Association of Sleep Duration and Working Hours with Suicidal Ideation in Shift Workers: The Korean National Health and Nutrition Examination Survey 2007–2018

Objective@#This study investigated whether sleep duration and working hours were associated with the risk of suicidal ideation. @*Methods@#Data from 13,628 shift workers (age ≥19) were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2007–2018. We included healthy shift workers without depressive disorders and chronic medical illnesses. Sleep duration, working hours, and suicidal ideation were assessed using a self-reported questionnaire. Logistic regressions were used to examine the association of sleep duration and working hours with the risk of suicidal ideation. We examined interactions between sleep duration and working hours in association with suicidal ideation. In addition, interactions of sex or age were also analyzed. @*Results@#Shift workers sleeping for 52 hours/week had a higher risk of suicidal ideation compared with those working ≤40 hours/week. In terms of interaction by sex or age groups in the association between working hours and the risk of suicidal ideation, the relationship was stronger for men than for women and for those aged <45 years than for those aged ≥45 years. @*Conclusion@#Shorter or longer sleep durations, and long working hours were associated with a higher risk of suicidal ideation. Under long working hours, male shift workers or those aged <45 years were more vulnerable to suicidal ideation.

Insomnia, Anxiety, and Depression in Patients First Diagnosed With Female Cancer

Objective@#This study evaluated whether insomnia, anxiety, and depression differ by type of gynecological or breast cancer. @*Methods@#From September 7, 2011, to July 14, 2015, this study included 232 patients who were diagnosed with gynecological or breast cancer for the first time. The severity of insomnia, anxiety, and depression was measured with the National Cancer Center Psychological Symptom inventory (NCC-PSI), a self-reported scale, at the first outpatient visit after surgery. Multivariate logistic regression analyses were used to identify which diagnosis was associated with significant symptom levels. @*Results@#Patients with ovarian cancer and breast cancer reported more severe insomnia and problems with daily life compared with cervical cancer patients. Anxiety symptoms were more distressing among breast cancer patients than cervical cancer patients, and the degree of interference in daily life was severe. Finally, compared to those with cervical cancer, ovarian cancer and breast cancer patients reported more severe depression, and their daily life was disrupted more often than reported by cervical cancer patients. @*Conclusion@#Many female cancer patients are suffering distress but are not looking for specialized care. Psychiatric approach in the early stages of cancer diagnosis is needed and will require overcoming the stigmas of mental illness and cancer.

Association of Sleep Duration and Working Hours with Suicidal Ideation in Shift Workers: The Korean National Health and Nutrition Examination Survey 2007–2018

Objective@#This study investigated whether sleep duration and working hours were associated with the risk of suicidal ideation. @*Methods@#Data from 13,628 shift workers (age ≥19) were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2007–2018. We included healthy shift workers without depressive disorders and chronic medical illnesses. Sleep duration, working hours, and suicidal ideation were assessed using a self-reported questionnaire. Logistic regressions were used to examine the association of sleep duration and working hours with the risk of suicidal ideation. We examined interactions between sleep duration and working hours in association with suicidal ideation. In addition, interactions of sex or age were also analyzed. @*Results@#Shift workers sleeping for 52 hours/week had a higher risk of suicidal ideation compared with those working ≤40 hours/week. In terms of interaction by sex or age groups in the association between working hours and the risk of suicidal ideation, the relationship was stronger for men than for women and for those aged <45 years than for those aged ≥45 years. @*Conclusion@#Shorter or longer sleep durations, and long working hours were associated with a higher risk of suicidal ideation. Under long working hours, male shift workers or those aged <45 years were more vulnerable to suicidal ideation.

