Development and Validation of a Screening Scale for Depression in Korea: The Lee and Rhee Depression Scale

OBJECTIVE: The aim of this study was to develop a culturally sensitive instrument that addressed how individuals express and experience depression to detect this disorder in Koreans. We also assessed the validity, reliability, and diagnostic utility of this scale (Lee and Rhee Depression Scale; LRDS). METHODS: The sample consisted of 3,697 normal adults selected from 12 administrative districts (Do) and 448 Korean patients diagnosed with depression using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Reliability was calculated using Cronbach's alpha. Construct validity, discriminant validity, and concurrent validity were also measured. Receiver-operator-characteristic (ROC) analysis was employed to evaluate diagnostic efficiency. RESULTS: The LRDS was found to be a reliable instrument (Cronbach's alpha=0.95) consisting of six factors: negative thinking about the future, negative thinking about the self, worry and agitation, depressed mood, somatization, and loss of volition. Comparison of LRDS scores discriminated the group of patients with depression from the normal individuals in the control group. The measure showed good concurrent validity in that scores were significantly and strongly correlated with scores on established scales such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), and the D scale of the Minnesota Multiphasic Personality Inventory-second edition (MMPI-2). Diagnostic efficiency was 77.7%, and the cut-off scores were 65 for males and 70 for females. CONCLUSION: To our knowledge, this is the first study to develop a depression-screening scale on the basis of Korean patients' complaints about the disorder. As a culturally sensitive tool, the LRDS will be useful in clinical and research settings in Korea.

Association of the 5-HT5A Receptor Gene Polymorphisms and Citalopram Response in Korean Patients with Major Depressive Disorder

OBJECTIVES: Some reports have suggested that 5-HT5A polymorphism allelic association was associated with depression, however, there has been no report about relationship between the 5-HT5A gene and antidepressant response. We conducted the association study of the 5-HT5A receptor gene polymorphisms (-19G/C,12A/T) and response to citalopram in Korean patients with major depressive disorder(MDD). METHODS: A total of 106 patients with major depressive disorder were included in this study. The patient's symptoms were measured by 21-item Hamilton Depression Rating Scale(HAMD) at baseline, week 1, week 2, week 4 and week 8 during citalopram treatment. A Responder to citalopram was defined by 50% reduction of total HAMD scores. To analyze genetic polymorphisms, a polymerase chain reaction based method was used. RESULTS: At week 8, responders were 62, non-responders were 44. No significant differences of genotypes or allelic association in 19G/C and 12A/T polymorphisms were observed between responsive and non-responsive patients. CONCLUSION: These results do not support the hypothesis that this polymorphism of the HT5A receptor gene is involved in the therapeutic response to citalopram.

Electroconvulsive Therapy in Major Depressive Disorder

Major depressive disorder(MDD) is one of the most common diseases with serious health consequences such as increased morbidity, disability, and mortality. Electroconvulsive therapy(ECT) has been used as a treatment for mental disorder since the 1930s. A growing number of recent publications support the conclusions that ECT is an effective and safe treatment for depressed patients. Dosing strategies, frequency, safety, side effects and efficacy of ECT in MDD will be considered. ECT may be an alternative to treatment with antidepressants.

No Association between the 5-HT6 Receptor C267T Polymorphism and Response to Citalopram Treatment in Patient with Major Depressive Disorder

The serotonin 6(5-HT6) receptor gene is a candidate gene for influencing the clinical response to treatment with antidepressants. The purpose of this study was to determine the relationship between the C267T polymorphism in the 5-HT6 receptor gene and the treatment response to citalopram in a Korean population with major depressive disorder(MDD). METHODS: Citalopram was administered for 8 weeks to the 90 patients who completed study. 21-item Hamilton depression rating scale(HAMD-21) was used as a outcome measure. RESULTS: We found that the genotype, allele, and allele-carrier distributions did not differ significantly between MDD patients and normal controls. A main effect of an interaction of genotype with time on the decrease in the HAMD-21 score during the 8 weeks study period was not found. ANOVA revealed no significant effects of the C825T polymorphism on the decrease in the HAMD-21 score at each time period. CONCLUSIONS: These results suggest that the C267T polymorphism in the 5-HT6 receptor gene is not associated with the treatment response to citalopram.

