A Pilot Study on the Development and the Effect of a Cognitive-Behavioral Intervention for Undergraduates at Mental Health High Risk / 정신신체의학

Objectives@#: The purpose of this study was to develop a cognitive-behavioral intervention for college students at high risk for mental health and to investigate its effect on mental health outcomes. @*Methods@#: The program was developed to reduce depressive symptoms and adverse outcomes while promoting resilience and positive effects. It consisted of eight sessions in a small group format for eight weeks. Thirty subjects at high risk for mental health participated in the program. Outcomes on the depressive symptoms, resilience, satisfaction with life, negative affect, and positive affect were evaluated at pre-and post-intervention. @*Results@#: Depressive symptom scores reduced significantly post-intervention compared to pre-intervention (t=3.51, p=0.002). Resilience scores (t=-3.65, p=0.001) and satisfaction with life scores (t=-3.00, p=0.006) increased after intervention than pre-intervention. Positive affect scores decreased post-intervention (t=2.28, p=0.031). There was no significant difference between pre-and post-intervention negative affect scores (t=-0.94, p=0.356). @*Conclusions@#: Present study demonstrated that group-based cognitive-behavioral intervention could be helpful for college students at high risk for mental health to reduce mental health symptoms and improve healthy protective factors.

Defining Subtypes in Children with Nail Biting: A Latent Profile Analysis of Personality

Objective@#This study aimed to examine personality profiles and behavioral problems of children with nail biting (NB) to gain insight into the developmental trajectory of pathological NB. @*Methods@#681 elementary school students were divided into non NB (n=436), occasional NB (n=173) and frequent NB group (n=72) depending on the frequency of NB reported in Child Behavioral Checklist (CBCL). Children’s personality was assessed using the Junior Temperament and Character Inventory (JTCI), and behavioral problems were assessed using the CBCL. Latent Profile Analysis (LPA) was performed using JTCI profiles to classify personalities of the children with NB (belonging to frequent and occasional NB group, n=245). @*Results@#For subscale scores of CBCL, the total, internalizing, externalizing, anxious/depressed withdrawn/depressed, depression, thought, rule-breaking, and aggressive behavior problems, were most severe in the frequent NB group followed by occasional NB and non NB group. LPA of personality profile in children with NB revealed four classes (‘adaptiveness,’ ‘high reward dependence,’ ‘low self-directedness,’ and ‘maldaptiveness’). The four personality classes demonstrated significant group differences in all of the CBCL subscales. Children who showed low self-directedness and cooperativeness and high novelty seeking and harm avoidance personality profiles demonstrated highest tendency for problematic behavior irrespective of the frequency of NB. @*Conclusion@#Children with NB reported significantly more problematic behaviors compared to children without NB. Children with specific personality profile demonstrated higher tendency for problematic behavior irrespective of the frequency of NB. Therefore, accompanying personality profiles should be considered when assessing behavioral problems in children with NB.

Discrepancies of Implicit and Explicit Self-Esteem as Predictors of Attributional Bias and Paranoia

OBJECTIVE: The current study aimed to examine the association of implicit self-esteem, explicit self-esteem and their interaction with paranoia and attributional bias. The relationship of the size and the direction of the discrepancy between implicit and explicit self-esteem with paranoia and attributional bias was examined. METHODS: A total of 128 female college students participated. We administered the Implicit Association Test to assess implicit self-esteem, and the Rosenberg Self-Esteem Scale to measure explicit self-esteem. Paranoia Scale was used, and the attributional bias was assessed using the Ambiguous Intentions Hostility Questionnaire. RESULTS: Results showed that explicit but not implicit self-esteem was negatively associated with paranoia, blame bias and hostility perception bias in ambiguous situations. The interaction of implicit and explicit self-esteem was associated with hostility perception in ambiguous situations. As for the discrepancy, the size of the discrepancy between implicit and explicit self-esteem was positively associated with hostility perception in ambiguous situations. Moreover, the direction of the discrepancy was specifically relevant: damaged self-esteem (high implicit and low explicit self-esteem) was associated with increased levels of paranoia, blame bias and hostility perception in ambiguous situations. CONCLUSION: These findings provide new insights into the role of the implicit and explicit self-esteem in attributional bias and paranoia and point to damaged self-esteem as a possible vulnerability marker for illogical attribution of blaming others and perceiving hostility in social situations.

