Effects of Atomoxetine on Height and Weight in Korean Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Kukju Kweon,Je Sik Yoon,Kee Jeong Park,Seon-Ok Kim,Jin-Ho Choi,Hyo-Won Kim 대한신경정신의학회 2018 PSYCHIATRY INVESTIGATION Vol.15 No.6

Objective We aimed to investigate the long-term effects of atomoxetine on growth in Korean children and adolescents with attentiondeficit/hyperactivity disorder (ADHD). Methods The medical records of 82 subjects (mean age, 9.0±2.0 years; 64 boys) with ADHD treated with atomoxetine for at least 1 year at the Department of Psychiatry at Asan Medical Center were retrospectively reviewed. Height and weight data were prospectively obtained and retrospectively gathered and converted to age- and gender-corrected z scores using norms from Korean youths. Growth changes were analyzed using random coefficients models with changes in height or weight z scores as the dependent variables. Results Height z scores significantly decreased during the treatment period (β=-0.054, p=0.024). Height z scores decreased during the 1st year of treatment (β=-0.086, p=0.003), but did not change after the 1st year. Weight z scores did not change significantly during treatment(β=0.004, p=0.925). Conclusion Our results suggest that long-term atomoxetine treatment may be associated with deficits in height growth in Korean youths, although this effect was minor and tended to be attenuated over the first year. Because of the limitations of this study such as retrospective design and selection bias, further prospective studies are needed.

Effectiveness and Safety of Bupropion in Children and Adolescents with Depressive Disorders: A Retrospective Chart Review

Kukju Kweon,Hyo-Won Kim 대한정신약물학회 2019 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.17 No.4

Objective: This study aimed to investigate the effectiveness and safety of bupropion extended-release for the treatment of depressive disorder in children and adolescents. Methods: This was a 12-week, retrospective chart review of bupropion, which included 127 youth (age, 15.3 ± 2.3 years; 66 boys) with depressive disorders (105 with major depressive disorder, 14 with dysthymia, 11 with adjustment disorder with depressed mood, and seven with depressive disorder not otherwise specified). Illness severity at baseline and at the 4th, 8th, and 12th weeks was retrospectively scored using the Clinical Global Impressions-Depression-Severity (CGI-Depression-S) and/or Clinical Global Impressions-Depression-Improvement (CGI-Depression-I). Results: The mean dose of bupropion was 180.0 ± 52.6 (range, 75−300) mg/day and the mean duration 33.9 ± 53.1 (range, 7−295) weeks. The CGI-Depression-S scores were significantly decreased over 12 weeks (F = 132.125, p < 0.001, partial 2 = 0.508). Fifty-eight subjects (45.7%) were determined to be responders at 12 weeks (defined by a CGI-Depression-I score ≤ 2). Forty-six patients (36.2%) discontinued bupropion before the 12 weeks (19 due to adverse events, 15 due to poor effectiveness, three due to referral to other clinics, and nine due to follow-up loss for unknown reasons). Overall, bupropion was well tolerated. The most common adverse event was irritability (n = 12, 9.4%), which resolved spontaneously in eight subjects or after drug discontinuation in four subjects. Conclusion: Our results provide preliminary evidence of the effectiveness and safety of bupropion in children and adolescents with depressive episodes. Large, prospective, placebo-controlled studies are needed to confirm these findings.

Genome-Wide Analysis Reveals Four Novel Loci for Attention-Deficit Hyperactivity Disorder in Korean Youths

Kukju Kweon,Eun-Soon Shin,Kee Jeong Park,Jong-Keuk Lee,Yeonho Joo,Hyo-Won Kim 대한소아청소년정신의학회 2018 소아청소년정신의학 Vol.29 No.2

