Psychopathological Characteristics of Modern Type Depression / 생물치료정신의학

Objectives@#This research probes into the characteristics of modern type depression (MTD) in South Korea, drawing parallels to Japan’s hikikomori state. It aims to bridge cultural value gaps and highlight its significance in South Korea, given the observed reclusive youth behaviors. @*Methods@#Participants undertook a semi-structured interview assessing hikikomori tendencies and MTD. Also, self-reports were done using the 25-item Hikikomori Questionnaire (HQ-25), 22-item Tarumi’s Modern-Type Depression Trait Scale: Avoidance of Social Roles, Complaint, and Low Self-Esteem (TACS-22), Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory-II (BDI-II), Young’s Internet Addiction Test (YIAT), Smartphone Addiction ScaleShort form Version (SAS-SV), Revised UCLA Loneliness Scale (RULS), Lubben Social Network Scale (LSNS-6). Scores were analyzed by group (MTD, control) using and logistic regression was done. Additional analysis was done by group (modern type with hikikomori and modern type without hikikomori). @*Results@#Of 59 participants, 29 had MTD. In both groups, age and sex were matched with differences in education years. The MTD group contained 14 hikikomori individuals. Logistic regression identified the HQ-25 as a significant predictor for MTD. Notably, specific components like “low self-esteem” in TACS-22 and “isolation” in the HQ-25 significantly influenced MTD status. HQ-25 and RULS were significantly different between modern type with hikikomori and modern type without hikikomori. @*Conclusions@#Using Japanese diagnostic criteria, this study illuminated MTD in Korean patients. The findings underscore isolation and low self-esteem predicted diagnosis of MTD. As MTD shares common pathological traits with hikikomori, the therapeutic interventions are important in Korea.

Impact of a Psychiatric Consultation Program on COVID-19 Patients: An Experimental Study

Objective@#Following the coronavirus disease-2019 (COVID-19) outbreak, the importance of addressing acute stress induced by psychological burdens of diseases became apparent. This study attempted to evaluate the effectiveness of a new mode of psychiatric intervention designed to target similar psychological crises. @*Methods@#Participants included 32 out of 114 COVID inpatients at a hospital in Daegu, Korea, who were assessed between March 30 and April 7, 2020. Multiple scales for screening psychological difficulties such as depressed mood, anxiety, insomnia, acute stress, and suicidality were done. Psychological problem evaluations and interventions were conducted in the form of consultations to alleviate participants’ psychological challenges via telepsychiatry. The interventions’ effects, as well as clinical improvements before and after the intervention, were analyzed. @*Results@#As a result of screening, 21 patients were experiencing psychological difficulties beyond clinical thresholds after COVID-19 infection (screening positive group). The remaining 11 were screening negative groups. The two groups differed significantly in past psychiatric histories (p=0.034), with the former having a higher number of diagnoses. The effect of the intervention was analyzed, and clinical improvement before and after the intervention was observed. Our intervention was found to be effective in reducing the overall emotional difficulties. @*Conclusion@#This study highlighted the usefulness of new interventions required in the context of healthcare following the COVID-19 pandemic.

The Usefulness of Quantitative Electroencephalography in Diagnosis and Severity Evaluation of Delirium: A Retrospective Study

Objective@#Incontrovertible disease markers are absent in delirium. This study investigated the usefulness of quantitative electroencephalography (qEEG) in diagnosing delirium. @*Methods@#This retrospective case-control study reviewed medical records and qEEG data of 69 age/sex-matched patients (delirium group, n=30; control group, n=39). The first minute of artifact-free EEG data with eyes closed was selected. Nineteen electrodes’ sensitivity, specificity, and correlation with delirium rating scale-revised-98 were analyzed. @*Results@#On comparing the means of absolute power by frontal, central, and posterior regions, the delta and theta powers showed significant differences (p<0.001) in all regions, and the magnitude of the absolute power was higher in the delirium group than in the control group; only the posterior region showed a significant (p<0.001) difference in beta power. The spectral power of theta at the frontal region (area under the curve [AUC]=0.84) and theta at the central and posterior regions (AUC=0.83) showed 90% sensitivity and 79% specificity, respectively, in differentiating delirious patients and controls. The beta power of the central region showed a significant negative correlation with delirium severity (R=-0.457, p=0.011). @*Conclusion@#Power spectrum analysis of qEEG showed high accuracy in screening delirium among patients. The study suggests qEEG as a potential aid in diagnosing delirium.

