Intervention of Nonsuicidal Self-Injury in School Counseling / 정신신체의학

Recently, nonsuicidal self-injury (NSSI) has been increasing considerably in school counseling. According to the Youth Counseling and Welfare Development Institute, the number of counseling support for NSSI adolescent in 2018 was more than three times higher than the previous year, and the average time when NSSI behavior first appeared was 12.43 years old. As such, adolesnect NSSI continues to increase in recent years, and the age is also gradually decreasing. Nevertheless, research on the motives and characteristics of NSSI among domestic adolescents is still insufficient. This may be attributed to the difficulty of conducting research because self-injury behavior is secretly performed. However, it is also true that this reality has another limitation in the school field, which urgently requires counseling intervention and prevention of students' mental health problems. In addition, counseling for self-injury in the school scene is the biggest cause of exhaustion for counselors because they are under very great stress to cope with repeated self-harm in the dual role of counselors and teachers in school situations. Therefore, this study examines the causes and characteristics of involuntary self-injury through previous research analysis, and examines various difficulties experienced as a school counselor, as well as the effective intervention method of non suicidal self-injury in school counseling.

Domestic Violence: Evaluation and Prevention of Medical Sequelae of Victims / 신경정신의학

Domestic violence is a phenomenon that requires extensive medical attention as it has both short-term and long-term effects on the victims as well as their families and communities. Therefore, clinicians need to have not only a general knowledge of domestic violence, but also need to be skilled in early identification of victimized patients, proper intervention methods, and assessment of sequelae. Furthermore, as health care service providers, clinicians should make efforts to refer patients to appropriate institutions as a means of preventing further violence. This paper presents general ideas about the high-risk domestic violence group, gives guidelines for clinicians who are likely to meet such victims as a patient, and describes sequelae of and treatments for domestic violence victims and their children. In conclusion, through such medical endeavors and the roles of experts, the desire for an increase in social sensitivity to domestic violence and for minimizing short-term and long-term sequelae can be fulfilled. In the future, it is necessary to develop more suitable guidelines for the treatment of domestic violence victims and to undertake studies into the attitudes of medical professionals facing domestic violence victims in Korea.

Psychiatric Symptoms and Clinical Diagnosis in High School Students Exposed to the Sewol Ferry Disaster

BACKGROUND: Two hundred and fifty 11th grade students and teachers from Danwon High School drowned, during a school trip, in the Sewol Ferry Disaster. The goal of this study was to investigate the experiences of the psychiatrists who volunteered and provided psychiatric services to the students at Danwon High School. METHODS: From the second day to the 138th day after the disaster, pro bono psychiatrists provided post-disaster interventions to the 10th and 12th-grade Danwon High School students who did not attend the trip. Officially, 167 psychiatrists conducted outreach in approximately 550 encounters. The study questionnaires were distributed retrospectively to psychiatric volunteers who conducted outreach at Danwon High School. We surveyed the pro bono psychiatrists about their experiences, including the students' chief complaints, psychiatric problems, clinical diagnoses, and psychiatrists' treatment recommendations. RESULTS: We reached 72 (43.1%) of the 167 volunteers, and they reported on 212 (38.6%) of the 550 encounters. The common chief complaints were mental health problems, companion problems, and family problems. The most frequent psychiatric symptoms were anxiety (76.89%), depressive mood (51.42%), and concentration difficulty (50.94%). The most frequent clinical diagnoses of the students were normal reaction (41.04%), acute stress disorder (24.53%), adjustment disorder (17.92%), anxiety disorders (9.43%), and posttraumatic stress disorder (6.60%). More than half of the students needed “additional counseling/therapy” (41.04%) or “referral to psychiatric treatment” (14.15%). CONCLUSION: During the acute aftermath of the Sewol Ferry Disaster, volunteer psychiatrists were able to provide services. These services included psychiatric assessments, crisis counseling, psychological first aid, and referrals for ongoing care. More than half of the students were perceived to have a psychiatric diagnosis, and a substantial proportion of students needed further treatment. Future research should focus on the short- and long-term effects of psychiatric interventions and the characterization of post-disaster mental health needs and service provision patterns.

