Predicting Behavior Problems in Korean Preschoolers: Interactions of the SLC6A4 Gene and Maternal Negative Affectivity.

OBJECTIVE: This study aimed to investigate whether maternal negative affectivity (MNA) moderates the effect of genetic polymorphism of SLC6A4 on behavior problems in children. METHODS: Study participants comprised 143 preschoolers and their mothers from South Korea. The Childhood Behavior Checklist and Emotionality, Activity, and Sociability adult scale were used to measure child behavior and maternal affectivity. DNA from saliva was genotyped to determine serotonin transporter polymorphism. RESULTS: MNA appeared to exert effects in externalizing (b =5.78, p＜0.001) and internalizing problems (b =6.09, p＜ 0.001). Interaction between SLCA4 polymorphism and MNA showed effects on externalizing (b =-7.62, p＜0.01) and internalizing problems (b =-9.77, p＜0.01). Children with two short alleles showed considerable differences in both externalizing and internalizing problems according to MNA; however, children with one short allele or none showed relatively few differences in behavior problems due to maternal affectivity. CONCLUSION: The effect of SLC6A4 polymorphism on child behavior seemed to be moderated by MNA. In addition, the impact of MNA was found to vary based on a child’s genetic risk. High MNA may trigger the risk allele while low MNA causes the risk allele to illicit less behavior problems. Children with two short variants of the SLC6A4 gene may benefit from intervention that modulates MNA.

A 7-year follow-up study on the mental health of North Korean defectors in South Korea.

This study was conducted to describe the relationship of past trauma and current stress on the mental health of North Korean (NK) defectors living in South Korea 7 years after a baseline assessment. Of the 200 who participated in the initial study, 106 participated in follow-up. Previous data regarding past traumatic events experienced in North Korea and during defection, past posttraumatic stress disorder (PTSD), and their current stress levels were correlated with the participants' current mental health status including depression, anxiety, and PTSD. The rate of PTSD in the sample and the scores on the PTSD symptom scale decreased significantly from the baseline. The participants' current mental health was negatively related to previous traumatic experiences in North Korea and past symptoms of PTSD, but unrelated to previous trauma experienced during defection. In addition, although current mental health was negatively related to only current culture-related stress, it was unrelated to the level of current ordinary life stress. The results of this study suggest that PTSD symptoms decreased during the 7 years between assessments, and that current culture-related stress is the most important variable related to the mental health of NK defectors living in South Korea.

Differences in temperament and character dimensions of personality between patients with Hwa-byung, an anger syndrome, and patients with major depressive disorder.

OBJECTIVE: This study examined differences in temperament and character dimensions of personality between patients with Hwa-byung (HB) and those with major depressive disorder (MDD). METHOD: Of 144 participants, 96 completed the Korean version of the Temperament and Character Inventory-Revised Short (TCI-RS) and the Hwa-byung Scale. We diagnosed participants according to the DSM-IV and the Research Diagnostic Criteria for Hwa-byung. We compared TCI scores between the HB group (with or without MDD; N=55) and the MDD-only group (N=41) and correlated them with the total scores on six HB-specific symptoms (global HB severity) on the Hwa-byung Scale. RESULTS: Compared to patients with only MDD, patients with HB with or without MDD exhibited significantly higher scores on Impulsiveness; Harm Avoidance (HA) and its subscales of Anticipatory Worry; and Self-Transcendence (ST), with its subscale of Self-Forgetfulness. However, HB patients had lower scores on Self-Directedness, with its subscales of Responsibility, and Self-Acceptance; and Acceptance. Moreover, Global HB Severity had significant, positive correlations with ST, its subscale Self-Forgetfulness, and Anticipatory Worry but negative correlations with Attachment and Compassion. LIMITATIONS: Our data are cross-sectional and self-reported, so they are subject to personal perceptual bias. The number of participants may be too low for us to generalize the results. CONCLUSION: These results suggest that HB is a different clinical entity from MDD in relation to personality traits, and that symptoms unique to HB are closely correlated with ST.

Posttraumatic stress disorder in former 'comfort women'.

