Improving the Screening Instrument of Bipolar Spectrum Disorders: Weighted Korean Version of the Mood Disorder Questionnaire

Narei Hong,Won-Myong Bahk,Bo-Hyun Yoon,Kyung Joon Min,Young Chul Shin,Duk-In Jon 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.3

Objective: It is not easy to diagnose bipolar disorders accurately in the clinical setting. Although Korean version of the Mood Disorder Questionnaire (K-MDQ) is easily administered, it still has weakness regarding case finding. In this study, we suggest a new weighted version of the K-MDQ to increase its screening power. Methods: Ninety-five patients with bipolar disorders and 346 controls (patients with schizophrenia, patients with depressive disorders, patients with anxiety disorders, and subjects without any psychiatric disease) were enrolled in this study. The subjects received brief information on the K-MDQ, and then independently completed the questionnaire. Results: Using odds ratios, we constructed a new weighted K-MDQ (W-K-MDQ). Item 1 (feel so good or hyper) was weighted 7 times and item 4 (less sleep) 3.5 times. Item 7 (easily distracted) and item 11 (more interested in sex) were excluded. Part 2 (simultaneity) and 3 (functional impairment) were also excluded as in the original K-MDQ. The sensitivity of the W-K-MDQ with a cutoff value of 10 was enhanced to 0.789. The area under the receiver operating characteristic curve was increased to 0.837. Conclusion: We suggested a new formula for K-MDQ using 11 of its items. The W-K-MDQ can be easily applied with good sensitivity to screen for bipolar disorders in clinical settings in Korea. Further evaluations with larger samples are needed to establish the usefulness of the W-K-MDQ.

Opioid Analgesics and Depressive Symptoms in Burn Patients: What Is the Real Relationship?

Narei Hong,정명훈,김지욱,전욱,최인근,강태천,백석기,이병철 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.3

Objective: Major burn injuries are strongly associated with both psychological trauma and severe pain, and opioids are the mainstay analgesics for the treatment of severe burn pain. The objectives of this study are to find the complex relationship between opioid dose, depression, and post-traumatic stress disorder (PTSD) symptoms during the acute management of pain in burn patients. Methods: The symptoms of depression and PTSD were assessed in 43 burn patients immediately following wound stabilization and 2 weeks after the initial evaluation. Results: Total opioid doses and Hamilton Depression Scale (HAMD) scores obtained during the second evaluation were positively but weakly correlated after controlling for age and total burn surface area (R=0.33, p=0.03). Moreover, pain management with opioids was significantly more common in burn patients with low Clinician Administered PTSD Scale scores (evaluation 1) and high HAMD scores (evaluation 2) (F=6.66, p=0.001). Conclusion: High opioid dose following acute burn trauma might have correlation with depressive symptoms. Monitoring of depressive symptoms may be important following acute burn trauma and consequent opioids pain management, particularly when PTSD symptoms appear minimal during the early stabilization of patients.

Efficacy and Safety of Escitalopram, Desvenlafaxine, and Vortioxetine in the Acute Treatment of Anxious Depression: A Randomized Rater-blinded 6-week Clinical Trial

Cheolmin Shin(Cheolmin Shin),Sang Won Jeon(Sang Won Jeon),Seung-Hoon Lee(Seung-Hoon Lee),Chi-Un Pae(Chi-Un Pae),Narei Hong(Narei Hong),Hyun Kook Lim(Hyun Kook Lim),Ashwin A. Patkar(Ashwin A. Patkar ) 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.1

