiety and social anxiety as compared to the control group. The FMRI results revealed that the peer-rejection group exhibited greater and remarkably more extensive activation of brain regions encompassing the amygdala, orbitofrontal cortex and ventrolateral prefrontal cortex in response to negative feedback stimuli of emotional faces. The different brain reactivities characterizing emotion processing during interpersonal relationships may be present between children who do and do not experience peer rejection.

Risk and protective factors predicting multiple suicide attempts

This study compared demographical and clinical variables between first and multiple suicide attempters and investigated risk and protective factors predicting multiple attempts. 228 patients visiting emergency department after attempting suicide were divided into two groups: first attempter (n=148, 64.9%) and multiple attempter (n=80, 35.1%). Demographic variables, clinical characteristics, factors related with suicide behavior, and psychiatric resources between two groups were compared. Multivariate logistic regression analysis was conducted to investigate risk and protective factors predicting multiple attempts. The results showed that multiple attempters were younger, not married, more severe in psychopathology (e.g., psychiatric disorder, personality disorder, lower function, and suicide family history) and suicidality (e.g., repetitive/severe/continuous suicide ideation), and lower in psychiatric resources (e.g., interpersonal stress/conflict, conflicting interpersonal relationship, socially isolated, lower personal achievement, and lower ability to control emotion) than first attempters. Suicide ideation severity and conflicting interpersonal relationships predicted multiple suicide attempts, whereas past year's highest global functioning score and age over 45 protected against multiple suicide attempts. This study demonstrated that multiple suicide attempters have more severe clinical profile than first suicide attempters. Moreover, decreasing severity of suicide ideation, improving interpersonal relationships, and enhancing functioning level of suicide attempters might be important in preventing them from re-attempting suicide.

Affective state-dependent changes in the brain functional network in major depressive disorder

In major depressive disorder (MDD), as a network-level disease, the pathophysiology would be displayed to a wide extent over the brain. Moreover, the network-wide changes could be dependent on the context of affective processing. In this study, we sought affective state-dependent changes of the brain functional network by applying a graph-theoretical approach to functional magnetic resonance imaging data acquired in 13 patients with MDD and 12 healthy controls who were exposed to video clips inducing the negative, neutral or positive affective state. For each affective condition, a group-wise brain functional network was constructed based on partial correlation of mean activity across subjects between brain areas. Network parameters, global and local efficiencies, were measured from the brain functional network. Compared with controls', patients' brain functional network shifted to the regular network in the topological architecture, showing decreased global efficiency and increased local efficiency, during negative and neutral affective processing. Further, the shift to the regular network in patients was most evident during negative affective processing. MDD is proposed to provoke widespread changes across the whole brain in an affective state-dependent manner, specifically in the negative affective state.

Psychometric properties of the Korean version of stanford acute stress reaction questionnaire

The present study aimed to examine the psychometric properties of the Korean version of Stanford Acute Stress Reaction Questionnaire (SASRQ). A Korean version of the SASRQ was produced through forward translation, reconciliation, and back translation. A total of 100 healthy, non-clinical participants were selected through screening and clinical interview, and they each were given a set of questionnaires including SASRQ. Psychometric properties of SASRQ were then examined through statistical analyses. Full-scale and subscales of SASRQ yielded excellent internal consistency (Cronbach's alpha=0.98 and 0.78-0.95, respectively). Test-retest reliability at 2-week intervals was satisfactory, with coefficient r ranging between 0.47 and 0.71. Convergent validity was also demonstrated by strong correlations between SASRQ and other trauma-related questionnaires. Correlation with Social Desirability Scale, however, was not found to be significant; thus evidenced divergent validity. The Korean version of SASRQ appears to be a reliable and valid measurement tool for assessing symptoms of acute stress disorder. Including clinical samples for comparison with controls would be necessary in future studies.

