The Relation between Anger Management Style and Organ System-Related Somatic Symptoms in Patients with Depressive Disorders and Somatoform Disorders

PURPOSE: The objective of this study was to examine the relation between anger management style and organ system- related somatic symptoms in depressive disorder and somatoform disorder patients. MATERIALS AND METHODS: The subjects included 73 patients with depressive disorders and 47 with somatoform disorders. Anger management styles were assessed by the Anger Expression Scale, while the severity of organ system-related somatic symptoms was evaluated using the Somatic Stress Response Scale (SSRS). The severity of depression and hostility was assessed by the Symptom Checklist-90-Revised (SCL-90-R) depression and hostility subscales. RESULTS: The results of multiple regression analyses showed that, in depressive disorder patients, the level of anger expression was significantly associated with the severity of somatic symptoms related to neuromuscular, cardiorespiratory and gastrointestinal systems. However, in these patients, the level of anger suppression was not significantly associated with the severity of somatic symptoms related to any specific organ systems. In patients with somatoform disorders, there was no significant association between the level of anger suppression or anger expression and the severity of the somatic symptoms related to any specific organ systems. CONCLUSION: These results suggest that, in depressive disorder patients, anger expression is likely to be predominantly involved in the neuromuscular, cardiorespiratory and gastrointestinal organ systems. However, in each of depressive disorder and somatoform disorder patients, anger suppression is not likely to be associated with any specific organ systems.

Development of the Stress-induced Cognition Scale

The objective of this study was to develop the stress-induced cognition scale (SCS). A preliminary survey was conducted on 109 healthy adults to obtain cognitive stress responses. Then, 215 healthy subjects completed a preliminary questionnaire. A comparison was made regarding cognitive stress responses among 73 patients with depressive disorders and 215 healthy subjects. Factor analysis of the SCS yielded 3 subscales: extreme thought, aggressive-hostile thought, and self-depreciative thought. The test-retest reliability for the 3 subscales and the total score was significantly high, ranging from 0.87 to 0.95. The Cronbach's alphafor the 3 subscales and total score ranged from 0.82 to 0.94. The convergent validity was calculated by correlating the 3 subscales and total score of the SCS with the total score of the global assessment of recent stress (GARS) scale, the perceived stress questionnaire (PSQ), and the Symptom Checklist-90-Revised (SCL-90-R). The correlations were all at significant levels. The depressive disorder group scored significantly higher than the healthy control group in all the subscale scores and total scores of the SCS. Female subjects were significantly higher than males in the total scores of the SCS. These results indicate that the SCS is highly reliable and valid, and that it can be utilized as an effective measure for research related to cognitive assessment.

Development of the Stress-induced Cognition Scale

The objective of this study was to develop the stress-induced cognition scale (SCS). A preliminary survey was conducted on 109 healthy adults to obtain cognitive stress responses. Then, 215 healthy subjects completed a preliminary questionnaire. A comparison was made regarding cognitive stress responses among 73 patients with depressive disorders and 215 healthy subjects. Factor analysis of the SCS yielded 3 subscales: extreme thought, aggressive-hostile thought, and self-depreciative thought. The test-retest reliability for the 3 subscales and the total score was significantly high, ranging from 0.87 to 0.95. The Cronbach's alphafor the 3 subscales and total score ranged from 0.82 to 0.94. The convergent validity was calculated by correlating the 3 subscales and total score of the SCS with the total score of the global assessment of recent stress (GARS) scale, the perceived stress questionnaire (PSQ), and the Symptom Checklist-90-Revised (SCL-90-R). The correlations were all at significant levels. The depressive disorder group scored significantly higher than the healthy control group in all the subscale scores and total scores of the SCS. Female subjects were significantly higher than males in the total scores of the SCS. These results indicate that the SCS is highly reliable and valid, and that it can be utilized as an effective measure for research related to cognitive assessment.

