Computerized Version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS-COMP): Development and Validation of the Korean Clinician-Administered Version

Objective@#The purpose of the present study was to develop and validate the Korean version of the clinician-administered KSADSCOMP, which is the recently updated, web-based computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children (KSADS). @*Methods@#A total of 71 participants (mean age=12.04±3.86 years, female=29.57%) participated in the study. A child-adolescent psychiatrist established a diagnosis for the participant after a thorough psychiatric interview with the participant and the parent. Researchers who were blind to the diagnoses administered the clinician-administered KSADS-COMP to the parents and participants. The gold-standard diagnoses made by child-adolescent psychiatrists were compared to the current diagnoses generated by the clinician-administered KSADS-COMP. Percent agreement, Cohen’s Kappa, Gwet’s first-order agreement coefficient (AC1), sensitivity, specificity, positive predictive value, and negative predictive value were calculated. @*Results@#Gwet’s AC1, our preferred measure of agreement, showed excellent range between 0.78 and 1. Sensitivity, specificity, positive predicted value and negative predictive value also showed high scores. @*Conclusion@#The current study demonstrated excellent criterion validity of the Korean version of the clinician-administered KSADSCOMP, though the small sample size could be a limitation. The current study was the first study to examine the criterion validity of the KSADS-COMP. Due to its readily usable format and efficient and accurate diagnostic process, widely-use of KSADS-COMP is expected.

Effects of Screen Time on Problematic Behavior in Children During the COVID-19 Pandemic in South Korea

Objectives@#The coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in face-to-face classes worldwide, affecting the mental health of children and their parents. The global pandemic has increased children’s overall use of electronic media. This study analyzed the effect of children’s screen time on problematic behaviors during the COVID-19 pandemic. @*Methods@#A total of 186 parents from Suwon, South Korea, were recruited to participate in an online survey. The mean age of the children was 10.14 years old, and 44.1% were females. The questionnaire included questions on children’s screen time, problematic behaviors, and parental stress. Children’s behavioral problems were evaluated using the Behavior Problem Index, whereas the Parental Stress Scale was used to estimate parental stress. @*Results@#The mean smartphone usage frequency of the children was 5.35 days per week, and the mean smartphone screen time was 3.52 hours per day. Smartphone screen time (Z=4.49, p<0.001) and usage frequency (Z=2.75, p=0.006) were significantly correlated with children’s behavioral problem scores. The indirect effect of parental stress on this relationship was also statistically significant (p=0.049, p=0.045, respectively). @*Conclusion@#This study suggests that children’s smartphone screen time has affected problematic behaviors during the COVID-19 pandemic. Furthermore, parental stress is related to the relationship between children’s screen time and problematic behaviors.

Lower-Income Predicts Increased Smartphone Use and Problematic Behaviors Among Schoolchildren During COVID-19 Related School Modification: A Longitudinal Study

Background@#As the coronavirus disease 2019 (COVID-19) has continued for a couple of years, the long-term effects of the pandemic and the subsequent school curriculum modification on the mental health of children and parents need to be investigated. To clarify the changes that can occur during one school year and to predict the risk factors for vulnerable groups, this study identified parameters relative to children’s screen time, their problematic behavior, and parental depression. @*Methods@#A total of 186 participants were analyzed who were parents of elementary schoolchildren in South Korea. These parents were required to complete a web-based questionnaire twice. The questionnaires were conducted in June 2020 and September 2021. Participants’ general demographics including family income, children’s screen time, sleep patterns, problematic behavior, and parental depression were assessed via the parental questionnaire that included various measurement tools. @*Results@#Children’s body mass index (BMI) increased significantly in 2021 (18.94 ± 3.75 vs. 18.14 ± 3.30, P < 0.001). Smartphone frequency of use per week (5.35 vs. 4.54, P < 0.001) and screen time per day (3.52 vs. 3.16, P < 0.001) significantly increased during the period of the COVID-19 pandemic. The television screen time (2.88 vs. 3.26, P < 0.001), frequency of viewing (3.77 vs. 4.77, P < 0.001), and children’s problematic behaviors significantly decreased (9.15 vs. 11.85,P < 0.001). A lower income household was a key predictor of increased smartphone frequency (B = 1.840, 95% confidence interval [CI], 0.923–2.757, P < 0.001) and smartphone screen time (B = 1.992, 95% CI, 1.458–2.525, P < 0.001). The results showed that the lower income household (B = 5.624, 95% CI, 2.927–8.320, P < 0.001) and a child’s psychiatric treatment history (B = 7.579, 95% CI, 5.666–9.492, P < 0.001) was the most significant predictor of problematic behaviors of children and parental depression (B = 3.476, 95% CI, 1.628–5.325, P < 0.001; B = 3.138, 95% CI, 1.827–4.450, P < 0.001). @*Conclusion@#This study suggested that children’s smartphone screen time and BMI increased during COVID-19 because of the school curriculum modification following school closures in South Korea. The increased children’s problematic behaviors and parental depression were predicted by lower-income households and the previous psychiatric history of children. These results indicate that multiple social support systems to the vulnerable group are needed during the ongoing pandemic and that a modified school setting is required.