OBJECTIVE: This study investigated the mental health of former 'comfort women' who serviced the Japanese Imperial Military during the Second World War. METHOD: We evaluated 26 former comfort women's life histories, cognitive functioning, DSM-IV diagnosis of posttraumatic stress disorder (PTSD), depression, paranoid state, anger, and Rorschach test results, and compared the data with those of 24 healthy women. RESULTS: Cognitive functioning was not significantly different between former comfort women and the comparison group. All 26 former comfort women had undergone traumatic experiences such as sexual slavery and had suffered PTSD symptoms at least once in their lives. Of the 26, 8 (30.8%) were diagnosed as having PTSD, as opposed to none in the comparison group. The women's PTSD symptoms were characterized by avoidance behavior, intrusive and distressing recollections, and anger. There were no significant differences in depression or paranoid state between the two groups, but former comfort women had impairments in anger control. Former comfort women with PTSD were more depressed. On the Rorschach test, former comfort women revealed characteristic responses related not only to sex and morbidity but also to anger and violence. LIMITATIONS: The small number of subjects might not represent all former comfort women. Some data collected by self report might limit the objectivity of the results. CONCLUSIONS: The results suggest that former comfort women are still suffering from traumatic memories, symptoms of PTSD, including avoidant behavior, and anger control impairment, even 60 years after the end of the war.

No evidence of an association between A218C polymorphism of the tryptophan hydroxylase 1 gene and aggression in schizophrenia in a Korean population.

PURPOSE: We investigated the association between the tryptohan hydroxylase 1 (TPH1) gene and aggression in schizophrenia in a Korean population. MATERIALS AND METHODS: The sample included 61 aggressive patients as well as 104 non-aggressive patients from psychiatric hospitals and 335 healthy volunteers in Korea. Blood samples were collected from all participants for TPH1 A218C genotyping. The patients were administered standard psychiatric interviews as well as a self-report questionnaire for anger-related traits. RESULTS: In the case-control phenotypic comparisons, there was no significant association between the aggressive patients and the TPH1 A218C polymorphism. There was no significant effect of the TPH1 genotype on the anger-related traits, or no significant interaction between the genotype and group (aggressive and non-aggressive patients). CONCLUSION: These findings suggest that TPH1 does not play a major role in aggressive behavior via anger in schizophrenic patients.

The anger syndrome hwa-byung and its comorbidity.

BACKGROUND: The aim of this study was to identify patients with hwa-byung (HB), a Korean culture-related anger syndrome, and to compare the comorbidities of HB with those of other psychiatric disorders. METHODS: The study participants included 280 patients with depressive disorders, anxiety disorders, somatoform disorders, adjustment disorders, or self-labeled hwa-byung. For all patients, the DSM-IV diagnosis was made using the Korean version of the Structured Clinical Interview for the DSM-IV Diagnosis (SCID-1). The diagnosis of HB was made according to research diagnostic criteria of HB. Assessment of HB symptoms was performed using the Hwa-byung Scale. RESULTS: Female patients were more and mean age was older in HB group than non-HB group. Of 280 patients, 183 patients were diagnosed with HB. Forty-seven of these patients had only HB, and the rest had various comorbid DSM-IV diagnoses, with major depressive disorder (MD) and generalized anxiety disorder (GAD) being the most frequent. The distributions of single diagnoses and comorbid diagnoses were similar for HB, MD and GAD. LIMITATIONS: Sample size may be small, axis II diagnoses were not assessed, and patients with psychotic features were not included. CONCLUSIONS: Our results suggest that HB, which comprises unique anger-related symptoms, is comparable to MD or GAD in comorbidity profile.

Testing women's propensities to leave their abusive husbands using structural equation modeling.

BACKGROUND: Many Korean women are just beginning to recognize that what they considered to be normal treatment is actually domestic violence. Many are becoming more intolerant of the abuse and more likely to desire to leave an abusive relationship. OBJECTIVE: The aim of this study was to test, using the framework of sociostructural and psychological-relational power (PRP), a model of Korean women's propensities to leave their abusive husbands. METHODS: Multigroup structural equation modeling was used to test relationships between variables chosen from the sociostructural power and PRP to explain intolerance to abuse. Married Korean women (n = 184) who self-identified as being abused physically, psychologically, sexually, or financially participated in the study. RESULTS: The multigroup analysis revealed that the relationship of abuse and Hwa-Byung (a culture-bound syndrome that denotes Korean women's anger) with intolerance was supported for women with low education (defined as having an education of high school or less: < or =12 years); also for this group, particularly among the younger women, high power was related to high levels of reported abuse and abuse intolerance. For women in the high-education group (education beyond high school: > or =13 years), high power was related to abuse, Hwa-Byung, and abuse intolerance; age did not influence power. Overall, the multigroup model adequately fitted the sample data (chi2 = 92.057, degree of freedom = 50, p = .000; normal fit index = .926, comparative fix index = .964, root mean square error of approximation = .068, Hoelter's critical number = 152), demonstrating that education is a crucial moderator of Korean women's attitude toward the unacceptability of abuse and propensity to terminate the marriage. DISCUSSION: This study found support for a model of abuse intolerance using the framework of sociostructural power and PRP, primarily for the low-education group. Hwa-Byung was a mediating factor that contributed to intolerance to abuse in women with low education. This study highlights the importance of understanding the cultural assumptions that guide Korean women's beliefs and behaviors about abuse intolerance, suggesting that effective intervention programs should be specific to age and education, including a focus on resource availability, which could clarify the variations in Korean women's responses to abuse intolerance.

