Attachment Insecurity and Stigma as Predictors of Depression and Anxiety in People Living With HIV

Objective@#The purpose of this study was to examine whether attachment insecurity, stigma, and certain demographic and medical factors predict depression and anxiety in people living with HIV (PLWH). @*Methods@#Participants were 147 PLWH who visited the outpatient infection clinic in Kyungpook National University Hospital (KNUH; Daegu, South Korea) between June 2020 and January 2021. We measured HIV-related stigma, attachment anxiety and avoidance, depressive symptoms, and anxiety symptoms. @*Results@#Logistic regression analysis showed that unemployment, longer time receiving antiretroviral therapy, higher attachment avoidance, and higher attachment anxiety were significant predictors of depression. Results also showed that longer time receiving antiretroviral therapy, higher attachment anxiety, and concern with public attitudes were significant predictors of anxiety. @*Conclusion@#In addition to education to reduce public stigma, interventions to reduce PLWH’s self-stigma should continue. We suggest attachment-based psychotherapy as an effective intervention to improve PLWH’s mental health.

Psychiatric Understanding and Treatment Consideration in HIV Infection / 생물치료정신의학

Following the development of human immunodeficiency virus (HIV) treatments, the mean lifespan of patients with an HIV infection has increased to a level comparable to the general population. Patients receiving HIV treatment can achieve viral suppression and perform routine activities without the risk of infection transmission. Recently, the quality of life (QoL) and mental health of patients are becoming the primary outcomes in HIV treatment. The objective of this review was to investigate psychiatric disorders in patients with an HIV infection and available treatment programs. A search for clinical studies and scientific publications was performed. Patients with an HIV infection had a higher prevalence of psychiatric disorders than the general population. The psychopathological factors in HIV infection included neurobiological changes of infection, side-effects of medications, negative social perception, and unresolved intrapsychic conflicts. Severe and unmanaged psychiatric disorders with HIV infection negatively impacted HIV infection transmission and treatment adherence. However, psychiatric treatment programs and referrals to a psychiatric professional were found to be insufficient in most countries. This review revealed a need for psychiatric interventions in clinical practice to improve patients’ mental health and HIV treatment adherence. Psychiatric interventions integrated with conventional HIV treatment can be efficacious to achieve this goal. In addition, clinicians need to investigate and recognize HIV-related stigma as the relationship between patients and clinicians has a significant role in the patient’s treatment adherence.

Personality Types as Predictors of Breast Cancer Screening Compliance in Korean Patients: A Mixed-Method Approach

Objective@#The purpose of this study is to identify personality types that can influence breast cancer screening (BCS) compliance among Korean women with breast cancer using a mixed-method approach. @*Methods@#The participants consisted of 93 women who underwent surgery for breast cancer between July 2010 and March 2012. The demographic and medical characteristics of the participants were evaluated through structured interviews. To identify personality types, in-depth interviews were performed and the transcribed interviews were evaluated using interpretive phenomenological analysis. The participants were categorized into two groups (compliance and non-compliance) based on compliance with the Korean Breast Cancer Society recommendations for BCS. @*Results@#Five personality types were identified through phenomenological analysis. There were significant differences in the chi-square test results for the BCS compliance and non-compliance groups according to age (p=0.048), cancer stage (p<0.001), and personality types (p=0.018). Logistic regression showed that the odds ratio for compliance with BCS was 9.35 (p=0.01) for individuals with a cautious-organized personality type, 9.38 (p=0.02) for those with a cautious-dependent personality, and 10.58 (p=0.04) for those with a sensitive-downcast personality compared to those with a cautious personality type. @*Conclusion@#Participants with cautious-organized, cautious-dependent, and sensitive-downcast personality types were less likely to follow the BCS recommendations than those with a cautious personality type. This study provides a basis for the future development of an effective questionnaire to investigate the personality types of individuals with breast cancer in order to predict compliance with BCS.