Development of the Anger Coping Scale / 신경정신의학

OBJECTIVES: The purpose of this study was to develop the Anger Coping Scale (ACS). METHODS: First, a preliminary survey was conducted for 123 healthy adults to obtain 23 response items. Second, a preliminary questionnaire was completed by 258 healthy subjects. Third, a comparison was made regarding anger coping between 72 depressive disorder patients and 258 healthy subjects. RESULTS: Factor analysis yielded 5 subscales : behavioral aggression, problem-solving coping, verbal aggression, tensionreleasing coping and anger suppression. Reliability was computed by administering the ACS to 53 healthy subjects during a 2-week interval. Test-retest reliability for 5 subscales was significantly high, ranging between .39-.78. Cronbach's alpha for 5 subscales ranged between .58-.86. Convergent validity was computed by correlating the 5 subscales score with the total score of the Aggression Questionnaire, the State Trait Anger Expression Inventory, the anger and aggression subscale of the Stress Response Inventory and the hostility subscale of the Symptom Checklist-90-Revised. The depressive disorder group scored significantly higher on the anger suppression subscale than the control group. However, the normal control group scored significantly higher on the behavioral aggression and tension-releasing coping subscale than the depressive disorder group. CONCLUSION: These results indicate that the ACS is highly reliable and valid. In addition, depressive disorder patients are more likely to use anger suppression than healthy individuals, whereas healthy individuals are more likely to use both behavioral aggression and tension-releasing coping than depressive disorder patients. Further transcultural study on anger coping is required.

Development of the Somatic Stress Response Scale and Its Application in Clinical Practice

The objective of this study was to develop the Somatic Stress Response Scale (SSRS), and then to use the scale in clinical practice. A preliminary survey was conducted using 109 healthy adults to obtain somatic stress responses. Then, 215 healthy subjects completed a preliminary questionnaire. A comparison was made regarding the somatic stress responses among 191 patients (71 with anxiety disorders, 73 with depressive disorders and 47 with somatoform disorders) and 215 healthy subjects. Factor analysis of the SSRS yielded five subscales: the cardiorespiratory response, somatic sensitivity, gastrointestinal response, general somatic response and genitourinary response subscales. The test-retest reliability for the five subscales and the total score was significantly high, ranging from .86 to .94. The Cronbach's yen afor the five subscales ranged from .72 to .92, and was .95 for the total score. By correlating the five subscales and the total score of the SSRS with the somatization subscale scores of the Symptom Checklist-90-Revised (SCL-90-R), convergent validity was calculated. The correlations were all at significant levels. Each of the disorder groups was significantly higher in scores of the cardiorespiratory response, gastrointestinal response, general somatic response and genitourinary response subscale, and in the total SSRS score than the healthy group. Only the depressive disorder group scored significantly higher on the somatic sensitivity subscale than the healthy group, and they also scored significantly higher on the genitourinary response subscale than the anxiety disorder group did. These results suggest that the SSRS is highly reliable and valid, and that it can be effectively utilized as a measure for research of the somatic symptoms related to stress. It also implies that somatic sensitivity and genitourinary responses are associated with depressive disorders.

Development of the Cognitive Stress Response Scale / 신경정신의학

OBJECTIVE: The purpose of this study was to develop a cognitive stress response scale (CSRS). METHODS: First, a preliminary survey was conducted for 109 healthy adults to obtain 29 response items. Second, a preliminary questionnaire was completed by 215 healthy subjects. Third, a comparison was made regarding cognitive responses among 73 patients with depressive disorders and 215 healthy subjects. RESULTS: Factor analysis yielded 3 subscales: extreme-negative thought, aggressive-hostile thought, and self-depreciative thought. Reliability was computed by administering the CSRS to 62 healthy subjects during a 2-week interval. Test-retest reliability for 3 subscales and the total score were significantly high, ranging between. 87-.95. Internal consistency was computed, and Cronbach's alpha for 3 subscales ranged between. 82-.91, and .94 for the total score. Convergent validity was computed by correlating the 3 subscales and the total score with the total score of the global assessment of recent stress (GARS) scale, the perceived stress questionnaire (PSQ), and the symptom checklist-90-revised (SCL-90-R). The correlations were all at significant levels. The depressive disorder group was significantly higher than control group in all the subscale scores and total scores of the CSRS. In total scores of the CSRS, female subjects were significantly higher than males. CONCLUSION: These results indicate that the CSRS is highly reliable and valid, and that it can be utilized as an effective measure for research related to cognitive assessment.

The Relationship of Anger Expression and Alexithymia with Coronary Artery Stenosis in Patients with Coronary Artery Diseases

This study examined the relationship between anger expression or alexithymia and coronary artery stenosis in patients with coronary artery diseases. 143 patients with coronary artery diseases (104 males and 39 females) were enrolled in this study. The severity of their coronary artery stenosis was measured by angiography. The Anger Expression Scale and the Toronto Alexithymia Scale were used to assess the level of anger expression and alexithymia. The more stenotic group (occluded by 75% or more) exhibited a significantly higher level of alexithymia than the less stenotic group (occluded by less than 25%). Multiple regression anaylsis on the extent of stenosis also revealed that regardless of gender and age, the coronary artery disease patients with higher alexithymia were likely to show a greater level of stenosis. However, no significant differences were found on either the anger-in or anger-out subscale scores between the two groups. These results suggest that alexithymia is associated with the severity of coronary artery stenosis in patients with coronary artery disease. However, both anger expression and anger suppression were not shown to be associated with the severity of coronary artery stenosis.

