Preliminary Report of Validity for the Infant Comprehensive Evaluation for Neurodevelopmental Delay, a Newly Developed Inventory for Children Aged 12 to 71 Months

Objectives@#Early detection of developmental issues in infants and necessary intervention are important. To identify the comorbid conditions, a comprehensive evaluation is required. The study’s objectives were to 1) generate scale items by identifying and eliciting concepts relevant to young children (12–71 months) with developmental delays, 2) develop a comprehensive screening tool for developmental delay and comorbid conditions, and 3) assess the tool’s validity and cut-off. @*Methods@#Multidisciplinary experts devised the “Infant Comprehensive Evaluation for Neurodevelopmental Delay (ICEND),” an assessment method that comes in two versions depending on the age of the child: 12–36 months and 37–71 months, through monthly seminars and focused group interviews. The ICEND is composed of three parts: risk factors, resilience factors, and clinical scales. In parts 1 and 2, there were 41 caretakers responded to the questionnaires. Part 3 involved clinicians evaluating ten subscales using 98 and 114 questionnaires for younger and older versions, respectively. The Child Behavior Checklist, Strengths and Difficulties Questionnaire, Infant-Toddler Social Emotional Assessment, and Korean Developmental Screening Test for Infants and Children were employed to analyze concurrent validity with the ICEND. The analyses were performed on both typical and high-risk infants to identify concurrent validity, reliability, and cut-off scores. @*Results@#A total of 296 people participated in the study, with 57 of them being high-risk (19.2%). The Cronbach’s alpha was positive (0.533–0.928). In the majority of domains, the ICEND demonstrated a fair discriminatory ability, with a sensitivity of 0.5–0.7 and specificity 0.7–0.9. @*Conclusion@#The ICEND is reliable and valid, indicating its potential as an auxiliary tool for assessing neurodevelopmental delay and comorbid conditions in children aged 12–36 months and 37–71 months.

Diagnostic Distribution of Psychiatric Disorders among Korean Young Adults

Objectives@#The prevalence of psychiatric disorders among young adults is different from that among younger or older age groups because of biological and environmental changes. The purpose of this study was to analyze the diagnostic distribution of psychiatric disorders in 19–30-year-old Koreans based on their age and gender using data from the Korean National Health Insurance Service (NHIS). @*Methods@#From the 2011 medical claims sample data of NHIS of 1,375,842 people, we extracted the data of 221,038 people aged 19–30 years, including 106,232 (48.1%) men and 114,806 (51.9%) women. We evaluated the overall changes in the diagnostic distribution of psychiatric disorders over a 3-year period. @*Results@#The diagnostic frequency in women was 13,627 (59.0%), which was significantly higher than that in men. “Other anxiety disorders” was the most common psychiatric disorder in both genders, followed by depressive episodes, somatoform disorders, “other neurotic disorders,” and nonorganic sleep disorders. In men, attention-deficit/hyperactivity disorder or intellectual disabilities were not among the top 10 disorders. In women, no significant changes in major psychiatric disorders were seen over the 3-year period. @*Conclusion@#These results reveal the trends of diagnostic distribution of mental illnesses depending on the development, particularly in young adulthood. It is necessary to identify whether such trends are due to biological or environmental factors, aging processes, or complex influences.

Diagnostic Distribution of Psychiatric Disorders among Korean Young Adults

Objectives@#The prevalence of psychiatric disorders among young adults is different from that among younger or older age groups because of biological and environmental changes. The purpose of this study was to analyze the diagnostic distribution of psychiatric disorders in 19–30-year-old Koreans based on their age and gender using data from the Korean National Health Insurance Service (NHIS). @*Methods@#From the 2011 medical claims sample data of NHIS of 1,375,842 people, we extracted the data of 221,038 people aged 19–30 years, including 106,232 (48.1%) men and 114,806 (51.9%) women. We evaluated the overall changes in the diagnostic distribution of psychiatric disorders over a 3-year period. @*Results@#The diagnostic frequency in women was 13,627 (59.0%), which was significantly higher than that in men. “Other anxiety disorders” was the most common psychiatric disorder in both genders, followed by depressive episodes, somatoform disorders, “other neurotic disorders,” and nonorganic sleep disorders. In men, attention-deficit/hyperactivity disorder or intellectual disabilities were not among the top 10 disorders. In women, no significant changes in major psychiatric disorders were seen over the 3-year period. @*Conclusion@#These results reveal the trends of diagnostic distribution of mental illnesses depending on the development, particularly in young adulthood. It is necessary to identify whether such trends are due to biological or environmental factors, aging processes, or complex influences.

