Association of the Comprehensive Attention Test and the Korean Wechsler Intelligence Scale for Children-Fourth Edition in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Objectives@#This study aimed to investigate the correlation between the Comprehensive Attention Test, Korean-Wechsler Intelligence Scale for Children-Fourth Edition, and Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-IV scores in children and adolescents with ADHD. @*Methods@#Fifty-five children and adolescents diagnosed with ADHD and not taking psychiatric medications were included in this retrospective study. A correlation analysis was performed. @*Results@#Although simple visual and auditory selective attention have diagnostic value in traditional continuous performance tests, this study revealed that inhibition-sustained attention and interference-selective attention are also effective in evaluating ADHD. Furthermore, the correlation between the attention and intelligence test scores varied depending on the use of visual or auditory stimuli. @*Conclusion@#The findings of this study contribute to clarifying our understanding of the cognitive characteristics of children and adolescents with ADHD and can be used in future research.

The association between adverse childhood experiences and self-harm among South Korean children and adolescents: a cross-sectional study

Purpose@#Adolescent self-harm is a public health problem. Research suggests a link between adverse childhood experiences (ACEs) and self-destructive behaviors. Few studies, however, have examined the effects of ACEs on self-harm among Asian adolescents. This study explored the association between lifetime ACEs and a history of self-harm among Korean children and adolescents in elementary, middle, and high schools. @*Methods@#A cross-sectional, retrospective medical record review was conducted on a dataset of a national psychiatrist advisory service for school counselors who participated in the Wee Doctor Service from January 1 to December 31, 2020. The data were analyzed using multiple logistic regression to predict self-harm. @*Results@#Student cases (n=171) were referred to psychiatrists by school counselors for remote consultation. Multiple logistic regression analyses revealed that the odds of self-harm were higher among high school students (adjusted odds ratio [aOR]=4.97; 95% confidence interval [CI]=1.94-12.76), those with two or more ACEs (aOR=3.27; 95% CI=1.43-7.47), and those with depression (aOR=3.06; 95% CI=1.32-7.10). @*Conclusion@#The study's findings provide compelling evidence that exposure to ACEs can increase vulnerability to self-harm among Korean students. Students with a history of ACEs and depression, as well as high school students, require increased attention during counseling. School counselors can benefit from incorporating screening assessment tools that include questions related to ACEs and depression. Establishing a systematic referral system to connect students with experts can enhance the likelihood of identifying self-harm tendencies and offering the essential support to prevent self-harm.

Comparative Functional Connectivity of Core Brain Regions between Implicit and Explicit Memory Tasks Underlying Negative Emotion in General Anxiety Disorder

Objective@#To investigate not only differential patterns of functional connectivity of core brain regions between implicit and explicit verbal memory tasks underlying negatively evoked emotional condition, but also correlations of functional connectivity (FC) strength with clinical symptom severity in patients with generalized anxiety disorder (GAD). @*Methods@#Thirteen patients with GAD and 13 healthy controls underwent functional magnetic resonance imaging for memory tasks with negative emotion words. @*Results@#Clinical symptom and its severities of GAD were potentially associated with abnormalities of task-based FC with core brain regions and distinct FC patterns between implicit vs. explicit memory processing in GAD were potentially well discriminated. Outstanding FC in implicit memory task includes positive connections of precentral gyus (PrG) to inferior frontal gyrus and inferior parietal gyrus (IPG), respectively, in encoding period; a positive connection of amygdala (Amg) to globus pallidus as well as a negative connection of Amg to cerebellum in retrieval period. Meanwhile, distinct FC in explicit memory included a positive connection of PrG to inferior temporal gyrus (ITG) in encoding period; a positive connection of the anterior cingulate gyrus to superior frontal gyrus in retrieval period. Especially, there were positive correlation between GAD-7 scores and FC of PrG-IPG (r2 = 0.324, p = 0.042) in implicit memory encoding, and FC of PrG-ITG (r2 = 0.378, p = 0.025) in explicit memory encoding. @*Conclusion@#This study clarified differential patterns of brain activation and relevant FC between implicit and explicit verbal memory tasks underlying negative emotional feelings in GAD. These findings will be helpful for an understanding of distinct brain functional mechanisms associated with clinical symptom severities in GAD.

