Pharmacological evaluation of HM41322, a novel SGLT1/2 dual inhibitor, in vitro and in vivo

HM41322 is a novel oral sodium-glucose cotransporter (SGLT) 1/2 dual inhibitor. In this study, the in vitro and in vivo pharmacokinetic and pharmacologic profiles of HM41322 were compared to those of dapagliflozin. HM41322 showed a 10-fold selectivity for SGLT2 over SGLT1. HM41322 showed an inhibitory effect on SGLT2 similar to dapagliflozin, but showed a more potent inhibitory effect on SGLT1 than dapagliflozin. The maximum plasma HM41322 level after single oral doses at 0.1, 1, and 3 mg/kg were 142, 439, and 1830 ng/ml, respectively, and the T(1/2) was 3.1 h. HM41322 was rapidly absorbed and reached the circulation within 15 min. HM41322 maximized urinary glucose excretion by inhibiting both SGLT1 and SGLT2 in the kidney. HM41322 3 mg/kg caused the maximum urinary glucose excretion in normoglycemic mice (19.32±1.16 mg/g) at 24 h. In normal and diabetic mice, HM41322 significantly reduced glucose excursion. Four-week administration of HM41322 in db/db mice reduced HbA1c in a dose dependent manner. Taken together, HM41322 showed a favorable preclinical profile of postprandial glucose control through dual inhibitory activities against SGLT1 and SGLT2.

Pharmacotherapy for Obesity in Mood Disorders / 정신신체의학

The prevalence of obesity and overweight is increasing in mood disorder, and it is connected to an increased cardiovascular mortality. Because of them, treatment for obesity may be an essential part of mood disorder treatment. Similar to the general population, non-pharmacological treatment such as correction of life habits should be considered first of all. If this approaches are fail, pharmacological treatment for obesity would be required as next step. Any drug for obesity is not approved officially in mood disorder. So approved drugs in general population, and drugs supported by several studies are prescribed in clinical settings. Several treatment guidelines for mood disorder and studies support that orlistat, metformin, topiramate and bupropion is effective and safe.

Effects of Repetitive Transcranial Magnetic Stimulation to Temporoparietal Cortex in Patients with Chronic Schizophrenia with Treatment-Resistant Auditory Hallucinations / 신경정신의학

OBJECTIVES: It has been reported that repetitive transcranial magnetic stimulation (rTMS), which stimulate the focal region of brain may relieve auditory hallucination in patient with schizophrenia. This study was aimed to evaluate the effect of rTMS on left and right temporoparietal cortex in schizophrenic patients with treatment-resistant auditory hallucination. METHODS: Twenty-six patients with chronic schizophrenia with treatment -resistant auditory hallucination were randomly allocated to rTMS group on left and right temporoparietal head regions. The rTMS was applied to TP3/4 region by EEG 10-20 international system at 1 Hz for 20 minutes per day for 10 treatment days. A Figure of eight TMS coil with a solid core was used for rTMS at 100% of individual motor threshold. Efficacy was evaluated with Auditory Hallucination Rating Scale (HRS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) Scale on 5 and 10 days of treatment. RESULTS: Ten days administration of 1-Hz rTMS to temporoparietal cortex significant improved frequency (p<0.001) and attentional salience (p=0.038) of auditory hallucination, positive (p<0.001) and negative symptom (p=0.02), and CGI-improvement (p<0.001). There were no significant differences between right and left side stimulations. CONCLUSION: These results suggest that the low frequency rTMS on temporoparietal cortex may be useful in treating schizophrenic patients with treatment-resistant auditory hallucination and it could be a useful novel treatment option.

Effects of Repetitive Transcranial Magnetic Stimulation to Temporoparietal Cortex in Patients with Chronic Schizophrenia with Treatment-Resistant Auditory Hallucinations / 신경정신의학

