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Objective@#This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. @*Methods@#Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. @*Results@#Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. @*Conclusion@#Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.
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Objectives@#：In this study, elderly hospitalized patients aged 65 years or older who were admitted to a university hospital and referred to the department of psychiatry were classified into youngest-old, middle-old, and oldest-old. It was conducted to find out what factors contribute to the agitation pattern by age group, wheth-er there is a difference in the factors, and whether there is a difference in the severity of the agitation pattern. @*Methods@#：From July 1, 2021 to December 31, 2021, the medical records of patients aged 65 years or older who were referred to the department of psychiatry were retrospectively reviewed. Age, gender, route of hospitalization, department of referral, reason for referral, treatment method, presence of internal and surgical diseases, and hematological test data were investigated. @*Results@#：There was a significant correlation with the RASS score in cases of surgery referral and high CRP levels for youngest-old aged 65 to 74 years, in cases of surgery referral, dementia and hyponatremia for middleold aged 75 to 84 years, in case of dementia for oldest-old aged 85 years old or older. In addition, there were differences in the severity of agitation patterns between age groups. @*Conclusions@#：As the age group increases, the agitation of delirium patients becomes more severe, and vari-ous factors contributing to the agitation pattern also differ by age group. Therefore, when treating elderly pa-tients with delirium, attention should be paid to factors that may affect agitation depending on age.
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Objectives@#：Zolpidem is a common drug used in insomnia. However, there are several reports of side effects of the central nervous system or sleep related behavior in patients who took zolpidem. This study was conducted to investigate risk factors affecting sleep related behavior after taking zolpidem in inpatients. @*Methods@#：From January 1, 2019 to December 31, 2019, medical records of patients who took zolpidem hospitalized at Inha University Hospital were reviewed retrospectively. @*Results@#：907 patients who took Zolpidem, 102 (11.2%) showed sleep related behavior, and if they were 65years of age or older, men, taking antipsychotics, and taking antipsychotics and benzodiazepines at the same time, they were significantly more likely to show sleep related behavior. @*Conclusions@#：Risk factors for sleep-related behavior after use of zolpidem are estimated gender, elderly, antipsychotics, and combination of antipsychotics and benzodiazepines.
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Objectives@#Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. @*Methods@#Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. @*Results@#In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. @*Conclusion@#Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.
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Objective@#This study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. @*Methods@#A total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. @*Results@#After the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. @*Conclusion@#We conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.
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Objectives@#Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. @*Methods@#Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. @*Results@#In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. @*Conclusion@#Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.
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Objective@#This study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. @*Methods@#A total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. @*Results@#After the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. @*Conclusion@#We conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.
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Background@#Burnout syndrome (BOS) is defined by the World Health Organization (WHO) as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. This study aims to create the Korean version burnout syndrome scale (KBOSS) that conforms to WHO’s definition of BOS and present the cut-off points for screening. @*Methods@#We developed the KBOSS based on WHO’s definition of BOS. An online survey was conducted through a specialized online research company. We recruited 444 workers for this research. The validity of the KBOSS was assessed using factor analysis and Pearson’s correlation. The KBOSS reliability was assessed using Cronbach’s alpha coefficient. The cut-off points for each of the three dimensions were derived using the upper quartile score. @*Results@#The validity and reliability of the KBOSS were good. Regarding reliability, the scale’s overall Cronbach’s alpha was 0.813. Cronbach’s alpha of each three-dimension was as follows: exhaustion, 0.916; cynicism, 0.865; and professional inefficacy, 0.819. The cut-off points of BOS three dimensions are exhaustion ≧ 21; cynicism ≧ 18; and inefficacy ≧ 15. @*Conclusion@#The developed questionnaire (KBOSS) can be a useful tool for screening of BOS.
