The mental health of medical students in Daegu during the 2020 COVID-19 pandemic / 한국의학교육

Purpose@#In February 2020, the first outbreak of coronavirus disease 2019 (COVID-19) occurred in Daegu, South Korea, and confirmed cases increased sharply, sparking intense anxiety among residents. This study analyzed the data of a mental health survey on students enrolled at a medical school located in Daegu in 2020. @*Methods@#An online survey was administered to 654 medical school students (pre-medical course: 220 students, medical course: 434 students) from August to October 2020, with 61.16% (n=400) valid responses. The questionnaire included items about COVID-19-related experiences, stress, stress resilience, anxiety, and depression. @*Results@#Of the survey participants, 15.5% had experienced unbearable stress, with the most significant stress factors (in descending order) being limited leisure activities, unusual experiences related to COVID-19, and limited social activities. Approximately 28.8% reported psychological distress, and their most experienced negative emotions were helplessness, depression, and anxiety (in descending order). The mean Beck Anxiety Inventory and Beck Depression Inventory-II scores were 2.44 and 6.08, respectively, both within normal ranges. Approximately 8.3% had mild or greater anxiety, and 15% had mild or greater depression. For students under psychological distress, the experience of unbearable stress before COVID-19 affected anxiety (odds ratio [OR], 0.198; p<0.05), and having an underlying condition affected depression (OR, 0.190; p<0.05). With respect to their psychological distress during August–October 2020 compared with that during February–March 2020 (2 months from the initial outbreak), anxiety stayed the same while depression increased and resilience decreased at a statistically significant level. @*Conclusion@#It was found that some medical students were suffering from psychological difficulties related to COVID-19, and there were several risk factors for them. This finding suggests that medical schools need to not only develop academic management systems but also provide programs that can help students manage their mental health and emotions in preparation for an infectious disease pandemic.

Prevalence of Addictive Behaviors in Medical Students and Their Association With Stress

Objective@#This study aims to investigate the prevalence of the addictive use of the internet, smartphone, and alcohol in medical students, the association of this addictive use with stress, and the mediating roles of resilience and self-esteem in this association. @*Methods@#A total of 866 medical students completed measures of three addictive uses as well as psychological scales for stress, resilience, and self-esteem. Correlation analyses and parallel mediation analysis were carried out. @*Results@#The prevalence of potential-risk and high-risk users was 5.8% and 1.7% for internet use, 5.4% and 2.2% for smartphone use, 22.6% and 5.3% for alcohol use, respectively. All three addictive behaviors tended to increase in terms of prevalence or mean score according to an increase in a students’ grade. Stress was positively correlated with internet use (r=0.324, p<0.001) and smartphone use (r=0.347, p<0.001). Resilience and self-esteem were found to be mediators in the association between stress and internet use or smartphone use. @*Conclusion@#These findings suggest that addictions in medical students are as prevalent as in a general population and that internet use and smartphone use may be better explained by a stress-addiction model with resilience and self-esteem as mediators than alcohol use.

Impact of the COVID-19 Pandemic on the Mental Health of Adolescent Students in Daegu, Korea

Background@#In February 2020, as coronavirus disease 2019 (COVID-19) spread rapidly in Daegu, South Korea, students in that region experienced many emotional difficulties. In this study, we analyzed the stress and emotional crisis experienced by students during the COVID-19 pandemic, its causative factors, and the factors that affect negative emotions. @*Methods@#We identified the demographic information related to the experiences of unbearable stress and emotional crisis and their causal factors at three points in time: before the pandemic, during its peak, and at the time of the survey (2–3 months after the peak). In addition, we analyzed the factors related to depression and anxiety experienced by students during the COVID-19 pandemic. The Korean version of the Patient Health Questionnaire 9 and the Korean version of the Generalized Anxiety Disorder 7 was used to assess for depressive and anxiety symptoms in the subject students, respectively. @*Results@#A total of 8,177 students participated in the analysis, with 4,072 boys (49.8%), 4,105 girls (50.2%), and 4,463 middle school students (54.6%) and 3,177 high school students (45.4%). The percentage of students who experienced unbearable stress was 9% before the COVID-19 pandemic, increased to 16% at the peak of the COVID-19 pandemic, then decreased to 12.7% at the time of the survey. Stress was experienced more by girls (18.1% versus 13.8% in boys; χ2 = 28.159, P < 0.001) and high school students (19.0% versus 13.5% in middle school students; χ2 = 45.437, P < 0.001). Overall, 7.6% experienced emotional crises during the COVID-19 pandemic, which was more prevalent in girls (10.1% versus 5.2% in boys; χ2 = 71.025, P < 0.001) and in high school students (8.8% versus 6.7% in middle school students; χ2 = 12.996, P < 0.001). Depression and anxiety was seen in 19.8% and 12.3% of students during the COVID-19 pandemic, respectively. The risk factors for depression and anxiety included unbearable stress before the COVID-19 pandemic (P < 0.001), mental health (P = 0.044), and age (P = 0.040), whereas resilience was identified as a protective factor for depression and anxiety (P = 0.001). @*Conclusion@#Students in Daegu experienced lots of mental difficulties since the COVID-19 pandemic. It will be necessary to improve stress management and resilience to improve students' mental health in disasters such as the COVID-19 pandemic.

