Gender-Specific Association between Alcohol Consumption and Stress Perception, Depressed Mood, and Suicidal Ideation: The 2010–2015 KNHANES

OBJECTIVE: Alcohol drinking can cause various psychiatric and medical diseases. Although women generally consume less alcohol than men, they may be at a greater risk for alcohol-related psychological distress. The aim of the current study is to evaluate whether the association between alcohol consumption and psychological distress, including stress, depressed mood, and suicidal ideation and the risks of psychological distress differ based on gender. METHODS: The cross-sectional study included 31,657 participants (17,915 women and 13,742 men) from the 2010–2013 and 2015 Korea National Health and Nutrition Examination Survey. Alcohol drinking and Alcohol Use Disorders Identification Test (AUDIT) levels were assessed for evaluating the amount of alcohol intake and alcohol-related problems. Self-perception of stress, depressed mood, and suicidal ideation were assessed for evaluating psychological distress. Odds ratio and 95% confidence intervals for psychological distress were calculated using multiple logistic regression models. RESULTS: The risks of psychological distress were not significantly associated with drinking level in both sexes. However, the risks of psychological distress were associated with an increase in AUDIT levels, and there were gender differences in the psychological consequences of alcohol-related problems. The association was more drastic in women, and women showed a significant association even though the severity of drinking problem was low with the exception of stress perception. CONCLUSION: The risks of psychological distress were associated with the severity of alcohol-related problems and women were more likely to be susceptible. Therefore, it is recommended that women even at low-risk for problematic drinking should be screened for psychological distress.

An Exploration of the Oryza sativa L. Cyanidin-3-glucoside on the Cognitive Function in Older Adults with Subjective Memory Impairment

OBJECTIVE: Cyanidin-3-glucoside (C3G), is a component of anthocyanin, have been considered to positively influence cognition and be beneficial for the prevention and treatment of dementia. We aimed to assess the safety and efficacy of cyanidin-3-glucoside-rich Oryza sativa L. (black rice) extract on cognitive function. METHODS: A 12-weeks double-blind randomized, placebo controlled trial assessed safety and cognitive outcomes in participants with subjective memory impairment (n=48) following consumption of 6 black rice extract capsules or a placebo. Cognitive function was assessed using the ADAS-cog and the CERAD-K. Subjective memory impairment also assessed. Safety was assessed by hematologic blood test, urine analysis, and participant reports of adverse events. RESULTS: There was significant improvement on subjective memory in intervention group. There was no statistically significant difference in objective cognitive outcomes following 12 weeks of consuming black rice extract. ADAS-cog scores, however, trended toward improvement in the intervention group compared to the placebo group. There was no adverse event. CONCLUSION: Although significant improvement in objective cognitive function was not proved, we found that C3G-rich Oryza sativa L. extract improves subjective memory in this study. Therefore the results may be informative of the possible effectiveness of the C3G-rich Oryza sativa L. on cognitive function.

Feasibility of Psychosocial Distress Screening and Management Program for Hospitalized Cancer Patients

OBJECTIVE: Although the diagnosis and treatment of cancer is associated with psychosocial distress, routine distress screening is difficult in hospitalized oncology settings. We developed a consecutive screening program for psychosocial distress to promote psychiatric treatment of cancer patients and evaluated the feasibility of our program by Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). METHODS: Among 777 cancer inpatients recruited from the Catholic Comprehensive Institute of Seoul St. Mary's Hospital, 499 agreed to complete primary distress screening through DT. We conducted secondary distress screening through HADS in 229 patients who had high scores of DT. RESULTS: Of the 499 participants, 270 patients with low scores of DT were included in the distress education program. 229 patients with high scores of DT received secondary distress screening through HADS. Among 115 patients with low scores of HADS, 111 patients received distress management. Among 114 patients with high scores in the secondary distress screening, 38 patients received psychiatric consultation service whereas 76 patients refused psychiatric consultation. CONCLUSION: Using consecutive screening for psychosocial distress appeared to be feasible in an inpatient oncology setting. Nevertheless, the low participation rate of psychiatric consultation service in cancer patients with high distress level should be improved.

Thalamic Shape and Cognitive Performance in Amnestic Mild Cognitive Impairment

OBJECTIVE: This study aimed to investigate thalamic shape alterations and their relationships with various episodic memory impairments in subjects with amnestic mild cognitive impairment (aMCI). METHODS: We compared volumes and morphological alterations of the thalamus between aMCI subjects and healthy controls. In addition, we investigated the correlation between thalamic deformations and various memory impairments in aMCI subjects using a comprehensive neuropsychological battery. RESULTS: The normalized left thalamic volumes of the aMCI group were significantly smaller than those of the healthy control group (p<0.0001). aMCI subjects exhibited significant thalamic deformations in the left thalamic dorso-medial and antero-medial areas compared with healthy individuals. CERAD-K Word List Memory scores were significantly correlated with the left dorso-medial areas in aMCI subjects. There were no significant correlations between verbal fluency, Boston naming test, constructional praxis, Word List Recognition, and Visuospatial Recall scores and thalamic shape in aMCI subjects. Verbal delayed recall scores were also significantly correlated with the left dorso-medial areas in the aMCI group. CONCLUSION: Structural alterations in the thalamic deformations in the left dorso-medial and antero-medial areas might be core underlying neurobiological mechanisms of thalamic dysfunction related to Word List Memory and delayed verbal recall in individuals with aMCI.

