Screening Tool for Anxiety Disorders: Development and Validation of the Korean Anxiety Screening Assessment

OBJECTIVE: This study evaluated the psychometric properties of the Korean Anxiety Screening Assessment (K-ANX) developed for screening anxiety disorders. METHODS: Data from 613 participants were analyzed. The K-ANX was evaluated for reliability using Cronbach’s alpha, item-total correlation, and test information curve, and for validity using focus group interviews, factor analysis, correlational analysis, and item characteristics based on item response theory (IRT). The diagnostic sensitivity and specificity of the K-ANX were compared with those of the Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder 7-item scale (GAD-7). RESULTS: The K-ANX showed excellent internal consistency (α=0.97) and item-total coefficients (0.92–0.97), and a one-factor structure was suggested. All items were highly correlated with the total scores of the BAI, GAD-7, and Penn State Worry Questionnaire. IRT analysis indicated the K-ANX was most informative as a screening tool for anxiety disorders at the range between 0.8 and 1.6 (i.e., top 21.2 to 5.5 percentiles). Higher sensitivity (0.795) and specificity (0.937) for identifying anxiety disorders were observed in the K-ANX compared to the BAI and GAD-7. CONCLUSION: The K-ANX is a reliable and valid measure to screen anxiety disorders in a Korean sample, with greater sensitivity and specificity than current measures of anxiety symptoms.

The Reliability and Validity of the Korean Version of the Autism-Spectrum Quotient

OBJECTIVE: This study was conducted to investigate the reliability and validity of the Korean version of Autism-Spectrum Quotient (AQ). METHODS: 20 participants with high-functioning autism (HFA) and 99 normal participants were recruited. All participants were completed the AQ and Empathy Quotient (EQ), and parents of the HFA group completed the parent-report AQ. For testing the reliability, we examined Cronbach’s alpha, performed item analysis, and compared self versus parent report score of HFA participants. For testing the validity, we compared the difference of the score of AQ among HFA and control group using independent t-tests, and performed correlation analysis between AQ and EQ. The receiver operation characteristic curve analysis was performed to determine a cut-off. RESULTS: The Korean version of the AQ exhibited adequate internal consistency, and in most items, the HFA group scored higher in comparison to the control group. It was demonstrated that AQ has good discriminant validity through the confirmation of the significant difference in the AQ score between two groups. The concurrent validity was established through the significant correlation between AQ and EQ in the HFA group. The best estimate cut-off score of AQ for screening was 23. CONCLUSION: The Korean version of the AQ was determined as a reliable and valid instrument to assess HFA in Korean population.

Protective Role of Parenting Attitude on the Behavioral and Neurocognitive Development of the Children from Economically Disadvantaged Families

OBJECTIVE: Association between home environment and the behavioral and neurocognitive development of children from a community childcare center for low-income families was examined (aged 6 to 12 years, n=155). METHODS: The parents performed a questionnaire on home environment (K-HOME-Q) to assess home environment including parenting attitude and the Child Behavior Checklist (K-CBCL). The children performed the Wechsler Intelligence (IQ) Scale, Stroop interference test (Stroop), word fluency test (WF), and design fluency test (DF) to assess their neurocognitive development. RESULTS: ‘Nurturing of Development’ and ‘Variety of Language Interaction’ scores from the K-HOME-Q, were inversely associated with total behavior problems, externalization, rule-breaking, and aggressive behavior subscales of K-CBCL, and ‘Emotional atmosphere’ and ‘Tolerance toward the child’ scores showed inverse associations with the total behavior problems, rule-breaking, aggressive behavior, and withdrawn/depressed subscales. Despite economic hardship, the mean scores of the neurocognitive tests were comparable to the average level of Korean children’s normative sample. However, ‘Nurturing of Development’ and ‘Tolerance toward the Child’ score of K-HOME-Q were associated with better executive function (IQ, WF, DF). CONCLUSION: These results suggest that parental stimulation of development and tolerant parenting attitude may offer protection against the negative effects of suboptimal economic environment on children’s behavior and neurocognitive development.

