The Association Between Socioeconomic Changes and Adolescent Mental Health After COVID-19 Pandemic / 정신신체의학

Objectives@#: The purpose of this study is to investigate depression and suicide ideation according to socioeconomic changes after COVID-19 among Korean adolescent. @*Methods@#: Data on the study population were obtained from the 16th Korea Youth Risk Behavior Web-based Survey (KYRBS). The KYRBS is a nationally representative sample of Korean adolescents (aged 12-18 years) that originally included over 103 questions in 15 domains of health-risk behaviors. In the 16th KYRBS, a total 54,948 students from 793 schools responded to the survey. Chi-square test and logistic regression analysis were conducted regarding depression and suicide ideation. @*Results@#: This study suggests that changes in the family household before and after COVID-19 pandemic are also affecting the mental health of the adolescents. The study shows that worse change of family household is significant associations with suicidal ideation and depression. Adolescents reporting worse (AOR 1.38; 95% CI 1.38-1.57) and much worse (AOR 2.07; 95% CI 1.87-2.29) were significantly more likely to report depression. Adolescents reporting worse (AOR 1.34; 95% CI 1.34-1.60) and much worse (AOR 2.01; 95% CI 1.76-2.29) were significantly more likely to report suicide ideation. @*Conclusions@#: In this study, it was confirmed that young people from socially disadvantaged backgrounds are at high risk of suicide ideation and more depression. The results of this study suggest that we should consider improving the screening and prevention of mental health problems for adolescents with poor socioeconomic changes of COVID-19.

The Characteristics Related to Zolpidem-Using Suicide Attempts in Patients Who Visited Emergency Department / 정신신체의학

Objectives@#：The purpose of this study is to identify differences between suicide attempters who used zolpidem and others who used different methods in emergency department. @*Methods@#：This study classified 2,734 suicide attempters, who went to emergency department from 2009 to 2018, into zolpidem user group, another drug user group and non-drug user group. For these three groups, chisquare test and logistic regression analysis were conducted regarding sociodemographic feature and clinical feature related with suicide. @*Results@#：In the result of logistic regression analysis of a variable, which showed meaningful difference between suicide attempter group who used zolpidem and the other group who did not use the drug, the occurrence of zolpidem-using suicide attempers was related with the case where anxiolytics/hypnotics was used or the case where lethality and intention was low. In the drug intoxication group which showed similar feature, there was also a relevance between anxiolytics/hypnotics and the occurrence of zolpidem-using suicide attempts. @*Conclusions@#：This study identified significant difference of sociodemographic and clinical feature in suicide attempter group who used zolpidem and the other group. This result can contribute to plan further medicinal treatment in using zolpidem

Longitudinal Influence of Chronic Intimate Partner Violence on Suicidal Ideation among Korean Married Woman / 정신신체의학

Objectives@#：This study looked at the effects of chronic IPV on suicide ideation among married women in the country. @*Methods@#：This study used data from the five-year-old Korea Welfare Panel and analyzed using questions about verbal and physical violence, depression and suicide ideation that were investigated every year. Age, education, and economic levels, drinking, religion, chronic disease, satisfaction with family relationship, satisfaction with social relationship, were included as variables. @*Results@#：The five-year cumulative score of verbal violence had a statistically significant effect on the depres-sive symptom, and the relative risk was 1.180. The relative risk of five-year-old cumulative score of verbal violence in suicidal ideation was 1.276, and it was also significant even if they exclude the effects of depressive symptom.On the other hand, the five-year cumulative score of physical violence was found to have no significant impact on suicide ideation if they excluded the effects of depressive symptom. @*Conclusions@#：Unlike previous studies, this study found that chronic verbal IPVs increase suicide ideation,even though they do not contain effects of depression. Such findings suggest that intervention in IPV in married women may help reduce the nation's suicide rate.

