A Comparative Study on the Cognitive and Clinical Characteristics of Childhood/Adolescent- and Adult-Onset of Bipolar Disorder / 생물치료정신의학

Objectives@#：Childhood/adolescent-onset of bipolar disorder presents functional impairments on emotional, academic, and social aspects. These impairments could continue into adulthood. However, there are few studies comparing cognitive function between childhood/adolescent- and adult-onset using psychological test. This study aims to improve understanding of childhood/adolescent-onset of bipolar disorder by comparing differences in cognitive function, clinical and demographic features between the two groups. @*Methods@#：This study was conducted on 145 patients diagnosed with bipolar disorder type I, II, and other specified bipolar disorder by DSM 5 at the time of discharge from 2016 to 2019 at the Department of Psychiatry, Pusan National University Yangsan Hospital. Demographic information, clinical data, and results of psychological tests (K-WISC-IV, K-WAIS-IV) were collected and reviewed. @*Results@#：Childhood/adolescent-onset group was significantly low in total potential IQ and in language understanding than adult-onset group (p=0.008 and p=0.013). The childhood/adolescent group had significantly more psychiatric comorbidities than the adult group (p<0.001). The average number of prescribed antipsychotic agents was 1.18 (SD= ±0.64) in the childhood/adolescent group, and 1.78 (SD=±0.82) in the adult group. The difference was statistically significant (p<0.001). @*Conclusion@#：Patients with childhood/adolescent-onset bipolar disorder have lower total potential IQ and language understanding comparing patients with adult-onset bipolar disorder. This highlights the importance of conducting a well-designed prospective study to find out more about the characteristics of childhood/adolescent-onset bipolar disorder.

The Impact of Emotional Exhaustion on Psychological Factors in Workers with Secondary Traumatic Experiences: A Multi-Group Path Analysis

Objective@#The objective of the present study was to explore causal pathways to understand how second traumatic experiences could affect the development of emotional exhaustion and psychiatric problems. @*Methods@#A total of 582 workers who had jobs vulnerable to secondary traumatic experiences were enrolled for this study. Emotional exhaustion, secondary trauma, resilience, perceived stress, depression, anxiety, and sleep problems were evaluated. A model with pathways from secondary traumatic experience score to depression and anxiety was proposed. The participants were divided into three groups according to the resilience: the low, middle and high resilience group. @*Results@#Resilience was a meaningful moderator between secondary traumatic experiences and psychiatric problems. In the path model, the secondary trauma and perceived stress directly and indirectly predicted perceived stress, emotional exhaustion, depression, anxiety, and sleep problems in all three groups. Direct effects of perceived stress on depression and anxiety were the largest in the low resilience group. However, direct effects of secondary trauma on perceived stress and emotional exhaustion were the largest in the high resilience group. @*Conclusion@#Understanding the needs of focusing for distinct psychological factors offers a valuable direction for the development of intervention programs to prevent emotional exhaustion among workers with secondary traumatic experiences.

Changes in Urine Osmolal Concentration with Lithium Treatment in Children and Youth with Bipolar Disorder / 신경정신의학

Objectives@#Bipolar disorder has a high rate of recurrence, which can cause problems such as declines in cognitive and social functions. Lithium is the primary medication for preventing recurrence, but the medication compliance is poor owing to side effects that include diarrhea, tremor, polyuria, polydipsia, diabetes insipidus, increased creatinine level, and weight gain. Polyuria and polydipsia also cause voluntary discontinuation of the medication. However, no domestic and international studies have evaluated the direct correlation between lithium therapy and polydipsia in pediatric patients. Therefore, we assessed this relationship by evaluating urine osmolality changes after lithium administration in pediatric patients. @*Methods@#This study focused on patients admitted to the Department of Psychiatry, Pusan National University Yangsan Hospital. Patients had bipolar disorder types I or II and other specified bipolar disorders based on the DSM-5, criteria at discharge from December 1, 2018, to April 31, 2020. Urine osmolarity changes from admission to discharge in the patients who used lithium for the first time after admission were reviewed. @*Results@#For 47 patients, the change in osmolality was statistically significant (mean, 203.32±280.68; p<0.001) and significantly higher in those aged <14 years than in those aged ≥14 years (p=0.038). Antipsychotic use and sex-related differences did not affect urine osmolality. @*Conclusion@#The first-time users of lithium had significantly reduced urine osmolality at discharge. Considering the lithium effect on the kidneys, a prospective study to identify the relationship between lithium use and polydipsia is necessary.

