Seasonal Affective Disorder: Focusing on Psychophysiological Aspects / 수면정신생리

The Seasonal Affective Disorder (SAD) is a disorder characterized by prolonged periods of depression and various physical and psychological symptoms experienced during specific seasons, typically winter. In this review aims to provide a comprehensive overview of SAD with a specific focus on psychophysiological aspects. Through the review from ancient times to the present, this paper explores the characteristics, causes, and underlying mechanisms of SAD. Particularly, it comprehensively reviews the research findings on the relationship between external factors such as light, sunlight, climate, and their association with SAD.Furthermore, the paper discusses the interplay between SAD and psychophysiological changes, along with the latest research trends in treatment and prevention strategies. By combining theoretical and practical perspectives on SAD, this article aims to provide a holistic understanding and offer suggestions for future research directions and clinical interventions.

Reliability and Validity of the Korean Version of the Ask Suicide-Screening Questions (ASQ)

Background@#The Ask Suicide-Screening Questions (ASQ) tool is a simple suicide screening tool developed to screen patient suicide risk (SR). The purpose of this study was to verify the reliability and validity of the ASQ tool in hospitalized patients. @*Methods@#The internal consistency and test-retest reliability of the South Korean version of the ASQ tool were verified in 99 hospitalized patients admitted to a tertiary medical institution in Seoul. To verify the correlations and validity of each convergence with other scales, the Mini-International Neuropsychiatric Interview (MINI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Satisfaction with Life Scale (SWLS) were also conducted to determine convergent and discriminant validity. Then, the receiver operating characteristic (ROC) curve diagnosis values for suicide and depression levels with the highest correlations were analyzed. @*Results@#As a result, Cronbach’s alpha was 0.826, and when each item was removed sequentially, Cronbach’s alpha ranged from 0.736–0.840, showing stable internal consistency. Most of the corrected item-total correlation were over 0.500; however, a relatively low correlation was shown for the fourth and fifth questions, which had values of 0.429 and 0.410, respectively. The test-retest reliability was 0.830, and the MINI and PHQ-9 showed high values of 0.872 and 0.672, respectively. The area under the curve (AUC) according to the ASQ diagnosis value was also the highest for the MINI (0.936). @*Conclusion@#The validity and reliability of the South Korean version of the ASQ tool were demonstrated. Through this validation, the ASQ tool can be used for simple suicide risk screening (SRS) in hospitalized patients.

Risk for Self-Harm or Harm to Others: Definition and Assessment of Dangerousness / 대한정신분열병학회지

The Mental Health Act of 1995 was fully revised on May 29, 2016, and implemented on May 30, 2017, under the name of the Mental Health Promotion and Mental Health Service Support Act (Mental Health Welfare Act). The act newly defined mentally ill people as those with significant limitations in independent daily life and reduced their classification based on severity. Before the revision, patients could be admitted to the hospital if satisfied with the risk of self-injury or harm to others or the need for treatment. The self-injury and harm to others risk criteria for involuntary admission is based on the idea of respecting patients’ right to self-determination. However, predicting future risks can be challenging, and the situation at the time of judgment should be considered. This study aims to examine the administrative and legal interpretation of the self-injury or harm to others risk for involuntary admission, review definitions and evaluations of the risk of self-harm in various areas, and suggest improvements for mental health policies or guidelines.

Gambling Disorder Symptoms, Suicidal Ideation, and Suicide Attempts

Objective@#Gambling disorder (GD) patients have a higher suicide risk compared to the general population. The present study investigates the suicide-related risk factors of GD patients by analyzing GD diagnosis-related symptoms and suicide-related behaviors of subjects. @*Methods@#This study investigated which symptoms among GD diagnosis criteria are related to suicide risk in 142 patients diagnosed with GD. To analyze the relationship between GD symptoms and suicidal ideation and suicide attempt, the odds ratio (OR) was determined through multivariate logistic regression. @*Results@#The number of symptoms was significantly higher in the subjects who had suicidal ideation group and attempt group. In the cases of past suicide attempts, responses to withdrawal and escape questions were significantly higher; in the cases of ongoing suicidal ideation, responses to negative consequences and bailout questions were significantly higher. When depression was corrected, the ‘bailout’ item was, indicating that ‘bailout’ increased suicidal ideation (OR=4.937, 95% CI=1.009–24.164). In the suicide attempt group, ‘relieve’ item may increase suicide attempt (OR=6.978, 95% CI=1.300–35.562). @*Conclusion@#Past suicide attempts in GD patients correlated with withdrawal symptoms, and financial problem correlated with suicidal ideation. This suggests that evaluating suicide risk is important when evaluating GD patients, and evaluation of financial problems is important for GD patients with suicide risks.