Insomnia, Anxiety, and Depression in Patients First Diagnosed With Female Cancer

Objective@#This study evaluated whether insomnia, anxiety, and depression differ by type of gynecological or breast cancer. @*Methods@#From September 7, 2011, to July 14, 2015, this study included 232 patients who were diagnosed with gynecological or breast cancer for the first time. The severity of insomnia, anxiety, and depression was measured with the National Cancer Center Psychological Symptom inventory (NCC-PSI), a self-reported scale, at the first outpatient visit after surgery. Multivariate logistic regression analyses were used to identify which diagnosis was associated with significant symptom levels. @*Results@#Patients with ovarian cancer and breast cancer reported more severe insomnia and problems with daily life compared with cervical cancer patients. Anxiety symptoms were more distressing among breast cancer patients than cervical cancer patients, and the degree of interference in daily life was severe. Finally, compared to those with cervical cancer, ovarian cancer and breast cancer patients reported more severe depression, and their daily life was disrupted more often than reported by cervical cancer patients. @*Conclusion@#Many female cancer patients are suffering distress but are not looking for specialized care. Psychiatric approach in the early stages of cancer diagnosis is needed and will require overcoming the stigmas of mental illness and cancer.

The Association between Physical Activity and Anxiety Symptoms for General Adult Populations: An Analysis of the Dose-Response Relationship

Objective@#The aim of this study is to determine the dose-response relationship between physical activity and anxiety symptoms. @*Methods@#We included data of 124,434 participants who had comprehensive health-screening examinations from January 1st, 2012, to December 31st, 2016, in Kangbuk Samsung Hospital, Seoul and Suwon, South Korea. We measured the level of physical activity using the International Physical Activity Questionnaire-short form (IPAQ-SF) and estimated anxiety symptoms using the Beck Anxiety Inventory (BAI). BAI scores of 19 and above were defined as cases. Logistic regression was used to analyze the association between physical activity and BAI-defined anxiety. Furthermore, we assessed whether sex differences might affect the relationship between physical activity and BAI-defined anxiety by stratifying our data. @*Results@#Compared with the sedentary group (0–600 METs-min/week), individuals achieving 600–6,000 METs-min/wk had a significantly lower risk of BAI-defined anxiety with a U-shaped relationship in general adults. After stratifying our data by sex, we found that optimal ranges of physical activity were 600–9,000 METs-min/wk for men, but 1,200–3,000 METs-min/wk for women. @*Conclusion@#We identified a U- or J-shaped association between physical activity and anxiety symptoms, suggesting an optimal dose and upper limit of physical activity for decreasing anxiety symptoms. Optimal levels and upper limits of physical activity for reducing anxiety symptoms were higher for men than for women.

The Relationship between Serum Vitamin D Levels,C-Reactive Protein, and Anxiety Symptoms

Objective@#The aim of study is to investigate the relationship between serum vitamin D, c-reactive protein (CRP) levels, and anxietysymptoms. @*Methods@#Serum vitamin D and CRP levels of 51,003 Korean adult participants were collected retrospectively. Anxiety symptoms wereassessed using the Korean version of Beck Anxiety Inventory. Logistic regression was used to estimate the odds ratio (ORs) of anxietysymptoms by serum vitamin D and CRP levels. The regression was adjusted for covariates, and each model was adjusted mutually for vitaminD and CRP levels. @*Results@#Compared with sufficient vitamin D levels (≥20 ng/mL), insufficient (10–19.99 ng/mL) and deficient (<10 ng/mL) vitamin Dlevels were significantly associated with risk of anxiety symptoms. Also, continuous vitamin D levels were negatively associated with therisk of anxiety symptoms. CRP levels did not affect the relationship between vitamin D levels and risk of anxiety symptoms. @*Conclusion@#Insufficient (10–19.99 ng/mL) and deficient (<10 ng/mL) vitamin D levels were significantly associated with risk of anxietysymptoms. After adjusting for CRP levels, the results were not changed, and no evidence of interaction between vitamin D and CRP levelswas found. CRP levels did not account for the association between vitamin D levels and risk of anxiety symptoms.Psychiatry Investig 2020;17(4):312-319

An Anxiety, Depressed Mood, and Insomnia in Newly Diagnosed Women Breast Cancer Patients and Thyroid Cancer Patients

OBJECTIVES: In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. METHODS: The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. RESULTS: Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). CONCLUSIONS: A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.

