Why “Suicide CARE” Is Required for North Korean Defectors in South Korean Society?

박선철 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.5

Does Age at Onset of First Major Depressive Episode Indicate the Subtype of Major Depressive Disorder?: The Clinical Research Center for Depression Study

박선철,박용천,한상우,황태연,김재민,전태연,이민수,김정범,임현우 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with majordepressive disorder (MDD) in a large cohort of Korean depressed patients. Materials and Methods: We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reportedby the subjects. The subjects were divided into four age-at-onset subgroups:childhood and adolescent onset (ages <18), early adult onset (ages 18‒44), middle adult onset (ages 45‒59), and late onset (ages 60+). Using analysisof covariance (ANCOVA) and ordinal logistic regression analysis with adjustingthe effect of age, the relationships between clinical features and age at onset of MDD were evaluated. Results: There was an apparent, but inconsistent correlationbetween clinical features and age at onset. Earlier onset MDD was significantlyassociated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptomsubscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001). Conclusion: Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.

복합외상과 극단적 스트레스 장애

박선철,김석현,Park, Seon-Cheol,Kim, Seok-Hyeon 대한불안의학회 2009 대한불안의학회지 Vol.5 No.2

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.

Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study

박선철,사공정규,구본훈,김재민,전태연,이민수,김정범,임현우,박용천 대한의학회 2016 Journal of Korean medical science Vol.31 No.4

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.

초발 정신분열병 환자의 정신병 비치료기간과 관련된 정신사회적 요인

박선철,김대호,남정현,이해원 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.4

Objectives : This study investigated the psychosocial factors and clinical symptoms related to the duration of untreated Psychosis (DUP) in 35 consecutive first-episode inpatients with schizophrenia. Mcthods : Data from 35 schizophrenic patients were obtained from two general psychiatric inpatient units at a university medical center. These data included scores from Index of Social Position (ISP), Positive and Negative Syndrome Scale (PANSS) and Symptom Checklist-90-Revised (SCL-90-R) as well as socio-demographic informations. Rcsults : Among socio-demographic variables, lower social position (r=.610, P<.001), male sex (r=.407, P=.015), and grew up in rural area (r=.335, p=.045) were significantly correlated with DUP. The interpersonal sensitivity of SCL-90-R was the only symptomatic variable significantly correlated with DUP (r=.379, P=.027). However, after controlling interactive effects of the variables, only lower social position and interpersonal sensitivity remained significant. Lower social position was more influential on DUP than interpersonal sensitivity in the multiple regression model. Conclusion : Both social and symptomatic factors independently influenced DUP in schizophrenic patients. Lower social position defined by education and occupation of patients or caretakers may reflect barriers to psychiatric services or poor identification of mental illness. This together with patients' subjective distress in interpersonal interactions may delay the intervention of psychiatric services.

Patterns of Antipsychotic Prescription to Patients with Schizophrenia in Korea: Results from the Health Insurance Review & Assessment Service-National Patient Sample

박선철,이명수,강승걸,이승환 대한의학회 2014 Journal of Korean medical science Vol.29 No.5

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.

Prevalence and Clinical Correlates of Insomnia in Depressive Disorders: The CRESCEND Study