Anger and Coronary Calcification in Individuals with and without Risk Factors of Coronary Artery Disease

The authors investigated the relationship between anger and the calcification of the coronary artery in individuals with and without risk factors for coronary artery disease in Korea. Sixty-one subjects with risk factors of coronary artery disease and 31 subjects without risk factors were enrolled in this study. Electron Beam Computed Tomography was used to measure the calcium level of coronary artery. The anger expression scale was used to measure the anger levels. The anxiety, depression, hostility, and somatization subscales of the symptom checklist-90-revised (SCL-90-R) and the global assessment of recent stress (GARS) scale were used to assess the psychopathology and perceived stress. The logistic regression analysis results showed that only the anger-total score was significantly associated with the coronary calcification regardless of the risk factors. These results suggest that anger plays an important role in the calcification of the coronary artery.

The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(I): Comparison of Therapeutic Effecacy / 신경정신의학

OBJECTIVES: This randomized, multicenter, open-label, parallel clinical trial was carried to compare the therapeutic efficacy and the proportion of successful switch between 'direct switching method' and 'start-tapering switching method' when switching an antipsychotic to olanzapine. METHODS: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10 from 13 hospitals, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The therapeutic efficacy was measured with PANSS, BPRS, and CGI-Severity. A successful switching was defined as the completion of the 6 week trial without either worsening of the symptom(i.e. CGI-S score becomes worse twice consecutively) or the exacerbation of extrapyramidal symptoms(i.e. Simpson-Angus Scale scores becomes worse). RESULTS: 103 schizophrenic patients were participated in this study. There were no differences in baseline characteristics such as the demographic variables, the severity of symptoms, the history of previous antipsychotics treatments, the dosage of olanzapine used and the compliance between two groups. The proportion of successful switch was 71.1% for "direct switching method" and 82.2% for "start-tapering switching method", and there was no significant difference between the two switching methods. Also response rates to olanzapine based on total PANSS total scores were not different between the two groups(26.9% vs. 31.1%). At the time of completion of the trial, the scores of PANSS total, PANSS subscales, CGI-S and BPRS have significantly decreased after switching to olanzapine. But the changes of all scales measuring therapeutic efficacy in both endpoint and weekly analyses were not significantly different between the two switching methods. CONCLUSION: Although this study trial has many limitations and problems as an open clinical trial, the results may suggest that there were no significant differences between the two switching methods in the therapeutic efficacy. It was also found that the additional therapeutic benefits could be obtained by switching their antipsychotics to olanzapine.

The Relationship of Stress-Induced Hypothalamic-Pituitary-Adrenal Axis Function with Cell-mediated Immunity / 신경정신의학

The objective of this study was to examine the relationship between stress-induced hy-pothalamic-pituitary-adrenal(HPA) axis function and cell-mediated immunity in healthy individuals. Thirty-three medical students participated in the study 5 weeks before an academic examination period and then during the exam period. Cell-mediated immune function was measured by lymphocyte proliferative response to phytohemagglutinin(PHA) and interleukin-2(IL-2) production. Plasma adrenocorticotropic hormone(ACTH) and cortisol as well as plasma prolactin were assessed by radioimmunoassay. Global assessment of recent stress(GARS) scale and symptom checklist-90-revised(SCL-90-R) were used to measure the level of subjective stress and distress. The total scores of the GARS scale were significantly higher during the exam period than during the nonexam period, but no significant differences were found in scores of each SCL-90-R subscale between the two periods. Plasma ACTH levels, lymphocyte proliferation and IL-2 production were significantly higher during the exam period than during the nonexam period. Subjects with higher perceived stress were found to have significantly higher IL-2 production during the exam period than those with lower perceived stress. However, plasma cortisol and prolactin levels showed no significant differences between the two periods. Also, regression analyses showed no significant relationships between each of the endocrine and immune parameters. These results suggested that mild stressors such as examination may activate some HPA axis function and cell-mediated immunity. However, it was found that there was no significant relationship between ACTH or cortisol levels and stress-induced immune activation.

