Korean Version of the Delirium Rating Scale-Revised-98: Reliability and Validity

OBJECTIVE: The aims of the present study were 1) to standardize the validity and reliability of the Korean version of Delirium Rating Scale-Revised-98 (DRS-R98-K) and 2) to establish the optimum cut-off value, sensitivity, and specificity for discriminating delirium from other non-delirious psychiatric conditions. METHODS: Using DSM-IV criteria, 157 subjects (69 delirium, 29 dementia, 32 schizophrenia, and 27 other psychiatric patients) were enrolled. Subjects were evaluated using DRS-R98-K, DRS-K, Mini-Mental State Examination (MMSE-K), and Clinical Global Impression-Severity (CGI-S) scale. RESULTS: DRS-R98-K total and severity scores showed high correlations with DRS-K. They were significantly different across all groups (p=0.000). However, neither MMSE-K nor CGI-S distinguished delirium from dementia. All DRS-R98-K diagnostic items (#14-16) and items #1 and 2 significantly discriminated delirium from dementia. Cronbach's alpha coefficient revealed high internal consistency for DRS-R98-K total (r=0.91) and severity (r=0.89) scales. Interrater reliability (ICC between 0.96 and 1) was very high. Using receiver operating characteristic analysis, the area under the curve of DRS-R98-K total score was 0.948 between the delirium group and all other groups and 0.873 between the delirium and dementia groups. The best cut-off scores in DRS-R98-K total score were 18.5 and 19.5 between the delirium and the other three groups and 20.5 between the delirium and dementia groups. CONCLUSION: We demonstrated that DRS-R98-K is a valid and reliable instrument for assessing delirium severity and diagnosis and discriminating delirium from dementia and other psychiatric disorders in Korean patients.

Current Use of Depression Rating Scales in Mental Health Setting

OBJECTIVE: This study was to investigate the current use of depression rating scales by psychiatrists and clinical psychologists in Korea. METHODS: The questionnaires from many psychiatrists and clinical psychologists were included in the analysis. The questionnaire was composed of items about examining the percentage of patients clinically using depression rating scales, reasons for not use of them, the degree of satisfaction, the perceived agreement rate between the result of depression rating scales and doctor's clinical interview in the evaluation of patients with depressive symptoms. Data were analyzed by chi-square and independent t-test. RESULTS: The clinical use of depression rating scales was more frequent in the psychologists than in the psychiatrists. The purposes for using depression rating scales were assessed into six areas, there was no significant difference in between two groups, and both groups pointed out their purpose as rating of severity and screening. The reasons for not using scales were that their interview may be sufficient for diagnosis and assessment of depressive patients and they are not familiar with the use of depression rating scales. The psychiatrists usually prefer the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale and Symptom Checklist 90-Revision (SCL-90-R) in order of frequency, and the clinical psychologists are more likely to use the BDI, Minnesota Multiphasic Personality Inventory and SCL-90-R. Overall rate of satisfaction in the use of the scales was 67.29+/-14.45% and overall perceived agreement rate was 70.89+/-16.45%. CONCLUSION: Currently used depression rating scales at the clinical practice were not various. Therefore, to heighten clinicians' utility of these depression rating scales measures, either educational efforts or advertisements, or both, will be necessary to spread them wildly.

Effect of Long-Term Aripiprazole Therapy on Social Functioning in Korean Patients with Schizophrenia: A 52-Week, Prospective, Open-Label Study / 대한정신약물학회지

OBJECTIVE: We examined the effect of long-term aripiprazole therapy on social functioning in Korean patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder. METHODS: In this 52-week open-label, multicenter, single-arm study, 300 Korean patients with schizophrenia were treated with aripiprazole 10-30 mg/day after administration of 15 mg/day during the first 2 weeks. The primary efficacy measure was the Korean-Social Functioning Scale (SFS-K), and the secondary efficacy measures were the Emotion Assessment, and the Positive and Negative Syndrome Scale (PANSS) score and the Clinical Global Impression - Severity of Illness (CGI-S) to investigate for correlation between social functioning and clinical symptoms. RESULTS: At week 52, there were significant improvements in all the areas of the SFS-K. There was generally no difference in the change of social functioning between patients in the first episode and patients having previous episodes. Significant improvements were also observed in negative emotion and emotional control. Statistically significant correlation between the SFS-K and the PANSS score was observed at week 52. CONCLUSION: The present study showed that long-term treatment with aripiprazole contributed to significant improvement in social functioning in patients with schizophrenia in the long-term treatment. This improvement of social functioning was modestly associated with clinical improvement of symptoms. The results suggest that long-term aripiprazole therapy could be effective not only in treating clinical symptoms, but also in improving social functioning in patients with schizophrenia-spectrum disorder.

The Rationale and Effect of Antipsychotics Combination Therapy / 대한정신약물학회지

Up to the present date, the principle of antipsychotics treatment in patients with schizophrenia is antipsychotics monotherapy. The reasons for the drug monotherapy may be associated with the fact that typical antipsychotics were assumed to have similar mechanism of action and that combination use of more than two antipsychotics would offer no benefit over that of monotherapy with the agents. However, because the newer `atypical' antipsychotics have the notable features in their diverse pharmacologic action and lower adverse event profiles, many practitioners have an interest in using the combination therapy. Some patients with schizophrenia and schizoaffective disorder have no response to atypical antipsychotics and the studies increasingly reported that the antipsychotics combinations improve the symptom profiles of psychotic patients. Thus, the antipsychotic combination therapy is an additional option in treatment-resistant psychotic patients. These combination therapies are commonly used in clinical practice, but we are in lack of the evidence of the rationale and background of this practice. Since most studies for antipsychotics combination therapy are open trial or retrospective study, we need the further prospective clinical studies with double-blind, placebo-controlled design in order to definitively determine the effectiveness of such practice.