OBJECTIVES: It has been reported that repetitive transcranial magnetic stimulation (rTMS), which stimulate the focal region of brain may relieve auditory hallucination in patient with schizophrenia. This study was aimed to evaluate the effect of rTMS on left and right temporoparietal cortex in schizophrenic patients with treatment-resistant auditory hallucination. METHODS: Twenty-six patients with chronic schizophrenia with treatment -resistant auditory hallucination were randomly allocated to rTMS group on left and right temporoparietal head regions. The rTMS was applied to TP3/4 region by EEG 10-20 international system at 1 Hz for 20 minutes per day for 10 treatment days. A Figure of eight TMS coil with a solid core was used for rTMS at 100% of individual motor threshold. Efficacy was evaluated with Auditory Hallucination Rating Scale (HRS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) Scale on 5 and 10 days of treatment. RESULTS: Ten days administration of 1-Hz rTMS to temporoparietal cortex significant improved frequency (p<0.001) and attentional salience (p=0.038) of auditory hallucination, positive (p<0.001) and negative symptom (p=0.02), and CGI-improvement (p<0.001). There were no significant differences between right and left side stimulations. CONCLUSION: These results suggest that the low frequency rTMS on temporoparietal cortex may be useful in treating schizophrenic patients with treatment-resistant auditory hallucination and it could be a useful novel treatment option.

A Case of Frontotemporal Dementia with Family History

The average age of frontotemporal dementia onset is much younger than that of the Alzheimer's disease. Behavioral disturbances occur at the early stage of frontotemporal dementia, and social dysfunction and personality deterioration may ensue. For this reason, it may be misdiagnosed as other psychiatric disorders. Therefore, more careful observation and concern is required for proper diagnosis. This report is about the case of a patient who had been misdiagnosed of disorders like schizotypal personality disorder, schizophrenia, obsessive compulsive disorder etc., and therefore have been treated for those. We reviewed this case based on the data of neuropsychiatric history, family history, neuropsychological test, brain MRI, and SPECT, and considered this case as frontotemporal dementia with family history. This is the first frontotemporal dementia case with family history in Korea, so hereafter we may discover the gene locus associated with this case. This study can be very useful for the following frontotemporal dementia studies in Korea.

Effects of Brief Symptom Management Module on Inpatients with Chronic Schizophrenia: A Preliminary Study / 신경정신의학

OBJECTIVES: The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpatients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. METHODS: The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). RESULTS: Overall, patients showed improvement over the treatment period on psychopathology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9+/-4.0 before training to 12.9+/-4.2 after training(p<0.01) and scores of CGI were improved from 3.7+/-0.9 to 2.8+/-0.8 (p<0.01). However age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with un-awareness of psychosis. CONCLUSION: These results suggest that SMM-B could be a reliable method to improve self-awareness of psychosis in patients with chronic schizophrenia and one of important elements in rehabilitation.

Therapeutic Factors of Large Group Psychodrama for Psychiatric Inpatients / 신경정신의학

OBJECTIVES: This study was performed to make a model of large group psychodrama suitable for Korean inpatients and easy for psychiatrists trained in the individual psychotherapy and the group psychotherapy to use, to investigate the therapeutic factors after applying this model to inpatients, and then to contribute to the treatment of inpatients. METHODS: The study subjects were all the inpatients and the therapists(the auxiliary ego's) who participated in psychodrama from March 1998 to September 1998. The subjects were composed of 346 inpatients(152 males, 194 females) and 60 therapists. To the inpatients 13-Therapeutic Factors Scale, Scale of General Attitude to Psychodrama, and the Questionnaire describing helpful things in psychodrama were administered. To the therapists 13-Therapeutic Factors Scale and the Questionnaire describing helpful things in psychodrama were administered. The inpatient group were divided into 4 groups(the audience, the auxiliary ego's, the participants in sharing, the protagonists). The therapeutic factors among 4 groups were compared. RESULTS: First, the therapeutic factors described by the inpatient group were as follows: 1) Most inpatients made great account of 'existential factor' and 'the corrective recapitulation of the primary family group' regardless of their roles in psychodrama. 2) The inpatients who participated in psychodrama directly as the protagonists, the auxiliary ego's, or the participants in sharing made much account of 'development of socializing techniques'. The inpatients who participated in psychodrama more directly as the protagonists or the auxiliary ego's made much account of 'catharsis'. 3) All the inpatients except the protagonists made much account of 'instillation of hope'. 4) The audience made much account of 'identification' and 'universality'. Especially, 'identification with members' was much accounted of by the participants in sharing. 'Universality' also was much accounted of by the auxiliary ego's. Next, when we compared the therapeutic factors in the inpatient group with those in the therapist group, the therapist group made much account of 'group cohesiveness' which the inpatient group made little account of. And the therapist group made no account of 'development of socializing techniques' which the inpatient group made much account of. CONCLUSION: By dividing the inpatient group according to their roles, we found the characteristics of the inpatient large group psychodrama and of the therapeutic factors according to the roles of the inpatients. This model could be applied to the treatment for the inpatients easily and was helpful to many inpatients on the whole.

