Korean Epidemiologic Catchment Area(KECA) Study for Psychiatric Disorderscc: Prevalence of Specific Psychiatric Disorders / 신경정신의학

OBJECTIVES: This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). METHODS: Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November 30, 2001. RESULTS: Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major depressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. CONCLUSION: The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed.

Prediction of the Long-Term Response of Risperidone to Schizophrenia by Acute Phase Response Profile in Clinical Setting / 대한정신약물학회지

OBJECTIVE: Risperidone, one of the most widely used atypical antipsychotics, not only ameliorates the positive symptoms of the acute phase but also improves the long-term quality of life as well. To achieve sufficient therapeutic effects, it is important to readjust the treatment regimen in case of insufficient response at an appropriate time point. However, few studies have dealt with this issue in clinical settings. METHODS: We investigated the past treatment history of 51 schizophrenics treated with risperidone for more than 48 weeks by retrospective chart review. The patients were divided into responders and non-responders by predetermined criteria, and CGI-severity scores at 7 selected time points were assessed. The time pattern of therapeutic responses was analyzed, and the appropriate point of time to reliably predict the long-term efficacy was sought. RESULTS: Thirty-one (60.8%) and 20 (39.2%) patients were respectively defined as responders and non-responders by our criteria. There was no difference in the risperidone dosage between responders and non-responders, at any time point evaluated. We observed that significant differences in the pattern of CGI-severity score between the two groups emerged after the 8th week, and that the treatment response profile during this phase might predict long-term outcome. CONCLUSION: The results of this study suggest that the 8-week point may be the most appropriate time to assess the clinical response to risperidone and to decide whether to continue with the regimen or change it. However, this was a naturalistic study and the study results require further confirmative research.

Prevalence of Suicide Behaviors(Suicidal Ideation and Suicide Attempt) and Risk Factors of Suicide Attempts in Junior and High School Adolescents / 신경정신의학

OBJECTIVES: Aims of this study were 1) to estimate prevalence rates of suicidal ideation and suicide attempt, 2) to find out whether the gender difference and age difference(13-15 years vs 16-18 years) for suicide behaviors exist, 3) to analyse correlates of suicide attempts among junior and high school adolescents aged 13-18 years old. METHODS: A self-administered questionnaire was used in a cluster random sample of 2,203 school adolescents(male 1,105, female 1,098). Data were obtained on a wide range of constructs including suicidal ideation and attempts during past 2 weeks, depressive symptoms, symptoms of DSM-IV alcohol dependence, family structure, socioeconomic status, smoking, satisfaction with school achievements, and subjective health status. Chi-square test were done for analysing gender difference and age difference of suicide behaviors. Statistical analyses including uni-variate and multi-variate logistic regression analysis were done for each sex, respectively. RESULTS: 1) The prevalence of suicide ideation during past 2 week was 30.7% in the total sample. The prevalence rates of male and female ideators were 26.9% and 34.9% respectively. The prevalence of suicide attempt during past 2 week was 5.3% in the total sample. The prevalence of suicide attempt in males was 3.4% and 7.3% in females. 2) Gender difference was significant. That is, female respondents showed higher rate of suicidal ideation and suicide attempt. In our study age difference was found only at the rate of suicide attempt. That is, older adolescents(16-18 years) showed only statistically significant higher rate of suicide attempt than younger adolescents(13-15 years). 3) Multi-variate logistic regression analysis revealed that the correlates for suicide attempt were female, moderate to severe depressive symptoms, alcohol dependence in the total sample. In males the correlate for suicide attempt was alcohol dependence. In females, were moderate to severe depressive symptoms, and alcohol dependence. CONCLUSION: Depressive symptoms, alcohol dependence, presence of suicidal ideation were strong predictors for suicide attempts. This suggest that early detection of treatment of depression and alcohol dependence is important and psychiatric approach and follow-up be needed for the prevention of suicide.

Longitudinal Study of Cerebral Blood Perfusion Deficits in 12 Cases of Dementia of Alzheimer's Typer / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the pattern of longitudinal changes in cerebral blood perfusion defects using SPECT in patients with dementia of Alzheimer's type . METHOD: Twelve patients with dementia of Alzheimer's type(10 male, 2 female; mean age 73.25+/- 10.62 years), diagnosed by the criteria of the DSM IV and the NINCDS-ADRDA, and ten normal comparison subjects(7 male, 3 female; mean age 75.10+/-5.76 years) were recruited. They were rated by Mini-Mental Status Examination, Mattis dementia Rating Scale, and Hamilton Depression Rating Scale. rCBF(regional cerebral blood flow) was measured using 99mTc-HMPAO SPECT at the initial study in all subjects, but rCBF was remeasured only in the patients after the follow-up period of average 2 years. SPECT scans of dementia patients and comparison subjects were analyzed by three- dimensional volume of interest method. RESULTS: Results were as follows. 1) There were significant perfusion defects in the bilateral frontal and temporoparietal areas in patients with dementia compared with normal comparison subjects at the baseline evaluation. More extensive perfusion defects including left superior frontal and medial temporal areas were observed in the follow-up SPECT scan compared with baseline scan. 2) There was significant negative correlation between rCBF of bilateral temporal lobe at the baseline scan and the rate of decline of scores of MMSE-K and Mattis dementia rating scale. 3) Various areas of the brain showed correlations between rCBF at the baseline scan and the rate of decline of scores of five subscales of Mattis dementia rating scale. CONCLUSIONS: Three-dimensional VOI approach using SPM analysis showed the characteristic perfusion defects and pattern of longitudinal changes in the patients of dementia of Alzheimer's type, which may be overlooked by the conventional region-of-interest technique. This alteration in rCBF may be closely related to the pathophysiological process of dementia of Alzheimer's type.

Three and Half Year Follow-Up Study on a Rural Elderly Cohort: Prevalence, Incidence, and Service Utilization of Dementia and Depressive Disorders

OBJECTIVES: To evaluate the incidence rate and associated factors of dementia in the elderly of rural community. METHODS: This study was three and half year follow-up of Yonchon cohort, participated in a prevalence study of dementia and depression in 1996 (N=1,037). A two-phase study was conducted using the Korean version of Psychogeriatric Assessment Scale in phase I and the diagnostic interview according to DSM-IV criteria by two psychiatrists in stage II. RESULTS: Of the 968 elderly residents who had not dementia in 1996 prevalence study, 596 residents completed the incidence study. The annual incidence rate for total dementia, dementia of Alzheimer's type and vascular dementia were 1.88% (1.86% in men, 1.98% in women), 1.58% (1.39% in men, 1.80% in women) and 0.34% (0.45% in men, 0.25% in women), respectively. Increasing age was significantly associated with total dementia and dementia of Alzheimer's type (p<0.01, p<0.05, respectively). There was statistically significant difference of the three and half year mortality rate between the dementia patients who were diagnosed in prevalence study and the non-dementic elderly (chi2=28.89, df=1, p<0.001). Only the 2.8% of newly onset dementia patients sought psychiatric service in the previously year. CONCLUSIONS: The incidence of dementia among the Korean elderly in a rural community was relatively consistent with the epidemiological studies of other countries. Age was the only risk factor for total dementia and dementia of Alzheimer's type. Very few dementia patients were treated by psychiatrist.