Longitudinal Influence of Chronic Intimate Partner Violence on Suicidal Ideation among Korean Married Woman / 정신신체의학

Objectives@#：This study looked at the effects of chronic IPV on suicide ideation among married women in the country. @*Methods@#：This study used data from the five-year-old Korea Welfare Panel and analyzed using questions about verbal and physical violence, depression and suicide ideation that were investigated every year. Age, education, and economic levels, drinking, religion, chronic disease, satisfaction with family relationship, satisfaction with social relationship, were included as variables. @*Results@#：The five-year cumulative score of verbal violence had a statistically significant effect on the depres-sive symptom, and the relative risk was 1.180. The relative risk of five-year-old cumulative score of verbal violence in suicidal ideation was 1.276, and it was also significant even if they exclude the effects of depressive symptom.On the other hand, the five-year cumulative score of physical violence was found to have no significant impact on suicide ideation if they excluded the effects of depressive symptom. @*Conclusions@#：Unlike previous studies, this study found that chronic verbal IPVs increase suicide ideation,even though they do not contain effects of depression. Such findings suggest that intervention in IPV in married women may help reduce the nation's suicide rate.

Prolonged Risk of Suicide Reattempts in Patients with Alcohol Use Disorder and Acute Alcohol Use: A Register-Based Follow-Up Study (2010–2015)

OBJECTIVE@#This study aimed to clarify the role of acute alcohol use and alcohol use disorder in individuals exhibiting suicidal behaviors, including repetition of suicide attempt.@*METHODS@#Data pertaining to 691 suicide attempters who had visited an emergency center and had been followed-up from 2010 to 2015 were gathered. Participants were categorized into following three groups according to alcohol use pattern at the time of the suicide attempt: 1) suicide attempters with neither alcohol use disorder nor acute alcohol consumption (NAU), 2) suicide attempters who had used alcohol during the suicide attempt but did not have alcohol use disorder (AAU), and 3) suicide attempters with alcohol use disorder (AUD). Group comparisons and multivariate Cox proportional models for suicidal behavior were used for statistical analysis.@*RESULTS@#AUD have been shown to have lower lethality of suicide attempt but higher risk of suicide reattempts in the future. Furthermore, positive relationships between suicide reattempts and AUD persisted throughout the longer period than other groups.@*CONCLUSION@#Suicide attempters with AUD should be considered a high-risk group for suicide reattempts in future, and this group should be followed-up for a longer period with specialized care program.

The Characteristics of Child and Adolescent Suicide Attempters Admitted to a University Hospital / 정신신체의학

OBJECTIVES: The purpose of this study was to identify the differences of demographic and clinical characteristics between child-adolescents who received medical inpatient care and non-hospitalized adolescents after suicide attempts. METHODS: The study included 35 child-adolescents who were hospitalized (Admission group) and 114 child-adolescents who were not hospitalized (Non-Admission group) as a result of a suicide attempt from 2009 to 2015. We compared sociodemographic, clinical, and suicide attempt-related characteristics through a chi-square test and logistic regression analysis to evaluate the differences between the two groups. RESULTS: Child-adolescents of this study most commonly attempted suicide by poisoning, and for motivation of interpersonal problems. Admission group had significantly fewer attempts through injury by sharp objects (χ²=4.374, p=0.037) and attempted suicide with a higher chance of actually dying when compared to Risk-Rescue Rating Scale (t=1.981, p=0.049). In addition, Admission group had relatively common motivation for academic problems (χ²=12.082, p=0.001) and less motivation for interpersonal difficulties. (χ²=9.869, p=0.002) Psychiatric diagnosis at the time of visiting the emergency department showed higher rates of depression in the admission group than Non-Admission group (χ²=8.649, p=0.003). The results of logistic regression showed that depression affects hospitalization (OR=2.783, 95% CI 1.092–7.089, p=0.032). CONCLUSIONS: This study is meaningful in that it revealed the social and clinical characteristics of all child-adolescents who were hospitalized at a university hospital after attempting suicide. This study identified differences in motivation, methods, and psychiatric diagnosis of hospitalized adolescents and those who were not. Therefore, the results may help adolescent suicide attempters to get a discriminatory approach based on their admission.

