The Link Between Sleep and Diabetes Mellitus:A Literature Review / 우울ㆍ조울병

Sleep, which was previously not a topic for discussion in clinical practice, is now a problem that cannot be disregarded in people with diabetes mellitus. Instead, the importance of sleep has increased for the management and prevention of diabetes mellitus. Diabetes mellitus and dyssomnias are both chronic conditions that have a significant effect on the quality of life and health. Numerous research has shown that the relationship between diabetes mellitus and sleep is bidirectional rather than linear. In this review, not only the effects of diabetes mellitus on sleep, but also the effects of sleep on diabetes mellitus are investigated, and the biological mechanisms are summarized as well.

Serum vitamin D levels and ovarian reserve markers in secondary amenorrhea patients: Is there a link?

Objective@#To investigate whether serum 25-hydroxyvitamin D [25(OH)D] level is associated with ovarian reserve markers in secondary amenorrhea (SA) patients. @*Methods@#Sixty-three women diagnosed with SA were recruited during 12 months from the initiation of this prospective observational study. Serum 25(OH)D levels, serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were estimated in study participants and ovarian reserve markers were compared between participants with vitamin D deficiency and those with normal vitamin D levels. @*Results@#Of the 63 participants, 27 (42.9%) were vitamin D deficient (<20 ng/mL) and 36 (57.1%) had normal vitamin D levels. The mean AMH levels and AFC were 10.86±8.94 µ/L and 15.23±7.65 in the vitamin D deficient group, and 7.24±5.62 µ/L and 12.30±6.95 in the normal vitamin D group. Univariate and multivariate linear regression analysis of log10 transformed AMH and AFC with serum 25(OH)D adjusted for age and body mass index confirmed no association between vitamin D levels and AMH levels or AFC. There was also no correlation between serum 25(OH)D and AMH levels or AFC in all participants. However, participants with vitamin D deficiency had an increased chance of having polycystic ovarian syndrome (PCOS) as cause of SA than those with normal vitamin D levels (adjusted odds ratio, 7.559; 95% confidence interval, 1.28–44.65; P=0.026) after adjustment for clinical factors by logistic regression model. @*Conclusion@#There was no correlation between serum 25(OH)D levels and ovarian reserve markers in SA patients, but vitamin D deficiency may be linked to PCOS patients.

Serum vitamin D levels and ovarian reserve markers in secondary amenorrhea patients: Is there a link?

Objective@#To investigate whether serum 25-hydroxyvitamin D [25(OH)D] level is associated with ovarian reserve markers in secondary amenorrhea (SA) patients. @*Methods@#Sixty-three women diagnosed with SA were recruited during 12 months from the initiation of this prospective observational study. Serum 25(OH)D levels, serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were estimated in study participants and ovarian reserve markers were compared between participants with vitamin D deficiency and those with normal vitamin D levels. @*Results@#Of the 63 participants, 27 (42.9%) were vitamin D deficient (<20 ng/mL) and 36 (57.1%) had normal vitamin D levels. The mean AMH levels and AFC were 10.86±8.94 µ/L and 15.23±7.65 in the vitamin D deficient group, and 7.24±5.62 µ/L and 12.30±6.95 in the normal vitamin D group. Univariate and multivariate linear regression analysis of log10 transformed AMH and AFC with serum 25(OH)D adjusted for age and body mass index confirmed no association between vitamin D levels and AMH levels or AFC. There was also no correlation between serum 25(OH)D and AMH levels or AFC in all participants. However, participants with vitamin D deficiency had an increased chance of having polycystic ovarian syndrome (PCOS) as cause of SA than those with normal vitamin D levels (adjusted odds ratio, 7.559; 95% confidence interval, 1.28–44.65; P=0.026) after adjustment for clinical factors by logistic regression model. @*Conclusion@#There was no correlation between serum 25(OH)D levels and ovarian reserve markers in SA patients, but vitamin D deficiency may be linked to PCOS patients.

