Possible Association of the Ubiquitin-Specific Peptidase 46 Gene (USP46) with Affective Temperamental Traits in Healthy Korean Volunteers

OBJECTIVE: Ubiquitin-specific peptidase 46 gene (USP46) polymorphisms is part of ubiquitin-proteasome system, which is responsible for dynamic cellular processes such as the regulation of cell cycle. USP46 has been reported to be associated with major depressive disorder. The objective of the present study was to investigate the association of USP46 polymorphisms with affective temperamental traits in healthy subjects. METHODS: A total of 557 Korean healthy volunteers were recruited, and 545 subjects (328 male, 217 female) were included in the final analysis. The DNA of the subjects was isolated from saliva samples. Two single-nucleotide polymorphisms (SNPs) rs346005, rs2244291 in USP46 were genotyped. Affective temperaments were assessed using the Korean version of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). RESULTS: A significant association was found between rs346005 genotypes and TEMPS-A only in male subjects. In particular, subjects with the CC genotype of rs346005 showed a more depressive temperament than subjects with AA or CA genotypes in males. For rs2244291, there were no associations between the rs2244291 genotypes and TEMPS-A scores. CONCLUSION: Some affective temperaments may serve as a genetic predisposing factors for affective disorders, such as depressive disorder, via vulnerability genes related to the ubiquitin-proteasome system.

Clinical Efficacy of Repetitive Transcranial Magnetic Stimulation for Treatment of Depression and Latest Trends in TMS Techniques

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique which can change cortical excitability in targeted area by producing magnetic field pulses with an electromagnetic coil. rTMS treatment has been used to treat various neuropsychiatric disorders including depression. In this review, we evaluate the literature on rTMS for depression by assessing its efficacy on different subtypes of depression and different technical parameters. In particular, we focus on the results of randomized clinical trials and meta-analyses for depression after the US Food and Drug Administration approval in 2008, which acknowledged its efficacy and acceptability. We also review the new forms of rTMS therapy including deep TMS, theta-burst stimulation, and magnetic seizure therapy (MST) that have been under recent investigation. High frequency rTMS over left dorsolateral prefrontal cortex (DLPFC), low frequency rTMS over right DLPFC, or bilateral rTMS is shown to be effective and acceptable in treatment for patients with non-psychotic, unipolar depression either as monotherapy or adjuvant. Deep TMS, theta-burst stimulation and MST are promising new TMS techniques which warrant further research.

Association between the Catechol-O-Methyltransferase (COMT) Val(158)Met Polymorphism and Alexithymia in Patients with Obsessive-Compulsive Disorder

PURPOSE: Alexithymia, defined as a deficit in the ability to recognize and describe one's own feelings, may be related to the development and maintenance of obsessive-compulsive symptoms. The aim of this study was to evaluate the association between the catechol-O-methyltransferase (COMT) Val158Met polymorphism and alexithymia in patients with obsessive-compulsive disorder (OCD). MATERIALS AND METHODS: We recruited 244 patients with OCD (169 males, 75 females). Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS-20), and genotyping of the COMT Val(158)Met polymorphism was evaluated. RESULTS: Patients with the COMT Val/Val genotype had significantly higher total and "difficulty identifying feelings" (DIF) subdimension scores than those with the Val/Met or Met/Met genotypes. Patients with the COMT Val/Val genotype had significantly higher "difficulty describing feelings" (DDF) subdimension scores than those with the COMT Val/Met genotype. However, there were no differences in the scores for the "externally oriented thinking" (EOT) subdimension among the three genotypes. CONCLUSION: These results indicate that the high-activity Val allele of the COMT Val(158)Met polymorphism is associated with increased alexithymic traits in patients with OCD. The present finding suggests that alexithymia is an endophenotype of OCD that is mediated by the COMT Val(158)Met polymorphism.