Effectiveness of Reading Disorder Intervention Program-Open Trial / 신경정신의학

Objectives@#This study investigated the effectiveness of the intervention program for elementary school students with reading disorders. @*Methods@#The intervention program focused on phonological awareness, phonics, and decoding training applied individually to 25 children with a reading disorder by the teachers in charge for four months. To measure the efficacy, this study evaluated the word reading accuracy, fluency, and the related cognitive functions, including phonemic awareness, phonics, and rapid automatized naming using the Computerized Comprehensive Learning Test-Reading before and after the program. @*Results@#After the intervention, improvements were observed in the following: the reading fluency score and fluency percentile in the word attack test; reading accuracy rate, fluency score, and fluency percentile in the nonword decoding test; fluency score and fluency percentile in the rapid automatized naming tests; accuracy rate in the letter-sound matching test; accuracy rate in the nonword repetition test. On the other hand, there was no significant difference in the paragraph reading fluency test. According to the subtypes of reading disabilities, children with dyslexic or mixed types improved after the intervention. @*Conclusion@#Reading accuracy and fluency of school-aged children with reading disorders improved through the intervention program by the schoolteachers.

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures

Background@#Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19. @*Methods@#Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic. @*Results@#During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency. @*Conclusion@#During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of highrisk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.

Effectiveness of Reading Disorder Intervention Program-Open Trial / 신경정신의학

Objectives@#This study investigated the effectiveness of the intervention program for elementary school students with reading disorders. @*Methods@#The intervention program focused on phonological awareness, phonics, and decoding training applied individually to 25 children with a reading disorder by the teachers in charge for four months. To measure the efficacy, this study evaluated the word reading accuracy, fluency, and the related cognitive functions, including phonemic awareness, phonics, and rapid automatized naming using the Computerized Comprehensive Learning Test-Reading before and after the program. @*Results@#After the intervention, improvements were observed in the following: the reading fluency score and fluency percentile in the word attack test; reading accuracy rate, fluency score, and fluency percentile in the nonword decoding test; fluency score and fluency percentile in the rapid automatized naming tests; accuracy rate in the letter-sound matching test; accuracy rate in the nonword repetition test. On the other hand, there was no significant difference in the paragraph reading fluency test. According to the subtypes of reading disabilities, children with dyslexic or mixed types improved after the intervention. @*Conclusion@#Reading accuracy and fluency of school-aged children with reading disorders improved through the intervention program by the schoolteachers.

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures

Background@#Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19. @*Methods@#Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic. @*Results@#During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency. @*Conclusion@#During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of highrisk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.

Understanding of Sexual Violence and the Role of Health Care Provider in Korea / 신경정신의학

The issues raised by the ‘me too’ movement, which have been alarming members of Korean society since early 2018, are ‘unspeakable.’ In past instances of sexual violence, the silence of some victims indicated there was no crime and no harm. The societal approach that did not identify, name, or reveal the damage made the existence of ‘sexual violence’ possible. In the medical community, it is necessary for sexual violence victims who visit medical institutions to ensure the victim can “talk” to a health care provider. Medical practitioners need to have the knowledge, skills, and experiences to enable victims of sexual violence to engage in professional interventions at each stage of sexual violence treatment. During each stage, medical staff should base their treatment on an understanding of the specific situation of the sexual violence victim. In this review article, we introduce various phenomena associated with sexual violence that is aimed at minority groups, including technology-facilitated sexual violence.