Psychometric properties of the Korean version of the Interpersonal Sensitivity Measure (IPSM-K)

The aim of this study was to investigate the psychometric properties of a Korean version of Interpersonal Sensitivity Measure (IPSM). A Korean version of the IPSM (IPSM-K) was produced through forward translation, reconciliation, and back translation. A total of 338 healthy, non-clinical participants were selected through screening and clinical interview, and they each were given a set of questionnaires including IPSM-K. All subscales, as well as a full-scale IPSM-K showed satisfactory internal consistency (Cronbach's alpha=0.73-0.83 and 0.94, respectively). Test-retest reliability at 2-week intervals was significant, with coefficient r ranging between .80 and .94. In terms of convergent validity, IPSM-K showed the significant positive correlation with sociotropy and autonomy subscale of Personal Style Inventory-II, as well as with neuroticism subscale of Neuroticism Extraversion Openness-Personality Inventory. IPSM-K had no correlation with Social Desirability Scale, thus demonstrated divergent validity with social desirability. A factor analysis of the scale was conducted and five factors emerged (low self-confidence, interpersonal awareness, lack of assertiveness/separation anxiety, interpersonal vulnerability, and need for approval). This study demonstrated that IPSM-K could be useful in assessing interpersonal sensitivity in Korean population.

Threat-induced autonomic dysregulation in panic disorder evidenced by heart rate variability measures

OBJECTIVE

The objective was to compare autonomic response to threatening stimuli between patients with panic disorder (PD) and healthy volunteers by using 5-min recordings of heart rate variability (HRV).

METHODS

Twenty-seven patients with PD and 20 healthy controls were recruited. The first 5-min measurement of HRV was conducted at resting state. HRV measurement during threatening stimuli was conducted while participants were viewing 15 threatening pictures. Spectral analyses measures included high-frequency (HF; 0.15-0.4 HZ) component, low-frequency (LF; 0.04-0.15 Hz) component and LF/HF ratio.

RESULTS

There was no significant HRV difference between the two groups at the resting state. During threatening stimuli, the PD group had significantly higher LF power and LF/HF ratio and significantly lower HF power than the healthy controls (for all, P<.01). A two-way analysis of variance was employed to determine the effect of group (patient and control) and condition (threatening and resting) on all three HRV measures. The analysis showed a significant main effect of group (F=12.21; P<.01), condition (F=14.21; P<.001) and interaction effect between group and condition (F=4.83; P<.05) on LF/HF ratio.

CONCLUSIONS

The findings from the present study suggest that patients with PD exhibit a sympathetic predominance when faced with threatening stimuli compared with normal control subjects.

Development and Standardization of Extended ChaeLee Korean Facial Expressions of Emotions

OBJECTIVE

In recent years there has been an enormous increase of neuroscience research using the facial expressions of emotion. This has led to a need for ethnically specific facial expressions data, due to differences of facial emotion processing among different ethnicities.

METHODS

FIFTY PROFESSIONAL ACTORS WERE ASKED TO POSE WITH EACH OF THE FOLLOWING FACIAL EXPRESSIONS IN TURN: happiness, sadness, fear, anger, disgust, surprise, and neutral. A total of 283 facial pictures of 40 actors were selected to be included in the validation study. Facial expression emotion identification was performed in a validation study by 104 healthy raters who provided emotion labeling, valence ratings, and arousal ratings.

RESULTS

A total of 259 images of 37 actors were selected for inclusion in the Extended ChaeLee Korean Facial Expressions of Emotions tool, based on the analysis of results. In these images, the actors' mean age was 38±11.1 years (range 26-60 years), with 16 (43.2%) males and 21 (56.8%) females. The consistency varied by emotion type, showing the highest for happiness (95.5%) and the lowest for fear (49.0%). The mean scores for the valence ratings ranged from 4.0 (happiness) to 1.9 (sadness, anger, and disgust). The mean scores for the arousal ratings ranged from 3.7 (anger and fear) to 2.5 (neutral).

CONCLUSION

We obtained facial expressions from individuals of Korean ethnicity and performed a study to validate them. Our results provide a tool for the affective neurosciences which could be used for the investigation of mechanisms of emotion processing in healthy individuals as well as in patients with various psychiatric disorders.