Clinical Characteristics of Aggressive Behavior Problems in Children with Autism Spectrum Disorder: Preliminary Study

OBJECTIVES: The aim of this study was to investigate the clinical characteristics of aggressive behavior problems in children and adolescents with autism spectrum disorder (ASD). METHODS: Children and adolescents with ASD, aged 6–18 years, were included in this study. We divided them into two groups according to the presence or absence of aggressive behavior. They were assessed using three scales, the Korean-Child Behavior Checklist (K-CBCL), Behavior Problem Inventory, and Social Communication Questionnaire, which were completed by their parents, who conducted a continuous performance test to evaluate their attention function. The statistical analysis was done using the Mann-Whitney U-test between the two groups at a p-value of 0.05. RESULTS: A total of 17 children participated in this study. Ten children (7 boys, 12.4±4.27 years) were included in the group with aggressive behavior problems and 7 children (6 boys, 13.8±3.53 years) in the group without aggressive behavior problems. There were no significant differences in the age, gender or intelligence quotient of the two groups. The children with aggressive behavior problems showed a trend of higher T-scores in the attention problems and anxiety/depressed subscale of the CBLC (p<0.1). CONCLUSION: The results suggest that aggressive behavior problems in children with ASD may be related to their attention problems, anxiety and depression.

Stress Coping Strategies and Quality of Life in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: The aims of this study were to investigate the pattern of stress coping strategies and the effects of stress coping strategies on quality of life in patients with schizophrenia. METHODS: Stress coping strategies and quality of life were examined using Ways of Coping Checklist and Schizophrenia Quality of Life Scale for 98 patients with schizophrenia. Stress coping strategies were composed of problem-focused coping, social support seeking, emotion-focused coping, and wishful thinking. Among these, problem-focused coping and social support seeking were active coping strategies while emotion-focused coping and wishful thinking were passive coping strategies. Positive and Negative Syndrome Scale (PANSS) and Beck's Depression Inventory (BDI) were also administered. RESULTS: Active coping scores were higher than passive coping scores in patients with schizophrenia. Quality of life was higher in the active coping group compared to the passive coping group. Active coping usage was a significant predictor of higher quality of life even after controlling for gender, age, PANSS, and BDI scores. CONCLUSION: Patients with schizophrenia used more active coping strategies than passive coping strategies, which showed significant association with higher quality of life. A treatment program to provide education on use of active coping strategies in a proper and flexible way might contribute to enhanced quality of life in patients with schizophrenia.

Reliability and Validity of Korean Version of the Conners Adult Attention Deficit Hyperactivity Disorder Scale in General Population / 신경정신의학

OBJECTIVES: This study was conducted in order to determine the validity and reliability of the Korean Version of the Conners Adult ADHD Rating Scales-42 items & 26 items (K-CAARS-42 & K-CAARS-26) in nonclinical adult subjects. METHODS: The K-CAARS-42 & K-CAARS-26 was tested in non-clinical (n=270) native Korean-speakers. Internal consistency reliability was calculated using Cronbach's alpha and test-retest reliability was measured using Pearson correlations. To see validity, we performed the confirmatory factor analysis for determination of whether the four-factor model fit the data. RESULTS: The results showed that the subscales had acceptable internal consistency reliability and high test-retest reliability ; and the second-order scores showed significant correlation with the Korean version of the Barratt Impulsiveness Scale-11-Revised and Prospective and Retrospective Memory Questionnaire. The Confirmatory factor analysis revealed a four-factor structure of both K-CAARS-42 and K-CAARS-26. CONCLUSION: The K-CAARS-42 & K-CAARS-26 is reliable and has possible utility for symptom assessment of attention deficit and hyperactivity disorder in nonclinical adult subjects. Further research is needed in order to determine the cutoff score for administration of the K-CAARS-42 & K-CAARS-26 to clinical adult subjects.

Efficacy of the Mentalization Improvement Program for Adolescent (MIPAdo) for Enhancement of Mental Health in School Children

OBJECTIVES: Understanding the emotions, thoughts, feelings and behaviors of others, as well as oneself, is part of the mentalizing function. We developed a new school-based community model for mental health, called the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM), based on the concept of mentalization. METHODS: The MIPAdo-CM was composed of 12 sessions and was applied to 403 students in the 2nd grade of a middle school. Every session was conducted after the regular school hours for 6 weeks. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test (EET), Peer Aggression Scale (PAS), Peer Bullying Scale (PBS), School Adjustment Scale (SAS), Test Anxiety Inventory (TAI) and Visual Analogue Scale between the subject and the control group. RESULTS: There was no significant difference between two groups in AMPQ-R, EET, PAS, PBS, SAS, and TAI. On the Visual Analoge Scale, however, students in the trial classes reported more increase in understanding and respect for both others and themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves, erence between two groups in AMPQ-R, Empathy test, To prove objective usefulness of this program, further studies with more structured design will be needed.

