Physical Violence Reported by Han and Korean Chinese School Children (II): Cross-Cultural Comparison of Risk Factors / 신경정신의학

OBJECTIVES: The prevalence of child physical violence may differ between cultures. However, it is poorly understood why differences exist. Authors' previous study (Kim et al. 2005) confirmed different prevalence of physical violence existed in Han and Korean Chinese children. This study further investigated the cross-cultural differences in risk factors for violence and its possible linkage with different prevalence between ethnic groups. METHODS: Datas contain responses from 1158 Han and 1145 Korean Chinese children in fourth to sixth grade (aged 10 to 12) from eight ethnic elementary schools in Yanji city of North Eastern China. Demographic variables and attitude toward corporal punishment were compared between violenced and non-violenced children in each ethnic group. Significant variables from bivariate analyis were further used for binary logistic regression analysis to identify best fitting model of risk factors in each group.Additionally risk factors for types of violence (i.e., family violence, peer violence, and violence by teachers) were also examined. RESULTS: Identified common risk factors were boys and younger children. Results form the Han group also revealed single or absent parents, having siblings, and approval of corporal punishment as additional risk factors, while Korean Chinese group included poor economic state. Most consistent and salient risk facor for each type of violence was the experience of other types of violence. CONCLUSION: Current findings are consistent with previously indentified risk factors in the literature. Basically, two ethnic groups had a very similar pattern of risk factors. However, minor differences did exist in additional factors. This may suggest that culturally different mediating factors are responsible for cross-cultural difference in prevalence of child violence.

Factor Structure of the Korean Version of Illness Intrusiveness Rating Scale: Cross-cultural Implications

The Illness Intrusiveness Rating Scale (IIRS) measures illness-induced disruptions to 13 domains of lifestyles, activities, and interests. A stable three-factor structure has been well documented; however, the cross-cultural validity of this scale needs to be tested. This study investigated the factor structure of the Korean version of IIRS in 712 outpatients at a university medical center. A predominant diagnosis of the patients was rheumatoid arthritis (47%). The Center for Epidemiological Studies-Depression Scale (CES-D), and Health Assessment Questionnaire (HAQ) were also administered. Exploratory Principal Component Analysis identified a two-factor structure, "Relationships and Personal Development (RPD)" and "Instrumen-tal", accounting for 57% of the variance. Confirmatory analyses extracted an identical factor structure. However, a goodness-of-the fit test failed to support two-factor solution (X2 =138.2, df=43, p<.001). Two factors had high internal consistency (RPD, alpha=.89; Instrumental, alpha=.75) and significantly correlated with scores of HAQ (RPD, r=.53, p<.001; Instrumental, .r=44, p<.001) and CES-D (RPD, .r=55, p<.001; Instrumental, .r=43, p<.001). These findings supported construct validity of the Korean version of IIRS, but did not support cross-cultural equivalence of the factor structure.

Physical Violence Reported by Han and Korean Chinese School Children(I): Ethnic Difference in the Prevalence / 신경정신의학

OBJECTIVES: This study sought to determine ethnic difference in physical violence and to see if ethnicity is an independent predictor of violence by surveying eight Korean or Han ethnic elementary schools in Yanji city, China. A total of 2,316 school children from fourth through sixth grade participated the study. METHODS: Participants completed a questionnaire on sociodemographic background and experiences of physical violence during the previous year using the Conflict Tactics Scale. The history of physical violence was categorized as within the family, by peers, or by teachers. RESULTS: Han children reported significantly higher rates of physical abuse compared with Koreans (76.2% vs. 54.9%, chi2=116.12, df=1, p=<.001). Binary logistic regression analysis identified five risk factors for physical violence:(1) ethnic Han (odds ratio [OR]=3.01, 95% confidence interval [CI]=2.47-3.66), (2) boys (OR=2.76, 95% CI=2.28-3.36), (3) poor economic status (OR=1.69, 95% CI=1.17-2.42), (4) single or absent parents (OR=1.42, 95% CI=1.09-1.86), (5) interaction of fourth-graders with promotive or neutral opinions of corporal punishment (OR=2.41, 95% CI=1.86-3.13). Ethnicity remained an independent risk factor after other sociodemographic variables were controlled. CONCLUSION: These findings showed cross-cultural risk factors of child physical abuse, including ethnicity which previously identified as a factor in literature. This study particularly reports lower prevalence of physical violence in ethnic minority, Korean-Chinese, compared with the Han ethnic group. This result explained a special environment of Korean self-government district and the successful adaptation of the ethnic minority to the mainstream culture.