Predicting Working Memory Capacity in Older Subjects Using Quantitative Electroencephalography

OBJECTIVE: We utilized a spectral and network analysis technique with an integrated support vector classification algorithm for the automated detection of cognitive capacity using resting state electroencephalogram (EEG) signals. METHODS: An eyes-closed resting EEG was recorded in 158 older subjects, and spectral EEG parameters in seven frequency bands, as well as functional brain network parameters were, calculated. In the feature extraction stage, the statistical power of the spectral and network parameters was calculated for the low-, moderate-, and high-performance groups. Afterward, the highly-powered features were selected as input into a support vector machine classifier with two discrete outputs: low- or high-performance groups. The classifier was then trained using a training set and the performance of the classification process was evaluated using a test set. RESULTS: The performance of the Support Vector Machine was evaluated using a 5-fold cross-validation and area under the curve values of 70.15% and 74.06% were achieved for the letter numbering task and the spatial span task. CONCLUSION: In this study, reliable results for classification accuracy and specificity were achieved. These findings provide an example of a novel method for parameter analysis, feature extraction, training, and testing the cognitive function of elderly subjects based on a quantitative EEG signal.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (III): Pharmacological Treatment

The objective of this review is the revision of the Korean practice parameters for the pharmacological treatment of attention-deficit hyperactivity disorder (ADHD) based on the change in the diagnostic system from DSM-IV-TR to DSM-5 and psychopharmacological developments. For the evidence-based approach, the authors conducted a review of the literature, including controlled clinical trials, studies of the side effects of drugs, toxicology and meta-analyses from the United States and Europe, as well as recent research conducted in Korea. The review committee composed of Korean experts on ADHD reviewed the revised parameters. This revised version reveals how to use central nervous system psychostimulants, non-stimulants such as atomoxetine and alpha2 agonists, and other medication for ADHD, and how to manage the adverse effects of such medication. At the end of this revised version, the authors propose recommendations for the pharmacotherapy of ADHD.

Correlation of Executive Function and Quantitative Electroencephalography in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder / 정신신체의학

OBJECTIVES: Attention-deficit hyperactivity disorder(ADHD) is characterized by significant impairments in executive functions, with a prevalence of approximately 3-5% of all children worldwide. The goal of this study was to examine the relationship between executive functions and electrophysiological activities in children and adolescents with ADHD. METHODS: In 31 patients with ADHD, resting-state EEG was recorded, and Comprehensive Attention Test(CAT), Stroop Color-Word Inference Test(Stroop CWIT), Trail Making Test(TMT), and Wisconsin Card Sorting Test(CST) were administered. Korean version of the ADHD Rating Scale(K-ARS) was assessed. RESULTS: Alpha and beta power positively correlated with the Attention Quotient(AQ), while delta power negatively correlated with AQ from CAT. In the Stroop CWIT, decreased delta power and increased beta power were related to higher performance. Power of the alpha band increased with higher TMT performance. Moreover, delta power negatively correlated with good performance on the CST, while alpha and high gamma band showed a positive correlation. Correlation with the parent-rating of ADHD symptoms showed a negative correlation between alpha power and higher scores on the K-ARS. CONCLUSIONS: These findings indicate that relative power in higher frequency bands of EEG is related to the higher executive function in children and adolescents with ADHD, while the association with the relative power in lower frequency bands of EEG seem to be vice versa. Furthermore, the findings suggest that QEEG may be a useful adjunctive tool in assessing patients with ADHD.

The Relationship between Personality, Sense of Efficacy, and Stress in Korean Teachers

Several studies have linked teachers' personality characteristics and sense of efficacy to stress. However, investigating the relationship between these three constructs in this context was limited. This study aims to investigate the relationship between personality, sense of efficacy and perceived stress among Korean teachers. A total of 137 teachers working in elementary, middle, and high schools located in Seoul, South Korea were recruited for the study. The participants were administered Temperament and Character Inventory, Teacher's Sense of Efficacy Scale (TSES), and Perceived Stress Scale. The TSES was negatively correlated with harm avoidance and positively correlated with persistence, self-directedness, cooperativeness, and self-transcendence. Perceived stress was positively correlated with harm avoidance and negatively correlated with persistence and self-directedness. The path analysis showed that harm avoidance directly predicted perceived stress (β=0.37, 95% CI=0.21–0.53, p=0.002), and self-directedness and persistence predicted one's sense of efficacy (β=0.18, 95% CI=0.01–0.39 and β=0.31, 95% CI=0.10–0.47), which predicted perceived stress (β=-0.21, 95% CI=-0.39 to -0.02). The results of the present study indicate that harm avoidance might be associated with stress-proneness, while persistence, self-directedness, and sense of efficacy might act as protective resources against stress in Korean teachers.