Role of Sleep Center for Integrative Approach to Sleep Disorders / 이화의대지

The prevalence of sleep disorder is about 30% of the population. Common sleep disorders are insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder and parasomnia. These sleep disorders lead various medical and mental complications. However, most sleep disorders are underdiagnosed and not treated appropriately. Sleep medicine is important for treating these sleep disorders and maintaining general healthy conditions. Specialized and comprehensive treatments for sleep disorder are important in sleep medicine.

Current Clinical Practice of Insomnia / 이화의대지

Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.

Association between Obesity Indices and MMSE-K in Elderly / 신경정신의학

OBJECTIVES: The aim of this study was to investigate associations between obesity indices and cognitive functions using data from individuals older than 65 years in South Korea. METHODS: A total of 151 Koreans older than 65 years participated in this study voluntarily. Obesity was determined using body mass index (BMI) and waist-hip ratio (WHR). Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination (MMSE-K). The participants were divided into four groups according to BMI : underweight (BMI or =25.0), and two groups according to WHR : normal (WHR or =0.8). Baseline characteristics were compared among different BMI or WHR subgroups. RESULTS: Older age and smoking habits showed an association with poor cognitive function. Among different BMI groups, the overweight group had the highest scores of MMSE-K ; the item scores for time and place orientation (4.48+/-0.770 and 4.80+/-0.500) and attention/calculation (4.00+/-1.258) as well as total score (25.88+/-2.877). Overweight in BMI showed an association with better cognitive function (OR(adjusted )=0.098, 95% confidence interval=0.017-0.577). CONCLUSION: In this study, the overweight group measured by BMI showed better cognitive function than other groups. Overweight in elderly might be acceptable in order to maintain cognitive performance. Further investigation regarding the underlying mechanism explaining the relationship between cognitive function and body weight will be needed.

Influences of Stress, Anxiety, Depression, and Personality Trait on Nausea, Vomiting, and Retching of Breast Cancer Patients Receiving Chemotherapy / 신경정신의학

OBJECTIVES: The aim of this study was to identify influences of stress, anxiety, depression, and personality trait on nausea, vomiting, and retching of breast cancer patients perceiving chemotherapy. METHODS: Breast cancer patients who were admitted to Ewha Womans University Cancer Center for women to receive chemotherapy participated in the study. In addition to sociodemographic and clinical factors, self-reported questionnaires, including Type D personality Scale 14, Hospital Anxiety and Depression Scale, and Global Assessment of Recent Stress scale were used to evaluate psychological factors of the subjects. For examination of anticipatory and post chemotherapy nausea, vomiting, and retching, the subjects filled out the Rhodes Index of Nausea, Vomiting, and Retching and Visual Analogue Scale. RESULTS: No significant influence of type D personality, anxiety, or depression on nausea, vomiting, and retching was observed. If the patient experienced more severe stress, higher scores for anticipatory and post chemotherapy nausea, vomiting, and retching were recorded. The tendency was retained after adjusting for the cycle number of chemotherapy, the emetic risk of the chemotherapy regimen, type D personality, anxiety, and depression. Specifically, financial problems, unusual happenings, ordinary daily stress, and general stress were significantly related to nausea, vomiting, and retching. CONCLUSION: Assessment of life stress, especially for financial problems, unusual happenings, and ordinary daily stress of patients receiving cancer chemotherapy can be used as an effective way to reduce the risk of nausea, vomiting, and retching related during chemotherapy.

