Brief Screening for Four Mental Illnesses of the Elderly in Community Mental Health Services: the BS4MI-Elderly

Objective@#Early detection and proper management of mental illness can help to prevent severe deterioration. However, with limited financial and human resources of community mental health services, it is not practical to carry out all conventional screening tools simultaneously. In this study, we aimed to develop and validate a brief but comprehensive screening questionnaire for four common mental illnesses of the elderly. @*Methods@#The brief screening for four mental illnesses of elderly (BS4MI-elderly) is a 14-item binary response questionnaire that covers dementia, depressive disorder, sleep disorder, and hwa-byung. To test validity, we compared conventional scale scores for three groups of participants classified using the BS4MI-elderly. The sensitivity, specificity, predictive value of positive test, likelihood ratio of positive test and internal consistency of the BS4MI-elderly were assessed. Finally, a correlation analysis between the BS4MI-elderly and general mental health scales was conducted. @*Results@#A total of 254 participants aged over 65 years were recruited. The BS4MI-elderly showed moderate to high sensitivity for the test that distinguishes the normal group from the risk and disorder groups (dementia: 0.61, depressive disorder: 0.88, sleep disorder: 0.85, hwa-byung: 0.94) and high specificity for the test that distinguishes the disorder group from the normal and risk groups (dementia: 0.91, depressive disorder: 0.93, hwa-byung: 0.84, sleep disorder: 0.84). The BS4MI-elderly also exhibited good internal consistency and significant correlations with general mental health scales. @*Conclusion@#The BS4MI-elderly, a brief but comprehensive screening tool, could be a useful instrument for screening the elderly in community mental health services.

PRSS1, SPINK1, CFTR, and CTRC Pathogenic Variants in Korean Patients With Idiopathic Pancreatitis

BACKGROUND: This study aimed to identify pathogenic variants of PRSS1, SPINK1, CFTR, and CTRC genes in Korean patients with idiopathic pancreatitis. METHODS: The study population consisted of 116 Korean subjects (65 males, 51 females; mean age, 30.4 yr, range, 1-88 yr) diagnosed with idiopathic chronic pancreatitis (ICP), idiopathic recurrent acute pancreatitis (IRAP), or idiopathic acute pancreatitis (IAP). We analyzed sequences of targeted regions in the PRSS1, SPINK1, CFTR, and CTRC genes, copy numbers of PRSS1 and SPINK1, and clinical data from medical records. RESULTS: We identified three types of pathogenic PRSS1 variants in 11 patients, including p.N29I (n=1), p.R122H (n=1), and p.G208A (n=9). Sixteen patients exhibited heterozygous pathogenic variants of SPINK1, including c.194+2T>C (n=12), p.N34S (n=3), and a novel pathogenic splicing variation c.194+1G>A. A heterozygous CFTR p.Q1352H pathogenic variant was detected in eight patients. One patient carried a heterozygous CTRC p.P249L pathogenic variant, which is a known high-risk variant for pancreatitis. All patients had normal PRSS1 and SPINK1 gene copy numbers. Weight loss occurred more frequently in patients carrying the p.G208A pathogenic variant, while pancreatic duct stones occurred more frequently in patients with the c.194+2T>C pathogenic variant. CONCLUSIONS: Pathogenic variants of PRSS1, SPINK1, and CFTR were associated with idiopathic pancreatitis, while pathogenic variants of CTRC were not. Copy number variations of PRSS1 and SPINK1 were not detected.

The effects of alveolar bone loss and miniscrew position on initial tooth displacement during intrusion of the maxillary anterior teeth: Finite element analysis / 대한치과교정학회지