Efficacy of the Short Form of Mentalization Improvement Program for Adolescent (MIPAdo) for Enhancement of Mental Health in School Children

OBJECTIVES: We developed the short form of the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM-S), based on the concept of the mentalization. METHODS: The MIPAdo-CM was composed of 6 sessions and was applied to 133 students in the 1st grade of a middle school for six weeks during their regular school hours. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test, Peer Aggression Scale, Peer Bullying Scale, School Adjustment Scale, Test Anxiety Inventory and Visual Analogue Scale between the subject and the control group. RESULTS: On the Visual Analoge Scale, students in the trial classes reported an increased understanding and respect for others, as well as themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves. To prove objective usefulness of this program, further studies should be administered in the form of long-term, regular and structured courses.

The Study on Reliability and Validity of Korean Version of the Barratt Impulsiveness Scale-11-Revised in Nonclinical Adult Subjects / 신경정신의학

OBJECTIVES: This study was conducted in order to determine the validity and reliability of the Korean version of the Barratt Impulsiveness Scale-11-Revised (K-BIS-11-R) in Nonclinical Adult Subjects. METHODS: The K-BIS-11-R was tested in non-clinical (n=270) native Korean-speakers. Internal consistency reliability was calculated using Cronbach's alpha and test-retest reliability was measured using Pearson correlations. To see external validity, we performed confirmatory factor analysis for determination of whether the three-factor model, proposed by the previous report, fit the data. RESULTS: According to the results, the K-BIS-11-R had an acceptable test-retest reliability and internal consistency reliability. In addition, the K-BIS-11-R total score and second-order subscale score showed significant correlation with Conners' Adult attention deficit/hyperactivity disorder Rating Scale-Korean and Buss & Durkee Hostility Inventory. In addition, no significant difference was observed between the K-BIS-11-R total score and demographic variables. Thus, the K-BIS-11-R total score was transformed to standard score. CONCLUSION: K-BIS-11-R is a reliable and valid measure and has possible utility for assessment of impulsiveness in nonclinical adult subjects. Further research is needed in order to determine the cutoff score for administration of K-BIS-11-R to clinical adult subjects.

A Pilot Study of the Usefulness of Intelligence Test in Assessment of Attention-Deficit Hyperactivity Disorder

OBJECTIVES: We analyzed the usefulness of intelligence test in assessing attention-deficit hyperactivity disorder (ADHD). METHODS: The medical records of 312 patients with ADHD who visited the child psychiatry department in one university hospital in Seoul, Korea, were reviewed. Demographic data and scores on the Korean Wechsler Intelligence Scale for Children-III (K-WISC-III) and Korean-Conners' Parent Rating Scale (K-CPRS) were analyzed. To assess the relationship with comorbidities, ADHD subjects were classified as; externalizing disorders, internalizing disorders, tic disorders, and no comorbidities. RESULTS: Verbal intelligence quotient (VIQ) was significantly higher than performance IQ (PIQ)(102.6+/-14.44, 99.2+/-14.48, p<.001). Using mean scatter method, subtest scores such as 'information, similarities, digit span and coding' were significantly lower than mean scores of sum of subtests of VIQ or PIQ (p<.05). Regarding comorbidities, children with externalizing disorders exhibited. Lower scores on 'information and vocabulary' than other groups (p=.008). Children with no comorbidities exhibited higher scores on 'similarities and object assembly' than children with externalizing/internalizing disorders (p=.001) and also on 'comprehension' than children with externalizing disorders (p=.006). For subtypes of ADHD, children with hyperactive-impulsive type had higher scores on 'comprehension' than children with inattentive and combined type (p=.004). CONCLUSION: These results suggested that intelligence test might provide useful information for assessing ADHD.

