Effects of Pain and Somatic Symptoms on Elderly Depression Symptoms and Quality of Life / 우울ㆍ조울병

OBJECTIVES: The purpose of this study was to investigate the effects of pain and somatic symptoms on depressive symptoms and quality of life in the elderly population.METHODS: This study analyzed 147 elderly people living in a small city. This study used the Alcohol Use Disorder Identification Test (AUDIT-K), Short Geriatric Depression Scale (SGDS-K), Patient Health Questionnaire (PHQ-15), Geriatric Pain Measurement (GPM-K), World Health Organization Quality of Life (WHQQOL-BREF), and Multidimensional Scale of Perceived Social Support (MSPSS) as measuring tools for review of the elderly population. The student-t test and chi-square test were used to compare the characteristics of depression in the case of the participants. A hierarchical regression analysis was performed by the utilization of a Pearson's correlation test.RESULTS: Among the 147 elderly people studied, there were 43 (29.2%) who showed depressive symptoms. There was a difference in psychological variables according to depressive symptom between MSPSS (p < 0.01), GPM-K (p < 0.001), PHQ-15 (p < 0.001), and WHOQOL-BREF (p < 0.001). The quality of life of the elderly participants was significantly correlated with age (p < 0.05), annual income (p < 0.05), MSPSS (p < 0.01), and GPM-K (p < 0.01). As a note, the final regression model of the quality of life showed that 40.0% of the quality of life was related to high social support, low educational attainment, pain experienced by the participants and other characteristic physical symptoms.CONCLUSION: This study confirmed the effects of pain and somatic symptoms on the incidence of depression and quality of life in the elderly urban dwelling populations.

Psychosocial Factors Influence the Functional Gastrointestinal Disorder among Psychiatric Patients / 정신신체의학

OBJECTIVES: This study aimed to investigate the psychosocial characteristics of functional gastrointestinal disorder (FGID) in patients with psychiatric disorders. METHODS: This study was conducted with 144 outpatients visiting the psychiatric clinic at a university hospital. FGIDs were screened according to the Rome III questionnaire-Korean version. Demographic factors were investigated, and psychosocial factors were evaluated using the Hospital Anxiety Depression Scale, Patient Health Questionnaire-15, Childhood Trauma Questionnaire-Korean, and State-Trait Anger Expression Inventory. Chi-squared test and student's t-test were used as statistical analysis methods. RESULTS: There were differences in education level between two groups divided according to FGID status (χ²=10.139, p=0.017). Comparing the psychiatric disorder by FGID group, irritable bowel syndrome (IBS) group showed significant differences (χ²=11.408, p=0.022). According to FGID status, IBS group showed significant differences for anxiety (t=−3.106, p=0.002), depressive symptom (t=−2.105, p=0.037), somatic symptom (t=−3.565, p < 0.001), trait anger (t=−3.683, p < 0.001), anger-in (t=−2.463, p=0.015), and anger-out (t=− 2.355, p=0.020). Functional dyspepsia group showed significant differences for anxiety (t=−4.893, p < 0.001), depressive symptom (t=−3.459, p < 0.001), somatic symptom (t=−7.906, p < 0.001), trait-anger (t=−4.148, p < 0.001), state-anger (t=−2.181, p=0.031), anger-in (t=−2.684, p=0.008), and anger-out (t=−3.005, p=0.003). Nonerosive reflux disease group showed significant differences for anxiety (t=−4.286, p < 0.001), depressive symptom (t=−3.402, p < 0.001), somatic symptom (t=−7.162, p < 0.001), trait anger (t=−2.994, p=0.003), state anger (t=−2.259, p=0.025), anger-in (t=−2.772, p=0.006), and anger-out (t=−2.958, p=0.004). CONCLUSIONS: Patients with psychiatric disorders had a high prevalence of FGID, and various psychosocial factors contributed to such differences. Therefore, the psychiatric approach can offer better understandings and treatments to patients with FGID.