COVID-19 Pandemic and Mental Health of Vulnerable Two Groups:Developmental Trauma of the Child-Adolescents and Work Disaster of Health Care Workers / 전남의대학술지

COVID-19 has spread worldwide. People are struggling to adjust to a new normal, but changes in their daily routines are also causing stress. A person may feel depressed, uneasy, or suicidal and may complain of symptoms such as panic attacks, post-traumatic stress disease (PTSD), psychosis, obsessive–compulsive disorder, or paranoia when personal resilience cannot effectively process the stress. Children, adolescents, and health care workers are especially psychologically vulnerable groups in the pandemic calamity situation; therefore, a long-term intervention plan is necessary for them. When intervening with children and adolescents, it should be considered that each individual has different ways of expressing stress according to the developmental level of cognition, language, and emotion, and taking into account these developmental levels, it is necessary to help them achieve developmental tasks appropriate for their age. Health care workers feel psychological pain from problems such as the risk of becoming infected, the risk of passing the virus to their families, overwork, isolation, and stigma. Therefore, it is necessary to help them recover themselves by supplying personal protective equipment and providing the most basic resources necessary for adequate rest, work-life balance, and childcare.

Characteristics of the Perception of the Somatic Symptoms and the Cognitive Emotion Regulation Strategies in Patients With Posttraumatic Stress Disorder / 정신신체의학

Objectives@#：The purpose of this study is to investigate the characteristics of the perception of the somatic symptoms and the cognitive emotion regulation strategies in patients with posttraumatic stress disorder (PTSD). @*Methods@#：A total of 48 patients meeting DSM-5 criteria for PTSD and 48 normal controls were recruited for participation in this study. We evaluated subjects using Clinician-Administered PTSD Scale (CAPS), Somato-Sensory Amplification Scale (SSAS), Hamilton Anxiety Scale (HAM-A) and Cognitive Emotion Regulation Questionnaire (CERQ). We analyzed data using an independent t-test and Pearson’s correlation analysis. @*Results@#：In terms of SSAS, PTSD patients presented higher average SSAS scores than normal controls but the result is not statistically significant. In PTSD patients, the severity of PTSD is significantly correlated with CERQrumination and CERQ-catastrophizing. The SSAS scores of PTSD patients show the significant positive correla-tion with PTSD hyperarousal symptoms, CERQ-catastrophizing and CERQ-blaming others. @*Conclusions@#：These results reveal that patients with PTSD have maladaptive cognitive emotion regulation strategies such as rumination and catastrophizing. Somato-sensory amplification seems to be related with PTSD hyperarousal, CERQ-catastrophizing and CERQ-blaming others. Therefore, reducing somato-sensory amplifica-tion, rumination and catastrophizing can be helpful to reduce PTSD symptoms and somatic symptoms in PTSD patients.

Development of the Korean Form of the Premonitory Urge for Tics Scale: A Reliability and Validity Study