The Relationship between Risk Taking, Impulsivity and Intolerance of Uncertainty

OBJECTIVES: Risk taking has been implicated in the development of various psychiatric disorders. Previous studies have indicated that risk taking behavior is associated with high levels of impulsiveness. Risk taking entail uncertain situation that outcome probability is unknown. This study tested impulsivity, intolerance of uncertainty and risk taking behavior. METHODS: A total of 73 participants completed a test battery comprised of the UPPS-P scale as a psychometric measurement of five dimensions of impulsivity, Intolerance of Uncertainty Scale, and Balloon Analog Risk Task (BART) as a behavioral measure of risk taking. The Pearson correlation analysis was used. RESULTS: The sensation seeking factor was positively correlated with BART measure (r = 0.27, p = 0.02). Specifically, the relationship between sensation seeking and BART was significant in females. CONCLUSIONS: Among the five factors of UPPS-P, only the sensation seeking factor predicts risk taking propensity.

Relationships between Chronotypes and Temperament and Character Dimensions in Healthy Young Adults

OBJECTIVES: Circadian rhythms have been known to have associations with psychiatric disorders and personality traits. The present study investigated the relationships between circadian typology and temperaments/characters in a non-clinical Korean population. METHODS: Two hundred six healthy Korean college students (male 109, female 97) participated in this study. The subjects completed the Composite Scale of Morningness for circadian typology and 140-item Temperament and Character Inventory-Revised-Short version (TCI-RS). RESULTS: Multivariate analyses of covariance showed a significant association between chronotypes and temperamental dimensions of the TCI-RS. Morning types were significantly associated with lower harm avoidance and higher persistence and self-directedness dimensions, compared to evening types and intermediate types. No interaction effects between sex and chronotypes were shown for temperamental dimensions. CONCLUSIONS: The present findings suggest that high persistence and self-directedness characters are related to morning types and high harm avoidance temperament is more related to evening types.

Emotional Dysregulation, Attributional Bias, Neurocognitive Impairment in Individuals at Ultra-High Risk for Psychosis and with Schizophrenia : Its Association with Paranoia / 대한정신분열병학회지

OBJECTIVES: Paranoia is a complex phenomenon, affected by a number of factors such as depression, trait anxiety, and attributional bias in schizophrenia. The aim of this study was to explore whether paranoia within continuum of clinical and subclinical states is associated with emotional dysregulation, attributional bias and neurocognitive impairment in whole individuals of normal controls, ultra-high risk (UHR) for psychosis and schizophrenia. METHODS: 101 normal controls, 50 participants at UHR for psychosis, and 49 schizophrenia patients were recruited. All subjects were asked to complete self-reported paranoia scale and emotional dysregulation scales including Rosenberg's self-esteem, Spielberg's state-trait anxiety inventory and Beck depression inventory. The attributional style was assessed by Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were also requested to complete the comprehensive neurocognitive battery. RESULTS: Multiple linear regression analysis showed that paranoia were found to be associated with emotional dysregulation (state anxiety, trait anxiety and depression), composite blaming bias in ambiguous situation, impairment of attention and working memory in whole participants [F (9, 190)=34.85, p<0.001, adjusted R2=0.61]. CONCLUSION: The main findings suggest that paranoia is a complex affective and cognitive structure that may be associated with emotional dysregulation, blaming bias and attention and working memory impairment in clinical and non-clinical paranoia.

Theory of Mind as a Mediator of Reasoning and Facial Emotion Recognition: Findings from 200 Healthy People

OBJECTIVE: It was proposed that the ability to recognize facial emotions is closely related to complex neurocognitive processes and/or skills related to theory of mind (ToM). This study examines whether ToM skills mediate the relationship between higher neurocognitive functions, such as reasoning ability, and facial emotion recognition. METHODS: A total of 200 healthy subjects (101 males, 99 females) were recruited. Facial emotion recognition was measured through the use of 64 facial emotional stimuli that were selected from photographs from the Korean Facial Expressions of Emotion (KOFEE). Participants were requested to complete the Theory of Mind Picture Stories task and Standard Progressive Matrices (SPM). RESULTS: Multiple regression analysis showed that the SPM score (t=3.19, p=0.002, beta=0.22) and the overall ToM score (t=2.56, p=0.011, beta=0.18) were primarily associated with a total hit rate (%) of the emotion recognition task. Hierarchical regression analysis through a three-step mediation model showed that ToM may partially mediate the relationship between SPM and performance on facial emotion recognition. CONCLUSION: These findings imply that higher neurocognitive functioning, inclusive of reasoning, may not only directly contribute towards facial emotion recognition but also influence ToM, which in turn, influences facial emotion recognition. These findings are particularly true for healthy young people.