Mental Health Interventions Provided by Volunteer Psychiatrists after the Sewol Ferry Disaster: April 16–November 30, 2014

OBJECTIVE: The aim of this study was to examine the experience of volunteer psychiatrists who provided mental health interventions to adolescents and teachers of Danwon High School from April 16, 2014, to November 30, 2014. METHODS: Data for this study were collected from 72 volunteer psychiatrists about their intervention experiences for 212 adolescents and 32 teachers during the eight months following the disaster. Developmental survey themes were identified, and coding was used to analyze the data. In addition, qualitative data analysis was performed using ATLAS.ti (version 8.2, 2018, ATLAS.ti GmbH). RESULTS: A volunteer prepared with appropriate mental health interventions may facilitate the emergency response to a disaster. Intervention services included psychological first aid, psychoeducation, screening, anxiety reduction techniques, and group therapy. CONCLUSION: In the acute aftermath of the Sewol Ferry disaster of April 16, 2014, volunteer psychiatrists were able to provide mental health interventions in a disaster response setting. The outcomes from this study have important policy and mental health system implications for volunteer psychiatrists. The results of this study constitute the basis of a better understanding of the essential mechanisms of crisis interventions after a disaster.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Microglia and Autism Spectrum Disorder: Overview of Current Evidence and Novel Immunomodulatory Treatment Options

Autism spectrum disorder is a rapidly increasing heterogeneous neurodevelopmental syndrome, remarked by persistent deficit in social communication, and restricted, repetitive patterns of behavior and interest. Lately, maternal immune activation and micgroglial dysfunction in the developing brain have been gaining mounting evidence and leading to studies of various novel agents as potential treatment options. A few immunomodulatory treatment options—luteolin, minocycline, suramin, vitamin D, gut microbiota—are discussed in the current article, regarding the current understanding of their mechanisms and evidence for potential clinical use. More studies are warranted to understand their exact mechanisms of action and to verify efficacy and safety in human subjects.

The Wnt Signaling Pathway and Related Therapeutic Drugs in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a series of neurodevelopmental disorder with a large genetic component. However, the pathogenic genes and molecular mechanisms of ASD have not been clearly defined. Recent technological advancements, such as next-generation sequencing, have led to the identification of certain loci that is responsible for the pathophysiology of ASD. Three functional pathways, such as chromatin remodeling, Wnt signaling and mitochondrial dysfunction are potentially involved in ASD. In this review, we will focus on recent studies of the involvement of Wnt signaling pathway components in ASD pathophysiology and related drugs used in ASD treatment.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (I): Clinical Presentation and Comorbidity

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder that can affect individuals across their lifespan. It is characterized by the core symptoms of inattention, impulsivity and hyperactivity. ADHD develops as a result of the complex interplay between genetic and environmental factors. Children and adults with ADHD usually suffer concomitantly from other psychiatric comorbidities, including both externalizing and internalizing disorders. It is associated with functional impairment and poor long-term outcomes. This review aims to summarize the key findings from recent research into ADHD and its prevalence, core symptoms, cause and comorbidities from childhood to adulthood.

Psychiatric Symptoms in Teachers from Danwon High School after Exposure to the Sinking of the Motor Vessel Sewol

OBJECTIVE: The goal of this study was to describe the psychiatric symptoms in the teachers from Danwon High School who were exposed to the sinking of the Motor Vessel Sewol. METHODS: Data were collected from 32 teachers who underwent psychiatric interventions by 16 volunteer psychiatrists for 3 months after the sinking of the Motor Vessel Sewol. RESULTS: The most commonly diagnosed clinical diagnosis in the teachers were normal reaction, acute stress disorder and adjustment disorder. Psychiatric symptoms including anxiety, depressed mood and sleep disturbances were also observed. CONCLUSION: In the acute aftermath of the Sewol Ferry sinking on April 16, 2014, psychiatrists volunteered to provide professional psychiatric interventions to Danwon High School teachers. These results suggest the importance of crisis intervention focused on the teachers who are exposed to disasters. The implications for future research and interventions are discussed.

Smartphone Addiction of Adolescents, Not a Smart Choice

No abstract available.

