The Relationship Between Brain Activation for Taking Others’ Perspective and Interoceptive Abilities in Autism Spectrum Disorder: An fMRI Study

Objectives@#In this functional magnetic resonance imaging study, we aimed to investigate the differences in brain activation between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals during perspective taking. We also examined the association between brain activation and empathic and interoceptive abilities. @*Methods@#During scanning, participants from the ASD (n=17) and TD (n=22) groups were shown pain stimuli and asked to rate the level of the observed pain from both self- and other-perspectives. Empathic abilities, including perspective taking, were measured using an empathic questionnaire, and three dimensions of interoception were assessed: interoceptive accuracy, interoceptive sensibility, and interoceptive trait prediction errors. @*Results@#During self-perspective taking, the ASD group exhibited greater activation in the left precuneus than the TD group. During other-perspective taking, relative hyperactivation extended to areas including the right precuneus, right superior frontal gyrus, left caudate nucleus, and left amygdala. Brain activation levels in the right superior frontal gyrus while taking other-perspective were negatively correlated with interoceptive accuracy, and those in the left caudate were negatively correlated with perspective taking ability in the ASD group. @*Conclusion@#Individuals with ASD show atypical brain activation during perspective taking. Notably, their brain regions associated with stress reactions and escape responses are overactivated when taking other-perspective. This overactivity is related to poor interoceptive accuracy, suggesting that individuals with ASD may experience difficulties with the self-other distinction or atypical embodiment when considering another person’s perspective.

Pandemic Grief Reaction and Intolerance of Uncertainty on the Cognitive-Behavioral Model of COVID-Related Hypochondriasis Among Firefighters

Objective@#This study aimed to explore the feasibility of cognitive-behavioral model hypochondriasis regarding coronavirus disease-2019 (COVID-19) among firefighters. In addition, we examined the possible role of their grief reaction and intolerance of uncertainty in the model of COVID-related hypochondriasis. @*Methods@#An anonymous online survey was done on October 27–28, 2022, among firefighters who witnessed people’s death. Demographic characteristics were collected, and their psychological states were assessed using rating scales such as the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Fear of COVID-19 Scale (FCV-19S), Pandemic Grief Scale (PGS), and Intolerance of Uncertainty Scale–12 (IUS-12). @*Results@#Their OCS score was expected by the CRBS (β=0.30, p<0.001), FCV-19S (β=0.10, p<0.001), PGS (β=0.29, p<0.001), and IUS12 (β=0.04, p=0.024) (F=134.5, p<0.001). The COVID-related cognitive-behavioral model of hypochondriasis was feasible among firefighters who witnessed people’s death. Their pandemic grief reaction and intolerance of uncertainty directly influenced their preoccupation with coronavirus, and viral anxiety and coronavirus reassurance-seeking behavior mediated the relationship. @*Conclusion@#Firefighters’ viral anxiety and coronavirus reassurance-seeking behavior mediated the influence of pandemic grief reaction or intolerance of uncertainty on the preoccupation with coronavirus.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

Objective@#We aimed to investigate the effect of nursing professionals’ resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. @*Methods@#We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. @*Results@#Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31–1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03–1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85–0.97) were expecting variables for the depression of healthcare workers. @*Conclusion@#Nursing professionals’ level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Development of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Work-related Stress and Anxiety in Healthcare Workers in Response to Viral Epidemics