Attributional Style in Healthy Persons: Its Association with 'Theory of Mind' Skills

OBJECTIVE: Attributional style, especially external personal attribution bias, was found to play a pivotal role in clinical and non-clinical paranoia. The study of the relationship of the tendency to infer/perceive hostility and blame with theory of mind skills has significant theoretical importance as it may provide additional information on how persons process social situations. The aim of this study was whether hostility perception bias and blame bias might be associated with theory of mind skills, neurocognition and emotional factors in healthy persons. METHODS: Total 263 participants (133 male and 130 female) were recruited. The attributional style was measured by using the Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were requested to complete a Brune's Theory of Mind Picture Stories task, neurocognitive task including Standard Progressive Matrices (SPM) and digit span, and other emotional dysregulation trait scales including Rosenberg's self-esteem, Spielberg's trait anxiety inventory, and Novaco anger scale. RESULTS: Multiple regression analysis showed that hostility perception bias score in ambiguous situation were found to be associated with theory of mind questionnaire score and emotional dysregulation traits of Novaco anger scale. Also, composite blame bias score in ambiguous situation were found to be associated with emotional dysregulation traits of Novaco anger scale and Spielberg's trait anxiety scale. CONCLUSION: The main finding was that the attributional style of hostility perception bias might be primarily contributed by theory of mind skills rather than neurocognitive function such as attention and working memory, and reasoning ability. The interpretations and implications would be discussed in details.

Relations of Self-Esteem with Paranoia in Healthy Controls, Individuals at Ultra-High Risk for Psychosis and with Recent Onset Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Some emotional components, such as self-esteem, depression and anxiety, have been reported to be associated with paranoia in non-clinical population and schizophrenia patients. The aim of this study was to investigate the correlation between self-esteem and paranoia in healthy controls, in ultra-high risk for psychosis and schizophrenia patients. METHODS: 34 subjects with recent onset schizophrenia, 36 subjects with ultra-high risk for psychosis, and 44 healthy volunteers participated in this study. A detailed assessment was made of the paranoia, self-esteem, depression, and anxiety. RESULTS: In all three groups, there were a negative correlation between paranoia and self-esteem, and positive correlations between paranoia and depression and anxiety. In healthy control, lower self-esteem showed a trend to predict higher paranoia, and in ultra-high risk for psychosis, this trend tern on statistically significant level, and in recent onset schizophrenia group, this correlation was disappeared. CONCLUSION: The individual who have lower self-esteem showed higher paranoia tendency under delusional level, but after formation of persecutory delusion, the tendency was disappeared. This result supports the hypothesis that persecutory delusions are a defense against negative affective process.

A Validation Study of the Korean-Version of the Dimensional Obsessive-Compulsive Scale / 신경정신의학

OBJECTIVES: This study was conducted to examine the reliability and validity of the Dimensional Obsessive-Compulsive Scale-Korean version (DOCS-K). METHODS: Fifty four individuals with obsessive-compulsive disorder (OCD) completed a battery of measures including the DOCS-K, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive-Compulsive Inventory-Revised-Korean version (OCI-R-K), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Psychometric properties of the DOCS-K were analyzed. RESULTS: The Cronbach's alpha value for internal consistency of DOCS-K was in excellent range (0.91-0.95). The construct validity was analyzed on the basis of principal component analysis and 4-factor structure of the original scale was maintained. The DOCS-K total and subscale scores were more strongly correlated with those of other OC symptom-specific measures (convergent validity) than those of nonspecific depression or anxiety measures (discriminant validity). The DOCS-K total score was strongly correlated with total scores of Y-BOCS (r=0.64, p<0.01) and OCI-R-K (r=0.71, p<0.01). Correlations between the DOCS-K subscales and corresponding subscales of the OCI-R-K were stronger than correlations with the noncorresponding subscales : 1) DOCS-K Contamination and OCI-R-K Washing (r=0.69), 2) DOCS-K Responsibility and OCI-R-K Checking (r=0.54), 3) DOCS-K Unacceptable Thoughts and OCI-R-K Obsessing (r=0.73), 4) DOCS-K Symmetry and OCI-R-K Ordering (r=0.55). CONCLUSION: This study revealed that the DOCS-K has good reliability and validity. Therefore, the DOCS-K can be used as a promising measure of dimensional OC symptoms in Korea.