Psychosocial Interventions for Children and Adolescents after a Disaster: A Systematic Literature Review (1991–2015)

OBJECTIVES: The aim of this systematic literature review is to analyze the psychosocial interventions for children and adolescents after disasters. METHODS: We conducted a review of the extant research literature from 1991 to 2015 via a comprehensive search of the MEDLINE, EMBASE, Cochrane CENTRAL, PubMed and PsyclNFO databases. The keywords employed in this research included: ‘child’, ‘adolescent’, ‘youth’, ‘disaster’, ‘posttraumatic’, ‘psychosocial’, ‘therapy’ and ‘intervention’. The researchers followed the PRISMA guidelines. A total of 850 articles were screened for their eligibility and fifty-nine were found to meet the study criteria. The final data analysis was performed based on the disaster type, study design, type of intervention, sample size, age, school grade, number of sessions, setting of intervention delivery, providers, approach and parent involvement. RESULTS: Countries worldwide have experienced various kinds of disasters, including earthquakes, hurricanes, vessel accidents, tornados, tsunamis, volcanic eruptions, war, fire, terrorism, and traffic accidents. The types of psychosocial intervention that were conducted after these disasters included: psychological first aid, psychological debriefing, psychoeducation, trauma focused cognitive behavior therapy, eye movement desensitization reprocessing, prolonged exposure therapy, group play therapy and arts therapy, project interventions, school-based interventions and web-based interventions. CONCLUSION: The findings of the systematic literature review suggest that an appropriate psychosocial intervention could be utilized as evidence-based mental health treatment for children and adolescents after disasters.

The Major Elements of Psychological Assessment and Intervention for Children and Adolescents after a Disaster: A Professional Delphi Preliminary Survey

OBJECTIVES: This study attempted to evaluate the usefulness and direction of development of post-traumatic assessment and interventions based on the opinions of psychiatrics and disaster and trauma-related experts using the Delphi survey technique. METHODS: In-depth individual interviews served as the pre-survey and were followed by Delphi primary and secondary surveys. Specialists in child and adolescent mental health, psychological support professionals specialized in disasters and related practitioners with experience of disasters in Korea completed a set of questionnaires and participated in focus group interviews and in-depth individual interviews on post-traumatic assessment and intervention. RESULTS: We found that the following issues have a significant impact on the interventions after disasters: the proper time of the initial interview in the event of a disaster, assessment notices, aged assessment services, mandatory enforcement measures, scale screening and treatment intervention elements, symptoms degree classification, intervention standardization, the use of a levelled program, care unit environment, and operation plan. CONCLUSION: This study proposed effective mental health intervention measures and has implications for the development of evaluation treatment protocols after disasters.

Factors Associated with Disclosure of Sexual Abuse of Children and Adolescent Victims

OBJECTIVES: The purpose of this study was to analyze the factors related to the disclosure patterns of sexual abuse in children and adolescent victims. METHODS: A sample of 153 children and adolescents who visited the Sunflower children's Center (Incheon) between January 1, 2011 and December 31, 2012 were analyzed. The medical records of the victims were reviewed retrospectively. RESULTS: Ninety (58.8%) subjects made a disclosure of sexual abuse voluntarily. The revelation was most commonly made to a parent. The severity and duration of sexual abuse were related to the disclosure patterns. In addition, the group that displayed below average intelligence, particularly subjects in the group with borderline intellectual functioning, tended to disclose their history of abuse less voluntarily than the subjects with normal intelligence. CONCLUSION: The current study provides insight into the factors that affect disclosure patterns in children and adolescent sexual abuse victims. To prevent sexual abuse, we suggest that special legal assistance and social concern be required for children and adolescents with borderline intellectual functioning.

Risk Factors for Suicidal Ideation of the General Population

The aim of this study was to investigate risk factors of suicide ideation in general population. A total of 1,116 adults were sampled with randomization in an urban area. After excluding 116 participants due to incomplete answer, 1,000 participants (500 males; mean age 39.6 +/- 11.6) completed self-report questionnaire including the Center for Epidemiologic Study Depression Scale (CES-D), the Beck Scale for Suicide Ideation (BSI), the Spielberger State-Trait Anger Expression Inventory (STAXI), the Barratt Impulsiveness Scale (BIS), and questions on weekday sleep duration. Results showed higher scores on the BSI were related with higher scores on the STAXI, CES-D, a family history of psychiatric illness, and short or long sleep duration ( or = 10 hr) (adjusted R2 = 0.151, P < 0.001, P < 0.001, P = 0.001, and P = 0.008, respectively). The predictive power of the STAXI scores, the presence of psychiatric family history and short or long sleep duration was stronger in the high CES-D group with scores of 16 or higher (adjusted R2 = 0.275, P < 0.001, P < 0.001, and P < 0.001, respectively). These findings suggest that suicide idea in general population may be related with the presence of family history for psychiatric illness, depressive mood, high anger and short or long sleep duration.

