The Relations among Sociodemographic, Clinical and Psychological Characteristics and Quality of Life in Patients with Psychotic Disorders and Their Caregivers / 신경정신의학

OBJECTIVES: Quality of life in patients with psychotic disorders and their caregivers has a important role on the treatment and relapse prevention of the patients. This study was intended to investigate the effects of patient's sociodemographic, clinical and psychological(self-esteem, social support and external control) characteristics, and caregivers' sociodemographic and psychological characteristics on quality of life in patients and caregivers. METHODS: The subjects were composed of 48 out-patients (schizophrenic disorder, mood disorders and other psychotic disorders) and 48 caregivers. Patients' clinical characteristics, patients' and their caregivers' sociodemographic, psychological characteristics(self-esteem, social support and external control) and quality of life were investigated. First of all, patients' self-esteem, social support, external control and quality of life were compared with caregivers'. After the correlations among each characteristics in patients and caregivers were calculated, the multiple regression analyses were conducted, where the predictable variables were those that had already shown significant correlations with quality of life. RESULTS: Patients' self-esteem and quality of life were significantly lower than their caregivers'. In patients, high socioeconomic status and self-esteem were correlated with high perception on the social support and quality of life. Also, the satisfaction to the medication was positively correlated with perception on the social support, quality of life and more external control. In addition, high compliance on medication and high perception on the social support were correlated with high quality of life. In caregivers, patients' onset age was positively correlated with caregivers' quality of life. Also, more caregivers' stress was correlated with their lower self-esteem, and higher caregivers' self-esteem was correlated with higher perception on the social support and quality of life. Furthermore, higher caregivers' perception on the social support was correlated with higher quality of life. The characteristics that predicted patients' quality of life significantly were self-esteem and perception on the social support, and the characteristics that predicted caregivers' quality of life significantly were caregivers' perception on the social support and patients' onset age. CONCLUSION: These results suggested that for improving the quality of life of patients and their caregivers, it was important not only to alleviate and treat the patient's symptom, but also to increase self-esteem and provide social support.

Psychiatric Function and Quality of Life of Workers with Long-Term Exposure to Organic Solvents / 신경정신의학

OBJECTIVES: The aim of this study was to evaluate the psychiatric function and quality of life of the chemical workers who had been exposed to long-term, low-level organic solvents in the Y industrial complex. METHODS: A total of 144 male workers, of whom 82 were in the exposed group and 60 in the unexposed-control group, were evaluated by using Symptom Checklist-90-R(SCL-90-R), series of neuropsychological tests(critical flicker fusion threshold, CFFT); choice reaction time, CRT; compensatory tracking task, CTT); digit symbol substitution test, DSS), and the Korean version of the SmithKline Beecham Quality Of Life scale(KvSBQOL). For the statistical analyses, comparisons of the means of the two groups were performed for each variable with two-tailed t-test as well as ANCOVA including age and education as covariates. RESULTS: For the SCL-90-R, the nine symptom scales and the three global indices were clinically within normal range in both groups. However, the scores on the symptom scales of 'somatization', 'depression', 'hostility' and 'phobic anxiety', and those on the global indices of 'global severity index' and 'positive symptom total', were significantly higher in the exposed group than in the unexposed group. In terms of the neuropsychological function and the quality of life, there wes no significant difference between the two groups. CONCLUSIONS: These findings suggested that the long-term exposure to mixed organic solvents, even at the low level below the permissible exposure limit, might induce some psychiatric problems.

The Development of a Korean Modification of the Scale to Measure Subjective Well-Being under Neuroleptic Treatment (KmSWN) / 신경정신의학