Clinical Characteristics of People Who Attempted Suicide by Carbon Monoxide Poisoning in Korea / 우울ㆍ조울병

Background@#The rate of suicide by carbon monoxide (CO) poisoning is increasing rapidly in Korea. In this study, we aimed to investigate the clinical characteristics of suicide attempters in Korea and to identify risk groups for choosing CO poisoning as a suicide method. @*Methods@#Patients who visited the emergency department after attempting suicide between April 2017 and June 2019 were included in this study. We reviewed the medical records and evaluated the demographic and clinical data of suicide attempters. Cross-tabulation analyses and multivariable logistic regression analyses were performed. @*Results@#Statistically significant risk groups for suicide by CO poisoning were men (odds ratios [OR], 1.71), those who were 25-44 years of age (OR, 7.35), those with no psychiatric history (OR, 2.12), and those who made a suicide plan (OR, 7.70). Among suicide attempters grouped according to psychiatric diagnoses, those with adjustment disorders were most likely and those with psychosis were least likely to choose CO poisoning as the suicide method. @*Conclusion@#To prevent a CO poisoning suicide attempt, it seems warranted to develop a tool to screen patients for suicide risk as part of a regular health checkup so that early intervention can be provided.

Treatment-Resistant Schizophrenia: Terminology and Clinical Features / 대한정신분열병학회지

Schizophrenia is one of serious mental illnesses and is often described as a heterogeneous disorder. Approximately one-third of schizophrenia cases are treatment-resistant schizophrenia (TRS). The aim of this study was to review the definitions and clinical features of TRS. Though it was found that the criteria for TRS were considerably diverse, the Treatment Response and Resistance in Psychosis (TRRIP) consensus criteria were recently introduced. According to the TRRIP criteria, TRS should be suspected if symptoms persist alongside psychotic symptoms despite sufficient treatment for ≥12 weeks, or two or more symptoms persist significantly for ≥6 weeks. The clinical characteristics of TRS includes an earlier age of onset, more severe and familial form, possibly more rural residence, unlikely association with male sex, and an increase in cognitive deficits.

Mediating Effect of Internet Addiction on the Association between Resilience and Depression among Korean University Students: A Structural Equation Modeling Approach

OBJECTIVE: This study examined the mediating role of internet addiction in the association between psychological resilience and depressive symptoms. METHODS: 837 Korean university students completed a survey with items of demographic information, Connor-Davidson Resilience Scale (CD-RISC), Internet Addiction Test (IAT), and Patient Health Questionnaire (PHQ-9) in 2015. The complex associations among psychological resilience, internet addiction, and depressive symptoms were delineated using structural equation models. RESULTS: In the most parsimonious model, the total effect and indirect effect of resilience on depressive symptoms via internet addiction, were statistically significant. The goodness of fit of the measurement model was satisfactory with fit indices, normed fit index (NFI) of 0.990, non-normed fit index (NNFI) of 0.997, comparative fit index (CFI) of 0.998, root mean square error (RMSEA) of 0.018 (90%CI=0.001–0.034); and Akaike Information Criterion (AIC) of -21.049. CONCLUSION: The association between psychological resilience and depressive symptoms was mediated by internet addiction in Korean university students. Enhancement of resilience programs could help prevent internet addiction and reduce the related depression risks.

