Association between Quantitative Electroencephalography Findings and Cognitive-Behavioral Characteristics in Attention Deficit/Hyperactivity Disorder : A Retrospective Cross-Sectional Study / 신경정신의학

OBJECTIVE: This study examined the association between the wave form in quantitative electroencephalography (QEEG) and the cognitive and behavioral characteristics measured by the Korean version of Wechsler Intelligence Scale for Children 4th edition (K-WISC-IV), Korean version of the attention deficit/hyperactivity disorder Rating Scale (K-ARS), and Korean version of Child Behavior Checklist (K-CBCL) in children diagnosed with ADHD. METHOD: A retrospective cross-sectional study was performed on children aged 8 to 13 years, who were diagnosed with ADHD at Samsung Medical Center from November 2011 to March 2017. A total of 57 ADHD children were selected by a medical chart review. Their QEEG findings and psychological test results, including K-WISC-IV, K-CBCL, and K-ARS (n=42), were collected. The QEEG was analyzed by the ranges of Hz: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), and beta (12–25 Hz) and transformed to the z-scored relative power. The collected data were analyzed using Pearson and Partial correlation analysis. RESULTS: The Letter-Number Sequencing scores of K-WISC was positively correlated with fronto-central alpha. The hyperactivity/impulsivity scores of K-ARS were positively correlated with the theta/beta ratio. Among the items of K-CBCL, social immaturity was positively correlated with delta and theta, and negatively correlated with alpha. Social competence was negatively correlated delta and theta, and positively correlated with alpha. CONCLUSION: These results suggest that the resting state QEEG results of children with ADHD may reflect their cognitive and behavioral characteristics, especially in working memory/executive function, hyperactivity/impulsivity, and sociality.

Perfil integral del candidato al Programa de Alta Exigencia Académica (PAEA) de la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM) / Comprehensive profile of candidates to the High Academic Performance Program (PAEA) of the Faculty of Medicine at Universidad Nacional Autónoma de México (UNAM)