Clinical Characteristics of Female Alcoholic Inpatients in a Mental Hospital / 신경정신의학

OBJECTIVES: This study aimed to provide a basic data of female alcoholics by understanding the gender differences of the clinical characteristics including demographic characteristics, alcoholic history, family history, drinking patterns, reasons for drinking, and comorbidity in male and female alcoholics. It also ained to establish the therapeutic plans through understanding the patterns of disease and the patterns of family cooperation in female alcoholics. METHODS: The study subjects consisted of 51 male and female alcoholics admitted to a mental hospital from January 1, 1991 to May 31, 1996. Subjects were age- and sex-matched. We reviewed patients' charts and administered questionaires. Mean age of female alcoholics was 44.45+/-11.02 years and that of male alcoholics was 44.17+/-10.08 years. All male and female patients met with the DSM-III-R criteria of alcohol dependence. RESULTS: Female alcoholics were later in drinking-onset age, and to had shorter duration of previous drinking history and less average amount of daily drinking than male alcoholics. And female alcoholics were found to seek treatment more voluntarily, and to have less frequent delirium tremens after admission and less medical complications such as hepatitis and diabetes mellitus. Also female alcoholics had more frustration experiences of separation such as death of family member, divorce, and husband's physical abuse. Female alcoholic's families had more uncooperative attitude toward treatment such as threat to divorce after admission. CONCLUSIONS: There were many differences between male and female alcoholics of demographic characteristics, clinical characteristics, and patterns of family cooperation. Female alcoholics were found to have more experiences of psychosocial frustration including death of family member and marital conflicts, and more uncooperative attitude of her family members. Therefore, it is required that therapists consider the characteristics of female alcoholics upon treatment and prevention, and have more concern about female alcoholics.

A Comparative Study on the Therapeutic Factors of Group Psychotherapy and Psychodrama Applied to Psychotic Patients / 신경정신의학

OBJECTIVES: This study was performed to investigate the therapeutic factors of group psychotherapy and psychodrama which were applied to psychotic patients, and to compare the therapeutic characteristics of two therapies. METHODS: The subjects of this study were patients of a day hospital from September 1996 to May 1997. The subjects were composed of 35 psychotic patents(22 males, 13 females). Both of group psychotherapy and psychodrama were done to the patients of the day hospital. After these therapeutic factors were checked by the members of group psychotherapy, the protagonists of psychodrama, and the audience of psychodrama using 13 therapeutic factors scale. All three groups divided into higher functioning group and lower functioning group by mutual consent of the therapists in the treatment team meeting according to the patient's life of the day hospital, the attitude in programs, and the state during the interview with the therapist. And then therapeutic factors of higher and lower functioning group were compared. By the mean score of each therapeutic factor the rank of therapeutic factors was decided. By these ranks we compared the important therapeutic factors on the members of group psychotherapy, the protagonists, and the audience. RESULTS: The results were as follows : 1) The protagonists of psychodrama set a very high value on 'catharsis' and 'the corrective recapitulation of the primary family group', regardless of their functional level. 2) The protagonists with a higher function set a higher value on 'guidance of therapists', while those who had a lower function set a higher value on 'guidance of members'. 3) The audience of psychodrama set a very high value on 'identification with therapists', 'identification with members', and set a high value on 'universality'. 4) The higher functioning group of the group psychotherapy, the audience, and the protagonists set a high value on 'interpersonal learning', especially the patients of group psychotherapyset a very high value on 'interpersonal learning' 5) The lower functioning group of the protagonists and the group psychotherapy set a high value on 'development of socializing techniques'. CONCLUSION: From the results of this study, we can draw some suggestions. First, if therapists take the above-mentioned therapeutic factors into consideration during the sessions of group psychotherapy or psychodrama, they can obtain more effective therapeutic outcome. Second, it is desirable that both group psychotherapy and psychodrama should be used more extensively as important methods of treatment in clinical settings. Third, the combination of group psychotherapy and psychodrama would be more effective than the separate application of each therapy.