Differences in Symptoms, Functions, and Their Outcomes According to the Degree of Trauma in Patients with Early Psychosis / 신경정신의학

Methods@#The study involved 226 people who participated in the Korean Early Psychosis Cohort Study, and we divided the participants into two groups according to the degree of trauma.Positive and Negative Syndrome Scale (PANSS) and Social and Occupational Functioning Assessment Scale (SOFAS) were compared at the start of the study and at 12 months after the treatment using paired t-test and repeated measures analysis of variance. @*Results@#At the beginning of the study, there was no significant difference between the two groups. But after 12 months of treatment, the high trauma group showed less improvement in PANSS negative score, general psychopathological score, total score, and SOFAS than the low trauma group. @*Conclusion@#In patients with early psychosis and at least moderate severity of premorbid trauma, negative symptoms, general psychopathological, and social and occupational functional improvements after treatment are less.

Comparison of Cognitive Control Deficits in Patients with Schizophrenia and Bipolar I Disorder / 신경정신의학

Methods@#Three groups were included in this study: remitted schizophrenia patients (n=56), patients in euthymic states of bipolar I disorder (n=52), and healthy control (n=57), who were matched on sex, age, years of education. The Continuous Performance Test of the AX version (AXCPT) was used to evaluate the cognitive control function. Intelligence, psychopathology, and psychomotor speed were also examined. The degree of cognitive control deficits was assessed by the commission error rates, correct response times, and the d’ values. @*Results@#Both patient groups performed worse in the AX and BX trials than the healthy control. Both patient groups showed a delayed response in all trials than the healthy control. The d’ value was the highest in the healthy control group, but there were no significant differences between the two patient groups. The profile of defects in the two patient groups was the same, with the BX trial having the highest defects in the order of the AX, BY, and AY trials. @*Conclusion@#These findings indicate that cognitive control is impaired in patients with schizophrenia and bipolar I disorder. Impairments in cognitive control are likely to be a possible shared pathophysiological marker for both disorders.

The rs6265 Polymorphism of the BDNF Gene Is Related to Higher-Lethality Suicide Attempts in the Korean Population

Objective@#Since the risk of suicide cannot be predicted by clinical symptoms alone, and suicide is known to have a genetic component, the discovery of genetic markers that can predict the lethality of suicide attempts is a clinically important topic. There have been many studies aiming to determine whether the rs6265 polymorphism of the BDNF gene is associated with suicidality; however, the results have been mixed, and there have been few studies investigating the relationship between this polymorphism and suicide attempt lethality. @*Methods@#We assessed suicide lethality in 258 individuals who had attempted suicide using the relative risk ratio (RRR) scale and by genotyping the rs6265 polymorphism of the BDNF gene. @*Results@#The RRR score for suicide attempts was higher in subjects with Met/Val and Val/Val genotypes than in that with a Met/Met genotype (p=0.015). The RRR score for suicide attempts was also higher in Val allele carriers (Met/Val+Val/Val) than in Met/Met homozygotes (p=0.006). @*Conclusion@#This study demonstrates the possibility that the rs6265 polymorphism of the BDNF gene could be used as a genetic marker to predict the lethality of suicide attempts, but more replication studies are needed for the application of this result in clinical practice.

Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia

Objective@#While impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship. @*Methods@#A total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution. @*Results@#Patients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls. @*Conclusion@#Our results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia

Characteristics of High-Intent Suicide Attempters Admitted to Emergency Departments

BACKGROUND: The suicide rate in Korea has been the highest among the Organization for Economic Cooperation and Development countries since 2003. However, there is a lack of in-depth data regarding the characteristics of suicide attempters. Understanding the intent of suicide attempters will help improve the effectiveness of suicide prevention strategies. Therefore, to provide a resource for developing the necessary interventions, this study aimed to examine the differences in suicide-related and clinical variables according to the strength of suicidal intent. METHODS: The subjects were 328 suicide attempters admitted to emergency departments at 5 university hospitals in Daegu-Gyeongbuk province between 2011 and 2014. We used various scales to examine suicide-related and clinical variables and a structured questionnaire to explore psychosocial characteristics. We evaluated suicidal intent using the Pierce Suicide Intent Scale and a clinician-rated scale that measured suicidal authenticity. RESULTS: Individuals with high suicidal intent were significantly older, had higher Hamilton Depression Rating Scale (HDRS) scores, higher rates of premeditation, and sustained suicidal ideation. Furthermore, suicide methods, timing, and psychiatric treatment histories differed by the strength of subjects' suicidal intent. Moreover, multiple logistic regression showed that depressed mood as a reason for attempting suicide, premeditation, and higher HDRS scores were significantly associated with higher suicidal intent. CONCLUSION: Depression, premeditation, older age, and sustained suicidal ideation were characteristics of individuals with high suicidal intent, and it is necessary to evaluate and monitor these factors to prevent repeated suicide attempts.

Comparison of Cognitive Controls in Patients with Bipolar I Disorder and Their Unaffected First-Degree Relatives

OBJECTIVES: This study intended to identify the deficits of cognitive control among patients with bipolar I disorder and their first-degree relatives, and identify the possibility of cognitive control as an endophenotype of bipolar disorder. METHODS: The study included three groups: euthymic states patients with bipolar I disorder (n = 55), unaffected first-degree relatives of probands with bipolar I disorder (n = 30), and a healthy control group (n = 51), that was matched on age, sex, and years of education. The AX version of the continuous performance test (CPT) was used to examine cognitive control. Error rate, correct response times of each subsets (AX, BX, AY, BY), and d' as an indication of accuracy sensitivity index were calculated. Psychopathology, intelligence, and psychomotor speed were also assessed. RESULTS: Patients with bipolar I disorder showed significantly worse error rates in the AX (p = 0.01) and BX (p = 0.02) subsets and d' (p = 0.05) than the others. They also showed more delayed correct response times than the healthy control group and first-degree relatives in all subsets (p < 0.01). But first-degree relatives showed neither high error rates nor delayed correct response times than healthy control group. CONCLUSIONS: These findings suggest that cognitive control is impaired in bipolar I disorder but less likely to be an endophynotype of bipolar I disorder.

Mediating Effect of Resilience on the Association between Emotional Neglect and Depressive Symptoms

OBJECTIVE: Previous studies have reported that childhood maltreatment experiences could induce biological and psychological vulnerability in depressive disorders. However, it is still unclear that type-specific effects of childhood maltreatment on psychological resilience, depressive symptoms and interactions among childhood maltreatment experiences, resilience, and depressive symptoms. METHODS: A total of 438 medical students were included in the study. The Childhood Trauma Questionnaire-Short Form, the Conner-Davidson Resilience Scale, and the Beck Depression Inventory were used for measuring childhood maltreatment experiences, psychological resilience, and depressive symptoms, respectively. We investigated the effects of childhood maltreatment experiences on resilience and depressive symptoms using correlation analysis. In addition, we analyzed the mediating effect of resilience on the association between childhood maltreatment and symptoms of depression. RESULTS: Among childhood maltreatment, emotional neglect was a significant predictor of the scores of low resilience and high depressive symptoms in both gender groups (all ps < 0.05). Furthermore, resilience was found to be a mediator connecting emotional neglect experiences with depressive symptoms. CONCLUSION: Our results suggest that emotional neglect has detrimental effects on mood and resilience, and clinicians need to focus on the recovery of resilience when they deal with depressive symptoms in victims of childhood maltreatment.

