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Objective: Our study aimed to measure inter-rater and test-retest reliability, concurrent and convergent validity, and factor solutions of the Korean version of the Clinical Language Disorder Rating Scale (CLANG). Methods: The Korean version of the CLANG for assessing thought, language, and communication, the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used to evaluate language disorder, formal thought disorder, positive and negative symptoms, manic symptoms, and depressive symptoms, respectively, in 167 hospitalized patients with schizophrenia. The factor solution was obtained by the direct oblimin method. A receiver operating characteristic curve was used to find the optimal cut-off score for discriminating schizophrenia patients with and without disorganized speech. Results: Inter-rater reliability was considered moderate (intraclass coefficient=0.67, F=3.30, p=0.04), and test-retest reliability was considered high (r=0.94, p<0.001). Five factors, namely, pragmatics, disclosure, production, prosody, and association, were identified. An optimal cut-off score of 7 points with 84.5% sensitivity and 81.7% specificity was proposed for distinguishing schizophrenia patients with and without disorganized speech. Conclusion: Our findings suggest that the Korean version of the CLANG is a promising tool for evaluating language disorder in patients with schizophrenia.
Disorder of Extreme Stress, Not Otherwise Specified (DESNOS) is the proposed diagnosis that meets the severe, complex, and prolonged psychological sequela of victims with chronic traumatization (e.g., family violence, incest, and childhood sexual or physical abuse). The hallmarks of DESNOS are a multiplicity of symptoms (e.g., somatization, dissociation, and depression), pathological changes in relationships, identity disturbances, and a propensity to experience repeated harm and injury at the hands of oneself and others. DESNOS can be directly assessed by Structured Interview of Disorder of Extreme Stress (SIDES) and Self- Report Inventory of Disorder of Extreme Stress (SIDES-SR). The treatment of DESNOS should be phaseoriented and involve movement back and forth among three basic stages : 1) stabilization ; 2) trauma processing ; 3) reintegration.
Objective: We aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9). Methods: Two hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea. Results: Greater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, p<0.001], reduced/increased sleep (aOR=3.269, p<0.001), psychomotor retardation/agitation (aOR=2.243, p=0.004), and concentration problem (aOR=16.116, p<0.001) were independently associated with increased likelihood of having depressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, p<0.001]. Conclusion: Our findings suggested that the diagnostic weighting of little interest, reduced/increased sleep, psychomotor retardation/agitation, and concentration problem is needed to detect depressive disorder among the elderly patients with chronic physical diseases.
'스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 7시까지 원문보기가 가능합니다.
Objective The purpose of this investigation was to identify distinctive clinical correlates of psychotic major depression (PMD) as compared with non-psychotic major depression (NPMD) in a large cohort of Korean patients with major depressive disorder (MDD). Methods We recruited 966 MDD patients of age over 18 years from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Diagnoses of PMD (n=24) and NPMD (n=942) were made with the DSM-IV definitions and confirmed with SCID. Psychometric scales were used to assess overall psychiatric symptoms (BPRS), depression (HAMD), anxiety (HAMA), global severity (CGI-S), suicidal ideation (SSI-Beck), functioning (SOFAS), and quality of life (WHOQOL-BREF). Using independent t-tests and χ2 tests, we compared clinical characteristics of patients with PMD and NPMD. A binary logistic regression model was constructed to identify factors independently associated with increased likelihood of PMD. Results PMD subjects were characterized by a higher rate of inpatient enrollment, and higher scores on many items on BPRS (somatic concern, anxiety, emotional withdrawal, guilt feelings, tension, depression, suspiciousness, hallucination, motor retardation, blunted affect and excitement) global severity (CGI-s), and suicidal ideation (SSI-Beck). The explanatory factor model revealed that high levels of tension, excitement, and suicidal ideation were associated with increased likelihood of PMD. Conclusion Our findings partly support the view that PMD has its own distinctive clinical manifestation and course, and may be considered a diagnostic entity separate from NPMD.
Background/Aims: Chronic obstructive pulmonary disease (COPD) is a major cause of mortality in the world. There are no population-based studies on longterm mortality in COPD patients in Korea. Methods: Using the large, population-based, National Health Insurance Service- National Sample Cohort (NHIS-NSC), we identified COPD patients using the International Classification of Disease-Tenth Revision (ICD-10) and prescription details in the NHIS-NSC during 2003 to 2013. We analyzed the survival curves of COPD patients by sex, age, and cause of death. Results: A total of 14,127 individuals older than 40 years were diagnosed with COPD. There were a total of 3,695 deaths (26.2%) in COPD patients during the study period. The 5-year mortality of COPD patients was 25.4% (29.9% in males and 19.1% in females). The mortality rate increased rapidly with age. The most common cause of death in COPD was chronic lower respiratory disease. Conclusions: This study described long-term mortality in COPD patients in Korea. Higher mortality was observed in males, and it was closely related to age.
