Mediating Effect of Intolerance of Uncertainty and Cancer-Related Dysfunctional Beliefs About Sleep on Psychological Symptoms and Fear of Progression Among Cancer Patients

Objective@#This study aimed to explore the mediating effects of cancer-related dysfunctional beliefs regarding sleep and intolerance of uncertainty on the effect of depression, insomnia, and anxiety on fear of progression (FoP). @*Methods@#We retrospectively reviewed medical records of patients with cancer who visited the Sleep Clinic for cancer patients in Asan Medical Center for the first time between December 2021 and March 2022. Data collected included age, sex, types of cancer, staging, current treatment modalities, and history of surgical procedures. In addition, psychological symptoms were rated using the Insomnia Severity Scale (ISI), Patient Health Questionnaire–9 items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Short form of Fear of Progression Questionnaire, Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), single item of pain and fatigue, Connor Davidson Resilience Scale 2-item (CD-RISC2), and Intolerance of Uncertainty–12 (IUS-12). The predictive variables for FoP were determined by linear regression analysis. @*Results@#The FoP was significantly correlated with age (r=-0.289), ISI (r=0.178), PHQ-9 (r=0.703), STAI-S (r=0.377), fatigue (r=0.452), CD-RISC2 (r=-0.270), IUS-12 (r=0.585), and C-DBS (r=0.427, all p<0.01). A mediation analysis showed that intolerance of uncertainty and dysfunctional beliefs about sleep mediated the relationship of FoP with insomnia, depression, or anxiety. @*Conclusion@#Psychological support for intolerance of uncertainty and cancer-related dysfunctional beliefs about sleep in patients with cancer may be beneficial to reduce their FoP.

Effect and Safety of Pressure Sensor-equipped Handpiece in Phacoemulsification System

Purpose@#To evaluate the effect of the Active Sentry handpiece of the Centurion Vision System compared to the Centurion Ozil handpiece for phacoemulsification in cataract surgery. @*Methods@#A retrospective study was conducted on 281 patients (449 eyes) who underwent cataract surgery between August 2020 and June 2021. Preoperative measurements, intraoperative parameters, complication rate, and postoperative outcomes were compared between the Active Sentry handpiece and the Centurion Ozil handpiece groups. Additionally, the parameters were compared in different cataract severity groups and multiple predictive factors for the number of active surge mitigation (ASM) actuations were assessed with the Active Sentry handpiece. @*Results@#There were 198 eyes in the Active Sentry group and 251 eyes in the Centurion Ozil group. There were no statistically significant differences between the two groups, as the cumulative dissipated energy in the Active Sentry and Centurion Ozil groups were 8.32 ± 7.74 and 7.87 ± 9.25 μJ, respectively (p = 0.576). Total surgery time, ultrasound usage time, aspiration time, amount of fluid aspirated, postoperative corrected distant visual acuity, and postoperative decrease in corneal endothelial cell density were comparable between the two groups. The significant contributors to the number of ASM actuations were age, preoperative corrected distant visual acuity, axial length, and total ultrasound time. @*Conclusions@#There was no clear advantage of the Active Sentry handpiece compared to the Centurion Ozil handpiece. ASM actuation increases with age, poor visual acuity before surgery, short axial length, and prolonged ultrasound usage time. It is expected that in more severe and high-risk cataract surgery, the Active Sentry handpiece functions more effectively, possibly affecting the safety and prognosis.

Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing

Background@#This study investigated the relationship between preoccupation with coronavirus disease 2019 (COVID-19), reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing among frontline nursing professionals working in COVID-19 inpatient wards. Additionally, the study aimed to determine whether the commitment to physical distancing mediates the influence of intolerance of uncertainty on viral anxiety. @*Methods@#Frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals in Korea were surveyed between April 7 and 26, 2022.The survey included scales—such as the Obsession with COVID-19 Scale, Coronavirus Reassurance-Seeking Behaviors Scale, Fear of COVID-19 Scale, and Intolerance of Uncertainty Scale-12 and a questionnaire on adherence to physical distancing. A total of 256 responses were analyzed after excluding inappropriate or incomplete responses. @*Results@#Pearson’s correlation analysis found that age was significantly associated with the Obsession with COVID-19 Scale (r = −0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). Linear regression analysis ascertained that age (β = −0.07, P = 0.002), Coronavirus Reassurance-Seeking Behaviors Scale (β = 0.35, P < 0.001), and Fear of COVID-19 Scale (β = 0.24, P < 0.001) were predictors of obsession with COVID-19 (Adjusted R 2 = 0.60, F = 78.1, P < 0.001). The indirect pathway by mediation analysis showed that reassurance-seeking and viral anxiety mediated the effect of intolerance of uncertainty on the preoccupation with COVID-19. @*Conclusion@#During the pandemic, there may be a strong association between reassuranceseeking behavior, viral anxiety, and a heightened preoccupation with COVID-19 among frontline healthcare workers. Thus, from the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups.