Avoidant Insecure Attachment as a Predictive Factor for Psychological Distress in Patients with Early Breast Cancer: A Preliminary 1-Year Follow-Up Study

OBJECTIVE: To identify attachment insecurity as an associative factor with unresolved psychological distress 1 year after surgery in the early breast cancer (BC) population. METHODS: One-hundred fourteen participants completed the Hospital Anxiety and Depression Scale (HADS) and the Experiences in Close Relationship (ECR-M36) questionnaire within 1 week (baseline) and at 1-year post-surgery (follow-up). Participants were categorized into the distress and the non-distress groups based on a HADS-total score cut-off of 15. Logistic regression analysis revealed predictive factors of distress at follow-up. RESULTS: At baseline, 53 (46.5%) participants were found to be in the distress group. The degree of distress decreased over 1 year (p= 0.003); however, 43 (37.7%) showed significant remaining distress at follow-up. Baseline scores of the ECR-M36 avoidance [odds ratio (OR)=1.045, 95% confidence interval (CI)=1.002–1.090] and HADS-total (OR=1.138, 95% CI=1.043–1.241) were predictors of distress at follow-up. CONCLUSION: A substantial proportion of early BC patients suffer distress even one-year after surgery. Avoidant attachment appeared to be an influential factor on distress in early BC patients. Moreover, the finding that initial distress level could predict one at 1-year post-operation warrant a screening and management of distress along with BC treatment.

Mediating Effect of Resilience on the Association between Emotional Neglect and Depressive Symptoms

OBJECTIVE: Previous studies have reported that childhood maltreatment experiences could induce biological and psychological vulnerability in depressive disorders. However, it is still unclear that type-specific effects of childhood maltreatment on psychological resilience, depressive symptoms and interactions among childhood maltreatment experiences, resilience, and depressive symptoms. METHODS: A total of 438 medical students were included in the study. The Childhood Trauma Questionnaire-Short Form, the Conner-Davidson Resilience Scale, and the Beck Depression Inventory were used for measuring childhood maltreatment experiences, psychological resilience, and depressive symptoms, respectively. We investigated the effects of childhood maltreatment experiences on resilience and depressive symptoms using correlation analysis. In addition, we analyzed the mediating effect of resilience on the association between childhood maltreatment and symptoms of depression. RESULTS: Among childhood maltreatment, emotional neglect was a significant predictor of the scores of low resilience and high depressive symptoms in both gender groups (all ps < 0.05). Furthermore, resilience was found to be a mediator connecting emotional neglect experiences with depressive symptoms. CONCLUSION: Our results suggest that emotional neglect has detrimental effects on mood and resilience, and clinicians need to focus on the recovery of resilience when they deal with depressive symptoms in victims of childhood maltreatment.

Reliability and Validity of the Korean Version of the Modified Adult Attachment Scale for the Use of Medically Ill Patients

OBJECTIVE: The Modified Experiences in Close Relationships (ECR-M36) scale was developed for medically ill, older individuals in 2008 (Toronto, Canada, department of psychosocial oncology and palliative care, Princess Margaret Hospital). The scale has displayed satisfactory reliability and validity. This study aimed to test the reliability and validity of the Korean version of Modified Experiences in Close Relationships (K-ECR-M36) questionnaire in female patients with breast cancer. METHODS: A total of 199 post-operative breast cancer patients completed the K-ECR-M36 as well as other psychological measures including the Revised Adult Attachment Scale (RAAS), World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF), and Hospital Anxiety and Depression Scale (HADS). The reliability and validity of the K-ECR-M36 were evaluated. Explorative factor analysis was conducted to identify the factor structure of the K-ECR-M36. RESULTS: The K-ECR-M36 showed good internal consistency (Cronbach's alpha=0.87) and reasonable test-retest reliability (r=0.752, p<0.001). The total as well as avoidance and anxiety subscales demonstrated construct validity with the RAAS, the HADS, and the WHOQOL-BREF. Factor analysis revealed four-factor structure which was originally proposed by Brennan, Clark, and Shaver (1998). CONCLUSION: These findings support that the K-ECR-M36 has satisfactory reliability, validity and factor structure among patients with breast cancer.

Reliability and Validity of the Korean Young Schema Questionnaire-Short Form-3 in Medical Students

OBJECTIVE: The Young Schema Questionnaire (YSQ) is a self-report measure of early maladaptive schemas and is currently in its third revision; it is available in both long (YSQ-L3) and short (YSQ-S3) forms. The goal of this study was to develop a Korean version of the YSQ-S3 and establish its psychometric properties in a Korean sample. METHODS: A total of 542 graduate medical students completed the Korean version of the YSQ-S3 and several other psychological scales. A subsample of 308 subjects completed the Korean YSQ-S3 both before and after a 2-year test-retest interval. Correlation, regression, and confirmatory factor analyses were performed on the data. RESULTS: The internal consistency of the 90-item Korean YSQ-S3 was 0.97 and that of each schema was acceptable, with Cronbach's alphas ranging from 0.59 to 0.90. The test-retest reliability ranged from 0.46 to 0.65. Every schema showed robust positive correlations with most psychological measures. The confirmatory factor analysis for the 18-factor structure originally proposed by Young, Klosko, and Weishaar (2003) showed that most goodness-of-fit statistics were indicative of a satisfactory fit. CONCLUSION: These findings support the reliability and validity of the Korean version of the YSQ-S3.