Objectives: The molecular mechanisms underlying attention-deficit hyperactivity disorder (ADHD) remain unclear. Therefore, this study aimed to identify the genetic susceptibility loci for ADHD in Korean children with ADHD. We performed a case-control and a family-based genome-wide association study (GWAS), as well as genome-wide quantitative trait locus (QTL) analyses, for two symptom traits. Methods: A total of 135 subjects (71 cases and 64 controls), for the case-control analysis, and 54 subjects (27 probands and 27 unaffected siblings), for the family-based analysis, were included. Results: The genome-wide QTL analysis identified four single nucleotide polymorphisms (SNPs) (rs7684645 near APELA, rs12538843 near YAE1D1 and POU6F2, rs11074258 near MCTP2, and rs34396552 near CIDEA) that were significantly associated with the number of inattention symptoms in ADHD. These SNPs showed possible association with ADHD in the family-based GWAS, and with hyperactivity-impulsivity in genome-wide QTL analyses. Moreover, association signals in the family-based QTL analysis for the number of inattention symptoms were clustered near genes IL10, IL19, SCL5A9, and SKINTL. Conclusion: We have identified four QTLs with genome-wide significance and several promising candidates that could potentially be associated with ADHD (CXCR4, UPF1, SETD5, NALCN-AS1, ERC1, SOX2-OT, FGFR2, ANO4, and TBL1XR1). Further replication studies with larger sample sizes are needed.

Effects of Adversities during Childhood on Anxiety Symptoms in Children and Adolescents: Comparison of Typically Developing Children and Attention-Deficit/Hyperactivity Disorder Group

You Bin Lim,Kukju Kweon,Bung-Nyun Kim 대한소아청소년정신의학회 2021 소아청소년정신의학 Vol.32 No.3

Objectives: Childhood adversity is a risk factor for anxiety symptoms, but it affects anxiety symptoms in attention-deficit/hyperactivity disorder (ADHD). The current study aimed to examine the association between childhood adversity and anxiety symptoms in participants with and without ADHD. Methods: Data were obtained from a school-based epidemiological study of 1017 randomly selected children and adolescents. The ADHD and non-ADHD groups were divided using the Diagnostic Interview Schedule for Children Predictive Scale (DPS). The DPS was also used to assess comorbidities such as anxiety and mood disorders. The childhood adversities were assessed using the Early Trauma Inventory Self Report-Short Form, and the anxiety symptoms were assessed using the Screen for Child Anxiety Related Disorders. Linear and logistic regression models were used to investigate the association between childhood adversity and anxiety in the ADHD and non-ADHD groups with adjustments for age and sex. Results: This study found that the ADHD group did not show any significant association between anxiety symptoms and childhood adversities, whereas the non-ADHD group always showed a significant association. In a subgroup analysis of the non-ADHD group, the normal group without any psychiatric disorders assessed with DPS demonstrated a statistically significant association between childhood adversities and anxiety symptoms. These results were consistent with the association between childhood adversities and anxiety disorders assessed using DPS, as shown by logistic regression. Conclusion: The association between anxiety symptoms and childhood adversities statistically disappears in ADHD; ADHD may mask or block the association. Further longitudinal research is necessary to investigate this relationship.

Cognitive Emotion Regulation Strategies and Insomnia or Other Psychiatric Symptoms among Humidifier Disinfectant Victims

Seockhoon Chung,Suk-Hoon Kang,Kukju Kweon,Soyoung Youn,Hyang Soon Kang,Sang-Bum Hong,Soo Jong Hong 대한수면학회 2018 sleep medicine research Vol.9 No.1

Background and Objective In South Korea, numerous people have died of lung injury from humidifier disinfectant. The objective of this study was to explore the association between cognitive emotion regulation strategies for victims of humidifier disinfectant accidents in Korea and their insomnia and other psychiatric problems. Methods Among 196 subjects experiencing humidifier disinfectant-related interstitial pneumonitis, 40 subjects were assessed for their psychological states between June 2015 and May 2016. Their psychiatric symptoms were assessed using Insomnia Severity Index, Hospital Anxiety and Depression Scales, Patient Health Questionnaire-9, posttraumatic stress disorder Checklist for DSM-5, and Cognitive Emotion Regulation Questionnaire. Results Subjects’ adaptive cognitive emotion regulation strategies were not correlated with rating scale scores. However, total score of maladaptive cognitive emotion regulation strategy was significantly correlated with all rating scale scores (all p < 0.01). Among maladaptive strategies, rumination and catastrophizing strategies were significantly correlated with severity of insomnia and other psychiatric symptoms. Conclusions There was an association between victims’ maladaptive coping strategies and insomnia or other psychiatric symptoms. Thus, managing their coping strategies is necessary to help them survive in their current environment.

