Comparison of Emotional and Psychological Characteristics between Suicide Attempters and Non-Attempters in Depressed Patients : Using MMPI-2 Profiles / 정신신체의학

OBJECTIVES: To examine emotional and psychological characteristics associated with suicide attempts in depressed patients. METHODS: A sample of 37 inpatients diagnosed with major depressive disorder or depressive disorder NOS was divided into two groups : lifetime suicide attempters(N=15 ; 40.54%), non-attempters(N=22 ; 59.46%). Beck Depression Scale(BDI), Beck Anxiety Scale(BAI), Hamilton Depression Rating Scale(HDRS), Hamilton Anxiety Rating Scale(HARS), and MMPI-2 were used to evaluate symptoms severity and psychological characteristics. RESULTS: Suicide attempters scored higher on the BDI though there were no group differences on the HDRS and on the both anxiety scales. Also they showed higher scores on the F, Fb, Pa, RC1, DEP, HEA, PK, AAS among MMPI-2 subscales. Our findings suggest that suicide attempters among depressed patients undergo more severe subjective distress and difficulties in adjustment than non-attempters. Also they were more hostile to others and showed lower trust. Lastly, they showed more somatic complaints and substance related problems. CONCLUSION: The present study showed that suicide attempters among depressed patients have distinct emotional and psychological characteristics. MMPI-2 would be helpful to assess suicidal risk of depressed patients.

Symptoms to Use for Diagnostic Criteria of Hwa-Byung, an Anger Syndrome

OBJECTIVE: The aim of this study was to identify the characteristic symptoms which can be used for the diagnosis of hwa-byung, a culture-related anger syndrome in Korea. METHODS: The symptoms of the Hwa-byung Scale were correlated with the Korean versions of the Hamilton Depression Rating Scale (K-HDRS) and the State and Trait Anger Inventory (K-STAXI) in 89 patients, who were diagnosed as having major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria and who had self-labeled hwa-byung. Also, the symptoms of the Hwa-byung Scale were correlated with each other. RESULTS: The symptoms of the Hwa-byung Scale which were significantly correlated with the state anger of the K-STAXI but not with the depressive mood (item 1 of K-HDRS) included feelings of unfairness, subjective anger, external anger, heat sensation, pushing-up in the chest, dry mouth, and sighing. The symptoms which were significantly correlated with state anger and depressed mood included respiratory stuffiness, "haan" and hate. The symptoms which were not significantly correlated with depressed mood and state anger included going-out, epigastric mass, palpitation, headache/pain, frightening easily, many thoughts, and much pleading. These symptoms also showed higher correlation with each other in the correlation matrix. CONCLUSION: Our findings suggest that hwa-byung is different from depressive syndrome in terms of its symptom profile, and suggest what symptoms should be included in the diagnostic criteria of hwa-byung, an anger disorder.

Development of Hwa-Byung Scale and Research Criteria of Hwa-Byung / 신경정신의학

OBJECTIVES : The aim of this study was to identify the characteristic symptoms for diagnosis of Hwabyung (HB), a culture-related anger syndrome in Korea; to construct a rating scale for HB and test its validity and reliability; and propose diagnostic criteria for HB. METHODS : Subjects were male and female Korean patients, who were diagnosed following Structured Clinical Interview (SCID) as having depressive disorders, anxiety disorders and somatoform disorders and who reported as having self-labeled HB. A HB Scale was constructed with 22 of the most common symptoms of HB as identified by previous studies. The HB scale's inter-rated reliability was tested with 60 subjects. Its validity was tested by comparison between a HB only group(n=47) and depressive disorder only group (n=44). Logistic regression analysis was conducted to make a predictive model of HB. Based on these results diagnostic criteria for HB was proposed. RESULTS : Inter-rated reliability in each of all the items and the total score of the HB Scale were statistically significant. The HB scale differentiated HB from depressive disorder with statistical significance. In logistic regression analysis, the ability of the HB model to predict symptoms of heat sensation, ukwool/boon (feeling of unfairness), and subjective anger was high with sensitivity of 80.0%, specificity of 88.4%, accuracy of 84.1% and area under ROC of 0.92. Based on these results and information from previous research, diagnostic criteria of HB were formulated. CONCLUSION : The HB Scale was found to be reliable and valid. Consequently, diagnostic criteria of HB were proposed, to include subject anger, "kwool/boon" (Feeling of unfairness), expressed anger, heat sensation, hostility, "haan", pushing-up in the chest, epigastric mass, respiratory stuffiness, palpitation, dry mouth, sighing, racing thoughts, and lamentation.