Comparison of Cognitive Control Deficits in Patients with Schizophrenia and Their Unaffected First-Degree Relatives / 신경정신의학

OBJECTIVES: This study aimed to identify the differences in the profiles of cognitive control deficits among schizophrenic patients and endophenotypes. METHODS: The study examined three groups: remitted patients with schizophrenia (n=54), unaffected first-degree relatives of the probands with schizophrenia (n=36), and a healthy control group (n=51), which were all matched for age, sex, and years of education. The AX version of the continuous performance test was used to examine cognitive control. The error rate, correct response times of each subset (AX, BX, AY, BY), and d′ as an indication of the accuracy sensitivity index were calculated. The psychopathology, intelligence, and psychomotor speed were also assessed. RESULTS: Patients with schizophrenia showed significantly poorer error rates and d′ in the AX and BX subsets than the others. They showed more delayed correct response times than the healthy control group in all subsets. The first-degree relatives also showed more delayed correct response times in the BX and AY subsets than the healthy control group, but were similar to the patients. CONCLUSION: These findings suggest that cognitive control is impaired in schizophrenia and endophynotypes possibly share this delayed information processing from the higher loading states of cognitive control.

Psychometric Properties of the Hypomania Checklist-32 in Korean Patients with Mood Disorders

OBJECTIVE: The aim of this study was to examine the validity of the Korean version of the Hypomania Checklist-32, second revision (HCL-32-R2) in mood disorder patients. METHODS: A total of 454 patients who diagnosed as mood disorder according to Structured Clinical Interview for DSM-IV Axis I Disorders, clinician version (SCID-CV) (bipolar disorder [BD] I, n=190; BD-II, n=72; and major depressive disorder [MDD], n=192) completed the Korean module of the HCL-32-R2 (KHCL-32-R2). RESULTS: The KHCL-32-R2 showed a three-factorial structure (eigenvalue >2) that accounted for 43.26% of the total variance. Factor 1 was labeled “active/elated” and included 16 items; factor 2, “irritable/distractible” and included 9 items; and factor 3 was labeled “risk-taking/indulging” and included 9 items. A score of 16 or more on the KHCL-32-R2 total scale score distinguished between BD and MDD, which yielded a sensitivity of 70% and a specificity of 70%. MDD and BD-II also could be differentiated at a cut-off of 15 with maximized sensitivity (0.67) and specificity (0.66). Cronbach’s alpha of KHCL-32-R2 and its subsets (factors 1, 2, and 3) were 0.91, 0.89, 0.81 and 0.79, respectively. Correlations between KHCL-32-R2 and Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale and Korean version of Mood Disorder Questionnaire were −0.66 (p=0.41), −0.14 (p=0.9), and 0.61 (p < 0.001), respectively. CONCLUSION: The KHCL-32-R2 may be a useful tool in distinguishing between bipolar and depressive patients in clinical settings.

The Association of the 2nd to 4th Digit Ratio with the Age of Onset and Metabolic Factors in Korean Patients with Schizophrenia

OBJECTIVES: The ratio of second to fourth digit length (2D : 4D) could be a potential epigenetic marker of sexual dimorphism reflecting prenatal testosterone exposure. Testosterone is known to affect the development of the brain through an epigenetic mechanism. The purpose of this study was to investigate the effects of exposure to fetal testosterone on the metabolic syndrome based on 2D : 4D of schizophrenia patients and the relationship with the age of onset of schizophrenia. METHODS: A total of 214 schizophrenia patients participated in this study. The participant's physical and blood tests were performed according to the American National Cholesterol Education Program's Third Amendment of the Metabolic Syndrome Diagnostic Criteria, and the 2D : 4D was measured by the method designed by McFadden. Data were statistically analyzed by t-test, Pearson's correlation analysis and multiple regression model analysis. RESULTS: 2D : 4D was significantly higher in female than male in both hands, and there was a statistically significant negative correlation between 2D : 4D and the age of onset of schizophrenia in male. However, 2D : 4D did not show statistically significant correlation with metabolic factors. CONCLUSIONS: Fetal testosterone suggests the possibility of affecting the age of onset of schizophrenia through the epigenetic mechanism, but there is no clear relationship with metabolic factors.