Objectives@#This study aimed to evaluate the reliability and validity of the Korean Form of the Premonitory Urge for Tics Scale (K-PUTS). @*Methods@#Thirty-eight patients with Tourette’s disorder who visited Jeonbuk National University Hospital were assessed with the K-PUTS. Together with the PUTS, the Yale Global Tic Severity Scale (YGTSS), the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the attention-deficit/hyperactivity disorder (ADHD) rating scale (ARS), and the Adult ADHD Self-Report Scale (ASRS) were implemented to evaluate concurrent and discriminant validity. @*Results@#The internal consistency of items on the PUTS was high, with a Cronbach’s α of 0.79. The test-retest reliability of the PUTS, which was administered at 2 weeks to 2 months intervals, showed high reliability with a Pearson correlation coefficient of 0.60. There was a significant positive correlation between the overall PUTS score and the YGTSS score, showing concurrent validity. There was no correlation between the PUTS, CY-BOCS, and ASRS scores, demonstrating the discriminant validity of the PUTS. Factor analysis for construct validity revealed three factors: “presumed functional relationship between the tic and the urge to tic,” “the quality of the premonitory urge,” and “just right phenomena.” @*Conclusion@#The results of this study indicate that the K-PUTS is a reliable and valid scale for rating premonitory urge of tics.

MRI-Based Multimodal Approach to the Assessment of Clinical Symptom Severity of Obsessive-Compulsive Disorder

Objective@#This study assessed the associations of the abnormal brain activation and functional connectivity (FC) during memory processing and brain volume alteration in conjunction with psychiatric symptom severity in patients with obsessive-compulsive disorder (OCD). @*Methods@#Twenty-OCD patients and 20-healthy controls (HC) underwent T1-weighted and functional imaging underlying explicit memory task. @*Results@#In memory encoding, OCD patients showed higher activities in right/left (Rt./Lt.) inferior temporal gyrus (ITG), medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), compared with HC. In task-based FC, caudate (Cd) was positively connected with DLPFC and ITG in OCD, while HC showed different connectivities of Cd-ACC and Rt.-Lt. ITG. In memory retrieval, only Cd was activated in OCD patients. Cd was positively connected with DLPFC and vmPFC in OCD, but negatively connected between same brain areas in HC. OCD patients showed increased gray matter (GM) volumes of cerebellum, DLPFC, orbitofrontal cortex (OFC), hippocampus, Cd and ITG, and concurrently, increased white matter volumes of DLPFC. In OCD patients, GM volumes of Cd and OFC were positively correlated with HAMA and Y-BOCS. Functional activity changes of Cd in OCD were positively correlated with Y-BOCS. @*Conclusion@#Our findings support to accessing clinical symptom and its severity linked by brain structural deformation and functional abnormality in OCD patients.

The Bodily Panic Symptoms and Predisposing Stressors in Korean Patients with Panic Disorder / 신경정신의학

OBJECTIVES@#The purpose of this study was to investigate the distinctive features of bodily panic symptoms and the predisposing conditions in Korean patients with panic disorder.@*METHODS@#This was a retrospective chart review study and the data were collected from twelve university-affiliated hospitals in Korea. The patients selected met the diagnostic criteria for panic disorder, were older than 20 years of age, and had initially visited a psychiatry department. The assessments included the chief complaints related to bodily panic symptoms, recent stressors, recent history of alcohol and sleep problems, and time to visit an outpatient clinic.@*RESULTS@#A total of 814 participants were included in the study. The most commonly experienced symptoms were cardiovascular and respiratory symptoms, which were observed in 63.9% and 55.4% of participants, respectively. Just before the onset of a panic attack, 25.6% of participants experienced sleep-related problems. Episodic binge drinking was also frequently observed (13.2%) and was more prevalent in men than in women (22.6% vs. 4.9%, p<0.001). About 75% of participants experienced stressful life events just before panic onset. Work-related issues were more prevalent in men than in women (22.0% vs. 13.4%, p=0.001). Family-related issues (4.8% vs. 14.1%, p<0.001) and conflict with a spouse or partner (4.0% vs.11.7%, p<0.001) were more prominent in women than in men.@*CONCLUSION@#Our results suggest that cardiovascular symptoms are the most common bodily panic symptoms in Korean patients. Our results suggest that a substantial portion of the Korean patients experienced stressful life events, sleep problems, and/or episodic binge drinking just before the onset of panic disorder.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Risk Factors Associated with the Fear of Falling in Community-Living Elderly People in Korea: Role of Psychological Factors

