Development of Mental Healthcare Model in Seoul

Objective@#To develop an integrated and comprehensive community-based mental healthcare model, opinions were collected on various issues from practitioners in mental health service institutions currently offering mental healthcare services in Seoul through a focus group interview, qualitative research method, and Delphi survey. @*Methods@#The focus group interview was conducted with six practitioners from mental health welfare centers and six hospital-based psychiatrists. A questionnaire of opinions on the mental healthcare model was filled by these practitioners and psychiatrists. A Delphi survey was additionally conducted with a panel of 20 experts from a community mental health welfare center and hospital-based psychiatrists. @*Results@#The focus group interview results showed the need for integrated community-based mental healthcare service and the need to establish a system for managing mental and physical health in an integrated manner. Based on the survey results, the current status of community-based mental healthcare services was investigated, and the direction of the revised model was established. The Delphi survey was then conducted to refine the revised model. @*Conclusion@#The present study presents the Seoul-type community-based mental healthcare model with integrated services between a psychiatric hospital with a mental health welfare center as well as combined mental and physical health services. This is ultimately expected to help people with mental illnesses live healthy lives by meeting their needs as community members.

Association Between Suggestive Symptom of Restless Legs Syndrome and COVID-19 Vaccination: A Pilot Study

Objectives@#Various sensory symptoms have been recognized after COVID-19 vaccination. Here, we aimed to explore the association between the suggestive symptom of restless legs syndrome (RLSss) and COVID-19 vaccination using an online survey. @*Methods@#We prospectively studied participants who were working in our hospital after at least the first dose of the ChAdOx1 or BNT162b2 mRNA vaccine. The participants were invited via smartphone messages and voluntarily filled out an online questionnaire that included adverse events after vaccination. We considered the participants as having RLSss if they reported that they had three or more symptoms in the restless legs syndrome (RLS) diagnostic criteria. @*Results@#A total of 628 participants (506 female; mean age, 37.7±12.4 years) responded fully to our online survey. 588 participants (93.6%) received the first dose of the ChAdOx1 vaccine (BNT162b2 mRNA vaccine for 40 participants). A total of 44 out of the 628 participants (7.0%) reported that they had RLSss. Myalgia was more common in participants with RLSss than in those without RLSss (97.7% vs. 67.3%, p<0.001). Multivariate testing showed that age (odds ratio, 1.037 per 1 year increase; 95% CI, 1.004–1.071) and the presence of myalgia (odds ratio, 20.479; 95% CI, 4.266–368.206) were associated with the presence of RLSss. @*Conclusions@#This pilot study explored RLSss after COVID-19 vaccination and the results suggested that RLS might be one of the causes of adverse symptoms after COVID-19 vaccination. Further studies are required to confirm the relationship between RLS and COVID-19 vaccination.

Influencing Factors of Depression and Stress of the Elderly in Seoul: Analysis of 2018 Community Health Survey Data

Objective@#This study analyzed the relationship between sociodemographics and health behaviors that affect depression and stress of the aged 65 or older living in Seoul in 2018. @*Methods@#The subjects were selected according to the purpose by receiving raw data from the Korea Centers for Disease Control and Prevention, and 5,753 respondents were analyzed. @*Results@#In depression, the demographic and sociological factors with differences were sex, marriage, single-person household,current basic living, economic activity and monthly income, and the health behaviors with significant differences were past smoking, diabetes and insufficient annual medical use. In the stress level, the demographic and sociological factors with differences were age, sex, current basic living, monthly income and education, and the health behaviors with significant differences were current/past smoking, diabetes and insufficient annual medical use. The factors affecting depression and stress were not completely consistent but similar, and both had low rates of expert counseling. @*Conclusion@#This study is meaningful in that it identified the factors affecting the depression and stress of the elderly especially in Seoul, the metropolitan city. If future research reveals additional factors, it will be helpful to suggest the direction of government policy and contribute to improving the quality of life of the elderly in the super-aged era.

