Suicide Risk in Patients With Diabetes Varies by the Duration of Diabetes: The Korea National Health and Nutrition Examination Survey (2019)

Objective@#The objectives of this study were to investigate the suicide risk in diabetes patients and evaluate the variations in suicide risk by the duration of diabetes using a large population sample in South Korea. @*Methods@#Data from 6,296 adults in the 2019 Korea National Health and Nutrition Examination Survey were included. The suicidal ideation, suicide plans, and suicidal behavior of diabetes patients were compared to the general population. After classifying the patients into ≤1 year, 2 to 9 years, and ≥10 years of diabetes duration, we evaluated the relationship between the duration of diabetes and the suicide risk. @*Results@#Diabetes patients had higher prevalences of suicidal ideation (9.1%, p<0.001) and suicide plans (3.6%, p<0.001) than the general population. After adjusting for potential confounding factors, suicide plans (adjusted odds ratio [aOR]=2.926, 95% confidence interval [CI]=1.325–6.463) were significantly associated with diabetes. In the 2 to 9 years group of diabetes patients, we found an increase in the risk of suicidal ideation (aOR=2.035, 95% CI=1.129–3.670), suicide plans (aOR=3.507, 95% CI=1.538–7.996), and suicidal behavior (aOR=7.130, 95% CI=2.035–24.978) after adjusting for the covariates. However, no increases in suicide risk were observed ≤1 year and ≥10 years after diabetes diagnosis. @*Conclusion@#In adults, diabetes is associated with an increase in suicide risk. Suicide risk in diabetes patients showed an inverted U-shaped depending upon the duration of diabetes.

Mediation Effect of the Coping Strategies on the Relation Between Stress and Sleep Quality

Objective@#Recently data has been accumulated regarding the role of coping strategies in the relationship between stress and sleep quality. Therefore, we set out to identify the mediating effects of coping strategies between stress and sleep quality. @*Methods@#A online-based cross-sectional study was performed using the Perceived Stress Scale-10, the Pittsburgh Sleep Quality Index, and a simplification of the 60-item Coping Orientation to Problems Experienced (Brief COPE) inventory in the nonclinical adult sample. The 24 items of Brief COPE were categorized into four factors (social support, problem solving, avoidance, positive thinking). Then, we used the PROCESS macro to conduct the multiple mediation analysis for the four coping styles as potential mediators in the relationship between stress and sleep quality, and an additional subgroup analysis was examined to identify a gender difference for the mediation effect. @*Results@#As a group, four coping styles mediated significantly the association between perceived stress and poor sleep quality. And avoidance has maintained its significance thought all regression analyses. Finally, this results remained as same in the females. @*Conclusion@#The effect of perceived stress on poor sleep quality was mediated by coping strategies, especially by avoidance. Thus, further research should consider the coping styles of individuals to reduce the influence of stress on sleep quality.

Predictors of 1-Year Rehospitalization for Patients with Major Depressive Disorder: A Retrospective Study in a University Hospital / 우울ㆍ조울병

Background@#This study aimed to assess the clinical characteristics of patients with major depressive disorder who were rehospitalized within 1 year and to determine whether the 1-year rehospitalization rate varied depending on the type of medication and treatment method. @*Methods@#Clinical characteristics of 531 patients hospitalized for major depressive disorder were assessed. The use and type of antidepressants, antipsychotics, mood stabilizers, and hypnotics were also evaluated. @*Results@#Of the 531 subjects, 68 (12.8%) were rehospitalized within a year. The number of past depressive episodes (1.56±2.67 vs. 0.90±1.18) (p=0.048) and the number of previous psychiatric hospitalizations (0.82±1.93 vs. 0.29±0.83 times) (p=0.029) were high in the 1-year rehospitalization group. The rate of family history of mood disorder (25.0% vs. 13.6%) (p=0.014) and the rate of comorbid personality disorder (16.2% vs. 8.6%) (p=0.049) were also high in the 1-year rehospitalization group. Multiple logistic regression analysis showed that the number of previous psychiatric hospitalizations affected the rate of 1-year rehospitalization (p=0.003). @*Conclusion@#The number of previous psychiatric hospitalizations could be used to predict rehospitalizations of patients with major depressive disorder within 1 year. In addition, family history of mood disorders and comorbidity of personality disorders may affect rehospitalization of such patients.