Associated Factors of Quality of Life in First-Episode Schizophrenia Patients

OBJECTIVE: Improving quality of life is an important goal in the treatment of schizophrenia. In previous research, quality of life has been reported to be compromised in patients with schizophrenia. The aim of this study was to investigate whether quality of life may be impaired in first-episode schizophrenia patients and to identify the associated factors of quality of life in first-episode schizophrenia. METHODS: Forty-eight patients with first-episode schizophrenia and 20 normal controls were recruited. Quality of life was measured by using the Quality of Life scale (QLS). General and social self-efficacy, perceived social support were measured by using the self-report scales. The clinical assessments and comprehensive neurocognitive battery were also administered. RESULTS: First-episode group showed significantly decreased QLS total and QLS subscale scores compared to normal controls group. The key associated factors of quality of life in patients with first-episode schizophrenia were the negative symptoms and social self-efficacy. CONCLUSION: This finding implies that compromised quality of life may be already emerged in schizophrenia in their first-episode and the psychosocial interventions should be targeting the negative symptoms and the psychosocial protective factors including self-efficacy in addition to simply ameliorating the positive symptoms to foster social reintegration and recovery of first-episode patients.

Anxiety and Pharmacological Interventions in Cancer Patients : Systematic Review / 신경정신의학

OBJECTIVES: Cancer patients experience various types of anxiety, from normal fears to pathological anxiety, through the entire process of the illness. This anxiety requires attention, because it may interfere with their cancer treatment and result in a negative impact on quality of life. The present paper aimed to provide an overview of current pharmacotherapy for anxiety in the oncology setting, by systematically reviewing the related literature. METHODS: We searched both international and Korean domestic databases with the search terms "cancer", "anxiety", and "pharmacological treatment", targeting between 1980 and 2008, and graded the evidence levels according to the Scottish Intercollegiate Guideline Network (SIGN). RESULTS: Of 215 studies searched, we selected only 22 pharmacological clinical studies. There was no meta-analysis or systematic review of psychopharmacotherapy for anxiety disorders among cancer patients. Also, we reviewed a few expert opinions and available clinical trials on anxiety in general. CONCLUSION: Based on the limited evidence, the present review provides an understanding and some recommendations for treating anxiety in cancer patients. Further investigation of psychopharmacotherapy for anxiety in cancer patients is warranted, to develop evidence-based guidelines for comprehensive cancer care.

Development of the Korean Affective Word List / 신경정신의학

OBJECTIVES: As interest in the field of affective science continues to increase, research into the arousal of emotions by the use of facial stimuli, event pictures, and stimulus words is now being actively pursued. The purpose of this study was to develop a Korean Affective Word List for eliciting emotional reactions. METHODS: The preliminary selection process was more carefully divided into the primary process when the words were extracted which the author thought elicited the emotions of happiness, sadness, fear, anger, and disgust from the Korean-Language Dictionary according to vocabulary frequency, the secondary process when the words were extracted which the Affective Words Selection Committee judged elicited only a single category of emotion. The affective words selected in the two-stage preliminary process were then presented to normal, young subjects, who were asked to allocate each word on the basis of their emotional reaction to one of the following emotional categories: happiness, sadness, fear, anger, disgust, and surprise. After the selected words caused the intended-emotional response with inter-rater agreement in more than 80%, a total of 166 words were selected except surprise. The complementary selection process was carried out following the preliminary process in order to make up for the lack of surprise words and the relative want of anger words. RESULTS: A total of 184 words were finally selected: 83 words for happiness, 36 for sadness, 24 for fear, 10 for anger, 20 for disgust, and 11 for surprise. CONCLUSION: These Korean affective words are expected to be widely used for eliciting emotions in future Korean research on emotion.

