Clinical Applications of the Microbiome in Obstetrics

Human microbiome refers to the genetic material of approximately 1013 microorganisms present in the human body. These microbiomes interact significantly with the physiological, metabolic, and immune systems, particularly during pregnancy. Microbiome dysbiosis in pregnant women and their fetuses is associated with obstetric complications and poor neonatal outcomes. Oral and gut microbiomes can influence the placenta, uterus, and fetus via hematogenous translocation. Through ascending translocation, vaginal microbiota can directly affect the uterine environment. Current research focuses on the presence of the placental microbiome, which is characterized by low biomass. However, more well-controlled studies are required to specifically address the contamination issues. Use of antibiotics during pregnancy and the mode of delivery, specifically cesarean section, have been linked to the establishment of the neonatal gut microbiome. Probiotic supplementation may be beneficial during pregnancy, particularly for women receiving antibiotic treatment.

Development of the Battery Test for Screening of Depression and Mental Health: PROtective and Vulnerable factors battEry Test (PROVE) / 신경정신의학

Objectives@#This study developed a battery test that allows a comprehensive evaluation of depressive symptoms and related protective-vulnerable factors to screen for depression and mental health and examined the reliability and validity of the test. @*Methods@#PROtective and Vulnerable factors battEry test (PROVE) consisting of five sub-sections was developed: depressive symptomatology (PROVE-DS), suicide risk (PROVE-SR), and three protective-vulnerable factors, which were adult attachment type (PROVE-ATT), adverse childhood experience (PROVE-ACE), and mentalization capacity (PROVE-MC). Two hundred and thirteen subjects completed the PROVE test and other comparative scales, and the analysis was carried out based on the data. @*Results@#The PROVE test showed good convergent, discriminant, and concurrent validity as well as adequate internal consistency. In addition, five sub-sections of the PROVE test showed significant relevance to each other. @*Conclusion@#The results of this study indicate that the PROVE test is a reliable and valid test, which will be useful for the prevention, evaluation, and treatment of depression in various clinical settings.

Development of the Battery Test for Screening of Depression and Mental Health: PROtective and Vulnerable factors battEry Test (PROVE) / 신경정신의학

Objectives@#This study developed a battery test that allows a comprehensive evaluation of depressive symptoms and related protective-vulnerable factors to screen for depression and mental health and examined the reliability and validity of the test. @*Methods@#PROtective and Vulnerable factors battEry test (PROVE) consisting of five sub-sections was developed: depressive symptomatology (PROVE-DS), suicide risk (PROVE-SR), and three protective-vulnerable factors, which were adult attachment type (PROVE-ATT), adverse childhood experience (PROVE-ACE), and mentalization capacity (PROVE-MC). Two hundred and thirteen subjects completed the PROVE test and other comparative scales, and the analysis was carried out based on the data. @*Results@#The PROVE test showed good convergent, discriminant, and concurrent validity as well as adequate internal consistency. In addition, five sub-sections of the PROVE test showed significant relevance to each other. @*Conclusion@#The results of this study indicate that the PROVE test is a reliable and valid test, which will be useful for the prevention, evaluation, and treatment of depression in various clinical settings.

Rapid Symptom Improvement in Major Depressive Disorder Using Accelerated Repetitive Transcranial Magnetic Stimulation

Objective@#Repetitive transcranial magnetic stimulation (rTMS) has contributed to increase in the remission rate for patients with major depressive disorder (MDD). However, current rTMS treatment is practically inconvenient because it requires daily treatment sessions for several weeks. Accelerated rTMS treatment is as efficient and safe for MDD patients as conventional rTMS. @*Methods@#Fifty-one patients with MDD participated in this study; they were randomized into accelerated rTMS (n = 21), conventional rTMS (n = 22), and sham-treatment (n = 8) groups. The accelerated and conventional rTMS groups received 15 sessions for 3 days and 3 weeks, respectively. The sham-treatment group received 15 sham rTMS sessions for 3 days. Primary outcome was assessed using self-report and clinician-rated Korean Quick Inventory of Depressive Symptomatology (KQIDS-SR and KQIDS-C, respectively). Adverse effects were monitored using the Frequency, Intensity, and Burden of Side Effects Rating scale. Changes in depressive symptoms were compared among the three groups using mixed model analyses. @*Results@#For the KQIDS-SR score, there was a significant main effect of “time” (F3,47 = 11.05, p < 0.001), but no effect of “group” (F2,47 = 2.04, p = 0.142), and a trend-level interaction effect of “group × time” (F6,47 = 2.26, p = 0.053). Improvement in depressive symptoms, based on the KQIDS-SR score 3 weeks after treatment, was more prominent in the accelerated rTMS group than in the sham-treatment group (p = 0.011). Tolerability was comparable among the three groups. @*Conclusion@#The accelerated rTMS treatment group showed rapid improvement of depressive symptoms compared with the sham-treatment and conventional rTMS treatment groups. Therefore, accelerated rTMS treatment could be a viable option for MDD, with improved accessibility.