OBJECTIVE: The aim of this study was to determine the optimal loading conditions for pure intrusion of the six maxillary anterior teeth with miniscrews according to alveolar bone loss. METHODS: A three-dimensional finite element model was created for a segment of the six anterior teeth, and the positions of the miniscrews and hooks were varied after setting the alveolar bone loss to 0, 2, or 4 mm. Under 100 g of intrusive force, initial displacement of the individual teeth in three directions and the degree of labial tilting were measured. RESULTS: The degree of labial tilting increased with reduced alveolar bone height under the same load. When a miniscrew was inserted between the two central incisors, the amounts of medial-lateral and anterior-posterior displacement of the central incisor were significantly greater than in the other conditions. When the miniscrews were inserted distally to the canines and an intrusion force was applied distal to the lateral incisors, the degree of labial tilting and the amounts of displacement of the six anterior teeth were the lowest, and the maximum von Mises stress was distributed evenly across all the teeth, regardless of the bone loss. CONCLUSIONS: Initial tooth displacement similar to pure intrusion of the six maxillary anterior teeth was induced when miniscrews were inserted distal to the maxillary canines and an intrusion force was applied distal to the lateral incisors. In this condition, the maximum von Mises stresses were relatively evenly distributed across all the teeth, regardless of the bone loss.

Effects of Early Childhood Peer Relationships on Adolescent Mental Health: A 6- to 8-Year Follow-Up Study in South Korea

OBJECTIVE: Peer relationships are one of the important factors in children's development. The present study examines the relationship between the effects of early peer relationships and adolescent psychological adjustment. METHODS: The first survey took place from 1998 to 2000, and a follow-up assessment obtained data in 2006, as the original participants reached 13-15 years of age. The first assessment used the Korean version of the Child Behavior Checklist (K-CBCL) and simple questions about peer relationships to evaluate the participants. The follow-up assessment administered the Korean Youth Self Report (K-YSR). RESULTS: Children's peer relationships have longitudinal effects on mental health and adjustment. Children who had qualitative peer-relation problems were more likely to exhibit internalizing problems as adolescents. CONCLUSION: Children who have poor peer relationships might become more vulnerable to emotional problems and social adjustment as adolescents.

Comparison of Improvacuter EDTA Tube with BD Vacutainer EDTA Tube for Routine Hematological Analysis: Clinical Significance of Differences, Stability Study, and Effects of K₂ and K₃ EDTA

BACKGROUND: The type of blood collection tubes is an important pre-analytical factor that may affect test results. We compared the test results of the Improvacuter EDTA tube (Improve Medical, China) with those of the currently used BD Vacutainer EDTA tube (Becton Dickinson, USA) and investigated the effects of K₂ and K₃ EDTA additives. METHODS: Peripheral blood samples from 100 outpatients were collected into the aforementioned tubes. The samples were evaluated for 17 hematological analytes, hemoglobin A1c, and erythrocyte sedimentation rate (ESR). The results were analysed using the paired t-test for comparison. Bland-Altman plots and Passing-Bablok regressions were used for analytes with statistically significant differences in the comparison. If the differences were not within total allowable error, they were defined as clinically significant. For stability testing, the initial results were compared against those from samples preserved for 72 hours. White blood cell count, red blood cell count, platelet count, and mean corpuscular volume from both tubes were compared to ascertain the differences between K₂ and K₃ EDTA additives. RESULTS: Hematocrit, mean corpuscular volume, mean corpuscular haemoglobin concentration, and ESR showed statistically significant differences (P<0.05) between two tubes. However, these differences were not considered clinically significant. Most of the analytes presented statistically significant differences in stability test; however, they were not clinically significant either. Additionally, the differences in the hematological parameters shown in the outcome were not clinically significant, depending on the type of the EDTA additives. CONCLUSIONS: The results indicate that Improvacuter EDTA tubes showed satisfactory performance. We conclude that the tubes are suitable for common clinical hematological use.