Emotional Responsivity to the Emotional Words in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Patients with schizophrenia are reported to exhibited a reduced level of responsivity to highly arousing negative emotional pictures and to demonstrate a threatening bias to facial stimuli. The aim of this study was to investigate whether patients with schizophrenia show impaired and biased responsivity to threatening emotional words stimuli. METHODS: Eighteen subjects with schizophrenia (M=10, F=8) and 18 healthy controls (M=8, F=10) were involved in this study. Emotional words stimuli (happy, sad, fearful, angry, surprising, and disgusting words) were selected from a Korean affective words list (Kim et al., Unpublished). All subjects were asked to rate feelings elicited by emotional words, using the seven point Likert scale for each of the six basic emotions. RESULTS: Patients with schizophrenia displayed less emotional responsivity to disgusting and angry words as compared to healthy controls, while there were no significant differences in response to happy, sad, or fearful words. Emotional responsivity bias to disgust and happiness was observed in patients with schizophrenia. CONCLUSION: Patients with schizophrenia may show reduced responsivity to disgust and anger words stimuli and biased responsivity to disgust and happiness. These findings are in line with previous findings of reduced reactivity to highly arousing emotional picture stimuli, social threatening bias, and Pollyanna tendencird in schizophrenia.

Development of Korean Version of the Ambiguous Intentions Hostility Questionnaire(K-AIHQ) / 신경정신의학

OBJECTIVES: We studied the psychometric properties of a Korean version of the Ambiguous Intentions Hostility Questionnaire (K-AIHQ), which measures hostile social-cognitive biases for use in the research on paranoia. METHODS: The translation and back-translation of the AIHQ with concern for the cultural differences were done according to the standard procedure. A sample of 83 healthy volunteers completed the K-AIHQ. RESULTS: The scores of the K-AIHQ were comparable to the results of the original studies. The Paranoia Scale was correlated with the K-AIHQ, but Magical Ideation and Perceptual Aberration scales were not correlated with the K-AIHQ. The interrater reliabilities of the items in each situation were in the acceptable range. CONCLUSION: The KAIHQ seems to be a reliable and valid test to measure the hostile social cognitive biases of patients with paranoia.

Mood-Congruent Bias to Emotional Word, Face, and Scene Stimuli in Patients with Bipolar Mania : Comparison to Normal and Schizophrenia Subjects / 대한정신약물학회지

OBJECTIVE: Patients with bipolar mania have difficulty in recognizing or attending to negatively affective stimuli and have an affective bias, which is congruent with the current mood. However, previous reports have adopted words or facial pictures, not scenic pictures as affective stimuli. In this study, patients with mania performed the word, face and scenic picture-based affective go-nogo tasks respectively. The results were compared to those of patients with schizophrenia and healthy controls. METHODS: Twenty patients with bipolar mania, 20 patients with schizophrenia, and 20 healthy comparison subjects, matched for age, gender and intelligence, performed affective gonogo tasks which contained happy/sad words, facial pictures, and scenic pictures respectively. RESULTS: On the scenic picturebased affective go-nogo task, a significant interaction between subject group and target valence emerged {F (2, 57)=4.86, p<0.05}. Pairwise comparison showed the manic patients required significantly more time to respond to sad than to happy stimuli (t=3.22, df=19, p<0.01), but schizophrenia patents and healthy subjects did not differ in time to respond to happy or sad stimuli (t=1.95, df=19, p=0.07 ; t=-1.23, df=19, p=0.23). CONCLUSION: Manic patients displayed a mood-congruent bias toward affective scenic pictures, but not toward affective word or facial pictures. This finding suggests that complex and scenic stimuli may give a more influence on the affective arousal state and therefore increase the mood-congruent bias in manic patients.

Mood-Congruent Bias to Emotional Word, Face, and Scene Stimuli in Patients with Bipolar Mania : Comparison to Normal and Schizophrenia Subjects / 대한정신약물학회지