Treatment Effect of Psychoeducation and Training Program Using Virtual Reality Technique in the Patients with Depressive Symptoms / 신경정신의학

OBJECTIVES: To compare the clinical effectiveness of the virtual reality (VR) programs in assessing psychosocial problems, improving symptoms, and reducing suicide risk in depressive patients with those of pharmacotherapy.METHODS: Thirty-six patients were recruited with depression in the treatment group and 22 participants in the healthy control group through internet advertisements between November 2018 and March 2019. Participants in the treatment group were allocated randomly at a 1:1 ratio to either the VR group or pharmacotherapy group. At the baseline, all participants were assessed with a comprehensive battery for their psychological characteristics by structured scales using VR technologies. Assessments of patients in the treatment group were repeated four weeks after therapeutic intervention. The primary outcome measures were the Korean Version of Quick Inventory of Depressive Symptomatology-Self-Report and suicidality scales of the Korean Mini International Neuropsychiatric interview. The borderline personality (Personality Assessment Inventory-Borderline Features Scale) and resilience (Korean Resilience Questionnaire) were also evaluated.RESULTS: Twenty-four depressive patients completed the treatment, and the final assessment was conducted after four weeks of treatment. In the initial assessment, the patient group showed significantly higher depressive symptoms, suicidality, borderline personality trait, and lower resilience than healthy control group. After the four-week therapeutic interventions, the VR group showed significant improvement in depression, suicidality, borderline personality trait, and resilience. In addition, there was no significant difference in the treatment efficacy between the VR group and the pharmacotherapy group.CONCLUSION: In this study, the VR treatment program has clear benefits for emotional distress and reducing suicidality in depressive patients. Evidence-based VR treatments may show new clinical potential for depressive disorder.

Effectiveness of Korean Mentalization Based Treatment in Patients with Borderline Personality Disorder: Preliminary Report on Interim Analysis / 신경정신의학

OBJECTIVES: The treatment of borderline personality disorder (BPD) in Korea has been based mainly on individual psychopharmacotherapy and psychotherapy. No quantitative study has examined the effectiveness of group psychotherapy for patients with BPD in Korea. In the present study, the mentalization-based treatment (MBT) program developed from the Anna Freud Center in London was conducted in the author's hospital. This article presents the results of a preliminary analysis of the treatment effects of the Korean MBT for BPD.METHODS: The recruited subjects are patients diagnosed with BPD at Gangnam Severance Hospital. A psychological assessment was conducted at baseline and every six months during the treatment. Statistical analysis was performed using the data of 62 people at the baseline assessment, and the treatment effectiveness was analyzed with the data from 21 people who participated in the treatment group over six months.RESULTS: Borderline personality features were positively correlated with depressive symptoms, anxious attachment, avoidant attachment, and novelty seeking trait, and negatively correlated with self-directedness. After the 12-month treatment, the depressive symptoms and self-disclosure scores were improved significantly. In addition, the self-directedness, cooperativeness factor scores of the temperament and character inventory, and the self-regulation ability score of the resilience scale were also improved significantly.CONCLUSION: This study suggests that the Korean MBT can improve depressive symptoms and induce positive changes in personality functioning. Although the number of people who continued MBT over 12 months was very small due to the high dropout rate, this study is the first quantitative study on the effects of the Korean MBT for BPD patients.

Effect of Korean Version of Psychological First Aid Training Program on Training Disaster Mental Health Service Provider / 신경정신의학

Objectives@#This study aimed to develop a Korean version of psychological first aid training program (K-PFA) and examine the education effect on trainees. @*Methods@#This study enrolled 485 subjects who completed both K-PFA and study surveys. In addition to mental health professionals, subjects with various ages and educational backgrounds were included to examine the education effects of the capabilities in conducting PFA and understanding acute phase disaster mental health (DMH). @*Results@#Both mental health professionals and non-professionals improved their understanding of acute-phase DMH intervention and their perceived capabilities in conducting PFA. @*Conclusion@#The development of a DMH intervention-training program adapted to Korean domesticcircumstances and culture represents a significant step towards a comprehensive and individualized intervention for disaster survivors.

Preliminary Findings on the Effectiveness of Meaning-Centered Psychotherapy in Patients with Pancreatobiliary Cancer

PURPOSE: This study investigated the effectiveness of meaning-centered psychotherapy (MCP), which is known to be a helpful psychotherapeutic intervention in distressing conditions, for patients with pancreatobiliary cancer. MATERIALS AND METHODS: We recruited 37 patients with pancreatobiliary cancer from three university general hospitals and assessed their psychological characteristics. Patients who reported clinically significant emotional distress were recommended to undergo MCP. Patients who consented to MCP were provided four sessions of the therapy. Patient psychological characteristics were assessed again 2 months after MCP. For statistical comparison, outcome variables included anxiety, depression, mental adjustment to cancer, and quality of life (QoL), as well as the degree of stress and physical symptoms. RESULTS: Sixteen patients completed the MCP and the final assessment 2 months later. In the initial assessment, the patients receiving MCP showed higher levels of anxiety and depression than those not receiving MCP, and QoL was also lower in terms of role function, emotional function, social function, and global QoL. At the 2-month follow-up, the MCP group showed a significant improvement in anxiety (p=0.007), depression (p=0.010), and anxious preoccupation (p < 0.001). In addition, QoL significantly improved in the MCP group, while there was no significant change in the non-MCP group. CONCLUSION: In this study, MCP showed potential therapeutic benefits against emotional distress in patients with pancreatobiliary cancer, improving their QoL.