Development and Comparison of Warfarin Dosing Algorithms in Stroke Patients

PURPOSE: The genes for cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) have been identified as important genetic determinants of warfarin dosing and have been studied. We developed warfarin algorithm for Korean patients with stroke and compared the accuracy of warfarin dose prediction algorithms based on the pharmacogenetics. MATERIALS AND METHODS: A total of 101 patients on stable maintenance dose of warfarin were enrolled. Warfarin dosing algorithm was developed using multiple linear regression analysis. The performance of all the algorithms was characterized with coefficient of determination, determined by linear regression, and the mean of percent deviation was used to predict doses from the actual dose. In addition, we compared the performance of the algorithms using percentage of predicted dose falling within ±20% of clinically observed doses and dividing the patients into a low-dose group (≤3 mg/day), an intermediate-dose group (3-7 mg/day), and high-dose group (≥7 mg/day). RESULTS: A new developed algorithms including the variables of age, body weight, and CYP2C9 and VKORC1 genotype. Our algorithm accounted for 51% of variation in the warfarin stable dose, and performed best in predicting dose within 20% of actual dose and intermediate-dose group. CONCLUSION: Our warfarin dosing algorithm may be useful for Korean patients with stroke. Further studies to elucidate clinical utility of genotype-guided dosing and find the additional genetic association are necessary.

Psychopathology Associated with Cyberbullying among Middle School Students / 신경정신의학

OBJECTIVES: Cyberbullying has recently become a major concern in Korea and especially poses a serious threat to adolescents. The object of this study is to examine the psychopathology of perpetrators and victims of cyberbullying. METHODS: In a cross-sectional study, 490 middle school students completed questionnaires on bullying and victimization experiences in cyberspace. Korean-Youth Self Report (K-YSR) was included to evaluate the psychopathology of the students. RESULTS: The prevalence rates of victims and perpetrators of cyberbullying were 6.92% and 3.33%, respectively. Among 9 sub-scales of K-YSR, the scores of depressed/anxious (p=0.049), thought problems (p=0.002), and attention problems (p=0.039) were significantly different between victim, perpetrator, victim/perpetrator, and control group. Multinomial logistic regression indicated that the victim group was associated with depressed/anxious [odds ratio (OR)=1.10], social immaturity (OR=1.24), thought problems (OR=1.32), and self-destructive identity problems (OR=1.16). The perpetrator group was associated with thought problems (OR=1.37) and attention problems (OR=1.21). The victim/perpetrator group was associated with delinquent behavior (OR=2.04). CONCLUSION: Middle school students involved in cyberbullying were associated with psychopathologies including depression, anxiety, thought problems, attention problems, and delinquent behaviors. The risk of cyberbullying is escalating with the rapid advancement in technology. Therefore, a comprehensive approach should be employed for prediction and prevention of cyberbullying in adolescents.

Validation of the Mood and Anxiety Symptom Questionnaire in Korean Adolescents

OBJECTIVE: The tripartite model categorizes symptoms of depression and anxiety into three groups: 1) non-specific general distress that is shared between depression and anxiety, 2) depression-specific symptoms that include low positive affect and loss of interest, and 3) anxiety-specific symptoms that include somatic arousal. The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure these three factors of depression and anxiety. The purpose of the present study was to test the psychometric properties of the Korean version of the MASQ (K-MASQ) in adolescents. METHODS: Community-dwelling adolescents (n=933) were randomly assigned to two groups. Exploratory factor analysis and confirmatory factor analysis were conducted in each group to identify the factor structure of the K-MASQ. The reliability and validity of the K-MASQ were also evaluated. RESULTS: Our results support the three-factor structure of the K-MASQ in adolescents. However, we found that the specific items of each factor differed from those of the original MASQ. That is, the depression-specific factor was only related to low positive affect and not loss of interest, and the anxiety-specific factor included more items related to general somatic symptoms of anxiety. The reliability and validity of the K-MASQ were found to be satisfactory. CONCLUSION: The K-MASQ supports the tripartite model of depression and anxiety and has satisfactory reliability and validity among Korean adolescents. The K-MASQ can be used to distinguish unique symptoms of depression and anxiety in Korean adolescents.