Association between the serotonin transporter gene (5-HTTLPR) and anger-related traits in Korean schizophrenic patients.

BACKGROUND: The serotonin transporter-linked polymorphic region (5-HTTLPR) short allele confers a general sensitivity to environmental stimuli, and anger is suspected to have a direct influence on aggressive behavior in schizophrenia. In the present study, we investigated whether the 5-HTTLPR gene was associated with aggression and/or anger-related traits in schizophrenia. METHODS: A total of 103 schizophrenic patients, including 46 aggressive and 57 nonaggressive patients, were recruited from psychiatric hospitals in Korea. All of the aggressive patients had committed at least 2 significant violent acts requiring repeated confinement in each of the 2 weeks preceding study inclusion, as well as 2 or more serious assaults on others. Blood samples were collected from all patients for 5-HTTLPR genotyping, and all patients underwent clinical assessments for symptoms of schizophrenia, aggressive behavior and anger-related traits. RESULTS: There was no significant difference in the distribution of the 5-HTTLPR genotype/alleles between the aggressive and nonaggressive patients. Aggressive patients carrying the s allele exhibited more anger-related traits than those with the l/l homozygotes, but this difference was not significant after correction for multiple testing. Furthermore, there was a dose-dependent relationship between the s allele and high angry temperament subscale scores in the aggressive patients. CONCLUSION: These findings seem to support the idea that 5-HTTLPR predisposes aggressive patients to exhibit more anger-related traits, though they do not support the existence of a direct association between 5-HTTLPR and aggressive behavior in schizophrenia in the Korean population; however, larger studies are needed.

Aggressive behavior model in schizophrenic patients.

This study aimed to determine the optimal model for explaining the aggressive behavior of schizophrenic patients in relation to certain behavioral variables including anger, schizophrenic symptoms, and cognitive function. Schizophrenic patients were evaluated with the Modified Overt Aggression Scale (MOAS) for aggressive behaviors, with irritability and resentment; with the Buss-Durkee Hostility Inventory (BDHI) for anger; with the Wisconsin Card Sorting Test (WCST) and the Grooved Pegboard Test for cognitive function; and with the Positive and Negative Syndrome Scale (PANSS) for schizophrenic symptoms. The structural equation model (SEM) in AMOS 7 for the score of "aggressive behavior in the last week" in the MOAS, was used for statistical analysis. For the SEM, two factors (irritability and resentment) were selected from the BDHI and constituted the anger construct. Through factor analysis, two factors (executive function and motor function) were selected from the cognitive function measurements to constitute the cognitive function construct. Two factors (positive and negative symptoms) in the PANSS constituted the symptom construct. The best model for aggressive behavior (MOAS) with three constructs revealed a direct, significant path of "anger emotion to aggressive behavior". This result suggests that the aggressive behavior of schizophrenic patients is directly related to anger. Schizophrenic symptoms and cognitive function were indirectly related to aggressive behavior through the relationship between the emotion of anger and aggressive behavior.

Symptoms to use for diagnostic criteria of hwa-byung, an anger syndrome.