Clinical Characteristics and Therapeutic Intervention of Nonsuicidal Self-Injury in Adolescents / 생물치료정신의학

Nonsuicidal Self-Injury(NSSI) is defined as a direct, intentional, socially unacceptable injury to one’s own body without suicidal intent. It is a major clinical and public health problem among adolescents around the world. Further, it is highly likely to be comorbid with various psychiatric disorders and is a high risk factor for suicide. In addition, NSSI may persist chronically in a number of adolescents. Therefore, appropriate and early intervention for adolescent NSSI is necessary, as adolescence is considered to be a key period for prevention and intervention. In this review, the overall characteristics and treatments of adolescent NSSI were investigated. However, there is still a lack of research on the risk factors and treatment for NSSI in adolescence. It is expected that if additional research is conducted based on previous studies, intervention and treatment, both of which are highly effective and early, will be provided to adolescents.

The Psychological Impact of Quarantine during COVID-19 Pandemic: A Cross-Sectional Study / 생물치료정신의학

Objectives@#：This study assessed the psychological impact of quarantine during the coronavirus disease 2019 (COVID-19) outbreak. @*Methods@#：A total of 2080 participants filled the self-report questionnaire from March 17 to April 20, 2020 in Daegu, Republic of Korea. An online link was sent to currently or previously quarantined participants. The self-report questionnaire included patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), primary care post-traumatic stress disorder screen for diagnostic and statistical manual-5 (PTSD-PC), state-trait anger expression inventory (STAXI), and P4 suicidality screener scale (P4). PHQ-9 score of 5 or more and 9 or less indicates mild to moderate depressive symptoms, and 10 or more indicates severe depressive symptoms; A GAD-7 score of 5 or more and 14 or less indicates mild to moderate anxiety symptoms, and a score of 15 or more indicates severe anxiety symptoms; A PTSD-PC-5 score of 2 indicates mild to moderate PTSD; a score of 3 or higher indicates severe PTSD; A STAXI score of 14 or higher indicates severe anger symptoms; In P4, the cut-off points for each self-report questionnaire were set as mild suicidal thoughts at 1 point or more and 2 points or less, and severe suicide thoughts at 3 or more points. Logistic regression analyses were used to explore COVID-19-related risk factors. @*Results@#：The prevalence of mental health symptoms among the survey respondents was at 52.5% for depression, 44.5% for anxiety, 39.4% for post-traumatic stress, 31.6% for anger, and 10.9% for suicidal ideation. Participants with confirmed or suspected COVID-19 family members showed a high risk for symptoms of anxiety, posttraumatic stress, and anger. Participants with financial loss had increased symptoms of depression, anxiety, posttraumatic stress, anger, and suicidal ideation. Participants with a history of medical/psychiatric illnesses reported more symptoms of depression, anxiety, post-traumatic stress, anger, and suicidal ideation. Having inadequate basic supplies during quarantine was associated with negative mental health outcomes. @*Conclusions@#：Quarantine had a negative psychological impact on all five mental health factors. The risk of depression, anxiety, post-traumatic stress disorder, anger, and suicidality increased among those who suffered from financial losses due to COVID-19. The associated risk factors will help identify populations at risk for mental health problems and implement mental health intervention policies.

Developing Korean Version of the 25-item Hikikomori Questionnaire / 신경정신의학

Objectives@#Hikikomori is a social condition characterized by social withdrawal. It is essential to develop an objective indicator to screen for this condition and provide early intervention. Therefore, this study verified the validity and reliability of a Korean version of the 25-item Hikikomori Questionnaire (HQ-25). @*Methods@#Semi-structured interviews were conducted with participants at high risk of feeling loneliness and who were recruited through online and offline methods. Data based on clinical scales were collected, and after four weeks, a self-report questionnaire was administered to a few participants to confirm the degree of agreement. @*Results@#One hundred forty-three people were enrolled, out of which 45 were identified as hikikomori. There was a significant difference in scores between the hikikomori group and the unaffected group (64.44 and 39.30, respectively; p<0.01). Convergent diversity and test-retest reliability were satisfactory. The area under the receiver operating characteristic curve was 0.817. Based on confirmatory factor analysis, the existing model was found suitable. In this study, sensitivity and specificity were 88.9% and 52.0% at 40.5 points, and 84.4% and 49.0% at 41.5 points, respectively. @*Conclusion@#The Korean version of the HQ-25 has secure validity and reliability. This scale can be beneficial in the screening and early intervention of hikikomori.