The Role of Uncontrolled Eating and Screen Time in the Link of Attention Deficit Hyperactivity Disorder with Weight in Late Childhood

OBJECTIVE: The aim of this study was to examine the mediating roles of uncontrolled eating and sedentary behaviours in the link of attention deficit hyperactivity disorder (ADHD) and weight. METHODS: A total of 352 children in fifth and sixth grade participated in the present study by completing the self-rated Three-Factor Eating Questionnaire and Children of Alcoholics Screening Test during regular classes. An additional questionnaire completed by their parents provided information about the children's ADHD and emotional symptoms, sedentary behaviour based on screen time, and parental variables. The questionnaires were surveyed within one week after their schools' annual physical check-up. RESULTS: Hierarchical regression analyses revealed that uncontrolled eating was complete mediator in association between ADHD symptoms and body mass index (BMI) for boys, incomplete mediator for girls. However, screen time had no significant effect on the ADHD symptoms-BMI link for both gender. CONCLUSION: The findings of this study suggest that gender specific intervention programs may be need to help eating behaviour in children with ADHD and overweight.

Gender Differences in the Effect of Alcohol Use on Intent and Lethality of Suicidal Attempts / 정신신체의학

OBJECTIVES: The aim of this study was to clarify the role of alcohol use disorders and acute alcohol consumption in suicide attempts by gender. METHODS: Data of 1,152 suicide attempters(487 males and 742 females) who had visited an emergency center was gathered. Suicide attempts were categorized into three groups according to alcohol use: an alcohol use disorder group(AUD), an acute alcohol use group(AAU), and a no-alcohol use group(NAU). The intent and lethality of suicide attempts were evaluated by Suicidal Intents Scale and Risk-Rescue Rating Scale. RESULTS: For Suicidal Intents Scale score, the male AUD group revealed a significantly lower mean score than the male AAU one. However, there were no statistically significant differences for female subjects across subgroups. With regard to the Risk-Rescue Rating Scale score, there were no significant differences for males, while the AUD group showed both the lowest highest rescue scores and lowest risk-rescue scores within female groups. CONCLUSIONS: AUD in females was more likely regarding impulsive suicide attempts with high rescue chances. Consuming alcohol might have different effect on suicide attempts by gender and our study shows that alcohol use is an important risk factor according to gender, particularly with regard to female suicide attempts.

A Preliminary Study for the Development of the Elderly Smoking Cessation Program : Focus on the Expectancy, Self-Efficacy and Accessing Cognitive Functions

OBJECTIVE: This study aimed to investigate the smoking behavior and attitude about smoking cessation of elderly and to evaluate the effect of accessing cognitive function in order to develop the cessation program for elderly smokers. METHODS: The participants were 108 enrolled from attending the cessation program of national non-smoking guide center. We examined the Smoking Cessation Motivation Scale, The Perceived Smoking Cessation Effects Scale (PSCES), Smoking selfefficacy/temptation, The Why test and Tobacco Craving Questionnaire. Cognitive status was ascertained by interviewing with geriatric neuropsychiatrist and comprehensive neurocognitive test battery. RESULTS: The older group had lower negative effect score of PSCES (52.0±17.7, 61.3±16.6, p=0.006) and higher smoking self-efficacy score (29.4±7.2, 26.0±8.3, p=0.028) than younger group. 47.1% of older group and 12.3% of younger group were mild cognitive impairment (p<0.001). The success rate of smoking cessation after 12 weeks was 92.2% in older group and 91.2% in younger group (p=1.00). CONCLUSION: The results indicate that the smoking cessation of elderly is not so challenge otherwise known as. Although the prevalence of mild cognitive impairment in smokers was higher than the general population, cognitive assessment and feedback might be made of the high success rate of smoking cessation. Further attention should be paid to the elderly tailored smoking cessation program and long-term follow-up.