Prevalence of Reading and Mathematical Learning Disabilities in Korean School-Aged Children of Jeju Region / 신경정신의학

OBJECTIVES: This study investigated the prevalence of reading and mathematical learning disabilities of students at primary schools in Jeju Island, South Korea. We examined major causes of learning disabilities including reading disorder, mathematical disorder, attention deficit, and other causes including socioemotional factors. METHODS: We conducted screening processes to 659 participants (340 male, 51%) in 4 elementary schools in Jeju Island. To identify the causes of learning problems, 84 children were administered tests such as the Korean-Wechsler Intelligence Scale for Children-fourth edition, the Comprehensive Learning Test-Reading/Math, and the Comprehensive Attention Test. RESULTS: This study found that 13% of elementary school students in the Jeju region had learning disabilities. Among learning disabilities, specific reading and mathematical disorders accounted for 9% of study subjects. In addition, 2% of participants had intellectual impairment and 1% had other causes such as socioemotional factors. 65% of children with learning disabilities and 74% of children with reading or mathematic disorders had concurrent attention deficit disorder. 68% of children with reading disorders also had comorbid mathematical disorder. CONCLUSION: The prevalence, causes, and comorbidity of reading and mathematical learning disabilities of students in Jeju Island, South Korea did not differ from those in foreign countries. Because most learning disabilities are complex, comprehensive evaluations and tailored interventions are necessary to help children with learning disabilities.

Development of Korean Adult ADHD Rating Scale

OBJECTIVES: Symptoms of attention-deficit hyperactivity disorder (ADHD) during childhood may persist into adulthood. This study included the development and validation process of the Korean Adult ADHD Rating Scale (K-AARS), which was developed for screening and monitoring treatment of adults with ADHD. METHODS: Preliminary questionnaires of the K-AARS were based on the reviews of previous adult ADHD scales and clinical experiences of the board certified child and adolescent psychiatrists in Korea. For this study, 136 adults (18-50 years old) with inattention, hyperactivity and/or impulsivity symptoms were enrolled as ADHD subjects, and compared with 406 control subjects (18-50 years old) without ADHD symptoms. Construct validity was examined using explorative factor analysis and Cronbach's alpha to obtain internal reliability coefficients. Concurrent validity was evaluated by comparison with the Conners' Adult ADHD Rating Scale (CAARS). RESULTS: An explorative factor analysis showed that the K-AARS had 8 factors (inattention, hyperactivity, impulsivity, antisocial personality disorder/conduct disorder/oppositional defiant disorder, impairment, driving, emotional dysregulation, disorganization). K-AARS was highly reliable in terms of internal consistency (Cronbach's alpha 0.77-0.95) and correlation between factors (0.57-0.86). Concurrent validity with the CAARS and discriminant validity were statistically significant. CONCLUSION: The K-AARS is a valid and reliable measure for assessment of Korean adults with ADHD.

Prevalence and Correlates of Problematic Internet Experiences and Computer-Using Time: A Two-Year Longitudinal Study in Korean School Children

OBJECTIVE: To measure the prevalence of and factors associated with online inappropriate sexual exposure, cyber-bullying victimisation, and computer-using time in early adolescence. METHODS: A two-year, prospective school survey was performed with 1,173 children aged 13 at baseline. Data collected included demographic factors, bullying experience, depression, anxiety, coping strategies, self-esteem, psychopathology, attention-deficit hyperactivity disorder symptoms, and school performance. These factors were investigated in relation to problematic Internet experiences and computer-using time at age 15. RESULTS: The prevalence of online inappropriate sexual exposure, cyber-bullying victimisation, academic-purpose computer overuse, and game-purpose computer overuse was 31.6%, 19.2%, 8.5%, and 21.8%, respectively, at age 15. Having older siblings, more weekly pocket money, depressive symptoms, anxiety symptoms, and passive coping strategy were associated with reported online sexual harassment. Male gender, depressive symptoms, and anxiety symptoms were associated with reported cyber-bullying victimisation. Female gender was associated with academic-purpose computer overuse, while male gender, lower academic level, increased height, and having older siblings were associated with game-purpose computer-overuse. CONCLUSION: Different environmental and psychological factors predicted different aspects of problematic Internet experiences and computer-using time. This knowledge is important for framing public health interventions to educate adolescents about, and prevent, internet-derived problems.