A Day Care Model for Rehabilitation of Chronic Psychotic Patients / 신경정신의학

OBJECTIVES: The purpost of this study was to present general system,operation,and program of a day care model managed by a psychiatrist,to evaluate the results of performing this model,and thus to developa day care model applied to Korean situation appropriately for promoting maintenance and rehabilitation of chronic psychotic patients. METHODS: We performed this day care model(hereinafter called as this model) from March 1997 to February 1998. The subjects were composed of 23 psychotic patients. PANSS, Quality of Life Scale,Life Satisfaction Self-Rating Scale were used before beginning this model-and after three months of performing this model. Program Helpfulness Scale,13 Therapeutic Factors Scale were used at one month of day care and after three months of day care. RESULTS: 1) This model helped maintenance and rehabilitation of chronic psychotic patients through reducing their symptoms and increasing quality of life. 2) This model used the various group therapy, especially creative art therapy and activeity therapy, played an important fole,for recovering Physical,psychological,and social functions. 3) Important therapeutic factors at early and late period of this model were identification with therapists,guidance of therapists,and the corrective recatitulation of the primary family group. Important therapeutic factors at early period were group cohesiveness and altruism, and at late period instillation of hope. 4) This model was useful for integration the multidisciplinary therapeutic team and the various therapeutic methods. CONCLUSION: This model would be applied to day care in this country effectively and efficiently for maintenance and rehabilitation of chronic psychotic patients.

The Effectiveness of a Day Hospital Model for Integrated Therapy of Psychotic Patients / 신경정신의학

OBJECTIVES: A day hospital has been remodeled after a vision to help psychotic patients quickly recover their psychological and social functions and lessen their induced regressions caused by long-term hospitalization, thereby enhancing their social abilities. The authors concerned once developed a day hospital model of an integrated therapy for psychotic patients suitable for Korean situation in their previous paper. Based on it, the present study was to determine how effective a day hospital would be, in comparison of the following two paired groups: day hospital group with experience of hospitalization(hereinafter abbreviated as DH group) & day hospital parents group with experience of hospitalization(hereinafter abbreviated as DH parents group) and OPD group with experience of hospitalization(hereinafter abbreviated as OPD group) & OPD parents group with experience of hospitalization(hereinafter abbreviated as OPD parents group). METHODS: During the 18-month long research period(from May to 1996 October 1997), 17 day hospital patients with experience of hospitalization & their parents and the same number of OPD patients with experience of hospitalization & their parents were corespondingly paired with at random, who identified themselves closest in the following categories: diagnosis, age, sex and function. All of them were asked to check questionnaires on their respective quality of life, insight, and their attitude about drug. Day hospital patients with experience of hospitalization and their parents were checked from the first day they were treated while OPD patients with experience of hospitalization and their parents were examined after discharge from hospital, commonly at the interval of 2 weeks, 3 months, 6 months, 12 months, and 18 months. RESULTS: 1) The quality of life scored higher in DH group than in OPD group. It turned increased significantly at the 3rd month and continued the same until the 12th month. At the 18th month, it showed a significant downturn. Meanwhile, DH group showed a significant upturn at the 3rd month and it turned down at 12 month. 2) The insight of DH group and DH parents group scored higher compared with OPD group and OPD parents group between the 3rd and 18th month, with the 3rd and 6th month showing a particular strength as well. Meanwhile, it continued unchanging for day DH group and DH parents group from the date on, of their discharge from hospital. 3) Attitude towards drugs scored higher in DH group than in OPD group at the 3rd and 6th month. It continued unchanging between the 6th and 18th month. It didn't score significantly higher in DH parents group than in their counterparts. 4) Satisfaction on the therapy started upward in DH group at the 3rd and 6th month, and scored higher in them than in their counterparts during the period form the 6th and 18th month. It started upward as well in DH parents group at the 3rd and 6th month, and scored higher in them than in their counterparts during the period form the 6th to the 18 month. 5) Number, and duration of DH group totalled lower than those by OPD group during the research period. CONCLUSION: The day hospital model, developed by the authors concerned, has proved a highly effective treatment for psychotic patients, as the data scored higher in the day hospital patients and their parents than in the OPD patients with experience of hospital and their parents in terms of "quality of life" by patients, insight, attitude toward drugs and satisfaction on its therapy.