Prevalence of Metabolic Syndrome in Patients with Schizophrenia in Korea: A Multicenter Nationwide Cross-Sectional Study

OBJECTIVE: We designed a nationwide study with limited exclusion criteria to investigate the prevalence of metabolic syndrome (MetS) in Korea and its relationship with antipsychotic medications. METHODS: This multicenter, cross-sectional, and observational study included patients diagnosed with schizophrenia or schizoaffective disorder. Sixteen hospitals enrolled 845 patients aged 18 to 65 years prescribed any antipsychotic medication between August 2011 and August 2013. MetS was diagnosed using the criteria of the modified Adult Treatment Panel III of the National Cholesterol Education Program with the Korean abdominal obesity definition (waist circumference ≥85 cm in women, ≥90 cm in men). RESULTS: The prevalence of MetS in all patients was 36.5% and was significantly higher in men than women (men, 40.8%; women, 32.2%) and was significantly correlated with age [odds ratio (OR) 1.02] and duration of illness (OR 1.03). The prevalence of MetS across antipsychotic drugs in the major monotherapy group was as follows: 18.8% for quetiapine, 22.0% for aripiprazole, 33.3% for both amisulpride and paliperidone, 34.0% for olanzapine, 35% for risperidone, 39.4% for haloperidol, and 44.7% for clozapine. CONCLUSION: The prevalence of MetS is very high in patients with schizophrenia or schizoaffective disorder. Screening and monitoring of MetS is also strongly recommended.

Dose Trends of Aripiprazole from 2004 to 2014 in Psychiatric Inpatients in Korea

OBJECTIVE: Although aripiprazole has been widely used to treat various psychiatric disorders, little is known about the adequate dosage for Asian patients in clinical practice. Hence, we evaluated the initial and maximum doses of aripiprazole from 2004 to 2014 to estimate the appropriate dosage for Korean psychiatric inpatients in clinical practice. METHODS: In this retrospective study, we reviewed the medical records of patients who were hospitalized in five university hospitals in Korea from March 2004 to December 2014. The psychiatric diagnosis according to the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition during index hospitalization and the initial and maximum doses of aripiprazole were evaluated. RESULTS: There were 74 patients in Wave 1 (2004–2006), 201 patients in Wave 2 (2007–2010), and 353 patients in Wave 3 (2011–2014). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2. The maximum doses of aripiprazole in each diagnostic group were not significantly different among Waves 1, 2, and 3. CONCLUSION: The relatively low initial doses of aripiprazole documented in our study may reflect a strategy by clinicians to minimize the side effects associated with aripiprazole use, such as akathisia.

Comparison of Clinical Characteristics between Single and Repeated Suicide Attempters Admitted to Emergency Room / 신경정신의학

OBJECTIVES: This study compares single and repeat suicide attempts, and evaluates the risk factors associated with suicide re-attempts. METHODS: Two hundred and seventy-nine patients admitted to emergency rooms in four university hospitals in Daegu after suicide attempt were included in this study (n=179 single suicide attempters, n=100 repeated attempters). A structured interview focused on demographic, clinical, suicidal and psychological characteristics was administered to these patients after recovery from physical and psychological impairments. RESULTS: Individuals with repeated suicide attempts were younger, more highly educated, had more history of psychiatric treatments, took more psychiatric medications, and had more sustained suicidal ideations, bipolar disorders and personality disorders than individuals with single suicide attempt. Individuals with repeated suicide attempts marked significantly higher scores in the Childhood Trauma Questionnaire, Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale. Multivariate logistic regression showed that below the sixties, history of psychiatric treatments, personality disorders, substance use disorders and sustained suicidal ideations were significantly associated with predictive factors for subsequent suicide attempt. CONCLUSION: Our findings suggest that repeat suicide attempters have different clinical characteristics from single suicide attempters, and some risk factors raise the risk of further suicide attempts. It is necessary for suicidal prevention program planners to be aware of these risk factors, especially for first-time suicide attempters.

Neuroglial Cells and Schizophrenia

In the past decade, structural, molecular, and functional changes in glial cells have become a major focus in the search for the neurobiological foundations of schizophrenia. Glial cells, consisting of oligodendrocytes, astrocytes, microglia, and nerve/glial antigen 2-positive cells, constitute a major cell population in the central nervous system. There is accumulating evidence of reduced numbers of oligodendrocytes and altered expression of myelin/oligodendrocyte-related genes that might explain the white matter abnormalities and altered inter- and intra-hemispheric connectivities that are characteristic signs of schizophrenia. Astrocytes play a key role in the synaptic metabolism of neurotransmitters ; thus, astrocyte dysfunction may contribute to certain aspects of altered neurotransmission in schizophrenia. Increased densities of microglial cells and aberrant expression of microglia-related surface markers in schizophrenia suggest that immunological/inflammatory factors are of considerable relevance to the pathophysiology of psychosis. This review describes current evidence for the multifaceted role of glial cells in schizophrenia and discusses efforts to develop glia-directed therapies for the treatment of the disease.