Prescription Trends of Psychotropics in Children and Adolescents with Autism Based on Nationwide Health Insurance Data

Children with autism are often medicated to manage emotional and behavioral symptoms; yet, data on such pharmacotherapy is insufficient. In this study, we investigated the Korean National Health Insurance Claims Database (NHICD) information related to autism incidence and psychotropic medication use. From the 2010–2012 NHICD, we selected a total of 31,919,732 subjects under 19 years old. To examine the diagnostic incidence, we selected patients who had at least one medical claim containing an 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for pervasive developmental disorder, F84, not diagnosed in the previous 360 days. Psychotropics were categorized into seven classes. Then, we analyzed the data to determine the mean annual diagnostic incidence and psychotropic prescription trends. Diagnostic incidence was 17,606 for the 3 years, with a mean annual incidence per 10,000 population of 5.52. Among them, 5,348 patients were prescribed psychotropics. Atypical antipsychotics were the most commonly used, followed by antidepressants. An older age, male sex, and the availability of medical aid were associated with a higher rate of prescription than observed for a younger age, female sex, and the availability of health insurance. Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Therefore, medication-related safety data and policies for psychotropic drugs in autism should be prepared.

Valproic Acid Induces Telomerase Reverse Transcriptase Expression during Cortical Development

The valproic acid (VPA)-induced animal model is one of the most widely utilized environmental risk factor models of autism. Autism spectrum disorder (ASD) remains an insurmountable challenge among neurodevelopmental disorders due to its heterogeneity, unresolved pathological pathways and lack of treatment. We previously reported that VPA-exposed rats and cultured rat primary neurons have increased Pax6 expression during post-midterm embryonic development which led to the sequential upregulation of glutamatergic neuronal markers. In this study, we provide experimental evidence that telomerase reverse transcriptase (TERT), a protein component of ribonucleoproteins complex of telomerase, is involved in the abnormal components caused by VPA in addition to Pax6 and its downstream signals. In embryonic rat brains and cultured rat primary neural progenitor cells (NPCs), VPA induced the increased expression of TERT as revealed by Western blot, RT-PCR, and immunostainings. The HDAC inhibitor property of VPA is responsible for the TERT upregulation. Chromatin immunoprecipitation revealed that VPA increased the histone acetylation but blocked the HDAC1 binding to both Pax6 and Tert genes. Interestingly, the VPA-induced TERT overexpression resulted to sequential upregulations of glutamatergic markers such as Ngn2 and NeuroD1, and inter-synaptic markers such as PSD-95, α-CaMKII, vGluT1 and synaptophysin. Transfection of Tert siRNA reversed the effects of VPA in cultured NPCs confirming the direct involvement of TERT in the expression of those markers. This study suggests the involvement of TERT in the VPA-induced autistic phenotypes and has important implications for the role of TERT as a modulator of balanced neuronal development and transmission in the brain.

Is Sorting Hat in Harry Potter Identity Identifier for Adolescents?

This study analyzes the role of the Sorting Hat in structuring the identity of the characters in the Harry Potter series written by J. K. Rowling. In the different stages of adolescence, one explores and re-establishes one's identity. One's sense of identity is determined by the commitments made regarding personal and social traits. However, it is difficult to establish a concrete identity formation process theory that is communicable to adolescents. In Harry Potter, the characters' identities are reflected upon the Sorting Hat and are continuously molded throughout the book. The Sorting Hat provides nurturing experiences based on temperament. Based primarily on their temperament, it sorts the students into four houses, each with their own distinct characteristics. Once sorted, the houses become the living and learning communities in which the students share the same dormitory and classes until their graduation. Within the community, the students seek connections, supportive relationships, and understanding within the group. The taking on of the group identity is an explanatory variable in the formation of individual identity. The Sorting Hat provides the students with stability and a safe boundary. After being sorted based on their temperament, the inexperienced and immature adolescents can explore different options under the guidance of the Hat before making a definite commitment. By presenting them with an appropriate environment (such as a mentor, friend, or family member), the Hat further shapes their identity and integrates the identity elements ascribed in the beginning. By providing experiences and interactions based on their unique temperament and environment, the Sorting Hat plays a crucial role in establishing the students' identities. The Sorting Hat can be an ideal model for finding one's identity during adolescence.

Erratum: Valproic Acid Induces Telomerase Reverse Transcriptase Expression during Cortical Development

In the ‘Acknowledgements’ section on page 263 of the original article, the grant number was incorrectly stated.

The Diagnostic Distribution of Psychiatric Disorders among the Population Under 19 Years Old: Based on the National Insurance Data

OBJECTIVES: As a preliminary study on the prevalence of mental disorders in Korean children and adolescents, we investigated the diagnosis distribution of mental disorders in people under 19 years of age using the health insurance data. METHODS: From the 2011 health insurance data of 1,375,842 people, the data of 286,465 people under 19 years old were extracted. Among them, we selected 10,778 with psychiatric diagnoses; male 6,453 (59.9%) and female 4,325 (40.1%). The frequency of psychiatric diagnoses in the males was 10,140 (62.7%) cases, which was significantly higher than that (6,031; 37.3%) in the females. We categorized the groups into 3 year intervals. RESULTS: In the males under 3 years old, F80 was the most prevalent diagnosis, followed by F98. F90 and F41 were the most prevalent in the 4-15 and above 16 years old groups, respectively. In the females, F98 was the most prevalent in the children up to 3 years old, while F80 was the second most prevalent. In the 4-6 years of age group, F98 was the most prevalent, followed by F93. F90 and F41 were predominant in the 7-12 and above 12 years old groups, respectively. CONCLUSION: In the analysis of the frequency of diagnosis of mental disorders in the population under 19 years old, there were significant differences in the distribution based on age and gender.

