Development of a Wellness Index for Workers

PURPOSE: The purpose of this study was to develop a wellness index for workers (WIW) and examine the validity and reliability of the WIW for assessing workers' wellness. METHODS: The developmental process for the instrument included construction of a conceptual framework based on a wellness model, generation of initial items, verification of content validity, preliminary study, extraction of final items, and psychometric testing. Content validity was verified by 4 experts from occupational health nursing and wellness disciplines. The construct validity, convergent validity and discriminant validity were examined with confirmatory factor analysis. The reliability was examined with Cronbach's alpha. The participants were 494 workers from two workplaces. RESULTS: Eighteen items were selected for the final scale, and the results of the confirmatory factor analysis supported a five-factor model of wellness with acceptable model fit, and factors named as physical . emotional . social . intellectual . occupational wellness. The convergent and discriminant validity were also supported. The Cronbach's alpha coefficient was .91. CONCLUSION: The results indicate that the WIW is a valid and reliable instrument to comprehensively assess workers' wellness, and to provide basic directions for developing workplace wellness program.

Impairment of Neurocognitive Functions in Young Alcohol Dependent Patients: Problem Solving and Executive Functions / 신경정신의학

OBJECTIVES: The decline in general neurocognitive functions of alcoholics has been previously reported, especially in the area of memory, problem-solving and executive function which are important for occupational performance or adaptation to enviroment. On the other hand, young alcoholics under the age of 40 with relatively short duration of problem drinking were reported of no significant decline in neurocognitive functions consisting of memory, problem-solving and executive function. The objective of this study is to investigate whether there is a decline in neurocognitive functions around memory, problem-solving and executive function in abstinent young alcoholics. METHODS: 24 male and female alcohol dependent patients from the age of 19 to 39 years, who were detoxified in the hospotal were recruited as subjects. Normal control group of 20 males and females who matched for age, sex, educational level were selected. Clinical characteristics of the subjects were examined by demographic variables, alcohol history, Beck's Depression Inventory, Michigan Alcohol Screening Test and Standard Progressive Matrices. Also, subtests of Wechsler Memory Scale-Revised, Block design from the Korean-Wechsler Adult Intelligence, Wisconsin Card Sorting Test were performed in order to evaluate the subjects' neurocognitive functions. RESULTS: Compared to normal controls, significant decline in neurocognitive functions such as memory, problem-solving and executive function were observed in young alcohol dependent patients with an average age of 32. Parts of the neuropsychological tests showed significant correlation with duration of lifetime drinking and lifetime alcohol consumption. CONCLUSION: This study shows that, unlike previous reports, decline in memory, problem-solving and executive function occur in young alcoholics as in chronic alcoholics. This implies that young alcoholics can experience difficulty in occupational performance and adaptation to environment, and may be less responsive to treatment due to neurocognitive damage. The results of this study inclicate the importance of early identification, intervention, and planning therapeutic strategies in young alcoholics.

The Study on Reliability and Validity of Korean Versions of Obsessive Compulsive Drinking Scale for Outpatient of Alcohol Dependence / 신경정신의학

OBJECTIVES: This study is to examine the efficacy and the limitation of translated Korean version of the Obsessive-compulsive Drinking Scale. The Korean version of the scale is to be used for treatment and research on alcoholism. METHODS: This study was carried out to examine reliability and validity of the translated Korean version of the Obsessive-compulsive Drinking Scale. One hundred forty two out-patient alcohol dependence subjects were measured of their cognitive and behavioral aspects of craving with this scale. RESULTS: For 142 tested alcoholic subjects, internal consistency among 14 items of the Obsessive-compulsive Drinking Scale was 0.8947(Crohnbach's alpha). For 40 detoxified alcoholics, test-retest reliability of total score of the Korean version of the Obsessive-compulsive Drinking Scale was 0.76 (correlation coefficient, p<0.01). In 131 alcoholic subjects, validity of total score of the Korean version of the Obsessive-compulsive Drinking Scale was examined by correlation analysis with visual analogue scale (VAS). Correlation coefficient was 0.52 with VAS. Especially, correlation coefficient of compulsive subscale of the Korean version of the Obsessive-compulsive Drinking Scale was 0.61 with VAS. The total score of the Korean version of the Obsessive-compulsive Drinking Scale which was analyzed by repeated measure analyses of variance during 8 weeks was significantly different between the relapse group and the abstinence group. CONCLUSION: The Korean version of the Obsessive-compulsive Drinking Scale shows very similar psychometric performance to the original Obsessive-compulsive Drinking Scale developed by Anton. The Korean version, therefore, is an useful instrument that reflects characteristic drinking behaviors of alcoholics.