Symptom severity of panic disorder associated with impairment in emotion processing of threat-related facial expressions

AIM

To compare emotion recognition patterns between patients with panic disorder (PD) and healthy volunteers and to analyze the correlation between the degree of emotion recognition impairment and symptom severity in patients with PD.

METHODS

Twenty-four patients with PD and 20 healthy controls were tested with a facial emotional expression recognition task involving four basic emotions (i.e. happiness, sadness, anger, and fear). Emotion recognition measures included the recognition threshold, response time, response time of correctly classified emotions (response time_crt), and recognition error. An average of all four emotions for each emotion recognition measure was compared between the two groups and then a comparison of recognition measures for each specific emotion was conducted. The correlations between severity of the State-Trait Anxiety Inventory, Beck Depression Inventory (BDI), and Panic Disorder Severity Scale with emotion recognition indices were also analyzed.

RESULTS

Average recognition threshold was significantly higher in the PD group compared to the control group. In the PD group, there was a non-significant trend of increase in the emotion recognition threshold for fear and the response time for anger compared with the control group. In the correlation analysis, higher trait anxiety was associated with slower response time_crt for anger and a higher BDI score was associated with slower response times and response time_crt for happiness and anger.

CONCLUSION

This study suggests that symptom severity of PD might be associated with impairment in emotion processing of threat-related facial expressions.

Characteristics of drug overdose in young suicide attempters

Objective

Few studies have focused on the characteristic features of drug overdose in children and adolescents who have attempted suicide in Korea. The present study examined the characteristics of drug overdose in children and adolescents who visited the emergency room following drug ingestion for a suicide attempt.

Methods

The medical records of 28 patients who were treated in the emergency room following a drug overdose from January 2008 to March 2011 were analyzed. Demographic and clinical variables related to the suicide attempts were examined.

Results

The mean age of the patients was 16.6±1.7 years (range 11-19 years), and 20 of the patients (71.4%) were female. Most of the patients (n=23, 82.1%) overdosed on a single drug; acetaminophen-containing analgesics were the most common (n=12, 42.9%). Depression was the most common psychiatric disorder (n=22, 78.6%), and interpersonal conflict was the most common precipitating factor of the suicide attempts (n=11, 39.3%). This was the first suicide attempt for approximately 80% of the patients. About one fourth of the patients (n=7, 25%) had follow-up visits at the psychiatric outpatient clinic.

Conclusion

Early screening and psychiatric intervention for depression may be an important factor in preventing childhood and adolescent suicide attempts. Developing coping strategies to manage interpersonal conflicts may also be helpful. Moreover, policies restricting the amount and kind of drugs purchased by teenagers may be necessary to prevent drug overdose in this age group.

Impact of early-life stress and resilience on patients with major depressive disorder

PURPOSE

Early-life stress (ELS) has a long-lasting effect on affective function and may entail an increased risk for major depressive disorder (MDD). However, resilience can play a protective role against developing psychopathology. In this study, we investigated the relationships of depressive symptoms with ELS and resilience in MDD.

MATERIALS AND METHODS

Twenty-six patients with MDD as well as age- and gender-matched healthy controls were included in this study. Each subject was assessed concerning ELS, resilience, and depressive symptom severity with self-report questionnaires. Independent samples t-test and Mann-Whitney test were performed to compare ELS and resilience between the patient and control groups. Spearman correlation analyses and linear regression analysis were conducted to investigate significant ELS and resilience factors associated with depressive symptoms.

RESULTS

In the MDD patient group, subjects reported greater exposure to inter- parental violence, and five factor scores on the resilience scale were significantly lower in comparison to the control group. In linear regression analysis, in regards to resilience, depressive symptom score was significantly associated with self-confidence and self-control factors; however, ELS demonstrated no significant association with depressive symptoms.