Is Oxytocin Application for Autism Spectrum Disorder Evidence-Based?

Autism spectrum disorder (ASD) is characterized by persistent deficits within two core symptom domains: social communication and restricted, repetitive behaviors. Although numerous studies have reported psychopharmacological treatment outcomes for the core symptom domains of ASD, there are not enough studies on fundamental treatments based on the etiological pathology of ASD. Studies on candidate medications related to the pathogenesis of ASD, such as naltrexone and secretin, were conducted, but the results were inconclusive. Oxytocin has been identified as having an important role in maternal behavior and attachment, and it has been recognized as a key factor in the social developmental deficit seen in ASD. Genetic studies have also identified associations between ASD and the oxytocin pathway. As ASD has its onset in infancy, parents are willing to try even experimental or unapproved treatments in an effort to avoid missing the critical period for diagnosis and treatment, which can place their child in an irreversible state. While therapeutic application of oxytocin for ASD is in its early stages, we have concluded that oxytocin would be a promising therapeutic substance via a thorough literature review focusing on the following: the relationship between oxytocin and sociality; single nucleotide polymorphisms as a biological marker of ASD; and validity verification of oxytocin treatment in humans. We also reviewed materials related to the mechanism of oxytocin action that may support its potential application in treating ASD.

The Differences of Serum Homocysteine Levels in Mild Cognitive Impairment and Dementia of Alzheimer's Type with or without Depressive Symptoms / 정신신체의학

OBJECTIVES: Mild cognitive impairment(MCI) and dementia of Alzheimer's type(AD) are characterized by progressive decline of cognitive abilities and a wide range of neuropsychiatric symptoms like depression. Among various diagnostic tools of AD, many studies showed that elevated levels of serum total homocysteine are associated with increased risk of developing Alzheimer's disease, depression and other neuropsychiatric disorders. We investigated whether elevated homocysteine concentrations are associated with depressive symptoms in MCI and AD. METHODS: A total of 86 patients diagnosed with MCI or AD participated. Total serum homocysteine levels in fasting blood samples were measured. We examined cognitive symptoms by MMSE-KC, Global Deterioration Scale(GDS), Clinical dementia rating(CDR) and depressive symptoms by Korean version of Geriatric Depression Scale(K-GDS). RESULTS: The total serum homocysteine levels were significantly higher in MCI with depression than in MCI without depression. There was no significant difference in the mean homocysteine levels between AD patients with depression and AD patients without depression. The total homocysteine levels showed a negative correlation with MMSE-KC and a positive correlation with CDR, GDS. CONCLUSIONS: These findings suggest that elevated homocysteine level is a risk factor for the decline of cognitive function and depression. We found a significant relationship between elevated serum homocysteine level and depressive symptoms in MCI. But our study had several limitations, thus more research is needed to confirm this finding.

Neuropsychiatric Symptoms in Patients with Mild Cognitive Impairment and Dementia of Alzheimer's Type / 정신신체의학

OBJECTIVES: We investigated the prevalence and composite score of the neuropsychiatric symptoms in patients with mild cognitive impairment(MCI), and dementia of Alzheimer's type(AD). The aim of this study is to analyze the correlation between the result of Korean Neuropsychiatric Inventory(K-NPI) and cognitive function. METHODS: A total of 163 patients diagnosed with MCI or AD was divided into three groups(55 MCI patients, 56 dementia patients with mild stage, and 52 dementia patients with moderate, severe stage). We examined neuropsychiatric symptoms by K-NPI and compared the prevalence and composite score of each subdomain in K-NPI among three groups. RESULTS: The most common symptoms in the MCI group were depression/dysphoria, sleep/night-time behavior, anxiety, and irritability/lability. In mild AD group, the most frequent disturbance was agitation/aggression, depression/dysphoria, anxiety, apathy/indifference, and sleep/night-time behavior. In moderate to severe AD group, the most frequent disturbance was apathy/indifference, depression/dysphoria, agitation/aggression, and delusion. The frequencies of delusion, hallucination, agitation/aggression, apathy/indifference, aberrant motor behavior, appetite/eating change were statistically significant. The total NPI score showed a negative correlation with MMSE-KC and a positive correlation with GDS. CONCLUSIONS: Neuropsychiatric symptoms are common features of MCI and AD. These symptoms observed in MCI are similar to those of mild AD. Psychosis is most common in moderate to severe AD, leading to a faster rate of cognitive decline. Therefore, proper management according to the neuropsychiatric symptoms of MCI and three stages of dementia is needed.