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Objective@#Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate. @*Methods@#We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. @*Results@#The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). @*Conclusion@#Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

Effects of Cognitive-Behavioral Therapy Based Music Therapy in Korean Adolescents with Smartphone and Internet Addiction

Objective@#The purpose of this study was to evaluate the effects of adding music therapy (MT) to cognitive-behavioral therapy (CBT) on symptoms of smartphone/internet addiction and psychiatric comorbidities. @*Methods@#Overall, 155 patients diagnosed with addiction were assigned to either the CBT-MT group or CBT group. Both groups received CBT for 8 weeks, while the CBT-MT group received additional MT. The intervention was completed by 67 and 71 participants in the CBT-MT and CBT groups, respectively. @*Results@#The total scores of Young Internet Addiction Scale (YIAT) and Smartphone Addiction Proneness Scale (SAPS) decreased significantly (p<0.001 for both) in both groups, while the total scores of State Anxiety Inventory for Children (SAIC) (p<0.001), Trait Anxiety Inventory for Children (TAIC) (p<0.001), Conners-Wells’ Adolescent Self-Report Scale-Short form (CASS(S)) (p=0.048), and Barratt Impulsiveness Scale-11 (BIS-11) (p<0.001) decreased only in the CBT-MT group. The decrements in YIAT (p=0.025), SAIC (p=0.043), TAIC (p=0.011), and BIS-11 (p=0.012) in the CBT-MT group were significantly greater than those in the CBT group. @*Conclusion@#Combined MT and CBT improved the symptoms of smartphone/internet addiction, anxiety, and impulsivity in adolescents. This combination could therefore be an effective treatment of smartphone or internet addiction along with behavioral disorders such as anxiety and impulsivity.

The Association of Anxiety Severity With Health Risk Behaviors in a Large Representative Sample of Korean Adolescents

Objectives@#Anxiety disorders are the most common psychiatric disorders in adolescents and seem to occur the earliest among all forms of psychopathology. The aim of this study was to investigate the association of anxiety severity with health risk behaviors and mental health in adolescents. @*Methods@#Data from the 2020 Korean Youth Risk Behavior Web-Based Survey were analyzed. A total of 54948 adolescents responded to the 7-item Generalized Anxiety Disorder Scale (GAD-7) for the assessment of their anxiety severity as well as to the mental health and health risk behavior survey. Logistic regression analysis, t tests, and variance analysis of a complex sample general linear model were used to examine the association of anxiety severity with health behaviors and mental health. @*Results@#After statistical adjustment for sociodemographic characteristics, the subjects in the severe anxiety group were significantly more likely to be current smokers (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.72–2.50), current drinkers (OR: 1.91, 95% CI:1.67–2.19), experience habitual substance use (OR: 10.89, 95% CI: 8.22–14.42), have sexual intercourse (OR: 2.10, 95% CI: 1.76–2.51), and have unprotected intercourse (OR: 2.21, 95% CI: 1.67–2.92) than those in the normal group. Anxiety severity negatively correlated with sleep satisfaction and happiness, but positively correlated with stress perception, loneliness, depressive symptoms, and suicidality. @*Conclusion@#Adolescent anxiety is associated with health risk behaviors and poor mental health. Thus, early screening and intervention for anxiety in adolescents could contribute to the management and coping of youth health risk behaviors in the community.

The Association of Anxiety Severity With Health Risk Behaviors in a Large Representative Sample of Korean Adolescents

Objectives@#Anxiety disorders are the most common psychiatric disorders in adolescents and seem to occur the earliest among all forms of psychopathology. The aim of this study was to investigate the association of anxiety severity with health risk behaviors and mental health in adolescents. @*Methods@#Data from the 2020 Korean Youth Risk Behavior Web-Based Survey were analyzed. A total of 54948 adolescents responded to the 7-item Generalized Anxiety Disorder Scale (GAD-7) for the assessment of their anxiety severity as well as to the mental health and health risk behavior survey. Logistic regression analysis, t tests, and variance analysis of a complex sample general linear model were used to examine the association of anxiety severity with health behaviors and mental health. @*Results@#After statistical adjustment for sociodemographic characteristics, the subjects in the severe anxiety group were significantly more likely to be current smokers (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.72–2.50), current drinkers (OR: 1.91, 95% CI:1.67–2.19), experience habitual substance use (OR: 10.89, 95% CI: 8.22–14.42), have sexual intercourse (OR: 2.10, 95% CI: 1.76–2.51), and have unprotected intercourse (OR: 2.21, 95% CI: 1.67–2.92) than those in the normal group. Anxiety severity negatively correlated with sleep satisfaction and happiness, but positively correlated with stress perception, loneliness, depressive symptoms, and suicidality. @*Conclusion@#Adolescent anxiety is associated with health risk behaviors and poor mental health. Thus, early screening and intervention for anxiety in adolescents could contribute to the management and coping of youth health risk behaviors in the community.

