MRI study of the cavum septum pellucidum in obsessive-compulsive disorder

Chon, Myong-Wuk,Choi, Jung-Seok,Kang, Do-Hyung,Jung, Myung Hun,Kwon, Jun Soo Springer-Verlag 2010 European archives of psychiatry and clinical neuro Vol.260 No.4

Prescription Pattern of Antidepressants for Children and Adolescents in Korea Based on Nationwide Data

Chon, Myong-Wuk,Lee, Jungsun,Chung, Seockhoon,Kim, Yangsik,Kim, Hyo-Won The Korean Academy of Medical Sciences 2017 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.32 No.10

<P>Antidepressant prescription for youths has recently been on the increase. There is a growing concern over the increasing off-label usage of antidepressants. Current data on off-label antidepressant usage vary across countries and healthcare systems. Therefore, we examined the extent and pattern of antidepressant prescription for Korean children and adolescents using population-based data. Our data was retrieved from the Korean National Health Insurance Service National Sample Cohort of the year 2013. Among 0.2 million children and adolescents aged 6–18 years from the cohort, subjects who had received any antidepressant medication in the year 2013 were investigated for the prescribed medication, concomitant psychotropic medication, and the associated diagnosis. A total of 2,190 children and adolescents (boys, 55.4%) received antidepressant medication. The most common diagnosis was depressive disorders (n = 469, 21.4%), followed by attention-deficit/hyperactivity disorder (n = 442, 20.2%). Among the prescriptions (n = 3,370), escitalopram (n = 650, 24.1%) and fluoxetine (n = 553, 20.5%) were the two most frequently prescribed drugs. A majority of prescriptions (n = 2,039, 60.5%) included concomitant psychotropic agents, consisting of antipsychotics (n = 901, 26.7%), sedatives (n = 263, 26.3%), medication for attention-deficit/hyperactivity disorder (n = 822, 24.4%), and some others. Our study shows the prescription pattern of antidepressants for children and adolescents in Korea, of which a large proportion is off-label. The results call for close monitoring by clinicians treating this population.</P>

Cortical Volumetric Correlates of Childhood Trauma, Anxiety, and Impulsivity in Bipolar Disorder

Song Hyehyun,Chon Myong-Wuk,Ryu Vin,Yu Rina,Lee Dong-Kyun,Lee Hyeongrae,Lee Wonhye,Lee Jung Hyun,Park Dong Yeon 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.7

Objective More recently, attention has turned to the linkage between childhood trauma and emotional dysregulation, but the evidence in bipolar disorder (BD) is limited. To determine neurobiological relationships between childhood trauma, current anxiety, and impulsivity, we investigated cortical volumetric correlates of these clinical factors in BD.Methods We studied 36 patients with DSM-5 BD and 29 healthy controls. Childhood trauma, coexisting anxiety, and impulsivity were evaluated with the Korean version-Childhood Trauma Questionnaire (CTQ), the Korean version-Beck Anxiety Inventory (BAI), and the Korean version-Barratt Impulsiveness Scale (BIS). Voxel-based morphometry (VBM) was used to assess gray matter volume (GMV) alterations on the brain magnetic resonance imaging (MRI). Partial correlation analyses were conducted to examine associations between the GMV and each scale in the BD group.Results Childhood trauma, anxiety, and impulsivity were interrelated in BD. BD patients revealed significant inverse correlations between the GMV in the right precentral gyrus and CTQ scores (r=-0.609, p<0.0003); between the GMV in the left middle frontal gyrus and BAI scores (r=-0.363, p=0.044). Moreover, patients showed similar tendency of negative correlations between the GMV in the right precentral gyrus and BIS scores; between the GMV in the left middle frontal gyrus and CTQ scores.Conclusion The present study provides evidence for a neural basis between childhood trauma and affect regulations in BD. The GMV alterations in multiple frontal lobe areas may represent neurobiological markers for anticipating the course of BD.