A Case Series of Eye Movement Desensitization and Reprocessing (EMDR) in 30 Psychiatric Patients: Korean Experience / 신경정신의학

OBJECTIVES: Eye Movement Desensitization and Reprocessing (EMDR) is an emerging psychotherapeutic technique for posttraumatic stress disorder and other conditions associated with psychological trauma. The effectiveness of this technique has been reported among North American and European populations; however, research on it's effectiveness among other ethnocultural groups is sparse. This is the first clinical study of EMDR in Korea with 30 Korean psychiatric patients in two clinical settings. METHODS: Diagnostically heterogeneous group of 30 psychiatric patients underwent a mean of 3.13 (95%CI=2.54-3.73) sessions of EMDR. The Clinical Global Impression-Change scale (CGI-C) was administered one week and six months after the termination of treatment. RESULTS: Participants had a mean CGI-C score of 1.80 (95%CI=1.44-2.16). We designated as 'responders' those who were 'very much improved' or 'much improved' on the CGI-C, 23 (77%) After six months, 19/23 (83%) still characterized as remaimed responders. All the patients with posttraumatic stress disorder, phobia, and grief reaction were responders, and those with personality disorder nonresponders. Results for depressive and other disorders were mixed. CONCLUSION: Despite methodological limitations, results from this study suggest that the EMDR can be applied to Korean psychiatric patients.

Family Violence: Psychiatric Aspects / 신경정신의학

OBJECTIVE: Psychiatrists have recently paid attention to family violence victims, possibly due to the increase of the case, difficulty in case finding and management, and unfavorable treatment outcome. In this review article, the author introduced knowledge and clinical guideline for desirable approach. METHODS: This article was from review of articles and the author's 20 years clinical experience at the victim clinic. RESULTS: Incidence of family violence in Korea is three fold higher than that of the United States and China. Batterers' personality and behavior pattern, their characteristic action of violence, victims' victimization process, victims' emotional and cognitive response, characteristics of victims' clinical behavior, desirable attitude of psychiatrists, and the 7 stage approach by the author were introduced.

Attachment and Behavior Problems in Adolescents: Internalizing and Externalizing Problems / 신경정신의학

OBJECTIVE: The purpose of this study was to examine the relationship between attachment and behavior problems in adolescents. METHOD: A sample of 792 high school students were examined. Revised Adult Attachment Scale, Self-report Attachment Style, Youth Self-Report Child Behavior Checklist (YSR) were used to measure the attachment quality, the attachment pattern and the behavior problems respectively. RESULTS: As to the attachment quality, high score in fear of rejection, low dependability and low intimacy were related to the development of adolescent's internalizing problems. As to the attachment pattern, preoccupied and fearful with attachment experience were linked to the internalizing behavior problems of higher level as well as 'Attention problems' and 'Aggressive behavior' sub-scales of externalizing ones on YSR. CONCLUSION: High fear of rejection, low dependability and low intimacy characterise the insecure attachment. So the insecure attachment might predict the development of all internalizing behavior problems, attention problems and aggressive behavior in adolescents. Also the result suggested that the adolescents classified as Dismissing attachment may have a positive view of the self and may minimize the self reported behavior problems.

Schizophrenic Hallucinations in Shanghai and Seoul:A Transcultural Study / 신경정신의학

OBJECTIVE: The types, contents and major themes of schizophrenic hallucinations in Shanghai and Seoul were compared for evaluating cultural differences and connotation. METHODS: Among the schizophrenic inpatients of Shanghai Mental Health Center in Shanghai and National Seoul Mental Hospital and Hanyang University Hospital in Seoul, 396 cases(182 cases in Shanghai, 214 cases in Seoul) were selected by two ways:a) five staged stratified random sampling of sex, age, education, clinical subtype and onset year, b) cases who have admitted for one to six months in their last admission. Among them, 231 cases(55.39% in Shanghai, 60.83% in Seoul) confirmed to have hallucinations were the final subjects of study. RESULTS: Frequencies in types of hallucination were not different between the two groups. However, contents and major themes were different:Political themes and related contents were dominant in Shanghai cases, and supernatural and religious themes and related contents were dominant in Seoul cases. CONCLUSION: It was concluded that contents and themes of hallucinations were closely related to the delusional contents and themes, and such patterns were considerably influenced by sociocultural characteristics.