Risks of Completed Suicide of Community Individuals with ICD-10 Disorders Across Age Groups: A Nationwide Population-Based Nested Case-Control Study in South Korea

OBJECTIVE: Suicide is the leading cause of death in 10–39-year-olds in South Korea, and the second highest rate among the OECD countries. However, few studies have investigated the particularity of completed suicide in South Korea. METHODS: Study subjects consisted of 2,838 suicide cases and 56,758 age and sex matched living controls from a national representative sample of 1,025,340 South Koreans. They were obtained from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) with follow-up up to 12 years. We obtained information on primary diagnosis of any ICD-10 disorder along with suicide cases during their lifetime. RESULTS: Among ICD-10 disorders, depression was the most common disorder (19.10%, n=542), found in victims of completed suicides except for common medical disorders such as hypertensive crisis, respiratory tract infection or arthropathies. After adjusting for sex, age, economic status, disability, and disorders, schizophrenia showed the strongest association with suicide (AOR: 28.56, 95% CI: 19.58–41.66) among all ICD-10 disorders, followed by psoriasis, multiple body injury, epilepsy, sleep disorder, depression, and bipolar disorder. For age groups, ≤19 years was associated with anxiety disorder (AOR=80.65, 95% CI: 13.33–487.93), 20–34 years with epilepsy (AOR=134.92, 95% CI: 33.69–540.37), both 35–49 years (AOR=108.57, 95% CI: 37.17–317.09) and 50–65 years (AOR=189.41 95% CI: 26.59–1349.31), with schizophrenia, and >65 years (AOR=44.7, 95% CI: 8.93–223.63) with psoriasis. CONCLUSION: Psychiatric and physical disorders carried greatly increased risks and numbers of suicides in South Korea. Schizophrenia was the strongest risk factor, especially 35–65 years, and depression was the most common in suicide victims among ICD-10 disorders in South Korea.

Design and Methods of the Korean National Investigations of 70,000 Suicide Victims Through Police Records (The KNIGHTS Study)

OBJECTIVE: The suicide rate in South Korea was the second highest among the Organization for Economic Cooperation and Development countries in 2017. The purpose of this study is to understand the characteristics of people who died by suicide in Korea from 2013–2017 and to better prevent suicide. METHODS: This study was performed by the Korea Psychological Autopsy Center (KPAC), an affiliate of the Korea Ministry of Health and Welfare. According to the Korea National Statistical Office, the number of suicide victims nationwide was estimated to reach about 70,000 from 2013 to 2017. Comprehensive suicide records from all 254 police stations in South Korea were evaluated by 32 investigators who completed a 14-day didactic training program. Then, we evaluated the characteristics of suicide victims in association with disease data from the National Health Insurance Database (NHID), which is anonymously linked to personal information of suicide victims. RESULTS: Thirty-one of 254 police stations in the Seoul metropolitan area were analyzed by August 10, 2018. Findings showed that the characteristics of suicide victims differed according to the nature of the region. CONCLUSION: Our results suggest that different strategies and methods are needed to prevent suicide by regional groups.

Comparisons of Neurocognitive Functions in Patients with Late-Life Depression versus Normal Elderly, and Association with Changes of Depressive Symptoms in a 3-Month Follow-Up

OBJECTIVE: This study aimed to investigate the neurocognitive functions of patients with late-life depression compared to healthy controls and their association with improvement of depressive symptoms. METHODS: We compared the results of neurocognitive tests between 41 patients with late-life depression and 20 healthy controls at baseline and 3 months later prospectively. And then we investigated the association of change of cognitive function and improvement of depressive symptoms in patients with late-life depression. RESULTS: Patients with late-life depression showed significantly impaired results in neurocognitive tests especially in domains of language, memory and frontal executive function compared to healthy control. However, after 3 months of treatment of depression, there was no association between the change of results of neurocognitive tests and the changes of scores of Hamilton Depression Rating Scale (HAM-D). CONCLUSION: Impairment of cognitive functions in late-life depression includes the domains of language, memory and executive function and after 3 months of treatment of depression, there was no association of improvement of depressive symptom and cognitive change in patients with late-life depression.

Pharmacological Treatments of Headache / 정신신체의학

Headache is one of the most common physical symptoms which almost everyone experience at least once during a life. Headache is often associated with disability, but rarely with secondary headache which could result in a serious life-threatening illness, i.e. brain tumor. However, in most cases, headache is a benign illness which comprises a primary headache, i.e. migraine or tension-type headache. The accurate diagnosis of headache is critical for clinicians and it begins with history taking and physical examination since there are no diagnostic tests for primary headaches. Nowadays, there are a wide variety of pharmacological treatments according to each headache disorder. The specific purposes of this review are introducing history of classification of headache disorder and presenting diagnostic process of headache disorder. Then, we discuss the effective pharmacological treatment strategies of each headache disorder.