Clinical Characteristics of NSSI and Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents / 정신신체의학

OBJECTIVES: The purpose of this study was to examine the prevalence and clinical characteristics of nonsuicidal self-injury (NSSI), and its association with suicide attempts among clinically depressed adolescents in Korea. METHODS: In total, 113 depressed adolescents aged 12– 18 years in South Korea were enrolled in this study. We assessed sociodemographic and clinical characteristics including suicidality and non-suicidal self-injury (NSSI) using various self-reported scales and semi-structured interview for diagnosis of psychiatric disorders. Demographic and clinical characteristics of the subjects were compared between NSSI and non-NSSI groups. We examined significant predictors of suicide attempts using logistic regression analysis. RESULTS: Among 113 depressed participants, 48 (42.1%) adolescents were classified into the NSSI group. In the NSSI group, there were significantly more females, showed higher depression, higher state-anxiety, and more suicide ideation. The most predictive factors of suicide attempts were history of NSSI, observed suicide/NSSI behaviors of their family or friends, and total state anxiety score. CONCLUSIONS: NSSI is more common problem among clinically depressed adolescents and history of NSSI is a significant predictor of present suicide attempts. To include the assessment of NSSI for clinically depressed adolescent may be crucial for intervention programs for high risk adolescents of suicide in Korea.

Relationship Between Metabolic Syndrome and Depression Using Patient Health Questionnaire-9 : 2016 Korea National Health and Nutrition Examination Survey Result Analysis / 우울ㆍ조울병

BACKGROUND: The purpose of this study was to investigate the relationship between metabolic syndrome and depressive symptoms by administering the nine-item depression module from the Patient Health Questionnaire-9 (PHQ-9) to participants from the general population of Korea.METHODS: In total, 8,150 adults participated in the 1st year of the 7th Korea National Health and Nutrition Examination Survey, which was conducted in 2016. Of them, 5,556 participants underwent tests pertaining to the criteria for metabolic syndrome and responded to PHQ-9; 2,594 respondents were excluded. Analysis of covariance was performed to analyze the relationship between the presence of metabolic syndrome and the PHQ-9 score after adjusting for the effects of demographic and hematologic characteristics and underlying diseases.RESULTS: The total PHQ-9 score (mean=2.98) was significantly higher in participants with metabolic syndrome than in those without it (mean=2.59) (p=0.002). Among the individual PHQ-9 items, changes in sleep, thoughts of suicide or self-harm, and depressive mood showed the greatest differences.CONCLUSION: The PHQ-9 scores in Korea were higher in adults with metabolic syndrome, suggesting an association between metabolic syndrome and depressive symptoms.

Relationship between Suicidal Ideation and Plasma C-Reactive Protein Level in General Population : The Korean National Health and Nutrition Examination Survey / 우울ㆍ조울병

OBJECTIVES: The purpose of this study is to inquire into the relationship between the association of suicidal ideation and the plasma C-reactive protein level in the general population.METHODS: This study selected a total of 5,090 subjects who have responded to the survey item on suicidal ideation status, and received the plasma C-reactive protein test, as a research subject using the 2015 data of the National Health and Nutrition Survey. This study conducted a covariance analysis by correcting a potential influence of demographic and hematological factors. Besides, this study intended to define the cut-off value of the optimum plasma C-reactive protein level, which once identified can distinguish between a subject with and without suicidal ideation using the model of the decision tree.RESULTS: The Plasma C-reactive protein level of a subject having suicidal ideation was noted as being significantly higher than the one having no suicidal ideation in the covariance analysis (p=0.046). In addition, the proper cut-off value of the plasma C-reactive protein level between the subjects with and without suicidal ideation was found to be 1.30 mg/L (p=0.003).CONCLUSION: It is noted that the high plasma C-reactive protein level showed a significant correlation with individuals with noted suicidal ideation. In addition, this study has significance in that it presented that the plasma C-reactive protein concentration has the possibility as an accurate and significant marker of suicidal ideation in the general population.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (II): Diagnosis and Assessment

Attention-deficit hyperactivity disorder (ADHD) is a highly prevalent, impairing, and comorbid disorder that persists into adulthood. ADHD should be diagnosed in the same manner as other common adult mental health disorders. The three most important components in the comprehensive evaluation of patients with ADHD are the clinical interview, medical examination, and completion and scoring of behavior rating scales. The diagnostic evaluation of ADHD should include questions about the symptoms, family history, prior evaluation and treatment of ADHD, as well as other problems including alcohol and drug use. Screening interviews or rating scales, as well as interviews, should be used. When it is feasible, clinicians may wish to supplement these components of the evaluation with the objective assessments of the ADHD symptoms, such as through psychological tests. These tests are not essential to reaching a diagnosis, however, or to treatment planning, but may yield further information about the presence and severity of cognitive impairments that could be associated with some cases of ADHD. As comorbidity is the rule rather than the exception, clinicians should carefully screen for comorbid disorders as part of a comprehensive assessment of ADHD. To receive a diagnosis of ADHD, the person must be experiencing significant distress or impairment in his or her daily functioning, and must not meet the criteria for other mental disorders which might better account for the observed symptoms, such as mental retardation, autism or other pervasive developmental disorders, mood disorders and anxiety disorders. This report aims to suggest practice guidelines for the assessment and diagnosis of children, adolescents and adults with ADHD in Korea.

