Add-on Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Adults with Post-traumatic Stress Disorder Who Failed to Respond to Initial Antidepressant Pharmacotherapy

This study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with post-traumatic stress disorder (PTSD) who continued to be symptomatic after more than 12 weeks of initial antidepressant treatment. Scores for the Clinician Administered PTSD Scale (CAPS) were rated pre- and post-EMDR and at a 6-month follow-up. After an average of six sessions of EMDR treatment, seven of 14 patients (50%) showed more than a 30% decrease in CAPS score and eight (57%) no longer met the criteria for PTSD. Our results indicate that EMDR could be successfully added after failure of initial pharmacotherapy for PTSD.

Reliability and Validity of the Korean Version of the Lifetime Stressor Checklist-Revised in Psychiatric Outpatients with Anxiety or Depressive Disorders

PURPOSE: Traumatic events and adverse stressful experiences are major etiological factors in a wide variety of physical and mental disorders. Developing psychological instruments that can be easily administered and that have good psychometric properties have become an integral part for research and practice. This study investigated the reliability and validity of the Korean version of the Lifetime Stressor Checklist-Revised (LSC-R) in a consecutive sample of psychiatric outpatients. The LSC-R is a 30-item self-reporting questionnaire examining lifetime traumatic and non-traumatic stressors. MATERIALS AND METHODS: A final sample of 258 outpatients with anxiety or depressive disorders was recruited at the psychiatric department of a university-affiliated teaching hospital. Self-reported data included the Life Events Checklist (LEC), the Zung Self-Rating Depression and Anxiety Scales, and the Impact of Events Scale-Revised, in addition to the LSC-R. A convenience sample of 50 college students completed the LSC-R on two occasions separated by a three week-interval for test-retest reliability. RESULTS: Mean kappa for temporal stability was high (κ=0.651) and Cronbach alpha was moderate (α=0.724). Convergent validity was excellent with corresponding items on the LEC. Concurrent validity was good for symptoms of post-traumatic stress disorder, depression, and anxiety. An exploratory factor analysis revealed that 11 factors explained 64.3 % of the total variance. CONCLUSION: This study demonstrated good psychometric properties of the Korean version of the LSC-R, further supporting its use in clinical research and practice with a Korean speaking population.

Desensitization of Triggers and Urge Reduction for Paruresis: A Case Report

Paruresis is a special type of non-generalized social phobia that involves fear and avoidance of urination in public restrooms. We administered eight 60-minute sessions of desensitization of triggers and urge reduction (DeTUR), an addiction protocol of eye movement desensitization and reprocessing (EMDR) therapy, to a 29-year old man with paruresis of 10 year duration. Because phobic avoidance is the hallmark of any anxiety disorder, we applied DeTUR targeting the urge to avoid each anxiety-provoking situation in succession. After treatment, the participant no longer met the requirements for a diagnosis of social anxiety disorder, and the self-reported symptoms of social anxiety had decreased to non-clinical levels; furthermore, these treatment gains were maintained at the one-year follow-up. Further clinical studies are needed to generalize this finding.

The Ratio of 2nd to 4th Digit Length in Korean Alcohol-dependent Patients

OBJECTIVE: The ratio of 2nd to 4th digit length (2D:4D) is a sexually dimorphic trait. Men have a relatively shorter second digit than fourth digit. This ratio is thought to be influenced by higher prenatal testosterone level or greater sensitivity to androgen. The purpose of this study is to investigate the relationship between alcohol dependence and 2D:4D in a Korean sample and whether 2D:4D can be a biologic marker in alcohol dependence. METHODS: In this study, we recruited 87 male patients with alcohol dependence from the alcohol center of one psychiatric hospital and 52 healthy male volunteers who were all employees in the same hospital as controls. We captured images of the right and left hands of patients and controls using a scanner and extracted data with a graphics program. We measured the 2D:4D of each hand and compared the alcohol dependence group with the control group. We analyzed these ratios using an independent-samples t-test. RESULTS: The mean 2D:4D of patients was 0.934 (right hand) and 0.942 (left hand), while the mean 2D:4D of controls was 0.956 (right hand) and 0.958 (left hand). Values for both hands were significantly lower for patients than controls (p<0.001, right hand; p=0.004, left hand). CONCLUSION: Patients who are alcohol dependent have a significantly lower 2D:4D than controls, similar to the results of previous studies, which suggest that a higher prenatal testosterone level in the gonadal period is related to alcoholism. Furthermore, 2D:4D is a possible predictive marker of alcohol dependence.

