The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer’s Dementia: A Double-Blind Randomized Placebo-Controlled Trial

Objective@#This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer’s dementia (AD). @*Methods@#This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician’s Interview-Based Impression of Change plus caregiver input, Gottfries–Bråne–Steen Scale, and Zarit Burden Interview were used as assessment scales. @*Results@#There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks. @*Conclusion@#Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.

The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer’s Dementia: A Double-Blind Randomized Placebo-Controlled Trial

Objective@#This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer’s dementia (AD). @*Methods@#This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician’s Interview-Based Impression of Change plus caregiver input, Gottfries–Bråne–Steen Scale, and Zarit Burden Interview were used as assessment scales. @*Results@#There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks. @*Conclusion@#Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.

Smartphone Addiction Proneness Is Associated With Subjective-Objective Sleep Discrepancy in Patients With Insomnia Disorder

Objective@#Subjective reports of patients with insomnia often show a discrepancy with their objective assessments of sleep. We aimed to assess subjective-objective sleep discrepancy in subjects with insomnia disorder as well as the psychological factors associated with the discrepancy. @*Methods@#This study is a secondary analysis of the baseline data of a randomized controlled study on 110 adults aged 18 years to 59 years with insomnia disorder. Subjective reports on sleep and the objective measures acquired by an overnight polysomnography were used to measure the sleep discrepancy. Smartphone Addiction Proneness Scale (SAPS), Center for Epidemiologic Studies Depression Scale (CES-D), beck anxiety inventory (BAI), and Global Assessment of Recent Stress (GARS) were used to evaluate the psychological factors associated with the sleep discrepancy. @*Results@#Mean total sleep time (TST) discrepancy of the participants was -81.65±97.41 minutes. Multivariable logistic regression analyses revealed that age (adjusted OR=1.07, 95% CI=1.01–1.13, p=0.027), years of education (adjusted OR=0.69, 95% CI=0.48–0.91, p=0.017), and smartphone addiction proneness (adjusted OR=1.14, 95% CI=1.04–1.27, p=0.008) were independent predictors of TST misperception. Mean sleep onset latency (SOL) discrepancy of the participants was 41.28±45.01 minutes. Only anxiety was an independent predictor of SOL misperception (adjusted OR=1.16, 95% CI=1.05–1.31, p=0.006). @*Conclusion@#The present study provides empirical evidence to increase our understanding of the various factors that are associated with subjective-objective sleep discrepancy. Screening insomnia patients with smartphone addiction proneness may help predict the potential discrepancy between the patients’ subjective reports and objective measures of sleep duration.

Knowledge and Perception of Attention-Deficit/Hyperactivity Disorder among Elementary-School Teachers / 신경정신의학

Objectives@#The aim of this study was to investigate elementary school teachers' knowledge and perception of attention-deficit/hyperactivity disorder (ADHD). Variables associated with the teacher's tendency to recommend treatment to parents of the ADHD children were also evaluated. @*Methods@#A total of 73 elementary-school teachers completed a self-questionnaire regarding their demographic characteristics, previous experience, and perception of ADHD children. Knowledge of the Attention Deficit Disorders Scale (KADDS) was used to examine the participants' level of knowledge of ADHD. Multivariable logistic regression analysis was performed to identify the variables associated with the participants' tendency to recommend treatment to parents of ADHD students. @*Results@#The average correct rate was 64.4% on the KADDS. 64 (87.7%) participants had a positive perception of medical treatments of ADHD, but only 41 (56.2%) participants reported that they would recommend treatment to parents of ADHD children. Teachers that were older and married were more likely to recommend treatment. The teacher's sense of efficacy was found to have a positive association with the tendency to recommend treatment to parents. @*Conclusion@#Educational programs and specific guidelines that can improve the knowledge of ADHD and self-efficacy as a teacher are needed for elementary school teachers. Teachers should understand that they have significant roles in the management of ADHD children.

Knowledge and Perception of Attention-Deficit/Hyperactivity Disorder among Elementary-School Teachers / 신경정신의학

Objectives@#The aim of this study was to investigate elementary school teachers' knowledge and perception of attention-deficit/hyperactivity disorder (ADHD). Variables associated with the teacher's tendency to recommend treatment to parents of the ADHD children were also evaluated. @*Methods@#A total of 73 elementary-school teachers completed a self-questionnaire regarding their demographic characteristics, previous experience, and perception of ADHD children. Knowledge of the Attention Deficit Disorders Scale (KADDS) was used to examine the participants' level of knowledge of ADHD. Multivariable logistic regression analysis was performed to identify the variables associated with the participants' tendency to recommend treatment to parents of ADHD students. @*Results@#The average correct rate was 64.4% on the KADDS. 64 (87.7%) participants had a positive perception of medical treatments of ADHD, but only 41 (56.2%) participants reported that they would recommend treatment to parents of ADHD children. Teachers that were older and married were more likely to recommend treatment. The teacher's sense of efficacy was found to have a positive association with the tendency to recommend treatment to parents. @*Conclusion@#Educational programs and specific guidelines that can improve the knowledge of ADHD and self-efficacy as a teacher are needed for elementary school teachers. Teachers should understand that they have significant roles in the management of ADHD children.

