Erratum: Posttraumatic Stress Disorder Symptoms and Posttraumatic Growth Following Indirect Trauma from the Sewol Ferry Disaster, 2014

In the original publication, reference number 20 was incorrect.

Posttraumatic Stress Disorder Symptoms and Posttraumatic Growth Following Indirect Trauma from the Sewol Ferry Disaster, 2014

OBJECTIVE: The definition of psychological trauma, which was traditionally restricted to immediate and direct experience, is now expanding to include mediated or vicarious experience. So the present study aims to examine the relationship between the negative effects and the positive outcomes to a national disaster by assessing the posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth of the general public. METHODS: A nationwide survey of the Korean population (n=811) who were exposed to the Sewol ferry disaster through the media participated in this research, completing a self-report questionnaire consisting of demographic characteristics, Impact of Event Scale-Revised- Korean, and Korean-Stress-related Growth Scale-Revised. The participants were divided into three groups according to the severity of PTSD symptoms, then one-way ANOVA were conducted. RESULTS: The results revealed 30.4% of the sampled participants reported stress symptoms equivalent to partial or full PTSD. Posttraumatic growth was significantly higher in the full and the partial PTSD symptom groups when compared to the normal group [F (2, 759)=20.534, p < 0.001]. At a subscale level, mature thinking showed a more significant result [F (2,759)=23.146, p < 0.001] than religious growth [F (2, 180.984)=4.811, p < 0.01]. CONCLUSION: The results indicated a general linear trend between the severity of PTSD symptoms and posttraumatic growth level, suggesting that indirect trauma also induces both PTSD symptoms and posttraumatic growth like direct trauma does. The theoretical implications based on these findings were discussed.

Analysis of Epidemiological Factors and Clinical Variations to Determine Whether Violent Behavior Appears in Trauma- and Stressor-Related Disorder Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to identify variables and determine their correlation with violent behavior in trauma- and stressor-related disorder diagnostic patients. METHODS: A one-year retrospective study (2012 to 2013) was performed on 91 trauma- and stressor-related disorder diagnosed patients at Hallym University Kangnam Sacred Heart Hospital. Study data were obtained from previous medical records. The subjects were divided into two groups based on the presence of violent behavior. RESULTS: Of the 91 trauma- and stressor-related disorder diagnosed patients, 33 patients exhibited violent behavior during their clinical course. Sociodemographic factors of age and marital status and their socioeconomic-environmental status were variables significantly related with the presence of violent behavior. Clinical data from Structured Clinical Interview for DSM, Post Traumatic Growth Inventory, and Social Support Scale scores were significantly associated with violence in trauma- and stressor-related disorder patients. CONCLUSION: In the clinical course of subjects with trauma- and stressor-related disorder, appearance of violent behavior should be monitored and approached in multiple ways to address socio-demographic, clinical, and psychological problems. Monitoring of significantly related variables and treatment compliance should be considered part of an appropriate therapeutic strategy for trauma- and stressor-related disorder patients.

The Relationship between Social Exclusion and Paranoid Ideation: Analysis of Moderating and Mediating Effects of Depression and Self-Esteem / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the relationship between social exclusion and paranoid ideation, and to explore moderating and mediating effects of depression and self-esteem in that relationship. METHODS: Ninety seven neurosis patients receiving treatment in a psychiatric outpatient setting were selected. Social Exclusion Scale, Beck Depression Inventory, paranoia scale of Symptom Checklist-90-Revised, and Rosenberg Self-Esteem Scale were used for evaluation. RESULTS: Social exclusion showed highly positive correlation with paranoid ideation, and had significant influence. Among three types of social exclusion, contempt, bullying, and isolation, only isolation showed significant influence on paranoid ideation. Depression showed a partial mediating effect on that relationship indicating that social exclusion affects paranoid ideation not only directly, but also indirectly. On the other hand, self-esteem showed no moderating or mediating effects on that relationship. CONCLUSION: Depression mediates the influence of social exclusion on paranoid ideation. This finding provides an opportunity to decrease paranoid ideation of neurosis patients by not only prescription of antipsychotic agents but also therapeutic approach to social exclusion and depression. An experimental study to verify these findings seems to be needed.