The importance to assess in a comprehensive way the cognitive, emotional, personal and social features of the students entering medical school is recognized nowadays in order to select from the candidates, not just those with high cognitive abilities, but also the ones with a vocation and interest in the study of this science. These are characteristics that should be specially sought among the students of high performance academic groups. In the Department of Medicine, as it is in some other departments at the Universidad Nacional Autónoma de México (UNAM), there is a special plan called High Academic Performance Program (PAEA), which aims to test innovative teaching models to generate health resources able to operate in special working conditions. Medicine students enrolled at the PAEA have a particular schedule which includes, in addition to the program established at the regular curriculum, some other specific activities, meaning greater demand for them. These special training includes activities such as: early introduction to research labs, based-problem learning, methodology workshops, introductory course in computing, and personalized assistance from academic tutors. It is because of these peculiar features, that, with this study, we aim to determine the profile of the students of the PAEA from the analysis and comparison of the candidates' characteristics. Materials and methods This was a comparative cross-sectional study that included all the first entry students at the Department of Medicine who applied to enter the selection process of the PAEA at the 2009-2010 period. These candidates were required to ask voluntarily to be included in the selection process to be part of PAEA, and to demonstrate at least a high school grade of 8.5, and to complete the assessment instruments. For this study, the assessment instruments used were: Minnesota Multiphasic Personality Inventory (MMPI-2), Differential Aptitude Test (DAT) sub-scale of abstract reasoning, and a semi-structured interview designed specifically for this evaluation. The variables considered for this research were: • Sociodemographic characteristics: All those features that define the economical, social and demographic situation of a person or population. • Academic background: All the information of studies and activities that the student has done throughout his/her school years. • Vocational features: Preferences, perceptions and attitudes of the student for his/her own autonomous choice of career or profession. • Personality traits: Generalized and focused mental systems that have the ability to convert external stimuli to guide different forms of behaviors. • Abstract reasoning: Mental process that allows people to solve logic problems, forecasting and planning. Data obtained from the instruments were analyzed with descriptive statistics, multiple linear regression, logistic regression, cluster analysis and factor analysis. Results The study included 194 candidates (100 of them were accepted to be included at the PAEA). In general, the studied population had a greater percentage of women (61.86%) and a mean age of 18.35 + 1.5 years old. Around a quarter of this population studied high school at Escuela Nacional Preparatoria (National High School), but it was observed that the highest percentage (20.1%) of students accepted to enter PAEA had the antecedent of being graduate from private high schools with high academic standards. This last finding is important since the candidates from these private schools are students who not only have access to a history of multiple academic and extracurricular activities, but they also come with certain academic stimulation, and so, it is expected that they have developed strategies to contend in competitive environments. The average grade of high school was lightly higher for the group of accepted students (9.27+0.41) than for those not accepted (9.13+0.47). Compared to those who were not accepted, more students in the group of accepted candidates were fluent in English (46.91%), French (1 4.43%) or other foreign language (3.61 %) besides Spanish. The personality profile obtained from the MMPI-2 was similar for both groups of candidates, accepted and not accepted. It was determined that accepted students were characterized by: having high energy and strength to achieve their goals, being sociable but with little commitment to the others, questioning the statu quo, being creative. However, within this group it was also observed that there was a tendency to manipulate other people to get what they wanted and that some of their behaviors may be governed by impulsivity. The group of candidates not accepted to the Program seemed to have the same personality features with greater energy, which could lead them into disarray. Characteristics such as social introversion and hypochondriasis have been aspects of interest in some previous studies. Both personality features have revealed significant long-term predictors, whether to have an adequate academic performance (associated to low levels of both social introversion and hypochondriasis) or to develop any psychopathology (related to high levels of social introversion and hypochondriasis). For this population, professional interests were directed towards the medical practice, while teaching was not considered as a priority interest (but it prevailed in the group of not accepted). Promotion of humanitarian aid discriminated those accepted candidates. At least 10% of the students in the group of accepted candidates said that they could see themselves having a successful future. The difference in interests within these students reflects distinct experiences in each group, and therefore dissimilar life projects that make them having diverse perspectives of present and future circumstances. The fact that the group of approved candidates has high motivation for success is consistent with their acceptance to be part of a group of high performance. However, it may be advisable to promote a training throughout their social awareness in order to enable them to have an overall performance of their profession. The best predictors of acceptance were: the rating of the overall review of knowledge (an exam that every first entry student does at the beginning of Medicine School) and the score of DAT's abstract reasoning, which correlated with r = 0.485. It is important to say that neither the grade of high school nor the age were good predictors to be accepted to PAEA. Conclusions Since PAEA seeks to select students with characteristics and skills that enable them to function in the field of medicine under a high rate of academic achievement, it is expected that, as it was confirmed in this research, accepted students where those who had greater cognitive abilities, who were fluent in other languages, with interest focused on successful clinical practice and research, and with less concern about socio-economical aspects of their environment. However, there are still many questions regarding the defining characteristics of this population and the way these features will impact their education. It is necessary to continue characterizing and studying the groups of students entering PAEA, and follow up their outcome in order to determine if the evaluated aspects have an influence on their academic performance during medical school.