Symptomatic and Clinical Profiles Across Motoric Subtypes in Delirium / 정신신체의학

OBJECTIVES: To investigate clinical and symptomatic differences among motoric subtypes of delirium. METHODS: A total of 256 patients referred to psychiatric consultation services for delirium due to general medical condition were assessed retrospectively. Motoric subtypes were determined according to Lipowski's criteria for hyperactive, hypoactive and mixed subtypes. All patients were evaluated according to Delirium Rating Scale-Revised-98(DRS-98-R) by trained psychiatrists to obtain symptomatic profiles of delirium. RESULTS: Hyperactive subtype were 50.8%(n=130), mixed 46.1%(n=118) and hypoactive 3.1%(n=8). Hyperactive patients were younger than mixed subtype(69.62±13.976 vs. 73.97±11.569, p=0.022) and received antipsychotics to manage symptoms of delirium more frequently(83.8% vs. 57.6%, p<0.001). Hyperactive patients had higher DRS-R-98 scores on both noncognitive(7.14±3.543 for hyperactive, 5.62±3.279 for mixed subtype) and cognitive subscales(10.00±3.574 for hyperactive, 6.38±2.875 for hypoactive, 7.43±3.771 for mixed subtype, p<0.001). CONCLUSION: We demonstrated that clinical and symptomatic profiles were different across motoric subtypes in delirium. Diagnostic and therapeutic approach should be made differently according to motoric subtypes of delirium and special attention is needed not to underestimate or delay treatment in specific motoric subtype of delirium.

Psychometric Properties of the Self-Report Version of the Strengths and Difficulties Questionnaire in Korea

OBJECTIVE: To examine the reliability and validity of the self-report Korean version of Strengths and Difficulties Questionnaire (SDQ-Kr) in the community sample. METHODS: The SDQ-Kr was administered to a large sample of school children and adolescents (n=2814) and youth attendees of a psychiatric clinic (n=385) aged 11-16 years. To examine temporal stability, the same questionnaire was administered to a subsample of 167 school youths five to six weeks after the initial assessment. To examine the reliability, we calculated Cronbach's alpha coefficients for internal consistency and Pearson's correlations for test-retest stability. In order to evaluate the factorial structure of the SDQ-Kr items, we conducted an exploratory factor analysis (EFA) with varimax rotation. Finally, discriminant validity was examined by using receiver operating characteristic (ROC) curves employing the area under the curve (AUC) as an index of discriminant ability. RESULTS: Although the internal consistency of some subscales of the SDQ-Kr was somewhat less satisfactory (alpha coefficients; 0.28-0.54) than the English original, coefficients for the total difficulties scores approached sufficient levels (coefficients; 0.69). Other psychometric properties including discriminant validity (AUC for total difficulties and four subscales >0.7) were comparable to those obtained in other language studies. CONCLUSION: The self-report SDQ-Kr exhibited a low level of reliability, indicating that some items need to be further evaluated and revised to improve the psychometric properties. We suggest that the total difficulties score could be used with more confidence for screening possible mental health problems in youths.

Clinical Characteristics of Misdiagnosed Delirium / 정신신체의학

OBJECTIVES: Delirium of hospitalized patients is common and it is significantly associated with increased mortality rate. Misdiagnosis rates of delirium are reported in a range of 36.7 to 63% in clinical setting. We aimed to identify the clinical features and symptomatic characteristics associated with misdiagnosis of delirium. METHODS: Subjects were 256 inpatients who were referred for psychiatric consultation and diagnosed with delirium by a psychiatrist at a university hospital between January 1 and June 30, 2012. Clinical data were obtained with retrospective chart review. Patients were divided into misdiagnosed group and correct diagnosed group, after reviewing the reason which were described in the consultation request form. RESULTS: Sixty nine(27%) subjects of the 256 patients were referred for other reasons(mood, substance, anxiety, dementia etc.) than "delirium/confusion" by clinician(misdiagnosed group). In misdiagnosed group, use of antipsychotics was more common. There were no differences between the two groups in age, gender, and department of referring clinician. Fluctuation score of DRS-R-98 was higher in the correct diagnosed group. CONCLUSIONS: In this study, the risk of misdiagnosis was higher when the patients have taken antipsychotics or less symptom fluctuation. Careful clinical attention is needed for diagnosis for delirium in these patients.