Altered Cortical Thicknesses of Left Pars Opercularis and Left Lateral Occipital Gyrus Can Be Associated with Psychotic Symptoms in Patients with Alzheimer's Disease

OBJECTIVE: The aims of this study was to present an association between the presence of psychotic symptoms and cortical thicknesses/subcortical volumes in patients with Alzheimer's disease (AD). METHODS: Fourteen AD patients with psychotic symptoms and 41 without psychotic symptoms underwent 3T MRI scanning. After adjusting the effects of confounding variables, the cortical thicknesses were compared between the AD patients with and without psychotic symptoms in multiple regions, across the continuous cortical surface. In addition, the subcortical volumes were compared with a structure-by-structure manner. RESULTS: AD patients with psychotic symptoms were characterized by significant smaller cortical thickness of left pars opercularis (F=4.67, p=0.02) and left lateral occipital gyrus (F=6.05, p=0.04) rather than those without psychotic symptoms, after adjusting the effects of age and scores on the Stroop test, non-psychotic items of Neuropsychiatry Inventory and Clinical Dementia Rating, triglyceride level and total intracranial volume. However, there were no significant differences in the subcortical volume between the two groups. CONCLUSION: These results suggest that AD psychosis may reflect more severe deterioration of neuropathologic change in specific brain region.

The Correlation of Levels of Serum Lipid, Homocysteine, and Folate with Volumes of Hippocampus, Amygdala, Corpus Callosum, and Thickness of Entorhinal Cortex in Patients with Amnestic Mild Cognitive Impairment or Dementia of Alzheimer's Type

OBJECTIVES: In this study, the authors evaluated the correlation between levels of serum lipid, homocysteine, and folate with volumes of hippocampus, amygdala, corpus callosum, and in patients with amnestic mild cognitive impairment (aMCI) or Alzheimer's disease (AD) type. METHODS: The study recruited patients who visited the dementia clinic of Haeundae Paik Hospital in Korea between March 2010 and June 2014. Among those, patients who had taken the neurocognitive test, brain magnetic resonance imaing, tests for serum lipid, homocysteine, folate, and apolipoprotein E (APOE) genotyping and diagnosed with aMCI or AD were included for analysis. Bilateral hippocampus, entorhinal cortex, amygdala and corpus callosum were selected for region of interest (ROI). The cross-sectional relationships between serum lipid, homocysteine, folate and ROI were assessed by partial correlation analysis and multiple linear regression analysis. RESULTS: In patients with aMCI, old age (> 80) and APOE epsilon4 carrier were associated with AD [odds ration (OR) : 12.80 ; 95% confidence interval (CI) : 2.25-72.98 and OR : 4.48 ; 95% CI : 1.58-12.67, respectively]. In patients with aMCI or AD, volumes and thickness of ROI were inversely correlated with levels of serum lipid and homocysteine. In multiple linear regression analyses, higher total cholesterol level was related to lower left, right hippocampus volume and left amygdala volume ; higher low-density lipoprotein cholesterol was related to lower right entorhinal cortex thickness ; higher homocysteine level was related to lower corpus callosum volume. CONCLUSIONS: Higher serum lipid and homocysteine levels are associated with decreased volume of hippocampus, amygdala, corpus callosum and entorhinal cortex thickness in patients with aMCI or AD. These findings suggest that serum lipid and homocysteine levels are associated with AD as a modifiable risk factor.

Erratum: Future of Clinical Practice in Psychiatry / 신경정신의학

In this paper, the ACKNOWLEDGMENT was given incorrectly.

Future of Clinical Practice in Psychiatry / 신경정신의학

The mission of psychiatric practice is rangesing from alleviating the distress and impairment caused by psychiatric disorders to promoting a state of well-being in order to cope with the normal stresses of life and for to improvement of social functioning. Various factors, including social changes in general and the change of Psychiatry is are grounded in clinical neuroscience and public health. The authors are to review the determinants of changes in clinical practice of psychiatry and to review plausible areas of new clinical practice in psychiatryic both from both a clinical neuroscience and a public health perspective.