A Study on Variables Influencing Acceptability and Perception Towards Suicide among the Elderly in the City of Bucheon / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the variables influencing acceptability and perception towards suicide among the elderly in Bucheon city, South Korea. METHODS: A total of 1099 elderly over 65 years old participated in this study. The subjects completed a self-questionnaire including their demographic characteristics, psychiatric characteristics, factor 1 and 4 of the Attitudes Towards Suicide-20, and Geriatric Depression Scale Short Form Korea Version. One-way analysis of variance was performed to identify the variables associated with the acceptability and perception towards suicide. RESULTS: As result of this study, the demographic characteristics (older age, lower education level, lower economic state, bereavement, divorce or separated marital status, and life without spouse) and psychiatric characteristics (psychiatric past history, treatment history, and suicidal attempt history) were found to be associated with a more acceptable attitude toward suicide. In addition, a lower education level, no psychiatric history, and no psychiatric treatment history influenced the lack of perception to suicide. CONCLUSION: For public services to prevent suicide of the elderly population who lack spontaneity and accessibility to suicidal evaluations, it would be important to focus on the variables identified in this study for enhancing the effectiveness of the services.

Particulate Matter and Cognitive Function / 신경정신의학

The term “particulate Matter (PM)” refers to the mixture of small-sized solid particles and liquid droplets floating in the air, and is referred to as PM₁₀ ( < 10 µm), PM(2.5) ( < 2.5 µm) and PM(1.0). Much PM is an anthropogenic substance generated by transportation or industrial activities, which is transformed into a second toxic substance by chemical reactions in the atmosphere. PM reaches the brain directly through olfactory transport, or through the blood-brain barrier during systemic circulation. PM that enters the local cerebral circulation causes neuroinflammation through microglial cells and endotoxins. According to previous studies, greater PM exposure results in lower brain volume, especially white matter. Among neurodevelopmental disorders, the correlation between the occurrence of autism spectrum disorder and exposure to PM is widely known. Other studies have found that exposure to PM was associated with low cognitive function and increased rate of cognitive aging. PM can also cause pathology of early Alzheimer's disease and increases the risk of Alzheimer's dementia and mild cognitive impairment.

Incidence and Course of Depression in Patients with Alzheimer's Disease

OBJECTIVE: Depressive symptoms are common in Alzheimer's disease (AD) and they might influence the course and prognosis of AD. Depression could appear anytime in the course of the disease, and could either last considerably long or disappear easily. This study is intended to investigate the occurrence of depression in the course of AD and the risk factors of incidence. METHODS: This study targeted 1,272 AD patients without depressive symptoms at the start of this study in Korea. A total of 775 subjects completed the study, and the occurrence of depression was assessed after 12 months. Demographic information of subjects was collected and cognitive functions, overall functions, and depression severity were assessed at the start of this study and after 12 months. RESULTS: Among the 775 subjects, 103 subjects (13.29%) developed depression 12 months later. The MMSE-KC scores showed significant changes in both groups that developed depression and did not. In the univariate analysis, significant differences in the incidence of depression were found in terms of gender, the administration of the antidepressant at the baseline, the SGDS-K score, and the GDS score. The multiple logistic regression analysis showed that the increase in the incidence of depression was associated with a female, in the increase in SGDS-K score and the GDS score. CONCLUSION: The incidence of depression in the subjects who completed the 12-month follow-up observation was 13.29%. Moreover, in the multivariate analysis, a female gender and the severity of dementia, including the overall functions, seemed associated with the occurrence of depression.

