Development of a Modified Korean Version of the Epworth Sleepiness Scale Reflecting Korean Sociocultural Lifestyle

OBJECTIVE: The Epworth Sleepiness Scale is a measure used for the diagnosis of sleep disorders including obstructive sleep apnea (OSA) syndrome, insomnia, and narcolepsy. Although a Korean version has been developed (the KESS), Korean lifestyle such as the floor culture and low driving rates has not been considered. We aim to develop and validate a modified KESS (mKESS) that reflects the Korean lifestyle. METHODS: The sample consisted of 795 healthy participants and 323 OSA patients. The mKESS was developed by modifying several questions to concern the floor culture (questions 1, 2, 6, and 7) and low driving rates (question 8). Feasibility of the modification was tested by comparing the KESS and mKESS using paired samples t-test and by examining internal consistency reliability. Then, mKESS scores of the OSA patients and general participants were compared to test its validity. RESULTS: Questions 1, 2, 7, and 8 were significantly different when comparing the performances of the general population on both scales. Especially, the mean scores on question 8 were significantly different in the non-driver group, but not in the driver group. Cronbach’s alpha of the mKESS was relatively higher than that of the KESS. Total mKESS scores of the OSA patients were significantly higher than that of the general population. CONCLUSION: The mKESS is more universally applicable for the clinical evaluation of people that live in Korea. Results support that the mKESS can be administered to measure the average daytime sleep propensity of the Korean population as an alternative to the KESS.

Circadian Polymorphisms in Night Owls, in Bipolars, and in Non-24-Hour Sleep Cycles

People called night owls habitually have late bedtimes and late times of arising, sometimes suffering a heritable circadian disturbance called delayed sleep phase syndrome (DSPS). Those with DSPS, those with more severe progressively-late non-24-hour sleep-wake cycles, and those with bipolar disorder may share genetic tendencies for slowed or delayed circadian cycles. We searched for polymorphisms associated with DSPS in a case-control study of DSPS research participants and a separate study of Sleep Center patients undergoing polysomnography. In 45 participants, we resequenced portions of 15 circadian genes to identify unknown polymorphisms that might be associated with DSPS, non-24-hour rhythms, or bipolar comorbidities. We then genotyped single nucleotide polymorphisms (SNPs) in both larger samples, using Illumina Golden Gate assays. Associations of SNPs with the DSPS phenotype and with the morningness-eveningness parametric phenotype were computed for both samples, then combined for meta-analyses. Delayed sleep and "eveningness" were inversely associated with loci in circadian genes NFIL3 (rs2482705) and RORC (rs3828057). A group of haplotypes overlapping BHLHE40 was associated with non-24-hour sleep-wake cycles, and less robustly, with delayed sleep and bipolar disorder (e.g., rs34883305, rs34870629, rs74439275, and rs3750275 were associated with n=37, p=4.58E-09, Bonferroni p=2.95E-06). Bright light and melatonin can palliate circadian disorders, and genetics may clarify the underlying circadian photoperiodic mechanisms. After further replication and identification of the causal polymorphisms, these findings may point to future treatments for DSPS, non-24-hour rhythms, and possibly bipolar disorder or depression.

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.

Evaluation of Two Circadian Rhythm Questionnaires for Screening for the Delayed Sleep Phase Disorder

OBJECTIVE: Delayed sleep phase disorder (DSPD) is a condition in which patients often fall asleep some hours after midnight and have difficulty waking up in the morning. Circadian chronotype questionnaires such as Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) and Basic Language Morningness (BALM) scale have been used for screening for DSPD. This study was to evaluate these two chronotype questionnaires for screening of DSPD. METHODS: The study samples were 444 DSPD and 438 controls. Cronbach's alpha coefficient was calculated to evaluate for internal consistency. An exploratory factor analysis was conducted using principal-axis factoring. The diagnostic performance of a test was evaluated using Receiver Operating Characteristic (ROC) curve analysis. A discriminant function analysis was also performed. RESULTS: For internal consistency, Cronbach's alpha of 0.898 for BALM was higher than the 0.837 for MEQ, though both have acceptable internal consistency. BALM has better construct validity than the MEQ because some MEQ items measure different dimensions. However, when we evaluated the efficiency of two questionnaires for DSPD diagnosis by using the ROC curve, the BALM was similar to the MEQ. In a discriminant analysis with the BALM to classify the two groups (DSPD vs. normal), 6 items were identified that resulted in good classification accuracy. Upon examination of the classification procedure, 94.2% of the originally grouped cases were classified correctly. CONCLUSION: These findings suggest that the BALM has better psychometric properties than the MEQ in screening and discriminating DSPS.