A Study on Correlation between Anxiety Symptoms and Suicidal Ideation

OBJECTIVE: In South Korea, the number of deaths from suicide has increased in the last two decades, and suicide has become both a social and political problem. In this study, after controlling the variables influencing suicidal ideation, it was expected that it would be determined if anxiety symptoms are independently related to suicidal ideation. METHODS: Data were obtained from 327 psychiatric outpatients accomplished a self-reported questionnaire that included sociodemographic characteristics and clinical variables as well as self-rating scales for measuring the severity of one's anxiety, depression, and suicidal ideation. Logistic-regression analyses were used to determine the correlation between anxiety symptoms and significant suicidal ideation, adjusting for covariates. RESULTS: The patients with significant suicidal ideation were shown to be less educated, unemployed, never married, divorced, or separated by death, or living alone, and were shown to have a lower income, a drinking habit, a higher number of past suicide attempts, and more family members who committed suicide, than the patients without significant suicidal ideation. After adjusting the covariates influencing significant suicidal ideation, anxiety symptoms were associated with significant suicidal ideation. However, after adjusting for depressive symptoms, only the trait anxiety was associated with significant suicidal ideation. CONCLUSION: These findings suggest that anxiety symptoms are an independent risk factor for suicidal ideation. Clinicians may thus use anxiety symptoms for the screening examination when evaluating suicidal ideation and risk, and will have to actively evaluate and treat the anxiety symptoms of patients with suicidal tendencies.

Expression of Hepatocyte Growth Factor/c-met by RT-PCR in Meningiomas

BACKGROUND: Hepatocyte growth factor (HGF) is a potent mitogenic cytokine. C-met protein, which is known to be the HGF receptor has transmembrane tyrosine kinase activity and is encoded by the c-met oncogene. The HGF/c-met signaling pathway may play various roles in the carcinogenesis of various organs. METHODS: We examined HGF and c-met mRNA expression by utilizing reverse transcription polymerase chain reaction on 40 surgically resected intracranial meningiomas (25 benign, 10 atypical, and 5 anaplastic cases). RESULTS: An HGF overexpression was detected in 28%, 50%, and 80% of the benign, atypical and anaplastic meningiomas, respectively; a high expression of HGF or the coexpression of HGF/c-met was detected in the high grade meningiomas (the atypical and anaplastic cases, p=0.046, p=0.014). An HGF expression was statistically significant in the recurrent meningiomas (p=0.003), and HGF expression was significantly lower than c-met mRNA expression in benign meningiomas (p=0.034). CONCLUSIONS: There was no correlation between histologic subtypes and HGF/c-met expression. Determination of HGF expression can be used as a molecular predictor for recurrence of meningioimas. These results suggest that HGF and c-met expression in meningiomas may be associated with anaplastic progression.

Antipsychotic Effects of Quetiapine in Naturalistic Long Term Follow Up Study

OBJECTIVE: This study aimed to examine the effectiveness of quetiapine and the effects of dosage relates to its effectiveness on schizophrenia and schizoaffective disorder in a naturalistic setting in Korean people. METHODS: This study was a 24-week, open-label, non-comparative, naturalistic study of quetiapine in patients diagnosed with schizophrenia and schizoaffective disorder according to DSM-IV. We stratified the patients into mild [(clinical global impression severity (CGI-S) or =4 at baseline). We investigated the response rate, defined as clinical global impression improvement (CGI-I) < or =2, in the severe group and the aggravation rate in the mild group using the last-observation-carried-forward (LOCF) and the Kaplan-Meier method (K-M). RESULTS: During the 24 weeks, 151 (18.4%) of the participants dropped out of the study. There was a significant decrease in the mean CGI-S score, from 4.5+/-1.1 at baseline to 2.8+/-1.1 at 24 weeks. The response rate of severe group was 54.5% (estimated by LOCF) and 73.3% (K-M estimated) at 24 weeks. All patients who completed the study had taken a mean quetiapine dosage of 507.9+/-245.9 mg daily. The decrease of CGI-S score in high-dose group (the maximum dose was 750 mg/d or above) was statistically significant than that in recommended-dose group (the maximum dose was less than 750 mg/d). CONCLUSION: This study demonstrated the long-term effectiveness of quetiapine in the treatment of schizophrenia and schizoaffective disorder in a naturalistic setting in Korean people. This study suggests that higher than recommended quetiapine dosages could be more effective in some patients.