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Objectives@#Adolescent suicide, a major cause of adolescent death, is affected by various factors, including attitudes toward suicide.This study investigated the association between parenting style and adolescents’ attitudes toward suicide and the mediating role of attitude toward suicide between parenting style and suicidal ideation. @*Methods@#We surveyed 1,071 adolescents from eight middle schools in Incheon, Korea. The survey included sociodemographic information, attitudes toward suicide, perception of parenting style, depression severity, and suicidality. @*Results@#Students in the authoritarian parenting group had a more permissive attitude toward suicide compared with the democratic and permissive parenting groups. These students considered that suicide is justified in certain situations and that choosing suicide is an individual’s right. They also had a negative attitude toward talking about suicide or intervening in others’ suicide. This association remained statistically significant after adjusting for the impact of confounding factors that could affect attitudes toward suicide, except for suicidal processes and preparedness to prevent suicide. In the mediation analysis, we observed that some factors of the attitudes toward suicide mediated between authoritarian parenting attitudes and suicidal ideation, namely, suicide as a right, preventability, suicide as normal/common, preparedness to prevent suicide, and resignation. @*Conclusion@#This study revealed the significant impact of parenting style on children’s attitudes toward suicide. Educating parents about the appropriate parenting attitudes–sympathetic and rational–can help prevent youth suicide.
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The prevalence of epilepsy and psychosis in 22q11.2 deletion syndrome (22q11.2DS) is higher than in the general population. Recent study on adults with 22q11.2DS reported that the most common trigger for provoked seizures was the use of antipsychotics and antidepressants. In this paper, blonaserin was used because aripiprazole, quetiapine, paliperidone were not effective. The patient had convulsion on the fourth day of taking blonaserin. Neurological and cardiac examination was carried out, and lamotrigine was added at the advice of neurologist. Than the patient didn’t have any convulsions and the symptoms gradually improved. When treating patients with 22q11.2DS, the medicine should be chosen carefully, and the patient should be observed closely, paying attention to the possibility of convulsions.
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Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by hyponatremia, low serum osmolality, and clinical euvolemia in the absence of diuretic medication. And the causes of SIADH are various, antipsychotic agents and traumatic brain injury (TBI) are well known. Quetiapine is often chosen to manage the maladaptive behavior of patients with post-TBI. Although a previous study reported that quetiapine doses ranging from 25 to 300 mg were effective and tolerable, the symptoms of the patient might be aggravated. The symptoms of TBI such as nausea, malaise, headache, lethargy, and mild cognitive deficits are similar to those of SIADH. So the differentiation between SIADH and TBI may be difficult. This paper reports a case of SIADH in a patient with a TBI after using a small dose of 25 to 50 mg quetiapine.
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Objectives@#The purpose of the present study was to examine the relationship between the chronotype and the burnout, so we investigated the mediating effects of the mediators such as perceived stress, stress response, and depression. @*Methods@#Employees working at Incheon Customs conducted a mental health self-examination through the internet. Among them, 174 people who agreed to the mental health survey participated in the study. Participants completed questionnaires including Composite Scale of Morningness (CSM), Center for Epidemiological Studies-Depression Scale (CES-D), Perceived Stress Scale (PSS), Stress Response Inventory (SRI), Maslach Burnout Inventory-General Survey (MBI-GS). @*Results@#Our results showed a higher degree of CES-D, SRI, exhaustion, and cynicism in evening and intermediate type compared to morning type, and a higher degree of professional efficacy in morning type compared to intermediate type. CSM was shown to have a direct effect on exhaustion and indirect effect through CES-D and SRI. CSM also had a direct effect on professional efficacy and had an indirect effect through the CES-D. However, CSM was found to have only indirect effects through the SRI for Cynicism. @*Conclusions@#In this study, individuals with evening type tend to experience a high degree of burnout (exhaustion, cynicism and professional efficacy) through the mediation effect of depression and stress response. Further study is necessary to reveal the effect of management of the depression and stress response in the employee with evening type.
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Objectives@#The purpose of the present study was to examine the relationship between the chronotype and the burnout, so we investigated the mediating effects of the mediators such as perceived stress, stress response, and depression. @*Methods@#Employees working at Incheon Customs conducted a mental health self-examination through the internet. Among them, 174 people who agreed to the mental health survey participated in the study. Participants completed questionnaires including Composite Scale of Morningness (CSM), Center for Epidemiological Studies-Depression Scale (CES-D), Perceived Stress Scale (PSS), Stress Response Inventory (SRI), Maslach Burnout Inventory-General Survey (MBI-GS). @*Results@#Our results showed a higher degree of CES-D, SRI, exhaustion, and cynicism in evening and intermediate type compared to morning type, and a higher degree of professional efficacy in morning type compared to intermediate type. CSM was shown to have a direct effect on exhaustion and indirect effect through CES-D and SRI. CSM also had a direct effect on professional efficacy and had an indirect effect through the CES-D. However, CSM was found to have only indirect effects through the SRI for Cynicism. @*Conclusions@#In this study, individuals with evening type tend to experience a high degree of burnout (exhaustion, cynicism and professional efficacy) through the mediation effect of depression and stress response. Further study is necessary to reveal the effect of management of the depression and stress response in the employee with evening type.