주의력결핍 과잉행동장애 아동의 약물치료가 운동협응력에 미치는 효과 : 개방연구

박기정(Kee Jeong Park),권국주(Kukju Kweon),이세정(Saejeong Lee),임연신(Yun Shin Lim),정유숙(Yoo Sook Joung),김효원(Hyo-Won Kim) 대한소아청소년정신의학회 2017 소아청소년정신의학 Vol.28 No.4

Objectives: The objective of this study was to investigate the effect of pharmacological treatments for attention-deficit hyperactivity disorder (ADHD) on motor coordination, using the Developmental Coordination Disorder Questionnaire (DCDQ). Methods: The participants were recruited from April 2015 to November 2016 from the Department of Psychiatry of Asan Medical Center and were treated for 3 months with methylphenidate or atomoxetine. The illness severity at baseline and 3 months were scored using the ADHD Rating Scale (ARS), Clinical Global Impression-Severity Scale (CGI-S) and/or Clinical Global Impression-Improvement Scale (CGI-I). A total of 39 children with ADHD (age 8.0±1.4 years, 36 boys) completed the Advanced Test of Attention (ATA) and their parents completed the DCDQ at baseline and 3 months. The paired t-test, mixed between-within analysis of variance and correlation analysis were used. Results: The CGI-S (p<0.001), ARS (p<0.001), and fine motor/hand writing (p=0.005) on the DCDQ were significantly changed between pre-treatment and post-treatment. When the participants were divided into those who were suspected of having developmental coordination disorder (DCD) (n=23) and those who probably did not (n=16), the control during movement, fine motor/hand writing and general coordination scores on the DCDQ showed the main effects for group (p<0.001, p<0.001 and p<0.001, respectively). The fine motor/hand writing on the DCDQ has a significant main effect for time [F(1,37)=7.31, p=0.010, η<SUP>2</SUP>=0.405] and the interaction effect between group and time was also significant [F(1,37)=4.63, p=0.038, η<SUP>2</SUP>=0.111]. The baseline visual commission error on the ATA is significantly correlated with the changes in the DCDQ total scores (r=0.330, p=0.040). Conclusion: Our results provide preliminary evidence that pharmacological treatment for ADHD improves not only the core symptoms of ADHD, but also the motor coordination. Further studies are needed to confirm the effect of the pharmacological treatment for ADHD on the motor coordination.

한국 정신질환자에서의 자살시도와 인터넷 중독 간의 연관성에 관한 환자-대조군 연구

손태혜,송승일,권국주,지현승,최광연,Sun, Tai hui,Song, Seung Il,Kweon, Kukju,Chee, Hyun Seung,Choi, Kwang-Yeon 대한불안의학회 2021 대한불안의학회지 Vol.17 No.2

Objective : Current study investigated the association between internet addiction and suicidal attempts in psychiatric patients. Methods : Patients who visited emergency department or psychiatry outpatient unit of Chungnam National University Hospital from January 2020 to July 2021 were included in this study. Total of 192 participants, 96 suicidal attempt cases and 96 psychiatric control patients without history of suicidal attempt were matched by gender and baseline diagnosis. Depression and internet addiction were assessed by using Patient Health Questionnaire-9 (PHQ-9) and Young's Internet Addiction Test (IAT). Independent t-tests, and logistic regression analyses were conducted. Results : IAT scores were significantly higher in suicidal attempt case group (41.09±18.196 years) compared to psychiatric control patients without history of suicidal attempt (36.63±17.016 years) (p=0.040). Internet addiction (adjusted Odds Ratio [aOR]=2.049, 95% Confidence Interval [CI]=1.004-4.539, p=0.0493) was an independent risk factor for suicidal attempt in psychiatric patients after controlling age, gender, and sociodemographic factors, such as marital status, education level and employment status. Conclusion : This is the first study to investigate the relationship between internet addiction and suicidal attempt in psychiatric patients in Korea. Internet addiction is significantly associated with suicidal attempt in psychiatric patients, after adjusting sociodemographic variables. This study provides evidence to future studies to further investigate on causality of internet addiction and suicidality in psychiatric patients.