Craving and treatment in smoking

Craving has been well known to be the most important clinical phenomenon in smoking cessation treatment and one that physicians always encounter. For successful and prolonged abstinence, understanding, evaluation, and management of craving are essential. The concept and definition of craving is still under debate, although its importance, relevance, and role in smoking relapse is evident. There are two types of craving, 'abstinence-induced craving' and 'cue-induced craving' according to time dynamic and causes. The evaluation of craving mainly depends on self-reported measures in the clinical field. Pharmacological treatments such as the nicotine patch, bupropion, and varenicline are effective for abstinence-induced craving. Psychosocial treatment and a few pharmacological agents such as nicotine gum and lozenges are useful for reducing cue-induced craving. This review was aimed at conveying up-to-date information on the characteristics, evaluation, and treatment of craving. Development of objective measurement tool for evaluation of craving is needed. The effects of pharmacological treatments on 'cue-induced craving' remain to be discovered. An active effort to alleviate each type of craving is necessary to enhance and prolong a patient's abstinence.

Alcohol Dependence, Mortality, and Chronic Health Conditions in a Rural Population in Korea

To determine the effects of excessive drinking and alcohol dependency on mortality and chronic health problems in a rural community in South Korea, this study represents a nested case-control study. In 1998, we conducted the Alcohol Dependence Survey (ADS), a population survey of a village in Korea. To measure the effects of alcohol on chronic health conditions and mortality over time, in 2004, we identified 290 adults from the ADS sample (N=1,058) for follow-up. Of those selected, 145 were adults who had alcohol problems, either alcohol dependence as assessed in the ADS by the Severity of Alcohol Dependence Questionnaire (N=59), or excessive drinking without dependency (N=86). Further 145 nondrinkers were identified, matching those with alcohol problems in age and sex. We revisited the village in 2004 and completed personal interviews with them. In multivariate logistic regressions, the rates of mortality and morbidity of chronic health conditions were three times greater for alcohol dependents compared with the rate for nondrinkers. Importantly, however, excessive drinking without dependency was not associated with the rates of either mortality or morbidity. Future investigations would benefit by attending more specifically to measures for alcohol dependence as well as measures for alcohol consumption.

A Prospective Study on Changes in Health Status Following Flood Disaster

OBJECTIVE: We examined changes in general health status, the prevalence of depression and post-traumatic stress disorder (PTSD) symptoms, and the existence of pre-trauma contributing factors in an agricultural population following a massive flood. METHODS: Eighty-three of 160 residents of Garisan-ni, Inje-gun, Gangwon-do, were assessed using the Korean version of the 36-Item Short-Form Health Survey (SF-36-K) between April and June 2006, just prior to a massive flood. Among those initially assessed, 58 residents were available for follow-up 18 months after the flood. Participants completed the SF-36-K, Beck Depression Index (BDI), Minnesota Multiphasic Personality Inventory (MMPI)-PTSD, and the Korean version of the Impact of Event Scale-Revised (IES-R) to detect depression and PTSD. Trauma experiences were also assessed. Factors related to changes in health status were then analyzed. RESULTS: SF-36-K total scale scores decreased significantly, suggesting a significant reduction in health-related quality of life. The largest reductions were noted in physical and social functioning. Fifty-three percent of the subjects were at least mildly depressed, and 17% had severe depression. In addition, 22% had PTSD on both the IES-R and MMPI-PTSD. Factors that contributed to the deterioration of health status following the flood were the number of disaster events and existence of depression (as assessed by the BDI). CONCLUSION: The flood was found to lead to deterioration of health status and to provoke depression and PTSD among the agricultural population in the mountainous region. We suggest that the number of disaster event experiences and existence of depression contriuted to changes in health status after the flood.