The Cognitive and Cerebral Functions of Patients with Conduct Disorder / 신경정신의학

OBJECTIVES: In oder to investigate the cognitive and cortical functions of patients with conduct disorder, the present study was carried out with the neuropsychological test battery and Event-Related Potentials(ERPs:P300). METHODS: The subjects were consisted of 18 patients with conduct disorder who fulfilled DSM-IV criteria and 18 normal controls. For all subjects the neuropsychological test battery and ERPs were administered. The neuropsychological test battery consisted of attention tests, memory tests and Card Sorting Test which is used to evaluate the problem-solving and hypothesis-testing. The P300 was measured by oddball paradigm in which 1,000Hz tone was served as standard stimulus and 2,000Hz tone as target stimulus. The task of the subject was to press response-button whenever the target stimulus was presented. K-WAIS was administered in order to control the intelligence of the subjects. RESULTS: The results were as follows: 1) Among subtests of the neuropsychological test battery, only the result of Card Sorting Test showed significant difference between conduct disorder group and control group. The conduct disorder group showed significant low hit-rate compared with control group. 2) The conduct disorder group showed decreased P300 amplitude compared with control group on Fz and Cz. Among 18 patients with conduct disorder, 12 patients showed negative potentials on Fz. 3) The conduct disorder group showed prolonged P300 latency compared with control group on Fz. CONCLUSION: These results indicate that the patients with conduct disorder seem to have retarded functions of problem-solving and hypothesis-testing, and this retardation seems to be related to the frontal dysfunction.

Comparison of Soft Neurologic Sings in Neuroleptic-naive, Treated, and Chronically Institutionalized Schizophrenics / 신경정신의학

OBJECTS: Many studies have demonstrated greater frequency of soft neurologic signs in patients with schizophrenia than in controls. However, factors associated with chronicity, institutionalization, individual differences and neuroleptic medication make it difficult to interpret these results. We report on our ongoing study of soft neurologic signs and their relationship to neuroleptics and institutionalization in schizophrenia. METHODS: Soft neurologic signs were examined with a standardized instrument, Neurological Evaluation Scale- Korean Version(NES-K) in 11 neuroleptic-naive patients with schizophrenia, 17 neuroleptic-treated patients and 14 chronically institutionalized patients. RESULTS: Scores of total items(p<0.005), sensory integration(p<0.05), sequencing of complex motor acts(p<0.05) and others(p<0.01) functional areas of NES-K were significantly different among three groups. There was no difference in the area of motor coordination. Posthoc analysis showed that scores of total items(p<0.005) and sensory integration areas(p<0.01) of NES-K were significantly higher in the institutionalized patients than those of neuroleptic-naive group. However scores of sequencing of complex motor act and others categories were not different in the institutionalized and neuroleptic-naive patients. CONCLUSION: These findings suggested that neuroleptic treatment or chronic institutionalization might partially affect soft neurologic signs, especially sensory integration area, in patients with schizophrenia. However, the soft neurologic signs of motor coordination area could be a biological trait marker of schizophrenia independent of confounding variables.

An Integrated Inpatient Group Psychotherapy Model Led by a Psychiatrist / 신경정신의학

OBJECTS: The purpose of this study was to present a model of inpatient group psychotherapy led by a doctor in charge, to evaluate this model in practice, and to give a effective inpatient treatment by application of this model. METHODS: The subject composed of 25 psychiatric inpatient. The authors performed this model of group psychotherapy for 6 months and evaluate this model by objective data. Also we analyzed this model globally to get comprehensive understandings. RESULTS: The results of the objective data were as follows: 1) This model was effective to subside patients' symptoms. And the patients estimated this model to be important and helpful to them. 2) Identification with therapist' among therapeutic factors was high rank. This meant that therapist him- or her-self is a important tool for therapy. 3) Therapeutic factors in upper level group was much different from those in lower level group. And various therapeutic factors was used complementarily between two groups. 4) To check '13 therapeutic factors' repeatedly made the patients acquire therapeutic factors spontaneously. And to check 'the most important event' repeatedly gave the opportunity of self-reflection. The results of global analysis to this model were as follows: 1) This group psychotherapy gave a field in which a therapist met patients as human being. 2) This model was easy to perform, and helpful to a comprehensive therapeutic approach. 3) This model was able to make the basis of continuous outpatient and day hospital treatment, and the basis of outpatient group psychotherapy or individual psychotherapy. 4) In this model, social workers, nurses, or students in practice played a role of the healthy ego. Therefore they were able to activate group psychotherapy. 5) This model was a practical and useful tool of the education for psychiatric residents, medical students, social works, and other students. CONCLUSION: This model of group psychotherapy was useful f3r inpatient treatment and easy to perform in general.