Abnormal asymmetry of white matter tracts between ventral posterior cingulate cortex and middle temporal gyrus in recent-onset schizophrenia

Joo, Sung Woo,Chon, Myong-Wuk,Rathi, Yogesh,Shenton, Martha E.,Kubicki, Marek,Lee, Jungsun Elsevier 2018 SCHIZOPHRENIA RESEARCH Vol.192 No.-

<P><B>Abstract</B></P> <P><B>Introduction</B></P> <P>Previous studies have reported abnormalities in the ventral posterior cingulate cortex (vPCC) and middle temporal gyrus (MTG) in schizophrenia patients. However, it remains unclear whether the white matter tracts connecting these structures are impaired in schizophrenia. Our study investigated the integrity of these white matter tracts (vPCC-MTG tract) and their asymmetry (left versus right side) in patients with recent onset schizophrenia.</P> <P><B>Method</B></P> <P>Forty-seven patients and 24 age-and sex-matched healthy controls were enrolled in this study. We extracted left and right vPCC-MTG tract on each side from T1W and diffusion MRI (dMRI) at 3T. We then calculated the asymmetry index of diffusion measures of vPCC-MTG tracts as well as volume and thickness of vPCC and MTG using the formula: 2×(right−left)/(right+left). We compared asymmetry indices between patients and controls and evaluated their correlations with the severity of psychiatric symptoms and cognition in patients using the Positive and Negative Syndrome Scale (PANSS), video-based social cognition scale (VISC) and the Wechsler Adult Intelligence Scale (WAIS-III).</P> <P><B>Results</B></P> <P>Asymmetry of fractional anisotropy (FA) and radial diffusivity (RD) in the vPCC-MTG tract, while present in healthy controls, was not evident in schizophrenia patients. Also, we observed that patients, not healthy controls, had a significant FA decrease and RD increase in the left vPCC-MTG tract. There was no significant association between the asymmetry indices of dMRI measures and IQ, VISC, or PANSS scores in schizophrenia.</P> <P><B>Conclusion</B></P> <P>Disruption of asymmetry of the vPCC-MTG tract in schizophrenia may contribute to the pathophysiology of schizophrenia.</P>

Validation of a Video Based Scale for Measuring Social Cognition in Schizophrenia

Jungsun Lee,Harin Kim,Myong- Wuk Chon,Joon- Ho Ahn,Yeon Ho Joo,Chang- Yoon Kim 대한신경정신의학회 2016 신경정신의학 Vol.55 No.2

Objectives Social cognition plays an important role in psychiatric symptoms and prognosis in patients with schizophrenia. Diagnostic scales are predominantly text- based or intended for the evaluation of theoretical concepts, with limited usefulness in clinical settings. We therefore developed a video based social cognition scale. Methods Our scale consists of 20 video clips portraying frequently experienced social interactions in real life. Patients were asked which interactions were socially unnatural and the reasons for lies told by actors. Our scale was validated and social cognition and its relationship with symptoms was evaluated using item response theory. Results A total of 209 participants (schizophrenia, 101 ; bipolar disorder, 49 ; healthy controls 59) were enrolled. Our scale showed high reliability and concurrent validity compared with the order subtest of the short form of the Weschler Adult Intelligence scale. Internal validity also was high (Cronbach s alpha=0.904). Most items were easy to answer and highly discriminative. The test information curve showed our scale to be more informative in patients with low social cognition ability. Conclusion Our scale may aid in the study of pathology and social cognition deficits in patients with schizophrenia.

Effectiveness and Safety of Electroconvulsive Therapy in Clinical Practice

Sung Woo Joo,Ha Eun Jeong,Myong-Wuk Chon,Yeon Ho Joo,Chang Yoon Kim,Jung Sun Lee 대한신경정신의학회 2016 신경정신의학 Vol.55 No.3

Objectives There is little research on the practice and effectiveness of electroconvulsive therapy (ECT) in Korea. This study investigated the practice pattern, effectiveness, and safety of ECT. Methods This chart review study included electronic medical records of 180 patients treated with ECT between January 2007 and December 2013 at the Asan Medical Center. Symptomatic improvement was assessed using Clinical Global Impression (CGI) scale. Treatment response was defined as CGI improvement scale score of 2 or less. Re-hospitalization was used as an indicator of recurrence. Safety was assessed by spontaneous reports from patients. Results One hundred and eighty patients underwent 1539 sessions of modified ECT. Their most frequent diagnosis was major depressive disorder (n=74, 41.1%). The most common indication for ECT was poor response to medication (n=177, 75.3%). Treatment response rate was 66.9% in acute phase group and 63.8% in the patients with poor response to medication. The recurrence rate at six months after the end of the course was 29.6%. Memory impairment or amnesia was the most common adverse effect. Conclusion There was a remarkable improvement following ECT in patients who responded poorly to medications, and most adverse effects were tolerable and temporary. The present study suggests that ECT could be a useful treatment option.

