Reliability and Validity of the Korean Version of Clinician-Administered Posttraumatic Stress Disorder Scale for DSM-5

BACKGROUND: For diagnosis of post-traumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS) is one of the most widely used structured diagnostic interviews. METHODS: In this study, we aimed to develop and validate the Korean version of CAPS for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ([DSM-5] K-CAPS-5). Seventy-one subjects with PTSD, 74 with mood disorder or anxiety disorder, and 99 as healthy controls were enrolled. The Korean version of the structured clinical interview for DSM-5-research version was used to assess the convergent validity of K-CAPS-5. BDI-II, BAI, IES-R, and STAI was used to evaluate the concurrent validity. RESULTS: All subjects completed various psychometric assessments including K-CAPS-5. K-CAPS-5 presented good internal consistency (Cronbach's α = 0.92) and test-retest reliability (r = 0.91). K-CAPS-5 showed strong correlations with the structured clinical interview for DSM-5 PTSD (k = 0.893). Among the three subject groups listed above there were significant differences in the K-CAPS-5 total score. The data were best explained by a six-factor model. CONCLUSION: These results demonstrated the good reliability and validity of K-CAPS-5 and its suitability for use as a simple but structured instrument for PTSD assessment.

Application of Short Screening Tools for Post-Traumatic Stress Disorder in the Korean Elderly Population

OBJECTIVE: Post-traumatic stress disorder (PTSD) is often missed or incorrectly diagnosed in primary care settings. Although brief screening instruments may be useful in detecting PTSD, an adequate validation study has not been conducted with older adults. This study aimed to evaluate the reliability and validity of the Korean version of the primary care PTSD screen (PC-PTSD) and single-item PTSD screener (SIPS) in elderly veterans. METHODS: The PC-PTSD and SIPS assessments were translated into Korean, with a back-translation to the original language to verify accuracy. Vietnamese war veterans [separated into a PTSD group (n=41) and a non-PTSD group (n=99)] participated in several psychometric assessments, including the Korean versions of the PC-PTSD (PC-PTSD-K), SIPS (SIPS-K), a structured clinical interview from the Diagnostic and Statistical Manual of Mental Disorders-IV(SCID), and PTSD checklist(PCL). RESULTS: The PC-PTSD-K showed high internal consistency (Cronbach α=0.76), and the test-retest reliability of the PC-PTSD-K and SIPS-K were also high (r=0.97 and r=0.91, respectively). A total score of 3 from the PC-PTSD-K yielded the highest diagnostic efficiency, with sensitivity and specificity values of 0.90 and 0.86, respectively. The 'bothered a lot' response level from the SIPS-K showed the highest diagnostic efficiency, with sensitivity and specificity values of 0.85 and 0.89, respectively. CONCLUSION: Our findings suggest that both PC-PTSD-K and SIPS-K have good psychometric properties with high validity and reliability for detecting PTSD symptoms in elderly Korean veterans. However, further research will be necessary to increase our understanding of PTSD characteristics in diverse groups with different types of trauma.

Comparison of Neurocognitive Functions between Positional Obstructive Sleep Apnea Patients and Non-Positional Obstructive Sleep Apnea Patients in the Korean Elderly Population / 신경정신의학

OBJECTIVES: Obstructive sleep apnea (OSA) is classified as positional sleep apnea (POSA) and non-positional sleep apnea (NPOSA) according to apnea-hypopnea index (AHI) changed by sleep position. The aim of this study was to compare neurocognitive functions between two groups in the elderly Korean population. METHODS: Forty-four subjects in OSA patients with total AHI> or =5 participated as criteria for POSA (n=25) with 1) supine position AHI/non-supine position AHI> or =2 and 2) total AHI> or =5 or not (NPOSA, n=19). All participants completed clinical interview by physician and neurocognitive function assessments. Mann-Whitney U and chi-square test were performed for comparison of neurocognitive functions and sleep characteristics with polysomnography between two groups. RESULTS: No significant difference in demographic and clinical characteristics was observed between the two groups. However the NPOSA group showed more decline than the POSA group on the Boston naming test (p=0.034), digit span test (p=0.001), go-no-go test (p=0.042), and fist-edge-palm test (p=0.007). CONCLUSION: In this study NPOSA patients were found to have lower cognitive functions compared to POSA patients. A larger sample and long term follow-up study might be needed.

Application of Mobile App and Paper Survey of PTSD Checklist in the Elderly Korean Veterans of the Vietnam War / 신경정신의학

OBJECTIVES: The posttraumatic stress disorder (PTSD) checklist (PCL) is currently the most popular self-report scale employed in screening PTSD. This study was conducted 1) to test the reliability and validity of PCL in veterans of the Vietnam War and 2) to compare the results when using a conventional paper survey and mobile app survey. METHODS: Participants included 186 Korean veterans of the Vietnam War. Mini Mental Status Examination, PTSD module of Structured Clinical Interview for DSM-IV (SCID), and Life Event Checklist were administered. PCL was administered in either written format or mobile app. Diagnostic validity of the PCL was compared using the PTSD module of SCID. Other psychometric properties of PCL were also calculated. RESULTS: PCL results using different methods, paper and mobile app, showed no significant difference in each item and total score. Cronbach's coefficient of PCL was 0.95, optimal cut-off 49.5, sensitivity 91.7%, and specificity 93.5%. CONCLUSION: PCL showed excellent internal reliability, sensitivity, specificity, and validity. There was no statistically significant difference between survey methods. These results suggest that PCL is a reliable self-report scale in veterans. In addition, PCL with mobile app can be helpful in screening PTSD.