No Evidence for Association between Tyrosine Hydroxylase Gene Val81Met Polymorphism and Susceptibility to Tardive Dyskinesia in Schizophrenia

OBJECTIVE: Tyrosine hydroxylase (TH) is the rate-limiting enzyme in dopamine biosynthesis. Because the TH Val81Met polymorphism is located in the amino-terminal regulatory domain of the tetrameric enzyme, it is a candidate marker for susceptibility to dopamine-related traits. We investigated the hypothesis that TH Val81Met polymorphism can influence susceptibility to tardive dyskinesia (TD) in schizophrenia. METHODS: TH Val81Met polymorphism was analyzed by PCR-based methods in 83 schizophrenic patients with TD and 126 schizophrenic patients without TD, matched for antipsychotic drug exposure and other relevant variables. RESULTS: There was no significant association of the genotype and allele frequencies determined by the TH Val81Met polymorphism between TD and non-TD patients. In addition, there was no significant difference in terms of total Abnormal Involuntary Movement Scale scores among the three genotype groups. CONCLUSION: Within the limitations imposed by the size of the clinical sample, these findings suggest that the Val81Met polymorphism of the TH gene does not contribute significantly to the risk for TD.

Disability Identity According to the Severity of Disabilities in Persons with Spinal Cord Injury

OBJECTIVE: To investigate the disability identity and life satisfaction according to the severity of disability in the spinal cord injured persons resident in the community. METHOD: The subjects of this national wide study were 397 spinal cord injured persons resident in the community. We investigated their disability identity, life satisfaction, depression, social integration and social support. The questionnaire included the newly developed disability identity scale to evaluate the disability identity, that consisted of five sub-scales (personal worth, self-acceptance with the disabled, individual civil right, common cause and external barriers) and 23 questions. The subjects were divided into four groups according to severity of disability: motor complete tetraplegia, motor incomplete tetraplegia, motor complete paraplegia and motor incomplete paraplegia. RESULTS: The scores of life satisfaction, depression and social support were not different according the four groups. However the disability identity scale of the motor incomplete paraplegia was lower than motor complete tetraplegia or motor complete paraplegia (p<0.05). The sub-scale score of the personal worth and self-acceptance were lower in less severely disabled persons. As the disability identity scale was higher, social integration (r=0.478, p=0.000), and social support (r=0.465, p=0.000) were moderate and the depression was negative (r=-0.252, p=0.000). Conclusion: Less severely disabled persons showed lower disability identity. Disability identity scale was significantly correlated with higher social integration, higher social support and lower depression score. The newly developed disability identity scale will be a useful tool for the evaluation of the psychological status and planning the rehabilitation strategy for spinal cord injured persons.

A Development of Korea Depression Scale / 신경정신의학

OBJECTIVES: This study was intended to develop the Korean Depression Scale (KDS) which reflects our culture and custom. METHODS: Participants were 3,707 normal adults selected from 12 administrative districts (Do) and 142 depressed patients. Internal consistency was calculated and construct and discrimination validation were performed. And ROC analysis was used to testify diagnostic efficiency for depressed patient. RESULTS: KDS was proved to be a reliable instrument (Cronbach alpha=.95) and it consisted of 6 factors; Negative thinking toward the future, Negative thinking toward the self, Worry and agitation, Depressed mood, Somatization, and Loss of volition. Patients' KDS score mean was higher than normal group's significantly. Diagnostic efficiency was 73.1% and the male's full scale cutoff score was 65, female 70. CONCLUSION: These results suggest that KDS is a reliable and valid tool which reflects Korean culture and custom. And the KDS will be useful in diagnostic evaluation of depression and treatment outcome study.

The Relationship among Eating Traits, Personality Characteristics, and Other Psychopathology in the Korean General Population / 신경정신의학