Anti-Intrusion Effect of Lorazepam: An Experimental Study

OBJECTIVE: Easy triggering of trauma-related episodic memory fragments caused by perceptual cues is tied to strong perceptual priming in the implicit memory system. And among benzodiazepines, only lorazepam has been consistently reported to have an atypical suppression effect on perceptual priming processes. The aim of this study was to investigate the effects of single doses of lorazepam, diazepam, and a placebo on intrusive memories after exposure to a distressing videotape and to explore whether the anti-intrusive effect of lorazepam is acquired as a result of the suppression of perceptual but not conceptual priming processes. METHODS: Under prospective, randomized, and double-blind conditions, we compared the anti-intrusion effect of a single dose of lorazepam (n=22) with that of diazepam (n=22) and a placebo (n=21) in young healthy Korean college students following exposure to a traumatic videotape. RESULTS: We present the first finding for an anti-intrusion effect of lorazepam. One day after the medication, lorazepam, rather than diazepam or the placebo, significantly reduced the extent of intrusion and data-driven processing of the traumatic information. There were no differences among the three conditions in state anxiety, depression, and an arousal scale throughout the experiment. CONCLUSION: Results from this study suggest the possibility of lorazepam as a candidate anti-intrusion drug, as well as the cautious use of diazepam in the treatment of PTSD patients. The anti-intrusive effect of lorazepam is directly related to its atypical inhibitory effect on implicit perceptual priming processes. The present study provides support for the enhanced perceptual priming hypothesis of PTSD.

State Effect of Traumatic Experience on Personality Structure

OBJECTIVE: Personality is defined as the trait-like qualities of a person. However, it has been recently suggested that the state effect of a situation leads to changes in scores on personality assessments. We predicted that traumatic experiences would induce changes not only in personality scores but also in the factor structures of personality assessments. METHODS: MethodsaaWe conducted a cross-sectional, case-controlled study using two data sets: a traumatized adolescent sample (n=71) and a non-traumatized adolescent sample (n=296). Personality factor structures were compared between the two samples using exploratory factor analyses for 25 lower-ordered subscales of the Temperament and Character Inventory (TCI). In the non-traumatized sample, evaluation of the scree plot suggested a five-factor solution supporting TCI's original seven-factor model. RESULTS: The traumatized sample showed a three-factor structure representing a biological factor, a social factor and an existential factor. This decrease in number of personality factors was caused by strengthened correlations among personality subscales related to coping with traumatic situations. Cloninger's psychobiological model of personality (i.e., temperament-character) was adequate in capturing personality traits of non-traumatized adolescents, but the tripartite view of existential psychology (i.e., body-mind-spirit) clearly corresponded to the factor structure of the traumatized adolescents. CONCLUSION: The three-factor solution of the present traumatized group is consistent with the tripartite model of personality (i.e., body-mind-spirit), while the five-factor solution of the non-traumatized group corresponds to Cloninger's seven-factor model. This is the first study to describe the state effects of traumatic experiences on personality structure.

Diabetes, Depression and Doctor-Patient Relationship / 당뇨병

Although diabetes mellitus (DM) is treatable, it is still not curable. Its chronicity is associated with a high prevalence of psychiatric disorders, especially depression in type 2 DM and learned helplessness in type 1 DM. In turn, this depression and helplessness may affect a patient's adherence to medical appointments, compliance to treatment, and effective doctor-patient relationships, which are vital to promising outcomes. This study reviews the existing literature regarding the interactional relationships between depression, DM and the doctor/patient relationship, and also suggests certain aspects of the doctor/patient relationship which can contribute to more successful treatment outcomes.

Illness Representation for Pathological Gambling / 신경정신의학

OBJECTIVES: In our studies, we have made efforts to compare illness representation among the pathological gamblers, social gamblers, the family members of gambler, the gambling industry employees, and general adults and to investigate what kinds of illness representation make an estimate of therapy intention. METHODS: 222 gambling users, 125 family members of gambler, 95 employees in gambling industry, and 1383 general adults were included in this study. Symptom representation, negative characteristic representation, negative consequence representation, internal and external attribution representation, spontaneous recovery representation, recovery representation through therapeutic help of speciality, time lapse representation were constructed and included for illness representation of pathological gambling. RESULTS: 1) Pathological gamblers had lower symptoms, negative characteristics, negative consequences and therapeutic help seeking representation than other groups, on the other hand higher external attribution representation and spontaneous recovery representation. 2) Families of problem gambler have inconsistent characteristics higher external attribution and negative consequences and lower therapeutic help seeking representation. 3) It was founded that negative consequences representation and external representation were low in gambling industry employees. 4) The more symptom representation increased and external attribution decreased, the more therapeutic intention increased in case of problem gamblers and their families. CONCLUSION: Pathological gamblers have the lowest awareness and acceptance on mental problem caused by excessive gambling. However, suggested that family members of gambler and gambling industry employees also have partially self defensive and contradicted representations. It was suggested that awareness on severity of symptom and internal attribution representation needs to be increased in order to participate therapeutic place.