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Coronavirus disease 2019 (COVID-19) reduces airline passengers, which leads to a sharp decline in airline sales. They are concerned about the dismissal or unpaid leave of the flight pilot and crew, and the management of the passengers is also under great stress. Stress management methods for COVID-19 can be divided into general stress management such as ‘Let’s change me’, ‘Let’s find the source of life’, and ‘Let’s ask for help’, and mental health management in a disaster situation.
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OBJECTIVES@#This study examined the association between depression and survival time in terminal cancer patients admitted to the palliative care unit. Emotional problems are important for terminal cancer patients in the palliative care unit, and evaluation of patients' depression plays an important role in treatment planning.@*METHODS@#From October 2015 to August 2018, we conducted a retrospective study of 291 terminal cancer patients admitted to a palliative care unit at a university hospital and evaluated depression with PHQ-9 at admission. Of the 291 patients, 146 (50.2%) completed PHQ-9 but 145 (49.8%) were not evaluated due to loss of consciousness or rejection.@*RESULTS@#4-week survival rate in the Kaplan-Meier survival analysis were 45.4% in the non-depressed group (PHQ-9<10) and 18.7% in the depressed group (PHQ-9≥10). According to the severity of depression, in the Cox proportional hazard model, the risk of mortality in moderate, moderately sever and severe group was 2.778, 1.882 and 3.423 times higher than minimal group, respectively.@*CONCLUSIONS@#Of the patients with terminal cancer who were admitted to the palliative care unit, the survival time was shorter in the depressed group than in the non-depressed group. Further research is needed to determine if treatment of depression increase the survival in terminal cancer patients.
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BACKGROUND: For diagnosis of post-traumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS) is one of the most widely used structured diagnostic interviews. METHODS: In this study, we aimed to develop and validate the Korean version of CAPS for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ([DSM-5] K-CAPS-5). Seventy-one subjects with PTSD, 74 with mood disorder or anxiety disorder, and 99 as healthy controls were enrolled. The Korean version of the structured clinical interview for DSM-5-research version was used to assess the convergent validity of K-CAPS-5. BDI-II, BAI, IES-R, and STAI was used to evaluate the concurrent validity. RESULTS: All subjects completed various psychometric assessments including K-CAPS-5. K-CAPS-5 presented good internal consistency (Cronbach's α = 0.92) and test-retest reliability (r = 0.91). K-CAPS-5 showed strong correlations with the structured clinical interview for DSM-5 PTSD (k = 0.893). Among the three subject groups listed above there were significant differences in the K-CAPS-5 total score. The data were best explained by a six-factor model. CONCLUSION: These results demonstrated the good reliability and validity of K-CAPS-5 and its suitability for use as a simple but structured instrument for PTSD assessment.
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Anxiety Disorders , Diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Mood Disorders , Psychometrics , Reproducibility of Results , Stress Disorders, Post-TraumaticABSTRACT
OBJECTIVES: This study aimed to compare the quality of life reported by patients with attention-deficit/hyperactivity disorder (ADHD) to the patients' quality of life as reported by their caregivers. In addition, it aimed to examine how emotional problems, including depression and anxiety, and the severity of the symptoms affect the quality of life reported by the patients and their caregivers. METHODS: The patients' quality of life and their degree of depression and anxiety were measured using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Child Self-Report, the Children's Depression Inventory (CDI), and the Revised Children's Manifest Anxiety Scale, respectively. The caregivers' perception of the patients' quality of life and severity of the ADHD symptoms were measured using the PedsQL 4.0 Parent Proxy Report and the Conners' Parent Rating Scale (CPRS), respectively. A total of 66 participants completed the survey. The independent-samples t-test, Pearson's correlation analysis, and multiple regression analysis were conducted. RESULTS: The mean score of the PedsQL 4.0 Child Self-Report was significantly higher than the mean score of the PedsQL 4.0 Parent Proxy Report. However, for school function, the PedsQL 4.0 Child Self-Report score was significantly lower than that of Parent Proxy Report. The correlation between the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores was significant only for emotional function and social function. The multiple regression analysis showed that the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores were significantly predicted by the CDI and CPRS scores, respectively. CONCLUSION: Our results demonstrate that there are clear differences between the quality of life reported by the patient themselves and that reported by their caregivers. In addition, the findings suggest that it is critical to treat the patients' accompanying depressive symptoms.