Effects of Emotional Management Training in Schizophrenic Patients / 신경정신의학

OBJECTIVES: Schizophrenic patients having a disturbance of cognition and emotion are least likely to identify emotional (especially negative) stimuli and cue in tense background stimuli. Also, schizophreinic patients tend to experience relapse if they are exposued to a situation which is emotionally laden. Although emotion itself is important, emotional processing has not been a therapeutic target and skill trainig which improves social competence has provided patients with emotional load. Therefore, we introduced Emotional Management Trainig (EMT) which deal with indirect and direct emotional processing, applied it to schizophrenic patients, and investigated the therapeutic effects. METHODS: We applied the Emotional Management Training (EMT) to 30 schizophrenic patients for 12 weeks, 2 times every week and psychoeducation to 23 schizophrenic patients as control group attention-placebo for 12 weeks, during the same period. Before and after treatment, we used the Trait Meta Mood Scale-short form (TMMS-S) as emotional proper, Social Perception Scale, Verbal Fluency Test, Verbal Paired Associates, and Similarities for cognitive functions. We also used Positive And Negative Syndrome Scale (PANSS) as psychopathology measurement and Social Problem Solving Scale (SPSI) as various kinds of social problem solving function measurement before and after treatment. RESULTS: The results showed that EMT group appeared to be more effective in improving the visual perception of social perception scale, verbal fluencies, positive symptoms, general psychopathology, and total score in PANSS than the control group. Also EMT group seemed to be more effective in total score and Problem Orientation score in SPSI than the control. But there were no differences in abstract function and verbal memory, negative symptoms, and Problem-Solving Skill score between the two groups. CONCLUSION: This study suggests that despite the limitations of the generalizability and the questions for the persistence of effectiveness, EMT might help schizophrenics get the motivational aspects, the familiarity with emotional-loaded situation, and initial processes, for social problem-solving.

A Clinical Significance of the Subjective Experiences of Negative Symptoms in the Patients with Schizophrenia / 신경정신의학

OBJECTIVE: Since the evaluation of negative symptoms has depended on the clinician's objective observation, the patients' subjective experience of negative symptoms has been neglected. However, in fact, a lot of patients are aware of their negative symptoms. There are several reports suggesting that patients suffer from the subjective experiences of their deficit symptoms, even though the objective positive and negative symtoms cannot be observed. Under these circumstances, we have attempted this study with the idea that it would be helpful in understanding the psychopathology of schizophrenia. Also it would help clarifying the relationship between subjective experience of negative symptoms and objective positive and negative symptoms, depression, anxiety symptoms, and extrapyramidal symptoms. METHOD: All the 37 patients satisfied the diagnostic criteria of DSM-IV for schizophrenia . The subjective experiences of negative symptoms were evaluated using Scale for the Subjective Experience of Negative Symptoms, Korean version(K-SENS), and for the depression, anxiety, extrapyramidal symptoms, we used Hamilton Rating Scale for Depression(HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Extrapyramidal Symptom Rating Scale(ESRS). The correlation between each psychopathology was tested by calculating Spearman correlation coefficient. RESULTS: There was a significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and the score of PANSS positive subscale(gamma=-0.40, p0.05), or negative subscale score(gamma=-0.20, p>0.05), or general psychopathology subscale score(gamma=-0.08, p>0.05), respectively. There was no significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and HAM-D(gamma=-0.01, p>0.05), or HAM-A(gamma=-0.11, p>0.05), ESRS(gamma=0.34. p>0.05), respectively. CONCLUSION: These results revealed that the negative correlation between the subjective negative symptoms experienced as an uncomfortable ones and the objective positive symptoms such as grandi-osity, suspiciousness/persecution, and hostility. From these results, the possibility that positive symptoms are used as a defense to hide from the subjectively experienced negative symptoms, or that patients may not be aware of their negative symptoms because they are overwhelmed by their positive symtpoms. is suggested. These results also suggest that subjective experiences of negative symptoms are independent from depression, anxiety and extrapyramidal symptoms.

A Case of the Dextromethorphan Hydrobromide Induced Mood Disorder with Manic Features / 대한정신약물학회지

The authors report a case of dexfromethorphan induced mood disorder with the review of literafures. The patient is a 19-year old female who had been taking dextromethorphan hydrobromide (trade name : romilar) for 14 month s to enjoy its pleasurable effects and to reduce anxiely. Acute intoxication symptoms of dextromethorphan hydrobromide were silly smiles, a euphoric feeling of floating and an optimistic mood. Tolerance developed and she had been taking 70 tablets (1050mg) ot maximum per day. Withdrawal symptoms were anxiely and its related symptoms and a craving for the drug. While taking 50 tagblets per day about 12 days prior to admission, she had developed leated and irritable mood. grandicstily and auditory hallucinations. These symptoms continued despite discontinuation of the drug after admission. the degree of elated and irritable patient's mood was prominent. flight of ideas was not so severe. However, there was prominent grandiosity and auditory hallucinations. She was treated with haloperidol and lithium and then showed gradual remission in 3weeks. If would necessary to explore any drug abuse history in psychiatric patients who are in their teens.