Sleep Patterns and Predictors of Daytime Sleepiness in High School Students / 신경정신의학

OBJECTIVES: Various sleep patterns may be shown in adolescents to be busy for studying. The aim of this study was to investigate sleep-wake patterns and to evaluate predictors of daytime sleepiness. METHODS: Among 1011 high school students living in Cheonan-si, demographic variables and self-reported questionnaires, including items about menstruation, Morningness-Eveningness Questionnaire (MEQ), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale (ESS) were admitted. RESULTS: total of 839 students (male=453, female=386) completed questionnaires. Significant differences in sleep pattern, categorized by score of MEQ (p=0.004), ESS (p<0.001), and BDI (p=0.012) were observed between male and female subjects. Logistic regression analysis showed that excessive daytime sleepiness was predicted by female [odds ratio (OR)=2.039, p=0.022] and sleep quality (OR=1.238, p=0.004). In the regression analysis of female students, dysmenorrhea (beta=0.108, p=0.029), eating of caffeine (beta=-0.114, p=0.019), MEQ (beta=-0.108, p=0.027), insomnia (beta=0.180, p=0.002), and depression (beta=0.116, p=0.029) might be associated with daytime sleepiness. CONCLUSION: In Korean high school students, female and sleep quality might be risk factors of daytime sleepiness. Daytime sleepiness was known to be related with cognitive dysfunction. Therefore, an education program for improving sleep quality in these adolescents should be considered for mental health.

Autonomic Symptoms and Their Associated Factors in Elderly Idiopathic REM Sleep Behavior Disorder Patients

OBJECTIVES: Idiopathic REM sleep behavior disorder (RBD) is by far the strongest clinical predictor of neurodegenerative disease available. Several potential early diagnostic markers of neurodegenerative disease including autonomic symptoms have been proposed, but they have generally not been tested in presymptomatic neurodegenerative disease. So the authors investigated autonomic symptoms and their associated factors in idiopathic RBD patients. METHODS: 52 idiopathic RBD patients and 52 controls participated in the study. Autonomic symptoms were evaluated by applying the unified multiple system atrophy rating scale (UMSARS) and measuring orthostatic systolic blood pressure drop. RESULTS: Idiopathic RBD patients showed significantly higher UMSARS subscale scores and sharper drop of orthostatic systolic blood pressure than controls. In multiple linear regression analysis, all autonomic symptoms and measured orthostatic systolic blood pressure drop were associated with RBD. In addition, orthostatic symptoms were associated with medication and age, urinary function was associated with benign prostatic hyperplasia, and measured orthostatic systolic blood pressure drop was associated with hypertension. CONCLUSION: In this study, idiopathic RBD patients showed more autonomic symptoms than controls. However, other autonomic symptoms-related factors also influenced some autonomic symptoms. Prospective studies should be performed to evaluate autonomic symptoms as a potential predictor of neurodegenerative diseases.

Reviewing and Constructing Clinical Trials Database for Psychotropic Drugs in Korea / 대한정신약물학회지

OBJECTIVE: Evidence-based medicine (EBM) became an important framework to help clinicians judge and decide on what is better or desirable practice under National Insurance Scheme. Clinical trials contribute to building the data for EBM. We tried to investigate the characteristics of clinical trials which had been published in Korean psychiatry journals and constructed them as database form. METHODS: We reviewed all original articles about clinical drug trials regarding human in twenty Korean psychiatric journals published from 1995 to 2010. Inclusion criteria were randomized clinical trials (RCT), controlled clinical trials (CCT), non-controlled clinical trials (NCCT), non-trial naturalistic trials (NTN) including pharmacological intervention. Case reports and case series were excluded. Initial review and classification has been done by EBM researcher and expert review was followed by insurance committee members of Korean College of Neuropsychopharmacology. RESULTS: Total number of clinical trials was 328 and all the articles were classified according to patients subtype and intervention. Among them, NCCT was 151 (46%), NTN was 78 (23.7%), RCT was 59 (17.9%), and CCT was 36 (10.9%). In this study, the articles in The Korean Journal of Psychopharmacology were 130 (39.63%) and the proportion of RCT was the most in Journal of the Korean Neuropsychiatric Association (19.84%). The schizophrenia came with 158 (47.02%), followed by major depressive disorder and other depressive disorder, bipolar disorder, dementia, panic disorder, schizoaffective disorder, and generalized anxiety disorder. The proportion of Institutional Review Board approved study and study with research grant has increased. CONCLUSION: In this study, we investigated the characteristics of clinical trials for psychotropic drugs and finished to construct clinical trial database for psychotropic drugs in Korea. We hope this database should be used for researchers who want to collect clinical evidence data and make clinical guidelines for Korean psychiatric patients. In future, supplementation and management of clinical trial database for psychotropic drugs and quality control of articles are needed.