Leadership, Ethics, Professional Role, and Future Direction of Psychiatrists / 신경정신의학

OBJECTIVES: The traditional roles of psychiatrists are being threatened according to the changes of requests from society. Psychiatrists need to rapidly adapt to new upcoming circumstances, improve leadership skills, and prepare for emerging ethical problems. The aim of this study is to predict and suggest what will happen in the future in the area of mental health, what role models might be required, what we should do and how we can prepare. METHODS: The authors interviewed seven mental health professionals on topics of leadership, participating roles of psychiatrists. Three models for psychiatrists were suggested : clinical model, community leader model, and mental health promoting model. Afterwards, a questionnaire on each role model was distributed to members of the Korean Neuropsychiatric Association via email and results were analyzed. RESULTS: Experts and stakeholders suggested that the following components from the interview will be fostered in the future : leadership in collaboration with other communities, introduction of leadership programs for young psychiatrists, strategies for sensitization of ethical issues, active communication with community partners, training professionals in legislation and administration. Regarding the questionnaire, 32 members responded. The most preferred role model was the Community leader model (46.9%, n=15), followed by the mental health promoting model (34.4%, n=11) and clinical model (15.6%, n=5). Most responders recognized that these issues are emerging and answered affirmatively on the developmental potential of each role model. A question about primary agents who are supposed to take charge of development of a suitable model was answered as follows : university professors for the clinical model (37.5%, n=12), psychiatrists working for public hospitals both for community leader (28.1%, n=9), and mental health promoting model (43.8%, n=14). Various opinions on leadership and strategies for fulfilling the role model were proposed. CONCLUSION: This study investigated leadership, ethics, social roles, and future directions of psychiatrists in order to provide suggestions on how to properly respond to changes of environment. It is expected that this study will be helpful in establishment of guidelines for leadership development and improving ethical orientation of psychiatrists, and will provide an opportunity for Korean NeuroPsychiatric Association members to have deep consideration and radical debate on our transforming roles.

A Study to Investigate the Medium- and Long-Term Developmental Directions of Mental Hospitals / 신경정신의학

OBJECTIVES: The aim of this study was to investigate medium- and long-term developmental directions of mental hospitals. METHODS: The preliminary investigation is composed of unstructured interviews with 10 psychiatrists, literature and case investigations, and development of models for medium- and long-term developmental model. The qualitative investigation consisted of constructed interviews with seven professionals. The quantitative investigation was conducted using questionnaires, which were sent to members of the Korean Neuropsychiatric Association, etc. Data were analyzed using frequency analysis. RESULTS: Through the preliminary investigation we were able to make three models : community model emphasizing linkage between mental hospitals and community, specialization model stressing specializations of mental hospitals, and extension model highlighting extensions of the roles of the mental hospital. In the qualitative investigation, two of the seven professionals gave a special preference for the community model, one for the specialization model, and two for the extension model. In the quantitative investigation, the community model and the specialization model were the most favorite models, and the extension model was the least favorite model. CONCLUSION: Three developmental models could be used in planning of the medium- and long-term developmental directions of mental hospitals, although each model needs to be embodied in order to work in practice.

The Impact of Major Depressive Disorder on Productivity in Workers: A Preliminary Study Using WHO-HPQ(Health and Work Performance Questionnaire) / 신경정신의학