Psychological Characteristics of Living Liver Transplantation Donors using MMPI-2 Profiles / 정신신체의학

OBJECTIVES: Living donor liver transplantation (LDLT) is a life-saving therapy for patients with terminal liver disease. Many studies have focused on recipients rather than donors. The aim of this study was to assess the emotional status and personality characteristics of LDLT donors. METHODS: We evaluated 218 subjects (126 male, 92 female) who visited Daegu Catholic University Medical Center from August 2012 to July 2018. A retrospective review of their preoperative psychological evaluation was done. We investigated epidemiological data and the Minnesota Multiphasic Personality Inventory-2 questionnaire. Subanalysis was done depending on whether subjects actually underwent surgery, relationship with the recipient, and their gender. RESULTS: Mean age of subjects was 32.19±10.91 years. 187 subjects received LDLT surgery (actual donors) while 31 subjects didn't (potential donors). Donor-recipient relationship included husband-wife, parent-children, brother-sister etc. Subjects had statistical significance on validity scale L, F, K and all clinical scales compared to the control group. Potential donors had significant difference in F(b), F(p), K, S, Pa, AGGR, PSYC, DISC and NEGE scales compared to actual donors. F, D and NEGE scales were found to be predictive for actual donation. Subanalysis on donor-recipient relationship and gender also showed significant difference in certain scales. CONCLUSIONS: Under-reporting of psychological problems should be considered when evaluating living-liver donors. Information about the donor's overall psychosocial background, mental status and donation process should also be acquired.

Psychiatric Symptoms in Systemic Lupus Erythematosus: Diagnosis and Treatment

According to the American College of Rheumatology classification, lupus erythematosus has five psychiatric manifestations, including cognitive dysfunction, mood disorder, anxiety disorder, psychosis, and acute confusional state, which are frequently accompanied by other symptoms. Cognitive dysfunction is the most common psychiatric manifestation in lupus patients with a prevalence rate ranging from 20% to 80%. The expression of psychiatric manifestations has been considered to be associated with disease activity, side effects of medications, and/or psychosocial stresses from the chronicity of lupus, but this has not been fully understood. Appropriate management of psychiatric symptoms is essential as it affects treatment adherence and quality of life. This review aimed to facilitate understanding of psychiatric manifestations of lupus through literature review on the prevalence, clinical features, diagnosis, and treatments of each psychiatric symptom.

A Brain Atlas of the Long Arm Octopus, Octopus minor

Cephalopods have the most advanced nervous systems and intelligent behavior among all invertebrates. Their brains provide comparative insights for understanding the molecular and functional origins of the human brain. Although brain maps that contain information on the organization of each subregion are necessary for a study on the brain, no whole brain atlas for adult cephalopods has been constructed to date. Here, we obtained sagittal and coronal sections covering the entire brain of adult Octopus minor (Sasaki), which belongs to the genus with the most species in the class Cephalopoda and is commercially available in East Asia throughout the year. Sections were stained using Hematoxylin and Eosin (H&E) to visualize the cellular nuclei and subregions. H&E images of the serial sections were obtained at 30~70-µm intervals for the sagittal plain and at 40~80-µm intervals for the coronal plain. Setting the midline point of the posterior end as the fiducial point, we also established the distance coordinates of each image. We found that the brain had the typical brain structure of the Octopodiformes. A number of subregions were discriminated by a Hematoxylin-positive layer, the thickness and neuronal distribution pattern of which varied markedly depending upon the region. We identified more than 70 sub-regions based on delineations of representative H&E images. This is the first brain atlas, not only for an Octopodiformes species but also among adult cephalopods, and we anticipate that this atlas will provide a valuable resource for comparative neuroscience research.