The Development of the Mission · Vision · Core Values for Korean NeuroPsychiatric Association / 신경정신의학

Awareness of public mental health has increased due to drastic changes in society, and issues concerning the rights of mentally ill patients have emerged. The Korean NeuroPsychiatric Association (KNPA) has examined the current environment and proposed directions for improvement of this field. As the step for the implementation of the development of the mission · vision · core values for KNPA, KNPA have gone on the effort to improve public mental health letting people realize of the work that KNPA have carried out and help members work together. The committee of special mission of KNPA began in 2016 and held its first meeting on March 25 with professional consultants. They researched and collected information, carried out interviews, surveys, analyzed various opinions, and examined information and materials throughout 7 meetings. The special members of KNPA submitted agendas to the board of directors on September 9th, and the provisional board committee debated and decided the final agendas on September 24th. They announced the mission · vision · core values for KNPA on October 28th at the great autumn congregation held in Kimdaejung Convention Center in Kwangju. The event has proved that all members of KNPA have cooperated for the rights and interest of the committee, and will lead the public mental health of our society. This will provide the basis for the better life of our society.

Factors Associated with Willingness to Visit Psychiatric Clinic among General Adult Population in Bucheon City / 신경정신의학

OBJECTIVES: The aim of this study was to investigate various factors associated with the willingness to visit psychiatric clinics among the general adult population in Bucheon city, South Korea. METHODS: One thousand seventy-five adults completed a self-questionnaire assessing their willingness to visit psychiatric clinics, family history of mental illnesses, frequency of contact with the mentally ill, stigma and discrimination toward the mentally ill, and the Community Attitude toward the Mentally Ill (CAMI). Logistic regression analyses were performed to identify variables associated with the willingness to visit psychiatric clinics. RESULTS: Study results showed that being single was associated with reduced willingness to visit psychiatric clinics. Subjects who had more frequent contact with mentally ill patients were more willing to visit psychiatric clinics. Concerning the CAMI scale, higher scores in authoritarianism and lower scores in benevolence subscales were associated with greater willingness to visit psychiatric clinic. Subjects who strongly admitted the existence of the stigma, and discrimination, toward mentally ill patients were more willing to visit psychiatric clinics. CONCLUSION: Enhanced understanding of the factors associated with the willingness to visit psychiatric clinics would be helpful in reducing barriers to mental health services utilization in the community.

Variables Affecting to Attitudes towards Suicide among General Adult Population in the City of Bucheon / 신경정신의학

OBJECTIVES: The goal of this study was to investigate variables affecting attitudes toward suicide among the general adult population in the city of Bucheon, Korea. METHODS: Study participants included 1000 subjects over 18 years old who visited public offices in Bucheon, Gyeonggi Province, South Korea. Subjects completed a series of questionnaires covering demographic characteristics, clinical characteristics, and prior suicidal ideation and attempts. The Attitudes Toward Suicide-20 and the Center for Epidemiologic Studies-Depression Scales were used to assess attitudes toward suicide and the severity of depression, respectively. Exploratory factor analysis of the responses was performed. RESULTS: Analysis of responses on the Attitudes Toward Suicide-20 Scale revealed four important factors : permissiveness and unpredictability, attitudes toward suicide prevention, relationship between suicide causes and processes, and lack of comprehension of suicide. We assessed relationships among clinical and demographic variables by assessing scores on the Attitudes toward Suicide scale. Demographic characteristics (sex, age, marital status, education, economic status, and religion), clinical characteristics (physical and psychological health), and prior suicidal ideation and attempts affected respondents attitudes toward suicide. CONCLUSION: The variables identified as affecting attitudes toward suicide in this study were similar to those reported in previous studies (i.e., sex, age, religion, education, physical, and psychological health, prior suicidal ideation and attempts). In support of previous research results, we suggest that identifying groups that exhibit variables associated with attitudes toward suicide is an important step in suicide prevention, as such attitudes may influence subsequent behavior. Educational campaigns aimed at suicide prevention can be enhanced by focusing on attitudes toward suicide.

Risk Factors for Suicidal Ideation in the Elderly / 신경정신의학

OBJECTIVES: This study investigated the factors associated with suicidal ideation in the elderly. METHODS: A total of 136 subjects over 60 years old who visited the public offices in Bucheon-si, Gyeonggi Province in South Korea participated in the study. Subjects completed a series of questionnaires including the following : demographic information ; physical illness ; psychological illness ; suicidal ideation. In addition, Center for Epidemiologic Studies-Depression Scale and Attitudes Towards Suicide-20 were used to assess the severity of depression and the attitude towards suicide, respectively. RESULTS: Multivariate logistic regression analyses were performed to determine the factors that affect suicidal ideation in the elderly. As a result, living alone, depression, having any physical illness, and permissive attitude towards suicide were risk factors for suicidal ideation in the elderly. CONCLUSION: ConclusionZZIn addition to previously identified risks factors (living alone, physical illness, and depression), the study found that permissive attitude towards suicide also serves as a risk factor for suicide in elderly people. Therefore, permissive attitude towards suicide should be addressed and evaluated in order to prevent suicide in the elderly.