Association between Glycemic Control in Patients with Diabetes and Mental Health Variables Including Depression / 우울ㆍ조울병

Background@#The purpose of this study was to measure several mental health variables according to HbA1c level and examine their relationship among diabetic patients. @*Methods@#Total 89 outpatients who attended diabetes education program at St. Vincent’s Hospital, The Catholic University of Korea College of Medicine, were enrolled this study. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Stress Response Inventory (SRI), abbreviated version of World Health Organization Quality of Life assessment instrument (WHOQOL-BREF), Insomnia Severity Index, and Epworth Sleepiness Scale (ESS) were administered to all patients. Significant differences between groups were assessed by t-test and chi-squared test. Pearson correlation and multiple linear regression analyses were used to identify the variables that affect HbA1c levels. @*Results@#The well-controlled group had a significantly lower BDI score than the poorly controlled group. The wellcontrolled group also showed significantly lower SRI and ESS. HbA1c, BDI, SRI, and ESS were positively correlated. Duration and BDI were the only variables affecting HbA1c levels. @*Conclusion@#Emphasis should be given to the identification and management of mental health problems, including especially depressive symptoms in patients with diabetes.

Correlation between Sleep and C-reactive Protein of Patients in Amnestic Mild Cognitive Impairment and Alzheimer’s Dementia

Objective@#Sleep affects systemic inflammation and amyloid deposition, and sleep disturbance is known to be a risk factor for cognitive decline. To date, literatures on the relationship between peripheral inflammatory markers and sleep in Alzheimer’s de-mentia and mild cognitive impairment patients have been scarce. The aim of this study was to determine the correlation between sleep and C-reactive protein (CRP) in Alzheimer’s dementia and amnestic mild cognitive impairment patients. @*Methods@#A total of 81 patients were divided in to four groups: amyloid negative healthy control, amyloid negative amnestic mild cognitive impairment, amyloid positive amnestic mild cognitive impairment, and amyloid positive Alzheimer’s dementia.Demographic data and cognitive measurement through the Consortium to Establish a Registry for Alzheimer’s Disease were conducted. Amyloid positivity status was attained through positron emission tomography scans using [18F]-flutemetamol. The quality of sleep was evaluated by the sleep item of Korean Neuropsychiatric Inventory (K-NPI-SLEEP), and peripheral blood tests were conducted to measure CRP. @*Results@#There was no statistically difference in CRP levels or K-NPI-SLEEP scores among four groups. Moreover, there was no association between K-NPI-SLEEP and CRP in four groups. @*Conclusion@#Since K-NPI-SLEEP score shows overall, subjective sleep problems, further follow-up studies in consideration for objective sleep studies to unravel the relationship of peripheral inflammatory markers and sleep in amnestic mild cognitive impairment and Alzheimer’s dementia patients.

Discontinuation Rate of Doxepin in Insomnia Patients / 정신신체의학

OBJECTIVES: We aimed to investigate the discontinuation rate and reasons of doxepin base prescription pattern in insomnia outpatients of psychiatry department of a university hospital. METHODS: 534 patients prescribed doxepin were screened. 201 patients were included and reviewed for their medical records retrospectively. The discontinuation rate and reasons of doxepin after 2 months of prescription were investigated. Patients were divided into three groups according to the prescription patterns. The initial group, prescribed doxepin as the first hypnotic, the add-on group, prescribed doxepin while maintaining existing hypnotics, and the switching group, prescribed doxepin after discontinuation of existing hypnotics. RESULTS: The discontinuation rate after 2 months of prescription of doxepin was 56.2%. There were significant differences in the discontinuation rate among three groups. The initial group had the highest while the add-on group had the lowest (p=0.018). In reasons for discontinuation of doxepin among three groups, lack of efficacy (p < 0.001) and adverse events (p < 0.001) were significantly higher in the add-on group. In the initial group, patient's refusal (p=0.022) and unknown or loss to follow up (p < 0.001) were significantly higher. CONCLUSIONS: The results of this study suggested that add-on is superior than switching method and gradual reduction of existing hypnotics is necessary to maintain doxepin treatment and prevent adverse events. Additional large scale prospective studies are needed to evaluate various factors and risks of discontinuation of doxepin.

Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment

Attention-deficit hyperactivity disorder (ADHD) is notorious for its debilitating consequences and early age of onset. The need for early diagnosis and intervention has frequently been underscored. Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. Genetic-phenotypic differences across individuals regarding the aforementioned sleep problems have been elucidated along with the possible use of these characteristics for early prediction of ADHD. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD, with novel treatment approaches ranging from melatonin and light therapy to myofunctional therapy and adjustments of the time point at which school starts.