CONCLUSION

Among resilience factors, self-confidence and self-control may ameliorate depressive symptoms in MDD. ELS, including inter-parental violence, physical abuse and emotional abuse, might be a risk factor for developing depression. Assessment of early-life stress and intervention programs for increasing resilience capacity would be helpful in treating MDD.

The Korean version of the Connor-Davidson Resilience Scale: an extended validation

The Connor-Davidson Resilience Scale (CD-RISC) is a brief self-rating questionnaire for measuring resilience. The aims of the present study were to describe the development of a Korean version of the CD-RISC (K-CD-RISC) and to more firmly establish its psychometric properties in terms of reliability and validity. The participants consisted of a general population sample (n=194) and psychiatric outpatients (n=127) with non-psychotic mood or anxiety disorders. The K-CD-RISC score means (standard deviation) were 65.9 (13.6) in the general population and 50.4 (20.5) in the psychiatric outpatients. The mean score of the general population was significantly higher than that of the psychiatric outpatients. Exploratory factor analysis revealed five factors, and the obtained factor structure was verified through confirmatory factor analysis. In the general population, the Cronbach's α coefficient of the K-CD-RISC was found to be 0.92. Greater resilience was found to be associated with less perceived stress, anxiety and depression and with higher levels of positive affect and purpose in life. Taken together, our findings suggest that the K-CD-RISC has good psychometric properties and is a valid and reliable tool for assessing resilience.

The impact of personality traits on emotional responses to interpersonal stress

Objective

The aim of the present study was to examine the impact of personality traits on emotional responses to interpersonal stress.

Methods

Thirty-two healthy college students (18 men, 14 women; age 25.2±2.7 years) participated in the study. Mood and anxiety were assessed with the Beck Depression Inventory and the State Trait Anxiety Inventory. Personality traits were assessed with the Interpersonal Sensitivity Measure (IPSM). The subjective emotional responses of participants to different (i.e., negative, neutral, and positive) interpersonal feedback were measured.

Results

Subject responses were positive to positive interpersonal feedback and negative to negative interpersonal feedback. The IPSM fragile inner self subscore was negatively correlated with the subjective emotional ratings in response to interpersonal feedback. No correlation was found between validation measures (i.e., the degree of attention in the task and task difficulty) and subjective emotional responses.

Conclusions

Taken together, emotional responses to interpersonal stress may be modulated by personality traits and may impact health and psychological outcomes. Therefore, proper screening and stress management programs that focus on personality traits may improve the mental health of college students.

Time to discontinuation among the three second-generation antidepressants in a naturalistic outpatient setting of depression

AIM

This study compared the discontinuation time among the three second-generation antidepressants (paroxetine, venlafaxine, and mirtazapine) in a naturalistic setting for outpatient treatment of depression.

METHODS

This study used data from retrospectively reviewed medical records of patients admitted to an outpatient psychiatric clinic between January 2003 and December 2005. Patient groups (paroxetine-, venlafaxine-, and mirtazapine-treated) were compared with each other with regard to their discontinuation times for a 6-month period after treatment initiation. The data were analyzed, using a Kaplan-Meier survival analysis, and a Cox proportional hazards regression model.

RESULTS

There were no significant differences in discontinuation times among the three second-generation antidepressants during the 6-month period after initiation of drug therapy.

CONCLUSIONS

In a naturalistic setting for the care of depression, it seems that there are no differences in discontinuation times among these three second-generation antidepressants.

A validation study of the Korean version of SPAN

PURPOSE

The SPAN, which is acronym standing for its four components: Startle, Physiological arousal, Anger, and Numbness, is a short post-traumatic stress disorder (PTSD) screening scale. This study sought to develop and validate a Korean version of the SPAN (SPAN-K).

MATERIALS AND METHODS

Ninety-three PTSD patients (PTSD group), 73 patients with non-psychotic psychiatric disorders (psychiatric control group), and 88 healthy participants (normal control group) were recruited for this study. Participants completed a variety of psychiatric assessments including the SPAN-K, the Davidson Trauma Scale (DTS), the Clinician-Administered PTSD Scale (CAPS), and the State-Trait Anxiety Inventory (STAI).