Acamprosate-induced Extrapyramidal Symptoms in an Elderly Patient with Alcohol Dependence

Acamprosate reduces the craving for alcohol by decreasing glutamate activity and increasing gamma-aminobutyric acid (GABA) action in patients with alcohol dependence. Acamprosate has tolerable side effects that include diarrhea, headache, dizziness and pruritus. In this study, we report acamprosate-induced extrapyramidal symptoms in an elderly patient with no history of neurologic disease. Severe extrapyramidal symptoms developed two days after the administration of acamprosate and improved over one week after the acamprosate was stopped. Extrapyramidal symptoms are commonly associated with dopamine receptor antagonists. However, there have been several reports of extrapyramidal symptoms occurring with drugs targeting other systems, including GABA, glutamate and serotonin. Acamprosate may decrease dopamine levels in the ventral tegmental area mediated by glutamatergic action and thus cause extrapyramidal symptoms. We suggest that acamprosate carries the risk of causing extrapyramidal symptoms.

A Pilot Study for Discovering Candidate Genes of Chromosome 18q21 in Methamphetamine Abusers: Case-control Association Study

OBJECTIVE: It was previously suggested that the malic enzyme 2 (ME2) as the candidate gene for psychosis in fine mapping of chromosome 18q21. Chromosome 18q21 is also one of the possible regions that can contribute to addiction. METHODS: We performed a pilot study for discovering candidate gene of chromosome 18q21 in the methamphetamine abusers for elucidating the candidate gene for methamphetamine addiction leading to psychosis. We have selected 30 unrelated controls (16 males, 14 females; age=59.8+/-10.4) and 37 male methamphetamine abusers (age=43.3+/-7.8). We analyzed 20 single nucleotide polymorphisms (SNPs) of 7 neuronal genes in chromosome 18q21 for DNA samples that was checked for the data quality and genotype error. The association between the case-control status and each individual SNP was measured using multiple logistic regression models (adjusting for age and sex as covariates). And we controlled false discovery rate (FDR) to deal with multiple testing problem. RESULTS: We found 3 significant SNPs of 2 genes in chromosome 18q21 (p-value<0.05; adjusting for age as covariate) in methamphetamine abusers compared to controls. We also found 2 significant SNPs of 1 gene (p-value<0.05; adjusting for age and sex as covariates) (rs3794899, rs3794901:MAPK4). Two SNPs in MAPK4 gene were significant in both statistical groups. CONCLUSION: MAPK4, the gene for mitogen-activated protein kinase 4, is one of the final 6 candidate genes including ME2 in 18q12-21 in our previous finemapping for psychosis. Our results suggest that MAPK4 can be a candidate gene that contribute to the methamphetamine addiction leading to psychosis.

Inner and Outer Resources of Coping in Newly Diagnosed Breast Cancer Patients: Attachment Security and Social Support

OBJECTIVES: The purpose of this study is to evaluate the effects of attachment security, social support and health-related burden in the prediction of psychological distress and the mediation effects of social support and health-related burden in relationship between attachment security and psychological distress. METHODS: Finally, 161 patients were included for the analysis. Chi-square test and independent samples t-test were used for comparing differences between depressive/anxious group and non-depressive/non-anxious group. For evaluating the relationship among attachment security, social support, psychological distress and health-related burden, structural equation modeling analysis were performed. RESULTS: 40.7% and 32.0% of the patients have significant depressive symptoms and anxiety symptoms, respectively. In the analysis for testing the differences between groups who have psychological distress and who have not, there were no significant differences of sociodemographic factors and medical characteristics between groups, except for association between depressive symptoms and type of surgery (p = 0.01). Contrary to sociodemographic and medical characteristics, there were significant differences of health-related burden and two coping resources (attachment security and social support) between groups (all p < 0.01), except for the support from medical team in between anxious group and non-anxious group (p = 0.20). In the structural equation model analysis (Model fit : chi-square/df ratio = 0.8, root mean square error of approximation = 0.000, comparative fit index = 1.000, non-normed fit index =0.991), attachment security and social support emerged as an important predictor of psychopathology. CONCLUSIONS: Attachment security and social support are important factors affecting the psychological distress. We suggest that individual attachment style and the social support state must be considered to approach the newly diagnosed breast cancer patients with psychological distress.