Little is known about the risk factors for the fear of falling in elderly Korean individuals. Thus, the present study aimed to investigate the risk factors for fear of falling in a representative elderly population of over 10,000 individuals aged 65 years and older. A multivariate multinomial analysis revealed that the risk factors associated with a severe fear of falling were being female [odds ratio (OR)=4.396], older age (OR=5.550 for those aged ≥85 years), lower level of education (OR=0.719 for those with ≥13 years of schooling), chronic illness (OR=2.788 for those with more than three chronic illnesses), poor subjective health (OR=6.268), functional impairments (OR=2.340), a history of falling (OR=7.062), and depression (OR=1.774). The ORs for each of these risk factors were particularly high in participants with a severe fear of falling. Particularly, a history of falling and/or poor subjective health status had strong independent associations with the fear of falling. The present findings may help health care professionals identify individuals that would benefit from interventions aimed at reducing the fear of falling.

Comparing Intelligence Test Profiles to Assess Tourette's Disorder with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The study compared the intelligence test profiles of Tourette's Disorder (TD), attention-deficit hyperactivity disorder (ADHD), and TD with ADHD (TD+ADHD) groups. METHODS: The Korean Wechsler Intelligence Scale for Children-third edition (K-WISC-III) and Korean Wechsler Intelligence Scale for Children-fourth edition (K-WISC-IV) were administered to 13 children and adolescents with TD, 17 children and adolescents with ADHD, and 15 children and adolescents with TD+ADHD. Each parameter was compared among the groups using the Kruskal-Wallis test. RESULTS: The mean scores of the freedom from distractibility/working memory index (FD/WMI) and the digit span and arithmetic subtests of the TD+ADHD group were significantly lower than those of the TD group. CONCLUSION: According to the intelligence test results, the comorbid ADHD+TD group showed a significant decrease in working memory compared to the TD group. These findings are similar to those of previous research on cognitive functions and suggest that the TD+ADHD comorbid and TD alone groups exhibit different endophenotypes. The results also imply that WISC-III and WISC-IV, the most commonly used intelligence tests clinically, are effective in evaluating cognitive functions such as attention. Further research is required to confirm these results.

Decreased Plasma BDNF Levels of Patients with Somatization Disorder

OBJECTIVE: Brain-derived neurotrophic factor (BDNF), one of the most abundant and important neurotrophins, is known to be involved in the development, survival, maintenance, and plasticity of neurons in the nervous system. Some studies have suggested that BDNF may play a role in the pathophysiology of several psychiatric illnesses such as depression and schizophrenia. Similarly, it is likely that the alteration of BDNF may be associated with the neuro-modulation that contributes to the development of somatization disorder. METHODS: The purpose of this study was to determine whether there is an abnormality of plasma BDNF levels in patients with somatization disorder, and to analyze the nature of the alteration after pharmacotherapy using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The plasma BDNF levels of the patients with a somatization disorder were significantly lower compared with those of the control volunteers (83.61±89.97 pg/mL vs. 771.36±562.14 pg/mL); moreover, the plasma BDNF levels of those patients who received an antidepressant were significantly increased after the treatment (118.13±91.45 pg/mL vs. 72.92±88.21 pg/mL). CONCLUSION: These results suggest that BDNF may play a role in the pathophysiology of somatization disorder.

