Factors Associated with Burnout among Healthcare Workers during an Outbreak of MERS

Objective@#Although healthcare workers (HCWs) experienced significant stress during the 2015 outbreak of Middle East Respiratory Syndrome (MERS), the factors associated with this stress remain unknown. Thus, the present study assessed burnout among HCWs during the MERS outbreak to identify the influential factors involved in this process. @*Methods@#This study was a retrospective chart review of the psychological tests and questionnaires completed by 171 hospital employees from two general hospitals that treated MERS patients. The tests included the Oldenburg Burnout Inventory, Positive Resources Test, the questionnaires assessed exposure to the MERS outbreak event and perceptions about MERS. @*Results@#Of the 171 HCWs, 112 (65.5%) experienced disengagement and 136 (79.5%) suffered from exhaustion. Disengagement was associated with lower levels of purpose and hope, a higher perception of job risk, and exposure to the media. Exhaustion was associated with lower levels of purpose and hope, a higher perception of little control of the infection, a higher perception of job risk, prior experience related to infections, and being female. @*Conclusion@#Our results revealed the risk and protective factors associated with burnout among HCWs during an outbreak of MERS. These findings should be considered when determining interventional strategies aimed at ameliorating burnout among HCWs.

Psychiatric Findings in Suspected and Confirmed Middle East Respiratory Syndrome Patients Quarantined in Hospital: A Retrospective Chart Analysis

OBJECTIVE: Little is known about the psychiatric complications or risk factors for depression in suspected or confirmed Middle East Respiratory Syndrome (MERS) patients quarantined in hospital. METHODS: A retrospective chart review was performed of all the patients admitted to the acute MERS inpatient unit at the NMC during the 2015 outbreak. RESULTS: 30 (75%) were confirmed to be MERS-CoV positive among 40 admitted cases. Among the 24 MERS survivors, 17 (70.8%) exhibited psychiatric symptoms and 10 (41.7%) received a psychiatric diagnosis and medication during their hospital stay. Suspected MERS patients did not exhibit psychiatric symptoms or receive a psychiatric diagnosis. 27 suspected or confirmed MERS patients (age 41.15±18.64, male 37.0%) completed psychological assessments. A multiple linear regression analysis revealed that the Korean National Health and Nutrition Examination Survey-Short form and the Impact of Event Scale-Revised scores were significantly positively correlated with Patient Health Questionnaire-9 scores. CONCLUSION: Our findings indicate that the acute treatment of MERS-CoV infections in quarantine had a significant impact on the patients’ mental health. Furthermore, assessment of the risk factors for depression may identify vulnerable patients who require psychiatric care and attention during hospital quarantine.

Subcortical Ischemic Change as a Predictor of Driving Cessation in the Elderly

OBJECTIVE: Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS: Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into ‘now driving’ and ‘driving cessation (driven before, not driving now)’. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS: In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p < 0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from ‘now driving’ state to ‘driving cessation’ state over time in the elderly (β=-0.508, p < 0.001). CONCLUSION: In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Clinical Characteristics and Use of Psychotropic Agents among HIV-Infected/AIDS Patients Referred for Psychiatric Consultation / 정신신체의학

OBJECTIVES: This study aimed to investigate the psychiatric status of HIV-infected/AIDS inpatients in a general hospital over the past 2.5 years. METHODS: A retrospective chart review was conducted of psychiatric consultations performed between January 1, 2011, and July 30, 2013. The records of 97 HIV-infected/AIDS patients were analyzed. These included a total of 282 psychiatric consultations. RESULTS: Of the 97 patients, 91(93.8%) were male, the mean age was 48 years, and mean number of consultations was 2.8. Depressed mood was reported in 102 consultations(23.8%), insomnia in 60(14.0%), and anxiety in 31(7.2%). Psychiatric disorders diagnosed on initial consultation included depressive disorder(37 patients ; 37.0%), cognitive disorder(11 ; 11.0%), and delirium(9 ; 9.0%). Recommended psychotropic medication included Lorazepam(99 ; 17.2%), Escitalopram(90 ; 15.7%), and Quetiapine(84 ; 14.6%). CONCLUSIONS: The main complaints of HIV-infected/AIDS patients were depressed mood, insomnia, and suicidal ideation(including suicide attempts). In total, 85(93.3%) patients of those consulted were diagnosed as meeting the criteria for a psychiatric condition. However, considering that only 16.9% of patients consulted received follow-up treatment, longitudinal research is needed to examine the influence of psychiatric disorders on the transmission of HIV-infection/AIDS, as well as on prognosis and treatment adherence.