Prediction of Treatment Response to Donepezil using Automated Hippocampal Subfields Volumes Segmentation in Patients with Mild Alzheimer's Disease

Previous studies reported some relationships between donepezil treatment and hippocampus in Alzheimer's disease (AD). However, due to methodological limitations, their close relationships remain unclear. The aim of this study is to predict treatment response to donepezil by utilizing the automated segmentation of hippocampal subfields volumes (ASHS) in AD. Sixty four AD patients were prescribed with donepezil and were followed up for 24 weeks. Cognitive function was measured to assess whether there was a response from the donepezil treatment. ASHS was implemented on non-responder (NR) and responder (TR) groups, and receiver operator characteristic (ROC) analysis was conducted to evaluate the sensitivity, specificity, and accuracy of hippocampal subfields in predicting response to donepezil. The left total hippocampus and the CA1 area of the NR were significantly smaller than those of the TR group. The ROC curve analysis showed the left CA1 volumes showed highest area under curve (AUC) of 0.85 with a sensitivity of 88.0%, a specificity of 74.0% in predicting treatment response to donepezil treatment. We expect that hippocampal subfields volume measurements that predict treatment responses to current AD drugs will enable more evidence-based, individualized prescription of medications that will lead to more favorable treatment outcomes.

Erratum to “Prediction of Treatment Response to Donepezil using Automated Hippocampal Subfields Volumes Segmentation in Patients with Mild Alzheimer's Disease”

Unfortunately, the corresponding author's affiliation was incorrect in the original publication of this article..

A Voxel Wise Analysis of Cerebral Beta Amyloid Retention in Healthy Controls and Subjects with Amnestic Mild Cognitive Impairment and Alzheimer's Disease

OBJECTIVE: The purpose of the study was to compare cortical amyloid deposition using 18F-florbetaben and positron emission tomography (PET) in healthy controls and subjects with amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD). METHODS: We investigated 25 patients : 10 age-matched healthy controls, 10 patients with aMCI and 5 with AD. All participants underwent PET after intravenous injection of 300 MBq of 18F-florbetaben. The 90 min post-injection brain PET data were analysed using statistical parametric mapping. RESULTS: When compared to healthy controls, amyloid deposition was significantly higher in frontal lobe medial frontal gyrus, limbic lobe posterior cingulate, parietal lobe precuneus, sub-loba insula, temporal lobe superior temporal gyrus, parietal lobe inferior parietal lobule, temporal lobe middle temporal gyrus, parietal lobe supramarginal gyrus, occipital lobe middle temporal gyrus of patient group (family wise error correction p<0.05). CONCLUSION: These results indicate 18F-florbetaben to be an efficacious β-amyloid-targeted tracer. Subjects with aMCI, AD could be easily differentiated from healthy controls by assessment of the PET data.

Visual Hallucinations and Amyloid Deposition in Parkinson's Disease Dementia: A Case Report

Parkinson's disease dementia (PDD) is notorious for its debilitating clinical course and high mortality rates. Consequently, various attempts to investigate predictors of cognitive decline in Parkinson's disease (PD) have been made. Here we report a case of a 75-year-old female patient with PD who visited the clinic with complaints of recurrent visual hallucinations and cognitive decline, whose symptoms were ameliorated by the titration of rivastigmine. Imaging results showed pronounced diffuse cortical amyloid deposition evidenced by 18F-florbetaben amyloid positron emission tomography (PET) imaging. This observation suggests that pronounced amyloid deposition and visual hallucinations in PD patients could be clinically significant predictors of cognitive decline in PD patients. Future research should concentrate on accumulating more evidence for possible predictors of cognitive decline and their association with PD pathology that can enable an early intervention and standardized treatment in PDD patients.

Characteristic Risk Factors Associated with Planned versus Impulsive Suicide Attempters

OBJECTIVE: The present study aimed to investigate predictors for planned suicide attempters. METHODS: This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared. RESULTS: Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs. CONCLUSION: The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.