Exploring the Differences between Adolescents' and Parents' Ratings on Adolescents' Smartphone Addiction

BACKGROUND: Smartphone addiction has recently been highlighted as a major health issue among adolescents. In this study, we assessed the degree of agreement between adolescents' and parents' ratings of adolescents' smartphone addiction. Additionally, we evaluated the psychosocial factors associated with adolescents' and parents' ratings of adolescents' smartphone addiction. METHODS: In total, 158 adolescents aged 12–19 years and their parents participated in this study. The adolescents completed the Smartphone Addiction Scale (SAS) and the Isolated Peer Relationship Inventory (IPRI). Their parents also completed the SAS (about their adolescents), SAS-Short Version (SAS-SV; about themselves), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). We used the paired t-test, McNemar test, and Pearson's correlation analyses. RESULTS: Percentage of risk users was higher in parents' ratings of adolescents' smartphone addiction than ratings of adolescents themselves. There was disagreement between the SAS and SAS-parent report total scores and subscale scores on positive anticipation, withdrawal, and cyberspace-oriented relationship. SAS scores were positively associated with average minutes of weekday/holiday smartphone use and scores on the IPRI and father's GAD-7 and PHQ-9 scores. Additionally, SAS-parent report scores showed positive associations with average minutes of weekday/holiday smartphone use and each parent's SAS-SV, GAD-7, and PHQ-9 scores. CONCLUSION: The results suggest that clinicians need to consider both adolescents' and parents' reports when assessing adolescents' smartphone addiction, and be aware of the possibility of under- or overestimation. Our results can not only be a reference in assessing adolescents' smartphone addiction, but also provide inspiration for future studies.

The Relationship between the Amisulpride-Induced Hyperprolactinemia and Taq1A Polymorphism of the Dopamine D2 Receptor Gene in Schizophrenia Patients

OBJECTIVES: This study was aimed to investigate the association between amisulpride-induced hyperprolactinemia and the Taq1A polymorphism in the D2 dopamine receptor gene (DRD2) in schizophrenic patients. METHODS: The plasma concentrations of prolactin were measured before and after treatment with amisulpride in one hundred and twenty-five schizophrenic patients. The effect of the Taq1A variants of the DRD2 on the risk of amisulpride-induced hyperprolac-tinemia was the main the outcome measure. The genotyping for Taq1A (rs1800497) polymorphism was performed using TaqMan single nucleotide polymorphism (SNP) genotyping assay. RESULTS: There was a significant difference between the prolactin level at baseline and the 6th week after treatment with amisulpride in all the subjects. However, there were no significant correlations between ΔProlactin (the difference between prolactin level at baseline and the 6th week after treatment) and the Taq1A genotypes. CONCLUSIONS: This is the first study to investigate the-correlations between the Taq1A polymorphism and the amisulpride-induced hyperprolactinemia in Korean schizophrenic patients. The current results suggested the further large-scale researches on various SNPs in the DRD2 gene will establish clear goals and provide answers to the unanswered questions described in this study.

Risk Factors for Smartphone Addiction in Korean Adolescents: Smartphone Use Patterns

With widespread use of the smartphone, clinical evidence for smartphone addiction remains unclear. Against this background, we analyzed the effect of smartphone use patterns on smartphone addiction in Korean adolescents. A total of 370 middle school students participated. The severity of smartphone addiction was measured through clinical interviews and the Korean Smartphone Addiction Proneness Scale. As a result, 50 (13.5%) were in the smartphone addiction group and 320 (86.5%) were in the healthy group. To investigate the effect of smartphone use patterns on smartphone addiction, we performed self-report questionnaires that assessed the following items: smartphone functions mostly used, purpose of use, problematic use, and parental attitude regarding smartphone use. For smartphone functions mostly used, the addiction group showed significantly higher scores in “Online chat.” For the purpose of use, the addiction group showed significantly higher “habitual use,”“pleasure,”“communication,”“games,”“stress relief,”“ubiquitous trait,” and “not to be left out.” For problematic use, the addiction group showed significantly higher scores on “preoccupation,”“tolerance,”“lack of control,”“withdrawal,”“mood modification,”“conflict,”“lies,”“excessive use,” and “loss of interest.” For parental attitude regarding children's smartphone use, the addiction group showed significantly higher scores in “parental punishment.” Binary logistic regression analysis indicated that “female,”“use for learning,”“use for ubiquitous trait,”“preoccupation,” and “conflict” were significantly correlated with smartphone addiction. This study demonstrated that the risk factors for smartphone addiction were being female, preoccupation, conflict, and use for ubiquitous trait; the protective factor was use for learning. Future studies will be required to reveal the additional clinical evidence of the disease entity for smartphone addiction.