Effects of Paroxetine on Symptoms of Hwa-Byung / 대한정신약물학회지

OBJECTIVE: This study consists of a single open clinical trial to evaluate the treatment effects of paroxetine on symptoms of hwa-byung, a Korean culture-related anger syndrome. METHODS: Eighty-nine patients with depressive disorders, anxiety disorders, somatoform disorders, or self-labeled hwa-byung were treated with paroxetine (Paxil CR) 12.5-37.5 mg/day for 8 weeks. Treatment effects were evaluated using the Hamilton Depression Scale (HAMD), the State and Trait Anger Inventory (STAXI), and the Hwa-byung Scale. RESULTS: Scores on all items ; total score on the Hwa-byung Scale ; scores on state anger, trait anger, and anger-in ; total score on the STAXI ; and total score on the HAM-D decreased significantly after eight weeks of paroxetine treatment compared to baseline. CONCLUSION: Paroxetine was shown to be effective for treating symptoms of hwa-byung, a chronic anger syndrome.

The Reliability and Validity of the Korean Adult Young ADHD Questionnaire-Self-Report(K-YAQ-S) and Young ADHD Questionnaire-Informant-Report(K-YAQ-I) / 신경정신의학

OBJECTIVES: The purpose of this study is to assess the psychometric properties and to investigate factor structure of the Korean version of the Young ADHD Questionnaire-Self-Report (K-YAQ-S) and the Young ADHD Questionnaire-Informant-Report (K-YAQ-I). METHODS: 269 normal college students completed the K-YAQ-S and the Lee Ji-Yeon's adult ADHD scale (1996). 213 informants of the subjects completed the K-YAQ-I. RESULTS: The K-YAQ-S and the K-YAQ-I had good internal consistency (Cronbach's =.957, .965). An ADHD symptomatology and emotional problem subscales of the K-YAQ-S showed strong correlation with the Lee Ji-Yeon's adult ADHD scale. The delinquency and social functioning subscales of the K-YAQ-S and all subscales of the K-YAQ-I correlated significantly but were relatively lower. An exploratory factor analysis showed that the K-YAQ-S revealed 4 factors (ADHD symptomatology, emotional problems, delinquency, social functioning) and the K-YAQ-I being composed of 3 factors (ADHD symptomatology/ aggressive behavior, emotional problem/social functioning, illegal act). CONCLUSION: These results suggest that the K-YAQ-S and the K-YAQ-I rating scale is a reliable and a valid test. These scales would be useful in diagnostic evaluation and in measuring the treatment effect for ADHD adult.

Psychosocial Factors Associated with Biological Markers in Korean Patients with Human Immunodeficiency Virus Infection / 신경정신의학

OBJECTIVES: The purpose of this study was to identify psychosocial factors associated with biological markers in Korean patients with human immunodeficiency virus (HIV) infection. METHODS: 50 patients with HIV infection were enrolled. We administered Stress Response Inventory (SRI), the Coping Scale, and the Korean version of Smithklein Beecham quality of life scale (QOL) to the 50 patients and measured CD4+ cell count and HIVRNA copies. RESULTS: Simple correlation analysis showed significant correlation between psychosocial factors and CD4+ cell count. Tension, aggression, depression, frustration subscale in SRI and distancing, self controlling in coping scale had negative correlation with CD4+ cell count, whereas QOL showed positive correlation. Multiple regression analysis showed significant negative association between distancing and CD4+ cell count. There were no differences in CD4+ cell count and HIVRNA between homosexual patients and heterosexual patients. However, aggression, confrontation in SRI, and distancing in coping scale scored significantly higher in heterosexual patients than homosexual patients. CONCLUSION: These results suggest that CD4+ cell count may be associated with psychosocial factors in Korean patients with HIV infection, and passive coping strategy like distancing may be one of important factors in the progression of HIV infection. These findings also suggest that psychosocial intervention programs are needed for Korean patients with HIV infection.