Reliability and Validity of the Korean Version of the PTSD Checklist Civilian Version in North Korean Defectors / 신경정신의학

OBJECTIVES: This study was conducted for development of the Korean version of the Posttraumatic stress disorder (PTSD) Checklist civilian version (PCL-C) by evaluating its reliability and validity for the North Korean defectors population. METHODS: A total of 69 North Korean defectors participated in this study. All patients were recruited from the psychiatric outpatient or inpatient ward. We categorized the participants into two groups according to the Clinician-Administered PTSD Scale (CAPS) diagnosis of PTSD (PTSD, n=32 ; Non-PTSD, n=37). All Subjects completed psychometric assessments, including the PCL-C, Minnesota Multiphasic Personality Inventory (MMPI-PTSD), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). RESULTS: Findings provided support for psychometric properties of the Korean version of the PCL-C. The PCL-C showed good internal consistency (Cronbach alpha=0.93), and a significantly positive correlation with CAPS and MMPI-PTSD (r=0.47, r=0.61, respectively). The optimal cutoff point of PCL-C for the North Korean defectors was at a total score of 56 with sensitivity and specificity of 0.88, and 0.50, respectively. CONCLUSION: Overall, the Korean version of the PCL-C appears to be a valid and reliable measure of PTSD symptoms among the North Korean defectors.

The Effect of Subjective Physical and Mental Health on Cognitive Decline in the Elderly

OBJECTIVES: The aim of this study was to describe subjective physical and mental health assessed by the single item self-rated physical health (SRPH), and self-rated mental health (SRMH) had influence on the cognitive decline in community-dwelling elderly. METHODS: This study was based on the Suwon Project, a cohort comprising of non-random convenience samples of ethnic Koreans aged 60 years and above. 1,356 individuals were assessed at 2 time points 2 years apart for questionnaire which included demographic characteristics, medical history, Korean Mini-Mental State Examination (K-MMSE), Korean version of Geriatric Depression Scale (SGDS-K), SRPH, and SRMH. Multiple logistic regression was used to assess K-MMSE score change from the SRPH, and SRMH. RESULTS: At baseline, both SRPH (beta=0.18, p<0.01) and SRMH (beta=0.19, p<0.01) score positively associated with the K-MMSE score. At follow-up, subjects with baseline lower SRMH score had significantly greater decline in K-MMSE score (beta=0.09, p=0.007). However, baseline SRPH score showed no effect to follow up K-MMSE score before and after adjusting age, sex, education, number of chronic disease, SGDS-K, and baseline K-MMSE score (p=0.89). CONCLUSION: Brief and easily collected subjective mental health may predict the risk of cognitive decline, but subjective physical health may not.

Relationship between Social Activity and Cognitive Function in Korean Elderly

OBJECTIVES: Among non-pharmaceutical measures for preventing cognitive impairment, involving in social activities is known to be very effective. We tried to examine the correlation between social activity and cognitive function. METHODS: This study was based on the Suwon Project, a cohort comprising of non-random convenience samples of ethnic Koreans aged 60 years and above. All the subjects completed the study questionnaire which included demographic characteristics, current and past history of illnesses, drug history, Korean version of Mini Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale, and Beck Anxiety Inventory. We checked the time consumed in each 9 social activities through the checklist. RESULTS: On multiple logistic regression analysis, the total time spent in social activities wasinversely associated with the K-MMSE score after adjusting confounding variables like age, sex, education level, depression, anxiety and vascular risk factor (beta=-0.041, p=0.024). On the other hand, correlation was found between K-MMSE score and time spent in participating in religious party (beta=0.053, p=0.003) as well as time spent in elder's university (beta=0.040, p=0.025) after adjustingage, sex, education, depression, anxiety and vascular risk factor. CONCLUSION: Our results suggest that involving in quality social activities might be more effective in improving cognitive function than spending longer total time in any social activity.

A Study of Psychiatric Problems of North Korean Refugees Who Visited a Psychiatric Clinic / 수면정신생리

PURPOSE: According to the statistics announced by the Ministry of Unification, the number of North Korean refugees living in South Korea has increased by 200 on average monthly in 2010. The number of refugees increased only by 300 annually until 2000. The total number of refugees as of February 2012 was 20,956. This study aims to investigate the psychobiology of the North Korean refugees who consulted psychiatric clinics among those living daily life in South Korea. METHODS: The subjects of this study were 85 North Korean refugees that consulted psychiatric clinics from January 1, 2005 to July 2011. This study obtained demographic and psychiatric information in a retrospective approach. RESULTS: Among the 85 North Korean refugees, 75 (88.2%) were females and their average age was 48 years of age. A total of 16 (18.8%) were admitted to a clinic and among the inpatients, 4 were admitted twice and two were admitted three times. As for the claimed symptoms of outpatients, insomnia was shown in 47 (55.3%) patients, headaches in 37 (43.5%), anxiety in 20 (23.5%), depression in 19 (22.4%), etc. The major symptoms represented by inpatients were insomnia in 14 (87.5%) patients, depression in 12 (75%), and headaches in 8 (50%), etc. CONCLUSION: The most frequent psychiatric symptoms of North Korean refugees living in South Korea were insomnia and headaches. It suggests that when performing psychiatric diagnosis and treatment of North Korean refugees, we have to take into consideration the fact that they claimed the physical symptoms more than the emotional ones. Also, from the aspect that most symptoms of North Korean refugees were insomnia, more profound research on sleep is required in the future.