RESULTS

Cronbach's α and test-retest reliability values for the SPAN-K were both 0.80. Mean SPAN-K scores were 10.06 for the PTSD group, 4.94 for the psychiatric control group, and 1.42 for the normal control group. With respect to concurrent validity, correlation coefficients were 0.87 for SPAN-K vs. CAPS total scores (p<0.001) and 0.86 for SPAN-K vs. DTS scores (p<0.001). Additionally, correlation coefficients were 0.31 and 0.42 for SPAN-K vs. STAI-S and STAI-T, respectively. Receiver operating characteristic analysis of SPAN-K showed good diagnostic accuracy with an area under the curve (AUC) of 0.87. The SPAN-K showed the highest efficiency at a cutoff score of 7, with a sensitivity of 0.83, a specificity of 0.81, positive predictive value (PPV) of 0.88, and negative predictive value (NPV) of 0.73.

CONCLUSION

These results suggest that the SPAN-K had good psychometric properties and may be a useful instrument for rapid screening of PTSD patients.

Hippocampal shape deformation in female patients with unremitting major depressive disorder

BACKGROUND AND PURPOSE

The hippocampal atrophy of MDD has been known, but the region shape contractions of the hippocampus in MDD were inconsistent. Spheric harmonic shape analysis was applied to the hippocampus in female patients with unremitting MDD to evaluate morphometric changes of the hippocampus.

MATERIALS AND METHODS

Shape analysis was performed by using T1-weighted MR imaging in 21 female patients with MDD and 21 age- and sex-matched healthy controls. Manually segmented hippocampi were parameterized, and the point-to-point-based group difference was compared by using the Hotelling T-squared test. The partial correlation analyses were tested between clinical variables and shape changes.

RESULTS

Both hippocampal volumes were small in patients with MDD compared with healthy controls, and the right hippocampal volume was negatively correlated with the number of episodes at marginal significance. Regional shape contractions were found in the ambient gyrus, basal hippocampal head, posterior subiculum, and dorsal hippocampus of the left hemisphere. The right hippocampus showed a similar pattern but was less atrophic compared with the left hippocampus. A negative correlation was found between the HDRS and shape deformation in the CA3, ambient gyrus, posterior subiculum, and gyrus fasciolaris of the left hippocampus.

CONCLUSIONS

We showed atrophy and regional shape contractions in the hippocampi of patients with MDD, which were more dominant on the left side. The causes of hippocampal damage could be the hypersecretion of glucocorticoids contributing to neuronal death or the failing of adult neurogenesis in the dentate gyrus.

Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period

BACKGROUND

The pattern of gastric cancer in the Western world is changing, with an increased proportion of tumours in the upper stomach. The aim of this study was to investigate changes in clinicopathological features and survival of patients with resected gastric cancer at a single institution, in an area of high incidence in the Far East.

METHODS

Clinical features and pathological findings were compared in patients with gastric cancer who underwent gastrectomy at Seoul National University Hospital during four consecutive periods (1986-1990, 1991-1995, 1996-2000 and 2001-2006).

RESULTS

There were 12 026 patients. The mean age increased from 53·4 years in the first period to 57·4 years in the last (P < 0·001). The proportion of patients aged 70 years or older also increased, reaching 16·1 per cent in the final period. Upper-third cancer increased from 5·3 per cent in the first period to 14·0 per cent in the fourth (P < 0·001). Early gastric cancer (pathological T1) increased continuously over the four time intervals, from 24·8 to 48·9 per cent (P < 0·001). The overall 5-year survival rate increased from 64·0 per cent in the first period to 73·2 per cent at the end (P < 0·001), and this survival improvement was apparent in patients aged 40 years or more.

CONCLUSION

The mean age of patients with gastric cancer has increased during the past 20 years. The proportion of early gastric cancer and overall survival have gradually increased, especially in patients aged over 40 years.