Clinical Validation of the Psychotic Depression Assessment Scale, Hamilton Depression Rating Scale-6, and Brief Psychiatric Rating Scale-5: Results from the Clinical Research Center for Depression Study
Objective: The aim of this study was to validate the psychotic depression assessment scale (PDAS), which includes the six-item melancholia subscale from the Hamilton depression rating scale (HAMD-6) and the five-item psychosis subscale from the brief psychiatric rating scale (BPRS-5). Data from the Clinical Research Center for Depression (CRESCEND) study, which is a 52-week naturalistic trial, were analyzed. Methods: Fifty-two patients with psychotic depression from the CRESCEND study met our inclusion criteria. The patients underwent the following psychometric assessments: the PDAS, including HAMD-6 and BPRS-5, the clinical global impression scales, the HAMD, the positive symptom subscale, and the negative symptom subscale. Assessments were performed at the baseline and then at weeks 1, 2, 4, 8, 12, 24, and 52. Spearman correlation analyses were used to assess the clinical validity and responsiveness of the PDAS. Results: The clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, were acceptable, with the exception of the clinical responsiveness of the PDAS for positive symptoms and the clinical responsiveness of BPRS-5 for negative symptoms. Conclusion: The clinical relevance of the PDAS has been confirmed and this clinical validation will enhance its clinical utility and availability.
Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptomof schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structureof language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluatethe network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosurefailure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within thenetwork structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorderin schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning oflanguage disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., durationof illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.
Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ2 test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001), and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry.
'스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 7시까지 원문보기가 가능합니다.
Objective: To test whether there are gender differences in the clinical characteristics of patients with psychotic depression (PD). Methods: Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, we tested for potential gender differences in clinical characteristics among 53 patients with PD. The Psychotic Depression Assessment Scale (PDAS) and other psychometric scales were used to evaluate various clinical features of the study subjects. Independent t-tests were performed for normally distributed variables, Mann-Whitney U-tests for non-normally distributed variables, and χ2 tests for discrete variables. In addition, to exclude the effects of confounding variables, we carried out an analysis of covariance (ANCOVA) for the normally distributed variables and binary logistic regression analyses for discrete variables, after adjusting the effects of marital status. Results: We identified more prevalent suicidal ideation (adjusted odds ratio [aOR]=10.316, p=0.036) and hallucinatory behavior (aOR=8.332, p=0.016), as well as more severe anxiety symptoms (degrees of freedom [df]=1, F=6.123, p=0.017), and poorer social and occupational functioning (df=1, F=6.265, p=0.016) in the male patients compared to the female patients. Conclusion: Our findings suggest that in South Korean patients with PD, suicidal ideation, hallucinatory behavior, and anxiety is more pronounced among males than females. This should be taken into consideration in clinical practice.
This study aimed to analyze the patterns of antipsychotic prescription to patients withschizophrenia in Korea. Using the Health Insurance Review & Assessment Service-NationalPatients Sample (HIRA-NPS), which was a stratified sampling from the entire populationunder the Korean national health security system (2009), descriptive statistics for thepatterns of the monopharmacy and polypharmacy, neuropsychiatric co-medications, andprescribed individual antipsychotic for patients with schizophrenia were performed. Comparisons of socioeconomic and clinical factors were performed among patientsprescribed only with first- and second-generation antipsychotics. Of 126,961 patients withschizophrenia (age 18–80 yr), 13,369 were prescribed with antipsychotic monopharmacyand the rest 113,592 with polypharmacy. Two or more antipsychotics were prescribed to31.34% of the patients. Antiparkinson medications (66.60%), anxiolytics (65.42%), moodstabilizers (36.74%), and antidepressants (25.90%) were co-medicated. Patients who wereprescribed only with first-generation antipsychotics (n = 26,254) were characterized bysignificantly older age, greater proportion of male, higher proportion of medicaid, highertotal medical cost, lower self-payment cost, and higher co-medication rates ofantiparkinson agents and anxiolytics than those who were prescribed only with secondgenerationantipsychotics (n = 67,361). In this study, it has been reported substantialprescription rates of first-generation antipsychotics and antipsychotic polypharmacy andrelatively small prescription rate of clozapine to patients with schizophrenia. Since thisstudy has firstly presented the patterns of antipsychotic prescription to schizophrenicpatients in Korean national population, the findings of this study can be compared withthose of later investigations about this theme.