Characteristics of Cognitive Function Changes and Related Factors in Individuals With Cognitive Impairment During the Pandemic of COVID-19: A Retrospective Chart Review Study

Objective@#This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. @*Results@#When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st–2nd) (p=0.045). After COVID-19 (2nd–3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. @*Conclusion@#Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.

A Study on Verification of Equivalence and Effectiveness of Non-Pharmacologic Dementia Prevention and Early Detection Contents : Non-Randomly Equivalent Design

Objective@#: The aim of this study was to verify the equivalence and effectiveness of the tablet-administered Korean Repeatable Battery for the Assessment of Neuropsychological Status (K-RBANS) for the prevention and early detection of dementia. @*Methods@#: Data from 88 psychiatry and neurology patient samples were examined to evaluate the equivalence between tablet and paper administrations of the K-RBANS using a non-randomly equivalent group design. We calculated the prediction scores of the tablet-administered K-RBANS based on demographics and covariate-test scores for focal tests using norm samples and tested format effects. In addition, we compared the receiver operating characteristic curves to confirm the effectiveness of the K-RBANS for preventing and detecting dementia. @*Results@#: In the analysis of raw scores, line orientation showed a significant difference (t=-2.94, p<0.001), and subtests showed small to large effect sizes (0.04–0.86) between paper- and tablet-administered K-RBANS. To investigate the format effect, we compared the predicted scaled scores of the tablet sample to the scaled scores of the norm sample. Consequently, a small effect size (d≤0.20) was observed in most of the subtests, except word list and story recall, which showed a medium effect size (d=0.21), while picture naming and subtests of delayed memory showed significant differences in the one-sample t-test. In addition, the area under the curve of the total scale index (TSI) (0.827; 95% confidence interval, 0.738–0.916) was higher than that of the five indices, ranging from 0.688 to 0.820. The sensitivity and specificity of TSI were 80% and 76%, respectively. @*Conclusion@#: The overall results of this study suggest that the tablet-administered K-RBANS showed significant equivalence to the norm sample, although some subtests showed format effects, and it may be used as a valid tool for the brief screening of patients with neuropsychological disorders in Korea.

Defense Mechanisms and Psychological Characteristics According to Suicide Attempts in Patients with Borderline Personality Disorder

Objective@#There have been many biological studies on suicide behaviors of borderline personality disorder (BPD), however few studies have sought to psychoanalytic characteristics including defense mechanisms. Therefore, we investigated psychological, symptomatic, and personality characteristics including defense mechanisms in suicide attempters and non-suicide attempters among patients with BPD. @*Methods@#We enrolled 125 patients with BPD. Forty-two patients with a history of one or more suicide attempts formed the suicide attempters group and 83 patients with no such history formed the non-suicide attempters group. We collated the differences in clinical and psychological characteristics between the two groups by using the Symptom Checklist-90-Revised (SCL-90-R), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Personality Disorder Questionnaire-4+ (PDQ-4+), and the Defense Style Questionnaire (DSQ). @*Results@#The suicide attempters group scored higher on the hostility subscale of SCL-90-R. The suicide attempters group also scored higher on the Infrequency, Back Infrequency, Lie, Masculinity-femininity, Paranoia, Psychasthenia, and Schizophrenia scales of the MMPI-2. The incidence of paranoid and antisocial personality disorders, as assessed by the PDQ-4+, was significantly different in both groups. Maladaptive, self-sacrificing defense style, splitting and affiliation on the DSQ were also higher for the suicide attempters group. In the results of the logistic regression analysis, gender, the F(B) and L scales on the MMPI-2, and ‘splitting of other’s image’ defense mechanism on the DSQ were the factors that significantly influenced to suicide attempts. @*Conclusion@#These findings suggest that impulsive psychiatric features and maladaptive defense style may be related to suicidal risk in patients with BPD. Therefore, our findings may help clinicians in estimating the risk of suicide in patients with BPD.