Objective: Anxious depression is associated with greater chronicity, higher severity of symptoms, more severe functional impairment, and poor response to drug treatment. However, evidence for first-choice antidepressants in patients with anxious depression is limited. This study aimed to compare the efficacy and safety of escitalopram, desvenlafaxine, and vortioxetine in the acute treatment of anxious depression. Methods: Patients (n = 124) with major depressive disorder and high levels of anxiety were randomly assigned to an escitalopram treatment group (n = 42), desvenlafaxine treatment group (n = 40), or vortioxetine treatment group (n = 42) in a 6-week randomized rater-blinded head-to-head comparative trial. Changes in overall depressive and anxiety symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), respectively. Results: Patients demonstrated similar baseline-to-endpoint improvement in scores and similar response and remission rates for HAMD and HAMA. Analysis of the individual HAMD items revealed that desvenlafaxine significantly reduced anxiety somatic scores (p = 0.013) and hypochondriasis scores (p = 0.014) compared to escitalopram. With respect to the individual HAMA items, desvenlafaxine treatment showed significantly lower scores for respiratory symptoms (p = 0.013) than escitalopram treatment and cardiovascular symptoms (p = 0.005) than vortioxetine treatment. The treatments were well tolerated, with no significant differences. Conclusion: Our results indicated no significant differences in the efficacy and tolerability of escitalopram, desvenlafaxine, and vortioxetine in this subtype of patients with anxious depression during the acute phase of treatment.

Late-Onset Psychosis

ByeongKil Yeon,Narei Hong 대한신경정신의학회 2007 PSYCHIATRY INVESTIGATION Vol.4 No.1

Objective-Although psychotic disorders usually manifest in young adulthood or middle age, some psychotic patients present psychotic symptoms for the first time in late life. The concept and diagnosis of late-onset psychosis have changed over the years. The authors review the clinical features, epidemiology and treatment of late-onset psychosis, with particular emphasis on lateonset schizophrenia. Methods-The authors conducted a MEDLINE literature review. Reviews, textbooks and some clinical studies about late-onset psychosis which were published in the literature were reviewed. Results-Although, in general, patients with late-onset schizophrenia have similar symptoms to those with early-onset schizophrenia, they are more likely to complain of hallucinations, persecutory delusions and partition delusions, and they are less likely to display formal thought disorder, affective flattening or blunting than their earlier-onset counterparts. Like early-onset schizophrenia patients, late-onset schizophrenia patients exhibit nonspecific structural changes in the brain. Although the exact prevalence of late-onset schizophrenia is not yet known, the 1-year prevalence rate of late-onset schizophrenia was found to be less than 1%. There is no trial-based evidence to help guide the choice of drug, however a number of special considerations are necessary when managing elderly patients. Conclusions-In the past few years, late-onset psychosis has begun to arouse the interest of psychiatrists, with research into late-onset schizophrenia being a relatively recent endeavor. The diagnosis and treatment of psychotic symptoms in elderly patients requires more than just extrapolation from that of young patients. There is a necessity for further researches involving Korean late-onset psychosis patients.

The Impact of Paliperidone Palmitate on Hospitalization in Patients with Schizophrenia: A Retrospective Mirror-image Study

So-Young Oh,전덕인,홍현주,Narei Hong,Jung-Seo Yi,Daeyoung Roh,정명훈 대한정신약물학회 2019 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.17 No.4

Objective: Whether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral antipsychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days. Methods: We performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after. Results: The mean number of admissions fell from 0.83 to 0.17 per patient (p < 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p < 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points. Conclusion: Our results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.

항정신병 약물 사용 및 치매의 심리행동 증상과 알츠하이머 환자의 인지능력 저하와의 연관성

장준호(June Ho Chang),전덕인(Duk In Jon),홍현주(Hyun Ju Hong),정명훈(Myung Hun Jung),홍나래(Narei Hong) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.2

Objective: Neuropsychiatric symptoms are common among patients with major neurocognitive disorder. Antipsychotic medications have been widely used to manage behavioral and psychological symptoms of dementia (BPSD), however efficacy and safety of these agents are conflicting. In this study, we tried to overview the association of antipsychotic medication use and neuropsychiatric symptoms with cognitive decline in patients with Alzheimer’s disease. Methods: We reviewed the medical charts of patients who were diagnosed as major neurocognitive disorder due to Alzheimer’s disease from November 2014 to October 2015. We reviewed whether the subjects had used antipsychotics, and whether patients had neuropsychiatric symptoms. We used linear mixed models to examine the statistical difference between each group. Results: Total of 106 subjects were included in the study. There was no statistically significant difference in cognitive function decline (Korean Version of Mini-Mental State Examination score change) between subjects with or without BPSD (p=0.62), and between subjects with or without antipsychotic medication (p=0.09). Conclusion: There was no evidence that antipsychotic medication and BPSD are associated with more cognitive decline. Findings imply that neuropsychiatric symptoms and cognitive impairment come from different etiologic causes, which highlights the heterogeneity of the disorder. Clinician should decide whether to use antipsychotic medication while carefully considering the effect and side effects of antipsychotic medication throughout the treatment period.