Psychosocial Factors Predicting Delayed Diagnosis of Breast Cancer: The Role of Marital Relationship Functioning / 정신신체의학

OBJECTIVES: Breast cancer has been the most prevalent female cancer in South Korea since 2001. Early detection of this disease is the most effective strategy for reducing mortality. The objective of this study was to identify factors which could predict advanced stage at diagnosis of breast cancer. METHODS: Participants who were initially diagnosed with breast cancer and referred to the Stress Clinic of the Breast Cancer Center at Kyungpook National University Hospital were included. Through a semi-structured interview, the authors investigated psychosocial variables such as the extent of marital and family functioning and emotional-economic family burden as well as sociodemographic and health behavior-, health characteristic- and cancer-related variables. RESULTS: Data were collected from 219 participants. One hundred and twenty(54.8%) subjects were diagnosed with advanced-stage breast cancer. Variables that were significantly different between the advanced-stage and early-stage groups included : monthly breast self examination(p<0.000), annual mammographic screening(p< 0.000), mode of tumor detection(p<0.000), nature of the first symptoms(p<0.000), time to treatment after di-agnosis(p<0.000), overloaded economic and family burden(p=0.018), marital functioning(p<0.000) and family functioning(p<0.00). Logistic regression analysis indicated that irregular annual mammography screening(OR=7.431 ; 95% CI 2.407-22.944) or a lack of screening(OR=25.299 ; 95% CI 7.855-81.482) and a dysfunctional marital relationship(OR=4.772 ; 95% CI 2.244-10.145) were significantly associated with advanced stage at diagnosis of breast cancer. CONCLUSIONS: We reconfirmed screening behavior to be a risk factor for delayed diagnosis of breast cancer. Our findings also emphasized the importance of psychosocial factors such as marital functioning in early detection of breast cancer. Psychiatric consultation in the area of martial functioning could be beneficial for increasing early detection in breast cancer.

The Role of Childhood Trauma on Early Maladaptive Schema Domain / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the effect of childhood trauma on early maladaptive schema domains. METHODS: A total of 305 graduate students completed the Young Schema Questionnaire-Short Form, the Korean version of the Childhood Trauma Questionnaire (K-CTQ), and the Beck Depression Inventory. RESULTS: According to the classification based on the total score of the K-CTQ, the group that experienced childhood trauma (n=41) showed higher scores than the group with no trauma (n=264) in all five schema domains. Subsequent multiple regression analyses revealed that four out of five schema domains were significantly explained by childhood trauma ; among them, childhood trauma was the most significant predictor of the Disconnection and Rejection schema domain, accounting for 15% of the total variance in this domain (F=8.1, p<0.001). In terms of the types of childhood trauma, emotional neglect had significant general effects on all schema domains except the Impaired Limits domain. CONCLUSION: These findings in a nonclinical sample support the notion that childhood traumatic experiences may significantly impact the maladaptive schema domains, particularly the Disconnection and Rejection schema domain. In addition, this study emphasized the diffuse impact of emotional neglect upon schema domains, which may be overlooked because of its implicit nature.

The Korean Version of the Body Image Scale-Reliability and Validity in a Sample of Breast Cancer Patients

OBJECTIVE: The Body Image Scale (BIS) developed in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group is a brief questionnaire for measuring body image concerns in patients with cancer. This study sought to assess the reliability and validity of the Korean version of the Body Image Scale (K-BIS). METHODS: The participants consisted of 155 postoperative breast cancer patients (56 breast conserving surgery, 56 mastectomy, and 43 oncoplastic surgery). Subjects were evaluated using the K-BIS, the Body-Esteem Scale for Adolescents and Adults (BESAA), the Rosenberg Self-Esteem Scale (RSES), the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF). Test-retest reliability and internal consistency were examined as a measure of reliability and validity was evaluated by convergent validity, discriminant validity and factor analysis. RESULTS: Cronbach's alpha value was 0.943. The total score of the K-BIS was negatively correlated with the BESAA (r=0.301, p59% variance. CONCLUSION: The K-BIS showed good reliability and validity for assessment of body image in Korean breast cancer patients.

