Standardized Suicide Prevention Program for Gatekeeper Intervention of North Korean Defectors in South Korea

Objective@#North Korean defectors (NKDs) have experienced substantial difficulties during the migration and settlement in South Korea. They have a high prevalence of depression, post-traumatic stress disorder, and suicidal behaviors. The high prevalence of mental disorders among NKDs can lead to a high suicide rate. However, there are no suicide prevention programs for NKDs. This study aims to customize a suicide prevention program with content suitable for NKDs’ particular circumstances. @*Methods@#A multidisciplinary research team developed this program based on domestic and international gatekeeper training programs for suicide prevention and articles related to suicide prevention. @*Results@#We developed a multi-part gatekeeper training program, “Suicide CARE for NKDs.” In the “Introduction,” trainees learn about the need for the program and its importance. In “Careful observation,” trainees learn to recognize linguistic, behavioral, and situational signals of suicide risk. In “Active listening,” trainees learn how to ask about suicidal thoughts and to listen empathetically. In “Risk evaluation and expert referral,” trainees learn to evaluate suicide risk and to connect NKDs with institutes or services. @*Conclusion@#We expect this program to become useful for training gatekeepers to prevent suicide among NKD. A future follow-up study is needed to confirm the efficacy of the program.

Korean Addiction Treatment Guidelines Series (I) : Development of Korean Guidelines for the Treatment of Alcohol Use Disorder / 신경정신의학

OBJECTIVES: The aim of this study is to develop Treatment Guidelines for Alcohol Use Disorder-the Korean Addiction Treatment Guidelines-using the Adaptation method. METHODS AND PROCEDURES: As the Adaptation method of Guidelines, the ADAPTE Manual, which is developed by ADAPTE collaboration is applied. In Part 1 : preparatory work prior to the beginning of Adaptation is performed. In Part 2 : the core phase of the Adaptation in which we searched the guidelines and performed a systematic review of the literature. The two guidelines (of the AU and the UK) are selected by gone through the methodological quality and currency evaluation for guidelines. And, in order to choose the proper recommendations, the contents were evaluated with regard to the applicability and acceptability of guidelines to the domestic. Finally, in Part 3 : the adapted guideline is reviewed externally, with review and plan update. Therefore, in this way, the Korean Guidelines for Treatment of Alcohol Use Disorder, comprised of 55 recommendations, was developed. CONCLUSION: In this study, Korean Guidelines for Treatment of Alcohol Use Disorder were developed by application of the Adaptation method of ADAPTE. These are the first evidence-based Korean Guidelines for Treatment of Alcohol Use Disorder, which were modified and accepted in accordance with Korean circumstances within the range not damaging the validity of the treatment worth, and it is expected to contribute to improvement in quality and efficiency enhancement of Korean treatment of Alcohol Use Disorder.

Neural Mechanism of Inferring Person's Inner Attitude towards Another Person through Observing the Facial Affect in an Emotional Context

OBJECTIVE: The goal of the present study was to identify the brain mechanism involved in the attribution of person's attitude toward another person, using facial affective pictures and pictures displaying an affectively-loaded situation. METHODS: Twenty four right-handed healthy subjects volunteered for our study. We used functional magnetic resonance imaging (MRI) to examine brain activation during attitude attribution task as compared to gender matching tasks. RESULTS: We identified activation in the left inferior frontal cortex, left superior temporal sulcus, and left inferior parietal lobule during the attitude attribution task, compared to the gender matching task. CONCLUSION: This study suggests that mirror neuron system and ventrolateral inferior frontal cortex play a critical role in the attribution of a person's inner attitude towards another person in an emotional situation.

Inpatient Treatment Programs for Alcohol Dependence

Alcohol use disorder is one of the major psychiatric problems in Korea. Inpatient treatment programs include general medical and psychiatric evaluation, detoxification and control of withdrawal symptoms, and psychosocial rehabilitation. Benzodiazepines are a common prescription for the control of withdrawal symptoms. Psychosocial therapy is a crucial element in the treatment and prognosis of alcoholism. There are many psychosocial treatment modalities in the inpatient setting. The main modalities of recently introduced psychosocial treatments of alcoholism in the inpatient setting are as follows: psychoeducation, cognitive-behavioral therapy, motivation enhancement therapy, and twelve-step facilitation therapy. In Korea, in contrast to the great social burden of alcohol-related problems, a comprehensive alcoholism treatment system is lacking. Therefore we need psychosocial treatment programs on alcoholism specifically modified and tailored to Korean people.