Changes in Urine Osmolal Concentration with Lithium Treatment in Children and Youth with Bipolar Disorder / 신경정신의학

Objectives@#Bipolar disorder has a high rate of recurrence, which can cause problems such as declines in cognitive and social functions. Lithium is the primary medication for preventing recurrence, but the medication compliance is poor owing to side effects that include diarrhea, tremor, polyuria, polydipsia, diabetes insipidus, increased creatinine level, and weight gain. Polyuria and polydipsia also cause voluntary discontinuation of the medication. However, no domestic and international studies have evaluated the direct correlation between lithium therapy and polydipsia in pediatric patients. Therefore, we assessed this relationship by evaluating urine osmolality changes after lithium administration in pediatric patients. @*Methods@#This study focused on patients admitted to the Department of Psychiatry, Pusan National University Yangsan Hospital. Patients had bipolar disorder types I or II and other specified bipolar disorders based on the DSM-5, criteria at discharge from December 1, 2018, to April 31, 2020. Urine osmolarity changes from admission to discharge in the patients who used lithium for the first time after admission were reviewed. @*Results@#For 47 patients, the change in osmolality was statistically significant (mean, 203.32±280.68; p<0.001) and significantly higher in those aged <14 years than in those aged ≥14 years (p=0.038). Antipsychotic use and sex-related differences did not affect urine osmolality. @*Conclusion@#The first-time users of lithium had significantly reduced urine osmolality at discharge. Considering the lithium effect on the kidneys, a prospective study to identify the relationship between lithium use and polydipsia is necessary.

Factors Associated with Emotional Exhaustion in South Korean Nurses: A Cross-Sectional Study

OBJECTIVE: We examined associations between emotional exhaustion and selected sociodemographic and psychological factors among nurses in inpatient and outpatient nursing units at a university hospital in South Korea. METHODS: The participants were 386 nurses who completed the Maslach Burnout Inventory, a measure of emotional exhaustion. Psychological characteristics were evaluated, including hardiness, self-esteem, experience of trauma, resilience, perceived stress, and social support. Correlation analyses examined the relationships between emotional exhaustion with sociodemographic, occupational, and psychological characteristics. Linear regression was used to evaluate the associations between emotional exhaustion and the assessed characteristics. RESULTS: Higher emotional exhaustion scores were associated with greater depression, anxiety, traumatic experience, and perceived stress. Exhaustion was inversely associated with hardiness, self-esteem, resilience, and quality of life. The regression analysis indicated that gender, marriage, resilience, depression, perceived stress, and secondary traumatic stress were significantly associated with emotional exhaustion. CONCLUSION: This study showed that psychological characteristics, such as resilience, depression, and secondary traumatic experiences, may cause emotional exhaustion. Understanding the needs of people with distinct demographic and psychological characteristics offers valuable direction for the development of intervention programs to prevent burnout among nurses.

Comparative Study on the Perception of the Neighborhood Environment and Experience of Out-of-School Activities between Typical Students and Attention-Deficit Hyperactivity Disorder Patients

OBJECTIVES: The purpose of this study is to investigate the differences between a attention deficit hyperactivity disorder (ADHD) group and a general student group in terms of the perception of the residential environment and periodic activities outside the classroom. METHODS: The patient group consisted of 62 outpatients or inpatients at the Department of Pediatric Psychiatry, and 49 patients diagnosed with ADHD were selected. For the control group, 3727 youths in elementary schools, middle schools, and high schools of one city were asked to fill out questionnaires. Of the 1717 respondents who responded to the questionnaires, 245 were selected for a patient-controlled study. The differences between the patient group and the control group were compared using the chi-squared test (χ2 test). RESULTS: There was a significant difference between the patient group and the control group in areas where students responded by “My neighborhood is dirty and littered (p < 0.05)”. There was also a significant difference between the patient group and the control group in terms of having more than one club activity per month (p < 0.05). CONCLUSIONS: It was found that the patients with ADHD are more aware of perceived negative aspects of the area in which they reside, thus reflecting their anxiety. In addition, it was also found that the patient group did not partake in as many social activities as the control group.

Predictive Value of Cardiac Magnetic Resonance Imaging-Derived Myocardial Strain for Poor Outcomes in Patients with Acute Myocarditis

OBJECTIVE: To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis. MATERIALS AND METHODS: We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (Ecc(SAX)), radial strain (Err(SAX)) from mid-ventricular level short-axis cine views and LV longitudinal strain (Ell(LV)), radial strain (Err(Lax)) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. RESULTS: During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, Ecc(SAX), Err(SAX), Ell(LV), and Err(Lax) values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an Err(Lax) value ≤ 9.48%. Multivariable backward regression analysis revealed that Err(Lax) values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CONCLUSION: CMR-derived Err(Lax) values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.