En la Facultad de Medicina, como en algunas otras de la Universidad Nacional Autónoma de México, existe un Programa de Alta Exigencia Académica (PAEA), el cual busca probar métodos de enseñanza novedosos para formar recursos capaces de desarrollarse en condiciones especiales de trabajo. Esto se lleva a cabo por medio de un programa en que el alumno lleva, además de las actividades regulares establecidas en el currículum de la carrera, algunas otras planeadas específicamente para estos grupos y que demandan mayores exigencias para los estudiantes que forman parte de ellos. Dadas estas características del PAEA en la Facultad de Medicina, es prioritaria una evaluación integral de los candidatos que formarán parte del programa, la cual debe incluir aspectos cognoscitivos, emocionales, personales y sociales. Por ello, el objetivo de este estudio fue establecer el perfil de los alumnos del PAEA a partir del análisis y la comparación de las características de la población de candidatos que se postularon para ingresar a este programa durante la promoción 2009-2010. Material y métodos Estudio transversal comparativo en el cual se incluyó a todos aquellos estudiantes de primer ingreso (ciclo 2009-2010) que solicitaron de manera voluntaria ingresar al proceso de selección del PAEA, que tuvieron por lo menos 8.5 de promedio en el bachillerato y que completaron los instrumentos de evaluación. Se aplicaron: el Inventario Multifásico de la Personalidad Minnesota-2 (MMPI-2), la subescala de razonamiento abstracto del Test de Aptitudes Diferenciales (DAT), y una entrevista semiestructurada diseñada expresamente para esta evaluación. Los datos obtenidos se manejaron con estadísticos descriptivos, regresión lineal múltiple, regresión logística, análisis de clusters y análisis factorial. Resultados Se incluyó a 194 aspirantes, de los cuales fueron aceptados 100, con un predominio en la población femenina (61.86%) y una media de edad de 1 8.35 ± 1.5. Una cuarta parte de la población estudiada provenía de las Escuelas Nacionales Preparatorias, pero el mayor porcentaje de aceptación (20.1%) para ingresar al PAEA se observó entre los alumnos egresados de escuelas preparatorias privadas de alto nivel académico. El perfil de personalidad obtenido por medio del MMPI-2 fue similar para los candidatos aceptados y los no aceptados. Los alumnos aceptados para ingresar al PAEA se caracterizaron por: presentar una gran energía y consolidar sus metas, ser sociables pero con poco compromiso con los demás, cuestionar el status quo y ser creativos; no obstante, se observó una tendencia a manipular a los demás para conseguir sus fines. Algunas de sus conductas pueden estar regidas por impulsividad. Los alumnos no aceptados presentaron estas características con una mayor energía que pudiera llevarlos a la desorganización. Los intereses profesionales se dirigieron hacia la práctica médica. Aunque la docencia no fue considerada como un interés, predominó entre los no aceptados, mientras que la promoción de ayuda humanitaria discriminó a los aceptados. Los mejores predictores de la aceptación fueron la calificación del examen general de conocimientos y el razonamiento abstracto, los cuales se correlacionaron con r=0.485. Ni la edad, ni el promedio de bachillerato fueron buenos predictores en cuanto a la aceptación para entrar al PAEA. Conclusiones Dado que el PAEA busca seleccionar alumnos con características y habilidades que les permitan desempeñarse en el campo de la Medicina con un ritmo de alto rendimiento académico, resulta esperable que, tal como se corroboró en esta investigación, se aceptaran alumnos con una mayor competencia cognoscitiva, con dominio de otras lenguas, con intereses centrados en la práctica clínica exitosa y en la investigación, y con menor preocupación por aspectos socioeconómicos de su entorno. Sin embargo, será preciso continuar perfilando y estudiando a los estudiantes de este programa con el fin de determinar aquellos rasgos que influyen en su desempeño durante la licenciatura.

The Cognitive Characteristics of Somatizer according to Depressive Symptoms and Sex / 신경정신의학