The Relationship between Perceived Stress and Coping Strategies in Patients with Coronary Artery Disease / 신경정신의학

OBJECTIVES: The objective of this study was to investigate the relationship between perceived stress and coping strategies in 138 patients with coronary artery diseases. METHODS: Global assessment of recent stress(GARS) scale and perceived stress response inventory(PSRI) were used to measure perception for stressors and stress responses. Coping scale was used to measure coping strategies. RESULTS: Scores of perceived stress related to work, job, interpersonal area, changes in relationship, sickness or injury, financial area, and overall global areas showed significant positive correlations with escape-avoidance. Also scores of perceived stress related to sickness or injury, financial problems, overall global areas showed significant correlations with accepting responsibility. Scores related to financial area showed significant positive correlation with planful problem solving and positive reappraisal. Escape-avoidance had a significantly positive correlation with negative emotional response, lowered cognitive function and general negative thinking, self-depreciative thinking, impulsiveaggressive thinking, general somatic symptoms, specific somatic symptoms, passive-responsive careless behavior and impulsive-aggressive behavior. Distancing had a significantly positive correlation with negative emotional response, lowered cognitive function and general negative thinking, general somatic symptoms and passive-responsive careless behavior. Confrontive coping, self-control, seeking social support, accepting responsibility, planful problem solving, and positive reappraisal were more frequently used in men than in women. Education had a significantly positive correlation with confrontive coping, self-control, seeking social support, accepting responsibility, planful problem solving, and positive reappraisal. CONCLUSION: The above results suggest that coping strategies of patients with coronary artery disease may be affected by types of perceived stressors, sex, and level of education, and that escapeavoidance and distancing may be the most ineffective coping strategies used in these patients.

Development of the Stress Response Inventory / 신경정신의학

OBJECTIVE: The purpose of this study was to develop the stress response inventory (SRI) which includes emotional, somatic, cognitive, and behavioral stress responses, and then to use the scale in clinical pracitice. METHODS: First, a preliminary survey was conducted for 109 healthy adults to obtain 70 response items. Second, a preliminary questionnaire was completed by 215 healthy subjects. Third, a comparison was made regarding stress responses among 242 patients (71 with anxiety disorder, 73 with depressive disorder, 47 with somatoform disorder, and 51 with psychosomatic disorder) and 215 healthy subjects. RESULTS: Factor analysis yielded 7 subscales: tension, aggression, somatization, anger, depression, fatigue and frustration. Reliability was computed by administering the SRI to 62 healthy subjects during a 2-week interval. Test-retest reliability for 7 subscales and the total score was significantly high, ranging between 0.69-.96. Internal consistency was computed, and Cronbach's alpha for 7 subscales ranged between .76-.91 and .97 for the total score. Concurrent validity was computed by correlating the 7 subscales and the total score with the total score of the global assessment of recent stress (GARS) scale, the perceived stress questionnaire (PSQ), and the symptom checklist-90-revised (SCL-90-R). The correlations were all at significant levels. Discriminant validity was computed by comparing the total score and the 7 subscale scores of the patient and control groups. Significant differences were found for 6 subscales and the total score, with the exception being the aggression subscale. The depressive disorder group was highest in total scores of SRI among 4 patient groups, and showed a significant higher scores in total scores of SRI than each of anxiety disorder and psychosomatic disorder groups. In total scores of SRI, female subjects were significantly higher than male ones, and subjects with lower income were significantly higher than those with higher income. CONCLUSIONS: These results indicate that the SRI is highly reliable and valid, and that it can be utilized as an effective measure of stress for research in stress-related fields. It is suggested that depressive disorder group is more susceptible to stress than any other patient groups.

Psychiatric care for patients with breast cancer

Psychiatric management of patients with breast cancer, as well as women's emotional reactions to all phases of breast cancer, were reviewed. These patients face two major losses; one is the physical loss of part of the body and a threat to life, and the other is the loss of femininity. The patients are also likely to suffer from various psychiatric problems including anxiety and depression. Oncologists should be alert to each patient's emotional reactions and potential psychiatric problems, and if necessary, should refer them to a psychiatrist. A combination of psychotherapeutic, behavioural, and pharmacologic techniques is available for the care of patients with breast cancer. Psychotherapeutic modalities include individual therapy, family therapy, group therapy, and self-help treatment. The author divided individual therapy into general and specific treatment. General treatment deals with a crisis-intervention and cognitive-behavioral approach, whereas specific treatment deals with issues relevant to patients with breast cancer. Some of the therapeutic processes were illustrated in a case report. These guidelines will contribute to the relief and prevention of emotional suffering stemming from an encounter with the most common form of cancer in women. Also, proper and effective care for patients with breast cancer requires combined use of a variety of therapeutic modalities as well as a multi-disciplinary approach including psychiatric care.