Characteristics of Suicide Attempters Admitted to the Emergency Room and Factors Related to Repetitive Suicide Attempts / 생물치료정신의학

Objectives@#：Suicide attempt history is one of the major suicide risk factors and the suicide mortality rate increases with the number of suicide attempts. This study aimed to compare demographic and clinical factors between first and multiple suicide attempters and investigate risk factors for multiple suicide attempts. @*Methods@#：Participants were 537 patients who were admitted to an emergency room after attempting suicide and divided into two groups (393 first attempters and 144 multiple attempters). Demographic factors, clinical characteristics, and suicide-related characteristics were compared between the two groups. Variables with a p-value lower than 0.1 were included in a multivariate logistic regression analysis. Logistic regression models were considered to identify independent risk factors for multiple suicide attempts. The significance level was set to 0.05. @*Results@#：Among demographic factors, the two groups differed in age, sex, education, occupation, and marital and cohabitation status. Multiple attempters were more likely to have a mental disorder, current use of psychiatric medication, interpersonal and psychiatric motivation for suicide, current suicidal thoughts, help seeking behavior, awareness of suicide, and agreement with psychiatric follow up. In the regression analysis, unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use emerged as significant risk factors of multiple suicide attempts. @*Conclusion@#：The study’s findings suggested that there are differences in the demographic and clinical characteristics of first and multiple suicide attempters. Specific strategies that consider unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use may be valuable for future suicide prevention.

Characteristics of Suicide Attempters Admitted to the Emergency Room and Factors Related to Repetitive Suicide Attempts / 생물치료정신의학

Objectives@#：Suicide attempt history is one of the major suicide risk factors and the suicide mortality rate increases with the number of suicide attempts. This study aimed to compare demographic and clinical factors between first and multiple suicide attempters and investigate risk factors for multiple suicide attempts. @*Methods@#：Participants were 537 patients who were admitted to an emergency room after attempting suicide and divided into two groups (393 first attempters and 144 multiple attempters). Demographic factors, clinical characteristics, and suicide-related characteristics were compared between the two groups. Variables with a p-value lower than 0.1 were included in a multivariate logistic regression analysis. Logistic regression models were considered to identify independent risk factors for multiple suicide attempts. The significance level was set to 0.05. @*Results@#：Among demographic factors, the two groups differed in age, sex, education, occupation, and marital and cohabitation status. Multiple attempters were more likely to have a mental disorder, current use of psychiatric medication, interpersonal and psychiatric motivation for suicide, current suicidal thoughts, help seeking behavior, awareness of suicide, and agreement with psychiatric follow up. In the regression analysis, unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use emerged as significant risk factors of multiple suicide attempts. @*Conclusion@#：The study’s findings suggested that there are differences in the demographic and clinical characteristics of first and multiple suicide attempters. Specific strategies that consider unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use may be valuable for future suicide prevention.

Cognitive dysfunctions in individuals with diabetes mellitus / 영남의대학술지

Some patients with type 1 and type 2 diabetes mellitus (DM) present with cognitive dysfunctions. The pathophysiology underlying this complication is not well understood. Type 1 DM has been associated with a decrease in the speed of information processing, psychomotor efficiency, attention, mental flexibility, and visual perception. Longitudinal epidemiological studies of type 1 DM have indicated that chronic hyperglycemia and microvascular disease, rather than repeated severe hypoglycemia, are associated with the pathogenesis of DM-related cognitive dysfunction. However, severe hypoglycemic episodes may contribute to cognitive dysfunction in high-risk patients with DM. Type 2 DM has been associated with memory deficits, decreased psychomotor speed, and reduced frontal lobe/executive function. In type 2 DM, chronic hyperglycemia, long duration of DM, presence of vascular risk factors (e.g., hypertension and obesity), and microvascular and macrovascular complications are associated with the increased risk of developing cognitive dysfunction. The pathophysiology of cognitive dysfunction in individuals with DM include the following: (1) role of hyperglycemia, (2) role of vascular disease, (3) role of hypoglycemia, and (4) role of insulin resistance and amyloid. Recently, some investigators have proposed that type 3 DM is correlated to sporadic Alzheimer’s disease. The molecular and biochemical consequences of insulin and insulin-like growth factor resistance in the brain compromise neuronal survival, energy production, gene expression, plasticity, and white matter integrity. If patients claim that their performance is worsening or if they ask about the effects of DM on functioning, screening and assessment are recommended.