인터넷 중독 예방 프로그램의 효과

박민수(Minn Suh Park),전덕인(Duk-In Jon),홍현주(Hyun Ju Hong),정명훈(Myung Hun Jung),홍나래(Narei Hong) 대한사회정신의학회 2017 사회정신의학 Vol.22 No.2

연구목적 : 인터넷이 보급되면서 인터넷 중독의 피해가 확산되고 있고, 청소년기는 중독에 대해 취약한 시기이기에 인터넷 중독에 대한 예방 책이 중요하다. 본 연구는 기존 인터넷 중독 예방 프로그램의 효과를 초등학교 고학년 학생 집단을 대상으로 중독 증상의 정도와 양상의 변화를 통해 확인하고자 했다. 방 법 : 경기도 1개 시의 5개 초등학교에 소속된 4, 5학년 초등학생 대상으로 인터넷 중독 예방 프로그램을 시행하였다. 이중 프로그램 시행 전, 직후 2번에 걸쳐 청소년 인터넷중독 자가진단 척도(KS-II)을 작성한 556명을 대상으로 분석을 시행하였다. 일반 사용자군, 위험 사용자군으로 나눠 일상생활 장애, 가상적 대인관계 지향성, 금단, 내성의 척도 내 4가지 영역에 대해 독립표본 T검정과 반복측정 분산분석을 시행하였다. 결 과 : 프로그램 시행 후 일반 사용자군과 위험 사용자군 모두 일상생활 장애, 가상적 대인관계 지향성, 금단, 내성 등 전 영역에 걸쳐 통계적으로 유의하게 점수가 감소하였다. 일상생활 장애, 금단, 총점의 경우, 두 군 사이의 상호작용 효과가 나타나 일반 사용자군에 비해 위험 사용자군에서 점수가 더 감소하였다. 결 론 : 인터넷 중독 예방 프로그램이 인터넷 중독 위험 사용자군과 일반 사용자군에서 인터넷 중독에 대한 인식 정도를 변화시키는 것을 통해 중독 증상의 정도와 양상에 영향을 준다는 것을 청소년 인터넷 중독 자가진단 척도의 변화로써 확인할 수 있었다. 또한 그중에서도 일상생활 장애, 금단 및 총점의 경우, 위험 사용자군에서 특이적으로 점수를 더욱 감소시킨다는 것을 알 수 있었다. Objectives : While Internet is being spread, the problems of internet addiction is also increasing in the world. Because adolescent is fragile to addiction, internet addiction prevention is important. This study tries to check the effect of the established internet addiction prevention program for elementary school students with change of addiction-related symptoms. Methods : The internet addiction prevention program was run for 4th and 5th grade students of 5 elementary schools in 1 city of Gyeonggi-Do, Korea. 556 participants completed Internet Addiction Scale for Adolescent (KS-II) before and after the 3-session program. We divided the participants into 2 groups, normal user group and risky user group, and conducted independent T test and repetitive ANOVA over 4 domains, disturbance in daily life, cyber world oriented, withdrawal symptom, and tolerance. Results : Over all domains, each score was statistically lowered in both normal user group and risky user group after the program. Due to interaction effect, score of disturbance in daily life, withdrawal symptom, and total score was decreased more in risky user group than in normal user group. Conclusion : This study showed that the internet addiction prevention program which would change the level of knowledge about internet addiction in normal user group and risky user group could affect severity and aspects of addiction symptom with change of score of self-report scale. Also, especially in disturbance in daily life, withdrawal symptom, and total score, decrease of the score decreased more than other domain.

