Relationship between Somatization and Mental Health of Registered Nurses / 정신신체의학

Objectives@#：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. @*Methods@#：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. @*Results@#：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. @*Conclusions@#：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

Relationship between Somatization and Mental Health of Registered Nurses / 정신신체의학

Objectives@#：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. @*Methods@#：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. @*Results@#：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. @*Conclusions@#：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

Factors Related to Diabetes Management in Mentally Ill Patients with Type 2 Diabetes: Focusing on Diabetes Knowledge

BACKGROUND: Diabetes is a chronic disease that cause premature death worldwide. The rate of testing for diabetes among mentally ill patients is 1.5 times that of the general population, and intervention in diabetes care is needed for patient with severe mental illness and diabetes.METHODS: This study was conducted using cross-sectional surveys distributed to patient with severe mental illness (n=54) among those who visited and were hospitalized at the National Mental Health Center.RESULTS: According to the assessment of the knowledge level of diabetes in patient with severe mental illness accompanied by type 2 diabetes, the correct answer rate was lower than that in the general population. Education and income affected the level of diabetes knowledge, and as diabetes knowledge level increased, blood sugar level were observed to decrease. The linear regression model showed that self-efficacy and education level were found to be predictors of diabetes knowledge, and diabetes knowledge level were predictors of fasting blood sugar levels.CONCLUSION: The results of this study showed that the higher education level and self-efficacy of the patient with severe mental illness and diabetes increased the diabetes knowledge and affecting glycemic control.

Chronic Physical Comorbidities and Total Medical Costs in Patients with Schizophrenia / 정신신체의학

OBJECTIVES: This study tried to explore the prevalence of chronic physical diseases in patients with schizophrenia and its effects on total medical costs. METHODS: The Health Insurance Review and Assessment Service data in 2014–2015 was employed. Only the injuries and diseases, identically diagnosed 3 times or more as a major or minor injury and disease, were classified into chronic physical diseases to improve data accuracy. Total medical costs included out-of-pocket and insurer's costs from health care system perspective. RESULTS: It was shown that 24.5%, 17.3% and 23.4% of schizophrenia patients had one, two and three or more chronic physical diseases, respectively. There was a high prevalence of not only metabolic, but also musculoskeletal, diseases in those patients. The amount of 2015 total medical costs of patients with schizophrenia in 2014 was about 1.08 trillion won. The factors affecting the costs included sex, age, number of chronic physical diseases, and health insurance status. CONCLUSIONS: It is considered that clinical practice guidelines based on personal diseases may not sufficiently solve the problems for comorbidities in schizophrenia patients. Accordingly, it should be required to develop models for new types of medical systems capable of treating and caring varied illnesses at the same time.

Relationship between Secondhand Smoking with Depressive Symptom and Suicidal Ideation in Korean Non-Smoker Adults: The Korean National Health and Nutrition Examination Survey 2010-2012 / 가정의학회지

BACKGROUND: Research suggests that mental health is affected not only by smoking, but also by secondhand smoking. But the most researches have been conducted in North America and/or Europe. We examined whether this relationship remains evident within the South Korean population. Specifically, we investigated the effect of secondhand smoking on depressive symptoms and suicidal ideation. METHODS: We analyzed data from 6,043 non-smoking adults who participated in the 2010-2012 Korea National Health and Nutrition Examination Survey. We compared the presence of depressive symptoms and suicidal ideation in 3,006 participants who were exposed to secondhand smoking in the office or at home with 3,037 non-exposed participants. RESULTS: In unadjusted logistic regression analysis, secondhand smoking exposure group had more suicidal ideations than no secondhand smoking exposure (16.1% vs. 12.2%; odds ratio [OR], 1.50; 95% confidence interval [CI], 1.241-1.804), but risk of depressive symptoms was not significantly different between two groups (15.2% vs. 12.2%; OR, 1.21; 95% CI, 0.997-1.460). In multivariate logistic regression analysis, Among those exposed to secondhand smoking, the OR for depressive symptoms was 1.02 (95% CI, 0.866-1.299) and 1.43 (95% CI, 1.139-1.802) for suicidal ideation. Overall, secondhand smoking at home was significantly related to depressive symptoms and suicidal ideation. Among females, secondhand smoking exposure at home only (not in the office) was related to depressive symptoms and suicidal ideation. CONCLUSION: Exposure to secondhand smoking, especially at home, may be associated with an increase in especially in female depressive symptoms and suicidal ideation among adults in South Korea.