The Efficacy and Safety of Topiramate in the Treatment of Alcohol Withdrawal / 신경정신의학

OBJECTIVES: Benzodiazepines are most often used for the treatment of alcohol withdrawal, but they also may result in several adverse consequencies such as sedation, respiratory depression, cognitive impairment, disinhibition, and abuse. New anticonvulsants, topiramate may have a potential to treat alcohol withdrawal effectively. This study compared the therapeutic responses of a benzodiazepine, lorazepam, and an anticonvulsant, topiramate, for the treatment of alcohol withdrawal. METHODS: Fifty-two hospitalized patients with the diagnosis of DSM-IV Alcohol dependence, after obtaining written informed consent, were randomely divided into the either lorazepam (N=27) or the topiramate (N=25) groups. Subjects were assessed with CIWA-Ar scores at the time of baseline, 1, 3, 5 day after the last alcohol drinking. Lorazepam was given 4 mg divided by 4 on day 1, tapering to 2 mg divided by 2, and topiramate was given fixed single dose of 50 mg a day. RESULTS: There were no significant differences between two groups in demographic or clinical characteristics except marital status and s-ALT level. Two groups had similar ADS scores and baseline withdrawal severity. There were no significant differences by treatment group in CIWA-Ar scores over time (F=0.883, p>0.05). CONCLUSION: Efficacy and safety were not different between the two groups. Therefore our results suggest that topiramate is a promising alternative agent to benzodiazepine for treating alcohol withdrawal.

Reliability and Validity of the KOREAN VERSION of the Preschool Temperament and Character Inventory(K-psTCI) / 신경정신의학

OBJECTIVES: The purpose of this study was to evaluate the reliability and validity of the Korean version of Preschool Temperament and Character Inventory (K-psTCI), a questionnaire based on Cloninger's seven-factor model of personality. METHODS: The psTCI was translated into Korean and administered to 266 children aged 2-6 years. A test-retest study of the K-psTCI was conducted across a 4-month interval. Internal consistency was calculated by Cronbach alpha. Test-retest and reliability was analyzed by Pearson correlation analysis. Factor analyses for the temperament and character dimensions were performed using principal component analysis, rotating factors by varimax. The psTCI scores of Korean and United States preschoolers there compared. RESULTS: Cronbach alpha values for the K-psTCI scales ranged from .62 to .78 for each dimensions. Test-retest correlations (r) ranged from .50 to .77 for each dimensions. Explorative factor analysis with the condition of eigenvalue greater than 2 produced four factors for the temperament items and three factors for the character items like the US original version of psTCI. Through factor analyses, five items in the K-psTCI were categorized differently from the US version of psTCI. Korean preschoolers had higher mean scores on Cooperativeness (CO) in males as compared to a sample of US preschoolers. CONCLUSION: The results of this study suggests that the Korean preschool TCI is satisfactory in reliability and validity.

Recent Psychosocial Therapeutic Approach on Alcohol Dependence / 신경정신의학

Alcohol use disorder is a one of major psychiatric problems in Korea. But after detoxification treatment, relapse is very frequent. Psychosocial therapy is a crucial element in alcoholism treatment and prognosis. There are so many psychosocial treatment modalities. In this article, various psychosocial treatments are explained. The main lists of introduced recent psychosocial treatments on alcoholism are as follows: therapeutic community, cognitive-behavioral therapy, motivation enhancement therapy, twelve step facilitation therapy, network therapy, and other community-based treatment. In Korea, in contrast to the importance of huge alcoholic problems, comprehensive alcoholism treatment system is weak. Therefore well-modified and Korean styled psychosocial treatment programs on alcoholism is requested.