Background@#The coronavirus disease 2019, or COVID-19, has had a major psychological impact on healthcare workers. However, very few scales are available to specifically assess work-related stress and anxiety in healthcare workers responding to a viral epidemic. This study developed a new assessment tool, the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) and aimed to validate it among healthcare workers directly affected by COVID-19 in Korea. @*Methods@#A total of 1,019 healthcare workers responded through anonymous questionnaires during April 20–30, 2020. Exploratory factor analysis (EFA) was conducted to explore the construct validity, and the reliability was assessed using internal consistency measures of Cronbach's alpha coefficients. Receiver operating characteristic analysis was conducted to define the most appropriate cut-off point of SAVE-9 using the Generalized Anxiety Disorder-7 scale (GAD-7; ≥ 5). Second, Spearman's rank correlation coefficient was used to establish convergent validity for the SAVE-9 questionnaire with GAD-7 and the Patient Health Questionnaire-9. @*Results@#The nine-item scale had satisfactory internal consistency (Cronbach's α = 0.795). It adopted a two-factor structure: 1) anxiety regarding viral epidemics and 2) work-related stress associated with viral epidemics. A cut-off score of 22 for the SAVE-9 ascertained levels of stress and anxiety in response to a viral epidemic in healthcare workers that warranted clinical attention. Correlations between the SAVE-9 and the other scales were statistically significant (P < 0.05). @*Conclusion@#The results suggest that the SAVE-9 is a useful, reliable, and valid tool to evaluate stress and anxiety responses in healthcare workers during viral epidemics.

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea

Background@#The healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcare-associated infection during the early spread of COVID-19. @*Methods@#A real-time online survey was conducted between April 14–18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout Inventory-General Survey scale, and the Stress and Anxiety to Viral Epidemics-9. @*Results@#The HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73;P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07–1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31–2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21–2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09–2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression. @*Conclusion@#The present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

Objective@#We aimed to investigate the effect of nursing professionals’ resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. @*Methods@#We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. @*Results@#Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31–1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03–1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85–0.97) were expecting variables for the depression of healthcare workers. @*Conclusion@#Nursing professionals’ level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Effect of Neck Rotating Directions on the Muscle Activity of Upper and Lower Trapezius during Shoulder External Rotation

Purpose@#This study examined the effects of the directions of neck rotation on the muscle activity of the upper trapezius and lower trapezius while rotating a shoulder externally. @*Methods@#Twenty-five healthy males participated in this study. The subjects were asked to rotate their shoulder externally with 90° shoulder abduction and 90° elbow flexion in three different neck rotations (neutral, ipsilateral, and contralateral) in the prone position. The muscle activities of the upper and lower trapezius were measured using surface electromyography. One way repeated measures ANOVA was used to compare the muscle activity of the upper and lower trapezius depending on the different neck turning directions. @*Results@#In the upper trapezius, turning the neck in the ipsilateral direction while turning a shoulder externally decreased the muscle activity significantly, but the muscle activity was increased significantly by turning the neck in the contralateral direction. On the other hand, in the lower trapezius, turning the neck in the ipsilateral direction increased the muscle activity significantly, but the muscle activity was decreased significantly by turning the neck in the contralateral direction decreased it significantly. @*Conclusion@#When someone has an imbalance of shoulder function, turning the neck in the ipsilateral direction while turning the shoulder externally in the prone position is effective in decreasing the activity of the upper trapezius and increasing the activity of the lower trapezius. Therefore, these results could be used as basic evidence for researching patients with shoulder problems.

Effect of Neck Rotating Directions on the Muscle Activity of Upper and Lower Trapezius during Shoulder External Rotation

Purpose@#This study examined the effects of the directions of neck rotation on the muscle activity of the upper trapezius and lower trapezius while rotating a shoulder externally. @*Methods@#Twenty-five healthy males participated in this study. The subjects were asked to rotate their shoulder externally with 90° shoulder abduction and 90° elbow flexion in three different neck rotations (neutral, ipsilateral, and contralateral) in the prone position. The muscle activities of the upper and lower trapezius were measured using surface electromyography. One way repeated measures ANOVA was used to compare the muscle activity of the upper and lower trapezius depending on the different neck turning directions. @*Results@#In the upper trapezius, turning the neck in the ipsilateral direction while turning a shoulder externally decreased the muscle activity significantly, but the muscle activity was increased significantly by turning the neck in the contralateral direction. On the other hand, in the lower trapezius, turning the neck in the ipsilateral direction increased the muscle activity significantly, but the muscle activity was decreased significantly by turning the neck in the contralateral direction decreased it significantly. @*Conclusion@#When someone has an imbalance of shoulder function, turning the neck in the ipsilateral direction while turning the shoulder externally in the prone position is effective in decreasing the activity of the upper trapezius and increasing the activity of the lower trapezius. Therefore, these results could be used as basic evidence for researching patients with shoulder problems.

