Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Objective@#The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). @*Methods@#A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. @*Results@#The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p ＜ 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). @*Conclusion@#The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

Comparison between Atomoxetine and OROS Methylphenidate as an Adjunctive to SSRIs in Attention-deficit/Hyperactivity Disorder Adults with Comorbid Partially Responsive Major Depressive Disorder: A Head-to-head, 12-week, Randomized, Rater-blinded Clinical Trial

Objective@#This study aimed to compare the efficacy and safety of atomoxetine (ATX) and OROS methylphenidate (MPH) as adjunctive to selective serotonin reuptake inhibitors (SSRIs) in adults with attention-deficit hyperactivity disorder (ADHD) with comorbid partially responsive major depressive disorder (MDD). @*Methods@#Sixty Korean adults with ADHD and comorbid partially responsive MDD were recruited in a 12-week, randomized, rater-blinded, active-controlled trial and were evenly randomized to ATX or OROS MPH treatment. @*Results@#Depressive symptoms measured using the Hamilton Depression Rating Scale and Clinically Useful Depression Outcome Scale, and ADHD symptoms measured using the Adult ADHD Self-Report Scale, as well as the Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and the Sheehan Disability Scale scores were significantly improved in both groups during the 12 weeks of treatment. The changes in all outcome measures during the 12-week treatment were not significantly different between the two groups (all p ＞ 0.05). No serious adverse events were reported and there were no significant differences in systolic and diastolic blood pressure, pulse rate, weight, or body mass index between the ATX and MPH groups. @*Conclusion@#Our findings suggest that ATX and MPH can be used as adjunctive treatments in adults with ADHD and comorbid partially responsive MDD. The efficacy and tolerability of ATX and MPH in adults with ADHD did not differ significantly. Further studies should be conducted to draw a definitive conclusion.

Switching Antipsychotics to Blonanserin in Patients with Schizophrenia: An Open-label, Prospective, Multicenter Study

OBJECTIVE: This study was performed to investigate the efficacy and tolerability of blonanserin in schizophrenic patients who were previously treated with other antipsychotics but, due to insufficient response, were switched to blonanserin. METHODS: A total of 52 patients with schizophrenia who were unresponsive to treatment with antipsychotic monotherapy or combination therapy were recruited into this 12-week, open-label, prospective, multicenter study. Patients were switched to blonanserin from their existing antipsychotics over a maximum 2-week tapering-off period. Efficacy was primarily evaluated using the 18-item Brief Psychiatric Rating Scale (BPRS). Assessments were performed at baseline, and at weeks 1, 2, 4, 8, and 12. RESULTS: Switching to blonanserin resulted in a significant decrease in the mean total score on the BPRS from baseline (56.8 ± 9.4) to week 12 (42.1 ± 13.8, p < 0.001). The most common adverse events were extrapyramidal symptoms (n = 12, 23.1%), insomnia (n = 10, 19.2%), and emotional arousal (n = 6, 11.5%). Overweight or obese patients (body mass index ≥ 23 kg/m2, n = 33) who switched to blonanserin exhibited significant weight loss from 75.2 ± 9.3 kg at baseline to 73.5 ± 9.2 kg at week 12 (p = 0.006). The total cholesterol (baseline, 236.1 ± 47.6 mg/dl; endpoint [week 12], 209.9 ± 28.0 mg/dl; p = 0.005) and prolactin levels (baseline, 80.0 ± 85.2 ng/ml; endpoint [week 12], 63.2 ± 88.9 ng/ml; p = 0.003) were also significantly improved in patients with hypercholesterolemia or hyperprolactinemia. CONCLUSION: The results of the present study suggest that switching to blonanserin may be an effective strategy for schizophrenic patients unresponsive to other antipsychotic treatments.