OBJECTIVES: The purpose of this study was to develop the Korean modification of SWN (KmSWN), based on the original 38-item SWN (a self-rating scale to measure subjective well-being under neuroleptic treatment) by Naber et. al. in 1994, but containing the reduced number of items and the modified content. METHODS: The KmSWN with 22 items and General Health Questionnaire/Quality of Life-12 (GHQ /QL-12) were administered to 204 out-patients with schizophrenia. Also, their sociodemographic and clinical characteristics were investigated. Data analyses were conducted based on 176 patients whose responses to the scale, as well as whose related informations, were reliable. First, the reliability and validity of KmSWN were assessed comprehensively. Second, the relationships between the total score of KmSWN and the sociodemographic and clinical characteristics were examined. Finally, in order to identify the predictable variables on the total score of KmSWN, the stepwise multiple regression analysis was conducted, where the independent variables were already shown significant correlations with the total score of KmSWN. RESULTS: Three of 22 items of KmSWN were excluded from the following analysis due to their poor internal consistency. KmSWN comprised with 19 items (KmSWN-19) showed high levels of spilthalf reliability (.91), mean of interitem correlations (.38) and internal consistency (Cronbach alpha .92). Factor analysis of the KmSWN-19 revealed that a three-factor solution accounted for 100% of total explained variance. The three factors were interpreted as 'dissatisfaction', 'physical and mental functioning', 'emotional regulation and self-control'. The concurrent validity of KmSWN-19 with GHQ/QL-12 was very high (-.83). Of the sociodemographic and clinical characteristics, age, disposable money, socioeconomic level, number of previous hospitalizations, compliance with medication and satisfaction with medication were positively correlated with the total score of KmSWN-19, while severity of illness, severity of parkinsonism, severity of dyskinesia, administration frequency of medication and omission number of medication were negatively correlated. However, the total score of KmSWN-19 was not correlated with the class and the dose of neuroleptics. In stepwise multiple regression analysis, the satisfaction with medication, the omission number of medication and the disposable money were significantly contributed to the total score of KmSWN-19, and they explained 24% of the variance. CONCLUSIONS: The above findings indicated that KmSWN-19 was a reliable, valid and practical self-rating scale to measure subjective well-being in out-patients with schizophrenia. Moreover, KmSWN-19 seemed to be a general scale applicable to all the schizophrenic or other psychotic patients if they were able to complete it, rather than a specific scale only for the patients undergoing the neuroleptic treatment. Based on the results of the predictable variables on the total score of KmSWN-19, one may argue that intraindividual characteristics such as value, belief and personality traits, although they were not evaluated in this study, should be considered in assessing subjective well-being or the quality of life.

Cross Validation of the Korean Translation of Composite Scale(KtCS) to Measure Morningness-Eveningness / 신경정신의학

OBJECTIVES: It is necessary to develop a questionnaire to classify the circadian rhythm for studying circadian rhythms and predicting shift work adaptability. This study attempted to confirm the general applicability of "Korean translation of Composite Scale(KtCS)" by Jin-Sang Yoon et al(1997), a Korean version of Composite Scale(CS) by Smith et al(1989). METHODS: KtCS and Life Habit Questionnaire(LHQ) were administered to 155 nurses(85 rotating shift nurses, 70 nurses on a fixed day schedule) and 247 female university students. We tested the distribution of KtCS scores and then subjects were categorized on the basis of their KtCS scores into evening(E), intermediate(I), and morning(M) types. Cut-off points for these categories were set at the 10th and 90th percentiles. We obtained the results of the internal consistency and the structure of factors of KtCS. We also compared the differences of life habits according to the circadian rhythm types. RESULTS: In both groups, nurses and female university students, the distributions of KtCS scores were negatively skewed but not significantly and the KtCS mean score was not significantly different. In nurses, Cronbach's alpha was 0.836, and three extracted factors were 'preferred times of performance and going to bed', 'rising time' and 'morning alertness'. In female university students, Cronbach's alpha was 0.787, and the same three factors as nurses were confirmed. However, only item 11 was loaded to factor 1 for the nurse group, whereas it was loaded to factor 2 for the student group. Life habits significantly differed among the three circadian rhythm types. The time of perceived peak alertness(mental and physical) was the latest in the E-type. The quality of academic performance during the morning was the highest in the M-type, and during the evening it was the highest in the E-type, but during the afternoon there was no significant differences among the three types. The bedtime and the rising time were latest in E-type, but the sleep lengths were not significantly different among the three types in both groups. CONCLUSIONS: The psychometric properties of KtCS in nurses were very similar to those of female university students and the previous findings of Jin-Sang Yoon et al(1997). This result supports that KtCS can be generally applied.