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

Measurement of Depression in Breast Cancer Patients by Using a Mobile Application : A Feasibility and Reliability Study / 신경정신의학

OBJECTIVES: This study examined feasibility and reliability of a mobile application to measure depression in breast cancer patients. METHODS: Forty-two breast cancer patients from the Department of Surgery at Asan Medical Center were included in the study. The Beck Depression Inventory (BDI), EuroQol Five Dimensional Questionnaire, and EuroQol Visual Analogue Scale were assessed at baseline and twice after surgery at regular intervals. The Patient Health Questionnaire-9 (PHQ-9) was delivered by as a push notification via mobile application every two weeks for 12 months. Feasibility was calculated using number of respondents and total number of PHQ-9 completed. Reliability was calculated from the relationship between PHQ-9 and BDI scores obtained within each two week period. Agreement between PHQ-9 and BDI scores in the diagnosis of depression was evaluated by kappa statistic and McNemar's test. RESULTS: One thousand and ninety-two notifications for PHQ-9 were sent, and 622 responses were reported (compliance rate=57%). The compliance rate was not related to demographic factors except for the date of the first use of the application. Pearson's r between PHQ-9 and BDI scores was 0.599 (p<0.001), and kappa analysis demonstrated moderate level of agreement in diagnosis of depression (κ=0.431). CONCLUSION: The compliance rate for patients reporting their symptoms by mobile application is high and the scores of PHQ-9 and BDI are correlated, which suggests that the mobile data measuring depression is reliable. However, this is a preliminary study and further study is needed to determine other factors that influence compliance rate.

Internet Game Overuser and Disembodiment : Neural Correlates as Revealed by Functional Magnetic Resonance Imaging

OBJECTIVES: The purpose of this study was to investigate the difference of brain activity between internet game overusers in adulthood and normal adults in a state of disembodiment. METHODS: The fMRI images were taken while the internet game overuser group (n = 14) and the control group (n = 15) were asked to perform the task composed of ball-throwing animations. The task reflected on either self-agency about ball-throwing or location of a ball. And each block was shown with either different (changing viewpoint) or same animations (fixed viewpoint). The disembodiment-related condition was the interaction between agency task and changing viewpoint. RESULTS: 1) In within-group analyses, the control group exhibited higher brain activation in the left precentral gyrus, the left inferior frontal gyrus, and the left insula. And the overuser group exhibited higher activation in the right cuneus, the left posterior middle occipital gyrus, and the left parahippocampal gyrus. 2) In between-group analyses, the control group exhibited higher activation in the right posterior superior temporal gyrus. And the overuser group exhibited higher activation in the left cuneus, and the left posterior middle occipital area. CONCLUSIONS: These results show that the disembodiment-related brain activation of internet game overusers in adulthood is different from that of normal adults.