Shared and Distinct Neurocognitive Endophenotypes of Schizophrenia and Psychotic Bipolar Disorder

OBJECTIVE: Schizophrenia and bipolar disorder are characterized by the presence of neurocognitive impairments on the psychosis continuum. The present study aimed to explore the shared and distinct endophenotypes between these disorders. METHODS: The study included 34 probands with remitted schizophrenia and 34 probands with euthymic bipolar disorder who had a history of psychotic symptoms that met the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, unaffected first-degree relatives of probands (31 relatives of probands with schizophrenia and 29 relatives of probands with bipolar disorder), and 34 healthy controls. Cognitive assessments were performed using the digit span, continuous performance, Rey auditory and visual learning, complex figure, verbal fluency, Wisconsin card sorting, and finger tapping tests. RESULTS: Probands with schizophrenia showed the most generalized and severe cognitive deficits across cognitive domains (working memory, verbal learning and memory, visual memory, verbal fluency, and executive function). Some domains of cognitive function (working memory, verbal learning, and memory) were also impaired in probands with bipolar disorder, but to a lesser degree than in probands with schizophrenia. All probands and relatives showed a common deficit in working memory compared to healthy controls. Relatives of probands with schizophrenia also showed verbal fluency dysfunction. Cognitive performance of all relatives was intermediate to the performance of both patients and healthy controls. CONCLUSION: These findings suggest that a deficit in working memory could be a shared endophenotype of genetic vulnerability to schizophrenia and psychotic bipolar disorder, and verbal fluency could be a candidate endophenotype for schizophrenia specifically.

Sociodemographic Factors and Comorbidities Associated with Remission from Alcohol Dependence: Results from a Nationwide General Population Survey in Korea

OBJECTIVE: The lifetime prevalence of alcohol dependence in South Korea remains higher than other countries. The aim of our study is to identify factors associated with remission from alcohol dependence. METHODS: Data from the Korean Epidemiological Catchment Area-Replication (KECA-R) study were used in our study. The Korean version of the Composite International Diagnostic Interview 2.1 (K-CIDI 2.1) was administered. Remission was defined as having no symptom of alcohol dependence for 12 months or longer at the time of the interview. Demographic and clinical variables putatively associated with remission from alcohol dependence were examined by t-test, chi-square-test and logistic regression analysis. RESULTS: The lifetime prevalence rate of alcohol dependence was 7.0%. Among them, 3.2% of the subjects were diagnosed with active alcohol dependence in the previous 12 months, and 3.8% were found to be in remission. Subjects in 35- to 44-year-old group, not living with partner group, and lower level of educational attainment group were more likely to be in the active alcohol dependence state. Of the comorbid mental disorders, dysthymia, anxiety disorder, nicotine use, and nicotine dependence were more common among the actively alcohol-dependent subjects. CONCLUSION: There is considerable level of recovery from alcohol dependence. Attention to factors associated with remission from alcohol dependence may be important in designing more effective treatment and prevention programs in this high-risk population.

Neurocognitive Deficits in Patients with Schizophrenia and Unaffected First-Degree Relatives

OBJECTIVES: This study aimed to identify the differences and the profiles of cognitive deficits in remitted patients with schizophrenia and first-degree relatives of schizophrenic probands. METHODS: A total of 26 remitted states of schizophrenia patients were included in the study and the same number of unaffected first-degree relatives of schizophrenic probands and healthy controls were matched for age, sex, years of education. Cognitive function of all participants was measured by using the Digit span test, the Continuous performance test, the Rey auditory & visual learning test, the Complex figure test, the Verbal fluency test, the Wisconsin card sorting test and the Finger tapping test. The effects of subsyndromal symptomatology and general intelligence score were controlled. RESULTS: Schizophrenia patients' group showed more significant impairment than other groups in verbal memory (learning, immediate recall, delayed recall), visual memory (copy, immediate recall, delayed recall) and cognitive flexibility domains. The family group and the patient group commonly performed significantly worse than healthy controls in working memory and verbal fluency (category) tests. There were no differences in sustained attention, psychomotor performance. CONCLUSIONS: Our research shows that the deficit in working memory and verbal fluency could be strong candidates of endophenotypic marker in schizophrenia.