Reliability and Validity of the Korean Version of the Symptom Checklist-Post-Traumatic Stress Disorder Scale

The Symptom Checklist - Post-Traumatic Stress Disorder Scale (SCL-PTSD), also known as Crime-Related PTSD Scale has been validated in survivors of interpersonal trauma in the general population. However, the psychometric properties have not been investigated in a clinical setting for patients with PTSD from diverse traumatic events. This study investigates the reliability and validity of the Korean version of the SCL-PTSD among 104 psychiatric outpatients with PTSD, caused by interpersonal (n = 50) or non-interpersonal trauma (n = 54). Self-report data of the SCL-PTSD, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Impact of Events Scale-Revised (IES-R) were gathered. The Korean version of the SCL-PTSD showed excellent internal consistency and moderate-to-good four-week temporal stability in both the interpersonal and non-interpersonal trauma groups. In comparison with other diagnostic groups, the scores of the SCL-PTSD were significantly higher compared to those of adjustment disorder, depression, other anxiety disorders, and schizophrenia, demonstrating its criteria-related validity. Convergent validity was confirmed because the scores of the SCL-PTSD were significantly correlated with BDI, SAI and TAI scores. Concurrent validity was demonstrated by significant correlation with the IES-R score. This study demonstrated the favorable psychometric prosperities of the Korean version of the SCL-PTSD, supporting its use in clinical research and practice.

Clinical Correlates of Subtype and Severity in Patients with Delirium / 신경정신의학

OBJECTIVES: Delirium is commonly seen in clinical settings, and it can substantially influence the prognosis of patients. In this study, we investigated delirium with respect to its severity, classification and characteristics on each subtype. METHODS: Severity of delirium was examined in delirium patients, who were referred to the department of psychiatry in a general hospital for multidisciplinary treatment. After classification based on subtypes, factors influencing these aspects of delirium were examined. RESULTS: Among the 193 consultation-liaison patients referred to the department of psychiatry in a general hospital, 61 patients (31.6%) were diagnosed with delirium. Compared to patients in the non-delirium group, patients in the delirium group were older, had a shorter education period, and medical history of surgery. Among the delirium patients, the hyperactive subtype was found to be the most common (57.4%) and patients with the mixed subtype showed the highest severity score for delirium symptoms. In addition, the patient with the hypoactive subtype had a higher frequency of medical history of depression compared to those with the other subtypes. CONCLUSION: People with symptoms of hypoactive delirium can be misdiagnosed due to recurrence of depression, therefore, careful examination is required, particularly in patients with a history of depression.

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.

Factors Associated with Suicidal Ideation in Korean Elderly Living Alone ; Sociodemographic and Clinical Characteristics

OBJECTIVE: The purpose of this study was to examine the relationship between suicidal ideation and the associated with sociodemographic and clinical factors in community dwelling, elderly living alone in Korea. METHODS: A total of the 329 community-dwelling elderly aged 65 years or older who lived alone were recruited and they underwent the questionnaire including their sociodemographic data, Activities of Daily Living/Instrumental Activities of Daily Living scale (ADL/IADL) and the Korean version of the Short Geriatric Depression Scale (SGDS-K). Suicidal ideation was evaluated by using the "suicidal thought" item of the Beck Depression Inventory (BDI). RESULTS: According to the result of our sample of elderly living alone, 22.8% of the subjects reported their suicidal ideation. ADL/IADL score (p<0.01), subjective economic status (p<0.05), and subjective health status (p<0.05) had a negative correlation with suicidal ideation. SGDS-K score (p<0.05) had positive correlations with suicidal ideation. Multiple regression analysis revealed that suicidal ideation correlates to ADL/IADL score (p=0.025). CONCLUSION: This study exhibit that ADL/IADL is significantly associated with suicidal ideation.