Cancer-Related Dysfunctional Beliefs About Sleep Mediate the Influence of Sleep Disturbance on Fear of Progression Among Patients With Surgically Resected Lung Cancer

Background@#Lung cancer is associated with significant psychological distress, including fear of progression (FoP). Because insomnia and depression are highly prevalent and associated with FoP, we examined the association between FoP, insomnia, and depression in cancer patients. Furthermore, we tested the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS) on this association. @*Methods@#We analyzed data collected from patients with surgically resected non-small cell lung cancer from a single-center randomized controlled study investigating digital healthcare applications. Baseline demographic and clinical variables were collected. In addition, selfreported questionnaires including the Fear of Progression Questionnaire-Short Form, Patients Health Questionnaire-9 items (PHQ-9), Insomnia Severity Index, and C-DBS were administered. @*Results@#Among the 320 enrolled patients with lung cancer, a regression model showed that FoP was predicted by age (β = −0.13, P = 0.007), PHQ-9 (β = 0.35, P < 0.001), and C-DBS (β = 0.28, P < 0.001). Insomnia did not directly influence FoP, but C-DBS mediated the association. Depression directly influenced FoP, but C-DBS did not mediate this association. @*Conclusion@#Among patients with surgically resected lung cancer, C-DBS mediated the effects of severity of insomnia on FoP. Depression directly influenced FoP, but C-DBS did not influence this association. To reduce FoP among patients with lung cancer, C-DBS should be addressed in the cognitive behavioral therapy module.

Grief Response of Nursing Professionals Is Associated With Their Depression, Loneliness, Insomnia, and Work-Related Stress While Working in COVID-19 Inpatients Wards

Objective@#We aimed to explore whether nursing professionals’ psychological states affect their grief response for a patient’s death in the coronavirus disease-2019 (COVID-19) inpatients’ ward. @*Methods@#Survey was conducted among frontline nursing professionals working in COVID-19 inpatients wards at three tertiary-level affiliated hospitals of the University of Ulsan during April 7–26, 2022. Participants’ information such as age, years of employment, or marital status were collected, and their responses to rating scales including Pandemic Grief Scale (PGS) for healthcare workers, Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), Patient Health Questionnaire-9 (PHQ-9), Loneliness and Social Isolation Scale, and Insomnia Severity Scale (ISI) were collected. @*Results@#All 251 responses were analyzed. We observed that 34% reportedly suffered from depression. The linear regression analysis showed that a high PGS score was expected by high SAVE-9 (β=0.12, p=0.040), high PHQ-9 (β=0.25, p<0.001), high loneliness (β=0.17, p=0.006), and high ISI score (β=0.16, p=0.006, F=20.05, p<0.001). The mediation analysis showed that the depression of nursing professionals directly influenced their pandemic grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. @*Conclusion@#We confirm that frontline nursing professionals’ depression directly influenced their grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. We hope to establish a psychological and social support system for the mental health of nurses working in the COVID-19 wards.