C-fos mRNA Expression in Rat Hippocampal Neurons by Antidepressant Drugs

This study was designed to examine the effects of two antidepressant drugs on the expression of c-fos mRNA in cultured embryonic rat hippocampal neurons. The drugs used were imipramine and amitriptyline. On the fourth day of culture, hippocampal neurons were treated with variable concentrations of each drug. Competitive RT-PCR(Reverse Transcriptase-PCR) analysis was used to quantify the c-fos mRNA expression induced by each drug. Experimental results showed that acute and direct treatment with imipramine and amitriptyline with relatively low concentrations(imipramine or =100micrometer, amitriptyline > or =100micrometer) c-fos mRNA was not detected. These findings suggest the followings. Firstly, the action mechanisms of these drugs on the hippocampal neurons might not be mediated by c-fos but by other immediate-early genes(IEGs). Secondly, their actions may be mediated indirectly via other areas of the brain. Thirdly, the expression of c-fos might be inhibited by high concentrations of these drugs, or the high concentrations could induce cell death. Finally, though cell death remains to be confirmed, the inhibition of c-fos induction or cell death could play a role in the cognitive impairments known to be adverse effects of some antidepressants. This study is believed to be a first step toward understanding the mechanisms of learning and memory. Further studies are needed to investigate the expression of various IEGs and changes in the hippocampal neurons of rat resulting from chronic treatment with antidepressant drugs.

Schizophrenic delusions in Seoul, Shanghai and Taipei: a transcultural study

In this transcultural study of schizophrenic delusions among patients in Seoul, Shanghai and Taipei, we discovered that both the frequency and content of delusions differed among the three groups; and that these differences could perhaps be explained by varying sociocultural and political situations. Delusional themes that are sensitive to sociocultural or political situations include guilt, love/sex, religion, somatic damage, economy/business and politics. Delusions regarding longevity, love/sex, dysmorphophobia/dysosmophobia, religion or supernatural matters, and espionage/spy stories were most frequent in Seoul patients. Those in Taipei predominantly had delusions about possession, religion or supernatural matters, hypnotism, and mass media/computers. Shanghai patients often had delusions of poisons, being prickled by poisoned needles, their brain and viscera extracted and being a family member of political authorities.

The Crisis of Psychiatry: Psychiatric Patients, Quo Vadis? / 신경정신의학

In the year two thousand and following years, there will be tremendous changes in the field of psychiatry. At this critical period, we should rethink the identity of psychiatry. The characteristics and problems of psychiatry in the near future include a) 'mindless' psychiatry confined into the brain cell, b) a continuous evolution of non-psychiatric practitioners, medical or nonmedical, c) the atrophy of psychiatric practice due to economic pressure by society, and d) psychiatric policy of functional diagnostic criteria and guidelines in practice. The above situations can result in a) the more superficial and easy going attitude of psychiatry in practice, b) superficial understanding of patients and inadequate treatment outccome, c) patients' frustration and seeking help from alternative or quasi-practitioners, and tele-psychiatry or cyber space. Psychiatrists' recognition of a crisis, active coping with the problems and harmonized and integrated education were suggested for the better contribution.

Validity Assessment of the CISS(Coping Inventory for Stressful Situation) in Korean High School Students / 신경정신의학

OBJECTIVES: CISS(Coping Inventory for Stressful Situation) is one of the measures to access the coping dimension with dispositional approach. Consisting of three subscales (i.e., task-focused, emotion-focused and avoidance-focused coping), CISS has 48 items and each subscales has 16 items. We undertook an investigation of the psychometric properties of the CISS in Korean highschool students to determine the extent to which this measure was generalizable to non-western populations. METHODS: The duration of the survey was from 1st of May to 30th of June, 1997. The subjects were 300 of 2nd grade students from 6 highschools in Seoul. Exploratory factor analysis was performed, and reliability, correlations and mean difference were estimated. RESULTS: Comparison of the factor loading patterns in our sample with published factor loading of the CISS confirmed that our loading patterns replicated established task-focused, emotion-focused and avoidance-focused coping constructs. However, 9 out of the 48 items were problematic. Of the avoidance-focused subscale, 4 items had unclear results, and of the emotion-focused subscales, 5 items had unclear results. Internal coefficients of the three subscales of the CISS range from 0.82-0.90 for male and female students. In intercorrelations among subscales, independence among factors was found in female students, but independence among subscales was not found in male students. CONCLUSION: Our results were equivocal in suggesting the cross-cultural stability ofthe structure of the CISS. We identified three underlying factors that replicated the established structure of the CISS in North America. However, instances of cross-loading among items and significant intercorrelations between factors suggest that these constructs may not constitute the mutually independent measures. Conceptualization of coping can be affected by theinfluence of cultural practices and preferences. The implication of the results is that Korean students in this sample did not consistently distinguish uniquely among the specificdimensions of coping as measured by the CISS in North America. We may have experienced more difficulties in replicating the factor structures of more abstract domains than concrete constructs due to the nuance of translation.