Apathy syndrome in a patient previously treated with selective serotonin reuptake inhibitors for depression / 영남의대학술지

There is considerable overlap in the clinical presentations of apathy and depression. However, differential diagnosis between apathy and other psychiatric conditions, including depression and dementia, is important. In this report, we present the case of a 67-year-old woman with a history of receiving selective serotonin reuptake inhibitor (SSRI) treatment for depression. Differential diagnosis between treatment-resistant depression and SSRI-induced apathy syndrome was required. The symptoms of her apathy syndrome were relieved after the discontinuation of SSRIs and the addition of olanzapine, methylphenidate, and modafinil. Furthermore, we briefly review related literature in this article.

Neurofeedback Treatment on Depressive Symptoms and Functional Recovery in Treatment-Resistant Patients with Major Depressive Disorder: an Open-Label Pilot Study

BACKGROUND: We evaluated the effects of neurofeedback as an augmentation treatment on depressive symptoms and functional recovery in patients with treatment-resistant depression (TRD). METHODS: We included 24 adult patients with TRD and 12 healthy adults. 24 TRD patients were assigned to the neurofeedback augmentation group (n = 12) and the medication-only (treatment as usual [TAU]) group (n = 12). The neurofeedback augmentation group underwent combined therapy comprising medication and 12–24 sessions of neurofeedback training for 12 weeks. To assess the serum levels of brain-derived neurotrophic factor (BDNF) in both groups, pre- and post-treatment blood samples were obtained. Patients were evaluated using the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Clinical Global Impression-Severity (CGI-S), 5-level version of European Quality of Life Questionnaire 5-Dimensional Classification (EQ-5D-5L), and Sheehan Disability Scale (SDS) at baseline, and at the 1-, 4-, and 12-week. RESULTS: From baseline to week 12, neurofeedback training reduced mean scores on HAM-D, BDI-II, CGI-S, and SDS, and increased mean EQ-5D-5L tariff score. In the neurofeedback augmentation group, the response and remission rates were 58.3% and 50.0%, respectively, at week 12. Changes in HAM-D, EQ-5D-5L tariff score, and SDS were significantly larger in the neurofeedback group than in the medication-only (TAU) group. No significant difference in BDNF level was found pre- vs. post-treatment in any of the groups. CONCLUSION: Despite the small sample size, these results suggest that neurofeedback treatment may be effective as an augmentation treatment, not only for depressive symptoms, but also for functional recovery, in patients with TRD. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0004183 ClinicalTrials.gov Identifier: NCT04078438

The Development of Evidence-Based Guideline for Diagnosis and Management of Headache in Korea

OBJECTIVE: We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients’ pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache. METHODS: This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies. RESULTS: We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique. CONCLUSION: Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.

Mechanism of Mindfulness-Based Intervention and Neurobiological Basis / 생물치료정신의학

Mindfulness is a process in which all thoughts, feelings, sensations, and all phenomena that happen to me are uncritically recognized as they are, so that they are eventually accepted and released without identifying or automatically responding to them. The clinical effects of mindfulness-based therapy have already been demonstrated in several studies. However, consistent results have not been reported for the mechanism of mindfulness-based treatment. Thus, this review aimed to describe a systematic review of the literature and research on the mechanisms of mindfulness-based interventions. Experienced meditators showed a physiological change in a ‘wakeful hypometabolic state’ during mindfulness meditation. In mindfulness meditation, it is known that certain areas other than brain activation during relaxation are additionally activated, particularly activation of fronto-limbic and fronto-parietal neural networks. The psychological mechanisms include meta-cognitive awareness, emotion regulation, reduction of automatic and self-referential thinking, concentration control, self-compassion, improvement of value clarification and self-regulation, exposure, extinction, and reconsolidation. Of the brain regions with changes in activity associated with mindfulness meditation, prefrontal cortex, the default mode network including cortical midline structures were associated with emotion regulation, concentration control, and reduction of automatic and self-referential thinking. In addition, brain regions associated with mindfulness meditation have been reported in the hippocampus, amygdala, and medical frontal cortices associated with memory reconsolidation and fear extinction. Thus, mindfulness-based interventions have a psychological and neurobiological effect with a special mechanism different from other psychological interventions, so that mindfulness based intervention can be an effective therapeutic intervention with a different mechanism from other psychological techniques.