OBJECTIVES: Major depressive disorder (MDD) causes patients' distress and makes socioeconomic burden, both directly and indirectly. We used the concept of lost productive time (LPT) to estimate the indirect costs and calculated both absenteeism and presenteeism among workers with MDD. METHODS: Depression group was recruited from workers visiting psychiatric outpatient clinic who had MDD without major physical or mental disorders (N=106). Age and sex matched healthy control group was also recruited through advertisement (M=100). All participants completed a interview using WHO Health and Work Performance Questionnaire (HPQ), Job Stress Measurement Scale for Korean Employees, and Hamilton Rating Scale for Depression. Statistical analysis was performed with independent t-test or Chi2 test as characteristics of values (p=0.05). RESULTS: The number of absence (0.94-day/month vs. 0.10-day/month, p=0.015) and the number of early leaving (2.56-day/month vs. 0.24-day/month, p<0.001) were significantly higher in the depression group. Depression group evaluated their performance level much lower than controls with significant value (5.16 vs. 7.62, p<0.001). In addition, depression group estimated their performance level during the last 4 weeks lower compared to the level of past 1-year (5.16 vs 6.63, p<0.001). The estimated costs of absenteeism in depression group were higher than controls by 2,520,000 Korean Won per year, and those of presenteeism were also higher by 4,880,000 Korean Won per year. The total costs of LPT in depression group were higher than controls by 7,400,000 Korean Won, which corresponds to 26% of mean annual salary. In addition, the level of occupational stress, such as high demand and interpersonal conflict, was higher in the depression group. CONCLUSION: Major depressive disorder costs substantial productivity loss to workers and their company. Presenteeism imposes more time cost than absenteeism. Effectiveness trials are needed to devise cost-effective programs for the early detection and treatment of depression at the workplace.

A 6 Months Follow-Up of Cognitive Function in Urban Community Elderly

OBJECT: The purpose of this study was to measure the natural changes of cognitive function over 6 months and to determine which cognitive tests were valuable for early detection of dementia in community dwelling elderly. METHOD: Cognitive functions were measured in 94 elderly registered at the Public Welfare Center in Gwacheon, the urban community of Kyunggido. After 6 months, same cognitive functions were re-measured in 54 elderly. The measures were Korean version of Mini-Mental State Examination (MMSE-K), Subtests of Korean Version of Memory Assesment Scales (KMAS), Verbal Fluency Test, Clock Drawing Task, Wechsler Digit Substitution Test and Wechsler Similarity Test. RESULTS: The mean age was 73.61+/-5.97 year. Most part of the tests were influenced by education, but not by age and sex. Of the MMSE-K subtests, the score of memory registration and memory recall declined after 6 months. The score of delayed recall of K-MAS declined, too. Decreased score was also observed in 'country' of the category verbal fluency test and 'n' of phonemic verbal fluency test, Wechsler digit substitution test and Wechsler similarity test. But, score decline was not statistically significant. Three persons were diagnosed as dementia after 6 months. And, they acquired low scores in above cognitive function tests in first cognitive function tests. CONCLUSION: Memory registration and memory recall of MMSE-K, delayed recall of K-MAS, verbal fluency test, Wechsler digit substitution test and Wechsler similarity test were sensitive to cognitive decline. The results suggest that these cognitive function tests could be applied to detect minimal changes of cognitive function in community dwelling elderly.

Telomerase Activity in Breast Cancer and Benign Breast Disease of Korea / 한국유방암학회지

BACKGROUND: Telomerase is an RNA-dependent DNA polymerase that compensates for the telomere shortening that occurs in its absence. Reactivation of telomerase is thought to be an important step in cellular immortalization, and recent studies have indicated that telomerase activity is often detected in primary human malignancies. The purpose of this study is to identify telomerase activity in breast cancer. MATERIALS & METHODS: Telomerase activities were analyzed in the samples of 12 breast cancer tissues and 11 benign breast disease tissues by TRAPeze ELISA detection kit (Oncor, Gaithersburg, USA). All samples were obtained from the excised mass at the time of specimen removal in the operating room and stored in liquid-nitrogen tank. RESULTS: Telomerase activity was detected in 10 of 12 (83.3%) breast cancer samples and 4 of 11 (36.4%) benign breast disease samples. The detection of telomerase activity in diagnosis of breast cancer has validity: 83.3% sensitivity rate, 63.6% specificity rate, 71.4% (+) predictability rate, 77.8% (-) predictability rate. The telomerase activity correlates with the estrogen receptor status (p=0.009). CONCLUSION: The telomerase activity can be detected in breast cancer sensitively. Further study with sufficient samples is needed to establish detection of telomerase activity as diagnostic tool in breast cancer.