Augmentation of Aripiprazole versus Bupropion on Specific Symptoms of Depression in Older Adult Patients : A Post-Hoc, Multi-Center, Open-Label, Randomized Study / 생물치료정신의학

OBJECTIVES: The purpose of this study was to compare aripiprazole versus bupropion augmentation therapy in older adult patients with major depressive disorder unresponsive to selective serotonin reuptake inhibitors(SSRIs).METHODS: This is a post-hoc analysis of a 6-week, randomized prospective open-label multi-center study in thirty older adult patients with major depressive disorder. Participants were randomized to receive aripiprazole(N=16, 2.5–10mg/day) or bupropion(N=14, 150–300mg/day) for 6 weeks. Montgomery Asberg Depression Rating Scale (MADRS), 17-item Hamilton Depression Rating scale(HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales(anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.RESULTS: There was a significantly greater decrease in MADRS scores in aripiprazole group compared to bupropion group at 4(p<0.05) and 6(p<0.05) weeks. There were significantly higher response rate at week 4(p<0.05) and 6(p<0.05) and remission rate at week 6 in aripiprazole group compared to bupropion group. Individual HAM-D17 items showing significantly greater change with adjunctive aripiprazole than bupropion: insomnia, late(ES=0.81 vs. −0.24, p=0.043), psychomotor retardation(ES=1.30 vs. 0.66, p=0.024), general somatic symptoms(ES=1.24 vs. 0.00, p=0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than bupropion with respect to mean change for drive(p=0.005).CONCLUSION: Results of this study suggested that aripiprazole augmentation have superior efficacy in treating general and core symptoms of depression in older adult patients. Aripiprazole augmentation is associated with greater improvement in specific symptoms of depression such as psychomotor retardation, general somatic symptoms and drive.

Characteristics of High-Intent Suicide Attempters Admitted to Emergency Departments

BACKGROUND: The suicide rate in Korea has been the highest among the Organization for Economic Cooperation and Development countries since 2003. However, there is a lack of in-depth data regarding the characteristics of suicide attempters. Understanding the intent of suicide attempters will help improve the effectiveness of suicide prevention strategies. Therefore, to provide a resource for developing the necessary interventions, this study aimed to examine the differences in suicide-related and clinical variables according to the strength of suicidal intent. METHODS: The subjects were 328 suicide attempters admitted to emergency departments at 5 university hospitals in Daegu-Gyeongbuk province between 2011 and 2014. We used various scales to examine suicide-related and clinical variables and a structured questionnaire to explore psychosocial characteristics. We evaluated suicidal intent using the Pierce Suicide Intent Scale and a clinician-rated scale that measured suicidal authenticity. RESULTS: Individuals with high suicidal intent were significantly older, had higher Hamilton Depression Rating Scale (HDRS) scores, higher rates of premeditation, and sustained suicidal ideation. Furthermore, suicide methods, timing, and psychiatric treatment histories differed by the strength of subjects' suicidal intent. Moreover, multiple logistic regression showed that depressed mood as a reason for attempting suicide, premeditation, and higher HDRS scores were significantly associated with higher suicidal intent. CONCLUSION: Depression, premeditation, older age, and sustained suicidal ideation were characteristics of individuals with high suicidal intent, and it is necessary to evaluate and monitor these factors to prevent repeated suicide attempts.

Screening with the Korean Version of the Mood Disorder Questionnaire for Bipolar Disorders in Adolescents: Korean Validity and Reliability Study