Attitude toward Suicide and Personal Experiences of Suicide among Doctors and Health Care Workers in Korea / 신경정신의학

OBJECTIVES: The aim of this study was to investigate attitudes toward suicide and personal experiences with suicide among doctors and health care workers in Korea. METHODS: A total of 622 participants were included in this study and 617 participants completed a self-report questionnaire that included 31 items; 184 doctors and 433 health care workers. A questionnaire was used for assessment of demographic characteristics, attitude toward suicide, and personal experiences with suicide in doctors and health care workers. The collected data were evaluated using chi-square and binary logistic regression analyses. A probability level of p<0.05 was considered statistically significant. RESULTS: More permissive attitudes toward suicide showed an association with doctor group and non-religious group (p<0.05). Religious group and older age showed an association with a more negative attitude (p<0.05). The lifetime and one-year prevalence rates of suicidal ideation were 31.4% and 9.8%, respectively, in all participants. The lifetime prevalence of suicidal ideation was higher in the religious group (33.9%, p<0.05). Among all participants, 32.1% reported loss of a patient by suicide, and 29.9% reported contact with a patient at risk of suicide or with depression. In addition, 72.5% reported contact with a depressed patient. CONCLUSION: Attitudes toward suicide among doctors and health care workers were shown to differ significantly between age, gender, doctor group and health care worker group, religious group and non-religious group. The reported level of suicidal ideation among doctors and health care workers is worthy of concern. Research is needed for establishment of effective prevention strategies on the basis of our findings.

Comparison of Treatment Adherence between Selective Serotonin Reuptake Inhibitors and Moclobemide in Patients with Social Anxiety Disorder

OBJECTIVE: With respect to the pharmacotherapy of social anxiety disorder (SAD), it has been suggested that treatment duration is an important factor that can significantly predict responses. The present study aimed to compare the treatment adherence of SAD patients who were taking either SSRIs or reversible inhibitors of MAO-A (moclobemide) by measuring treatment duration and all-cause discontinuation rates of pharmacotherapy in a natural clinical setting. METHODS: We retrospectively analysed the data of 172 patients diagnosed with SAD. Depending on their medication, we divided the patients into two groups, SSRI (n=54) or moclobemide (n=118). The expected number of all-cause discontinuation every 2 weeks after starting treatment was calculated by life table survival methods. A multi-variable Cox proportional hazard regression was used to analyze the potential influence of explanatory variables. RESULTS: Treatment duration was significantly longer in the SSRI group [46.41+/-56.96, median=12.0 (weeks)] than in the moclobemide group [25.53+/-34.74, median=12.0 (weeks), Z=2.352, p=0.019]. Overall, all-cause discontinuation rates were significantly lower with SSRIs (81%) than moclobemide (96%, chi2=4.532, p=0.033). CONCLUSION: The SSRI group had a longer treatment duration and lower all-cause discontinuation rate than moclobemide. Further, only the type of medication had a significant effect on all-cause discontinuation rates and therefore, we could predict better treatment adherence with the SSRIs in the treatment of SAD.

Prevalence and Correlates of Psychiatric Symptoms in North Korean Defectors

OBJECTIVE: The aim of the present study is to assess the prevalence of psychiatric symptoms and associated factors in North Korean Defectors (NKDs). METHODS: One hundred forty-four NKDs (male: 20; female: 124; average age: 40.4+/-11.7 yrs.) completed the Symptom Checklist-90-Revised (SCL-90-R) and the Center for Epidemiologic Studies Depression scale (CES-D). A stepwise logistic regression analysis was conducted to evaluate factors associated with the psychiatric symptoms of the participants. RESULTS: NKDs mainly reported somatization (42.4%) and depressive symptoms (38.9%). Female NKDs showed higher prevalence of somatization (p=0.001), anxiety (p=0.020), hostility (p=0.026) and psychoticism (p=0.022) than males. The presence of physical illness was strongly related to most psychiatric symptoms on the SCL-90-R including somatization (p<0.001), obsessive-compulsive symptoms (p=0.020), interpersonal sensitivity (p=0.031), depression (p<0.001), anxiety (p<0.001), hostility (p=0.011), paranoid ideation (p=0.015) and psychoticism (p<0.001). Younger age, unemployment, lower income, and longer duration of defection were found to be the risk factors of psychiatric symptoms. In regard to mental health service utilization, we found that most (83.3%) of the participants had not received any form of psychiatric help. CONCLUSION: Somatization and depression were the most prevalent psychiatric symptoms in NKDs. Our results suggest that psychiatric symptoms accompany certain sociodemographic and clinical characteristics that are associated with susceptibility to acculturation stressors. An understanding of these factors will be helpful providing appropriate mental health services to NKDs.