Deficits in facial emotion recognition in schizophrenia: a replication study with korean subjects

OBJECTIVE

We investigated the deficit in the recognition of facial emotions in a sample of medicated, stable Korean patients with schizophrenia using Korean facial emotion pictures and examined whether the possible impairments would corroborate previous findings.

METHODS

Fifty-five patients with schizophrenia and 62 healthy control subjects completed the Facial Affect Identification Test with a new set of 44 colored photographs of Korean faces including the six universal emotions as well as neutral faces.

RESULTS

Korean patients with schizophrenia showed impairments in the recognition of sad, fearful, and angry faces [F(1,114)=6.26, p=0.014; F(1,114)=6.18, p=0.014; F(1,114)=9.28, p=0.003, respectively], but their accuracy was no different from that of controls in the recognition of happy emotions. Higher total and three subscale scores of the Positive and Negative Syndrome Scale (PANSS) correlated with worse performance on both angry and neutral faces. Correct responses on happy stimuli were negatively correlated with negative symptom scores of the PANSS. Patients with schizophrenia also exhibited different patterns of misidentification relative to normal controls.

CONCLUSION

These findings were consistent with previous studies carried out with different ethnic groups, suggesting cross-cultural similarities in facial recognition impairment in schizophrenia.

Validation of limited lymphadenectomy for lower-third gastric cancer based on depth of tumour invasion

BACKGROUND

This study aimed to determine the appropriate extent of lymph node (LN) dissection in gastric cancer by analysing LN metastasis patterns from prospectively collected topographical data on nodal status at Seoul National University Hospital, Korea.

METHODS

The metastasis rate for each LN station was analysed according to the depth of tumour invasion in patients with primary lower-third gastric cancer who underwent curative gastrectomy. The Maruyama Index of unresected disease (MI) was calculated using the WinEstimate(®) program with simulation of various extents of LN dissection.

RESULTS

LN metastasis in mucosal cancer was rare; 2·6 per cent of patients had a MI of more than 5 with simulation of D1 plus station 7 dissection, whereas 0·9 per cent had a MI above 5 with D1 plus stations 7 and 8a. In submucosal cancer, 3·3 per cent of tumours metastasized to level 2 LN stations outside the range of D1 plus stations 7, 8a and 9. The proportion of patients with a MI above 5 was 9·0 per cent with D1 plus stations 7, 8a and 9 dissection. The nodal metastasis rate was higher at level 1 and 2 for muscularis propria or deeper cancers.

CONCLUSION

D1 dissection plus stations 7 and 8a for mucosal cancer, and D2 dissection for cancers of the muscularis propria or deeper seems appropriate. For submucosal cancer, an expanded dissection to the D2 level should be considered to ensure complete removal of metastatic LNs.

Reliability and validity of the korean version of the connor-davidson resilience scale

OBJECTIVE

The Connor-Davidson Resilience Scale (CD-RISC) measures various aspects of psychological resilience in patients with posttraumatic stress disorder (PTSD) and other psychiatric ailments. This study sought to assess the reliability and validity of the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC).

METHODS

In total, 576 participants were enrolled (497 females and 79 males), including hospital nurses, university students, and firefighters. Subjects were evaluated using the K-CD-RISC, the Beck Depression Inventory (BDI), the Impact of Event Scale-Revised (IES-R), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale (PSS). Test-retest reliability and internal consistency were examined as a measure of reliability, and convergent validity and factor analysis were also performed to evaluate validity.

RESULTS

Cronbach's alpha coefficient and test-retest reliability were 0.93 and 0.93, respectively. The total score on the K-CD-RISC was positively correlated with the RSES (r=0.56, p<0.01). Conversely, BDI (r=-0.46, p<0.01), PSS (r=-0.32, p<0.01), and IES-R scores (r=-0.26, p<0.01) were negatively correlated with the K-CD-RISC. The K-CD-RISC showed a five-factor structure that explained 57.2% of the variance.

CONCLUSION

The K-CD-RISC showed good reliability and validity for measurement of resilience among Korean subjects.

Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting

OBJECTIVE

Antidepressants used to treat depression are frequently associated with sexual dysfunction. Sexual side effects affect the patient's quality of life and, in long-term treatment, can lead to non-compliance and relapse. However, studies covering many antidepressants with differing mechanisms of action were scarce. The present study assessed and compared the incidence of sexual dysfunction among different antidepressants in a naturalistic setting.

METHODS

Participants were married patients diagnosed with depression, per DSM-IV diagnostic criteria, who had been taking antidepressants for more than 1 month. We assessed the participants via the Arizona Sexual Experiences Scale (ASEX), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI), and assessed their demographic variables, types and dosages of antidepressants, and duration of antidepressant use via their medical records.

RESULTS

One hundred and one patients (46 male, 55 female, age 42.2+/-7 years) completed the instruments. Thirteen were taking fluoxetine (mean dose 21.3+/-8.5 mg/day), 24 were taking paroxetine (mean dose 20.4+/-7.2 mg/day), 20 taking citalopram (mean dose 22.1+/-6.5 mg/day), 22, venlafaxine (mean dose 115.7+/-53.2 mg/day) and 22, mirtazapine (mean dose 18+/-8.7 mg/day). Mean ages, sex ratios, and BDI and STAI scores did not differ significantly across antidepressants. A substantial number of participants (46.5%, n=47) experienced sexual dysfunction. The prevalence of sexual dysfunction differed across drugs: citalopram 60% (n=12), venlafaxine 54.5% (n=12), paroxetine 54.2% (n=13), fluoxetine 46.2% (n=6), and mirtazapine 18.2% (n=4). Regression analyses revealed the significant factors for sexual dysfunction were being female, total scores on the BDI and SAI, and type of antidepressant (F=4.92, p<0.0001). Of the antidepressants, the mirtarzapine group's total ASEX score was significantly lower than the scores of the citalopram, fluoxetine, and paroxetine groups.

CONCLUSION

The incidence of sexual dysfunction was substantially high during antidepressant treatment. The incidence of sexual dysfunction differed among antidepressants having different mechanisms of action. Our study suggests the need for clinicians to consider the impact of pharmacotherapy on patients' sexual functioning in the course of treatment with antidepressants.

Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines

BACKGROUND

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely performed. Indications for these procedures have been extended in Korea and Japan. The aim was to evaluate whether these extended indications are safe.

METHODS

All patients who had surgery for early gastric cancer at Seoul National University Bundang Hospital between May 2003 and December 2007 were identified from a prospective database. Lymph node status was examined in patients who met extended indications for EMR and had undergone surgical resection.

RESULTS

Of patients with mucosal cancers, 129 met extended indications for EMR or ESD and three (2.3 per cent) had lymph node metastasis. Of the 52 submucosal cancers meeting extended indications for EMR or ESD, two (4 per cent) had lymph node metastasis. Differentiated mucosal cancers without ulcer formation did not have lymph node metastasis, irrespective of size.

CONCLUSION

Extending the indications for EMR and ESD according to the Japanese Gastric Cancer Association guidelines carries an increased risk of lymph node metastasis. For cancers meeting these criteria, treatment by gastric resection with lymph node dissection should still be considered. A well differentiated mucosal cancer of any size without ulceration may be considered as an extended indication for EMR or ESD.

The impact of executive function on emotion recognition and emotion experience in patients with schizophrenia

OBJECTIVE

This study investigated the impact of executive function on the performance of two different affective tasks, the Facial Affect Identification Task (FAIT) and the Iowa Gambling Task (IGT), in patients with schizophrenia.

METHODS

Thirty-nine patients with schizophrenia and 33 healthy controls completed the FAIT and the IGT, followed by the Wisconsin Card Sorting Test (WCST) and the intelligence quotient (IQ) test. In addition to correlation analysis, regression analysis was used to determine the extent to which the performance of the WCST, in particular, perseverative error (PE), accounted for the variation in both the FAIT and the IGT.