Sleep Patterns in Children with Attention-Deficit/Hyperactivity Disorder by Polysomnography / 대한정신약물학회지

OBJECTIVE: Sleep problems are a prominent feature in children with attention-deficit/hyperactivity disorder (ADHD) and about 25-43% of ADHD patients were reported to have sleep problems including higher level of nocturnal activity, longer sleep latency, lower sleep efficiency, more frequent night awakenings and shorter total sleep time. However, the association between sleep and ADHD is poorly understood and their relationships to sleep structure are not consistent across studies. The aims of our study were to ascertain the nocturnal sleep disturbances in patients with ADHD by objective measure, polysomnography. METHODS: The subjects were 20 patients with ADHD and 21 control children (6-12 years). We tested them by polysomnography to get sleep variables and compare sleep disturbances. In addition, we tested ADHD group by neurocognitive function test and assessed the correlation between sleep variables and neurocognitive functions in ADHD group. RESULTS: In sleep variables by polysomnography, the total time in bed (509.73+/-24.56 min vs. 490.51+/-20.71 min, p=0.01), sleep latency (21.30+/-19.33 min vs. 10.72+/-7.26 min, p=0.031) and limb movement arousal (6.56+/-2.19 /hr vs. 5.98+/-1.38 /hr, p=0.043) were significantly increased in patients with ADHD compared with controls. And the slow wave sleep (24.59+/-4.73% vs. 28.45+/-5.63%, p=0.023) were significantly decreased in patients with ADHD compared with controls. There were no significant differences in sleep period time and sleep efficiency test. CONCLUSION: The patients with ADHD had more sleep problems and results of this study suggested that they have significantly increased the total time in bed, sleep latency and Limb movement arousal. And in the patients with ADHD, some sleep variables indicated poor sleep quality. However, further studies should repeatedly suggest consistent results about sleep problems in children with ADHD.

Comparison of Treatment Response of Antipsychotics According to Sedative Effect in the Treatment of Patients with Delirium / 대한정신약물학회지

OBJECTIVE: The purpose of the study is to compare treatment responses and side effects of antipsychotic medications in hospitalized delirium patients. METHODS: Among delirium patients hospitalized 23 less-sedating agent group and 26 sedating agent group were included in the study. Less sedating agents are haloperidol and risperidone, and sedating agents are olanzapine and quetiapine. All candidates underwent Clinical Global Impression Scale (CGI), Delirium Rating Scale-Revised 98 (DRS-R 98), and Extrapyramidal Symptom Rating Scale during the treatment period. At baseline, 1st day, 2nd day, 3rd day, 4th day, 5th day, 6th day, 7th day, 10th day, and 14th day, we compared treatment responses and side effect profiles between two groups. RESULTS: The remission defined as below 16 score of DRS-R 98, and the remission rate of both group were 78.3% at less-sedating agent group, and 80.8% at sedating agent group. They showed no difference each other. Time to remission of less-sedating group was significantly shorter than sedating group, they were 2.89+/-1.41 days at less-sedating agent group, and 5.76+/-4.45 days at sedating agent group (p=0.015). After 2 days of treatment, less-sedating agent group showed greater decrement of CGI-S score than sedating agent group, the score were 3.22+/-1.20 at less-sedating agent, and 4.00+/-1.22 at sedating agent group (p=0.030). And DRS-R 98 score after 2 days of treatment showed difference between both group, less-sedating agent group was 17.00+/-8.88, and sedating group was 22.72+/-8.49, they were different statistically (p=0.044). The mean dosage of each drugs were haloperidol 1.93 mg, risperidone 0.71 mg, olanzapine 3.75 mg, and quetiapine 46.09 mg. But there were no significant differences of rate of adverse effects. CONCLUSION: There were no differences of total remission rate and rate of adverse effects between two groups for 2 weeks. But less-sedating agent group showed shorter time to remission and shorter duration of medication than sedating agent group. This study suggests that less-sedating agents are more suitable for early days of delirium treatment.

Changes of Sociodemographic and Clinical Characteristics of Patients Registered in a Community Mental Health Center: Comparing 2008 with 2012 / 대한정신약물학회지

OBJECTIVE: This study was designed to investigate the changes of sociodemographic and clinical characteristics of patients who were registered in a community mental health center. METHODS: The patients enrolled in this study were those registered in Suwon City Community Mental Health Center in 2008 and 2012, and there were 440 and 460 patients, respectively. The authors analyzed demographic data, medical insurance status, registration status of mental disability and clinical characteristics, such as diagnosis, type of medical institution the patients received medical care from, medication, duration of illness, Brief Psychiatric Rating Scale and global assessment function scores. RESULTS: There were more married patients in 2012 than in 2008 (23.1% vs. 34.3%, p<0.001) and the proportion of patients who were employed was larger in 2012 (8.2% vs. 10.2%, p=0.302). Also, in 2012, more patients received Level 1 medical care rather than health insurance (27.9% vs. 35.3%, p=0.007) and the number of patients with registered mental disability increased (27.7% vs. 52.6%, p<0.001). From 2008 to 2012, the number of patients diagnosed with other disorders besides psychotic disorders increased (15.5% vs. 22.9%, p=0.007). Also, more patients tended to receive medical treatment from private mental clinics (38.6% vs. 58.1%, p<0.001), and to be administered with atypical antipsychotics rather than conventional antipsychotics (58.6% vs. 80.4%, p=0.022). CONCLUSION: This study suggests that many characteristics of the patients registered in a community mental health center have been gradually changed. The patients registered in 2012 were likely to be diagnosed with other disorders besides psychotic disorders and to get more atypical antipsychotics compared to patients registered in 2008. This study would contribute to finding out the proper roles and functions of mental health centers, and, as a result, the mental health centers could be able to provide better quality of service to their registered patients.