정신건강의학과 외래에서의 벤조디아제핀계 향정신성의약품 처방간격 관련요인 분석

심재환(Jae-hwan Sim),한지연(Ji Yeon Han),전진용(Jin-yong Jun),전명욱(Myong-Wuk Chon) 한국중독정신의학회 2021 중독정신의학 Vol.25 No.1

Objective : This study investigated the factors affecting the prescription interval of benzodiazepines and related psychotropics. Methods : The prescription intervals were extracted from all patients (n=1873) who visited the outpatient department of a single psychiatric hospital for one month in June 2019, and the potential factors related to longer psychotropic prescription were explored. Logistic regression analysis was performed to assess the relationship between the potential risk factors and the length of psychotropic medication prescription in days. Results : Two cutoff values (30 days and 35 days) were used for the appropriate prescription interval. Older age [cutoff 30 days, Exp(B)= 1.014, p=0.001 ; cutoff 35 days, Exp(B)=1.014, p=0.001], fewer number of admissions [30 days, Exp(B)=0.459, p<0.001; 35 days, Exp(B)=0.438, p<0.001], fewer number of treatment sessions [30 days, Exp(B)=0.894, p<0.001; 35 days, Exp(B)=0.899, p<0.001], and longer duration of treatment [30 days, Exp(B)=1.022, p= 0.004 ; 35 days, Exp(B)=1.024, p=0.001] were related to a longer prescription interval of psychotropics. Longer duration of illness [30 days, Exp(B)=1.017, p=0.017] was related to a longer prescription term and on-site reception compared to reservation [35 days, Exp(B)=0.585, p=0.022] with a shorter prescription term. Conclusion : Our results suggest that the elderly and patients with a longer duration of illness need closer monitoring for long-interval prescription of benzodiazepines and related psychotropics.

정신치료 수련의 질과 역량에 관한 정신건강의학과 전공의 인식도 조사

김예지(Ye Ji Kim),견영기(Yeong Gi Kyeon),이승재(Seung Jae Lee),전명욱(Myong-Wuk Chon),이상원(Sang Won Lee),정성원(Sung Won Jung),이강욱(Kang Uk Lee),대한신경정신의학회 수련위원회(The Committee of Residency Training of the Korean Neurop 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

양극성 장애 환자에서 불안이 질병 경과에 미치는 영향 : 전향적 추적관찰에 대한 중간분석

김수정,김소정,송혜현,이원혜,전명욱,남윤영,박동연,Kim, Soojeong,Kim, So Jeong,Song, Hye Hyun,Lee, Wonhye,Chon, Myong-Wuk,Nam, Yoon Young,Park, Dong Yeon 대한생물정신의학회 2021 생물정신의학 Vol.28 No.1

Objectives Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. Methods A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. Results Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). Conclusions This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course. Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.

양극성장애 환자용 한국어판 기분 기록 스마트폰 어플리케이션의 개발 및 임상적 적용

송가영(Kayoung Song),이세정(Saejeong Lee),윤 운(Woon Yoon),김창윤(Changyoon Kim),주연호(Yeonho Joo),이중선(Jungsun Lee),전명욱(Myong-Wuk Chon) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.3

Objectives The aim of this study was to develop a Korean version of a mood chart application on an Android platform. Methods This application is based on the traditional mood chart. Eighteen adults with DSM-5 bipolar disorder were enrolled from November 2016 to March 2017. They were asked to rate their daily mood scores and severity of irritability and impulsivity for six months. Their clinicians rated their symptom severity monthly using the Clinical Global Impression-7 (CGI-7) scale. After six months, the participants completed an anonymous questionnaire regarding their satisfaction with the application. Results Of the 18 patients, one withdrew their consent from this study and six were males (35.3%) ; their mean age was 31.71±8.56 years. The mean follow-up duration was 159.12±49.45 days and the period of application use was 143.65±52.11 days. The mean total response rate was 59.45% and the mean response rate on the same day was 43.06%. The adherence to using the application decreased significantly declined over the duration since enrollment [odds ratio (OR)=1.008, p=0.008] but tended to increase according to age (OR=0.958, p=0.002). The application mood scores were correlated significantly with the manic (β=0.307, p=0.004) and depressive (β=-0.701, p<0.001) subscale, and the total (β=1.026, p=0.002) of the CGI-7 (linear mixed models). The majority of subjects agreed that the application helped them manage their symptoms (92.86%), stating that the application was easy to use (78.57%). Conclusion This application could be a valid and useful tool to monitor the mood symptoms of patients with bipolar disorder in Korea.