Co-Author Networks in Journal of the Korean Academy of Child and Adolescent Psychiatry

OBJECTIVES: The purpose of this study is to analyze the co-author networks in the Journal of the Korean Academy of Child and Adolescent Psychiatry, a representative journal published by a branch of the domestic psychiatric academy, in order to present the current state of the co-authoring of and developments in child and adolescent psychiatry. METHODS: We visualized and estimated the basic characteristics of the co-author networks shown by 564 authors who wrote 251 papers published in the Journal of the Korean Academy of Child and Adolescent Psychiatry between 2005 and 2015, in order to assess their network characteristics, author centrality, and relevance to research performance. RESULTS: The co-author networks in the Journal of the Korean Academy of Child and Adolescent Psychiatry showed the characteristics of a small world and scale-free network. There was a correlation between the author centrality within the network and the research performance of the authors, but less correlation was shown between the centrality and mean paper citation counts. CONCLUSION: The network structure in the Journal of the Korean Academy of Child and Adolescent Psychiatry showed similarity to the co-authoring of other branches. However, given that the mean paper citation counts were less correlated with the author centrality than those in other branches, it may be necessary to promote an increase in the mean paper citation counts.

Other N-Methyl-D-Aspartate (NMDA) Receptor Antagonists with a Rapid Onset of Action and Less Side Effect in the Treatment of Depression

Mood disorder is a common psychiatric illness with a high lifetime prevalence in the general population. Many prescribed antidepressants modulate monoamine neurotransmitters including serotonin, norepinephrine and dopamine. There has been greater focus on the major excitatory neurotransmitter in the human brain, glutamate, in the pathophysiology and treatment of major depressive disorder (MDD). Recently, ketamine, an N-methyl-D-aspartate receptor antagonist, has received attention and has been investigated for clinical trials and neurobiological studies. In this article, we will review the clinical evidence for glutamatergic dysfunction in MDD, the progress with ketamine as a rapidly acting antidepressant, and other N-methyl-D-aspartate receptor antagonist for treatment-resistant depression.

Survey of Depression in the Elderly Patients with Diabetes Mellitus / 신경정신의학

OBJECTIVES: Depression is commonly comorbid in elderly patients with physical illness. This study examined the prevalence of depression in the elderly with Diabetes Mellitus (DM). METHODS: Eighty-nine patients, over 60 years old, with DM were enrolled. The medical and psychiatric history, Hamilton Rating Scale for Depression (HDRS), Patient Health Questionnaire-9 (PHQ-9), Geriatric Depression Scale-Short form Korean (GDS-SF-K), and Mini-Mental Status Examination Korean version were examined. RESULTS: The prevalence of depression was estimated as 21.3% (male 4.5% ; female 16.9%) in HDRS, 32.6% (male 9.0% ; female 23.6%) in PHQ-9, and 24.7% (male 5.6% ; female 19.1%) in GDS-SF-K. CONCLUSION: The self-reporting scale, such as GDS-SF-K, PHQ-9 is an effective screening test for depression. The prevalence of elderly depression with DM ranged from 20% to 30%, the prevalence of depression is almost three times more common in women.

Parenting Stress and Efficacy of the Mothers of Children with Internet Addiction and Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The purpose of this study was to compare levels of parenting stress and efficacy in mothers of children suffering from attention-deficit hyperactivity disorder (ADHD) and internet addiction disorder (IAD), mothers of children with ADHD alone only, and those with normal children. METHODS: Participants were composed of 25 mothers of children with ADHD and IAD, 35 mothers of children with ADHD alone, and 50 mothers of normal children. They completed the Parenting Stress Index (PSI) and Parenting Sense of Competence (PSOC). RESULTS: In comparison with the mothers of normal children, the mothers of children with ADHD and IAD and the mothers of children with ADHD alone showed significantly higher levels of parenting stress and lower parenting efficacy. However, a comparison of mothers of children with ADHD and IAD with those of children with ADHD alone did not show any significant differences in their levels of parenting stress or efficacy. CONCLUSION: Mothers of children with ADHD, regardless of the presence of IAD exhibited a higher level of parenting stress and a lower level of parenting efficacy than mothers of normal children.