A Comparative Study on Alexithymia in Depressive, Somatoform, Anxiety, and Psychotic Disorders among Koreans

OBJECTIVE: Little is known about the characteristic differences in alexithymic construct in various psychiatric disorders because of a paucity of direct comparisons between psychiatric disorders. Therefore, this study explored disorder-related differences in alexithymic characteristics among Korean patients diagnosed with four major psychiatric disorders (n=388). METHODS: Alexithymic tendencies, as measured by the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), of patients classified into four groups according to major psychiatric diagnosis were compared. The groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM; n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68). RESULTS: We found that substantial portions of patients in all groups were classified as having alexithymia and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM, PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties describing feelings) than those with SM or AX, after adjusting for demographic variables. CONCLUSION: These findings suggest that alexithymia might be associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a discriminating feature of depressive disorders.

The Comparison of Psychological Characteristics Between Undergraduate and Graduate Medical Students / 신경정신의학

OBJECTIVES: The conversion of medical colleges into medical schools has been attempted by the Korean government since 2005. The aim of this study was to compare psychological characteristics of undergraduate and graduate medical students before and after changes in the medical educational system. METHODS: Four hundred-and-twenty-eight medical students participated in this study; 247 were undergraduates and 181 were graduate students. The participants completed psychological assessments including the Minnesota Multiphasic Personality Inventory (MMPI), the Symptom Checklist-90-Revision (SCL-90-R), the Beck Depression Inventory (BDI), and the Alexithymia Scale. RESULTS: Overall, undergraduate medical students demonstrated significantly higher scores than the graduate medical student on three of MMPI subscales (F, depression, and social introversion) and two of SCL-90-R subscales (somatization and obsessive-compulsive). When comparing the four groups (male undergraduate, female undergraduate, male graduate, female graduate) using analysis of covariance and controlling for age as a covariate, there were significant differences between male graduate and male undergraduate medical students in the same subscales except somatization, whereas there were no significant differences between female groups. CONCLUSION: These findings suggest that male graduate medical students may have better mental health states and less psychological problems than undergraduate medical students even after controlling for age. However, these differences were not found between female groups. Although every score of all items was within normal range regardless of group, distinctive differences between male graduate and undergraduate students were revealed for some psychological profiles such as depression, social introversion, and obsessive-compulsive traits.

Reliability and Validity of the 20-Item Toronto Alexithymia Scale in Korean Adolescents

OBJECTIVE: Adolescence is a period of developing emotional regulation. However, alexithymia has rarely been examined during this period. The objective of this study is to examine the factor structure and internal consistency of the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K) in normal adolescents in South Korea. METHODS: The TAS-20K was administered to a sample of 290 adolescents aged from 12 to 16 years old. Internal reliability, test-retest reliability, and factorial validity were evaluated. RESULTS: The three factors of the TAS-20K were confirmed by confirmatory factor analysis. The internal consistency, measured using Cronbach's alpha coefficient was acceptable for difficulty in identifying feelings, good for difficulty in describing feelings, and acceptable for externally oriented thinking. CONCLUSION: Our study indicates that the TAS-20K is an appropriate instrument to assess alexithymia in Korean adolescents.

Alexithymia and Stress Response Patterns among Patients with Depressive Disorders in Korea

OBJECTIVE: Alexithymic characteristics may represent cognitive and affective mediators between stressors and stress responses among those with depressive disorders. This study evaluated how alexithymic characteristics, as measured by the Korean version of the Toronto Alexithymia Scale-20 (TAS-20K), could be related to stress response patterns, as measured by the Stress Response Inventory (SRI), within a sample composed of individuals diagnosed with depressive disorders. METHODS: Participants comprised a cross section of patients diagnosed with depressive disorders (n=98). Data on demographic and psychosocial factors (i.e., sex, age, and level of education), clinical profiles {i.e., primary and comorbid psychiatric conditions meeting the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria at the time of the evaluation}, duration of illness, medications, and Clinical Global Impression (CGI) scores, and the results of psychological assessments (TAS-20K, SRI) were analyzed. RESULTS: Patients having depressive disorders with alexithymia obtained significantly higher scores in terms of all seven subscales of the SRI, as compared to those without alexithymia, a logistic regression model was used to assess possible predictors for the presence of alexithymia in patients with depressive disorders, including the seven subscales of the SRI, gender, age, and duration of illness. We found that aggressive and somatizing responses to stress were significantly associated with the presence of alexithymia among patients with depression. CONCLUSION: These findings suggest that patients having depression with alexithymia were more susceptible to stress than those without alexithymia. Clinicians might improve their treatment of depression by identifying the clinical predictors for alexithymia and by helping those individuals demonstrating such symptoms in coping with emotionally stressful situations.