Relationship between Serum Lipids and Psychiatric Symptoms / 대한정신약물학회지

OBJECT: Many studies found that psychological stress produced significant increases in cholesterol concentration. But recent study results suggested that lowering cholesterol increased non-illness mortality. Suicide rate were higher in low cholesterol groups. Also, depression and violence were related to low cholesterol. It is the purpose of this study to determine which psychiatric symptoms are correlated with serum concentration of cholesterol, triglyceride and HDL-C. METHOD: The subjects we included were 61 neurotic outpatients. Their psychiatric symptoms were assessed with SCL-90-R and additional symptoms check list and the results of their fasting serum concentration of cholesterol, triglyceride and HDL-C were obtained. The correlation between serum concentration of lipids and psychiatric symptoms were analyzed using Pearson's correlation test. RESULTS: The result showed significant positive correlation between somatization symptom dimension and serum cholesterol concentration. Serum cholesterol concentration were also negatively correlated with suppressed emotion of anger Serum concentration of triglyceride and HDL-C were not correlated with any symptom dimensions of SCL-90-R. CONCLUSIONS: These results suggest that somatization symptoms have some relationship with serum cholesterol and the role of cholesterol in psychiatric symptoms need to be included in future study.

Perceived stress, psychopathology, and family support in Korean immigrants and nonimmigrants

The purpose of this study was to determine the effects of immigration on perceived stress, psychopathology, and family support in Korean immigrants. A total of 105 immigrants and 32 nonimmigrants responded to the questionnaire. The Global assessment of recent stress (GARS) scale as well as anxiety, depression and somatization scales of the symptom checklist-90-revised (SCL-90-R), and the perceived social support scale were used to measure perceived stress, psychopathology and extent and of family support. Immigrants scored significantly higher on the somatization scale than nonimmigrants. However, no significant differences were found in scores on the anxiety and depression scales of SCL-90-R, total GARS scores for family support between the two groups. Immigrants with lower incomes had significantly higher scores on the anxiety, depression and somatization scales as well as total GARS scores than those with higher incomes, whereas the former were significantly lower in family support than the latter. Immigrants with nonprofessional occupations had significantly higher scores on the anxiety and somatization scales and lower scores for family support than those with professional occupations. The extent of satisfaction for family (spouses and children), job and friendship had significantly negative correlations with scores on all three scales of SCL-90-R in immigrants. These results suggest that Korean immigrants had more somatization than nonimmigrants, and that the immigrants' psychopathology, including somatization, could be greatly influenced by income, type of occupation, satisfaction for job, family and friendship.

The relationship of stress with serum IgE level in patients with bronchial asthma

The relationship of stress perception and frequency of stressors with serum total Ig E level was investigated in 54 outpatients with bronchial asthma. The GARS (global assessment of recent stress) scale and SRRS (social readjustment rating scale) were used to measure the degree of stress perception and frequency of stressors during a one-year period Total serum Ig E was measured by the PRIST method. 56% of the patients were found to have psychosomatic disorders, but there was no significant difference in stress perception and frequency of stressors between psychosomatic and non-psychosomatic groups. A considerable number of patients (63%) rated their symptoms as severe, but no significant correlation was found between severity of symptoms and stress perception. Severity of stress perception and frequency of stressors did not correlate with serum total Ig E level. Multiple regression analysis revealed that female patients were significantly higher in stress perception than male ones, and that chronicity of illness was more likely to increase stress perception. Extrinsic asthmatics had significantly more negative stressors than intrinsic ones. In conclusion, serum Ig E is considered a stable indicator of allergy not influenced by stress. It was also indicated that patients with bronchial asthma were more likely to perceive physical symptoms than psychological stress.

Stress perception of patients with non-insulin-dependent diabetes mellitus / 신경정신의학

No abstract available.

Stress perception of patients with non-insulin-dependent diabetes mellitus / 신경정신의학

No abstract available.

Stress perception of patients with peptic ulcer / 신경정신의학

No abstract available.

Illness behavior of medical inpatients reffered for psychiatric consultation / 신경정신의학

No abstract available.