Novel Non-contiguous Duplications in the DMD Gene in Five Patients with Duchenne Muscular Dystrophy

BACKGROUND: Muscular dystrophy is an X-linked recessive disorder caused by mutations in the DMD gene. Muscular dystrophy is classified into 2 types; Duchenne muscular dystrophy (DMD), which has severe clinical symptoms, and Becker muscular dystrophy (BMD), which has much milder clinical symptoms. Phenotypic progression to either DMD or BMD can be predicted by analyzing mutations in DMD by using the reading frame rule. METHODS: Of 88 patients with mutations in DMD, which were detected using Multiplex Ligation-dependent Probe Amplification DMD test kit (MRC-Holland, The Netherlands), medical records of 5 patients with non-contiguous duplications were reviewed. These rare non-contiguous duplications in DMD were compared with those reported previously. RESULTS: We identified 3 novel non-contiguous duplications in DMD that included exons 2-7 and 45-51, exons 5-37 and 50-59, and exons 52-53 and 56-61. The 5 patients with these non-contiguous duplications showed the phenotypic features of DMD. Especially, duplication of exons 52-53 and 56-61 was observed in a family, i.e., 2 DMD-affected brothers and their carrier mother. CONCLUSIONS: Prediction of phenotypes associated with complex non-contiguous duplications by using the reading frame rule is difficult because the duplications affect the expression of DMD together. Because most patients with non-contiguous duplications showed the phenotypic features of DMD, the reading frame rule should be interpreted cautiously. This study provides important insights on the non-contiguous duplications in DMD for understanding genotype-phenotype correlations and for developing dystrophin for therapeutic purposes.

A Validation Study of the Korean-Ruminative Response Scale in Korean Adolescents

OBJECTIVE: We aimed to evaluate the psychometric properties of Korean version of Ruminative Response Scale (K-RRS) for Korean adolescents. METHODS: A community sample of 1220 adolescents was recruited from middle schools and high schools. Exploratory factor analyses and confirmatory factor analyses were conducted, and additional analyses were performed to assess the reliability and validity of the K-RRS. RESULTS: An exploratory factor analysis of a sample of adolescents (n=550) yielded a three factor structure: 'depressive rumination', 'reflective pondering', and 'brooding'. Confirmatory factor analyses of another sample of adolescents (n=530) supported the three-factor model for the K-RRS. The K-RRS was found to have good internal consistency and construct validity. CONCLUSION: Our results suggest that K-RRS is a valid measurement to assess rumination in adolescents, as well as in adults.

A Pilot Prospective Study of the Relationship among Cognitive Factors, Shame, and Guilt Proneness on Posttraumatic Stress Disorder Symptoms in Female Victims of Sexual Violence

This study prospectively examined the relationships among cognitive factors and severity of Posttraumatic stress disorder (PTSD) symptoms in female victims of sexual violence. Thirty-eight victims of sexual violence recruited from Center for Women Victims of Sexual and Domestic Violence at Ajou University Hospital. Cognitive factors and PTSD symptom were assessed within 4 months of sexual violence and 25 victims were followed-up 1 month after initial assessment. Repeated-measured ANOVA revealed that PTSD incidence and severity decreased over the month (F [1, 21]=6.61). Particularly, avoidant symptoms might decrease earlier than other PTSD symptoms (F [1, 21]=5.92). This study also showed the significant relationship between early negative trauma-related thoughts and subsequent PTSD severity. Shame and guilt proneness had significant cross-sectional correlations with PTSD severity, but did not show associations when depression severity is controlled. Our results suggest that avoidant symptoms might decrease earlier than other PTSD symptoms during the acute phase and that cognitive appraisals concerning the dangerousness of the world seem to play an important role in the maintenance of PTSD (r=0.499, P<0.05).

Psychosocial Risk Factors Associated with Internet Addiction in Korea

OBJECTIVE: The aim of this study was to examine the prevalence of Internet addiction in middle school students and to identify associated psychosocial risk factors and depression. METHODS: This study was part of a larger epidemiological study on childhood psychiatric disorders conducted in Osan, a city of Republic of Korea. We used IAS for internet addiction, K-YSR for subjects' emotional and behavioral problems and K-CDI for depressive symptoms. We used the data of n=1217 completed cases. We put on independent variables, which are sex, age, smoking and alcohol experiences, economic status, age of first Internet use, K-YSR and K-CDI score. RESULTS: The subjects consisted of addicted users (2.38%), over users (36.89%) and normal Internet users (60.72%). Attention problems, sex, delinquent problems, K-CDI scores, thought problems, age and aggressive behavior were predictable variables of internet addiction. Age of initial Internet use negatively predicted Internet addiction. CONCLUSION: This result showed similar to other researches about sociodemographic, emotional or behavioral factors related to internet addiction. Generally, subjects with more severe internet addiction had more emotional or behavioral problems. It means that they already have had various difficulties when we found internet addiction of adolescents. Therefore it is necessary to evaluate whether the subjects have any emotional or behavioral troubles and to intervene to prevent internet addiction.