Incidence and Course of Depression in Patients with Alzheimer’s Disease

SeungHo Ryu,HanYong Jung,KangJoon Lee,SeokWoo Moon,DongWoo Lee,Narei Hong,BaikSeok Kee,DoHoon Kim,Changsu Han,ChangUk Lee 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.3

Objective-Depressive symptoms are common in Alzheimer’s disease (AD) and they might influence the course and prognosis of AD. Depression could appear anytime in the course of the disease, and could either last considerably long or disappear easily. This study is intended to investigate the occurrence of depression in the course of AD and the risk factors of incidence. Methods-This study targeted 1,272 AD patients without depressive symptoms at the start of this study in Korea. A total of 775 subjects completed the study, and the occurrence of depression was assessed after 12 months. Demographic information of subjects was collected and cognitive functions, overall functions, and depression severity were assessed at the start of this study and after 12 months. Results-Among the 775 subjects, 103 subjects (13.29%) developed depression 12 months later. The MMSE-KC scores showed significant changes in both groups that developed depression and did not. In the univariate analysis, significant differences in the incidence of depression were found in terms of gender, the administration of the antidepressant at the baseline, the SGDS-K score, and the GDS score. The multiple logistic regression analysis showed that the increase in the incidence of depression was associated with a female, in the increase in SGDS-K score and the GDS score. Conclusion-The incidence of depression in the subjects who completed the 12-month follow-up observation was 13.29%. Moreover, in the multivariate analysis, a female gender and the severity of dementia, including the overall functions, seemed associated with the occurrence of depression.

회복탄력성이 직장인의 주관적 스트레스에 미치는 영향

전가혜(Ka Hye Chun),전덕인(Duk-In Jon),홍현주(Hyun Ju Hong),정명훈(Myung Hun Jung),홍나래(Narei Hong) 대한사회정신의학회 2016 사회정신의학 Vol.21 No.2

연구목적 : 직장인의 스트레스는 개인적 차원에서 삶의 질을 떨어뜨릴 뿐만 아니라 사회경제적 부담의 증가를 초래한다. 본 연구에서는 지역 사회 직장인을 대상으로 주관적 스트레스 및 우울증의 유병률을 조사하고, 회복탄력성이 주관적 스트레스에 미치는 영향에 대해 확인하고자 한다. 방 법 : 일개 시에 위치한 사업장에서 근무 중인 직장인 462명을 대상으로 설문을 시행하였다. 연구 대상자들은 사회인구학적 요인에 대한 자기보고식 설문지에 응답하였다. 또한 PWI-SF(Psychosocial Well-being Index-short form), 한국어판 CES-D(The Center for Epidemiologic Studies Depression Scale), 회복탄력성 척도를 사용하여 중증 스트레스 및 우울증의 유병률과 관련 요인을 조사하 였다. 유의미한 중증 스트레스와 우울증은 PWI-SF 27점, CES-D 21점을 각각 절단점으로 하였다. 결 과 : 연구 대상자들의 17.1%가 중증 스트레스를 겪고 있는 것으로 밝혀졌다. 중증 스트레스에 관하여 성별(p=0.004) 및 회복탄력성 (p<0.001)에 따른 차이는 통계적으로 유의하였으나 연령, 결혼상태, 교육수준, 근속연수에 따른 차이는 통계적으로 유의하지 않았다. 특히, 회복탄력성이 낮을 경우 중증 스트레스를 겪을 위험도가 4.78배인 것으로 밝혀졌다. 또한 유의미한 우울증의 유병률은 14.9%였다. 결 론 : 본 연구를 통해 지역사회 직장인의 중증 스트레스의 규모와 우울증의 유병률을 알아 볼 수 있었다. 또한 회복탄력성이 주관적 스트레스에 대해 잠재적 보호요인의 역할을 할 수 있음을 확인하였다. 이 연구를 통해 지역사회 경쟁력 강화를 위하여 직장인의 스트레스 관리가 중요하며, 이를 위하여 회복탄력성의 향상을 포함한 다양한 정신건강서비스의 제공이 필요함을 제안할 수 있다. Objectives : Stresses of employees not only reduce the quality of life but also increase socioeconomic burden. The purpose of this study was to estimate the prevalence of severe stress and depression in community employees and to confirm the effect of resilience on subjective stress. Methods : Four hundred and sixty two community employees at one city were recruited for this study. The sociodemographic data were collected through self reports. We used PWI-SF (Psychosocial Well-being Index-short form), Korean version of CES-D(The Center for Epidemiologic Studies Depression Scale), and the scale of resilience to investigate the prevalence and correlation of severe stress and depression. Cutoff of clinically significant severe stress and depression was PWI-SF≥27 and CES-D≥21, respectively. Results : Seventeen point one percent of subjects suffered with severe stress. Although the prevalence of severe stress was not different by age, marital status, educational level and service year, it was different by gender (p=0.004) and resilience (p<0.001). Employees who have low resilience experience severe stress 4.78 times more than other employees. The prevalence of depression was 14.9%. Conclusion : This study revealed the prevalence of severe stress and depression in community employees and confirmed the role of resilience as a potential protective factor against subjective stress. The results suggest that to enhance the competitiveness of community, it is important to manage the stresses of employees and require variable mental health services including enhancement of resilience.