OBJECTIVE: This study aimed to evaluate the validity and reliability of a Korean version of the Mood Disorder Questionnaire-Adolescent version (K-MDQ-A) as a screening instrument for bipolar disorders in adolescents. METHODS: One hundred two adolescents with bipolar disorders and their parents were recruited from November 2014 to November 2016 at 7 training hospitals. One hundred six controls were recruited from each middle school in two cities of South Korea. The parent version of the original MDQ-A was translated into Korean. The parents of all participants completed the K-MDQ-A. The diagnoses of bipolar disorders were determined based on the Korean version of K-SADS-PL. The test-retest reliability with a 10-month interval was investigated in 33 bipolar adolescents. RESULTS: K-MDQ-A yielded a sensitivity of 0.90 and a specificity of 0.92 when using a cut-off score of endorsement of 5 items, indicating that symptoms occurred in the same time period and caused moderate or serious problems. The internal consistency of the K-MDQ-A was good. The correlations between each item and the total score ranged from 0.40 to 0.76 and were all statistically significant. Factor analysis revealed 3 factors that explained 61.25% of the total variance. The mean total score was significantly higher in bipolar adolescents (7.29) than in controls (1.32). The Pearson correlation coefficient for the total test-retest score was 0.59 (p < 0.001). CONCLUSION: The K-MDQ-A completed by parents showed the excellent validity and reliability and may be a useful screening tool for adolescents with bipolar disorders attending in- and outpatient psychiatric clinics.

Treatment by Transradial Urokinase Infusion and Percutaneus Transhepatic Thrombectomy in Superior Mesenteric Veno us Thrombosis with Intestinal Infarction / 대한내과학회지

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.

Treatment by Transradial Urokinase Infusion and Percutaneus Transhepatic Thrombectomy in Superior Mesenteric Veno us Thrombosis with Intestinal Infarction / 대한내과학회지

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.

Dose Trends of Aripiprazole from 2004 to 2014 in Psychiatric Inpatients in Korea

OBJECTIVE: Although aripiprazole has been widely used to treat various psychiatric disorders, little is known about the adequate dosage for Asian patients in clinical practice. Hence, we evaluated the initial and maximum doses of aripiprazole from 2004 to 2014 to estimate the appropriate dosage for Korean psychiatric inpatients in clinical practice. METHODS: In this retrospective study, we reviewed the medical records of patients who were hospitalized in five university hospitals in Korea from March 2004 to December 2014. The psychiatric diagnosis according to the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition during index hospitalization and the initial and maximum doses of aripiprazole were evaluated. RESULTS: There were 74 patients in Wave 1 (2004–2006), 201 patients in Wave 2 (2007–2010), and 353 patients in Wave 3 (2011–2014). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2. The maximum doses of aripiprazole in each diagnostic group were not significantly different among Waves 1, 2, and 3. CONCLUSION: The relatively low initial doses of aripiprazole documented in our study may reflect a strategy by clinicians to minimize the side effects associated with aripiprazole use, such as akathisia.

Chemoprevention of Colorectal Cancer in Inflammatory Bowel Disease / 대한소화기학회지

The risk of developing colorectal cancer is increased in patients with inflammatory bowel disease. Surveillance colonoscopy has not been shown to prolong survival and rates of interval cancer are reported to be high. Continuing colonic inflammation has been shown to be important in the development of colorectal cancer and therefore anti-inflammatory agents such as the 5-aminosalicylates and immunomodulators have been considered as potential chemopreventive agents. This review focuses on various chemopreventive agents that have been clearly shown to reduce the risk of colorectal adenoma and cancer in the patients with inflammatory bowel disease.

Association Study between Treatment Response of Amisulpride and Dopamine D3 Receptor Gene Polymorphisms

OBJECTIVES: The aim of this study is to evaluate the association between rs6280 and rs905568 genetic polymorphism of DRD3 gene and the treatment response of amisulpride. METHODS: After six weeks treatment of amisulpride, 125 schizophrenia patients were interviewed based on the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity (CGI-S). The genotyping for rs6280 and rs905568 was performed using TaqMan single nucleotide polymorphism (SNP) genotyping assay. RESULTS: There was no significant difference in the frequency of genotype and allele of rs6280 between the responders and non-responders based on the total, positive, and general score of PANSS and CGI-S score. However, there was a significant association between this SNP and treatment response in the negative score of PANSS (chi2 = 5.23, p = 0.022). There was no significant association between rs905568 and the response in positive, negative, general, and total PANSS score and CGI-S score. CONCLUSIONS: This is the first positive association study between DRD3 gene and the treatment response of negative symptoms to amisulpride in Korean schizophrenia patients. A larger scale research on more SNP of the DRD3 gene will make a progress in the study of pharmacogenetics on the treatment response of the amisulpride.