A Preliminary Study on the Development of Korean Medication Algorithm for Attention-Deficit Hyperactivity Disorder

OBJECTIVES: This study was conducted to develop a Korean algorithm of pharmacological and non-pharmacological treatment strategies in attention-deficit hyperactivity disorder (ADHD) and its specific comorbid disorders (e.g. tic disorder, depressive disorder, anxiety disorder, bipolar disorder, and oppositional defiant disorder/conduct disorder). METHODS: Based on a literature review and expert consensus, both paper- and web-based survey tools were developed with respect to a comprehensive range of questions. Most options were scored using a 9-point scale for rating the appropriateness of medical decisions. For the other options, the surveyed experts were asked to provide answers (e.g., duration of treatment, average dosage) or check boxes to indicate their preferred answers. The survey was performed on-line in a self-administered manner. Ultimately, 49 Korean child & adolescent psychiatrists, who had been considered experts in the treatment of ADHD, voluntarily completed the questionnaire. In analyzing the responses to items rated using the 9-point scale, consensus on each option was defined as a non-random distribution of scores as determined by a chi-square test. We assigned a categorical rank (first line/preferred choice, second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating score. RESULTS: Specific medication strategies for key clinical situations in ADHD and its comorbid disorders were indicated and described. We organized the suggested algorithms of ADHD treatment mainly on the basis of the opinions of the Korean experts. The suggested algorithm was constructed according to the templates of the Texas Child & Adolescent medication algorithm Project (CMAP). CONCLUSION: We have proposed a Korean treatment algorithm for ADHD, both with and without comorbid disorders through expert consensus and a broad literature review. As the tools available for ADHD treatment evolve, this algorithm could be reorganized and modified as required to suit updated scientific and clinical research findings.

Predictors of Quality of Life in Patients with Acute Coronary Syndrome / 신경정신의학

OBJECTIVES: An important therapeutic target for patients with acute coronary syndrome (ACS) is improved quality of life (QoL). This study investigated clinical factors affecting QoL in patients with ACS. METHODS: We evaluated 82 patients two weeks, and again at three months, after their ACS onset (diagnosis?), using the World Health Organization Quality of Life Instrument-Brief Form to assess QoL. For estimating their severity of depression, we used the Hamilton Depression Rating Scale. We used their Global Registry of Acute Coronary Events risk scores to measure the patients' ACS. Sociodemographic characteristics included age, gender, education, marital status, religion, current occupation, and monthly income. RESULTS: Depressive symptoms at baseline predicted higher QoL at both follow-ups. Some other factors, such as education, religion, and current occupation, were also significantly associated with QoL at three months' follow-up. CONCLUSION: Depression was the most important factor affecting QoL in patients with ACS, at both two weeks' and three months' follow-up.

Standardization and Validation of Big Five Inventory-Korean Version(BFI-K) in Elders

OBJECTIVES: The Big Five Inventory(BFI) and the Big Five Inventory-10(BFI-10) are widely used instruments for the evaluation of personality in various cultures, while they have not been formally validated in Korea. This study aimed to develop the Korean versions of BFI(BFI-K) and BFI 10(BFI-K-10) with a Korean elderly population. METHODS: The study sample consisted of 1,038 community dwelling elders. BFI-K and BFI-K-10 were administered. For the reliability analyses, scores on Guttmans' split half and Cronbach's alpha were estimated. For the validity analyses, the Korean version of Geriatric Depression Scale(KGDS) and the State-Trait Anxiety Inventory(STAI) were investigated. RESULTS: The reliability of the BFI-K was good(Guttmans' split half=0.59-0.78, Cronbach's alpha=0.52-0.75). Scores on the BFI-K-10 were significantly correlated with the scores on BFI-K. Scores on the BFI-K and the BFI-K-10 were significantly correlated with the scores on KGDS and STAI. CONCLUSION: Both BFI-K and BFI-K-10 might be reliable and valid instruments to evaluate the personality in Korean community elders. BFI-K-10 is short and easy to be administered, and therefore it would be very convenient to use.