A Day Hospital Model for Integrated Therapy of Psychotic Patients / 신경정신의학

OBJECTS: The purpose of this study was to present a day hospital model(hereinafter called as "this model") for integrated therapy, to evaluate the result of performing this model, and thus to develop day hospital model for helping psychotic patients effectively and promoting social readaptation. METHODS: The authors performed this day hospital model from 1996, May to December, A total of 25 psychotic Patients participated in this study. BPRS, Life Satisfaction Self-Rating Scale, Program Helpfulness Scale, 13 Therapeutic Factors, Scale, and Most Important Event Questionnaire were used at the start of day hospital treatment and at the end. RESULTS: The results were as follows: 1) In this model, it was possible to offer the wide treatment to heterogeneous patients who varied in age, number of admission, duration of illness, and functional level. 2) In the aspect of therapeutic effect, this model contributed for improving negative symptoms and increasing subjective life satisfaction. 3) When the patients were divided into the higher functional level group and the lower functional level group, the higher functional level group set a high value on group psychotherapy and psychodrama that were unstructured and could make patients explore their inner side deeply, But the lower functional level group did not so. Therefore dividing into two groups by functional level may be more effective for day hospital treatment. 4) Therapeutic factors were different between the periods of day hospital treatment, And in the higher functional level group, 'interpersonal learning' was important at the last period, but in the lower functional level group, 'socializing technique' was important at the last period. So long-term group psychotherapy may be more suitable for the after-care of the higher functional level group, and day care or other psychosocial rehabilitation programs may be more suitable for the after-care of the lower functional level group. 5) This model was easy to apply to Korean day hospital setting, and made staffs treat patients efficiently CONCLUSION: This day hospital model would be used effectively in Korean day hospital setting.

A Nationwide Epidemiological Study of Mental Disorders in Korea(XVIII): Cross-national Epidemiology of Social Phobia / 신경정신의학

The nationwide epidemiological study of mental disorders including social phobia in Korea using DIS-III Korean Version was conducted in the Capital City of Korea(Seoul) and 20 rural areas and compaired to the other 3 countries. The results were as follows: 1) Total number of study of Korea was 5.100, USA 18571, Canada 3258 and Puerto Rico 1513. 2) The highest response rate was Puerto Rico and Korea, USA and Canada in order. 3) Female ratio was highest in the USA and Canada, next is Puerto Rico and Korea. 4) The lifetime prevalance of social phobia of the USA was 2.6%, Canada 1.7%, Puerto Rico 1.0% and Korea 0.5%. The Highest ratio was the USA and Canada, Puerto Rico and Korea in male and in female in order. 5) Mean age of onset, Canada was earliest(14.6yrs. old) and USA(15.8), Pueno Rico(19.8) and Korea(24.3). In male the earliest was USA and Canada, Puerto Rico and Korea. Onset of social phobia before onset of other psychiatric disorder, the highest was Puerto Rico and USA Korea and Canada. 6) Comorbidity was the highest in the USA and Canada, Puerto Rico and Korea. 7) The effect of social phobia of the risk of suicide attempts in persons with any other psychiatric disorder, in case of comorbid with social phobia was much more frequent than not comorbid with social phobia. 8) Eating fear in front of people was the highest in the USA and Canada, Korea and Puerto Rico in order. Fear of speaking in front of group was the highest in Puerto Rico and USA Canada and Korea. Fear of speaking to strangers was the highest in Korea and Canada, USA and Puerto Rico.

An analysis of repeat visitors in the psychiatric emergency room / 신경정신의학

No abstract available.