Mediating Effect of Viral Anxiety and Perceived Benefits of Physical Distancing on Adherence to Distancing Among High School Students Amid COVID-19

Background@#The aim of this study is to explore whether high school students’ adherence to physical distancing was associated with health beliefs, social norms, and psychological factors during the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#Overall, 300 high school students participated in this anonymous online survey conducted from October 18–24, 2021. The survey included rating scales such as attitude toward physical distancing during the pandemic, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items, Satisfaction with Life Scale, and Connor Davidson Resilience Scale 2-items. @*Results@#The results revealed that perceived susceptibility or severity (β = −0.13, P = 0.038), perceived benefit (β = 0.32, P < 0.001), descriptive social norms (β = 0.10, P = 0.041), social injunctive norms (β = 0.19, P < 0.001), and SAVE-6 (β = 0.24, P < 0.001) predicted students’ adherence to physical distancing (adjusted R 2 = 0.42, F = 19.2, P < 0.001). Social injunctive norms and personal injunctive norms directly influenced adherence to physical distancing. Viral anxiety, measured by SAVE-6, mediated the association between social injunctive norms and adherence to physical distancing, and perceived benefits mediated the relationship between personal injunctive norms and adherence to physical distancing. The influence of perceived susceptibility or severity on adherence to physical distancing was entirely mediated by perceived benefits or viral anxiety. @*Conclusion@#Explaining the rationale or benefits of physical distancing may be important in increasing adherence to physical distancing among high school students.

Characteristics of Patients Presenting to a Psycho-Oncology Outpatient Clinic

Objective@#We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. @*Methods@#The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. @*Results@#Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. @*Conclusion@#There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

Association of the First Antipsychotic Treatment Duration With the Re-Initiation of Treatment in Schizophrenia: A National Health Insurance Data-Based Study / 대한정신분열병학회지

Objectives@#The optimal duration of maintenance treatment for patients with first-episode schizophrenia (FES) remains unclear. We examined the first antipsychotic treatment duration and its association with re-initiation of treatment using a nationwide claim database. @*Methods@#Data from the Health Insurance Review and Assessment Service database in South Korea for 2007–2016 were used. Linear regression analysis and Cox proportional hazard models were used to evaluate the associations between the duration of the first antipsychotic treatment, time to re-initiation of treatment, and occurrence of treatment re-initiation. @*Results@#Of 30,143 patients with FES, 80.4% (n=24,231) received <2 years of the first antipsychotic treatment. In patients who discontinued treatment (n=23,030), the rate of treatment re-initiation was 74.2% (n=17,086). As the duration of the first antipsychotic treatment increased, the time to re-initiation of treatment decreased (β=-0.146, p<0.001); however, the rate of treatment re-initiation was relatively constant (hazard ratio=1.001, p<0.001). @*Conclusion@#Long-term antipsychotic treatment was not significantly associated with the rate of treatment re-initiation but showed a negative association with the time to re-initiation of treatment. Further research is needed to better understand the optimal treatment duration for FES.

Characteristics of Patients Presenting to a Psycho-Oncology Outpatient Clinic

Objective@#We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. @*Methods@#The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. @*Results@#Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. @*Conclusion@#There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

Additive Burden of Abnormal Diffusivity in the Brainwith Schizophrenia: A Diffusion Tensor Imaging Studywith Public Neuroimaging Data

Objective@#Diffusion tensor imaging has been extensively applied to schizophrenia research. In this study, we counted the number ofabnormal brain regions with altered diffusion measures in patients with schizophrenia to enumerate the burden of abnormal diffusivityin the brain. @*Methods@#The public neuroimaging data of the COBRE project from SchizConnect were used for the study. The studied dataset consistedof data from 57 patients with schizophrenia and 71 healthy participants. FreeSurfer and FSL were applied for image processingand analysis. After verifying 161 regions of interest (ROIs), mean diffusion measures in every single ROI in all study participants weremeasured and normalized into Z-scores. Each ROI was then defined as normal or abnormal on the basis of a cutoff absolute Z-score of1.96. The number of abnormal ROIs was obtained by each diffusion measure. @*Results@#The numbers of ROIs with increased radial diffusivity and increased trace were significantly larger in the patient group than inhealthy participants. @*Conclusion@#Thus, the patient group showed a significant increase in abnormal ROIs, strongly indicating that schizophrenia is notcaused by the pathology of a single brain region, but is instead attributable to the additive burden of structural alterations within multiplebrain regions. Psychiatry Investig 2020;17(4):341-349