Psychosocial Correlates of Attempted Suicide and Attitudes Toward Suicide / 신경정신의학

OBJECTIVES: To examine psychosocial correlates of suicide attempts in a community population. METHODS: This study investigated suicide attempt history, demographic and psychosocial characteristics including depression using the Beck Depression Inventory (BDI), and responses to a questionnaire about attitudes toward suicide in a community sample. The demographic and psychosocial correlates of suicide attempts were evaluated using univariate and multivariate analyses. RESULTS: A total of 1,578 people completed the survey. Of these, 100 people (6.3%) had attempted suicide. In the univariate analyses, risk factors for attempted suicide were divorce, lower level of education, lack of a stable job, living in a rented house, undergoing psychiatric treatment, a family history of psychiatric illness, and being depressed (BDI > or =22). In the multivariate analysis, living in a rented house, undergoing psychiatric treatment, and being depressed were significantly associated with attempted suicide. Of the individuals who had attempted suicide, 42.0% were currently depressed, whereas the prevalence of depression in those who had not attempted suicide was 9.1%. In addition, individuals who had attempted suicide had permissive attitudes toward suicide and negative attitudes toward treatment for suicidal behavior. CONCLUSION: Attempted suicide was significantly associated with depression. Therefore, immediate and appropriate psychiatric treatment for depression in those attempting suicide is crucial.

Apolipoprotein E4 Genotype and Depressive Symptoms as Risk Factors for Dementia in an Older Korean Population

OBJECTIVE: Growing evidence suggests the separate associations of apolipoprotein E e4 allele (apo E4) and depression with incident dementia. This study investigated the separate and combined effects of apo E4 and depression on the incidence of dementia in both men and women. METHODS: Of 625 elderly without dementia at baseline, 518 (83%) were followed over a 2.4-year period and were assessed clinically for incident dementia. The apo E polymorphism was ascertained, and depression was identified using the Korean version of the Geriatric Depression Scale (KGDS). Covariates included age, gender, education, disability, alcohol history, physical activity, and vascular risk factors. RESULTS: The incidence of dementia was significantly higher in elderly Koreans with both apo E4 and depression compared to those without both factors [adjusted odds ratio (95% CI)=5.85 (1.77-19.38)]. This interaction was significant in men (p=0.049), but not in women (p=0.354). CONCLUSION: Depressed elderly people are at great risk for incident dementia in the presence of apo E4. Potential gender differences require further evaluation.

Psychosocial Correlates of Suicidal Ideation in Middle-School Students / 신경정신의학

OBJECTIVES: To examine the prevalence and psychosocial correlates of current suicidal ideation in middle-school students. METHODS: This school-based cross-sectional study enrolled 452 middle-school students in grade 7. Current suicidal ideation was defined as suicidal thoughts and a desire to be dead within two weeks. Sociodemographic variables, including environmental stressors, were collected to identify factors associated with current suicidal ideation. The students were asked to complete the Beck Depression Inventory, the Strength and Difficulties Questionnaire, the Korean Version of the Children of Alcoholics Screening Test, the Problem-Oriented Screening Instrument for Teenagers, and various scales measuring anger level and ability to control anger. RESULTS: Current suicidal ideation was reported by 31.3% of the students. In a multivariate logistic regression analysis, a previous suicide attempt, depression, parents with alcohol problems, family trouble, and anger level were independently associated with current suicidal ideation. The experiences of running away, domestic violence, being bullied, alcohol abuse, hyperactivity, and emotional problems were significantly more frequent in students with suicidal ideation, but they were not significantly associated with suicidal ideation in the multivariate analysis. CONCLUSION: This study suggests that a previous suicide attempt is a risk factor for current suicidal ideation. Appropriate management of depression and anger in middle-school students and interventions for family troubles and parental alcohol problems are needed to reduce suicidal ideation in middle-school students.