Impulsivity and Sensation-seeking of Pathological Gambling: Comparison with Alcoholism / 신경정신의학

OBJECTIVES: We investigated impulsivity and sensation seeking of pathological gambling, comparing with alcoholism and normal group. METHODS: 36 pathological gamblers, who were diagnosed by DSM-IV criteria, were compared with 31 alcoholism group and 26 healthy normal group with Barratt impulsivity scale and Zuckerman sensation seeking scale. RESULTS: 1) Pathological gamblers appeared to have much more impulsivity than alcoholism group or normal group. In respect to sensation seeking, no significant differences were founded among three groups. 2) Pathological gamblers tend to have more non-planning impulsivity, cognitive impulsivity, and motor impulsivity than alcoholic group. Comparing with normal group, pathological gamblers tend to have more non-planning impulsivity and motor impulsivity, but not in cognitive impulsivity. 3) There were no differences in three sub-scales including of thrill seeking, experience seeking and disinhibition out of four sub-scales of sensation seeking scale, among three groups. However, Boredom susceptibility was higher in pathological gamblers than alcoholics and normal group. CONCLUSIONS: These results suggested that personality of pathological gambler is most impulsive and boredom susceptible, which indicates that pathological gamblers is more serious pathological clinical disorder than alcoholism.

A Validation Study of the Suicide Probability Scale for Adolescents (SPS-A) / 신경정신의학

OBJECTIVES: We aimed to develope the Suicide Probability Scale for Adolescent (SPS-A) to evaluate the possibility of suicide behavior in adolescents. METHODS: SPS-A was adminstered to 792 middle and high school students for examining the reliability and validity. RESULTS: SPS-A was found to have significantly high internal consistency and total -subscale score correlations. Factor analysis yielded four factors of negative self-evaluation, hopelessness, suicide idea and hostility, which explained 53.28% of total variables. In the assessment of correlations with other suicide-related scales for the concurrent validity of SPS-A, Rosenberg self-esteem scale and Buss-Durkee hostility scale have significant correlations with SPS-A. However, Children's depression inventory and Hopelessness scale for adolescent did not have significant correlations with SPS-A. CONCLUSION: We concluded that SPS-A had high reliability and validity, which is usefull for evaluating suicide idea in adolescents. This study suggests that hopelessness and depressive symptoms are not for evaluating suicide risk in adolescents, unlike adult group.

The Psychological and Behavioral Characteristics of the Pathological Gamblers in Horse Racing / 신경정신의학

OBJECTIVES: We investigated the socio-demographic, psychological and behavioral characteristics of the pathological gamblers in horse racing. METHODS: Among 61 horse-racing gamblers, 20 pathological gamblers were diagnosed by DSM-IV criteria, and compared with 18 healthy horse racing spectators. RESULTS: 1) The education level of the pathological gamblers was lower and the duraton of gambling history longer than the healthy horse racing spectators. 2) The number and the amount of the bet of pathological gamblers in one day were higher than those of the healthy horse racing spectator. Especially, the highest amount of money gained of the pathological gambler were significantly larger than that of the healthy horse racing spectators. 3) The pathological gamblers bet with the purpose of restoring loss sum, gaining money, and avoiding dysphoric and negative mood. To be opposed, the healthy horse racing spectator play for rest, pleasure and excitement seeking. 4) The healthy horse racing spectators enjoy pleasure and euphoric mood through horse racing more than the pathological gamblers. However, the pathological gamblers experience repentance after game, and irritable and unstable mood while they were betting. 5) The pathological gamblers could control impulse less than the healthy horse racing spectator because of being habituated to the game. CONCLUSIONS: Horse racing is one of the most popular and legitimate leisure and gambling activities in Korea. In such a legitimate gambling activity, serious pathological gamblers are found frequently and their psychological and societal problems are increasing. Therefore, the prevention and the therapeutic intervention for the pathological gambling would be urgent.

