Predicting Suicidal Ideation in College Students with Mental Health Screening Questionnaires

OBJECTIVE: The present study aimed to identify risk factors for future SI and to predict individual-level risk for future or persistent SI among college students. METHODS: Mental health check-up data collected over 3 years were retrospectively analyzed. Students were categorized as suicidal ideators and non-ideators at baseline. Logistic regression analyses were performed separately for each group, and the predicted probability for each student was calculated. RESULTS: Students likely to exhibit future SI had higher levels of mental health problems, including depression and anxiety, and significant risk factors for future SI included depression, current SI, social phobia, alcohol problems, being female, low self-esteem, and number of close relationships and concerns. Logistic regression models that included current suicide ideators revealed acceptable area under the curve (AUC) values (0.7–0.8) in both the receiver operating characteristic (ROC) and precision recall (PR) curves for predicting future SI. Predictive models with current suicide non-ideators revealed an acceptable level of AUCs only for ROC curves. CONCLUSION: Several factors such as low self-esteem and a focus on short-term rather than long-term outcomes may enhance the prediction of future SI. Because a certain range of SI clearly necessitates clinical attention, further studies differentiating significant from other types of SI are necessary.

Minnesota Multiphasic Personality Inventory Characteristics of Parricide Offenders with Schizophrenia in Korea

OBJECTIVE: This study aims to examine the personality characteristics in parricide offenders, by using the Minnesota Multiphasic Personality Inventory (MMPI) test, which is commonly used in clinical medicine. METHODS: A total of 73 parricide offenders with schizophrenia who were admitted to National Forensic Hospital in Gongju city between September 2014 and February 2015, and 104 comparison schizophrenia patients who had been admitted to Dankook University Hospital in Cheonan city the same hospital, completed the Korean version of the MMPI. RESULTS: The parricide offender group showed significantly higher on L, F, Hs, Hy and Pd than the comparison group. The result of the regression analysis indicated that Pd and Si significantly increased the odd ratio of the sexual offender group by 2.77 times and 0.32 times, respectively (p=0.029 and p=0.023). The offenders of parricide may have developed the following characteristics: hypochondriasis, hysteria and psychopathic deviate. CONCLUSION: These results suggested that the psychopatholgy in the offenders of parricide might be different, compared to the control group.

Study of Factors Affecting on Evaluation of Sex Offenders' Criminal Responsibility / 신경정신의학

OBJECTIVE: This study analyzed factors affecting feeble-mindedness or insanity following a forensic evaluation for sex offenders, and to present a scientific basis that can provide practical assistance on a responsibility evaluation of sex offenders. METHODS: This study analyzed retrospectively 180 mental appraisals on sex offenders among mental appraisals documented by one psychiatrist from June, 2012 to December, 2015 at the National Forensic Hospital. RESULTS: Of the 180 mental appraisals, 123 people (68.3%) were found to be feeble-minded or insane, and 57 people (31.7%) were considered to be sane, i.e., competent to take responsibility. The two groups were different in IQ, occupational & marital status, victim numbers, psychiatric diagnosis, and sex offender characteristics, such as violence and intrusiveness. After evaluating the influence of variables that showed significant differences between the two groups on a responsibility assessment, sex offenders with fewer invasive sex offenses (OR=1.763, p<0.05), lower IQ (OR=1.031, p<0.01), lower numbers of victims (OR=1.349, p<0.05), and higher number of mental illnesses (OR=0.507, p<0.05) were more likely found to be feeble-minded or insane. CONCLUSION: This study indicates that criminal responsibility may be intact in repeat sex offenders who commit invasive sex crimes, such as rape, and is without intellectual disability compared to other kinds of sex offenders. Subsequent research will be needed to improve the objectivity and reliability of mental appraisals on sex offenders in the future.

Evaluation of Pedophilia Patients of the National Forensic Hospital by Types of Offense according to the Federal Bureau of Investigation (FBI) Typologies of Child Molesters / 대한법의학회지

This study aimed to classify individuals who had perpetrated child sexual abuse according to the Federal Bureau of Investigation (FBI) typologies of child molesters and to assess the correlations between sociodemographic and criminal variables. We examined a total of 26 patients diagnosed with pedophilia (DSM-IV-TR criteria) who had been hospitalized in the National Forensic Hospital for Cure Custody. Data were obtained through self-administered questionnaires and reviews of patient records. Patients were classified into preferential offenders or situational offenders based on FBI typologies. Current and first offense ages of preferential offenders were younger than those of situational offenders. Preferential offenders were more likely to have been exposed to sexual abuse during childhood, and were more likely to watch child pornography than situational offenders (p < 0.05). Additionally, recidivists had lower IQs (intelligence quotient), lower levels of education, and longer illness durations than first-time offenders (p < 0.05). A multiple logistic regression analysis revealed that IQ and duration of illness might be risk factors of recidivism, although results were not statistically significant (p < 0.1). We found that classification of individuals who had sexually abused children into preferential or situational types, based on FBI typologies, provided on pedophile characteristics and probability of recidivism. We highly recommended that low IQ patients receive intensive treatment and education in order to reduce the possibility of future offenses.