The Current Status of End-of-Life Care in Korea and Legislation of Well-Dying Act

Recently, the Well-dying Act was legislated in Korea, and it will come into force in 2018. The rapid aging of this society has made many older patients and their families suffer from pain and disability for a long time towards the end of life. Hospice care, when compared to life-sustaining treatment, can relieve such burdens. Regarding the decision of choosing hospice care at the end of life, advance care planning and advance directives can help people express their preference beforehand. In Korea, hospice care is still not actively used and most patients endure life-sustaining treatment until death. Many patients want hospice care, but there has not been a legal basis for such a decision, leading to social conflict and many legal problems. The Well-dying Act will provide a legal basis for such a decision. This will help establish and promote hospice care in Korea. However, sufficient discussion and preparation are required before enforcing the Act.

Factors Associated with Depression Assessed by the Patient Health Questionnaire-2 in Long-Term Cancer Survivors / 가정의학회지

BACKGROUND: This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors. METHODS: A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire. RESULTS: We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81-14.02) was associated with the increased risk of depression. CONCLUSION: These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.

Long-Term Tolerability of Escitalopram in Korean Adolescents

OBJECTIVES: We investigated the long-term tolerability of escitalopram in Korean adolescents. METHODS: The subjects were 37 adolescents, who had been diagnosed with depressive disorder in accordance to DSM-IV. Clinical effectiveness was assessed by Clinical Global Impression-Improvement (CGI-I) scale at the final follow-up visit. Tolerability was assessed through a medical record of the reason for discontinuation of escitalopram and documented adverse events. RESULTS: The mean duration of treatment was 78.1+/-89.5 days, and the mean dosage was 10.0+/-4.4mg/day. Out of the total 37 patients, two (5%) patients sustained use of escitalopram. Twelve patients (32.4%) discontinued use of escitalopram due to target symptom remission, and 23 patients (61.9%) due to insufficient efficacy. Six patients (16.2%) had at least one documented adverse event. However, no suicidal ideation or self-injurious behavior was reported. Significant differences in clinical symptom improvement efficacy were seen between the patients who were receiving escitalopram for less than 8 weeks (4.3%, 1/13) and those for more than 8 weeks (92.9%, 13/14). There was no significant difference between the tolerability of monotherapy compared to the concomitant use group. CONCLUSION: The results of this study suggest that long-term use of escitalopram may result in superior efficacy than short-term use, and is tolerable in Korean adolescents with depression.

Retrospective Analyses of Long-Term Use of SSRI in Children and Adolescents with Autism Spectrum Disorder

OBJECTIVES: The purpose of this study was to investigate clinical profile, efficacy, and safety of long-term treatment with selective serotonin reuptake inhibitors (SSRIs) in Korean autism spectrum disorders (ASDs) patients. METHODS: Effectiveness was assessed through a retrospective review of self-reported target symptom improvement at the last follow-up visit. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity (CGI-S) of illness and Clinical Global Impression-Improvement (CGI-I) Scales. Tolerability was assessed through a review of the reason for discontinuation of SSRI and documented adverse events. RESULTS: A total of 21 ASDs patients (aged 9 to 19 years) treated with SSRI during July 2010 to July 2011 in department of child and adolescent psychiatry of Seoul National Hospital were identified. The mean duration of SSRI treatment was 47.9 (standard deviation = 36.9) months (range 0.7-114.5), and the mean fluoxetine equivalent dosage of SSRIs was 27.1 +/- 10.8 mg. Nineteen (90.5%) patients were using concomitant medication. We found that SSRIs were prescribed for symptoms of agitation, stereotyped behavior, aggression, depression, impulsivity and self-injury in ASDs. Ten patients (47.6%) reported improvement in their target symptom after SSRI treatment based on CGI-I scores (CGI-I < or = 2). The side effects were reported in 5 patients (23.8%) ; vomiting (n = 2, 9.5%), excessive mood elevation (n = 1, 4.8%), insomnia (n = 1, 4.8%), somnolence (n = 1, 4.8%) and decreased appetite (n = 1, 4.8%). Self-injurious behavior was reported in one patient (4.8%). CONCLUSIONS: The results of this study suggest that SSRIs may be used effectively in children and adolescents diagnosed with ASDs. However, safety issues need to be considered carefully when choosing SSRIs for treatment. Future controlled trials are needed to confirm these findings.