Sleep Pattern, Job Satisfaction and Quality of Life in Nurses on Rotating Shift and Daytime Fixed Work Schedules / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate(1)the differences in the sleep pattern, job satisfaction, the quality of life between the rotating shift work nurses and the nurses on a fixed day schedule and (2)the effects of the individual(circadian rhythm and personality)and the work system factors on the job satisfaction and the quality of life. METHODS: Sleep Questionnaire, Korean translation of Composite Scale(KtCS) Job Satisfaction Index, General Health Questionnaire, Eysenck's Personality Questionnaire were administered to 85 rotating shift work nurses(the rotating group)and 70 nurses on a fixed day schedule(the daytime group) We compared the weekday sleep pattern, the frequency of sleep disorders during the last month, circadian rhythm patterns, job satisfaction, and the quality of life between the two groups. Also, we conducted the stepwise multiple regression analysis, where the independent variables were circadian rhythm, work schedule, extroversion, and neurotism and the dependent variables were the job satisfaction and the quality of life. RESULTS: Between the two groups, there were significant differences in the sleep pattern including the regularity of sleep and the frequency and duration of naps. The rotating group had more frequent sleep problems, poorer job satisfaction and quality of life as compared with the daytime group. The job satisfaction and quality of life were poorer in the nurses who were on a rotating shift work schedule and who had higher neurotic trend. On contrary, The job satisfaction and the quality of life were better in those who were on a fixed daytime shift work schedule and who had more an extroversive trend. However, the circadian rhythm had no significant effect on the job satisfaction and quality of life. CONCLUSIONS: The sleep pattern, job satisfaction, and the quality of life were significantly poorer in the rotating group than in the daytime group, as expected. In terms of individual factors which determine the job satisfaction and quality of life, the personality dimensions had a significant effect, whereas the circadian rhythm did not. These results suggest that the circadian rhythms of shift workers may be realigned and that personality characteristics may be an important factor in coping with shift work.

Personality Dimensions of Eysenck and Their Relations with Sleep Characteristics / 신경정신의학

OBJECTIVES: In order to evaluate the possible relationship between sleep and personality characteristics, it is desirable to adopt the personality theory with biological basis because sleep is a physiological phenomenon. The purpose of this study was to investigate their possible relationship using the personality dimensions of Eysenck, which is well known as a biological personality theory. METHODS: Sleep Questionnaires regarding the weekday sleep habits and the sleep disorders and Eysenck's Personality Questionnaire were administered to 532 university students. Data analysis was based on 509 students who gave reliable information. Firstly, the descriptive statistics of the scores on four personality dimensions(psychoticism, neuroticism, extraversion, lie)and sleep characteristics were obtained. Secondly, the possible relationships between each personality dimension and sleep characteristics (the weekday sleep habits and sleep disorders)were tested by calculating Pearson's product moment correlations. RESULTS: The four personality dimensions' scores and weekday sleep habits of subjects were within a normal range. The highest frequency of sleep disorder was induction difficulty of sleep and the lowest was sleep walking. Psychoticism was positively correlated with bedtime, rise time, sleep latency, number of awakening, regularity of sleep, frequency and duration of nap and doze, frequency of sleep disorders, while negatively correlated with the quality of sleep, and the score of circadian rhythm. The correlations between neuroticism and sleep characteristics were similar to those of psychoticism. Extraversion was positively correlated with the quality of sleep and the score of circadian rhythm, while not correlated with sleep disorders. Lie was positively correlated with the score of circadian rhythm, but negatively correlated with sleep latency, regularity of sleep, frequency and duration of nap and doze, and sleep disorders. CONCLUSIONS: The higher psychoticism and neuroticism, the poorer sleep habits and the higher frequency of sleep disorders. The higher extraversion, the better quality of sleep and the closer morningness. The higher lie, the closer morningness, the more regularity of sleep, the less sleepiness of daytime, and the less frequency of sleep disorders. These findings suggest that there exist the close relationships between Eysenck's personality dimensions and sleep characteristics.