Cognitive Characteristics of Attention-Deficit Hyperactivity Disorder in Korean Wechsler Intelligence Scale for Children-Fourth Edition: Focused on General Ability Index and Cognitive Proficiency Index

OBJECTIVES: The purpose of this study was to investigate the clinical utility of the Korean Wechsler Intelligence Scale for Children-Fourth Edition (K-WISC-IV) and General Ability Index (GAI) in children with attention-deficit hyperactivity disorder (ADHD). METHODS: The GAI and Full Scale IQ (FSIQ) in K-WISC-IV were compared for a group of 79 children with ADHD and 234 normal children. The mean differences within each group were testified by the t-test and Cohen's d. The Wechsler's descriptive classifications for each GAI and FSIQ score were analyzed in the children with ADHD. Additionally, the critical value for the difference between the means of the FSIQ and GAI was calculated in the normal children. RESULTS: The score on the GAI was higher than that on the FSIQ in the children with ADHD, with a mean difference of 2.19 points. The implications of these findings are discussed regarding the cognitive characteristics of the children with ADHD. According to Wechsler's descriptive classification, the application of the GAI showed a lower (7.59%), equal (61.65%) or higher (60.76%) prevalence of ADHD compared to the application of FSIQ. CONCLUSION: The implications of these findings are discussed regarding the cognitive characteristics of the children with ADHD. The GAI reflecting the attention and behavioral problems in children with ADHD could be utilized as an alternative global intelligence estimate that considers their potential for development.

Differential Response Style on the Personality Assessment Inventory according to Compensation-Seeking Status in Patients with Traumatic Brain Injury / 정신신체의학

OBJECTIVES: This study examined the characteristics and differences of PAI(Personality Assessment Inventory) profile between compensation-seeking(CS) and treatment-seeking(TS) patients with traumatic brain injury(TBI) and assessed the clinical meaning of the characteristics and differences of profiles between the two groups. METHODS: 36 TBI patients who visited the Wonkwang University Hospital were selected. The patients were categorized as compensation-seeking TBI patients(n=22) and treatment-seeking TBI patients(n=14). The PAI scales and subscales were used to compare differences between two groups. t-verification for each variable and comparison analysis were performed. RESULTS: In validity scales, CS group showed significantly higher NIM scores and lower PIM scores than TS groups. In full scales, CS group showed significantly higher SOM, ANX, ARD, DEP, and SCZ scores than TS group. In subscales, CS group showed significantly higher SOM-S, ANX-A, ARD-P, DEP(-C, A, P), (MAN-I), PAR-H, SCZ(-T, P), BOR(-A, N), and ANT-S scores than TS groups. In supplementary scales, CS group showed significantly higher SUI, NON and AGG-P, and lower RXR scores than TS group. CONCLUSIONS: There were significant differences in PAI scales with validity scales, some full and subscales according to compensation seeking status in TBI patients. The CS patients tended to exaggerate their symptoms on PAI, and showed higher scores representing somatic preoccupation and emotional distress. These results show the usefulness of PAI in reflecting the significant psychological differences between two groups.

The Relationship between Quality of Life and Psychosocial Characteristics in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: This study was to identify the relationship between quality of life and psychosocial characteristics in patients with schizophrenia. METHODS: The subjects were eighty nine patients with schizophrenia according to DSM-IV. The Korean Quality of Life Scale (K-QLS) and the Korean modified Scale to measure Subjective Well-being under Neuroleptic treatment (KmSWN) were used to assess quality of life. The psychopathology of each patient was assessed by the Positive and Negative Syndrome Scale (PANSS). The Scale to Assess Unawareness of Mental Disorder (SAUMD) was used for differentiating presence and absence of insight. The Social and Occupational Functioning Assessment Scale (SOFAS), the Scale of Social Support (SSS), and the Family Adaptability and Cohesion Evaluation Scale (FACES) were used for assessing psychosocial characteristics. The correlation between the scores of each quality of life scale and other scales was examined, and multiple regression analysis was performed to assess the contribution of the scores of each quality of life scale to other scales. RESULTS: The K-QLS score was significantly related to the scores of the PANSS, the SAUMD, the social conflict domain of the SSS, and the SOFAS. The KmSWN score was significantly related to the scores of the PANSS, the SOFAS, the social conflict domain of the SSS, and the FACES. In multiple regression analysis, the scores on the PANSS (32.9%), the SAUMD (5.8%), and the FACES (4.0%) were contributed to the score on the K-QLS, and the scores on the social conflict domain of the SSS (17.3%) and the FACES (12.9%) were contributed to the score on the KmSWN. CONCLUSION: The relation between the K-QLS score and the scores of other scales means that the objective quality of life increases according to decreased the severity of symptom, the high level of insight and the socio-occupational function. And the relation between the KmSWN score and the scores of other scales means that the subjective quality of life increases according to the perceptions to the high level of social support, the low level of social conflict, and the high level of family adaptability and cohesion. The objective quality of life assessed by the K-QLS is affected primarily by the severity of symptoms, and the subjective quality of life assessed by the KmSWN is affected by the subjective perceptions of social conflict, family adaptation and cohesion. These findings suggest that the treatment of symptoms is important in the treatment of schizophrenic patients, but that it is also important to approach to the psychosocial characteristics to increase subjective satisfaction from the quality of life in them