Patient Characteristics in Cases of Misdiagnosed Delirium upon Psychiatric Consultation in a University Hospital: A Pilot Study / 신경정신의학

OBJECTIVES: The misdiagnosis of delirium may result in a delay of correct diagnosis and appropriate treatment of the delirium. Additionally, aggravation of physical illnesses can occur. The objective of this study was to investigate patient characteristics in cases of misdiagnosed delirium upon psychiatric consultation in a university hospital. METHODS: Subjects included patients with delirium among all who we had consulted over a 12 week span. Psychiatric diagnosis was made by two well-trained psychiatrists by means of the DSM-IV-TR. Cognitive function, level of delirium, and physical function were evaluated by the Korean version of Mini Mental Status Examination (MMSE-K), the Delirium Rating Scale-Revised-98 (DRS-R-98), the Clinical Global Impression-Severity (CGI-S), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and the Global Assessment of Functioning Scale (GAF). In addition, we collected socio-demographic information, date of admission and consultation, present causes of consultation, and speculated psychiatric diagnoses made by referring physicians. RESULTS: Among 45 subjects with delirium, only 28 patients (62%) were diagnosed with delirium by referring physicians at the time of consultation. The remaining 17 patients (38%) had been diagnosed with other illnesses. The group of misdiagnosed patients tended to have a longer duration of formal education than those that had been correctly diagnosed. CONCLUSION: Early diagnosis and intervention of delirium can minimize subsequent problems related to delayed diagnosis. Therefore, it is vital to identify the factors related to misdiagnoses by referring physicians. This study showed that a longer duration of formal education is a contributing factor for the misdiagnosis of delirium. Longer education may cover up the typical symptoms of delirium. This can keep referring physicians from making a correct diagnosis. This study was a pilot study investigating diagnostic accuracy of delirium by referring physicians. Additional, well-controlled studies are warranted.

Attitudes of Korean Psychiatrists Toward Treatment Long-acting Injectable Antipsychotic / 신경정신의학

OBJECTIVES : Long acting injectable antipsychotic medication have the ability to sustain the drug effect for a long duration, thus enabling advances in the management of those psychiatric patients who have poor compliance or who have difficulty getting the oral form of their antipsychotic medications. Despite their benefits, previous studies have reported that depot antipsychotics have a much lower prescription ratein the treatment of schizophrenia or schizoaffective disorder. Psychiatrist's attitude toward depot antipsychotics clearly has an influence on the decision-making process regarding the selection of medications. Until now, there has been no data with respect to psychiatrists' attitudes regarding long-acting injectable antipsychotics in Korea. This study examined these attitudes toward antipsychotic depot medications as well as the factors which could contribute to their choice of depots. METHODS : We questioned 347 psychiatrists, who had been attending a conference, about their attitudes toward depot antipsychotic treatment. RESULTS : The most important factor causing reluctance with respect to prescribing depot treatment (for both classes of antipsychotics) was a presumed sufficient level of compliance with available oral antipsychotic treatments. In addition, typical depots are not considered to be an appropriate treatment option for first-episode patients, and as a result, they are used sparingly. Lastly, atypical longacting injectable drugs are avoided due to their strict criteria of insurance and high treatment costs. CONCLUSION : Aversions to prescribe depot treatment are frequent among psychiatrists and appear to be unrelated to the antipsychotic class. The stated reasons for not choosing depots are generally not supported by the current literature. Further research is required to clarify the advantages using depot treatments.