Pharmacologic Treatment of Restless Legs Syndrome / 대한정신약물학회지

Restless legs syndrome (RLS) is defined as the urge to move one's legs, accompanied by unpleasant sensations in one's limbs, and is typically more severe at night. Sleep hygiene measures should be recommended and all causes of secondary RLS such as iron deficiency and medications (antidepressants, antiemetics, antipsychotics, and antihistamines) should be excluded before pharmacological treatment of RLS is initiated. In view of evidence of their efficacy and tolerability, ropinorole, pramipexole, gabapentin, and oral iron should be considered as first-line treatments for RLS. Ropinirole and pramipexole are the only drugs approved for the treatment of RLS in Korea. Ropinirole is metabolized by cytochrome P450 1A2 in the liver. On the other hand, pramipexole is metabolized only to a minor degree, and urinary excretion is the major route of elimination; thus, doses of pramipexole should be reduced in patients with impaired renal functioning. Gabapentin, which is known to be effective for pain and sleep disturbances in patients with RLS, is also secreted unmodified by the kidneys. An oral iron supplement is recommended for patients with low normal serum ferritin levels (< or = 75 ng/mL). Levodopa, pergolide, cabergoline, valproic acid, carbamazepine, and IV iron dextran are classified as second-line treatments. Clonazepam, bupropion, and some opioids can also be used in patients with RLS. In conclusion, pharmacological treatment of RLS should be individualized according to the physical status of patients as well as their RLS symptoms, and augmentation should be carefully monitored when dopaminergic agents are used for long periods.

Disturbed Eating Attitudes and Behaviors in South Korean Boys and Girls: A School-Based Cross-Sectional Study

PURPOSE: This study was designed to assess the prevalence and correlates of disturbed eating attitudes and behaviors in South Korean students. MATERIALS AND METHODS: In a cross-sectional survey, 2,226 fourth and seventh grade students filled out questionnaires on eating attitudes and behaviors (Eating Attitude Test -26, EAT-26), coping strategies, fear of being overweight, behavioral problems, anxiety, depression, and self-esteem. RESULTS: Disturbed eating attitudes and behaviors were found in 7 percent of students. In the multivariate analyses, disturbed eating attitudes and behaviors were associated with the passive coping strategies, fear of being overweight, total behavioral difficulties, fourth grade, and high socioeconomic status (SES). Differences in the associations were found between boys and girls. There were significant associations between elevated EAT-26 scores and passive coping strategies, desired underweight body mass index (BMI), and low SES in boys; and between elevated EAT-26 scores and passive coping strategies, fear of being overweight, behavioral problems, being in the fourth grade, and high and low SES in girls. CONCLUSION: In South Korean children, disturbed eating attitudes and behaviors were associated with various psychological and sociocultural factors; some gender-related differences are also evident.

Disturbed Eating Attitudes and Behaviors in South Korean Boys and Girls: A School-Based Cross-Sectional Study

PURPOSE: This study was designed to assess the prevalence and correlates of disturbed eating attitudes and behaviors in South Korean students. MATERIALS AND METHODS: In a cross-sectional survey, 2,226 fourth and seventh grade students filled out questionnaires on eating attitudes and behaviors (Eating Attitude Test -26, EAT-26), coping strategies, fear of being overweight, behavioral problems, anxiety, depression, and self-esteem. RESULTS: Disturbed eating attitudes and behaviors were found in 7 percent of students. In the multivariate analyses, disturbed eating attitudes and behaviors were associated with the passive coping strategies, fear of being overweight, total behavioral difficulties, fourth grade, and high socioeconomic status (SES). Differences in the associations were found between boys and girls. There were significant associations between elevated EAT-26 scores and passive coping strategies, desired underweight body mass index (BMI), and low SES in boys; and between elevated EAT-26 scores and passive coping strategies, fear of being overweight, behavioral problems, being in the fourth grade, and high and low SES in girls. CONCLUSION: In South Korean children, disturbed eating attitudes and behaviors were associated with various psychological and sociocultural factors; some gender-related differences are also evident.