Differences in Resting-state Quantitative Electroencephalography Patterns in Attention Deficit/Hyperactivity Disorder with or without Comorbid Symptoms

OBJECTIVE: The aim of the present study was to evaluate the role of comorbid psychiatric symptoms on quantitative electroencephalogram (QEEG) activities in boys with the attention deficit/hyperactivity disorder (ADHD). METHODS: All participants were male students in the second, third or fourth grade in elementary school. Therefore, there were no significant differences in age or sex. Participants with ADHD were assigned to one of three groups: pure ADHD (n=22), ADHD with depressive symptoms (n=11), or ADHD with problematic internet use (n=19). The Korean version of the Children’s Depression Inventory and the Korean Internet Addiction Self-scale were used to assess depressive symptoms and problematic internet use, respectively. Resting-state EEG during eyes closed was recorded, and the absolute power of five frequency bands was analyzed: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), and gamma (30–50 Hz). RESULTS: The ADHD with problematic internet use group showed decreased absolute theta power at the central and posterior region compared with the pure ADHD group. However, The ADHD with depressive symptoms group showed no significant differences compared with the other groups. CONCLUSION: These findings will contribute to a better understanding of brain-based electrophysiological changes in children with ADHD in accordance with comorbid psychiatric symptoms.

The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction

Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents' Concerns for Children's Smartphone Activities Scale to measure parental monitoring and supervision of adolescents' smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents' Concerns for Children's Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents' concerns for their children's smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction.

Expert opinions on the concept of blood stasis in China: An interview study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study various experts' opinions on the defifinition and diagnosis of blood stasis in China.</p><p><b>METHODS</b>We e-mailed the selected experts to explain the purpose of the study and to invite them to participate and asked them to name a time for the investigator to call them. Eight experts and fifive organizations were interviewed in the research community investigating blood stasis in China.</p><p><b>RESULTS</b>Six main categories emerged from the interviews: (1) blood stasis concepts; (2) blood stasis-related biomarkers; (3) methods of diagnosing blood stasis; (4) drugs for promoting blood circulation and dissipating stasis; (5) blood stasis-related diseases; and (6) blood stasis-related societies. The consensus among the interviewed experts was that the defifinition of blood stasis is rather complicated and that there is no gold standard marker for detecting blood stasis.</p><p><b>CONCLUSIONS</b>This paper acquired experts' opinions on the defifinition and diagnosis of blood stasis in order to establish a modern concept of blood stasis. This paper also developed a diagnostic tool and diagnostic indices for blood stasis and identifified biological indices and pathologic mechanisms related to blood stasis, which might be of great reference value in future blood stasis standardization research.</p>

Psychopathological Characteristics of Social Withdrawal (Hikikomori) in the Korean Adolescent / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the social withdrawal tendency in Korean adolescents using the Hikikomori Behavior Checklist and to compare the psychopathological differences between the high risk group of social withdrawal (HRSW) and the low risk group of social withdrawal (LRSW). METHODS: Participants included 300 high school students from Daegu, Korea. Each participant completed several questionnaires including the demographic questionnaire, Korean-Version of the Hikikomori Behavior Checklist (K-HBCL), the Parental Screening Questionnaire for Hidden Youth (HYQ), Beck Depression Inventory (BDI), Anxiety Sensitivity Inventory (ASI), Social Avoidance and Distress scale (SAD), the Scale for Fear of Negative Evaluation (FNE), and Maudsley Obsessive-Compulsive Inventory (MOCI). The subjects were divided into two groups, the HRSW and LRSW, depending on the mean value of their total HBCL score, and their BDI, ASI, SAD, FNE, and MOCI scores were compared between HRSW and LRSW. RESULTS: The scales affecting the high-risk group were BDI, ASI, and SAD. The total score of K-HBCL showed positive correlation with the total score of BDI, ASI, SAD, FNE, and MOCI. CONCLUSION: The socially withdrawn adolescents had more problematic issues of their psychopathology. Several emotional factors would be useful in assessing the high-risk group of socially withdrawn adolescents.