Reliability and Validity of the Korean Version of the Cornell Scale for Depression in Dementia

OBJECTIVE: The aim of this study was to explore the reliability and validity of the Korean version of the Cornell Scale for Depression in Dementia (CSDD-K), a scale for assessment of depression in dementia. METHODS: The original CSDD was translated into Korean and the content was verified through back-translation procedures. This study included 59 depressive patients with Alzheimer's disease (AD), 62 non-depressive patients with AD and 36 healthy elderly controls. The subjects were assessed using CSDD-K, the 17-item Hamilton Depression Rating Scale (HAM-D17), the 15-item Korean version of Geriatric Depression Scale (GDS15) and the Korean version of Mini-mental Status Examination (MMSE-K). RESULTS: In the reliability test, Cronbach's alpha coefficient and test-retest reliabilities were 0.92 and 0.91, respectively, indicating that the CSDD-K has good internal consistency. There were significant differences in CSDD-K total scores between AD patients with depression and AD patients without depression (p<0.001). In the analysis of the concurrent validity of the CSDD-K, there were significant correlations between the CSDD-K and HAM-D17 (r=0.91, p<0.001) and between the CSDD-K and GDS15 (r=0.75, p<0.001). ROC curve analysis identified a cut-off score of 7 for the CSDD-K, where the sensitivity was 87.5% and the specificity was 100%. Factor analysis resulted in a four-factor solution accounting for 63.8% of the common variance. CONCLUSION: The CSDD-K showed good reliability and validity for the assessment of depressive symptom severity in AD patients. The CSDD-K is a useful instrument for assessing AD patients with depressive symptoms in Korean ethnic population.

A Voxel-Based Morphometry of Gray Matter Volume Reduction in Patients with Mild Cognitive Impairment

OBJECTIVES: Optimized voxel based morphometry (VBM) has been increasingly applied to investigate differences in the brain morphology between a group of patients with mild cognitive impairment (MCI) and control subjects. Optimized VBM permits comparison of gray matter (GM) volume at voxel-level from the entire brain. The purpose of this study was to assess the regional GM volume change measured by optimized VBM in MCI subjects compared to controls. METHODS: Twenty patients with MCI and 20 control subjects with normal cognition were recruited for this study. We applied the optimized VBM protocol to the image data including study-specific template and the modulation of the data with the Jacobian determinants. GM volume differences between the MCI subjects and the control subjects and their correlations with the neuropsychological performances were investigated. RESULTS: Optimized VBM analysis revealed GM volume reduction in hippocampus, precentral gyrus, insula and parietal operculum in the MCI group compared to the control group (family wise error corrected p < 0.05). Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K) word list recall scores were significantly correlated with the GM volumes of hippocampus, precuneus and posterior cingulate in the MCI group (FWE corrected p < 0.05). CONCLUSIONS: The results confirm previous findings of atrophic changes in medial temporal lobe and parietal lobe in the MCI group and suggest that these abnormalities may be related with cognitive decline and prognosis in patients with MCI.

Predicting Factors Associated with Drug Compliance in Psychiatric Outpatients of a University Hospital / 대한정신약물학회지

OBJECTIVE: Drug compliance is closely related to progress and prognosis of psychiatric disease. We investigated drug compliance in psychiatric outpatients and factors that influence their compliance. METHODS: Patients who visited a university hospital were asked about drug information and drug compliance using questionnaires. Medical records of the patients were reviewed. Demographic variables, clinical characteristics and drug compliance related variables were compared between non-compliance group and compliance group. Logistic regression analysis was performed to clarify predictors of poor compliance. RESULTS: One hundred eighty one patients participate in this study. 150 patients (82.9%) were compliance group, 31 patients (17.1%) were included in non-compliance group. Patient-related, illness-related and treatment-related factors, DAI total score and knowledge of side effect did not show any difference in both groups. However, illness severity was relatively higher in non-compliance group (p = 0.070) and patient's satisfaction about explanation of side effect was lower in noncompliance group (p = 0.061). Moreover, patients who negatively answered for question about negative recognition to psychiatric medication in DAI questionnaire were more common in non-compliance group (p = 0.075). In logistic regression, answering negatively to question about negative recognition to psychiatric medication in DAI questionnaire was related to non-compliance, but did not reached statistical significance (p = 0.086). CONCLUSION: This study suggests that improving negative recognition about psychiatric medication through drug education and good doctor patient relationship could enhance drug compliance.

Comparison of Atypical Antipsychotics Discontinuation Rate in Acute Phase Hospitalized Patients-Retrospective Chart Review Study / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to compare the discontinuation rate of widely prescribed atypical antipsychotics when administered to newly admitted, acutely ill patients with schizophrenia or bipolar mania. METHODS: Medical records of patients admitted to psychiatric ward of two university hospitals between January 2007 and December 2008 were retrospectively reviewed. Subjects were eligible for inclusion if they prescribed olanzapine, risperidone or aripiprazole for their psychotic or manic symptom control. Patient groups (olanzapine/risperidone/aripiprazole) were compared for rate of antipsychotics discontinuation and duration of treatment continuation. RESULTS: There was no statistically significant difference in the rates of discontinuation during hospitalized period between olanzapine, risperidone and aripiprazole. Rates of discontinuation were 14.5% for olanzapine, 18.6% for aripiprazole and 24.0% for risperidone. Predictor of treatment discontinuation was short titration period and long illness duration. CONCLUSION: This study demonstrated that risperidone, olanzapine and aripiprazole were comparable with no difference found on the discontinuation rate in treating acutely ill psychiatric patients. However, the small number of patients who participated in this study made it difficult to establish significance.