Prosody Processing of Korean Language in Stroke Patients: A Preliminary Study

OBJECTIVE: To investigate the hemispheric contributions to prosody recognitions and interference effects of semantic processing on prosody for stroke patients by using the Korean language. METHODS: Ten right hemisphere damaged patients (RHD), nine left hemisphere damaged patients (LHD), and eleven healthy controls (HC) participated. In pure prosody recognition task, four semantically neutral sentences were selected and presented in both sad and happy prosodies. In interference task, participants listened to emotionally intoned sentences in which the semantic contents were congruent or incongruent with prosody. Participants were asked to rate the valence of prosody while ignoring the semantic contents, and thus, reaction time and accuracy were estimated. RESULTS: In pure prosody recognition task, RHD showed low accuracy as compared to HC (p=0.013), and the tendency of group response showed that RHD performed worse than HC and LHD with regards to accuracy and reaction time. In interference task, analysis of accuracy revealed a significant main effect of groups (p=0.04), and the tendency implied that RHD is less accurate as compared to LHD and HC. The RHD took longer reaction times than HC in congruent and incongruent items (p<0.001). CONCLUSION: Right hemispheric laterality to prosody processing of Korean language in stroke patients was observed. Interference effects of semantic contents to prosody processing were not observed, which suggested unique characteristics of prosody for Korean language. These results could be referred as preliminary data for future researches on Korean languages.

Increased Cortical Thickness in Professional On-Line Gamers

OBJECTIVE: The bulk of recent studies have tested whether video games change the brain in terms of activity and cortical volume. However, such studies are limited by several factors including cross-sectional comparisons, co-morbidity, and short-term follow-up periods. In the present study, we hypothesized that cognitive flexibility and the volume of brain cortex would be correlated with the career length of on-line pro-gamers. METHODS: High-resolution magnetic resonance scans were acquired in twenty-three pro-gamers recruited from StarCraft pro-game teams. We measured cortical thickness in each individual using FreeSurfer and the cortical thickness was correlated with the career length and the performance of the pro-gamers. RESULTS: Career length was positively correlated with cortical thickness in three brain regions: right superior frontal gyrus, right superior parietal gyrus, and right precentral gyrus. Additionally, increased cortical thickness in the prefrontal cortex was correlated with winning rates of the pro-game league. Increased cortical thickness in the prefrontal and parietal cortices was also associated with higher performance of Wisconsin Card Sorting Test. CONCLUSION: Our results suggest that in individuals without pathologic conditions, regular, long-term playing of on-line games is associated with volume changes in the prefrontal and parietal cortices, which are associated with cognitive flexibility.

Images in Psychiatry / 신경정신의학

No abstract available.

Gamma Oscillation in Schizophrenia

Dysfunctional neural circuitry has been found to be involved in abnormalities of perception and cognition in patients with schizophrenia. Gamma oscillations are essential for integrating information within neural circuits and have therefore been associated with many perceptual and cognitive processes in healthy human subjects and animals. This review presents an overview of the neural basis of gamma oscillations and the abnormalities in the GABAergic interneuronal system thought to be responsible for gamma-range deficits in schizophrenia. We also review studies of gamma activity in sensory and cognitive processes, including auditory steady state response, attention, object representation, and working memory, in animals, healthy humans and patients with schizophrenia.

Development of Meditation Treatment Program / 신경정신의학

OBJECTIVES: Despite evidence of its therapeutic benefits and popular use for health purposes, meditation is out of the medicine in Korea. For the promotion of clinical use and research, it is needed to develop the standardized and structured meditation treatment program. METHODS: The authors selected a traditional Korean meditation as the model for a new meditation treatment program and surveyed the practitioners of this form of meditation to collect information about its effects and safety. The original meditation was modified for the physically or mentally compromised to practice it. The modified meditation was then used with psychiatric patients and breast cancer patients. RESULTS: The practitioners of a traditional Korean meditation were satisfied with the positive effects of meditation on physical and mental health. Original meditation was modified as a shorter and simpler form. In an empirical trial of the modified meditation technique, psychiatric inpatients showed low motivation and little benefit, but the breast cancer patients reported improvements in physical and mental status. There were no obvious adverse effects in either of the two clinical groups. CONCLUSION: A meditation treatment program based on a traditional Korean meditation was developed and found to be safe in psychiatric and breast cancer patients. The program proved effective in improving the quality of life for breast cancer patients. Further research into the clinical efficacy and the mechanisms of this meditation treatment program is needed.