OBJECTIVE: The purposes of this study were to clarify the roles of personality characteristics and general psychopathology, including depression and hypochondriasis, in individuals with eating disorders, and to test a continuum hypothesis of eating disorders. METHODS: Using a multi-stage questionnaire sampling method including area sampling, proportionated stratified sampling, and quota sampling, we surveyed 3,062 subjects(1249 males and 1813 females) from a target of 4,400 Korean adults over the age of 18 in a nationwide area(9 ku's, 10 middle or small cities, and 17 kun's). We used the questionnaire which consisted of three parts:general information, scales for eating traits, and scales for personality characteristics and other general psychopathology. RESULTS: Psychoticism was the only personality characteristics which had a significant relationship with various eating traits including 'eating habits'(r=-0.3195), 'the Eating Attitudes Test'(EAT, r=0.3657), and 'preference for vegetables and fish, and dislike for sweet,tasting foods'(r=-0.2740). Lie scale also had a significant relationship with 'preference for snacks and instant foods'(r=-0.2117). These results were consistent in examining the relationships across genders. In female, there was a significant relationship between 'preference for the traditional Korean foods' and 'psychoticism'(r=-0.2103) in addtion to above relationships. However, there were no significant relationships between any of the eating traits and other psychopathology. Relative to the relationship between personality characteristics and general psychopathology, there were significant correlations between 'depression' and 'interoversion-extraversion'(r=-0.2174), 'depression' and 'neuroticism'(r=0.4510>, and 'hypochondriasis' and 'neuroticism'(r=0.3432). These correlations in female was the same as those of the total group, while among males, 'depression' was significantly correlated with all four personality characteristics, and 'hypochondriasis' was significantly correlated with 'interoversion-extraversion'(r=-0.2265) and 'neuroticism'(r=0.3762). CONCLUSION: These results suggest that psychoticism is the only personaltiy characteristics related to eating-specific psychopathology, while general psychopathology, such as depression and hypochondriasis is not related to eating pathology but may influence eating disorders by their interaction with other personality characteristics, such as interoversion-extraversion and neuroticism. Considering the results of previous studies in the patients with eating disorders and high risk groups, which are similar with our results in the general population, our results support a continuum hypothesis of eating disorders. Our results also suggest that gender differences in the pathology of eating disorders are the result not of difference in eating-specific pathology itself but through difference in influences of concurrent general psychopathology, such as depression and hypochondriasis.

A Preliminary Study on the Standardization of Korean Version of the Family Adaptability and Cohesion Evaluation Scale II-a Reliability and Validity / 신경정신의학

OBJECTIVES: Family environment is important in treatment, course, relapse, and prognosis of psychiatric illnesses. Thus the evaluation of family structure and the family therapy is important in the investigation and treatment of psychopathology. This preliminary study was designed to attempt to verify the reliability and validity of a Korean version of Family Adaptability and Cohesion Evaluation Scale II(K-FACES II) which evaluate the adaptability and cohesion of family structures. METHOD: The translated FACES II which constructed a questionnaire composed of a total of 30 items was applied to 124 members from families with no psychiatric patient in Seoul and Pusan by random sampling. Then the authors extracted the factors which were able to compose the scale and evaluated the concurrent reliability. Also for the discriminative validity test, the authors selected 62 members, who have been no psychiatric history, of families with schizophrenic patient diagnosed with the criteria of DSM-IV who have been treated in Seoul National Mental Hospital and 60 members of families without schizophrenic patient in Seoul and Pusan for control. RESULT: The results were as follows: The authors extracted 5 subscales of emotional bonding, acceptability and sharing, participation, negotiation and satisfaction, responsibility and expectation of 'Family Adaptability and Cohesion Evaluation Scale' which constructed a questionnaire composed of a total of 23 items. Cronbach's alpha value of each subscale which show its internal consistency was .83, .75, .71, .75, .71 respectively. In the discriminative validity test, all subscales except 'responsibility and expectation' subscale significantly discriminated between family group with schizophrenic patient and control group. CONCLUSION: These findings confirmed the high reliability and validity of preliminary form of K-FACES II and suggest the possibility that K-FACES II could be a useful measure to evaluate the adaptability and cohesion of family structures. But we think that further study should be needed considering some limitations that 7 items were excluded and extracted factors could not be matched with FACES in factor analysis.

Neuropsychology of Memory / 수면정신생리

This paper reviewed models to explain memory and neuropsychological tests to assess memory. Memory was explained in cognitive and neuroanatomical perspectives, Cognitive model describes memory as structure and process. In structure model, memory is divided into three systems: sensory memory, short-term memory(working memory), and long-term memory. In process model, there are broadly three categories of memory process: encoding, storage, and retrieval. Memory process work in memory structure. There are two prominent models of the neuroanatomy of memory, derived from the work of Mishkin and Appenzeller and that of Squire and Zola-Morgan. These two models art the most useful for the clinician in part because they take into account the connections between the limbic and frontal cortical regions, The major difference between the two models concerns the role of the amygdala in memory processess. Mishkin and his colleagues believe that the amygdala plays a significant role while Squire and his colleagues do not, The most popular and widely used tests of memory ability such as WMS-R, AVLT, CVLT, RBMT, CFT, and BVRT-R, were reviewed.

The preliminary study of the Korean alcoholism screening test(III) / 신경정신의학

No abstract available.