Symptom Aggravation in an Elderly Schizophrenic due to Lorazepam Discontinuation of Long-term Use of Minimal Dosage: A Case Report / 신경정신의학

Withdrawal psychosis following long-term administration of benzodiazepine is relatively unclear and has rarely reported. Especially, there are few reports of lorazepam withdrawal characterized by psychotic aggravation in schizophrenia. We report a 64 years old chronic schizophreinc case who developed symptom aggravation and paroxysmal attack of severe psychotic symptom, following discontinuation of 1mg lorazepam, which has been used in combination with 100mg chlorpromazine for 13 years. It was suggested that long-term combination therapy with benzodiazepines in schizophrenia was strongly discouraged even if its dosage is minimal.

Psychiatry in Korea for 21 Century: Quo vadis? / 신경정신의학

In this review article, the author tried to predict the characteristic features of psychiatric population and mental health problems in a new century in Korea. Accordingly the desirable attitude of psychiatrists and the scope of psychiatry were suggested. As problem areas, problems of adolescence, senility, family, stragglers, quasireligion, community mental health and transcultural practice were predicted. As psychiatrists' scopes to be accomplished, subspecialty in practice, community-based approach, cooperation with parapsychiatric and religious personnels, transcultural approach in practice, accomplishment of desirable mental health delivery system were suggested. Finally, psychiatric education suitable for the future society was emphacized for the better contribution.

Religious Orientation and Persecutors in Delusions of Schizophrenic Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to evaluate the characteristics of relationship between the frequency of various persecutors in schizophrenic delusion and religious orientation with other religious variables. METHODS: The subjects were 105 schizophrenic patients. Diagnostic criteria used in this study was DSM-III-R. Religious orientation was assessed with the Intrinsic and Extrinsic Religious Orientation Scale. Demographic data, religious data, and contents of persecutory delusion were also analyzed. RESULTS: 1) The group obsessed with religious delusion regarded God, ghosts, and supernatural beings as persecutors. Predominantly, they used to have religious affiliation with protestantism before schizophrenic onset while being "intrinsic" in religious attitude. They also participated in religious activities more than 2 times every week. 2) The group who regarded religious leaders and shamans as persecutors predominantly had a religious affiliation after schizophrenic onset with "proreligious" and "intrinsic" religious attitude while some of them never participated in religious activity. 3) The group who regarded predominantly family and relatives as persecutors have a religious affiliation with buddhism and others(shamanism and etc) after schizophrenic onset with "extrinsic" religious attitude. CONCLUSION: These results suggest that religious orientation and other religious factors seem to affect persecutory delusion formation in schizophrenic patients.

Stress among Chinese, Korean-Chinese and Korean High School Students: A Transcultural Study / 신경정신의학

In this transcultural comparison, we examined areas of stress, coping strategies and psychosomatic symptoms resulting from such strategies in Chinese, Korean-Chinese and Korean high school students. A total of 1,042 second-year high school students participated in this study: 213 Chinese from Yanbien, China: 368 Korean-Chinese from Yanbien, China ; and 466 Koreans from Seoul, Korea. We administered the Stress Questionnaire Form for High school Students(Won and Lee 995), the Ways of Coping-Revised(Lazarus and Folkman 1984) and the Physical Symptom Scale of Stress(Allen and Hyde 1980) to investigate areas of stress, coping strategies and psychosomatic symptoms, respectively. The findings were understood and interpreted from focus group discussions. Although there were no differences in total stress scores among the three groups, there were significant differences in areas of stress. Chinese students manifested the highest stress scores in peer relation, family problem, heterosexual problem, the future-employment, and religious problem. Koreans scored the highest in academic performance, school life, extracurricular activity, psychological-personality problem, value system, and the future-employment. The Korean-Chinese students scored the highest in extracurricular activity, family-economic problem. In terms of collectivism versus individualism, Chinese students' stress was related more toward the collective situation, whereas the Korean students faced increased stress regarding the individual situation. In coping strategies, the Chinese were characterized by active coping, Koreans by passive coping and the Korean-Chinese by a mixture of the two. Koreans had the highest scores in psychosomatic symptoms, suggesting unfavorable coping strategies. The Korean-Chinese students seemed to lie intermediate between Koreans and Chinese in all three study areas, implying their cultural pluralism.