The Relationship between Quality of Life and Psychosocial Characteristics in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: This study was to identify the relationship between quality of life and psychosocial characteristics in patients with schizophrenia. METHODS: The subjects were eighty nine patients with schizophrenia according to DSM-IV. The Korean Quality of Life Scale (K-QLS) and the Korean modified Scale to measure Subjective Well-being under Neuroleptic treatment (KmSWN) were used to assess quality of life. The psychopathology of each patient was assessed by the Positive and Negative Syndrome Scale (PANSS). The Scale to Assess Unawareness of Mental Disorder (SAUMD) was used for differentiating presence and absence of insight. The Social and Occupational Functioning Assessment Scale (SOFAS), the Scale of Social Support (SSS), and the Family Adaptability and Cohesion Evaluation Scale (FACES) were used for assessing psychosocial characteristics. The correlation between the scores of each quality of life scale and other scales was examined, and multiple regression analysis was performed to assess the contribution of the scores of each quality of life scale to other scales. RESULTS: The K-QLS score was significantly related to the scores of the PANSS, the SAUMD, the social conflict domain of the SSS, and the SOFAS. The KmSWN score was significantly related to the scores of the PANSS, the SOFAS, the social conflict domain of the SSS, and the FACES. In multiple regression analysis, the scores on the PANSS (32.9%), the SAUMD (5.8%), and the FACES (4.0%) were contributed to the score on the K-QLS, and the scores on the social conflict domain of the SSS (17.3%) and the FACES (12.9%) were contributed to the score on the KmSWN. CONCLUSION: The relation between the K-QLS score and the scores of other scales means that the objective quality of life increases according to decreased the severity of symptom, the high level of insight and the socio-occupational function. And the relation between the KmSWN score and the scores of other scales means that the subjective quality of life increases according to the perceptions to the high level of social support, the low level of social conflict, and the high level of family adaptability and cohesion. The objective quality of life assessed by the K-QLS is affected primarily by the severity of symptoms, and the subjective quality of life assessed by the KmSWN is affected by the subjective perceptions of social conflict, family adaptation and cohesion. These findings suggest that the treatment of symptoms is important in the treatment of schizophrenic patients, but that it is also important to approach to the psychosocial characteristics to increase subjective satisfaction from the quality of life in them

The Relationship of Neurocognitive Function, Symptoms, Social Cognition and Social Function in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: The purpose of this study is to identify the relationship among neurocognitive function, symptom, social cognition, and social and occupational function in patients with schizophrenia. METHODS: Thirty patients with schizophrenia were subjected to following tests: The Wisconsin card sorting test(WCST), the digit span, the Rey-Kim memory test, the vigilance test, the positive and negative syndrome scale(PANSS), the ways of coping checklist, the scale to assess the unawareness of mental disorder(SUM.D.), the social and occupational function assessment(SOFAS) and the index of well-being(IWB). RESULTS: The results were as follows. The perseverative errors of WCST in neurocognitive function were significantly negatively correlated with the score of the SOFAS. The memory quotients of Rey-Kim memory test were significantly positively correlated with the scores of the SOFAS. The scores of digit span were positively correlated with the general satisfaction of life. Negative symptom, general psychopathology and total PANSS score in symptom measurements were significantly negatively correlated with SOFAS and IWB. But positive symptom had no correlation with any scale. The problem focused coping in the social cognition variable was correlated with the score of SOFAS and the general satisfaction of life. Results of the stepwise regression for the SOFAS score, the problem focused coping, the K-A learning slope of Rey-Kim memory test, the PANSS total score and the perseverative errors of WCST predicted 65.7% of total variance. Results of the stepwise regression for the IWB score, for the feeling about life, the general psychopathology of PANSS and the K-A delayed recall score of Rey-Kim memory test predicted 41.8% of total variance. For the general satisfaction of life, the PANSS total score, the K-A delayed recall of Rey-Kim memory test, the backward recall, the failure to maintain set of WCST predicted 67.3% of total variance. CONCLUSIONS: In this study, executive function, verbal memory, attention, negative symptom, general psychopathology, and problem focused coping were significantly correlated with social and occupational function in patients with schizophrenia. To predict the social and occupational function, the neurocognitive functions and the social cognition were significant variables. To predict subjective quality of life, symptom and neurocognitive variables were significant variables. Although the scales are very limited to measure various function areas and the subjects are heterogeneous, it is noteworthy that the search for correlation variables and prediction variables of social function of patients with schizophrenia is helpful for treatment and intervention.