Psychiatric Symptoms, Neurocognitive Function and Quality of Life according to Brain-MRI Findings in the Traumatic Brain Injury Patients / 신경정신의학

OBJECTIVES: This study was intended to compare psychiatric symptoms, neurocognitive function and quality of life between normal finding group and abnormal finding group on Brain-MRI. We investigated which variables were related to quality of life (QOL) in traumatic brain injury (TBI) patients. METHODS: Among thirty nine patients who had mild to moderate TBI, twenty two patients (57%) showed abnormal brain MRI findings correlated with their injury and 17 patients (43%) showed normal or nonspecific brain MRI findings. All patients completed Symptom check list-90-revised (SCL-90-R), Beck depression inventory (BDI), State-trait anxiety inventory (STAI), Korean version of the Smith Kline Beecham Quality of Life scale (KvSBQOL) and Marlowe-Crown Social Desirability Scale (MCSDS). Two psychiatrists assessed the patients using Hamilton rating scale for depression (HAMD), Hamilton anxiety scale (HAMA) and Functional assessment scale (FAS). In addition, Korean Wechsler Adult intelligence Scale (K-WAIS), Rey-Kim Memory Test (R-KMT) and Kims frontal-executive neuropsychological test (KF-ENT) were assessed. RESULTS: On FAS, the mean score was significantly lower in the abnormal finding on B-MRI group than the normal finding group (p=0.014). In the patients with abnormal MRI findings, the QOL scores significantly correlated with several subscales of SCL-90-R (obsessive-compulsive, depression, anxiety, global severity index and positive symptom total), FAS and memory quotient after controlling for MCSDS. However, in the patients with normal MRI findings, QOL scores significantly correlated with BDI and all subscales of SCL-90-R. When all pertinent variables were entered in stepwise regression analysis, depression (p<0.05) and interpersonal sensitivity (p<0.05) subscales of SCL-90-R explained 38.5% and 17.7% of the variance of the QOL score in patients with abnormal MRI findings. As for the patients with normal MRI findings, depression (p<0.05) subscale of SCL-90-R accounted for 54.2% of the variance of the QOL score. CONCLUSION: TBI patients who have persisting abnormal brain findings suffered from impaired daily functioning. Depression and interpersonal sensitivity explained 55% of the variance of the QOL together. In the patients with normal brain MRI findings, objective depression or anxiety did not correlate with QOL whereas subjective depressive symptom accounted for 54.2% of the variance of the QOL. This study suggests that subjective psychiatric symptoms including depression significantly correlated with the subjective QOL of TBI patients regardless of their brain MRI finding.

Gender Identity Disorder

Gender identity disorders are characterized by strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex), as well as a persistent discomfort with one's sex or sense of inappropriateness in the gender role of that sex. There are no well-established or exhaustive explanations for the development of gender identity disorder. Gender identity appears to be established and influenced by psychosocial factors during the first few years of life. However, many authors have argued for biological factors, if not causative, may predispose an individual to a gender identity disorder. Because most gender dysphoric individuals have adamant requests for sex reassignment (many often already taking opposite-sex hormones supplied by other physicians), it is extremely difficult to engage the patients in treatment with anything other than surgical reassignment as the goal. However, because surgery is irreversible, it is important to engage these patients in psychotherapy, even if surgery is indicated. The therapist should be careful to base the goals of therapy on what is desired by the patient. Behavior therapy has been used to modify specific cross-gender behaviors of child with gender identity disorder.