The Effect of Sexual Abuse on Posttraumatic Psychiatric Symptoms in Children and Adolescents with Sexual Abuse

OBJECTIVES: The purpose of this study is to examine the effects of the characteristics of victim and sexual abuse on posttraumatic psychiatric symptoms in children and adolescents with a history of sexual abuse. METHODS: A total of 137 children and adolescents were recruited from the Seoul Sunflower Children Center, a nation-funded sexual violence victim protection center, from January 2009 to December 2013. We collected the demographic data of the victims and the Trauma Symptom Checklist for Children (TSCC) from victims. We hypothesized victims' age, sex, and intelligence quotient, and the characteristics of sexual abuse as the affecting factors of posttraumatic psychiatric symptoms. Descriptive analysis and hierarchical regression analysis were performed for analysis of demographic data, TSCC scores, and psychiatric symptoms. RESULTS: The victims' age and the characteristics of sexual abuse were significantly related to the traumatic distress of sexual abuse. R-square was 23% for anxiety, 39% for depression, 21% for posttraumatic stress, and 37% for dissociation on TSCC. CONCLUSION: This study suggests that victims' age, type, frequency and duration of exposure, and disclosure of sexual abuse are significant affecting factors on posttraumatic psychiatric symptoms in children and adolescents. Exploration of psychiatric symptoms other than posttraumatic symptoms, and relations between pretraumatic and posttraumatic psychiatric symptoms is needed through collection of larger samples.

Abnormal Brain Activity in Social Reward Learning in Children with Autism Spectrum Disorder: An fMRI Study

PURPOSE: We aimed to determine whether Autism Spectrum Disorder (ASD) would show neural abnormality of the social reward system using functional MRI (fMRI). MATERIALS AND METHODS: 27 ASDs and 12 typically developing controls (TDCs) participated in this study. The social reward task was developed, and all participants performed the task during fMRI scanning. RESULTS: ASDs and TDCs with a social reward learning effect were selected on the basis of behavior data. We found significant differences in brain activation between the ASDs and TDCs showing a social reward learning effect. Compared with the TDCs, the ASDs showed reduced activity in the right dorsolateral prefrontal cortex, right orbitofrontal cortex, right parietal lobe, and occipital lobe; however, they showed increased activity in the right parahippocampal gyrus and superior temporal gyrus. CONCLUSION: These findings suggest that there might be neural abnormality of the social reward learning system of ASDs. Although this study has several potential limitations, it presents novel findings in the different neural mechanisms of social reward learning in children with ASD and a possible useful biomarker of high-functioning ASDs.

Gender Differences of Direct and Relational Aggression in Children and Adolescents / 정신신체의학

OBJECTIVES: The aim of this study was to investigate the gender differences of direct aggression and relational aggression in Korean elementary and middle school students. METHODS: Parents of 946 elementary school students(age 9.54±1.72 years, 485 boys, 461 girls) completed the Child Behavior Checklist(CBCL). Six-hundred-and-three middle school students(age 13.98±0.93 years, 301 boys, 302 girls) completed the Youth Self-Report(YSR). Independent t-test, chi-square test, and Fisher's exact test were used. RESULTS: Boys had significantly higher direct aggression scores than girls in elementary school students(p<0.001). There was no significance gender difference of relational aggression in elementary school students(p=0.235). In middle school students, boys had significantly higher direct aggression than girls(p=0.017), and girls had significantly higher relational aggression compared to the boys(p<0.001). CONCLUSION: Our results suggest the presence of gender differences in manifestation of aggression subtypes in Korean elementary and middle school students. These gender differences should be taken into account in prevention and intervention approaches of aggression in children and adolescents.

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.

An Open-Label Study of OROS-Methylphenidate for Neuropsychological Changes in Children and Adolescents with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: Previous studies reported that attention-deficit hyperactivity disorder (ADHD) resulted from a deficit of selective attention and sustained attention. In this study, we assessed the result of methylphenidate-induced changes of the cerebral frontal executive functions in patients with ADHD. METHODS: The subjects in this study consisted of 16 ADHD patients whose age ranged from 7 to 12. We used ADHD Diagnostic System (ADS) for the attention improvement, and the Stroop Test for the executive function response to pharmacotherapy with MPH. RESULTS: After pharmacotherapy with methylphenidate for 12 weeks, the study group showed improvement in the clinical aspects through Clinical Global Impression-Severity, ADHD-rating scale and Inattention/Overactivity With Aggression Conner's Parents Rating Scale. In the ADS test, only in auditory task there was a decrease of both the response time and the standard deviation of the response time significantly. In the Stroop Test, there was a decrease in the word task, color task and color-word task significantly. CONCLUSION: Our results show that psychostimulant medication improves neuropsychological function, including the cerebral frontal executive function. This study implies that we have to consider the improvement of executive function, as well as attention when evaluating the efficacy of treatment.