Psychometric Properties of the Hypomania Checklist-32 in Korean Patients with Mood Disorders

OBJECTIVE: The aim of this study was to examine the validity of the Korean version of the Hypomania Checklist-32, second revision (HCL-32-R2) in mood disorder patients. METHODS: A total of 454 patients who diagnosed as mood disorder according to Structured Clinical Interview for DSM-IV Axis I Disorders, clinician version (SCID-CV) (bipolar disorder [BD] I, n=190; BD-II, n=72; and major depressive disorder [MDD], n=192) completed the Korean module of the HCL-32-R2 (KHCL-32-R2). RESULTS: The KHCL-32-R2 showed a three-factorial structure (eigenvalue >2) that accounted for 43.26% of the total variance. Factor 1 was labeled “active/elated” and included 16 items; factor 2, “irritable/distractible” and included 9 items; and factor 3 was labeled “risk-taking/indulging” and included 9 items. A score of 16 or more on the KHCL-32-R2 total scale score distinguished between BD and MDD, which yielded a sensitivity of 70% and a specificity of 70%. MDD and BD-II also could be differentiated at a cut-off of 15 with maximized sensitivity (0.67) and specificity (0.66). Cronbach’s alpha of KHCL-32-R2 and its subsets (factors 1, 2, and 3) were 0.91, 0.89, 0.81 and 0.79, respectively. Correlations between KHCL-32-R2 and Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale and Korean version of Mood Disorder Questionnaire were −0.66 (p=0.41), −0.14 (p=0.9), and 0.61 (p < 0.001), respectively. CONCLUSION: The KHCL-32-R2 may be a useful tool in distinguishing between bipolar and depressive patients in clinical settings.

Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.

Korean Medication Algorithm for Depressive Disorder 2012 (III): The Subtypes of Depression / 대한정신약물학회지

OBJECTIVE: Recently, the pharmacotherapy including antidepressants in treating depression is widely used. However, as a result of newer agents that are continuously introduced, pharmacological treatment strategy is also changing. To catch up this trend, Korean Medication Algorithm Project for Depressive Disorder was developed in 2002 and revised in 2006. Since the last revision, the third revision reflected the new research result and the latest trends in the areas of pharmacological treatment. METHODS: One hundred and twenty three psychiatrists who have vast clinical experiences in depressive disorder are primarily selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. RESULTS: For dysthymic disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) [(es)citalopram, fluoxetine, sertraline, paroxetine], serotonin-norepinephrine reuptake inhibitor (SNRI) (venlafaxine, duloxetine, milacipran), and mirtazapine, was recommended as the first line medications. For melancholic type, SSRI, SNRI, and mirtazapine were recommended as the first line medications. For atypical type and seasonal pattern, bupropion as well as SSRI, SNRI, and mirtazapine, were recommended as the first line medications. CONCLUSION: The preferences of antidepressants in experts were different according to the subtype of depression. These results suggest that clinicians have to consider the subtype of depression in the treatment of depressive disorders.

Korean Medication Algorithm for Depressive Disorder (IV): Child and Adolescent/The Elderly/Female / 대한정신약물학회지

OBJECTIVE: Since the introduction of selective serotonin reuptake inhibitor in 1980s, there have been many changes in the treatment strategies for depressive disorders. To be of help for clinicians to select appropriate treatment strategies, Korean Medication Algorithm Project for Major Depressive Disorder was developed in 2002 and revised in 2006. To reflect changes in treatment pattern for depressive disorders since 2006, we revised the previous algorithm and developed Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012). METHODS: 123 psychiatrists who have vast clinical experiences in treating depressive disorders are primarily selected, and the survey was sent to them via mails. Among them, 67 psychiatrists answered the survey. This survey was composed of 44 questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific circumstances. Based on 95% confidence interval and overall scores, each treatment of option was classified into three categories of recommendation; first-line, second-line, and third-line treatment option. RESULTS: In child and adolescent, antidepressant monotherapy was selected as first-line treatment option for mild, moderate, and severe episode without psychotic features. The combination of antidepressant and atypical antipsychotics was advocated as first-line treatment option for severe episode with psychotic features. In geriatric depression, antidepressant monotherapy was advocated as treatment of choice for mild to moderate episode. For severe episode without psychotic features, antidepressant monotherapy was selected as first-line treatment option. For severe episode with psychotic features, combination of antidepressant and atypical antipsychotics was selected as treatment of choice. In premenstrual dysphoric disorder, antidepressant monotherapy was advocated as first-line treatment option. In postpartum depression, antidepressant monotherapy was selected as first-line treatment option for mild to moderate episode. For severe episode without psychotic features, both antidepressant monotherapy and combination of antidepressant and atypical antipsychotics were selected as first-line treatment option. For severe episode with psychotic features, both combination of antidepressant and atypical antipsychotics and combination of mood stabilizer and atypical antipsychotics were advocated as first-line treatment option. CONCLUSION: In KMAP-DD 2012, the recommendations for treatment options in Child and Adolescent Depressive Disorder and Geriatric Depression were newly introduced. In aspects of treatment options for Female Depression, KMAP-DD 2006 and KMAP-DD 2012 had some similarities. But there were some changes of the treatment strategies in KMAP-DD 2012 which seemed to reflect recent study results.

The Korean Version of 4th Revision of Schizophrenia Quality of Life Scale: Validation Study and Relationship with PANSS / 신경정신의학

OBJECTIVES: The present study was performed to verify the validity and value of 4th revision of Schizophrenia Quality of Life Scale (SQLS-R4) as an assessment tool in a Korean-language version (SQLS-R4K). METHODS: The subjects for present study were 174 patients with a diagnosis of schizophrenia as defined by DSM-IV. The SQLS-R4K was administered together with self-report Korean version of World Health Organization Quality of Life-Brief Scale (WHOQOL-BREF) to assess validity. A subset of respondents also completed the SQLS-R4K for a second time to assess test-retest reliability. To evaluate the relationship SQLS-R4K and clinical characteristics, psychotic symptoms and general functioning were evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning Scale (GAF) score respectively. RESULTS: All the scales of SQLS-R4K showed good internal consistency reliability. The correlations of items with their scale total revealed that all items were significantly correlated with their own scale score. In test-retest reliability, paired t-tests indicated that responses did not alter significantly between the two assessment. There was moderate correlation between WHOQOL-BREF sub-scores and SQLS-R4K score total. Also relevant correlations between PANSS, current GAF and SQLS-R4K were proved. CONCLUSION: From the results of the testing the reliability and validity of the SQLS-R4K, it is concluded that the SQLS-R4K is a simple and reliable scale for measuring quality of life in schizophrenic patients.