A Study of Predictive Factors of Treatment Response to Sertraline in Patients with Obsessive-Compulsive Disorder / 신경정신의학

OBJECTIVES: The pharmacologic treatment of obsessive-compulsive disorder(OCD) with serotonergic antidepressant agents is well established in clinical psychiatry on the basis of serotonin hypothesis. Studies on predictive factors of treatment response to OCD are relatively scarce. The author compared the demographic factors, age of onset, length of illness, family history of mental illness, previous drug history for OCD, severity and type of symptoms between the drug responders and non-responders to find out the predicitive factors that may be related to treatment response. METHODS: The subjects were 31, both inpatients and outpatients who met the diagnostic criteria for OCD by DSM-IV and scored 20 or higher on the Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) completed 12-week trial of sertraline. Y-BOCS, National Institute of Mental Health Obsessive-Compulsive Scale(NIMHOCS), Clinical Global Impression Scale(CGI) were scored to measure the changes of obsessive-compulsive symptoms, and Hamilton Anxiety Scale(HAM-A) was measured at each visit. RESULTS: 1) The responders, defined as achieving at least a 40% decrease in the Y-BOCS total score and more than a 2 point decrease in CGI score, were 17(54.8%), and non-responders were 14(45.2%). Responders tended to show later onset(p<0.1), and shorter duration of illness(p<0.05), and less previous drug therapy for OCD(p<0.05) than non-responders. There were no significant differences in family history of mental illness between the two groups. 2) The baseline Y-BOCS compulsive score was significantly lower in responders(p<0.05), although there was no significant difference in the baseline severity of other measures. 3) The obsession of contamination and washing behaviors were more frequent, but compulsive counting was not shown, in responders(p<0.05). The pathological doubt tended to be more common in nonresponders(p<0.1). CONCLUSIONS: In summary, the patients with shorter duration of illness, less prior drug therapy for OCD, and less severe compulsive behaviors, and the obsession of contamination and washing behaviors are expected to be better outcome with sertraline, whereas compulsive counting are the predictor of poor response.

Early Development and Premorbid Social Adjustment during Childhood and Adolescence in Schizophrenic Patients / 신경정신의학

OBJECTIVES: Schizophrenia, one of the major mental illnesses, shows abnormal developmental patterns such as delayed developmental milestones, impaired language and motor function, and poor premorbid social adjustment long before the onset of clinical symptoms of illness. In this study, we tried to find out developmental patterns and premorbid adjustment during childhood and adolescence in Schizophrenic patients. METHODS: The subjects were 56 inpatients (26 male patients and 30 female patients) who met the diagnostic criteria for schizophrenia by DSM-IV and 52 healthy control subjects (25 male patients and 26 female patients). Interview with subjects and their families and the review of medical records were done to assess sociodemographic factors, timing of developmental milestones, language and motor function of childhood, and timing of sexual maturational events. Obstetrical Complication Scale of Lewis was used to get information on the subjects' prenatal and perinatal history, and Premorbid Social Adjustment Scale (PSAS) to assess premorbid adjustment. RESULTS: 1) There were no significant differences in the rates of obstetrical complications. The deveolpmental milestones during infancy such as sitting, walking, age of first sentence were significantly delayed in the Schizophrenics than in the controls (p<0.05). 2) Disturbances of speech and language development were significantly more common in the schizophrenics than in the controls (p<0.05), but there were no significant differences in the rates of disturbance in motor development. Mean ages of reading and writing were significantly delayed in schizophrenics than in the controls (p<0.05). No significant differences were found between males and females for either language disturbance or motor disturbance in the Schizophrenics. 3) During adolescence, premorbid adjustment was poorer in Schizophrenic patients (p<0.05). The Schizophrenic patients scored significantly worse than the controls on both sociability and schooling domains (p<0.05). There was a trend for correlation between poor premorbid functioning and early age of onset, but it failed to achieve statistical significance (Spearman's coeff =-0.27, p=.07). 4) Male Schizophrenic subjects showed poorer premorbid functioning on schooling domain than female Schizophrenic subjects (p<0.05). No significant difference was recogni ed in timing of sexual maturational events between Schizophrenics and controls. CONCLUSION: In summary, the Schizophrenics were significantly delayed in infantile developmental milestones, impaired in development of language, delayed mean age of reading and writing, and showed poorer premorbid social adjustment than the controls.