Influence of Betaxolol on the Methamphetamine Dependence in Mice

OBJECTIVE: The noradrenaline system is involved in the reward effects of various kinds of abused drugs. Betaxolol (BTX) is a highly selective β1-antagonist. In the present study, we evaluated the effect of BTX on methamphetamine (MAP)-induced conditioned place preference (CPP) and hyperactivity in mice. METHODS: The mice (n=72) were treated with MAP or saline every other day for a total of 6 days (from day 3 to day 8; 3-times MAP and 3-times saline). Each mouse was given saline (1 mL/kg) or MAP (1 mg/kg, s.c.) or BTX (5 mg/kg, i.p.) or MAP with BTX (5 mg/kg, i.p.) 30 min prior to the administration of MAP (1 mg/kg, s.c.) every other day and paired with for 1 h (three-drug and three-saline sessions). We then compared the CPP score between the two groups. After the extinction of CPP, the mice were given BTX (5 mg/kg, i.p.) or saline (1 mL/kg) 24 h prior to a priming injection of MAP, and were then immediately tested to see whether the place preference was reinstated. RESULTS: The repeated administration of BTX 30 min prior to the exposure to MAP significantly reduced the development of MAP-induced CPP. When BTX was administered 24 h prior to the CPP-testing session on day 9, it also significantly attenuated the CPP, but did not result in any change of locomotor activity. In the drug-priming reinstatement study, the extinguished CPP was reinstated by a MAP (0.125 mg/kg, s.c.) injection and this was significantly attenuated by BTX. CONCLUSION: These findings suggest that BTX has a therapeutic and preventive effect on the development, expression, and drug-priming reinstatement of MAP-induced CPP.

Pharmacological Treatments of Headache / 정신신체의학

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

Brain Activation Patterns Associated with the Effects of Emotional Distracters during Working Memory Maintenance in Patients with Generalized Anxiety Disorder

Few studies have assessed the neural mechanisms of the effects of emotion on cognition in generalized anxiety disorder (GAD) patients. In this functional MRI (fMRI), we investigated the effects of emotional interference on working memory (WM) maintenance in GAD patients. Fifteen patients with GAD participated in this study. Event-related fMRI data were obtained while the participants performed a WM task (face recognition) with neutral and anxiety-provoking distracters. The GAD patients showed impaired performance in WM task during emotional distracters and showed greater activation on brain regions such as DLPFC, VLPFC, amygdala, hippocampus which are responsible for the active maintenance of goal relevant information in WM and emotional processing. Although our results are not conclusive, our finding cautiously suggests the cognitive-affective interaction in GAD patients which shown interfering effect of emotional distracters on WM maintenance.

Alteration of Brain-Derived Neurotrophic Factor Levels in Panic Disorder / 신경정신의학

OBJECTIVES: Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in neurogenesis and synaptic plasticity, has been implicated in the pathophysiology of several neuropsychiatric disorders. However, there have been no consistent findings regarding BDNF levels in panic disorder. In this study, we investigated plasma BDNF levels in panic disorder, and evaluated whether there is an association between plasma BDNF levels and severity of symptoms of panic disorder. METHODS: Plasma BDNF levels were measured in 110 panic disorder patients and 110 normal control subjects using the enzyme-linked immunosorbent assay. The severity of symptoms of panic disorder was determined using the Panic Disorder Severity Scale, Acute Panic Inventory, Agoraphobic Cognition Questionnaire, and Hamilton Anxiety Rating Scale. RESULTS: The mean plasma BDNF levels of patients with panic disorder were significantly lower compared with those of control subjects (192.50 pg/mL vs. 693.75 pg/mL). No significant association was observed between plasma BDNF levels and the severity of symptoms of panic disorder. CONCLUSION: These results suggest that BDNF may play a potential role in the pathophysiology of panic disorder.

A Case of Clinical Application of Covert Sensitization in a Patient with Kleptomania / 신경정신의학

Kleptomania is a well-known impulse-control disorder. Although it is a rare disease, it exerts a greater influence on the social and economic. There are a variety of treatments for kleptomania, however case reports of its specific treatment techniques are extremely rare. In this case, covert sensitization was applied to a 44-year-old hospitalized patient with kleptomania, which can facilitate a specific treatment method through case presentation.