Association between Abacus Training and Improvement in Response Inhibition: A Case-control Study

OBJECTIVE: The abacus, first used in Asian countries more than 800 years ago, enables efficient arithmetic calculation via visuo-spatial configuration. We investigated whether abacus-trained children performed better on cognitive tasks and demonstrated higher levels of arithmetic abilities compared to those without such training. METHODS: We recruited 75 elementary school children (43 abacus-trained and 32 not so trained). Attention, memory, and arithmetic abilities were measured, and we compared the abacus with the control group. RESULTS: Children who had learned to use an abacus committed fewer commission errors and showed better arithmetic ability than did controls. We found no significant differences between children with and without abacus training in other areas of attention. CONCLUSION: We speculate that abacus training improves response inhibition via neuroanatomical alterations of the areas that regulate such functions. Further studies are needed to confirm the association between abacus training and better response inhibition.

A Study on the Long and Mid-term Policy for Korean Neuropsychiatric Association / 신경정신의학

As the official organization of psychiatrists in South Korea since 1945, the Korean Neuropsychiatric Association (KNPA) has played important contribution in academic and mental health development. It is time to plan long-term policy for future strategy. Thus, the authors tried to perform brainstorming in members of a special task force team and survey for internal specialists in the KNPA and external professionals. Based on the above major issues and results of the survey, the authors suggest the overall direction of the long and mid-term policy for KNPA.

A Consideration for the Growth and Development of the Korean Neuropsychiatric Association / 신경정신의학

The Korean Neuropsychiatric Association (KNPA) should protect members' rights, and also plan long-term policy for public activity in a society. In these efforts, creation of mission, vision, and core values is of utmost importance. Second, effective communication among members is important for sharing and discussing the mission, vision, and core values of the KNPA. Third, public relations play a key role in advertising the policy and providing information. Based on the above major issues and results of representatives questionnaire, the authors suggest that careful planning of long-term policy and roles of the KNPA is needed.

Mediating Effects of Cognitive Effort and Depression on Intelligence, Memory, and Executive Functions in Individuals with Mild Traumatic Brain Injury

OBJECTIVE: Mild traumatic brain injury (mTBI) is frequently associated with psychiatric symptoms and cognitive dysfunction, as well as with the receipt of workers' compensation, as many mTBIs occur due to work-related accidents. We hypothesized that depression and insufficient cognitive effort mediate the relationship between sociodemographic variables and cognitive dysfunction in mTBI. METHODS: A retrospective chart review study was conducted using 115 records of patients with mTBI. Cognitive effort was measured based on scores on the Rey 15-Item Test. Multivariate linear regression analysis was performed to examine factors predictive of cognitive functions. Path analysis was subsequently performed to investigate the mediating effects of depression and cognitive effort in relation to receipt of workers' compensation and demographic variables. RESULTS: Fifteen of the 115 participants (13.0%) received failing scores on the Rey 15-Item Test, which indicated insufficient cognitive effort. Path analysis indicated that cognitive effort mediated the effects of age and workers' compensation on cognitive functions. CONCLUSION: Given the significant mediating effects of cognitive effort on cognitive performance, it is important to address patient motivation and encourage mTBI patients covered by workers' compensation to perform tests with authentic effort.

A Validation Study of the Korean Version of Warwick-Edinburgh Mental Well-Being Scale / 신경정신의학

OBJECTIVES: The aim of this study was to develop the Korean version of the Warwick-Edinburgh Mental Well-being Scale (K-WEMWBS) and to examine its factorial structure, reliability, and convergent/discriminant validity. METHODS: In this study, the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), a self-rating measure for assessment of mental well-being, was translated into Korean. It was completed by 222 respondents, including 117 healthy subjects and 105 psychiatric patients from both inpatient and outpatient clinics at Soonchunhyang University Hospitals in Bucheon, Cheonan, and Seoul. RESULTS: The K-WEMWBS showed good content validity. Confirmatory factor analysis supported a single factor structure. The Cronbach's alpha value for the K-WEMWBS was 0.944, which demonstrated good internal consistency. Test-retest reliability at 2-8 weeks was high (0.789). The K-WEMWBS showed high correlations with mental health, positive affect, and quality of life scales. Moderate negative correlation was observed between the K-WEMWBS and the negative affect scale. Discriminant validity was partially identified. Statistically significant differences in scores were observed between the psychiatric patient group and the control group. CONCLUSION: The results of this study indicate that the K-WEMWBS is a reliable and valid instrument for assessment of mental well-being, particularly the positive aspects of mental health.