A Pilot Study of the Usefulness of Intelligence Test in Assessment of Attention-Deficit Hyperactivity Disorder

OBJECTIVES: We analyzed the usefulness of intelligence test in assessing attention-deficit hyperactivity disorder (ADHD). METHODS: The medical records of 312 patients with ADHD who visited the child psychiatry department in one university hospital in Seoul, Korea, were reviewed. Demographic data and scores on the Korean Wechsler Intelligence Scale for Children-III (K-WISC-III) and Korean-Conners' Parent Rating Scale (K-CPRS) were analyzed. To assess the relationship with comorbidities, ADHD subjects were classified as; externalizing disorders, internalizing disorders, tic disorders, and no comorbidities. RESULTS: Verbal intelligence quotient (VIQ) was significantly higher than performance IQ (PIQ)(102.6+/-14.44, 99.2+/-14.48, p<.001). Using mean scatter method, subtest scores such as 'information, similarities, digit span and coding' were significantly lower than mean scores of sum of subtests of VIQ or PIQ (p<.05). Regarding comorbidities, children with externalizing disorders exhibited. Lower scores on 'information and vocabulary' than other groups (p=.008). Children with no comorbidities exhibited higher scores on 'similarities and object assembly' than children with externalizing/internalizing disorders (p=.001) and also on 'comprehension' than children with externalizing disorders (p=.006). For subtypes of ADHD, children with hyperactive-impulsive type had higher scores on 'comprehension' than children with inattentive and combined type (p=.004). CONCLUSION: These results suggested that intelligence test might provide useful information for assessing ADHD.

The Relationship between Empathy and Medical Education System, Grades, and Personality in Medical College Students and Medical School Students / 한국의학교육

PURPOSE: This study investigated the relationship between empathy and medical education system, grades, and personality in medical college (MC) students and medical school (MS) students. METHODS: One hundred fifty-five MC students and 137 MS students participated in this study, completing questionnaires on sociodemographic data, Jefferson Scale of Empathy, S-version, Korean edition (JSE-S-K), and Temperament and Character Inventory (TCI). RESULTS: Reward Dependence (RD), Cooperativeness (C), and Self-directedness+ Cooperativeness (SC), which are subscales of the TCI, correlated significantly with JSE-S-K score. Third-year students had significantly higher scores on the JSE-S-K than first-year students. MS students had significantly higher scores on the JSE-S-K and the SC subscale of the TCI than MC students. However, there were no significant differences in empathy with regard to age, sex, motivation toward medical science, club activity, and applied specialty. CONCLUSION: These results suggest that empathy is associated with personality traits, such as RD, C, and SC, and medical education curriculum contributes incrementally to empathy for students. The difference in test scores for empathy between MC students and MS students might be due to differences in personality traits, such as SC.

A Preliminary Study for Continuous Performance Test by Subtypes of Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The purpose of this study was to compare two subtypes of attention-deficit hyperactivity disorder (ADHD) and controls in their attention using ADHD diagnostic system(ADS), a kind of continuous performance test. METHODS: Subjects of this study were 8 children with ADHD-predominantly inattentive type, 28 children with ADHDcombined type and 20 control children. Ages ranged from 5 to 14 years. The Korean Educational Development Institute version of the Wechsler Intelligence Scale for Children(KEDI-WISC) and the ADS were administered to all subjects to provide measures of intelligence and attention. RESULTS: Significant differences were found in the ADS variables for the three groups. When compared with controls, the ADHD-predominantly inattentive type children scored significantly higher on the omission error at middle stage and later stage and ADHD-combined type children scored significantly higher on the omission error and reaction time at later stage. When compared with the other two groups, the ADHD-combined type children scored significantly higher on the commission error at all three stages. CONCLUSION: Our results suggest that the two subtypes of ADHD have different features in attention deficit. And there was a possibility that commission error is available variable to show cognitive characteristics of ADHD-combined type than any other ADS variables. Further studies are needed to evaluate this finding.

Change of Cognitive Functions in the Geriatric Depression Living in the Institution: 1 Year Follow-Up Study

OBJECTIVES: Cognitive impairment often occurs with geriatric depression, and may persist despite remission of depression. The authors investigated change of cognitive functions in geriatric depression according to time interval to identify whether cognitive impairment may persist or not. METHODS: At baseline and 1 year follow-up, total 88 non-demented participants living in the asylum for the aged had a clinical examination that included depression assessment (SGDS-K : Short Geriatric Depression Scale of Korean version) and neuropsychological test (frontal lobe function test and CERAD-K : the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease). We divided the elderly into two groups (depressed : 27, non-depressed : 61) and evaluated the differences in change of cognitive functions. RESULTS: Depressed group had lower scores on the word delayed recall test and construction recall test than non-depressed group at one-year follow-up. Except executive function, there was no significant difference in cognitive change between two groups according to time interval. CONCLSION: These results support previous observations that cognitive impairment in geriatric depression may persist, especially in the executive function. Timely identification of executive function of depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