Exploratory Factor Analysis of the Beck Anxiety Inventory and the Beck Depression Inventory-II in a Psychiatric Outpatient Population

BACKGROUND: To further understand the relationship between anxiety and depression, this study examined the factor structure of the combined items from two validated measures for anxiety and depression. METHODS: The participants were 406 patients with mixed psychiatric diagnoses including anxiety and depressive disorders from a psychiatric outpatient unit at a university-affiliated medical center. Responses of the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI)-II, and Symptom Checklist-90-Revised (SCL-90-R) were analyzed. We conducted an exploratory factor analysis of 42 items from the BAI and BDI-II. Correlational analyses were performed between subscale scores of the SCL-90-R and factors derived from the factor analysis. Scores of individual items of the BAI and BDI-II were also compared between groups of anxiety disorder (n = 185) and depressive disorder (n = 123). RESULTS: Exploratory factor analysis revealed the following five factors explaining 56.2% of the total variance: somatic anxiety (factor 1), cognitive depression (factor 2), somatic depression (factor 3), subjective anxiety (factor 4), and autonomic anxiety (factor 5). The depression group had significantly higher scores for 12 items on the BDI while the anxiety group demonstrated higher scores for six items on the BAI. CONCLUSION: Our results suggest that anxiety and depressive symptoms as measured by the BAI and BDI-II can be empirically differentiated and that particularly items of the cognitive domain in depression and those of physical domain in anxiety are noteworthy.

The Development of the Mission · Vision · Core Values for Korean NeuroPsychiatric Association / 신경정신의학

Awareness of public mental health has increased due to drastic changes in society, and issues concerning the rights of mentally ill patients have emerged. The Korean NeuroPsychiatric Association (KNPA) has examined the current environment and proposed directions for improvement of this field. As the step for the implementation of the development of the mission · vision · core values for KNPA, KNPA have gone on the effort to improve public mental health letting people realize of the work that KNPA have carried out and help members work together. The committee of special mission of KNPA began in 2016 and held its first meeting on March 25 with professional consultants. They researched and collected information, carried out interviews, surveys, analyzed various opinions, and examined information and materials throughout 7 meetings. The special members of KNPA submitted agendas to the board of directors on September 9th, and the provisional board committee debated and decided the final agendas on September 24th. They announced the mission · vision · core values for KNPA on October 28th at the great autumn congregation held in Kimdaejung Convention Center in Kwangju. The event has proved that all members of KNPA have cooperated for the rights and interest of the committee, and will lead the public mental health of our society. This will provide the basis for the better life of our society.

Validation of the Korean version of Center for Epidemiologic Studies Depression Scale-Revised(K-CESD-R) / 정신신체의학

OBJECTIVES: The Center for Epidemiologic Studies Depression scale-Revised is a recently revised scale which has been reported as a valid tool for the assessment of depressive symptoms. It encompasses cardinal symptoms of depression described in the Diagnostic and Statistical Manual of Mental disorders, fourth edition. In this study, we assessed the reliability, validity and psychometric properties of the Korean version of the CESD-R(K-CESD-R). METHODS: Forty-eight patients diagnosed as major depressive disorder, dysthymia, depressive disorder NOS according to the DSM-IV criteria using Mini International Neuropsychiatric Interview and 48 healthy controls were enrolled in this study. They were assessed with K-CESD-R, K-MADRS, PHQ-9, KQIDS-SR, STAI to check cross-validation. Statistical analyses were performed using calculation of Cronbach's alpha, Pearson correlation coefficient, Principal Component Analysis, ROC curve and optimal cut-off value. RESULTS: The Cronbach's alpha of K-CESD-R was 0.98. The total score of K-CESD-R revealed significantly high correlations with those of K-MADRS, PHQ-9, KQIDS-SR(r=0.910, 0.966 and 0.920, p<0.001, respectively). Factor analysis showed two factors account for 76.29% of total variance. We suggested the optimal cut-off value of K-CESD-R as 13 according to analysis of the ROC curve which value sensitivity and specificity both equally. CONCLUSIONS: These Results showed that the K-CESD-R could be a reliable and valid scale to assess depressive symptoms. The K-CESD-R is expected as a useful and effective tool for screening and measuring depressive symptoms not only in outpatient clinic but also epidemiologic studies.