OBJECTIVE: Patients with bipolar mania have difficulty in recognizing or attending to negatively affective stimuli and have an affective bias, which is congruent with the current mood. However, previous reports have adopted words or facial pictures, not scenic pictures as affective stimuli. In this study, patients with mania performed the word, face and scenic picture-based affective go-nogo tasks respectively. The results were compared to those of patients with schizophrenia and healthy controls. METHODS: Twenty patients with bipolar mania, 20 patients with schizophrenia, and 20 healthy comparison subjects, matched for age, gender and intelligence, performed affective gonogo tasks which contained happy/sad words, facial pictures, and scenic pictures respectively. RESULTS: On the scenic picturebased affective go-nogo task, a significant interaction between subject group and target valence emerged {F (2, 57)=4.86, p<0.05}. Pairwise comparison showed the manic patients required significantly more time to respond to sad than to happy stimuli (t=3.22, df=19, p<0.01), but schizophrenia patents and healthy subjects did not differ in time to respond to happy or sad stimuli (t=1.95, df=19, p=0.07 ; t=-1.23, df=19, p=0.23). CONCLUSION: Manic patients displayed a mood-congruent bias toward affective scenic pictures, but not toward affective word or facial pictures. This finding suggests that complex and scenic stimuli may give a more influence on the affective arousal state and therefore increase the mood-congruent bias in manic patients.

Some Psychological Correlates Affecting Recognition of Neutral Facial Emotion in Young Adults / 신경정신의학

OBJECTIVES: Previous studies have shown the relationship between recognition of facial expressions and psychiatric symptoms. This study investigated how healthy young adults recognize neutral faces and which psychological distresses and symptoms relate to their recognition of neutral faces. METHODS: One hundred forty-three healthy volunteers participated in this study. We used neutral facial pictures, selected from the Japanese and Caucasian Facial Expressions of Emotion (JACFEE) photo set, to evaluate participants' facial expression recognition and the State-Trait Anxiety Inventory, Beck Depression Inventory, Toronto Alexithymia Scale, Conner-Davidson Resilience Scale, and Temperament and Character Inventory (TCI) to measure and examine their psychological characteristics. RESULTS: There were significant positive correlations between the recognition rate of neutral expressions as contempt and trait-anxiety level (r=0.21 ; p=0.01) and depression (r=0.20 ; p=0.02). This contempt-recognition was significantly negatively correlated with resilience score (r=-0.22 ; p=0.01) and the TCI self-directedness subscale (r=-0.29 ; p=0.00). Also, the TCI's harm avoidance subscale score was significantly positively correlated with the contempt recognition rate (r=0.21 ; p=0.01). CONCLUSION: These finding suggests recognition of neutral faces as contempt may be related to psychological distress, including trait and temperament characteristics. This negative bias toward neutral emotion (expressions) may affect interpersonal relations and social functioning in a healthy population.

Psychosocial Aspects and Mental Health in Cancer Patients / 신경정신의학

Cancer patients suffer from significant psychological distress and considerable psychological morbidity throughout the course of their disease. The diagnosis of cancer, active treatment, palliative care and aftermath of cancer involve a long process of adaptation to multiple threats and stressful events. This review focused on psychosocial aspects of cancer, psychological reaction and adaptation of patients to cancer, psychological issues and psychiatric disorders in patients with cancer, and the need for screening of psychological distress at all stages of illness.

Emotional Responsivity to the Emotional Pictures: Distribution in an Evaluative Space / 신경정신의학

OBJECTIVES: To investigate the nature of emotional responsiveness in normal adults, we exam the emotional responses to emotional pictures in an evaluative space defined by arousal and valence. METHODS: Subjects were instructed to rate the arousal and valence that they experienced from the presentation of one of two sets of 60 emotional pictures. These two picture sets were comprised of 107 pictures: 101 selected from International Affective Pictures System and six pictures from our own collection. According to "evaluative space model", the authors set an evaluative space defined by the arousal scores as independent variable and the valence scores as dependent variable. In this evaluative space, one-hundred-and-seven pairs of coordinates representing respective emotional pictures were plotted. With regression analyses, the steepness of the regression lines on the plots with positive emotional responsiveness (n=51) and those with negative emotional responsiveness (n=56) were compared. RESULTS: In the evaluative space, the regression line of negative emotional responsiveness was significantly different from that of positive responsiveness. The slope of negative responsiviveness was significantly steeper than that of positive responsiveness. At a low arousal level, the absolute valence of a positive stimuli was larger than that of a negative picture. CONCLUSION: This finding indicates that the function of the negative affective responsiveness might be different from that of the positive responsitiveness. IAPS also seems applicable to Korean subjects.