Weissella confusa Bacteremia in an Immune-Competent Patient with Underlying Intramural Hematomas of the Aorta

No abstract available.

Difficulty in Facial Emotion Recognition in Children with ADHD

OBJECTIVES: It is known that children with attention-deficit hyperactivity disorder (ADHD) experience significant difficulty in recognizing facial emotion, which involves processing of emotional facial expressions rather than speech, compared to children without ADHD. This objective of this study is to investigate the differences in facial emotion recognition between children with ADHD and normal children used as control. METHODS: The children for our study were recruited from the Suwon Project, a cohort comprising a non-random convenience sample of 117 nine-year-old ethnic Koreans. The parents of the study participants completed study questionnaires such as the Korean version of Child Behavior Checklist, ADHD Rating Scale, Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Facial Expression Recognition Test of the Emotion Recognition Test was used for the evaluation of facial emotion recognition and ADHD Rating Scale was used for the assessment of ADHD. RESULTS: ADHD children (N=10) were found to have impaired recognition when it comes to Emotional Differentiation and Contextual Understanding compared with normal controls (N=24). We found no statistically significant difference in the recognition of positive facial emotions (happy and surprise) and negative facial emotions (anger, sadness, disgust and fear) between the children with ADHD and normal children. CONCLUSION: The results of our study suggested that facial emotion recognition may be closely associated with ADHD, after controlling for covariates, although more research is needed.

Early Risk Factors for Depressive Symptoms among Korean Adolescents: A 6-to-8 Year Follow-up Study

Depression during adolescence is critical to the individual's own development. Hence, identifying individuals with high-risk depression at an early stage is necessary. This study aimed to identify childhood emotional and behavioral risk factors related to depressive symptoms in Korean adolescents through a longitudinal study. The first survey took place from 1998 to 2000, and a follow-up assessment conducted in 2006, as the original participants reached 13-15 yr of age. The first assessment used the Korean version of Child Behavior Checklist and a general questionnaire on family structure, parental education, and economic status to evaluate the participants. The follow-up assessment administered the Korean Children's Depression Inventory. Multiple regression analysis revealed that childhood attention problems predicted depressive symptoms during adolescence for both boys and girls. For boys, family structure also predicted adolescent depressive symptoms. This study suggests that adolescents with attention problems during childhood are more likely to experience depressive symptoms.

The promotion of mental health and the prevention of mental health problems in child and adolescent / 소아과

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.

Emotional and Behavioral Problems in Children with Chronic Physical Illness

Children with chronic illness are known to have an increased risk of emotional and behavioral problems. Many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children. It is a major theoretical framework of the Wallander and Varni model that modifiable risk and resistance factors can be identified empirically. Risk factors in the original model include disease/ disability parameters, functional dependence in the activities of daily living, and psychosocial stressors. Resistance factors in the original model are delineated in three categories: intrapersonal factors such as competence, temperament; socialecological factors such as family psychological environment, social support; and stressprocessing factors such as cognitive appraisal and coping strategies. In addition, it is proposed that the factors such as age of onset, certainty of diagnosis and prognosis of illness affect adjustment. Children with chronic illness are known to have an increased risk of emotional, behavioral, academic problems. Research findings show that children with chronic illnesses are at a higher risk for developing emotional problems such as anxiety, depression, social withdrawal and low self-esteem. The parents of children with Type 1 diabetes and asthma reported emotional and behavioral problems more. Also children with chronic illness tend to more behavior problems than healthy peers. Especially, increased risk of children with neurological conditions is explained by the lower level of cognitive functioning. The association of poor school performance with type I diabetes and sickle cell anemia is proposed.