Brain-Derived Neurotrophic Factor(BDNF) Genetic Polymorphism and the Long-term Outcome of Antidepressant Treatment in Korean Depressive Patients

associated with the long-term outcome of the antidepressant treatment. However, further studies with another BDNF polymorphism should be needed.

Korean Clinical Practice Guideline for the Treatment of Depressive Disorder(II)

Depression has been causing huge direct and indirect losses to people's health because of its high prevalence, various clinical patterns, drug reaction and diverse courses different among individuals, but its treatment has not been systematic but dependent on individual clinicians'experience and knowledge. To correct this problem, it has been highly necessary to develop clinical guidelines defined as"systematically developed statements to assist practitioners'and patients'decisions about appropriate healthcare for specific clinical circumstances." Currently, countries throughout the world are making efforts to establish evidence-based guidelines among different levels of guidelines and to evaluate and test them. Although such efforts have been unsatisfactory in Korea because of several constraints including lack of high-quality RCT, the Korean Depression Clinical Practice Guideline has started to develop evidence-based guidelines, which are established through strictly designed processes. Thus, the present study purposed to review methods adopted in the development processes and to present the processes of developing the evidence-based guidelines clearly and transparently.

Factors Associated with Depressive Symptoms of the Married Women - Focused on Family Relationship Satisfaction and Conflict: Coping Method / 신경정신의학

OBJECTIVES: The purposes of this study were to investigate depressive symptoms among married women and to their understand depression through social and interpersonal factors. METHODS: The subjects were consisted of 632 married women who lived in 00 city. They completed the Beck Depression Inventory, Marital Global Distress Scale, Dissatisfaction with Children Scale, and Conflict-coping Method Scale. Descriptive statistics, correlation, chi2-test, ANOVA, step-wise regression, and hierarchical regression were applied to analyze the data. RESULTS: ANOVA analysis showed the differences in education, income, experience of abuse, parent-in-law relationship, marital global distress, dissatisfaction with children, rational coping, emotion/action-expression coping, and avoidant coping among the non-depressive group, mildly depressive group, and depressive group. Step-wise regression showed that the variance of the current depressive symptoms was accounted for by marital global distress, dissatisfaction with children, avoidance coping method, and satisfaction with parent-in-law (total account=36.1%). It was found that the rational coping method and avoidance coping method significantly mediated the relationship between the satisfaction with family relation and depressive symptoms. CONCLUSION: Therapeutic interventions for the married women experiencing depressive symptoms showed include their marital relationship. Based on the finding that the conflict coping methods mediated the association between the depressive symptoms and the family relation satisfaction, the effective conflict coping skills or social problem solving skills should be included in the interventions for married women.

Association between D2 Dopamine Receptor Gene Polymorphisms and Reward Dependence Personality Traits

BACKGROUND: The dopaminergic genes have been implicated with some personality traits. Many recent studies indicated that there is a correlation between D2 dopamine receptor gene(DRD2) polymorphisms and the personality traits. The purpose of this study is to investigate a possible association between DRD2 gene (TaqI A, TaqI B) polymorphism and personality traits. METHODS: The subjects were consisted of 173 blood-unrelated young female Koreans with a mean age(+/-SD) of 13.88(+/-0.29) years. These volunteers were recruited from one of the junior high schools in Seoul and were tested by the Korean version of the Temperament and Character Inventory(TCI). Genotyping of the DRD2 polymorphisms by PCR methods were carried out. Two DRD2 gene polymorphisms were classified and individually assessed as follows: TaqI A1+ vs A1-, TaqI B1+ vs B-. The associations between the TCI scores and TaqI A, TaqI B polymorphisms were assessed by Student's t-test. RESULTS: In the 173 subjects, the allele frequencies of the DRD2 TaqI A1, TaqI B1 alleles ranged from 0.42 to 0.43, and these results are quite different from the ranges of 0.15-0.20 in the case of a Caucasian population. The genotype frequencies of DRD2(TaqI A1, TaqI B1) variants showed no significant deviation from the Hardy-Weinberg equilibrium. RD4(dependence vs. independence) of Cloninger's TCI, a sub-dimension of Reward Dependence, was significantly higher in the subjects having DRD2 less frequent alleles than those without these alleles. CONCLUSION: This study suggests that the female subjects carrying the less frequent DRD2 alleles exhibited higher reward-dependent personality trait compared to those without these alleles.

The Comparison of the Neurocognitive Functions between Dysthymic Disorder and Major Depressive Disorder

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal braindamaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.