Meditation in Medical Perspective / 신경정신의학

Beyond the target of scientific researches, meditation is now one of the main tools for palliative and integrative medicine in Western society. Despite theof valuable heritages of meditation in Korea, meditation is not considered to have clinical implications as in Western medical society. It is partly due to the fact that while the mysterious aspect of meditation has been emphasized, a large number of scientific researches on meditation had not been known to Korean medical society. The authors reviewed several studies that examined the clinical effect of meditation and speculated its possibility as a method of clinical intervention.

Diffusion Tensor Imaging in Schizophrenia with Statistical Probabilistic Anatomical Mapping: A study of the Apparent Diffusion Coefficient Map / 신경정신의학

OBJECTIVES: Diffusion tensor imaging (DTI) studies of schizophrenia, thus far, have mainly focused on white matter abnormalities reflected in anisotropy indices such as fractional anisotropy (FA), but recently, new implications of apparent diffusion coefficient (ADC) have been proposed. This is, to our knowledge, the first study to analyze ADC maps of schizophrenic patients using statistical parametric anatomical mapping (SPAM). METHODS: DTI was performed in 20 schizophrenic patients and an equal number of age- and sex-matched healthy controls. ADC maps were then generated, from which 98 volumes of interest were extracted using SPAM. Probability-weighted mean values of ADC were calculated from each volume of interest and compared between the two groups. RESULTS: Significantly higher mean ADC values were observed in patients with schizophrenia compared to healthy controls in the following volumes of interest: hippocampal formation, bilateral uncus, right thalamus, right temporal lobe white matter, right superior temporal gyrus, bilateral insula and right lateral ventricle. CONCLUSION: The results support the recently proposed assertion that regionally increased ADC may reflect cortical brain atrophy. In addition, a new possibility is raised that a neuropathological event involving both the gray and the white matter may also play a role.

Social Cognition Deficits of Schizophrenia in Cartoon Task / 신경정신의학

OBJECTIVES: This study is to investigate the hypothesis that schizophrenic patients have difficulty in inferring mental state of others. METHODS: Twenty schizophrenic patients and twenty normal subjects were administered to the Cartoon Task required inferring the character's intention in a given context. RESULTS: The schizophrenic patients showed a statistically significant impairment in the Cartoon Task. Both groups chose the card depicting a frequent everyday action significantly more rather than the similar card to the last picture in each story for wrong answers. CONCLUSION: These preliminary results suggest that schizophrenia is associated with a specific deficit of the cognitive ability referred to as social cognition, and this deficit can be detected not only in the acute phase as found in previous research studies, but also in remission. Also when subjects fail to appreciate what is going on in the minds of other people, they seem to rely on a socially familiar experience.

The Contemplation of Neuropathological Abnormalities of the Corpus Callosum in Schizophrenia: A Diffusion Tensor Imaging Study / 신경정신의학

OBJECTIVES: Diffusion tensor imaging (DTI) is a new technique that can be used to visualize and measure the diffusion of water in brain tissue. It is particularly useful for evaluating white matter abnormalities. In this paper, we investigated the neuropathology of the corpus callosum in patients with schizophrenia through the new methods, diffusion tensor imaging. METHODS: Diffuse tensor imaging was performed in 19 schizophrenic patients and 26 healthy controls. One complementary measure, fractional anisotropy (FA), which is considered to be sensitive indices of axonal integrity, was obtained from regions of interest in the five areas of the corpus callosum. Neuropsychological measurement also underwent for measurement of frontal lobe function in two groups. RESULTS: There were no significant differences of FA in the DTI measures for either the schizophrenic patients compared with controls. FA was significantly decreased in women compared with men. Neuropsychological measurements such as Wisconsin card sorting test were correlated with FA of patients with schizophrenia. CONCLUSION: FA measures revealed no differences between schizophrenia and controls. The findings suggest that the structural integrity of white matter in patient with schizophrenia was not disrupted. The results are discussed in relation to previous studies reporting positive and negative findings. It is concluded that further studies using DTI in larger samples, improved and standardized methods of data acquisition and analysis are needed.