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department

Background@#Non-suicidal self-injury (NSSI) and suicidality are common reasons for child and adolescent psychiatric emergencies. We aimed to investigate the incidence of pediatric emergency department (PED) utilization for psychiatric problems in children and adolescents and to identify demographic and clinical characteristics of youths who visited the PED for suicide attempt (SA) and/or NSSI. @*Methods@#The medical records of children and adolescents who visited the PED for psychiatric problems from January 2015 to November 2019 were reviewed retrospectively.Demographic and clinical variables including psychiatric disorders were collected. We compared the characteristics of youths who presented to the PED for SA and/or NSSI with those of youths without SA or NSSI. Student's t-test, χ2 test, and multivariate logistic regression were used for statistical analysis. @*Results@#During 59 months of observation, 194 youths visited the PED and the number of total PED visits was 336. Among them, 46 youths (23.7%) visited the PED for SA and/or NSSI at least once, and the number of visits was 91 (27.1% of PED visits). Youths with SA and/or NSSI were older (P = 0.001) and more likely to be a girl (P = 0.005) and to report parental absence (P = 0.023). Bipolar and related disorders (P = 0.032) and depressive disorders (P = 0.004) were more common in youths with SA and/or NSSI, while schizophrenia spectrum and other psychotic disorders (P = 0.030) and somatic symptom and related disorders (P = 0.007) were more common in those without SA and NSSI. After adjusting for age, sex, and parental marital status, bipolar and related disorders (odds ratio [OR], 6.72), depressive disorders (OR, 9.59), and somatic symptom and related disorders (OR, 0.12) were significantly associated with SA and/or NSSI. Youths with SA and/or NSSI also stayed longer in the PED (P = 0.007). @*Conclusion@#SA and NSSI are one of the main reasons for child and adolescent admittance to psychiatric services in the PED and are associated with psychiatric comorbidities. An appropriate risk assessment for suicidality and self-injury and proper management and referral to mental health services at the PED are of the utmost importance.

Validation of a Video Based Scale for Measuring Social Cognition in Schizophrenia / 신경정신의학

OBJECTIVES: Social cognition plays an important role in psychiatric symptoms and prognosis in patients with schizophrenia. Diagnostic scales are predominantly text-based or intended for the evaluation of theoretical concepts, with limited usefulness in clinical settings. We therefore developed a video based social cognition scale. METHODS: Our scale consists of 20 video clips portraying frequently experienced social interactions in real life. Patients were asked which interactions were socially unnatural and the reasons for lies told by actors. Our scale was validated and social cognition and its relationship with symptoms was evaluated using item response theory. RESULTS: A total of 209 participants (schizophrenia, 101 ; bipolar disorder, 49 ; healthy controls 59) were enrolled. Our scale showed high reliability and concurrent validity compared with the order subtest of the short form of the Weschler Adult Intelligence scale. Internal validity also was high (Cronbach's alpha=0.904). Most items were easy to answer and highly discriminative. The test information curve showed our scale to be more informative in patients with low social cognition ability. CONCLUSION: Our scale may aid in the study of pathology and social cognition deficits in patients with schizophrenia.

The Drug Adherence and Treatment Effect of the Paliperidone Long Acting Injection / 신경정신의학

OBJECTIVES: The aim of this study was to examine the drug adherence and treatment effect of the paliperidone long acting injection (LAI) in patients with schizophrenia or other psychotic disorders. METHODS: We reviewed the medical charts of patients who were prescribed paliperidone LAI from January 2010 to April 2014. Date of each injection, last observation, and first admission after use of the drug were obtained. Kaplan-Meier survival analysis was used for calculation of drug adherence. The dose of paliperidone LAI, concurrent oral antipsychotics, and anticholinergic agent was also obtained. Antipsychotics dose was calculated as olanzapine equivalent dose. RESULTS: The drug adherence of the paliperidone LAI on day 365 was 65%. The reasons for all cause discontinuation were follow-up loss, no effect, poor insight, rejection, extrapyramidal symptom, pain, etc. A total dose of 9.1 mg of oral antipsychotics was decreased, while the dose of anticholinergic agent was increased. CONCLUSION: The drug adherence of the paliperidone LAI was 65%, which was concordant with previous studies. The dose of concurrent oral antipsychotics was increased, while the dose of anticholinergic agent was decreased.