Religious Orientation and Delusion in Schizophrenic Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to evaluate the characteristics of religious orientation and religious life pattern in schizophrenic patients and their relationships to the types and themes of delusion. METHODS: Subjects were 120 schizophrenic patients. Diagnostic criteria used in this study was DSM-III-R. Religious orientations were assessed with the Intrinsic and Extrinsic Religious Orientation Scale. Demographic data, religious data and contents of delusion were also analyzed. RESULTS: 1) Distribution and prevalence of religious affiliations were similar to those of general population in Korea. 2) Religious orientations of the schizophrenic patients changed from the "extrinsic" attitude to the "proreligious" attitude as time passed. 3) Prominent religious orientations were different according to religious affiliation. The "proreligious" orientation and the "intrinsic" orientation were dominant in the religious group, whereas the "extrinsic" orientation and "antireligious" orientation were dominant in the nonreligious group. 4) Religious orientations were different according to the types of religions. The "intrinsic" orientation was dominant in Protestantism and Catholicism, the "extrinsic" orientation was dominant in Buddhism and the "proreligious" orientation was dominant in other type of religious group. 5) Schizophrenic delusion and religious factors showed several characteristic relations First, it was suggested that religion facilitated the psychological maturation and served as a ventilating pathway of guilty feeling. Second, schizophrenic delusion seemed to be affected by the types of the religions. Buddhism group dominantly presented delusion of reference and of guilt, whereas Protestant and Catholic groups dominantly presented delusion of being controlled. Other groups of religion dominantly presented somatic delusion. Third, delusion of guilt was most prevalent in the "extrinsic" attitude and 1311owe4 by the "proreligious" and "intrinsic" attitudes. It was similar to the previous study that guilty feeling was most prevalent in the "extrinsic" attitude in the orders of the "antireligious" , the "proreligious" , and the "intrinsic" attitude. Fourth, religious and supernatural themes of delusion were most dominant in the "intrinsic" attitude, whereas realistic themes of delusion were most dominant in the "extrinsic" attitude. CONCLUSION: These results suggest that religious orientation and other religious factors seem to affect delusion formation and mental health in schizophrenic patients.

G-CSF Treatment of Clozapine-Induced Agranulocytosis: A Case Report / 신경정신의학

The authors present a successful treatment case of clozapine-induced agranulocytosis with granulocyte colony-stimulating factor(G-CSF). It is the first case in Korea that occurred despite proper monitoring by the Clozaril patient Monitoring System(CPMS) and lull clinical vigliance. The mechanism of clozapine-induced agranulocytosis is unknown. Various studies are attempting to identity the pathogenic mechanism involved, and whether it is immunologic like human leukocyte antigen(HLA)-associated or toxic like desmethylclozapine-associated. However, it is clear that the final common pathway is suppression of myeloid proliferation in the bone marrow. The theory that clozapine-induced agranulocytosis Is caused by suppression of colony forming units of granulocytes and macrophages(CFU-GM) forms the rationale far the use of G-CSF or GM-CSF. The management of clozapine-induced agranulocytosis should include accurate diagnosis of agranulocytosis through bone marrow examinations, prompt discontinuation of clozapine, consultation with a hematologist, infectious disease specialist. Reverse isolation and administration of prophylactic antibiotics are need for prevention of secondary infection. A potential decrease of recovery time achieved by G-CSF obviously lowers the risk of secondary infectious disease.

Practical problem of disability evaluation in neuropsychiatric field / 신경정신의학

No abstract available.

Chronological change of persecutors in schizophrenic delusion : Comparison between 1980-1982 and 1990-1992 / 신경정신의학

No abstract available.

Culture-relevant psychiatric practice: case study of a clinic / 신경정신의학

No abstract available.