Clinical Characteristics of Patients with Major Depressive Disorder That Affect One-Year Rehospitalization Rate: A Retrospective Study in a University Hospital / 대한정신약물학회지

OBJECTIVE: This study was designed to investigate the clinical characteristics of patients with major depressive disorder who were rehospitalized within a year in a naturalistic setting at a university hospital. METHODS: Inpatients with major depressive disorder patients were retrospectively investigated. Data on patients' demographic factors, clinical variables-age, sex, education year, socioeconomic state, marital state, illness duration, length of stay, severity of illness, presence of psychotic features, number of past depressive episodes and hospitalization, family history, comorbidity-were collected. Use of antidepressants, antipsychotics, mood stabilizers and hypnotics were investigated. RESULTS: A total of 238 patients participated in the study. No significant differences were observed between one-year rehospitalized group and the non-rehospitalized group in demographic factors and clinical variables except for the number of previous psychiatric hospitalizations. The mean number of previous psychiatric hospitalization was significantly higher in the one-year rehospitalized group than the non-rehospitalized group (0.41+/-0.83 times vs. 0.23+/-0.83 times) (p=0.048). No significant differences in rehospitalized rates were observed among the disparate treatment types. One-year rehospitalization rate was significantly higher in patients who discontinued antidepressants than the patients who continued the antidepressants (15.9% vs. 0%) (p=0.002). CONCLUSION: The present data suggest that the number of previous psychiatric hospitalizations is higher in patients who were rehospitalized within a year and the discontinuation of antidepressant might be an influencing factor. Further controlled studies are recommended to confirm our findings.

The Reliability and Validity of the Korean Version of Burden Assessment Scale (K-BAS) / 신경정신의학

OBJECTIVES: This study was conducted for evaluation of the reliability and validity of the Korean version of the Burden Assessment Scale (K-BAS). METHODS: A sample of 256 first-order relatives of schizophrenics completed the K-BAS and the data were analyzed for internal consistency and factor structure. In addition, a subset of participants (n=112) refilled the K-BAS after two weeks for test-retest reliability. To test for validity, the Family Burden Scale (FBS), Korean version of Drug Attitude Inventory-10 (KDAI-10), and Korean version of the Scale to Assess Unawareness of Mental Disorder (SUMD-K) were administered. RESULTS: The Cronbach's alpha coefficient of the K-BAS was high (0.91), which provided evidence for good internal consistency. The test-retest reliability of K-BAS was 0.86 (correlation coefficient, p<0.001). Convergent validity was examined through correlations between the K-BAS and the FBS (r=0.80, p<0.001). Divergent validity was examined through correlations between the K-BAS and KDAI-10 (r=-0.21, p=0.001), and between the K-BAS and SUMD-K (r=-0.02, p=0.796). Results of the factor analysis revealed a three-factor solution: activity limitation, social strain, and feelings of worry and guilt. CONCLUSION: These results suggest that the K-BAS had good psychometric properties and may be a useful instrument for evaluation of burden of families with schizophrenics.

The Reliability and Validity of the Korean Version of Patient Rejection Scale (K-PRS) / 신경정신의학