OBJECTIVE: The aim of this study was to identify the characteristic symptoms which can be used for the diagnosis of hwa-byung, a culture-related anger syndrome in Korea. METHODS: The symptoms of the Hwa-byung Scale were correlated with the Korean versions of the Hamilton Depression Rating Scale (K-HDRS) and the State and Trait Anger Inventory (K-STAXI) in 89 patients, who were diagnosed as having major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria and who had self-labeled hwa-byung. Also, the symptoms of the Hwa-byung Scale were correlated with each other. RESULTS: The symptoms of the Hwa-byung Scale which were significantly correlated with the state anger of the K-STAXI but not with the depressive mood (item 1 of K-HDRS) included feelings of unfairness, subjective anger, external anger, heat sensation, pushing-up in the chest, dry mouth, and sighing. The symptoms which were significantly correlated with state anger and depressed mood included respiratory stuffiness, "haan" and hate. The symptoms which were not significantly correlated with depressed mood and state anger included going-out, epigastric mass, palpitation, headache/pain, frightening easily, many thoughts, and much pleading. These symptoms also showed higher correlation with each other in the correlation matrix. CONCLUSION: Our findings suggest that hwa-byung is different from depressive syndrome in terms of its symptom profile, and suggest what symptoms should be included in the diagnostic criteria of hwa-byung, an anger disorder.

Mental health and quality of life of North Korean defectors living in Japan.

The aim of this study was to clarify the effect of migration of North Korean defectors to different host countries on the mental health and quality of life of the migrants by comparing three subject groups: North Korean defectors living in Japan, a group of Japanese workers living in Japan (for comparison), and North Korean defectors living in South Korea. The North Korean defectors living in Japan scored significantly higher on the Beck Depression Inventory, and also scored lower across all domains of the World Health Organization Quality of Life Assessment than the other two groups. However, no significant difference in the overall quality of life score was observed between the North Korean defectors living in Japan and the Japanese workers, while the North Korean defectors living in South Korea scored significantly higher as compared to both. These findings suggest that the insecurity of social factors because of poor fluency in the language of the host country, unemployment and unclear nationality, and the limited support system may contribute to the poor mental health and low quality of life of North Korean defectors living in Japan. Migration may promote a sense of achievement and improve the overall quality of life, but attention must be paid to the pervasive depression in these migrants.

Catechol-O-methyltransferase Val158Met polymorphism in relation to aggressive schizophrenia in a Korean population.

We examined the association between the Catechol-O-methyltransferase (COMT) Val158Met polymorphism and aggressive schizophrenia. The sample included 61 aggressive schizophrenic patients as well as 104 non-aggressive patients from psychiatric hospitals and 415 healthy volunteers in South Korea. In the case-control comparisons, there was no significant association between the aggressive schizophrenic patients and the COMT Val158Met polymorphism. Looking only at the subgroup of aggressive schizophrenic patients, however, we found a dose-dependent relationship between the Met allele and verbal aggression. In this subgroup, the Met carriers showed a higher verbal aggression score than those with the Val/Val homozygote. These findings support the hypothesized moderating role of the COMT gene in the aggressive behaviour in some schizophrenic patients, though they do not support the existence of a direct association between the COMT Val158Met polymorphism and aggressive schizophrenia case status in the Korean population.

Construct validity of the Korean Women's Abuse Intolerance Scale.

BACKGROUND: Domestic violence against married women has persisted throughout Korean history. However, very little empirical research has been conducted in Korea about domestic violence, its causes, or women's responses. OBJECTIVE: To develop and test psychometrically the Korean Women's Abuse Intolerance Scale (KWAIS) to measure women's propensity or desire to leave abusive husbands in Korea. METHODS: The first phase of the investigation involved qualitative research to explore the themes of women's responses to domestic violence and the development of the instrument. The second phase was a preliminary study conducted to examine women's responses to domestic violence. In the third phase, construct validity of the scale was established, using a sample of 184 married women living in Korea. RESULTS: The KWAIS adequately supported the underlying theory of women's responses to domestic violence, demonstrating strong content validity, high internal consistency (Cronbach's alpha of .98), and criterion-related validity evidenced by significant correlations that supported hypotheses among abuse intolerance and abuse (r = .69), traditional family ideology (r = -.78), marital satisfaction (r = -.85), attitude toward power ascription (r = .63), and collectivism (r = -.88). Factor analysis yielded a four-factor structure, explaining 78.4% of the common variance. Factor loadings ranged from .65 to .93. DISCUSSION: The findings for the psychometric properties of the KWAIS established its potential as a research instrument in measuring Korean women's propensity or desire to leave abusive husbands. Future studies need to focus on determining the predictive validity of the KWAIS and evaluating cross-cultural differences in women's propensity or desire to leave abusive husbands.

Clinical correlates of hwa-byung and a proposal for a new anger disorder.

This paper reviewed the studies on hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, I have proposed a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from those of the depressive disorders, which have been postulated to be similar to HB. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. I propose that the new anger disorder to be included in the new international classification system as a member of the larger family of mood disorders. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder.

