A Preliminary Study About Occupational Stress and Career Satisfaction of Korean Psychiatrists / 신경정신의학

Objectives@#Physicians experience high occupational stress due to heavy workload, responsibility and stressful situations in the medical field. Although occupational stress decreases productivity and increases medical accidents, occupational stress on Korean psychiatrists is not well studied. In this study, we investigated the occupational stress and career satisfaction of Korean psychiatrists. @*Methods@#Electronic surveys were conducted via e-mail, and a total of 266 psychiatrists fully answered the surveys. The surveys consisted of the Korean Occupational Stress Scale (KOSS), career satisfaction and stress inventory for the health professional. @*Results@#The mean KOSS score of Korean psychiatrists was lower than the score of other Korean professions (43.99 vs. 46.03). There are significant differences in the sub-items of KOSS, depending on the lifestyle, the career and the hospital on duty. Psychiatric residents scored significantly higher in job control and occupational climate than psychiatrists. On the other hand, workplace relationships and job insecurity scored significantly higher in psychiatrists. Psychiatrists working in general and university hospitals had higher stress in job demand than psychiatrists working at private psychiatric hospitals. Job control and lack of reward scores were high in psychiatrists working in national psychiatric hospitals, and 21.8% of psychiatrists answered that they would not become a psychiatrist again. @*Conclusion@#This study showed the overall job stress level of psychiatrists in Korea, and they were experiencing high job stress in different areas depending on factors, such as position, working environment and living habits.

Anatomical classification of animal bone relics excavated from the well area of Gasan-ri in Jinju

The classification of the bone pieces excavated from Gasan-ri archaeological site Ⅰ in Jinju, presumed to be relics was investigated macroscopically. The remains of the animal bone were 3 classes (Mammalia, Aves, Amphibia), 5 orders (Carnivora, Artiodactyla, Passeriformes, Rodentia, Salientia), and 6 species (Sus scrofa, Cervidae sp., Nyctereutes procyonides, Passeriformes sp., Rattus norvegicus caraco, Rana nigromaculata). The total weight of the animal bone remains was 1,002.80 g, with the identified bones comprising 975.30 g and an identification rate of 97.26%. A total of 447 animal bone fragments were identified, including 204 bone pieces of S. scrofa (468.00 g, 47.99%), 102 bone pieces of Cervidae sp. (453.79 g, 46.53%), 68 bone pieces of R. nigromaculata (4.69 g, 0.48%), 59 bone pieces of N. procyonides (47.14 g, 4.83%), 9 bone pieces of Passeriformes sp. (0.98g, 0.10%), and 5 bone pieces of Rattus norvegicus caraco (0.70 g, 0.07%). The bone pieces of the animal relics consisted of 81 skull (18.12%), 161 axial skeleton (36.02%), 64 forelimb (14.32%), and 141 hindlimb (31.54%) fragments. The archaeological significance of the animal bones excavated in this investigation was that wild boars and deer were presumed to have been mainly used animals in the Gasan-ri area of Jinju during the Three Kingdoms period.

A Recognition Survey by Psychiatry Residents and Psychiatrists Regarding the Quality of Residency Training and Clinical Competence in Korea / 신경정신의학

Objectives@#This study surveyed the quality of the residency training program and clinical competence of Korean psychiatry residents and psychiatrists. @*Methods@#Questionnaires regarding the quality of residency training and clinical competence were administered to Korean psychiatry residents (n=102) and psychiatrists (n=157). The authors analyzed the quality of training education according to the training environment and the correlation between the quality of training and the self-assessment competence level. @*Results@#The average score of the quality of training evaluated by the residents (n=102) was 3.57 (±1.00). Groups with more than or equal to three residents (annual) scored higher (3.69±1.03) than the groups with less than or equal to two residents (3.52±0.99). Groups with more than or equal to seven teaching psychiatrists scored higher (3.42±1.03) than the groups with less than or equal to six teaching psychiatrists (3.42±1.03). The quality of training and self-assessment competence showed a significant static correlation in the residents (R2=0.488, p<0.01) and psychiatrists (R2=0.508, p<0.01). @*Conclusion@#This study shows that the quality of residency education varies according to the clinical area and the environment. The importance of training education is emphasized by the static correlation between the quality of education and clinical competence.