Cognitive Dysfunction in the Geriatric Depression Living in the Institution

OBJECTIVES: There is a wide spectrum of cognitive dysfunction in geriatric depression due to heterogeneity. The Authors tried to investigate cognitive dysfunction in the elderly with depression and the association between geriatric depression and demographic variables such as sex, age, and education. METHODS: Total 101 non-demented participants living in the asylum for the aged had completed frontal lobe function test (executive function and conceptualization) and CERAD-K (the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease) to evaluate neuropsychological function. Symptoms of depression were evaluated by SGDS-K (Short Geriatric Depression Scale of Korean version). We divided the elderly into two groups (depressed, non-depressed group) to evaluate the differences in cognitive function. RESULTS: 30 (29.7%) of the subjects suffered depression and 50 (49.5%) had cognitive decline. Geriatric depression is not associated with age, sex, and education. Depressed older adults had lower executive function score in total group and cognitive decline group than non-depressed. Within cognitive decline group, subject with geriatric depression had lower scores in word fluency and word delayed recall than non-depressed. There was significant correlation between SGDS-K score and executive function. CONCLUSION: Subjects with geriatric depression had significant executive dysfunction. Executive dysfunction in depressed older adults may provide the basis for further investigation of mechanisms of geriatric depression. Timely identification of executive dysfunction fundamental to daily activities of depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

Analysis of 1968 Cases of Preoperative Laboratory Screening Test Results / 대한마취과학회지

BACKGROUND: The goal of preoperative screening test is to reduce the perioperative morbidity by patients management in case of abnormal test results. But, in view of the low incidence of perioperative complication in otherwise healthy surgical population and cost of routine preoperative screening tests, further examination of their usefulness is required. METHODS: The charts of 1968 patients performed preoperative screening laboratory tests were reviewed to analyse the results of tests retrospectively. The preoperative screening laboratory tests are hemoglobin, platelet count, bleeding time, prothrombin time, partial thromboplastin time, chest X-ray, electrocardiography (ECG), liver function test (LFT), urinalysis, BUN and creatinine. In cases of abnormal results obtained, further studies (pulmonary function test (PFT), arterial blood gas analysis (ABGA), 2D- echocardiography, holter ECG, coronary angiography and abdominal sonography) were analysed. RESULTS: The incidence of abnormal results of total preoperative screening test is 4.5%. The incidence of abnormal results of ECG, chest X-ray, LFT, hemoglobin, and others are 8.3%, 7.8%, 3.7%, 2% and less than 1% in order. For further study, PFT was done in 58 patients, ABGA in 72 patients, 2D-echocardiography in 96 patients, and Holter ECG in 6 patients. CONCLUSION: This study has shown that routine preoperative laboratory screening tests provided little information. Therefore, further studies would be necessary to evaluate the cost-benefit of preoperative screening test compared with the other methods such as history taking and physical examinations that is needed little cost.

Analysis of 1968 Cases of Preoperative Laboratory Screening Test Results / 대한마취과학회지

BACKGROUND: The goal of preoperative screening test is to reduce the perioperative morbidity by patients management in case of abnormal test results. But, in view of the low incidence of perioperative complication in otherwise healthy surgical population and cost of routine preoperative screening tests, further examination of their usefulness is required. METHODS: The charts of 1968 patients performed preoperative screening laboratory tests were reviewed to analyse the results of tests retrospectively. The preoperative screening laboratory tests are hemoglobin, platelet count, bleeding time, prothrombin time, partial thromboplastin time, chest X-ray, electrocardiography (ECG), liver function test (LFT), urinalysis, BUN and creatinine. In cases of abnormal results obtained, further studies (pulmonary function test (PFT), arterial blood gas analysis (ABGA), 2D- echocardiography, holter ECG, coronary angiography and abdominal sonography) were analysed. RESULTS: The incidence of abnormal results of total preoperative screening test is 4.5%. The incidence of abnormal results of ECG, chest X-ray, LFT, hemoglobin, and others are 8.3%, 7.8%, 3.7%, 2% and less than 1% in order. For further study, PFT was done in 58 patients, ABGA in 72 patients, 2D-echocardiography in 96 patients, and Holter ECG in 6 patients. CONCLUSION: This study has shown that routine preoperative laboratory screening tests provided little information. Therefore, further studies would be necessary to evaluate the cost-benefit of preoperative screening test compared with the other methods such as history taking and physical examinations that is needed little cost.