The Effectiveness of Cross-Tapering Switching to Ziprasidone in Patients with Schizophrenia or Schizoaffective Disorder

OBJECTIVE: Switching antipsychotics is one useful therapeutic option when the treatment of schizophrenia encounters suboptimal efficacy and intolerability issues. This study aimed to investigate the efficacy and tolerability of cross-tapering switching to ziprasidone from other antipsychotics. METHODS: A total of 67 patients with schizophrenia or schizoaffective disorder were recruited in this 12-week, multicenter, non-comparative, open-label trial. Prior antipsychotics were allowed to be maintained for up to 4 weeks during the titration of ziprasidone. Efficacy was primarily measured using the 18-item Brief Psychotic Rating Scale (BPRS) at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was secondarily measured by the Clinical Global Impression-Severity (CGI-S) scale and the Global Assessment of Functioning (GAF) scale at each visit. Regarding the metabolic effects of switching to ziprasidone, weight, body mass index (BMI), waist-to-hip ratio (WHR), and lipid profile-including triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol levels-were measured at each follow-up visit. RESULTS: The BPRS scores were significantly improved at 12 weeks after switching to ziprasidone (F=5.96, df=2.11, p=0.003), whereas the CGI-S and GAF scores were not significantly changed. BMIs, WHRs, and TG levels were significantly decreased, with no significant changes in other lipid profiles. CONCLUSION: Cross-tapering switching to ziprasidone is effective for patients with schizophrenia spectrum disorders. Beyond the efficacy of the procedure, favorable metabolic profiles show that switching to ziprasidone may be helpful for maintenance therapy over an extended period.

Introducing the Policy Research Project of the Korean Neuropsychiatric Association / 신경정신의학

Mental health policy influences the mental health system and promotion in the medium and longer term. Thus, many countries develop a mental health plan suitable for their countries. In 2012, the suicide rate in Korea was 28.1 per 100000 persons, representing a nine-year high among countries in the Organization for Economic Co-operation and Development. In addition, suicide rates in Korea increase as a function of age. For example, the prevalence of suicide per 100000 persons is 19.3 among people in their 20 s and 83.2 among those in their 70 s, respectively. Another important mental health issue in Korea is a need for 'positive psychiatry', which generally aims to improve mental health and psychiatric conditions, not only in patients with psychiatric illnesses but also in the general population. As the definition of mental health is being broadened, psychiatrists should expand their range of activities and collaborate more with other professional and civic groups. Psychiatrists belonging to various institutions, such as mental health groups, clinics, mental health hospital, and general hospital, also need to find ways to expand the importance of their roles. Given the growing responsibilities for the mental health policy, the Policy Research Institute of the Korean Neuropsychiatric Association planned eight review articles on the mental health of Korea in the medium and longer term.

The Future Report for the Innovative Advance of Korean Psychiatry in 2030 / 신경정신의학

Futurology is an interdisciplinary field, studying yesterday's and today's changes, and aggregating and analyzing both lay and professional strategies and opinions with respect to tomorrow. Therefore, the purpose of this article is to provide the future direction and strategy for the advancement of Korean psychiatry based on the author's subjective opinion as well as the objective consideration of future changes in the environmental factors affecting psychiatry. First, we attempted to analyze the pros and cons of our status, according to the SWOT analysis. There are several positive factors in the outer environment, such as the increase of personal income, healthy aging people, interest in mental health, and development of a national mental health plan. Meanwhile, the negative factors affecting our future originated from the excessive control by national health insurance as well as our short capacity for social or general mental health needs. Second, we estimated the needs from future changes that might affect modern psychiatry. The future changes force us to prepare ourselves to be more competent in fulfillment of customer oriented positive mental health needs. Further, greater competency is needed in application of neurobehavioral knowledge to the clinical field. In addition, development of dedicated leadership and partnership for accomplishment of social and community based projects is also needed. In conclusion, the Korean Neuropsychiatric Association, for organizational integration of the profession, must develop a strategic plan for achievement of the ideal goal. In the first step, from 2014 to 2019, we need to develop the vision, mission, strategy and framework of our organization. And, the mission should be carried out by several task forces. Consecutively, achievements of the task force should be applied to the organizational performance. In the second step, from 2020 to 2029, full time employment of a psychiatrist for the function of executive secretary should be established. In the third step, from 2029, we need to formally participate in the national project and community program by establishment of a full time organization for the major strategic area. The suggestions could be realized by the communication and commitment of the psychiatric organization.