The Effect of Paroxetine in Chronic Schizophrenic Inpatients with Depressive Symptoms: A Double-Blind Placebo-Controlled Study / 신경정신의학

OBJECTIVES: This double-blind placebo-controlled study was conducted to demonstrate the improvement of depressive, positive and negative symptoms, and general psychopatholgy in depressed chronic schizophrenic inpatients with adjunctive paroxetine 20mg therapy in the morning. METHODS: Forty nine chronic schizophrenic inpatients with depressive symptoms were randomly received adjunctive paroxetine or placebo for 6 week study period. Therapeutic effect and side effects were evaluated by means of the Hamilton Rating Scale for Depression (HRSD), the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Extrapyramidal Symptom Rating Scale (ESRS), the UKU side effect rating scale (UKU), and the Clinical Global Impression (CGI) at baseline, first, second, forth, and sixth week of treatment in a controlled double-blind design. RESULTS: 18 patients completed six weeks of paroxetine therapy, and 18 patients placebo therapy. 1) Comparison between paroxetine and placebo groups: (1) HRSD total scores in both groups were significantly decreased (p< 01) but there was no statistically significant difference between 2 groups. This study showed that significant effect in paroxetine group appeared at 2nd week of treatment (p< 01), while in placebo group at 4th week of treatment (p< 01). (2) PANSS, BPRS, CGI, ESRS, and UKU: In both groups, PANSS total scores and CGI scores were significantly decreased respectively (p< 01, p< 05) and thus indicated the improvement of global psychopathology and entire effects. There were no significant differences between 2 groups in positive, negative symptoms, general psychopathology, and drug side effects. 2) Comparison between responding and nonresponding groups in paroxetine adjunctive therapy: (1) Compared with nonresponding group, responding group had significant decrease in HRSD total score (p< 01), in HRSD subitems such as depressed mood, suicide, psychic anxiety, and feelings of guilt (p< 01), and in other subitems such as work and activity, early insomnia, and hypochondriasis (p< 05). (2) Compared with nonresponding group, responding group had significantly decrease in BPRS total score (p< 01) and in general subscale of PANSS (p< 05). CONCLUSION: The results suggest that both paroxetine and placebo groups were improved in depressive symptoms, but paroxetine group had more rapid improvement than placebo group. There were no significant differences in positive symptoms, negative symptoms, general psychopathology, and drug side effects between two groups. Compared with nonresponding group in paroxetine adjunctive therapy, responding group had significant improvement in depressive symptoms and general psychopathology.

A Transcultural Study of Eating Attitudes and Behaviors among Adolescents / 신경정신의학

OBJECTIVES: The goal of this research was to attempt to examine ethnic and cultural differences in factors associated with disordered eating attitudes and behaviors. METHODS: Data were collected from the four groups of 3,129 high school students aged between 13 and 16 years who completed school-based survey conducted in 1996. The students(663 Korean urban, 821 Korean rural, 830 Korean-Chinese and 815 Chinese adolescents) completed an instrument which assessed weight, height, Body Mass Index(BMI), parental income, father's level of education, weight control questionnaire, Body Image Scale(BIS), and eating attitudes and behaviors using the Eating Attitude Test-26(EAT-26). RESULTS: BMI did not vary significantly by race, sex, and socioeconomic status. There were many severely underweight and severely overweight students among Korean-Chinese and Chinese than among Korean urban and Korean rural students. The EAT-26 mean scores of Korean-Chinese and Chinese subjects were significantly higher than those of Korean urban and Korean rural subjects. The EAT-26 mean score of Korean-Chinese was the highest among the four racial groups. The prevalence of high risk EAT-26(EAT-26> or =20) students of Korean-Chinese was 6.9% which was the highest among the four groups. The BIS mean scores of Korean rural and Korean urban subjects were significantly higher than those of Korean-Chinese and Chinese subjects. The Korean subjects were more dissatisfied with their body than the Chinese. The prevalences of weight control behaviors were 26.7% in Korean urban, 23.2% in Korean rural, 10.6% in Korean-Chinese, and 4.6% in Chinese subjects. Dieting and exercise were most popular for weight reducing in Korean subjects. Dieting and drug use were most popular in Chinese subjects. CONCLUSION: These data suggest that there must be many eating disorder patients in Korea and China, and the eating attitudes and behaviors are influenced by ethnic and cultural factors. Implications for understanding sociocultural influence on eating attitudes and behaviors and acculturation are discussed.