A Preliminary Study on Korean version of the SmithKline Beecham Quality of Life Scale(KvSBQOL) / 신경정신의학

OBJECTIVES: The SmithKline Beecham' Quality of Life's scale(SBQOL) by Dunbar et at. was developed in an attempt to produce a valid scale which would be justice to the complexity of human experience which constitutes perceived Quality of life. This study was attempted to verify the reliability and validity of the Korean version of SBQOL(KvSBQOL). METHODS: KvSBQOL was administered to 377 university students. Subjects were asked to rate the same 23 items in the aspect of three states, i.e., 'self now'-as they felt at present: 'ideal self-how they would feel as their ideal person: 'sick self-how they would feel as a person who is sick or unwell. The distribution and the differences of KvSBQOL for three mental sets, as well as the split-half reliability, test-retest reliability, and internal consistency for the self now were assessed. For the evaluation of concurrent validity, the Stress Questionnaire(SQ) and Eysenck's Personality Questionnaire(EPQ) were employed as the external criterion. Construct validity was assessed by examining the relationship between the inter-element differences and the scores of other scales: Somatization(SOM) of SCL-90-R(Symptom Checklist-90-Revision), Beck Depression Inventory(BDI), Stait-Trait Anxiety Inventory(STAI) and Internal-External Control Scale(I-E Scale). And then, common factor analyses with varimax rotation and multiple regression analyses were carried out. RESULTS: The element score of self-now was normally distributed, that of ideal self was significantly negatively skewed, and that of sick self was significantly positively skewed. The significant inter-element differences(ideal self/self now, ideal self/sick self, self now/sick self) were found. The split-half reliability(.83), test-retest reliability(.84), and internal consistency(Cronbach alpha, .898) were found to be high. The inter-element distance(ideal self and self now) of the KvSBQOL score was positively correlated with the SQ score and neuroticism score of EPQ, while negatively correlated with extroversion score of EPQ. The inter-element distance showed significant correlations with SOM of SCL-90-R, BDI, STAI, 1-E Scale scores. Factor analysis of 23 items resulted in a five factor solution accounting for 34.24% of total explained variance. The five factors were interpreted as competence, psychological well-being, stability, physical well-being, and activity. The severity of somatization, depression, anxiety and external control contributed to five factors of KvSBQOL. CONCLUSIONS: These findings confirmed the high reliability and validity of KvSBQOL and suggest the possibility that KvSBQOL could be a useful measure of QOL in patients with psychiatric disorders.

A Preliminary Study on the Korean Translation of Composite Scale(KtCS) to Measure Morningness: Eveningness / 신경정신의학

OBJECT: The Composite Scale by Smith et al. has been proposed as an improved measure of momingness-eveningness. This study attempted to endorse that a Korean translation of Composite Scale(KtCS) can be useful to differentiate people according to circadianrhythm types. METHOD: KtCS and Life Habit Questionnaire(LHQ) were administered to 561 university students. LHQ consisted of items questioning sleep habits on weekdays(bedtime, rising time and sleep length), the time of perceived peak alertness(mental and physical), time of perceived peak performance(mental, physical and academic), and quality of academic performance during the morning, afternoon and evening. Subjects were categorized on the basis of their KtCS scores into evening(I) types, intermediate(I) types, and morning(M) types. The cut-off points for these categories were set at the 10th and 90th percentiles. In addition 7 I-type and 7 M-type subjects were selected from the student population who had participated in the previous survey and then, oral temperature of each subject was taken every hour torn 08 : 00 to 22 : 00. To assess both the internal and the external measurement properties of KtCS, descriptive statistics, reliability and validity were examined. RESULTS: The distribution of KtCS scores was significantly, negatively skewed. The KtCS scores closest to the 10th and 90th percentiles were 26 and 41 respectively. The split-half reliability(. 85), test-retest reliability( .91), and internal consistency(Cronbach alpha, .82) were obtained above the expected. Inter-item correlations were all positive and ranged from .10-.59 with a mean of .25. Item-total correlations varied from .33 to .63 with a mean of .45. Common factor analyses confirmed three factors: preferred times of performance and going to bed, arising time, and morning alertness. The validity of KtCS was further demonstrated through strong relationships between the scale and external criteria.4 discernable difference in oral temperature between the M-type and the type across morning to evening provided additional evidence for validity of the scale. CONCLUSIONS: The results would suggest the possibility that KtCS can be employed as a tool for selection of I-type people or M-type people. It is as yet, however, uncertain that KtCS might be suitable to select people for night shiftwork because the subjects of this study are limited to university students. Therefore, future research among varying types of people are required to endorse this study.