Cognitive dysfunctions in individuals with diabetes mellitus / 영남의대학술지

Some patients with type 1 and type 2 diabetes mellitus (DM) present with cognitive dysfunctions. The pathophysiology underlying this complication is not well understood. Type 1 DM has been associated with a decrease in the speed of information processing, psychomotor efficiency, attention, mental flexibility, and visual perception. Longitudinal epidemiological studies of type 1 DM have indicated that chronic hyperglycemia and microvascular disease, rather than repeated severe hypoglycemia, are associated with the pathogenesis of DM-related cognitive dysfunction. However, severe hypoglycemic episodes may contribute to cognitive dysfunction in high-risk patients with DM. Type 2 DM has been associated with memory deficits, decreased psychomotor speed, and reduced frontal lobe/executive function. In type 2 DM, chronic hyperglycemia, long duration of DM, presence of vascular risk factors (e.g., hypertension and obesity), and microvascular and macrovascular complications are associated with the increased risk of developing cognitive dysfunction. The pathophysiology of cognitive dysfunction in individuals with DM include the following: (1) role of hyperglycemia, (2) role of vascular disease, (3) role of hypoglycemia, and (4) role of insulin resistance and amyloid. Recently, some investigators have proposed that type 3 DM is correlated to sporadic Alzheimer’s disease. The molecular and biochemical consequences of insulin and insulin-like growth factor resistance in the brain compromise neuronal survival, energy production, gene expression, plasticity, and white matter integrity. If patients claim that their performance is worsening or if they ask about the effects of DM on functioning, screening and assessment are recommended.

Apathy syndrome in a patient previously treated with selective serotonin reuptake inhibitors for depression / 영남의대학술지

There is considerable overlap in the clinical presentations of apathy and depression. However, differential diagnosis between apathy and other psychiatric conditions, including depression and dementia, is important. In this report, we present the case of a 67-year-old woman with a history of receiving selective serotonin reuptake inhibitor (SSRI) treatment for depression. Differential diagnosis between treatment-resistant depression and SSRI-induced apathy syndrome was required. The symptoms of her apathy syndrome were relieved after the discontinuation of SSRIs and the addition of olanzapine, methylphenidate, and modafinil. Furthermore, we briefly review related literature in this article.

Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature

OBJECTIVE: Physical or mental imbalance caused by harmful stimuli can induce stress to maintain homeostasis. During chronic stress, the sympathetic nervous system is hyperactivated, causing physical, psychological, and behavioral abnormalities. At present, there is no accepted standard for stress evaluation. This review aimed to survey studies providing a rationale for selecting heart rate variability (HRV) as a psychological stress indicator. METHODS: Term searches in the Web of Science®, National Library of Medicine (PubMed), and Google Scholar databases yielded 37 publications meeting our criteria. The inclusion criteria were involvement of human participants, HRV as an objective psychological stress measure, and measured HRV reactivity. RESULTS: In most studies, HRV variables changed in response to stress induced by various methods. The most frequently reported factor associated with variation in HRV variables was low parasympathetic activity, which is characterized by a decrease in the high-frequency band and an increase in the low-frequency band. Neuroimaging studies suggested that HRV may be linked to cortical regions (e.g., the ventromedial prefrontal cortex) that are involved in stressful situation appraisal. CONCLUSION: In conclusion, the current neurobiological evidence suggests that HRV is impacted by stress and supports its use for the objective assessment of psychological health and stress.

Association between Cerebral Amyloid Deposition and Clinical Factors Including Cognitive Function in Geriatric Depression: Pilot Study Using Amyloid Positron Emission Tomography

The purpose of this study was to explore the relationship between cerebral amyloid deposition and overall clinical factors including cognitive functions in geriatric depression by using 18F-florbetaben positron emission tomography. Thirteen subjects aged over 60 years who had a history of major depressive disorder and also had subjective memory complaint were included. Of all subjects, 3 subjects judged as amyloid positive, and the others judged as amyloid negative. Their memory, visuospatial functions and attention abilities were negatively correlated with amyloid deposition in specific brain regions, but their language and recognition abilities were not correlated with any region. The amyloid deposition of the whole brain region was significantly negatively correlated with immediate memory.

Sleep and Temperature / 수면정신생리

Changes in core body temperature are closely related to initiation and maintenance of sleep, and are influenced by various factors such as air temperature, room temperature, clothing, human activities, and medications. These factors are closely related to sleep fragments, insomnia and other sleep disorders. Understanding the effect of the temperature related to human surroundings on the core body temperature and sleep, will be useful for understanding the physiology of sleep and to treat sleep disorders.