RESULTS

Relative to normal controls, patients with schizophrenia showed significant impairments in the IGT, the FAIT and the WCST even after controlling for IQ. While normal controls did not show any relationships between the WCST and two affective tasks, patients with schizophrenia showed that variables in the WCST correlated not only with the FAIT total correct score (r=-0.503, p=0.001 for PE) but also with the IGT net score (r=0.385, p=0.016 for PE). The PE score was a better predictor of the performance on the FAIT (R(2)=0.25) than that of the performance on the IGT (R(2)=0.15).

CONCLUSION

Our findings imply that deficits in executive function in schizophrenia can affect performance on facial emotion recognition task more than performance on task based on emotion experience, that is, the feedback from the body. Therefore, more consideration is needed of the impact of executive function when interpreting the result of "conventional" facial affect recognition tests as opposed to interpreting the IGT.

Efficacy and safety of quetiapine for depressive symptoms in patients with schizophrenia

OBJECTIVE

To investigate the efficacy and safety of quetiapine for depressive symptoms in patients with schizophrenia.

METHOD

Thirty-nine patients fulfilling DSM-IV-TR diagnostic criteria for schizophrenia and had depressive symptoms were studied in a prospective 6-week open-label design using quetiapine monotherapy. The brief psychiatric rating scale (BPRS), 17-item Hamilton depression rating scale (HAMD-17), Simpson-Angus rating scale, and the Barnes Akathisia rating scale (BARS) were used to assess patients at baseline, week 1, 2, 4, and 6.

RESULTS

Thirty patients (76.9%) completed this study. The dose of quetiapine at endpoint was 583 (+/-235 SD) mg/day. Treatment with Quetiapine was associated with significantly reduced depressive symptoms (HAMD-17 total score and BPRS depression/anxiety subscale) from the first week of treatment. Changes of mean score from baseline to endpoint were 7.8 +/- 6.2 for HAMD-17 total score and 3.4 +/- 3.6 for BPRS depression/anxiety subscale (LOCF, n = 39, p < 0.001). Quetiapine was well tolerated, with minimal extrapyramidal symptoms and non-significant increase in body weight (mean increase of 0.8 kg).

CONCLUSIONS

While the interpretation of findings from the open-label design of this study warrants appropriate caution, the results suggest that quetiapine may be an effective and tolerable treatment for depression in patients with schizophrenia.

Reliability and validity of the Korean version of the Impact of Event Scale-Revised

OBJECTIVES

The aim of this study was to explore the reliability and validity of the Impact of Event Scale-Revised Korean version (IES-R-K), a self-report scale for assessment of posttraumatic stress disorder (PTSD).

METHODS

The original Impact of Event Scale-Revised was translated into Korean, and the comparability of content was verified through back-translation procedures. This multicenter study included 93 patients with PTSD, 73 nonpsychotic psychiatric patients, and 88 healthy controls drawn from 18 hospitals across the country. The subjects were assessed using IES-R-K, Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory, and State Trait Anxiety Inventory (STAI; state anxiety subscale [STAI-S], trait anxiety subscale [STAI-T]) scales.

RESULTS

In the reliability test, Cronbach alpha coefficient and test-retest reliability were .93 and 0.91, respectively, indicating that the IES-R-K has good internal consistency. One-way analysis of variance revealed significant differences in IES-R-K scores among the patients with PTSD, nonpsychotic psychiatric patients, and healthy controls (F = 139.1, P < .001). Duncan post hoc test showed the significant differences among the 3 groups. To assess the validity of the IES-R-K, correlation coefficient between the IES-R-K and CAPS, STAI-S, and STAI-T was calculated. We found that there was a relatively high degree of correlation between the IES-R-K and CAPS (r = 0.92, P < .001). However, there was a relatively less degree of correlation between STAI-S and STAI-T and IES-R-K (r = 0.30, P < .001). Taken these together, IES-R-K showed good discriminant validity.

CONCLUSION

The IES-R-K showed good reliability and validity for the assessment of PTSD symptom severity. The IES-R-K is a useful instrument for assessing PTSD symptoms in Korea.