Depression and Socio-Demographic Characteristics Associated with Quality of Life in the Community-Dwelling Elderly Living Alone

OBJECTIVE: This study is to suggest the plans for improving the quality of lives of the solitary old people by evaluating the effects of depression, social supports, and activity of daily living to the quality of life. METHODS: The subjects of this research were 329 elderly people who lived alone in Gangseo-gu, Seoul, Korea. They were recruited and underwent the questionnaire including their sociodemographic data, Activities of Daily Living/Instrumental Activities of Daily Living scale (ADL/IADL) and the Korean version of the Short Geriatric Depression Scale (SGDS-K). Statistical analyses including Pearson's correlation test, multiple regression were performed in this study. RESULTS: They were composed of 83.6% females and 16.4% males and almost age was between 70 and 84 years old. House welfare availability (p<0.05), subjective economic status (p<0.05), and SGDS-K score (p<0.01) had a negative correlation with Quality of life. Multiple regression analysis revealed that Quality of life correlates to SGDS-K score (p<0.05). CONCLUSION: The quality of life of elderly living alone was related with depression. Early detection and management for depression may need to be considered for quality of life of community dwelling elderly living alone.

Change of Psychological Characteristics after Joining the Army According to Internet Addiction Tendency in Young Male Army Recruits

OBJECTIVES: The aim of this study was to find out the psychological changes associated with internet addiction between before and after the military drill among the young male army recruits. METHODS: All 1091 participants were army recruits aged from 19 to 22 years who participated in the 5-week military drill. They were assessed with some self-reported questionnaires [Sociodemographic questionnaires, Young's Internet Addiction Scale (IAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Barratt Impulsiveness Scale (BIS), the Attention-Deficit/Hyperactivity Disorder Self-Rated Scale (ASRS)]. They were divided into two groups, One is the internet addiction tendency group and the other is non-addiction group according to the IAS score. And the severity of the internet addiction tendency, depression, anxiety and impulsiveness were evaluated by the IAS, the STAI, the BDI, the BIS, the ASRS before and after military drill. RESULTS: The result of the paired t-test shows that the IAS, the STAI, the BDI, the BIS, the ASRS scores decreased after military drill in both non-addiction group and internet addiction tendency group. The result of the repeated measures ANOVA shows that there is an interaction effect between the changes of ASRS-hyperactivity (F = 23.437, p < 0.001), ASRS-impulsiveness (F = 4.896, p = 0.027), BIS-total (F = 4.057, p = 0.044), BIS-motor impulsiveness (F = 13.609, p < 0.001) scores and groups. The result of the generalized estimating equation shows that internet addiction tendency is associated with ASRS-inattention (beta = 0.075, p < 0.001), ASRS-hyperactivity (beta = 0.092, p = 0.002), STAI-trait anxiety (beta = 0.046, p < 0.001), BIS-motor impulsiveness (beta = 0.119, p = 0.028). CONCLUSIONS: The results show that psychopathologies such as internet addiction tendency, depression, anxiety, impulsiveness may improve after military drill regardless of the groups. Internet addiction tendency may be related to the ASRS-inattention, ASRS-hyperactivity, STAI-trait anxiety, motor-impulsiveness. So these findings may be considered in the treatment of internet addiction in terms of the impulsiveness control.