Prediction of Diagnosis of Dementia Using Cognitive Impairment Diagnosing Instrument(CIDI) / 신경정신의학

OBJECTIVES: This study aimed at investigating the diagnostic predictability of Cognitive Impairment Diagnosing Instrument(CIDI) in diagnosing dementia of elderly people aged 60 years or more. METHODS: The subjects were 129 patients with other mental diseases than dementia whose ages were more than 60 years and 86 patients with dementia. Psychiatric diagnoses were made by according to the DSM-IV criteria. Converted age(chronological age minus 59) was employed for the statistical reason. The length of education was classified into 4 intervals:1 for less than one year schooling, 2 for grade schooling, 3 for junior or senior high schooling and 4 for college or more schooling and each number expresses ordinal scale. The converted age, length of education expressed by one of 4 interval scores, and total CIDI score were independent variables while the diagnosis(dementia vs nondementia) was dependent variable in the logistic regression analysis. RESULTS: -2 log likelihood was 102.773 when the length of education, converted age and total CIDI score were included while it was 289.395 when only the constant was included(K 2=186.622, df=3, p=0.000). The goodness-of-fit statistic was 156.798(K 2=6.5843, df=8, p=0.5821), and the overall concordance of diagnostic classification was 90.2%. The logistic regression equation for the diagnosis of dementia was generated as follows:y=7.5752+0.0940*X 1+0.9820*X 2-0.1811*X 3(y=ln{pai/(1-pai)}, X 1:converted age, X 2:education intervals, X 3:total CIDI score, pai:possibility of dementia, > OR =0.50 indicating dementia and <0.50 indicating nondementia). The e bs(95% C.I.) for the converted age, education interval and total CIDI score were 1.0985(1.0107-1.1940), 2.6699(1.4134-5.0436), 0.8344(0.7898-0.8815), respectively. CONCLUSIONS: The CIDI could be considered as a useful diagnostic tool for dementia using the logistic regression analysis.

Revised Cognitive Impairment Diagnosing Instrument (CIDI): A Semi-Structured Interview Form for Assessment of Cognitive Functions / 신경정신의학

OBJECTIVES: This study was conducted in order to evaluate reliability and diagnostic validity of the CIDI. METHODS: 64 patients with DSM-IV dementia and 90 elderly patients with other mental disorders entered this study. Inter-subtest Pearson's correlations, corrected subtest-total correlations and Cronbach's alpha were computed for reliability while correlations of the total scores on CIDI with the performances on other scales relating to dementia, sensitivity and specificity, area under curve using the receiver operating characteristic curve, and group comparison were used for the assessment of validity. RESULTS: The CIDI's inter-subtest correlations ranged from 0.596 to 0.813, with a mean of 0.707. The corrected subtest-total correlations were between 0.759 and 0.890. Cronbach's alpha of the subtests was 0.941 and the Cronbach's alpha were between 0.928 and 0.948 when any subtest was deleted. In the demented subjects, the correlation coefficients of the total CIDI score with the performances on S-SDQ, IADL, BADL, BDRS, and MMSEK were around 0.5. Area under the receiver operating curve of CIDI was 0.933 with the standard error of 0.021(95% CI, 0.891-0.975). At the CIDI cutoff point of 65/66, sensitivity and specificity were 95.3% and 85.6%, respectively. The corresponding values of MMSEK were 0.930, 0.020 (95% CI, 0.891-0.969), 22/23, and 89.1% and 85.6%. The demented scored much poorer in all CIDI subtests than the nondemented mental patients, and the differences were highly significant. CONCLUSIONS: The CIDI was satisfactory regarding to reliabilities and diagnostic validities. The CIDI and MMSEK are thought to be reciprocal in assessment of cognitive functions: CIDI is preferable for clinical assessment of cognitive dysfunction and MMSEK for as a screening test.