Effects of Haloperidol and Risperidone on the Subjective Quality of Life in Stable Chronic Schizophrenic Patients / 신경정신의학

OBJECTIVE: The purpose of this study is to compare the effects of haloperidol and risperidone on the quality of life in chronic schizophrenic patients and to identify how the quality of life is related with the severity of psychopathology and drug side effects. METHODS: The study sample was composed of 38 ambulatory patients on haloperidol 1.5-4.5mg/day and 33 patients on risperidone 1-4mg/day for more than 2 years. They were physically healthy and had diagnoses of chronic undifferentiated or residual type of schizophrenia according to the criteria of DSM-IV. Those who had other comorbid mental disorders were excluded. For the assessment of the quality of life(QOL), the Korean version of WHOQOL was used. The severity of psychotic symptoms was evaluated by BPRS, and the side effects of the medication was evaluated by UKU Side Effects Rating Scales. RESULTS: The results showed that sex, age, education level, marital states, duration of antipsychotic medication and BPRS scores were not significantly different between the haloperidol group and risperidone group. But, the UKU Side Effects Rating Scales scores in the haloperidol group were significantly higher than those in the risperidone group. The mean score of the WHOQOL-BREF in the risperidone group was a little higher than that in the haloperidol group, and in the same way the 3 domain scores of the WHOQOL-BREF(physical, psychological, environmental domains) in the risperidone group was a little higher than those in the haloperidol group. However, the differences were not statistically significant between the two groups. There was a negative correlation between total QOL score and total BPRS scores, and both between BPRS item of tension and the total QOL score and between depressive mood and total QOL score. But, there was no correlation between total QOL score and UKU side effect scores. CONCLUSIONS: This study suggests that, if schizophrenia has once become chronic, the quality of life is not significantly influenced by the kind of antipsychotic drugs in the maintenance dose, and that the quality of life is correlated with a severity of the symptoms, especially tension and depressive mood.

Development of Korean Version of WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF) / 신경정신의학

OBJECTIVE: This study proposed to develop the Korean version of the WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF) and to test the validity and reliability of the Korean version of WHOQOL-BREF compared with the Korean version of WHOQOL. METHOD: The Korean version of the WHOQOL-BREF, which was developed according to WHO guidelines, was piloted on 538 respondents, including 171 medical patients from outpatient clinics at Severance hospital and 367 healthy subjects. A total of 489 respondents completed the study. To assess the test-retest reliability, 113 subjects repeated the rating within a 3-week interval. RESULTS: Correlations for test-retest reliability in all item scores of Korean versions of the WHOQOL and WHOQOL-BREF were highly significant (p< .0001). Differences between domain scores of the Korean version of the WHOQOL-BREF and those of the Korean version of WHOQOL were very small (mean differences=0.49). Domain scores produced by the Korean version of WHOQOL-BREF correlated significantly (p< .0001) with those of the WHOQOL. Cronbach alpha values were 0.898 and values for each domain were also high (0.583-0.777), which demonstrated good internal consistency. As for determining discriminant validity, scores were compared between gender, age groups, education levels, marital status, and health status. Differences in education levels and health status were statistically significant. Confirmatory factor analysis showed that four domain structures were appropriate (Bentler's comparative fit index: 0.859). For overall quality of life, the contribution of physical health domain was highest, followed by psychological and environmental domains. CONCLUSION: This study shows that the Korean version of the WHOQOL-BREF is a reliable and available test for assessing quality of life.

Development of the Korean Version of The World Health Organization Quality of Life Scale(WHOQOL) / 신경정신의학

OBJECTIVE: This study is to test the validity and reliability of the Korean version of the World Health Organization Quality of Life Assessment Instrument(WHOQOL). METHODS: According to the instructions of the WHOQOL group, THe WHOQOL was translated into Korean. Words for anchor points were selected based on a preliminary survey. Words or sentences were examined and modified by layman focus groups and a group of psychiatrists and psychologists so that the scale would be expressed in a more culturallyadequate and easily-understandable way. A back-translated Korean version into English was sent to the WHO group for examination. A group of 583 Koreans consisting of healthy people, medical patients and college students rated the Korean version of WHOQOL. For test-retest reliability, 113 college student rated it again after a 3-week interval. Statistical analysis was done with the collected data. RESULTS: Correlation coefficients were regarded to have good test-retest reliabilily. Cronbach alpha value of total score, and scores of domains and facets were high. Total score and score of domains and facets were significantly correlated with overall QOL score and QOL-general impression score showing a significant criterion validity. Path analysis for content validity showed a certain pattern of relations among domains. There were significant differences in some domains and facets between sexes and age groups, as well as between healthy group and patient groups showing a significant discriminative validity. CONCLUSION: The Korean version of WHOQOL was proved to be a reliable and valid instrument for quality of life.