Prevalence of Suicide Behaviors(Suicidal Ideation and Suicide Attempt) and Risk Factors of Suicide Attempts in Junior and High School Adolescents / 신경정신의학

OBJECTIVES: Aims of this study were 1) to estimate prevalence rates of suicidal ideation and suicide attempt, 2) to find out whether the gender difference and age difference(13-15 years vs 16-18 years) for suicide behaviors exist, 3) to analyse correlates of suicide attempts among junior and high school adolescents aged 13-18 years old. METHODS: A self-administered questionnaire was used in a cluster random sample of 2,203 school adolescents(male 1,105, female 1,098). Data were obtained on a wide range of constructs including suicidal ideation and attempts during past 2 weeks, depressive symptoms, symptoms of DSM-IV alcohol dependence, family structure, socioeconomic status, smoking, satisfaction with school achievements, and subjective health status. Chi-square test were done for analysing gender difference and age difference of suicide behaviors. Statistical analyses including uni-variate and multi-variate logistic regression analysis were done for each sex, respectively. RESULTS: 1) The prevalence of suicide ideation during past 2 week was 30.7% in the total sample. The prevalence rates of male and female ideators were 26.9% and 34.9% respectively. The prevalence of suicide attempt during past 2 week was 5.3% in the total sample. The prevalence of suicide attempt in males was 3.4% and 7.3% in females. 2) Gender difference was significant. That is, female respondents showed higher rate of suicidal ideation and suicide attempt. In our study age difference was found only at the rate of suicide attempt. That is, older adolescents(16-18 years) showed only statistically significant higher rate of suicide attempt than younger adolescents(13-15 years). 3) Multi-variate logistic regression analysis revealed that the correlates for suicide attempt were female, moderate to severe depressive symptoms, alcohol dependence in the total sample. In males the correlate for suicide attempt was alcohol dependence. In females, were moderate to severe depressive symptoms, and alcohol dependence. CONCLUSION: Depressive symptoms, alcohol dependence, presence of suicidal ideation were strong predictors for suicide attempts. This suggest that early detection of treatment of depression and alcohol dependence is important and psychiatric approach and follow-up be needed for the prevention of suicide.

Relationships between Temperament and Character Dimensions, Family Environmental Factors and Antisocial Personality Traits in Detained Delinquent Adolescents / 신경정신의학

OBJECTIVES: The purpose of the study was to examine the relationships between temperament and character dimensions and family environments, and to investigate the influences of those factors on the antisocial personality traits in delinquent adolescents. METHODS: The subjects consisted of 160 male adolescents detained at the public prosecutor's office on the suspicion of crimes. To assess personality dimensions and family environmental factors, the Temperament and Character Inventory(TCI) and the Family Environment Scale(FES) were completed. Antisocial personality traits were assessed by the number of antisocial personality disorder symptoms of the Personality Disorder Questionnaire-Revised. RESULTS: Most of the TCI dimensions except Reward Dependence(RD) were highly correlated with the subscales of FES. Among temperament dimensions, Novelty Seeking(NS) and Persistence(P) were significantly affected by Organization, and Harm Avoidance(HA) was influenced by Expressiveness of FES. Self-Directednss(SD) was best predicted by Organization and Achievement-Orientation. While the Independence had significant effect on Cooperativeness, Expressiveness and Achievement-Orientation best predicted the level of Self-Transcendence(ST). On factor analysis, NS, HA, SD and ST were allocated to the same factors with subscales of FES. The level of antisocial personality trait was best predicted by NS, P and SD scores of TCI, and conflict subscale scores of FES. CONCLUSION: The findings of this study suggest that not only the character dimensions but also the temperament dimensions have close relationships with family environmental factors, and that the antisocial personality traits of delinquent adolescents may developed by the interaction between temperament/character dimensions and family environments.

Factors Predicting Recidivism within 6 Months after Release among Arrested Delinquent Adolescents / 신경정신의학

OBJECTIVES: This study was performed to investigate the factors predicting recidivism within 6 months after release in arrested juvenile delinquents for proper screening and intervention of high-risk subjects. METHODS: The subjects consisted of 125 arrested male adolescents who were released after legal procedure in prosecutor office and court. The socio-demographic and crime-related characteristics were evaluated by police records, and the familial, psychopathology and personality characteristics, and the level of moral development measured by the Conflict Tactics Scale(CTS), Family Environment Scale(FES), Parental Behavioral Inventory, Symptom Checklist-90-Revised(SCL-90-R), Beck Depression Inventory, Beck Anxiety Inventory, Korean form of Moral Developmental Inventory for adolescents, and Personality Disorder Questionnaire-Revised(PDQ-R). RESULTS: The recidivism rate within 6 months after release was 44% of the initial sample. Recidivists were younger and had higher scores on Anger-hostility scale of SCL-90-R and lower principle morality score than nonrecidivists. More recidivists had history of physical abuse and antisocial personality disorder on PDQ-R than nonrecidivists. They also showed the crimerelated characteristics of lower percent of violence crime, higher incidence of previous conviction, younger age of the first crime. Among those variables, logistic regression showed that age of first crime, antisocial personality disorder, and history of physical abuse best predicted the recidivism within 6months after release. CONCLUSION: These results of present study suggest that the recidivism rate of arrested male adolescents is very high, and the age of first crime, antisocial personality disorder and history of physical abuse were key factors predicting recidivism. To prevent repeated crime of delinquent adolescents, the development of programs for those high-risk groups to help rehabilitation and adaptation in community would be essential.