Association between Thyroid Dysfunction and Severity, Treatment Response in Schizophrenic Inpatients

OBJECTIVES: Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. METHODS: Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. RESULTS: The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. CONCLUSIONS: The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

Therapeutic Effects of Leuprorelin (Leuprolide Acetate) in Sexual Offenders with Paraphilia

BACKGROUND: This study examined the clinical effects of leuprolide acetate in sexual offenders with paraphilic disorders evaluated by means of objective psychiatric assessment. METHODS: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. RESULTS: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. CONCLUSION: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.

Study of Factors Affecting on Evaluation of Sex Offenders' Criminal Responsibility / 신경정신의학

OBJECTIVE: This study analyzed factors affecting feeble-mindedness or insanity following a forensic evaluation for sex offenders, and to present a scientific basis that can provide practical assistance on a responsibility evaluation of sex offenders. METHODS: This study analyzed retrospectively 180 mental appraisals on sex offenders among mental appraisals documented by one psychiatrist from June, 2012 to December, 2015 at the National Forensic Hospital. RESULTS: Of the 180 mental appraisals, 123 people (68.3%) were found to be feeble-minded or insane, and 57 people (31.7%) were considered to be sane, i.e., competent to take responsibility. The two groups were different in IQ, occupational & marital status, victim numbers, psychiatric diagnosis, and sex offender characteristics, such as violence and intrusiveness. After evaluating the influence of variables that showed significant differences between the two groups on a responsibility assessment, sex offenders with fewer invasive sex offenses (OR=1.763, p<0.05), lower IQ (OR=1.031, p<0.01), lower numbers of victims (OR=1.349, p<0.05), and higher number of mental illnesses (OR=0.507, p<0.05) were more likely found to be feeble-minded or insane. CONCLUSION: This study indicates that criminal responsibility may be intact in repeat sex offenders who commit invasive sex crimes, such as rape, and is without intellectual disability compared to other kinds of sex offenders. Subsequent research will be needed to improve the objectivity and reliability of mental appraisals on sex offenders in the future.

A study on the factors affecting the follow-up participation in birth cohorts

OBJECTIVES: A stable follow-up participation rate is a very important factor for validity in a cohort study. This study analyzed the factors that affect the participation rate at one hospital-based birth cohort in South Korean. METHODS: The participants were recruited from the Mothers' and Children's Environmental Health study between 2006 and 2010. The analysis targeted 1751 mothers who participated in a birth cohort. We conducted analyses of general characteristics during pregnancy and those of infants at birth that affect the participation rate of the 6-month follow-up survey. RESULTS: The participation rate for the 6-month follow-up survey was 60.4%. The participation rate in the follow-up of the subsequent period decreased within a 5% to 10% range compared to the number of subjects. The participation rate of premature infants was 16.9% lower than that of a full-term infant (52.6% vs. 69.5%). Analysis showed a 16.7% difference between the participation rate of low-birthweight infants in follow-ups (53.7%) and the participation rate of infants with normal weight (70.4%). The participation rate of mothers who were employed during pregnancy was significantly lower for the 6-month follow-up compared to the participation rate of mothers who were unemployed during pregnancy. CONCLUSIONS: In this study, factors such as premature birth, low-birthweight, and the employment status of the mother during pregnancy affected the participation rate of the follow-up survey for the birth cohort at six months. A specific strategy is needed to encourage survey participation for the high risk groups in the follow-ups.

Short-term Effect of Fine Particulate Matter on Children's Hospital Admissions and Emergency Department Visits for Asthma: A Systematic Review and Meta-analysis / 예방의학회지

OBJECTIVES: No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter (PM2.5) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies. METHODS: Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger's test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3. RESULTS: We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of PM2.5 on children's hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children's hospital admissions and emergency department visits for asthma were positively associated with a short-term 10 μg/m3 increase in PM2.5 (relative risk, 1.048; 95% CI, 1.028 to 1.067; I2=95.7%). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe. CONCLUSIONS: We strengthened the evidence on the short-term effect of PM2.5 on children's hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence.