Factorial Validity and Psychometric Properties of the Korean Version of the Children's Response to Traumatic Events Scale-Revised in Recently Traumatized School Children / 신경정신의학

OBJECTIVES: Posttraumatic stress disorder (PTSD) in children is prevalent and often persists for many years after the trauma. Therefore, screening and early detection using psychometrically sound instruments is a pivotal element of appropriate management. This study tested the reliability and validity of a Korean version of the Child Reaction to Traumatic Events Scale-Revised (K-CRTES-R) in a sample of recently traumatized school children. METHODS: The K-CRTES was administered to a total of 464 school children aged ten to twelve who had witnessed or had been confronted with a tragic accident involving three deaths. Internal consistency, two week test-retest reliability, and construct validity were assessed. A non-random portion of participants also completed the State Anxiety Inventory and the Subjective Unit of Distress Scale for testing convergent validity. Exploratory factor analysis was conducted for a random half of participants (n=232), and, for the remaining half, we tested the model fit by performance of confirmatory factor analysis. RESULTS: Two week test-retest reliability was high (r=0.85), and internal consistency was excellent (Cronbach alpha=0.92). The total score for the K-CRTES-R showed significant correlation with state anxiety and subjective level of anxiety, thus confirming its convergent validity. In addition, the K-CRTES-R distinguished between direct exposure and indirect confrontation, demonstrating the discriminant validity of the scale. In addition, we confirmed the factorial validity by identifying a two-factor structure (intrusion-hyperarousal and avoidance) that explained 56% of the total variance. This two factor solution and other previously suggested PTSD models showed fit indices that were within an acceptable range. CONCLUSION: Findings of our study indicate that the K-CRTES-R is a good measure of reliability and validity that can be used to assess the impact of trauma in Korean speaking children.

Symptomatic Correlates of Interpersonal Trauma in Outpatients with Anxiety Disorders / 신경정신의학

OBJECTIVES: Psychiatric patients report higher rates of interpersonal trauma, and they present with more symptoms and behavioral problems. However, less is known about other anxiety disorders, except for posttraumatic stress disorder. In this study, we investigated symptomatic correlates of interpersonal trauma (i.e., physical or sexual assaults) in patients with heterogeneous anxiety disorders. METHODS: We surveyed a consecutive sample of 90 outpatients with DSM-IV anxiety disorders (panic disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, anxiety disorder not otherwise specified) at the psychiatric department of a university-affiliated hospital. The questionnaire was comprised of the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, State and Trait Anxiety Inventory, and Impact of Events Scale-Revised. RESULTS: Patients with interpersonal trauma (n=51) demonstrated a significantly higher level of interpersonal sensitivity, paranoid ideation, and obsessive-compulsive subscale of the SCL-90-R. However, logistic regression analysis suggested that interpersonal sensitivity alone was suggested as the best fitting model. CONCLUSION: Anxiety disorder patients with interpersonal trauma demonstrated difficulty in domains of interpersonal relationship. Clinicians treating this population should consider this finding for better engagement and management.

Eye Movement Desensitization and Reprocessing for Adolescent Depression

While cognitive behavior therapy is considered to be the first-line therapy for adolescent depression, there are limited data on whether other psychotherapeutic techniques are also effective in treating adolescents with depression. This report suggests the potential application of eye movement desensitization and reprocessing (EMDR) for treatment of depressive disorder related, not to trauma, but to stressful life events. At present, EMDR has only been empirically validated for only trauma-related disorders such as posttraumatic stress disorder. Two teenagers with major depressive disorder (MDD) underwent three and seven sessions of EMDR aimed at memories of stressful life events. After treatment, their depressive symptoms decreased to the level of full remission, and the therapeutic gains were maintained after two and three months of follow up. The effectiveness of EMDR for depression is explained by the model of adaptive information processing. Given the powerful effects observed within a brief period of time, the authors suggest that further investigation of EMDR for depressive disorders is warranted.