A Study for Improvement of Faculty Mentoring Program in Gachon Medical School / 한국의학교육

To foster humanistic physician, and to support medical students with the many adjustment problems which they commonly encounter in medical school, more personal and closer relationships between faculty members and students are warranted. This study was carried out to investigate faculties' and student's perceptions of the mentoring program in Gachon medical school. A total of 90 faculty members and 131 students responded to questionnaires. Most of the faculties and students believe this program to hold an important role in medical education. While majority of faculty members thought that the most important purpose of the program is to develop student attitudes by being a positive role model, most students perceived the development of personal relationships with faculties as being the most important. In addition, both faculty members and students listed an interest in education, as well as compassion for students as being important characteristics of a good mentor. With regard to perceived or anticipated problems of this program, many faculty members pointed to a lack of time and experience, while students indicated faculty members' passive attitudes and lack of interest in cultivating relationships with students. Findings from this study suggest several directions for improvement. First, to encourage active participation, students and faculties must understand the purpose of this program. Second, a training program to develop mentoring abilities should be provided for faculty. Third, a network among cooperating services should be introduced to keep this program running more effectively. Further, mentors and students should have regular meetings to promote closer relationships between them. This improved faculty mentoring program can serve as a continuing basis to facilitate personal and professional development of medical students.

Designing of an Education Model for Career Planning in Medical Schools / 한국의학교육

The purpose of educational effort for career planning in medical school is to help students develop identity as a competent physician and to assist them in selecting their future career properly. To achieve the above, the specific education programs for career plan together with an individual counselling and problem solving approach are required. We proposed an education model for career planning in Gachon Medical School which would be directed by cooperative system consisted of medical school, faculty mentor and student counselling office. Career education should not be limited to several lectures or short-term counselling, but it requires a continuous and consistent program implemented throughout 6 years of medical school life. At the same time, an opportunity to explore future career and to consult their problems in accord with needs and characteristics of individual students must be provided. Further study should be directed to examine the usefulness and problems of this education model. In addition, a persistent attention to the problems in career planning of medical students and efforts to solve them is needed.

Clinical Study of Posterior Chamber Lens Implant in 1000 Eyes

The authors compared and analysed planned extracapsular cataract extraction(ECCE) and Kelman phacoemulsification(KPE) on the 1000 cases out of 1546 cases which had undergone cataract operation during the period of September, 1983 through June, 1989. The results were as follows; 1. Postoperative visual acuity of 0.5 or better was achieved in 96%(960 eyes) and 1.0 or better in 67.6%(676 eyes). Average of visual acuity was similar each other: 0.92 +/- 0.24 in planned ECCE and 1.00 +/- 0.21 in KPE. 2. The mean spherical equivalent of required spectacle lens power was similar too: -1.07D +/- 1.51 in total, -1.08D +/- 1.57 in planned ECCE and -1.05D +/- 1.42 in KPE. 3. The mean postoperative astigmatism was -0.81D +/- 1.05 in total, -0.98D +/- 1.15 in planned ECCE and -0.54D +/- 0.79 in KPE. There was significant correlation between two groups(P<0.01). 4. The difference between predicted and postoperative refraction in terms of spherical equivalent was -0.36D +/- 1.12 in total, -0.36D +/- 1.12 in planned ECCE and -0.37D +/- 1.11 in KPE with no significant different value. The difference by Binkhorst formula was -0.50D +/- 1.10, and -0.06D +/- 1.09, the significant correlative value by regression SRK formula(P<0.05). 5. Mean changes of corneal refractive power was 0.43D +/- 0.99 in horizontal meridian and -0.21D +/-1.14 in vertical meridian in planned ECCE and 0.23D +/- 0.72 in horizontal meridian and 0.01D +/- 0.90 in vertical meridian in KPE. There was significant correlation between two groups(P<0.01). 6. The correlation between postoperative corneal astigmetism and actual astigmatism by skiascopy was very close: regression coefficient was 0.64087 in total, 0.62698 in planned ECCE and 0.62026 in KPE respectively(P<0.01).

Clinical Analysis of Glaucoma Triple Procedure of Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined with Trabeculectomy

Glaucoma triple procedure of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy which was undergone in 21 eyes(20 cases) since May 1984, were reviewed. The results as follows. 1. In the distribution of sex and age of 20 patients, 16 patients(75%) were male, and seventies, which were most common, were 9 patients(45.0%); fifties, 5; forties, 1; thirties, 1. The average age was 63.9 years old. 2. In type of glaucoma, chronic open angle glaucoma which was most common, were 14 eyes(66.7%); chronic angle closure glaucoma, 5 eyes(23.8%); aphakic glaucoma, 1 eye(4.8%); secondary glaucoma, 1 eye(4.8%). 3. Visual acuity improved in 20 eyes but unchanged in 1 eye, and 14 eyes(66.7%) achieved visual acuity 0.5 or better. 4. Preoperative mean intraocular pressure(IOP)was 20.9mmHg and postoperative mean IOP was 6.1, 4.5mmHg lower than preoperative level at 2 and 6 months res pectively. 5. 2.1 glaucoma medications was needed preoperatively and 0.7, 0.8 was needed at postoperative 2 and 6 months respectively. 6. There were no serious complications that affected the visual acuity. However minor complications were as follows. Hyphema were 4 eyes(19.0%); mydriasis, 3 eyes(14.3%); flat chamber, 1 eye(14.3%); flat chamber, 1 eye(4.8%); cystoid macular edema, 1 eye(4.8%).