OBJECTIVES: The Patient rejection scale (PRS) has been reported as a valid tool for the assessment of rejecting feelings of family respondents toward schizophrenics who return to live with their families. The aim of this study was to assess the reliability and validity of the Korean-version of PRS (K-PRS). METHODS: A sample of 272 primary caregivers of schizophrenics completed the K-PRS and the data were analyzed for internal consistency and factor structure. Additionally 117 caregivers refilled K-PRS after two weeks for test-retest reliability. To test for validity, Family Questionnaire (FQ), Drug Attitude Inventory-10 (DAI-10) and the Scale to Assess Unawareness of Mental Disorder (SUMD) were administered. RESULTS: Internal consistency of K-PRS was good (Cronbach' alpha=0.787) and principal component factor analysis revealed the three-factor structure. The K-PRS also showed reasonable test-retest reliability (r=0.795). Convergent validity was examined through correlations between the K-PRS and the FQ-criticism subscale (r=0.78). Divergent validity was examined through correlations between the K-PRS and KDAI-10 (r=-0.02, p=0.001), and between the K-PRS and SUMD-K (r=-0.02, p=0.796). CONCLUSION: The Korean version of PRS proved to be a reliable and valid instrument measuring rejecting feelings in relatives of Korean patients with schizophrenia.

Sleep Patterns in Male Children with Attention-Deficit Hyperactivity Disorder by Actigraphy / 대한정신약물학회지

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD), the most common behavior disorder of childhood, is characterized by a pattern of diminished sustained attention and higher level of impulsivity. About 25-50% of ADHD patients were reported to have sleep problems including higher level of nocturnal activity, longer sleep latency, lower sleep efficiency, more frequent night awakenings and shorter total sleep time. However, there is a lack of consistent results of any significant sleep problems but higher number of sleep movement and night-to-night variability from objective data although the self- or parental reports have suggested higher rates of sleep problems. This study was to ascertain the nocturnal sleep disturbances in patients with ADHD by objective measure, actigraphy. METHODS: The subjects were 24 male patients with ADHD and 12 control children (6-12 years). We tested them by neurocognitive function test and applied actigraphy to get sleep variables and to compare sleep disturbances for 72 hours. RESULTS: 1) In Matching Familiar Figures Test, the patients with ADHD manifested significantly increased response error (58.71+/-28.16 percentile vs. 35.20+/-26.49 percentile, p=0.038) and response latency (69.71+/-23.57 percentile vs. 49.70+/-24.58 percentile, p=0.042) compared with control children. Also, the patients with ADHD required more time for Trail Making Test B than controls and the difference were statistically significant (164.2+/-90.88 sec. vs. 79.0+/-55.08 sec., p=0.043). 2) In sleep variables by actigraphy, the sleep latency (21.57+/-24.28 min. vs. 5.81+/-4.69 min., p=0.005), wake after sleep onset (WASO) (62.01+/-18.56 min. vs. 47.00+/-15.08 min., p=0.039) and fragmentation index (17.28+/-5.41% vs. 12.45+/-4.88%, p=0.048) were significantly increased in patients with ADHD compared with controls. There were no significant differences in total sleep time and sleep efficiency. CONCLUSION: The patients with ADHD had more sleep problems and results of this study suggested that they have significantly increased sleep latency, WASO and fragmentation index compared with controls. However, further studies improved by large sample sizes, addition of polysomnography and ADHD subtypes should repeatedly suggest consistent results about sleep problems in children with ADHD.

Reliability and Validity of the Korean Version of the Cornell Scale for Depression in Dementia

OBJECTIVE: The aim of this study was to explore the reliability and validity of the Korean version of the Cornell Scale for Depression in Dementia (CSDD-K), a scale for assessment of depression in dementia. METHODS: The original CSDD was translated into Korean and the content was verified through back-translation procedures. This study included 59 depressive patients with Alzheimer's disease (AD), 62 non-depressive patients with AD and 36 healthy elderly controls. The subjects were assessed using CSDD-K, the 17-item Hamilton Depression Rating Scale (HAM-D17), the 15-item Korean version of Geriatric Depression Scale (GDS15) and the Korean version of Mini-mental Status Examination (MMSE-K). RESULTS: In the reliability test, Cronbach's alpha coefficient and test-retest reliabilities were 0.92 and 0.91, respectively, indicating that the CSDD-K has good internal consistency. There were significant differences in CSDD-K total scores between AD patients with depression and AD patients without depression (p<0.001). In the analysis of the concurrent validity of the CSDD-K, there were significant correlations between the CSDD-K and HAM-D17 (r=0.91, p<0.001) and between the CSDD-K and GDS15 (r=0.75, p<0.001). ROC curve analysis identified a cut-off score of 7 for the CSDD-K, where the sensitivity was 87.5% and the specificity was 100%. Factor analysis resulted in a four-factor solution accounting for 63.8% of the common variance. CONCLUSION: The CSDD-K showed good reliability and validity for the assessment of depressive symptom severity in AD patients. The CSDD-K is a useful instrument for assessing AD patients with depressive symptoms in Korean ethnic population.