Psychiatric and Psychological Characteristics of Sexual Offenders in Korea / 신경정신의학

OBJECTIVES: In an effort to increase understanding of the relationship between sexual violence and mental illness, we conducted an investigation of the prevalence of psychiatric illness and associated psychological features of sexual offenders. METHODS: Twenty-two male sex offenders were referred for psychiatric diagnosis from the prosecutor's office and admitted to the hospital between August 2010 and May 2011. In order to identify Axis I and II disorders, including sexual disorders, we conducted the Korean version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. All participants completed psychological assessment batteries, including the Korean-Wechsler Adult Intelligence Scale, and self-report scales, including the Barratt Impulsiveness Scale, State-Trait Anger Expression Inventory, and the Rape Myth Acceptance Scale. Information on participants' legal, personal, and psychiatric family histories was also gathered. RESULTS: Many of the participants received diagnosis of Axis I disorders : Eight subjects (36.4%) had paraphilia, and five (22.7%) had pedophilia. Two subjects (9.1%) had schizophrenia, five (22.7%) had depressive disorder, and three (13.6%) had alcohol dependence. Participants also showed high rates of Axis II disorders : four of them (18.2%) had mental retardation or borderline intellectual functioning and seven (31.8%) had cluster B personality disorders. Participants' serum free testosterone level showed statistically significant correlation with motor impulsiveness (p<0.05). CONCLUSION: Sex offenders included in this study displayed high rates of mental illness, including paraphilia and intellectual disability. On the basis of our findings, we asserted that sex offenders should undergo careful evaluation for mental illness, and that management programs for sex offenders should include psychiatric evaluation and intervention.

Relationship between Physical Activity and Cognitive Function in the Elderly

BACKGROUND: Physical activity is considered an effective non-pharmaceutical preventive measure against cognitive impairment. This study was designed to investigate the correlation between physical activity and cognitive function. METHODS: Subjects were recruited from the Suwon Project, a cohort comprising a nonrandom convenience sample of ethnic Koreans aged 60 years or older. All participants completed study questionnaires which included questions about demographic characteristics, current and/or past medical history, and drug history. Cognitive functions were evaluated using the Korean version of Mini-Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale and Beck Anxiety Inventory. The total time spent to complete 10 physical activities was recorded on a daily basis. RESULTS: The total amount of time spent to execute 10 physical activities was 91.9+/-98.9 minutes per day. K-MMSE score was significantly associated with the duration of physical activity after adjustment for age, sex, educational level, depression, anxiety, and underlying diseases using multiple logistic regression analysis (beta=0.002, p<0.05). Categorizing physical activities into three groups by intensity yielded an interesting result; moderate intensity group demonstrated a direct correlation with cognitive function (beta=0.002, p<0.05). CONCLUSION: Although much remains to be elucidated, our results suggest that physical activity may be associated with cognitive function, after controlling for covariates.

Relationship Between Anxiety and Stroke Warning Signs in the Elderly

OBJECTIVES: We aimed to investigate the relationship between anxiety and stroke warning signs in the elderly. METHODS: Data obtained from 1,078 subjects (256 men and 822 women) aged above 65 years was analyzed from Suwon Project, which was a cohort comprising of nonrandom convenience samples. All the subjects completed the study questionnaire including their demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), SGDS-K (Korean version of the Geriatric Depression Scale-Short Form), BAI (Beck Anxiety Inventory). Stroke warning signs were defined as 5 stroke warning signs consistent with the American heart association public health message. RESULTS: There was significant relationship of anxiety and the number of stroke warning signs after adjusting age, sex, educational level and depression (beta=2.145, p<0.0001). On analysis of covariance, the interaction of the number of experienced stroke warning signs with sex on anxiety was observed after adjusting for the age, educational level, K-MMSE, and SGDS-K (p=0.011). CONCLUSION: These results suggest that there was significant relationship of anxiety and stroke the elderly.

Relationship between Mental Activity and Cognitive Function in Community-Dwelling Elderly

OBJECTIVES: The purpose of this study was to describe the status of mental activity participation in community-dwelling elderly and to evaluate the association between mental activity and cognitive function after adjustment for depression and anxiety. METHODS: This study was based on the Suwon Project, which was a cohort comprising of nonrandom convenience samples of ethnic Koreans aged 60 years and above. All the subjects completed the study questionnaire including their demographic characteristics, current and past illnesses history, drug history, Korean version-Mini Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale (SGDS-K), Beck Anxiety Inventory (BAI). We checked how many hours per day are used for each items of 11 mental activities through the checklist. RESULTS: Total time spent in 11 mental activities was 237.4+/-152.4 minutes per day. On multiple regression analysis, total time spent in 11 mental activities (MA-total), and time spent by watching television and reading book/newspaper showed statistically significant association with K-MMSE score after adjustment with age, sex, education, chronic medical illness, depression and anxiety. CONCLUSION: Our result suggested that mental activity may be associated with cognitive function in the elderly without cognitive impairment in the community after adjusting age, sex, education, chronic medical illness, depression and anxiety.

The Clinical Observations on PNS X-ray Abnormalities in Respiratory Diseases of Children

No abstract available.