Effects of Total Sleep Deprivation on the Cognitive Function in the Normal Adult Male Subjects / 신경정신의학

OBJECTIVES: This study was carried out to evaluate the effect of acute sleep deprivation of 36 hours on cognitive functions, and investigate which region of brain would dysfunction by sleep deprivation. METHODS: We carried out sleep deprivation in the 18 healthy and right handed males in their 20's. We also administered to them Luria-Nebraska Neuropsychological Battery and Calculation and Digit Span task of K-WAIS in order to examine cognitive functions before and after sleep deprivations. RESULTS: There were no differences in freedom from distractability, tactile function, visual function, reading, writing, calculation, and intellectual process function. However, motor function, rhythm, receptive speech, expressive speech, memory, and complex verbal arithmetic function decreased after sleep deprivation. In motor function, delayed speed and high fail rate in complex forms of praxis and selectivity of motor acts were observed. In area of receptive speech and expressive speech, understanding of logical and grammatical structure, spontaneous speech, sequencing and filling in items which are grammatically accurate decreased. All these functions related with dysfunction in right hemisphere anterior region. Also in localization scales, the fail rates of right frontal dysfunction scale and right temporal dysfunction scale increased after sleep deprivation. CONCLUSIONS: From these results, we suggest that sleep deprivation has negative effect on the cognitive functions. Especially, sleep deprivation might be associated with dysfunction of anterior region in right hemisphere or subcortical dysfunction.

The Preliminary Study on the Validation of Schizotypal Personality Questionnaire-Korean Version / 신경정신의학

In order to product and develop questionnaire which can assess the schizotypal personality by model of criteria in DSM-III-R it was presented 1311owing questions in this study. First, far the validation and manufacture of scale and sub-subscale that assess overall feature, nine characteristics of the schizotypal personality disorder, this study was concerned with validity, reliability and factor-analysis results of schizotypal personality questionnaire. Second, we would be present how schizotypal personality disorder trend is connected with trait-anxiety, hopelessness and self-concept. Also the difference Is compared with. Finally, 396(male 216 Ss/53,8%, female 180 Ss/45.5%) college students with mean age 21.2 years were sampled. Raine's schizotypal personality questionnaire(SOQ) which assess nine characterisitics of schizotypal personality disorder in DSM-III-R was translated and used. In this results, Raine's schizotypal personality questionnaire was appeared to have high internal validity, split-half reliability and test-retest reliability Also, 6 factors were affirmed by empirical confirmation through factor-analysis. 6 factors have been very reliable internal validity that ranges from .78 to .83. In these 6 factors, idea of reference, odd or eccentric behavior and odd speech were corresponded to the category model after DSM-III-B in Raine's scale. 'Cognitive, perceptive' dimension was centered of factor 1, 'Emotive, affective' dimension was centered of factor 2, social anxiety and constricted affect were constituted to 2nd factor. No close friends, schizoid trend and suspiciousness of schizotypal characteristics were constituted to 3rd factor by' interpersonal relationship' dimension. These empirical outcomes which confirmed through factor-analysis were very valid and connected much to Raine's scale which assessed schizotypal personality disorder, thus possibility of development and manufacture of schizotypal personality disorder scale through item revision was lighten. In 2nd study the higher schizotypal personality disorder trend, trait-anxiety and hoplessness were higher. But on the contrary, self-concept was lower. The group of high score in schizotypal personality questionnaire had more trait-anxiety and hopelessness than the group of low score in schizotypal personality questionnaire. Contrastly, positive self-concept was high in the group of low score. Also, the most predictable variable to the trait-anxiety was factor 2, predictable power R2 of factor 2 was 29.1%. To the hopelessness, factor 2 was the most powerful predictable variable. Predictable power of factor 2 was 11.2%, also. In self-concept, factor 2 explained 20.8% of self-concept, thus it was presented that factor 2 had the most powerful explanatory quantity. In these consequences, the factors which have meaningful connection to the trait-anxiety, hopelessness and low self-concept within 6 factors were really factor 2, 3, 1. Among these factors, 'Emotive' feature of factor 2 including social anxiety and constricted affect have the most effect on trait-anxiety, hopelessness and serf-concept. And next to factor 2, the isolated interpersonal relation which include no close friends and schizoid trend was some influential variable. Also peculiar, unusual perceptual experience, eccentric belief and magical thinking had some effect though small. The college students who had strong schizotypal personality trend had more social anxiety and more constricted emotional empathic ability, less self-expression, less social skill than common college students. These elements threaten, interrupt and retard identity establishment and intimacy-seeking which are important developmental tasks within this period. These experiences is accepted to ego-dystonic to schizotypal college students who have some or moderate reality testing, adaptive ability. Moreover, These peoples would feel locus of control externally, not internally and would have more control-failure experiences. All these elements elevate anxiety level, give rise to low self-concept and low expectation to the future. These outcomes all confirmed questions which presented in this study.