Shame in Korean Language: Factor Analysis of Shame-Related Adjectives / 신경정신의학

OBJECTIVES: The aim of this study was to investigate shame-related adjectives in the Korean language and to explore the factor structure of these adjectives. METHODS: Shame-related words were extracted from an adjectives checklist, the Korean Dictionary, the Korean Synonym Dictionary, and various shame scales developed by Western investigators. A questionnaire (the Korean Shame Scale: KSS) was constructed from 62 selected adjectives, and administered to 210 college students and 204 adults. The subjects also completed the Beck Depression Inventory, the Brief-Fear of Negative Evaluation Scale, the Social Avoidance and Distress Scale, the Revised Cheek & Buss Shyness Scale, and the Marlowe-Crowne Social Desirability Scale. RESULTS: A principal component analysis of the KSS data revealed a four factor structure: mortification, modesty, shyness, and embarrassment. All except the modesty factor showed significant correlations with depression, fear of negative evaluation, social avoidance and distress, and shyness. The college student group reported experiencing a shame-related distressful emotion more frequently than the adult group. CONCLUSION: Shame was found to be a complex psychological construct composed of quite different emotions. These emotions not only included painful feelings and uncomfortable self-consciousness, but were also related to personality traits and interpersonal attitudes.

Shame in Korean Language: Factor Analysis of Shame-Related Adjectives / 신경정신의학

OBJECTIVES: The aim of this study was to investigate shame-related adjectives in the Korean language and to explore the factor structure of these adjectives. METHODS: Shame-related words were extracted from an adjectives checklist, the Korean Dictionary, the Korean Synonym Dictionary, and various shame scales developed by Western investigators. A questionnaire (the Korean Shame Scale: KSS) was constructed from 62 selected adjectives, and administered to 210 college students and 204 adults. The subjects also completed the Beck Depression Inventory, the Brief-Fear of Negative Evaluation Scale, the Social Avoidance and Distress Scale, the Revised Cheek & Buss Shyness Scale, and the Marlowe-Crowne Social Desirability Scale. RESULTS: A principal component analysis of the KSS data revealed a four factor structure: mortification, modesty, shyness, and embarrassment. All except the modesty factor showed significant correlations with depression, fear of negative evaluation, social avoidance and distress, and shyness. The college student group reported experiencing a shame-related distressful emotion more frequently than the adult group. CONCLUSION: Shame was found to be a complex psychological construct composed of quite different emotions. These emotions not only included painful feelings and uncomfortable self-consciousness, but were also related to personality traits and interpersonal attitudes.

High-Resolution Actigraphic Analysis of ADHD: A Wide Range of Movement Variability Observation in Three School Courses - A Pilot Study / 대한의료정보학회지

OBJECTIVES: This study was conducted to determine whether or not newly proposed high-resolution activity features could provide a superior analytic foundation compared to those commonly used to assess transitions in children's activities, under circumstances in which the types of courses attended exert different situational effects on activity levels. METHODS: From 153 children at a local elementary school, 10 subjects with attention deficit hyperactivity disorder (ADHD) and 7 controls were recruited. Their activity data was collected using an actigraph while they attended school. Ratios of partitioned activity ranges (0.5-2.8 G) during the entire activity were extracted during three classes: art, mathematics, and native language (Korean). Extracted activity features for each participant were compared between the two groups of children (ADHD and control) using graphs and statistical analysis. RESULTS: Activity distributions between ADHD and control groups for each class showed statistically significant differences spread through the entire range in art class compared to native language and mathematics classes. The ADHD group, but not the control group, experienced many significantly different intervals (> 50%) having low to very high activity acceleration regions during the art and languages courses. CONCLUSIONS: Class content appears to influence the activity patterns of ADHD children. Monitoring the actual magnitude and activity counts in a wide range of subjects could facilitate the examination of distributions or patterns of activities. Objective activity measurements made with an actigraph may be useful for monitoring changes in activities in children with ADHD in a timely manner.