Effect of Aripiprazole on Cognitive Function and Hyperprolactinemia in Patients with Schizophrenia Treated with Risperidone

OBJECTIVE: This study aimed to assess the efficacy of aripiprazole for the management of cognitive impairments and hyperprolactinemia in patients with schizophrenia on a stable dose of risperidone. METHODS: Thirty-five subjects stabilized on risperidone (3-6 mg/day) for a minimum of 3 months were enrolled in a double-blind, placebo-controlled phase for 12 weeks and an open-label phase for another 12 weeks. Subjects were randomly assigned to receive 10 mg/day aripiprazole (n=17) or placebo (n=18). Over the following 12 weeks, the the aripiprazole group received a flexible dose of aripiprazole while tapering risperidone. At baseline, week 12, and week 24, subjects were evaluated using the Positive and Negative Syndrome Scale (PANSS), Extrapyramidal Syndrome Rating Scale (ESRS), and standardized neuropsychological assessments. Serum prolactin levels were checked at baseline, week 1, week 2, and week 24. RESULTS: The mean change in total PANSS and cognitive function test scores between baseline and endpoint were similar in the aripiprazole and placebo groups. Scores on the ESRS and negative subscale of PANSS differed significantly between groups in both phases of the study (p<0.05), indicating a positive effect of aripiprazole. Compared with placebo, aripiprazole significantly reduced mean baseline serum prolactin levels within 1 week (p=0.015). CONCLUSION: Adjunctive treatment with and switching to aripiprazole were not associated with improved cognitive function in patients with schizophrenia receiving risperidone; however, aripiprazole treatment decreased negative symptoms and risperidone-induced motor side effects and lowered serum prolactin levels.

Adjunctive Memantine Therapy for Cognitive Impairment in Chronic Schizophrenia: A Placebo-Controlled Pilot Study

OBJECTIVE: To investigate the effects of memantine, an N-methyl-d-aspartate (NMDA) receptor antagonist, on cognitive impairments in patients with chronic schizophrenia. METHODS: A 12-week, placebo-controlled trial was conducted to determine the effectiveness of memantine as an adjunctive treatment with conventional antipsychotic medications in 26 patients with chronic schizophrenia. The subjects were evaluated with the Korean version of the Mini-Mental State Examination (K-MMSE), the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), and a standard neuropsychological screening test. RESULTS: Memantine treatment was not associated with significantly improved cognitive test scores compared with the placebo control treatment. An improvement in the scores on the PANSS negative subscale was noted with memantine, but it was not significant. CONCLUSION: Adjunctive memantine treatment did not improve cognitive functioning or affect psychopathology in patients with chronic schizophrenia in the present study. Memantine, however, was tolerated well and did not exacerbate positive symptoms in patients with chronic schizophrenia.

Treatment of Developmental Disorders with ADHD Symptoms

Developmental disorders such as mental retardation, autism spectrum disorders, and learning disorders are frequently associated with attention-deficit/hyperactivity disorder (ADHD) symptoms such as inattention, hyperactivity, and impulsivity. The existing data for the pharmacological treatment of ADHD symptoms with developmental disorders suggest that the agents used to treat ADHD in typically developing children appear to have some benefit. However, the risks of treatment including side effect in these population appear to be greater than in typically developing children. Therefore, when considering pharmacotherapy for developmental disorders with ADHD symptoms, a cautious approach of starting with a low dosage and close monitoring of side effect are recommended.

Treatment of Developmental Disorders with ADHD Symptoms

Developmental disorders such as mental retardation, autism spectrum disorders, and learning disorders are frequently associated with attention-deficit/hyperactivity disorder (ADHD) symptoms such as inattention, hyperactivity, and impulsivity. The existing data for the pharmacological treatment of ADHD symptoms with developmental disorders suggest that the agents used to treat ADHD in typically developing children appear to have some benefit. However, the risks of treatment including side effect in these population appear to be greater than in typically developing children. Therefore, when considering pharmacotherapy for developmental disorders with ADHD symptoms, a cautious approach of starting with a low dosage and close monitoring of side effect are recommended.