Body Weight Gain and Metabolic Changes in Patients with Schizophrenia during 12-Week Randomized Treatment of Ziprasidone and Risperidone / 대한정신약물학회지

OBJECTIVE: Body weight gain and metabolic syndrome are frequent adverse side effects of atypical antipsychotics. However, ziprasidone has been reported to have less effect on body weight and other metabolic parameters of patients, such as blood glucose and cholesterol. In this study, changes in the body weight and metabolic parameters were compared between the treatment groups of ziprasidone and risperidone in the patients with schizophrenia or schizoaffective disorder. METHODS: Patients shown acute exacerbation of schizophrenia or schizoaffective disorder diagnosed by DSM-IV diagnostic criteria were randomly assigned to ziprasidone 40-80 mg b.i.d. (N=56) or risperidone 1-4 mg b.i.d. (N=56) for 12 weeks. Body weight was measured before treatment and at 1st, 2nd, 4th, 6th, 12th week after treatment. The serum levels of glucose and cholesterol were checked before treatment and 12th week after treatment, and serum levels of prolactin before treatment and at 4th and 12th week after treatment. RESULTS: Less gain of body weight was shown in the patients treated with ziprasidone compared to those treated with risperidone. Mean body weight gain for 12 weeks were 0.8 kg and 3.5 kg in the ziprasidone and risperidone group, respectively. There was significant difference in weight gain between these two groups from 4th week. Serum prolactin elevation was higher in the risperidone group than in the ziprasidone group. However, there were no significant differences in the effects on the level of blood glucose and cholesterol between two treatment groups. CONCLUSION: This study shows that ziprasidone had less effect on body weight and prolactin compared to risperidone in the patients with schizophrenia or schizoaffective disorder in Korea. Although further studies are necessary to investigate the long-term effects, the less effect of ziprasidone on body weight and serum prolactin in schizophrenia and schizoaffective patients in Korea may help to enhance treatment compliance and lessen the cardiovascular risks.

The Effect of Alcohol in the Nicotinic Acetylcholine Receptor / 대한정신약물학회지

OBJECTIVE: It has been well known that alcohol can modulate several ligand-gated ion channel and voltage-gated ion channels. But the roles of alcohol in the autonomic neurons still remain unclear. In this study, thus we characterized the neuronal acetylcholine receptor (nnAChRs) and investigated the modulation of nnAChRs by ethanol (EtOH). METHODS: We used whole-cells which were acutely dissociated male rat major pelvic ganglion (MPG) neurons, and used gramicidin perforated patch clamp techniques. RESULTS: MPG neurons can be classified on the basis of the response of the soma membrane to depolarizing current pulses ; either tonic or phasic neurons. Sympathetic neurons expressing T-type Ca(2+) channels showed tonic firing pattern, while parasympathetic neurons lacking T-type Ca(2+) channels phasic firing to depolarizing current pulses. When hyperpolarizing currents were injected, sympathetic neurons produced post-anodal rebound spikes, while parasympathetic neurons were silent. Under current clamp mode, Acetylcholine (ACh) evoked significant membrane depolarization and produced subsequently marked membrane hyperporization. Under whole-cell mode, application of ACh-induced inward currents held at holding potentials below 0 mV and reversal potential was close to 0 mV, an equilibrium potential of nonselective cation channel. The ACh-activated current was blocked by methyllycaconitine (MLA ; 10 micrometer), hexamethonium (100 micrometer) and alpha-bungarotoxin (alpha-BuTx ; 100 nM), nAChRs antagonists. EtOH (40 mM) potentiated ACh-induced depolarization and hyperpolarization. EtOH also increased both alpha-BuTx-sensitive and -insensitive ACh-activated currents. Futhermore, EtOH potentiated 5-HT-activated current but had a little effect on GABA-activated current. CONCLUSION: These results suggest that EtOH modulates nnAChRs and 5-HT receptors in MPG neurons.