Cyberbullying, Problematic Internet Use, and Psychopathologic Symptoms among Korean Youth

To evaluate the associations between cyberbullying behaviors and problematic internet use, and to compare psychopathologic symptoms in victims, perpetrators, and victims-perpetrators of cyberbullying to those in youths who were not involved in cyberbullying. A total of 4531 youths (11-14 years of age) were recruited from elementary and middle schools. Among 4531 youths, 9.7% were involved in cyberbullying; 3.3% were only victims; 3.4% were only perpetrators; and 3.0% were victims-perpetrators. Cyberbullying behaviors were associated with problematic internet use as well as various psychopathologic symptoms. Depressive symptoms were associated with cyberbullying victimization, and rule-breaking behaviors and aggressive behaviors have relevance to cyberbullying perpetration. Greater attention needs to be paid to identify youths earlier who are involved in cyberbullying and prevent serious adverse consequences in them.

The Validities and Efficiencies of Korean ADHD Rating Scale and Korean Child Behavior Checklist for Screening Children with ADHD in the Community

OBJECTIVE: The purpose of this study is to examine the validity of primary screening tools for attention deficit hyperactivity disorder (ADHD) in a community-based sample of children using the Korean version of the Child Behavior Checklist (K-CBCL) and the Korean version of the ADHD Rating Scale (K-ARS). METHODS: A large-scale community-based study for ADHD screening was conducted in the Jeollabuk province in the Republic of Korea. In 2010-2011, we surveyed a total of 49,088 first- and fourth-grade elementary school students. All of the participants in this study were assessed by the K-ARS-Parent version (K-ARS-P) and the K-ARS-Teacher version (K-ARS-T) as the primary screening instruments. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used for confirming the diagnosis of ADHD. DISC-IV was administered to subjects who received top 10% scores in the K-ARS-P or K-ARS-T tests. RESULTS: Of the 3,085 subjects who completed the DISC-IV, 1,215 were diagnosed as having ADHD. A reasonable level of sensitivity, specificity, and negative predictive value were obtained when the total K-ARS-P scores were > or =90th percentile. The positive predictive value and specificity increased significantly when the total K-ARS-P scores were > or =90th percentile, T scores were > or =60 in the attention problems of K-CBCL, and T scores were > or =63 in the total problems of K-CBCL. CONCLUSION: These results suggested that the K-ARS-P could effectively serve as a primary screening tool to identify elementary school children with ADHD in the community. Also, there might be some increment in the effectiveness of K-ARS-P when combined with K-CBCL-A and K-CBCL-T as a secondary screening tool.

Comparison of Antidepressants Tolerability in Cancer Patients Referred for Psychiatric Consultation / 정신신체의학

OBJECTIVES: Many patients diagnosed with cancer suffer from various psychiatric symptoms such as depression, anxiety and insomnia as well as cancer itself. Patients with cancer are more vulnerable to possible adverse events of psychotropic medications. Although antidepressants are widely used among cancer patients, there is little information about tolerability of antidepressants. This study was conducted to compare tolerability of antidepressants in cancer patients referred for psychiatric consultation. METHODS: The participants were cancer patients who had been referred to psychiatrist for their psychiatric symptoms. We retrospectively analyzed the data of patients diagnosed with cancer from 9 general hospitals in Korea. The discontinuation rate for a 6 months period after treatment initiation for three antidepressants(Escitalopram, Mirtazapine, Paroxetine) were compared. RESULTS: Antidepressants were prescribed for 96.3% of subjects and Escitalopram 150(47.2%), Mirtazapine 92 (28.9%) and Paroxetine 76(23.9%) were prescribed frequently in order There were no significant differences in discontinuation rates among the three antidepressants during the 6 month period after initiation of pharmacotherapy. But there was a difference in discontinuation rates between inpatients versus outpatients(p<0.0001). CONCLUSIONS: In a naturalistic setting for the antidepressant treatment for cancer patients, it seems that there are no differences in discontinuation rates among these three antidepressants. It is therefore essential that such interactions are carefully considered when treating patients of antidepressants who already have cancer.