MERS epidemiological investigation to detect potential mode of transmission in the 178th MERS confirmed case in Pyeongtaek, Korea / 한국역학회지

Most cases of Middle East Respiratory Syndrome (MERS) infection in Korea (outbreak: May 11-July 4, 2015) occurred in hospital settings, with uncertain transmission modes in some cases. We performed an in-depth investigation epidemiological survey on the 178th case to determine the precise mode of transmission. A 29-year-old man living in Pyeongtaek presented on June 16 with a febrile sensation, chills, and myalgia. Upon confirmatory diagnosis on June 23, he was treated in an isolation room and discharged on July 2 after cure. An epidemiological investigation of all possible infection routes indicated two likely modes of transmission: exposure to MERS in Pyeongtaek St. Mary's Hospital during a visit to his hospitalized father (May 18-29), and infection through frequent contact with his father between the latter's referral to Pyeongtaek Good Samaritan Bagae Hospital for treatment without confirmatory diagnosis until his death (May 29-June 6). Although lack of clear proof or evidence to the contrary does not allow a definitive conclusion, all other possibilities could be excluded by epidemiological inferences. While it is impossible to trace back the modes of transmission of all cases in a large-scale outbreak, case-by-case tracking and isolation of infected individuals and those in close contact with them is important in preventing the spread. Efforts should be made to establish a methodology for rapid tracking of all possible contacts and elimination-based identification of the precise modes of transmission.

Epidemiological investigation of the 119th confirmed Middle East Respiratory Syndrome coronavirus case with an indefinite mode of transmission during the Pyeongtaek outbreak in Korea / 한국역학회지

Since the first case was diagnosed on May 20, 2015, there were 186 confirmed cases of Middle East Respiratory Syndrome (MERS) until the end of outbreak in South Korea. Although medical institutions were the most identifiable sources of MERS transmission in South Korea, similar to other countries, in-depth epidemiological investigation was required for some confirmed cases with indefinite contact history or hospital visit records. The subject of epidemiological investigation in the present study was a 35 year-old male patient diagnosed with MERS (#119) who lived in Asan-city and worked in Pyeongtaek-city. Various potential sources of transmission were carefully investigated. While he could have been exposed to MERS through a friend from Saudi Arabia or confirmed MERS cases in his workplace, neighboring areas, and medical institutions, as well as contacts in his home, the chances of transmission were low; however, the potential for transmission through his local community could not be excluded. Practically, it was difficult to determine the modes of transmission for all outbreak cases in communicable disease that occurred in this short period of time. The investigation to identify the mode of transmission in this case was ultimately unsuccessful. However, the various data collected and analyzed to reveal modes of transmission provided detailed information that could not be collected using only interview surveys.

Control Study on Temperament and Character Traits, Resilience, and Predictors of Military Maladjusted Soldiers / 신경정신의학

OBJECTIVES: The purpose of this study was to reveal psychological traits, risk factors, and predictors of the military maladjusted group. In addition, we attempted to compare the correlation of temperament, character profile, and resilience between maladjusted and adjusted groups. METHODS: A total of 166 maladjusted soldiers who joined the green camp of three divisions and 125 adjusted soldiers participated in the survey from July to December 2013. As self-report questionnaire methods, Beck Anxiety Inventory, Beck Depression Inventory (BDI), and the Korean version of the Connor-Davidson Resilience Scale, Temperament and Character Inventory (TCI) were used. T-test, binary logistic regression analysis, Pearson's correlation, and multiple regression analysis were used as analytical methods. RESULTS: The maladjusted group showed a high level of anxiety, depression, and Harm Avoidance and a low level of resilience, Reward Dependence (RD), Persistence, Self-Directedness, and Cooperativeness compared with the adjusted group. BDI and RD were found to be statistically significant for prediction of military maladjustment. Higher correlation between resilience and TCI was observed for the maladjusted group, but not the adjusted group. CONCLUSION: We suggest that a high depression level and a low RD level should be included as predictors among target symptoms for development of psychological treatment for the maladjusted group. In addition, we suggest that the level of resilience can affect correlation of resilience with TCI.

Mental Health Policy in Korean Neuropsychiatric Association / 신경정신의학

Recently Our medical systems have been changed to a great extent and mental health systems have evolved as well ; with increased mental disorders, suicide, family violence, and increasing an elderly population. Currently, the general population has become more aware of an importance of mental health, and increasing mental disorders in turn led to massive social burdens. This requires an emergence of new national mental health policy. By establishing the national mental health policy, we, Korean Neuropsychiatric Association, are able to build a reputation that we deserve as a professional group, and provide the mental health promotion of the general population and improve the quality of life of those that are mentally ill.