The Effect of Circadian Types and Depressive Mood on Internet Addiction in Korean College Students

OBJECTIVES: The purpose of this study was to investigate the relationships among circadian types, depressive mood and internet addiction and to identify the mediating effect of depressive mood between circadian types and internet addiction in Korean College Students. METHODS: A total of 2632 participants completed questionnaires, which included the Korean translation of the Composite Scale of Morningness (CSM), the Patient Health Questionnaire (PHQ-9), and the Korean version of the Internet Addiction Test (KIAT). Statistical analyses were done using correlation analysis, analysis of covariance and multiple linear regression. RESULTS: The CSM score was negatively associated with the PHQ-9 score (r = -0.226, p < 0.001) and the KIAT score (r = -0.218, p < 0.001). The eveningness group showed higher scores in depressive mood and internet addiction than the morningness group (p < 0.001). Depressive mood showed a partial mediating effect between circadian types and internet addiction (β = 0.255, p < 0.001). CONCLUSIONS: Internet addiction was associated with circadian types and depressive mood. These results suggest that depression and circadian rhythm management would contribute to the prevention of internet addiction.

Suicide in Patients with Schizophrenia : A Review on the Findings of Recent Studies / 대한정신분열병학회지

The suicide risk of patients with schizophrenia is about 8.5-fold greater than that of the general population. Since 4-13% of patients with schizophrenia commit suicide, and 25-50% attempt suicide at least once during their lifetime, suicide can be a main cause of their higher mortality rate as compared with that of the general population. While evidence suggests that previous depressive disorders, previous suicide attempts, drug misuse, agitation or motor restlessness, fear of mental disintegration, poor adherence to treatment, and recent loss of another person are associated with the increased risk of suicide in schizophrenia, hallucinations have been associated with decreased suicide risk. Despite there being at least modest evidence suggesting that antipsychotics protect against suicidal risk, clozapine has been shown to be the most favorable second-generation antipsychotic for preventing suicide in patients with schizophrenia. In addition, selective serotonin receptor inhibitors can ameliorate suicidal ideation in schizophrenia. Furthermore, individual psychosocial interventions and psychotherapy, and reducing stigma, can be integral strategies for the prevention of suicide in schizophrenia. Further study is needed to identify the epidemiological characteristics and clinical correlates of suicide in Korean patients with schizophrenia, and provide an effective strategy for its prevention in Korea.

The Effect of Hippotherapy and Medication on Children with Attention Deficit Hyperactivity Disorder: A Pilot Study / 신경정신의학

OBJECTIVES: This study researched the clinical effects of hippotherapy and medication in attention deficit hyperactivity disorder (ADHD) children. METHODS: The study employed an open label randomized controlled trial. Participants were 10 children of ages between 6 and 12 years. These subjects were placed in 2 groups : the hippotherapy group and the medication group. Evaluation tools used in this study include Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean Version, the Wechsler Intelligence Scale for Children-IV, Korean Child Behavior Check List (K-CBCL), ADHD rating scale (ARS), Clinical Global Impression (CGI), and Quantitative electroencephalography (QEEG). RESULTS: Grossly scores of investigator-administered ADHD rating scale (ARS-I), K-CBCL, and CGI-Severity of Illness scale were improved in both the hippotherapy and the medication group. The ARS-I scores of the Hippotherapy group were not significantly different from baseline after 12 weeks. In the QEEG, theta/beta ratio of Pz area in the hippotherapy group was significantly different from baseline. Children treated with medication showed significant difference from baseline in ARS-I, K-CBCL subscales, and QEEG. CONCLUSION: The use of hippotherapy could be a viable treatment strategy as a part of a multimodal therapy for children with ADHD. This pilot study provides good prospects for future studies to document these positive trends on larger samples.