The Relationship between Alexithymia and General Symptoms of Patients with Depressive Disorders

OBJECTIVE: Depression has been associated with alexithymic features. However, few studies have investigated the differences in the general symptoms of patients with depressive disorders according to the presence of alexithymia. Thus, the aim of this study was to evaluate the relationship between alexithymia and symptoms experienced by patients with clinically diagnosed depressive disorders. METHODS: A chart review of patients who were evaluated using the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20) and Symptom Checklist 90-Revised (SCL-90-R) at the same time between the years 2003 and 2007 was conducted. A total of 104 patients with depressive disorders were included and divided into two groups: alexithymia (n=52) and non-alexithymia (n=52). A direct comparison between the two groups was carried out. Regression analysis was also carried out for the TAS-20 total and subset scores in order to model the relationship between alexithymia and symptoms. RESULTS: The presence of alexithymia was confirmed in 50% of the patients with depressive disorders, and the symptoms of depressive patients with alexithymia were more severe than those of their non-alexithymic counterparts on all 9 symptom domains of the SCL-90-R. Furthermore, regression analysis revealed that the presence of alexithymia was positively associated with depression, phobic anxiety, and psychoticism but inversely associated with anxiety. CONCLUSION: These results suggest that the clinical features of depression are partially dependent on the presence of alexithymia. Alexithymic patients with depressive disorders are likely to show more severe depressive, psychotic, and phobic symptoms. In other words, clinicians should suspect the presence of alexithymic tendencies if these symptoms coexist in patients with depressive disorders and address their difficulties in effective communication.

The Characteristics of Salivary alpha-Amylase Reactivity to Negative Affective Stimuli / 신경정신의학

OBJECTIVES: The aim of this study is to understand the characteristics of salivary ALPHA-amylase reactivity (sAA), as a biological maker of stress, by viewing negative affective pictures. METHODS: Forty six normal healthy subjects participated in this study. Prior to the experiment, the participants completed baseline psychological assessment including trait-dependent anxiety scales. On experiment, saliva samples were collected one time before and three times after exposure to 5-min stressor consisting 20 negative affective pictures. The state-related scales were measured before and just after exposure to stressor to assess the subjects' state anxiety. RESULTS: Overall, sAA was significantly decreased over time with the increase of negative affect score and state-anxiety. The Anxiety Scale Inventory scores were negatively correlated with the baseline as well as the other following sAA levels (all ps or =2, N=19) than in the lower counterpart (<2, N=27) in comparison between them (mean:46.6 vs. 76.5 U/mL, p=.024). After the exposure, the means of sAA levels significantly decreased over time in the lower susceptible group, whereas did not in the higher one (mean:-1.7 vs. -23.0 U/mL, p=.031). CONCLUSION: These findings suggest that the baseline level of sAA and its reactivity depend on individual trait of anxiety as well as state of reactivity to affective stress.

Natural Killer Cell Activity in North Korean Defectors with PTSD / 신경정신의학

OBJECTIVES: The objective of this study was to evaluate an association between posttraumatic stress disorder (PTSD) and altered immunity in North Korean defectors who were more likely to develop medical conditions and other stress-related psychiatric disorders. METHODS: Twenty-four North Korean defectors with PTSD and twenty-two controls without PTSD were recruited from the resettlement and training center for North Korean defectors in South Korea. Peripheral T lymphocyte subsets, natural killer (NK) cells, NK cell activity and plasma hormones (ACTH and cortisol) were obtained from all subjects. We also applied the Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for all subjects. RESULTS: We found NK cell activity was relatively lower than number of NK cells in North Korean defectors with PTSD. Subjects with PTSD had higher HAM-D and HAM-A scores than controls. However, there were no statistical differences in ACTH, cortisol, CD3, CD4, CD8, CD4/CD8 ratio, CD19 and CD56 between the two groups. CONCLUSION: These findings suggest North Korean defectors with PTSD show higher levels of depression, anxiety and impaired or weak immune function in NK cells.