Divided countries, divided mind 1: psycho-social issues in adaptation problems of north korean defectors.

A review of studies on the adaptation problems of North Korean defectors in South Korean society and studies of people's adaptation to political and cultural changes in other countries suggests that similar adaptation problems may occur in the process of and after unification. Defectors have various adaptation problems and some of them have psychiatric disorders such as depression and post-traumatic stress disorder (PTSD). The reasons for this were revealed to be the difference in the culture and personality between South and North Korea, which have developed for the last 60 years without any communication with each other, in spite of their common racial and cultural heritage. Economic factors including the lack of skills and knowledge for working at industrialized and competitive society like South Korean society, also aggravate the severity of such adaptation problems. Research on defectors' adaptation problems and on the differences in the culture and mentality between North and South Korea can provide useful information on what kinds of problems may arise during the process of and after unification and what should be done to achieve mutual adaptation and harmonious and peaceful unification.

Development of a structural model explaining medication compliance of persons with schizophrenia.

The purpose of this study was to develop and test a structural model explaining medication compliance of schizophrenia. From a review of the literature, a hypothetical model was developed based on the conceptual framework of the Health Belief Model with medication knowledge, symptom severity and social support as the exogenous variables, and perceived benefits, perceived barriers, substance use and medication compliance as the endogenous variables. Data was collected at various mental health facilities, including psychiatric outpatient clinics of general hospitals and community mental health centers, between March and May, 2001. A structured questionnaire was used by one- on- one interviews to collect data on 208 schizophrenic patients. Well established measurement instruments, with confirmed reliability, were used to assess each method variable. As a result of covariance structural analysis, the hypothetical model was found not to fit the empirical data well, so a parsimonious model was adopted after modifying the model. The final model was able to explain the 33 % medication compliance. Medication knowledge, social support and perceived benefits had significant effects on medication compliance. The findings of this study address the importance of medication education and social support to promote medication compliance. It is also suggested that various education programs and support groups are needed to enhance medication compliance.

Differences in beta-adrenergic receptor sensitivity between women and men with panic disorder.

This study was conducted on patients with panic disorder (PD) to examine the gender differences in the pathophysiology of PD by evaluating and comparing the value of CD(25)/wt, the chronotropic 25 dose of isoproterenol (CD(25)) divided by the body weight, which reflects the in vivo index of beta-adrenergic receptor sensitivity. This study included a total of 70 subjects, including 35 patients with PD (female: 13, male: 22) along with 35 healthy control subjects (female: 13, male: 22). There were significant differences in the mean value of CD(25)/wt (0.073+/-0.045 microg/kg vs. 0.032+/-0.019 microg/kg; p=0.006) and the serum epinephrine (EPI) level (77.3+/-64.1 pg/ml vs. 31.6+/-10.3 pg/ml; p=0.001) between the female panic patients and the female control subjects. However, there were no differences in either the CD(25)/wt value or the EPI level between the male panic patients and the male control subjects. These results suggest that the beta-adrenergic receptor sensitivity decreased in the female patients, but not in the male patients, which provides evidence for the possible existence of a gender difference in the pathophysiology of PD.

Effects of ginseng saponin administered intraperitoneally on the hypothalamo-pituitary-adrenal axis in mice.

Intraperitoneal injection of ginseng total saponin (GTS; 5 and 20 mg/kg) raised plasma corticosterone levels in mice. However, interestingly, pretreatment of animals with the same doses of GTS (5 and 20 mg/kg) significantly attenuated the immobilization stress-induced increase in plasma corticosterone levels. Of the ginsenosides Rb(1), Rb(2), Rc, Rd, Re, Rf, Rg(1), 20(S)-Rg(3), and 20(R)-Rg(3) injected intraperitoneally at doses of 0.1-2 mg/kg, Rc (2 mg/kg) significantly inhibited the immobilization stress-induced increase in plasma corticosterone levels. GTS and Rc administered intraperitoneally did not affect the immobilization stress-induced elevation of plasma adrenocorticotropic hormone (ACTH) level. Pretreatment with GTS and Rc significantly attenuated the increase in plasma corticosterone levels induced by intraperitoneal injection of ACTH (30 microg/kg). These results suggest that GTS and Rc inhibit the immobilization stress-induced increase in plasma corticosterone levels by blocking ACTH action in the adrenal gland. Ginseng may be proposed to be useful for treatment of stress related disorders.