Reliability and Validity of the Korean Version of the Beck Hopelessness Scale / 신경정신의학

OBJECTIVES: The Beck Hopelessness Scale (BHS) is a 20-item scale for measuring the extent of negative attitudes about the future. Previous studies repeatedly demonstrated clinical utility of BHS, particularly for predicting suicide. The aim of this study is to examine the reliability and validity of the Korean version of the Beck Hopelessness Scale (K-BHS), which is commonly used for measuring hopelessness. METHODS: The study sample consisted of 1022 community-dwelling general adults from 4 regional areas (i.e., Seoul, Gyeonggi, Cheongju, and Jinju) across South Korea. They completed the K-BHS, Patient Health Questionnaire-9, Spielberger State-Trait Anxiety Inventory, and Adult ADHD Self-Report Scale. RESULTS: The Cronbach's alpha value for the K-BHS was 0.85. Test-retest reliability at average 7.2 days was 0.86. Discriminant validity was determined. Confirmatory factor analysis supported a three factor model. CONCLUSION: The K-BHS demonstrated satisfactory reliability and validity and therefore may be useful in measuring the construct of hopelessness and in clinical suicide risk assessments. Further studies are needed in order to explore the psychometric features and correlates of this scale among clinical populations.

Life Satisfaction and Bipolarity according to Circadian Typology

OBJECTIVES: The purpose of this study was to investigate the relationships among circadian typology, bipolarity and life satisfaction of university students. METHODS: A total 1232 participants completed questionnaires, which included Composite Scale of Morningness (CSM), Satisfaction with Life Scale (SWLS), and Mood Disorder Questionnaire (MDQ). Statistical analyses were done using correlation analysis, and analysis of covariance. RESULTS: The CSM score was positively associated with SWLS score (r = 0.232 ; p < 0.001). The morningness group has higher life satisfaction than the eveningness group (p < 0.001). The eveningness group has higher bipolarity than the morningness group (p < 0.001). The CSM score was negatively associated with MDQ score (r = -0.128 ; p < 0.001). CONCLUSIONS: Bipolarity and life satisfaction were associated with circadian typology. Morningness was the important determinant of life satisfaction and bipolarity.

Treatment Response of Affect Regulation Group Therapy for Recently Traumatized School Children / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the treatment effect and predictors of response of affect regulation group therapy (ARGT) delivered to a group of recently traumatized children. METHODS: A total of 464 school children, who had witnessed or confronted a tragic accident at school, were given a single-session of affect regulation group therapy, that which included psychoeducation and affect regulation elements from eye movement desensitization and reprocessing. Of 213 children whose with initial score of Subject Unit of Disturbance Scale (SUDS) score over 4, we compared pre- and post-treatment scores and performed conducted the responder vs. non-responder comparison. The pPost-traumatic disorder (PTSD) symptom scores measured by using Child Reaction to Traumatic Events Scale-Revised (CRTES-R), demographic variables, and clinical variables were considered. RESULTS: Affect regulation group therapy was effective for children who had experienced an acute traumatic event (t=16.3, p<0.001). Baseline SUDS score of for non-responder were was significantly higher (t=-2.89, p<0.001) and CRTES-R score approached a level of significance level (t=-1.72, p=0.09). However, results of logistic regression analysis identified showed that the pretreatment SUDS score was the only significant predictor of non-response. CONCLUSION: Affect regulation group therapy appeared to be effective for children who had undergone experienced an acute traumatic event. And in addition, the survivors' subjective distress was more important to treatment response than severity of PTSD symptoms severity.

The Association between Weight-Related Attitudes and Suicidal Ideation in Adults / 신경정신의학

OBJECTIVES: The aim of this study is to investigate the relationship between weight-related attitudes and suicidal ideation among adults. METHODS: Data were obtained from the Fifth Korean National Health and Nutrition Examination Survey, a cross-sectional national health survey. We used a nationally representative sample of 12287 Koreans older than 19 years of age (5266 men and 7021 women). We used the logistic regression model to examine the relationship between weight-related attitudes and suicidal ideation, controlling for demographics, depressive mood, perceived stress, and substance use. RESULTS: A significantly higher number of women than men reported suicidal ideation (women : 18.3%, men : 10.3%). In men, weight control behavior aimed at weight loss (vs. no control) showed an association with suicidal ideation. For women, weight control behavior aimed at maintaining a certain weight (vs. no control) and obesity (vs. being underweight), as determined by Body Mass Index category, showed an association with suicidal ideation. For both sexes, distortions regarding perceived weight did not significantly affect suicidal ideationn. CONCLUSION: The results of this study suggest that weight-related attitudes, such as weight control behaviors, are useful indicators for identification of individuals at risk of committing suicide.