A Case-Controlled Study of Cognitive Behavioral Therapy for Patients with Schizophrenia Having Violence-Related Crime / 대한정신분열병학회지

OBJECTIVES: Despite remarkable development of pharmacotherapy for schizophrenia, some patients continuously have had violence problems. The violence of psychotic patients is recently becoming the focus of the attention. The aim of this study is to investigate the influence of Cognitive Behavioral Therapy (CBT) on patients with schizophrenia having violence related history. METHODS: 15 Patients with schizophrenia spectrum disorder of crime history were treated with individual CBT for 12 sessions, and assessed with 4 scales (Korean version of Aggression Questionnaire, Korean version of the Barratt Impulsiveness Scale-11-Revised, Beck Cognitive Insight Scale and Positive and Negative Syndrome Scale) to evaluate anger, impulse, insight and clinical symptoms respectively at baseline and post treatment. The comparison group consisted of 15 patients with schizophrenia spectrum disorder of crime history. They were also assessed with the same scales during the same period. RESULTS: Although impulsivity is not changed significantly after treatment, but there was significant improvement in clinical symptom, insight and aggression, especially self-reflectiveness and anger respectively. CONCLUSION: CBT can be one of the good therapeutic tools for patients with schizophrenia having violence problems in that it reduces aggression and enhances insight of patients with schizophrenia spectrum disorder.

Research on the Etiology of Pedophilia through Monozygotic Twins with Pedophilia : A Case Report / 신경정신의학

Recent studies have suggested an association of genetic and neurodevelopmental factors with development of paraphilia. In this case report on monozygotic twins with pedophilia, we aim to offer additional evidence indicating that genetic vulnerability may be a significant risk factor along with environmental influences on development of pedophilia. These twin pairs, who have been arrested for sexual offenses against boys, had experienced emotional and physical abuse during their childhood, and the older twin brother is reported to have a history of sexual abuse. Both showed homosexual tendencies, and the younger twin brother was also diagnosed as exhibitionism. This case implies greater involvement of genetic factors and associated vulnerabilities in the etiology of paraphilia, including pedophilia, than environmental factors such as childhood abuse. In the future, conduct of research will be needed in order to determine the biological markers related to the etiology of pedophilia.

The Impact of Personality Traits on Ratings of Obsessive-Compulsive Symptoms

OBJECTIVE: The goal of this study was to evaluate consistencies and discrepancies between clinician-administered and self-report versions of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and to examine relationships between these scales and personality traits. METHODS: A total of 106 patients with obsessive-compulsive disorder (OCD) participated in this study. All participants were assessed with both clinician-administered and self-report versions of the Y-BOCS. The Structured Clinical Interview for DSM-IV Axis II Disorders Personality Questionnaire (SCID-II-PQ) was used to evaluate relationships between personality traits and scores on the Y-BOCS. RESULTS: Scores on the clinician-administered Y-BOCS and its obsession subscale were significantly higher than were those on the self-report version. However, we found no significant differences in compulsion subscale scores. We also found that the discrepancies in the scores on the two versions of the Y-BOCS and its compulsion subscale were significantly positively correlated with scores for narcissistic personality traits on the SCID-II-PQ. Additionally, narcissistic personality traits had a significant effect on the discrepancy in the scores on the two versions of the Y-BOCS and its compulsion subscale in the multiple linear regression analysis. CONCLUSION: This is the first study to elucidate relationships between personality traits and discrepancies between scores on the two versions of the Y-BOCS. Although clinicians tend to rate obsessive symptoms as being more severe than do patients, clinicians may underestimate the degree to which individuals with narcissistic personality traits suffer more from subjective discomfort due to compulsive symptoms. Therefore, the effect of personality traits on symptom severity should be considered in the treatment of OCD.

Preliminary Study of Effect of Leuprolide Acetate Treatment on Sexual Fantasy of Sex Offenders / 대한법의학회지

This study investigated the effect of leuprolide acetate treatment on sex offenders' sexual fantasies and behaviors, as well as on their criminogenic psychological character and the risk of second conviction. The study participants consisted of 22 sex offenders who were confined to the National Institute of Forensic Psychiatry. Among them, 9 patients were given off-label leuprolide acetate for three months to inhibit sexual impulses, whereas the others were not given any medication. All sex offenders underwent two psychological evaluations; the first evaluation was conducted before starting medication, and the second was conducted after medication. Wilson's Sex Fantasy Questionnaire (WSFQ), the Rape Myth Acceptance Scale (RMAS), and the Endorsement of Violence Scale (EVS) were used for evaluation. Leuprolide acetate-treated sex offenders showed a statistically significant decline in the total WSFQ score (p < 0.05). However, the RMAS and EVS scores did not differ after leuprolide acetate treatment, indicating that cognitive distortions like rape myth acceptance and endorsement of violence were unchanged after leuprolide medication. Leuprolide acetate may reduce deviant sexual impulses and fantasies, as suggested by previous research form Korea and other countries. However, it probably cannot alter cognitive distortion. On the basis of these findings, we recommend a combination of leuprolide medication and other therapies, like cognitive behavioral therapy, for the treatment of paraphilic sex offenders.