Association with Self-Perception for Obesity and Mental Health among Korean Adolescent

OBJECTIVES: Obesity has been linked to various psychological problems as well as medical complications, especially among adolescents. Previous studies have suggested an association between body weight and depression or self-esteem ; however, there has been little evidence on self-perception of weight and mental health. The aim of this study was to examine the association of perceptional weight status with mental health in Korean adolescents. METHODS: This study was based on data obtained from the third Korean National Health and Nutritional Examination Survey (2005). The study sample consisted of 583 adolescents (268 boys, 315 girls) aged 12-18 years, who had completed the health survey, the health examination, and the nutritional survey. Participants were divided into two groups based on the actual or perceptional weight status: non-obese and obese. Questionnaires for stress, depressive mood, and suicidal thoughts were utilized as mental health indicators. RESULTS: The agreement between actual and perceptional weight status was moderate (kappa value, 0.585 ; p<0.01). The influencing factors for the discrepancy between actual and perceptional weight status were body mass index of subjects and their parents' education. The obese group was likely to have higher stress levels and more experience of depressive mood or suicidal ideation in regard to both actual and perceptional weight status. A multiple logistic regression analysis revealed that girls who had perceived themselves as obese were more likely to have an experience of depressive mood than other girls (unadjusted OR, 4.98 ; adjusted OR, 5.15). CONCLUSION: An experience of depressive mood was significantly associated with the perception of weight status and not actual weight status in Korean female adolescents.

Rotating Shift and Daytime Fixed Work Schedules as a Risk Factor for Depression in Korean Police Officers / 수면정신생리

OBJECTIVES: Working at other times than the regular day shift has been reported to be a stressor associated with health consequences and mental disorders as well as disturbance of sleep. In current study, we aimed at investigating the relationship between work schedule, sleep quality and depression among police officers. METHODS: Eleven hundreds and forty five police officers (male:1040, female:105) completed questionnaires of basic socio-demographic data, Pittsburgh Sleep Quality Index (PSQI), Korean Scale of Occupational Stress (KOSS), Impact of Event Scale - Revised (IES-R) and Center for Epidemiologic Study-Depression (CES-D). RESULTS: After controlling for age, sex and educational level, score of CES-D was correlated positively with the score of KOSS, PSQI and IES-R on partial correlation analysis (r=-0.077;p=0.009, r=0.262;p<0.000 and r=0.421, p<0.000, respectively). Logistic regression analysis revealed that female sex, age, the score of KOSS and IES-R and schedule of rotating shift work predicted higher score than 16 score of CES-D significantly in total subjects (p=0.023, p=0.015, p=0.000, p=0.000 and p=0.022, respectively). CONCLUSION: Current result suggested that not only female sex, age, higher occupational stress and impact of event scale but also rotating shift work schedule might be related to depression among police officers.

The Effect of Impulsivity and the Ability to Recognize Facial Emotion on the Aggressiveness of Children with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: A higher level of aggression has been reported for children with attention-deficit/hyperactivity disorder (ADHD) than for non-ADHD children. Aggression was shown to have a negative effect on the social functioning of children with ADHD. The ability to recognize facial emotion expression has also been related to aggression. In this study, we examined whether impulsivity and dysfunctional recognition of facial emotion expression could explain the aggressiveness of children with ADHD. METHODS: 67 children with ADHD participated in this study. We measured the ability to recognize facial emotion expression by using the Emotion Recognition Test (ERT) and we measured aggression by the T score of the aggression subscale of the Child Behavior Checklist (CBCL). Impulsivity was measured by the ADHD diagnostic system (ADS). RESULTS: The teacher rated level of aggression was related to the score of recognizing negative affect. After controlling for the effect of impulsivity, this relationship is not significant. Only the score of the visual commission errors explained the level of aggression of children with ADHD. CONCLUSIONS: Impulsivity seems to have a major role in explaining the aggression of children with ADHD. The clinical implication of this study is that effective intervention for controlling impulsivity may be expected to reduce the aggression of children with ADHD.