Subject(s)
Adolescent , Child , Humans , Anxiety , Cardiopulmonary Resuscitation , Caregivers , Depression , Manifest Anxiety Scale , Parents , Proxy , Quality of LifeABSTRACT
The purpose of this study was to develop and evaluate psychometrically the Korean version of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual-fifth edition (K-PC-PTSD-5). In total, 252 participants were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual-fifth edition-research version (SCID-5-RV). The K-PC-PTSD-5 showed good internal consistency (α = 0.872), test-retest reliability (r = 0.89), and concurrent validity (r = 0.81). A score of 3 was identified as the threshold for clinically significant posttraumatic stress disorder (PTSD) symptoms. Overall, the results indicate that the K-PC-PTSD-5 is a useful, timesaving instrument for screening PTSD symptoms.
Subject(s)
Mass Screening , Primary Health Care , Reproducibility of Results , Stress Disorders, Post-TraumaticABSTRACT
OBJECTIVES: Clozapine is an antipsychotic agent commonly prescribed in patients with treatment-resistant schizophrenia. A drawback of using clozapine is risk of hematologic side effects ranging from mild neutropenia to fatal agranulocytosis. In clinical settings, other atypical antipsychotic agents are frequently combined with clozapine because some treatment-resistant patients would not respond to clozapine alone. Unfortunately, other atypical antipsychotics may also cause hematologic side effects, and the combination therapy might aggravate the possible neutropenic side effects. The purpose of this study was to investigate the difference in the incidence of hematologic side effects between clozapine monotherapy and augmentation therapy. METHODS: We retrospectively reviewed the medical records of 114 patients who were diagnosed with schizophrenia and being prescribed with clozapine in a single university hospital. White blood cell count (WBC) and absolute neutrophil count (ANC) were identified every 1 month in clozapine monotherapy group and clozapine-atypical antipsychotics augmentation therapy group. RESULTS: Compared with clozapine monotherapy group, augmentation therapy group showed no significant differences in WBC and ANC for the first 6 months of combination. Amisulpride augmentation showed temporary increases in WBC and ANC, especially compared with paliperidone augmentation. CONCLUSION: Augmentation of amisulpride to clozapine might be associated with temporary increases in WBC and ANC during the first 3 months of combination. Further investigations should be carried out to clarify the clinical significance of our findings.
Subject(s)
Humans , Agranulocytosis , Antipsychotic Agents , Clozapine , Follow-Up Studies , Incidence , Leukocyte Count , Leukocytes , Medical Records , Neutropenia , Neutrophils , Paliperidone Palmitate , Retrospective Studies , SchizophreniaABSTRACT
OBJECTIVES: Clozapine is an antipsychotic agent commonly prescribed in patients with treatment-resistant schizophrenia. A drawback of using clozapine is risk of hematologic side effects ranging from mild neutropenia to fatal agranulocytosis. In clinical settings, other atypical antipsychotic agents are frequently combined with clozapine because some treatment-resistant patients would not respond to clozapine alone. Unfortunately, other atypical antipsychotics may also cause hematologic side effects, and the combination therapy might aggravate the possible neutropenic side effects. The purpose of this study was to investigate the difference in the incidence of hematologic side effects between clozapine monotherapy and augmentation therapy. METHODS: We retrospectively reviewed the medical records of 114 patients who were diagnosed with schizophrenia and being prescribed with clozapine in a single university hospital. White blood cell count (WBC) and absolute neutrophil count (ANC) were identified every 1 month in clozapine monotherapy group and clozapine-atypical antipsychotics augmentation therapy group. RESULTS: Compared with clozapine monotherapy group, augmentation therapy group showed no significant differences in WBC and ANC for the first 6 months of combination. Amisulpride augmentation showed temporary increases in WBC and ANC, especially compared with paliperidone augmentation. CONCLUSION: Augmentation of amisulpride to clozapine might be associated with temporary increases in WBC and ANC during the first 3 months of combination. Further investigations should be carried out to clarify the clinical significance of our findings.