OBJECTIVES: Recent researchers on the mechanism of somatization adapted the view of cognitive theory. A few studies were carried out on the studies of the difference of characteristics in various somatizers in Korea. The aim of the study was to investigate the differences of somato-sensory amplification and symptom interpretation in accation to depressive symptoms and sex. Furthermore, we investigated the relationship of somatosensory amplification and symptom interpretation to somatization in relation to depressive symptoms and sex. METHODS: The somatization scale of SCL-90-R, the depression scale of MMPI, Somato-sensory Amplification Scale (SSAS), and Symptom Interpretation Questionnaire (SIQ) were administered to 299 somatizers. Using independent t-test, we compared the difference of the mean score of SSAS and SIQ in each group. In addition, using stepwise multiple regression analysis, somatization scale was regressed on SSAS and SIQ subscales. RESULTS: Compared with each group, depressive somatizer's mean score of SSAS, SIQ physical, SIQ psychological, and SIQ catastrophic interpretation were significantly higher than non-depressive somatizer's. And female somatizer's mean score of SSAS were significantly higher than male somatizer's. As the results of regression analysis, indicate in depressive somatizer, SSAS, SIQ physical, and SIQ psychological interpretation predicted somatization, indicating that higher SSAS, SIQ physical, and psychological interpretation were related to somatization. Furthermore, in the female somatizer, SSAS, SIQ physical, and SIQ psychological interpretation predicted somatization, indicating that higher SSAS, SIQ physical, and SIQ psychological interpretation were related to somatization. On the other hands, in the male somatizer, SSAS and SIQ catastrophic interpretation predicted somatization, indicating that higher SSAS and SIQ catastrophic interpretation were related to somatization. CONCLUSION: These results suggested that the depressive somatizer amplified their somato-sensory perceptions because they internalized to depressive symptoms. In addition, these results suggest that because female somatizer tends to attribute somatic symptoms more to physical illnesses and to amplifiy their somato-sensory perceptions in comparison with male somatizer, female complains more somatic symptoms thus more prevalence of somatization disorder than male.

Cognitive Characteristics in Somatizers with Anxiety Symptoms / 신경정신의학

OBJECTIVES: Assuming that somatization closely interacts with anxiety symptoms, one might speculate that anxiety symptoms will produce the significant differences in development, course and treatment of somatization and the cause of these differences will be elucidated in the cognitive aspect. This study was performed to examine the cognitive characteristics in terms of the somatosensory amplification and the symptom interaction in patients with somatization accompanied by anxiety symptoms. METHODS : The following measures were administered to subjects who had a T-score of >60 on somatization subscale of Symptom Checklist-90-Revision (SCL-90-R):1) Minnessota Multiphasic Personality Inventory-Korean Version (MMPI-K), 2) Somato-sensory Amplification Scale (SSAS), 3) Symptom Interpretation Questionnaire (SIQ). There was a comparison of differences in the somatosensory amplification and the symptom interpretation between the anxiety group and the non-anxiety group divided by T-score of >60 on the psychasthenia subscale of MMSE-K. Multiple regression analysis was performed to determine the effect of the differences in the somatosensory amplification and the symptom interpretation on age, sex, marital status and level of education between those two groups. RESULTS : There was a greater amplification of sensation in the anxiety group than the non-anxiety group. The former showed a higher level of physical, psychological and catastrophic interpretation than non-anxiety group except with regard to environmental interpretation. Somatization was affected by somatosensory amplification and physical interpretation in both groups, as well as psychological interpretation in the anxiety group. CONCLUSION : Regarding the cognitive aspect, the somatosensory amplification and symptom interpretation were more severely distorted in patients accompanied by anxiety symptoms. These results suggest that a therapeutic approach based on the cognitive characteristics is essential for the effective management of somatizer.

Study on Cognitive Characteristics of Medical Ethics Education from the Perspective of Medical Teachers & Students / 中国医学伦理学

By investigating the perspectives of medical scholars, experts, personnel and students, this paper makes an investigation on the present cognition of medical ethics education in the medical department. By studying and comparing the respective opinions of medical teachers and students on the current medical ethics education, analysis on the application of medical ethics in clinical practice and medical research, and cognitive characteristics of the ethical expectation on medical treatment from the general public have been carried out, pointing out some specific problems affecting the actual effect in current medical and ethics education on teachers' and students' sides, and bringing forward some suggestions.