Psychometric Properties of the Life Events Checklist-Korean Version

OBJECTIVE: The Life Events Checklist is a brief screening instrument that is used for potentially traumatic events such as accidents, disasters, sexual or physical assaults, or combat-related exposures. The original English version was recently tested for reliability and validity and it showed good psychometric properties, and so its use is recommended for the assessment of trauma. METHODS: This study investigated the reliability and validity of a Life Events Checklist-Korean version in 157 consecutive psychiatric outpatients at a university-affiliated teaching hospital. The questionnaire also included the Impact of Events Scale-Revised (IES-R), the Beck Depression Inventory (BDI), and the State and Trait Anxiety Inventory (STAI). Correlation and principal component analyses were conducted. RESULTS: The four week test-retest reliability was good and the internal consistency was acceptable. In addition, the number of traumatic events was significantly correlated with the posttraumatic depressive and anxiety symptoms, which demonstrated the convergent validity of the scale. Additionally, exploratory factor analysis identified a six-factor structure that explained 57.2% of the total variance. CONCLUSION: These findings support the reliability and validity of the Life Events Checklist-Korean version.

Postpsychotic Posttraumatic Stress Disorder in Schizophrenia: Case Series / 신경정신의학

OBJECTIVES: A growing body of literature supports the view that experiences of psychotic symptoms or involuntary admission may act as traumatic events which cause post-traumatic stress disorder (PTSD). Authors report three cases of postpsychotic (PP) PTSD developed in the course of schizophrenic illness. METHODS: Clinician-administered PTSD Scale (CAPS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were administered for evaluation of symptomatology. RESULTS: Two cases represented PP/PTSD caused by psychotic symptoms, especially auditory and visual hallucination, and one case by forced involuntary admissions. All three cases met DSM-IV diagnostic criteria of PTSD. The severity was mild in the range of 48 to 51 by CAPS. CONCLUSION: PP/PTSD developed during or soon after psychotic episodes and persisted for as long as nine years. Clinicians working with individuals with psychotic disorders should keep in mind that some portion of their patients may suffer from lingering posttraumatic effect of psychotic episode -related experiences.

The MMPI Profile of Adult Schizophrenia with Childhood Physical or Sexual Abuse / 신경정신의학

OBJECTIVES: The symptomatic and behavioral correlates of childhood trauma in schizophrenia are beginning to emerge in the literature. This study aimed to investigate whether the association between personality traits and schizophrenia with childhood abuse can be replicated in Koreans using the Multiphasic Minnesota Personality Inventory (MMPI). METHODS: Eighteen schizophrenias with childhood abuse and 24 schizophrenic comparisons without abuse history were recruited at the inpatient units of two general hospitals and the subjects completed the MMPI. RESULTS: Subjects with schizophrenia plus childhood history of abuse had less educational years (p<.001). After controlling the educational year as a covariate, abused schizophrenic patients had higher scores in the Schizotypal (p=.003), Dependent (p=.014), Passive-aggressive (p=.034), Borderline (p=.045) subscales. For the validity and clinical subscales, significant differences were found in the F scale (p=.036), Hypochondriasis (p=.042), Depression (p<.001), Hysteria (p=.002), Personality disorder (p=.001), Paranoia (p=.024), Psychasthenia (p=.001) and Schizophrenia (p=.006) subscales. CONCLUSION: Our findings suggest that childhood abuse in schizophrenia is associated with more complex features of personality characteristics rather than specific cluster B personality traits.

A Case Series of Post-traumatic Obsessive Compulsive Disorder: a Six Month Follow-up Evaluation / 신경정신의학

A number of recent case reports and series indicate that obsessive compulsive disorder (OCD) can develop after traumatic experience as a comorbid conditon to post-traumatic stress disorder (PTSD). These descriptive studies consistently addressed that those patients respond poorly to treatments and had an unfavorable outcome. However, this conclusion was not supported by prospective follow up with objective measurement of symptomatology. This report presents three single trauma-related PTSD patients who developed full-blown OCD concurrently with or after the initiation of PTSD. These patients represent 10% of new PTSD outpatients at a PTSD clinic during one year period and 25% of PTSD patients who had been admitted. In all three cases compulsion seemed to distract or serve as avoidance to intrusive symptoms of PTSD. Despite Eye Movement Desensitization and Reprocessing (EMDR) and/or exposure therapy for PTSD together with at least two antidepressant trials for PTSD and OCD, at six month follow-up PTSD partially improved and OCD remained unchanged. This finding is consistent with previous reports from western literature.