주의력결핍 과잉행동장애에서 한국아동 인성평정척도의 임상적 적용

윤운(Woon Yoon),박기정(Kee-Jeong Park),권국주(Kukju Kweon),김효원(Hyo-Won Kim) 대한소아청소년정신의학회 2015 소아청소년정신의학 Vol.26 No.3

Objectives:The objective of this study was to compare the Korean Personality Rating Scale for Children (K-PRC) profile between children with attention-deficit hyperactivity disorder (ADHD) and typically developing children. We also aimed to investigate the association of K-PRC and ADHD symptoms. Methods:Ninety-nine youth (age 8.3±2.4 years, 72 boys) with ADHD and 84 controls (age 9.2±2.5 years, 43 boys) were recruited from the Department of Pediatric Psychiatry of the Asan Medical Center Children’s Hospital. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The parents of the subjects completed the ADHD rating scale, and K-PRC. Independent t-tests, analysis of covariance, partial correlation analyses, and Mc Nemar test were used for analysis. Results:Children and adolescents with ADHD showed higher K-PRC scores in verbal development, physical development, depression, delinquency, hyperactivity, family dysfunction and psychoticism. Delinquency and hyperactivity were significantly correlated with parent-rated ADHD rating scales and ADHD scores on K-SADS-PL. The hyperactive/impulsive and combined subtypes showed higher scores on hyperactivity and delinquency than the inattentive subtype, and the inattentive subtype showed higher scores on depression and social dysfunction of the K-PRC. Conclusion:Our results suggest that K-PRC could be used to comprehensively evaluate symptoms, combined psychopathologies, developmental delay and family dysfunction of children with ADHD.

진로계획과정모형에 기반한 충남대학교 의과대학 진로박람회 개선 사례

이소영,김정란,권국주,So-young Lee,Jeong Lan Kim,Kukju Kweon 연세대학교 의과대학 2024 의학교육논단 Vol.26 No.1

Medical students' career choices hold significant importance at both individual and national levels. Therefore, Chungnam National University College of Medicine aimed to systematize its revised career fair in 2022, basing its efforts on a career planning process model. Chungnam National University College of Medicine sought to formalize the design process by utilizing the ADDIE model (analysis design, development, implementation, evaluation model) in developing programs for the career fair program. Throughout the entire process, the student support center and student council actively collaborated, striving to incorporate students' requests and opinions. They designed and developed a program for all stages of the career planning process. However, a new stage ("review & ref lection") was added to the existing 4-phase model, creating a transformed framework where this stage interacts with the original 4 phases. Each stage involved portfolios, career aptitude tests, career-related lectures, posters with introductory information about majors, and booths for each major. The revised career fair attracted double the expected participants (N=589). The program evaluation survey showed overall positive responses (N=135). Additionally, some factors in the Specialty Indecision Scale showed significant differences between before and after the career fair. The success of the newly developed career fair at Chungnam National University College of Medicine can be attributed to its systematic framework and the active involvement of students throughout the process. However, for aspects with long-term implications, such as "understand yourself " and "choose your specialty," there may be a need for supplementary programs.

소아 청소년 양극성장애 환아군에서의 첫 기분 삽화의 극성에 따른 단기 예후 비교 : 단일 기관 연구

권국주,박수빈,이수민,김재원,신민섭,유희정,조수철,김붕년,Kweon, Kukju,Park, Subin,Lee, Soo-Min,Kim, Jae-Won,Shin, Min-Sup,Yoo, Hee-Jeong,Cho, Soo-Churl,Kim, Bung-Nyun 대한불안의학회 2013 대한불안의학회지 Vol.9 No.2

Objectives : This study was conducted to evaluate the association between first episode polarity of pediatric bipolar disorder and prognosis. Methods : We analyzed the clinical records of 66 inpatient subjects with DSM-IV defined pediatric bipolar disorder. The patients were split into 2 groups according to the polarity of the illness onset [depressive onset (DO) vs. manic/hypomanic/mixed onset (MO)]. Clinical feature and prognosis were compared between the two groups of patients. Results : In our sample, 68% of patients experienced a depressive onset. In DO patients, rates of suicidal attempt, episodic illness course and comorbid disruptive behavior disorder were higher than rates in MO patients. Conclusion : Findings from this study suggest that polarity of illness onset may be useful in predicting the prognosis of pediatric bipolar disorder.