박선철,김재민,전태연,이민수,김정범,정승희,박용천 대한신경정신의학회 2013 PSYCHIATRY INVESTIGATION Vol.10 No.4

Objective To investigate the prevalence, clinical manifestations, and clinical correlates of insomnia in a large cohort of Korean patients with depressive disorders. Methods We recruited 944 patients with depressive disorders from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Psychometric scales were used to assess depression (HAMD), anxiety (HAMA), psychotic symptoms (BPRS), global severity (CGI-S), and functioning (SOFAS). Insomnia levels were determined by adding the scores for all items on the HAMD insomnia subscale. The clinical characteristics of the patients with 'low insomnia' (summed score ≤3 on the HAMD subscale) and 'high insomnia' (score ≥4) were compared using statistical analyses. A logistic regression model was constructed to identify factors associated with 'high insomnia' status. Results Symptoms of insomnia were present in 93% of patients, while simultaneous early, middle, and late insomnia affected 64.1%. The high insomnia patients were characterized by significantly greater age, higher symptom levels (including core, gastrointestinal somatic and anxiety symptoms, and suicidal ideation), higher global severity and incidence of physical disorders, and greater insight. Explanatory factors of 'high insomnia' status were older age, higher gastrointestinal somatic and anxiety symptom levels, higher global severity, and greater insight. Conclusion In clinical psychiatry, insomnia has been significantly underdiagnosed and undertreated. It affects most patients with depressive disorders, and is indicative of the global severity of depression. Active efforts to diagnose and treat insomnia in patients with depressive disorders should be strongly encouraged. Further research is needed to improve the diagnosis and treatment of insomnia in depressive patients.

성경에 나타난 도 (道)

박선철,박용천 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.4

Objectives : It is interesting that the term "Tao" is seen in the Bible of Korean revised version, because Tao is the essential part of traditional Korean culture. Korean culture has 5000 years of history rooted in the humanitarian ideal that means devotion to the welfare of mankind. Such humanitarian ideal had accepted, digested and finally recreated many religions and ideas without conflict. Because understanding the patient's culture is important in the psychiatric practice, it is worthwhile to compare the Tao in the Bible and in the traditional culture. This will lead us to understand the Bible more accurately, and Un-derstanding the Bible can broaden our view toward the traditional Korean culture. Methods : The authors searched the term "Tao" in the Bible ofKorean Revised Version and compared it with the Biblia Hebrica Stuttgatensia, and Novum Testatum Graece to detect the original expressions of Tao. The meaning of Hebrew or Greek original expressions were compared with English expressions of The Holy Bible, the King James Version. Results : Tao was recorded 85 times in the Bible of Korean Revised Version. The majority of original expressions were "derek" (43 times) in Hebrew Old Testaments, and "hodos" (14 times) in Greek New Testament. The majority of English expressions corresponding to Tao were "way" or "ways" (59 times). "Derek" means the commandments of God. "Hodos" means the way ofJesus Christ. Conclusion : "Derek" and "hodos" commonly mean the righteousness and sanctification required to human with the berith (testament) of God. Tao in the Bible ofKorean Revised Version is similar to Tao in the traditional culture in the viewpoint of enlightenment. Korean psychotherapy can be elaborated further with the acceptance of Westem psychotherapy on the basis of deep understanding of Korean traditional culture, such as Tao.

증상 중심의 항우울제 선택

박선철 대한의사협회 2020 대한의사협회지 Vol.63 No.4

Most evidence-based pharmacological guidelines recommend selective serotonin reuptake inhibitors, serotoninnorepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors or norepinephrine and specific serotonin antidepressants as the first-line treatment for major depression. Since the clinical factors associated with treating patients with depression are relatively complex, it can be challenging to apply the recommendations of evidence-based medicine verbatim. Furthermore, the diagnostic criteria of major depressive disorders, which are defined in a polythetic and operational manner, inevitably result in their heterogeneity. Studies have inferred that depressive syndrome may be connected with “family resemblance” rather than being shared with a neurobiological essence. Therefore, the symptom-based selection of antidepressants can be supported by a network analysis that provides a novel perspective on the symptom structure of major depression. The symptom-based treatment algorithm suggests treatment options that can be applied to the symptoms that are included in and excluded from the diagnosis criteria of major depressive disorder. The symptom-based selection of antidepressants and other psychotropic agents involves matching the deconstructed symptoms of depression to the specific neuroanatomical regions and neurotransmitters. This ensures timely and optimized treatment options for patients with depression.

Poor Prediction of Potentially Drug Resistant Pathogens Using Risk Factors of Health Care-associated Pneumonia

박선철,강영애,박병훈,박무석,김영삼,김세규,장준,정지예 대한결핵 및 호흡기학회 2011 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.112 No.-