Current state of research on youth depression and suicide prevention

Suicide has dramatically increased in recent years, and South Korea is the highest rate among the Organization for Economic Cooperation and Development member countries. Noteably, suicide is the leading cause of death in South Korea in youths aged 15-24. Approximately 70-90% of youth suicides are related to a preexisting psychiatric disorder such as depressive disorder, conduct disorder, or substance abuse. Recently, some studies have proposed nationwide suicide prevention programs, but there have been no systematic studies about suicide and suicide prevention programs particularly for adolescents. In South Korea, to establish an evaluation system of mental health screening services and to develop a case management program, a mental health promotion model for adolescents and a few programs for depression and suicide prevention for adolescents are currently being developed. Developmental considerations and a multidisciplinary approach in the treatment and prevention of suicidal adolescents are very important. In addition it is necessary to conduct a systematized nationwide survey of depression and suicide in adolescents.

Determinants for Heart Rate Variability in a Normal Korean Population

This study examined the normal ranges and the determinants for various parameters of the short-term heart rate variability (HRV) measurements in a large Korean sample of healthy people. HRV measurements were obtained in 2,748 healthy men and 735 healthy women 18-65 yr of age. The mean total power (TP), low frequency (LF), high frequency (HF), and LF/HF ratio were 1,358.9 +/- 1,840.8 ms2, 417.3 +/- 807.6 ms2, 254.1 +/- 414.1 ms2, and 2.4 +/- 20.9 ms2 in the frequency-domain spectral analysis. The mean standard deviation of the normal-to-normal (NN) interval (SDNN) and the square root of the mean squared differences of successive NN intervals (RMSSD) were 39.6 +/- 22.1 ms and 29.7 +/- 18.1 ms in the time-domain analysis. The female subjects had significantly higher SDNN, RMSSD, and HF values than the male subjects. After controlling for age, there was no statistically significant difference in the SDNN. Quantile regression analysis showed that age and mean heart rate had a significant impact on short-term HRV measurement. Given that both clinicians and researchers are increasingly relying on short-term HRV assessment in measuring stress, our work suggests that age and gender should be considered as independent determinants for HRV.

Inappropriate Sexual Behavior in Patients with Dementia

Research about Inappropriate Sexual Behavior (ISB) among patients with dementia is not abundant although its impact on patients and carers can be significant. There are many reasons for this relative neglect. In particular, notable is a problem encountered in the inconsistency of definition and assessment of ISB as well as stigma of sexuality in patients with dementia. This article reviews the literature concerning sexually inappropriate behavior in demented patients. Behavioral and pharmacological treatment approaches are explored and the recommendations and guidelines offered by other researchers are described.

Inappropriate Sexual Behavior in Patients with Dementia

Research about Inappropriate Sexual Behavior (ISB) among patients with dementia is not abundant although its impact on patients and carers can be significant. There are many reasons for this relative neglect. In particular, notable is a problem encountered in the inconsistency of definition and assessment of ISB as well as stigma of sexuality in patients with dementia. This article reviews the literature concerning sexually inappropriate behavior in demented patients. Behavioral and pharmacological treatment approaches are explored and the recommendations and guidelines offered by other researchers are described.

A Correlation of Cognitive Function, Depression, Suicidal Idea and Serum Lipid Levels in the Elderly Over Sixty Years of Age

OBJECTIVES: We investigated a correlation of cognitive function, depression, suicidal idea and serum lipid levels in Korean elderly over 60 years old to find risk factors of deprssion and cognitive decline. METHODS: 834 persons participated in this study. Clinical evaluation was done at a point by using Mini-Mental State Examination in the Korean version of CERAD assessment packet(MMSE-KC). We also evaluated 165 persons that agreed to our exact examination for Geriatric Depression Scale(GDS), Scale for Suicidal Ideation(SSI), Hachinski Ischemic Score and serum lipid profile. Correlation analysis was used to evaluate correlation among serum lipid levels, MMSE-KC and SSI. One-way ANOVA was used for comparison of serum lipid levels and cognitive function, depression and SSI. We did a post-hoc analysis. RESULTS: Depression and suicidal ideation were related with cognitive impairment in Korean elderly over 60 years old. Those who have more severe cognitive impairment and depressive symptom, have higher Hachinski ischemic score. We can see high HDL cholesterol levels only in the normal control group. Low total, HDL, LDL cholesterol were related with depression. CONCLUSION: There was high prevalence of depression in the Korean elderly over 60 years old and low serum lipid level was related with severity of depression and high suicidal ideation. In the normal control group, we can see high HDL cholesterol levels. To confirm this result, we need well-designed and wide range study.