Intra-Individual Neuropsychological Test Variability : A Comparison of Patients with Schizophrenia, Their Siblings, and Healthy Controls / 신경정신의학

OBJECTIVES: Intra-individual variability of cognitive performance across different tests or domains has been reported as an important index of cognitive function. The aim of the current study is to examine the intra-individual variability across different cognitive domains and tests in patients with schizophrenia, their unaffected siblings, and normal controls. We also compared the variability among three patient sub-groups divided according to the duration of illness. METHODS: Comprehensive neurocognitive tests were administered in order to stabilize patients with schizophrenia (n=129), healthy siblings (n=38) of the patients, and normal controls (n=110). Intra-individual variability was computed from the variance of the scores of six cognitive domains of the Measurement and Treatment Research to Improve Cognition in Schizophrenia consensus battery. We examined intra-individual variability across six factor-based cognitive scores and individual test scores of each cognitive domain. RESULTS: Compared to the normal control and sibling groups, patients showed significantly increased intra-individual variability across six cognitive domains and individual cognitive tests of each domain. Compared to the normal control, siblings showed significantly increased intra-individual variability only across individual tests of the processing of speed domain. Among patient sub-groups, those with the longest duration of illness (> or =11 years) showed significantly higher intra- individual variability across six cognitive domains and across individual tests of the processing of speed domain compared to the other two groups. CONCLUSION: This study identified cognitive dissonances across six cognitive domain schizophrenia patients. These cognitive characteristics were not observed in the sibling groups and seemed to progress during the course of illness.

Social Support According to Temperament and Character in College Students / 신경정신의학

OBJECTIVES: In previous studies, both temperament and character were known as an important factor to determine the extent of social support. The purpose of this study was to evaluate effects of temperament and character on social support. METHODS: A total 4329 participants completed questionnaires, which included Lubben Social Network Scale (LSNS), Temperament and Character Inventory (TCI). This study used Pearson's correlation to evaluate the correlation between TCI dimensions and LSNS. To find the most influential TCI dimension for LSNS, multiple regression analysis was performed for this study. RESULTS: TCI dimensions showed significant mean differences depending on gender (p<0.001). LSNS had highest positive correlation with reward dependence (r=0.357, p<0.001). Three dimensions of TCI (Persistence, Self-Directedness, Cooperativeness) had positive correlation with LSNS (p<0.001). Harm avoidance had negative correlation with LSNS (r=-0.237, p<0.001). According to the results of the multiple regression analysis, reward dependence is the most influential TCI dimension (beta=0.261, t=15.963, p<0.001). CONCLUSION: This result shows that social support is affected by properties of temperament and character. Therefore, to measure properties of temperament and character will help to assess social support.

The Effect of Depression, Anxiety, Self-Esteem, Temperament, and Character on Life Satisfaction in College Students / 신경정신의학

OBJECTIVES: In order to improve the life satisfaction, we should be aware of psychological factors associated the life satisfaction. Therefore, the purpose of this study was to examine the effect of depression, anxiety, temperament, and character on life satisfaction in college students. METHODS: A total 314 participants completed questionnaires, which included Satisfaction with Life Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, The Rosenberg Self-Esteem Scale and Temperament and Character Inventory-Revised. To evaluate the difference according to social factor, t-test and one-way analysis of variance were performed. To analyze the effect of psychological characteristics on life satisfaction, stepwise multiple regression analysis was used. RESULTS: Life satisfaction was significantly different according to only gender of the social factors. Life satisfaction was positively correlated with self-esteem, self-directedness, and persistence (P). Conversely, depression, anxiety, harm avoidance, and novelty seeking (NS) were negatively correlated. Stepwise multiple regression revealed that depression, self-esteem, P, NS, and self-transcendence were factors affecting life satisfaction in university students. CONCLUSION: This result shows that life satisfaction is influenced by depression, self-esteem, temperament, and character. The findings of this study suggest that to improve the life satisfaction requires not only preventing and treatment of depression but also identifying the psychological characteristics, such as temperament and character.