Predictors of Clinical Response to Escitalopram in Obsessive-Compulsive Disorder / 대한정신약물학회지

OBJECTIVE: In this study, we aimed to investigate the predictors of clinical response to escitalopram (ESC) in obsessive-compulsive disorder (OCD) from the baseline clinical characteristics. In addition, we aimed to search the differences of prescription pattern between responders and non-responders to ESC. METHODS: Two hundred and twenty-three patients who met the DSM-IV criteria for OCD and visited at least once after the initiation of ESC prescription were included in this study. A primary outcome measure was the Clinical Global Impression-Improvement scale (CGI-I), which was scored at the time of retrospective chart review. Responders were defined as those with a CGI-I score of 1 or 2 at the final point of evaluation. Baseline clinical characteristics, prescription patterns, and adverse events were compared between responders and non-responders. We also examined the validity of the prediction model regarding treatment response to ESC. RESULTS: The OCD patients having aggressive obsessions and related compulsions showed significantly decreased response rate to ESC (odd ratio=0.285) in comparison with the OCD patients not having aggressive symptom dimension (p=0.002). The maximum dose of ESC prescription and rate of antipsychotics combination were higher in responders in comparison to the nonresponders. Among the adverse effects, sedation and constipation showed significantly different occurrence rate between responders versus non-responders. CONCLUSION: Aggressive obsessions and related compulsions seem to be associated with poor clinical response to ESC in OCD. Obsessive-compulsive symptom dimension should be considered when choosing a serotonin reuptake inhibitor for OCD.

Vulnerability Factors of Obsessive-Compulsive Disorder on the Temperamental and Affective Aspects and the Effect of Pharmacotherapy / 대한정신약물학회지

OBJECTIVE: Recently some behavioral features and affective traits are considered important for the phenotype of obsessive-compulsive disorder (OCD). The purpose of this study was to assess some specific behavioral, temperamental, emotional features of OCD patients and to investigate if there is any change in patterns of temperament-character after 4-month pharmacotherapy. METHODS: Fifty-six patients with OCD and 70 normal controls were enrolled in this study. Four self-report questionnaires were employed to assess temperamental characteristics and affective traits: The behavioral inhibition system and behavioral activation system scale, the Baratt impulsiveness scale, state-trait anger expression inventory, emotional intelligence inventory. Among 56 OCD patients, 21 subjects started pharmacotherapy and 4 months later, they repeated 4 self-report tests as the same above and Yale-Brown obsessive compulsive scale (Y-BOCS). And then we investigated the changes from initial results. RESULTS: Patients with OCD showed significantly greater expression of behavioral inhibition system (p<0.0001), more cognitive impulsiveness (p<0.0001), motor impulsiveness (p=0.0067) and increased level of state anger (p<0.0001), trait anger (p<0.0001) than healthy controls. Compared to the controls, the OCD patients also expressed significantly lower level of emotional intelligence for using to facilitate thinking (p<0.0001) and managing emotions (p<0.0001). After 4-month pharmacotherapy for 21 OCD patients, Y-BOCS scores significantly decreased while self-report tests showed no meaningful differences from baseline assessments. CONCLUSION: Our results suggest that patients with OCD may have some differences in behavioral and affective tendencies including behavioral inhibition, impulsiveness, anger experiences, and emotional patterns. And short term pharmacotherapy during 4 months improved the severity of obsessive-compulsive symptoms but didn't influence these traits. These results provide some perspectives about possible vulnerability or trait markers of OCD. Further research is needed to examine the effects of long term treatment and other investigation might be helpful to assess the relationships between these behavioral and affective aspects and clinical phenotypes of OCD.

Probable Case of Neuroleptic Malignant Syndrome Following Administration of Antituberculotic Drugs in a Chlorpromazine-Treated Patient

Neuroleptic malignant syndrome (NMS), a potentially fatal adverse reaction to neuroleptics, is known to occur more often in the initial stage of antipsychotic treatment. We describe a patient with chronic schizophrenia who, in a few days after the addition of antituberculotic drugs to his antipsychotic regimen, developed probable NMS without pyrexia. We reasoned that rifampin, a strong hepatic enzyme inducer, decreased the plasma chlorpromazine concentration of the patient, with the result of cholinergic hyperactivity and finally, the symptoms of NMS. Therefore, physicians should be aware of drug interactions and the likelihood of NMS, and consider antipsychotic dose adjustment when prescribing drugs that may influence pharmacokinetic properties of antipsychotics in a patient with schizophrenia receiving long-term antipsychotic treatment.