정신건강복지센터에 등록된 정신질환자의 자살 태도에 관한 연구

김원우(Won-Woo Kim),전덕인(Duk-In Jon),홍현주(Hyun Ju Hong),정명훈(Myung Hun Jung),홍나래(Narei Hong) 대한사회정신의학회 2022 사회정신의학 Vol.27 No.2

연구 목적 : 우리나라의 높은 자살률은 지속적으로 사회적 부담으로 작용하고 있다. 자살 태도란 개인이 자살에 대하여 가지는 일관된 견해를 말하며, 이는 교육을 통해 변화하여 자살 예방을 위한 긍정적인 행동을 하도록 하는 데 효과적일 수 있다고 밝혀진 바 있다. 정신 건강복지센터에서는 다양한 사업들을 통하여 자살 고위험군을 관리해오고 있으나, 아직까지 정신건강복지센터에 등록된 정신질환 자들을 대상으로 한 자살 태도 연구는 부족한 실정이다. 따라서 본 연구에서는 일개 시 정신건강복지센터에서 사례관리 중인 정신 질환자들의 자살에 대한 태도 및 인식을 조사하여 자살 예방을 위한 기초자료로 활용하고자 하였다. 방 법 : 일개 시 정신건강복지센터에서 정신건강서비스를 제공받는 만 19세 이상의 성인 200명을 대상으로 설문조사를 진행하였다. 설문 내용은 사회인구학적 및 임상적 특성, 자살에 대한 태도와 인식, 자살을 주제로 한 대중매체에 대한 태도 등으로 이루어졌다. 결 과 : 본 연구 대상자들 중 다수가 자살에 대해서 허용적인 태도를 보였고 자살에 대한 사회책임인식도 낮았다. 60세 이상의 집단에서는 젊은 연령에 비해 자살에 대하여 금기시(p<0.001)하고 비윤리적으로 바라보았고(p<0.001), 기혼 혹은 동거 중인 집단에서도 기타 결혼상태의 집단에 비해 자살에 대해 금기시(p=0.005) 하고 비윤리적(p=0.015)이라고 생각하는 태도를 보였다. 신경증을 진단받은 집단에서는 정신증을 진단받은 집단에 비해 자살에 대해 수용적 태도를 보이면서(p<0.001) 비윤리적으로 보는 시선은 적었고(p= 0.035), 자살예방센터를 이용 중인 집단은 그렇지 않은 집단에 비해 자살에 대해 수용적인 태도를 보였으며(p=0.001), 비윤리적이라고 생각하는 시선은 적었다(p=0.029). 결 론 : 본 연구에서 조사한 지역사회의 정신질환자들은 인구사회학적 및 임상적 변인에 따라서 자살 태도의 유의미한 차이를 보였다. 이러한 점들을 바탕으로 하여 본 연구의 결과는 지역사회 정신건강서비스의 효율적인 운영 및 정책 반영을 위한 기초 자료로 활용될수 있을 것으로 사료된다. Objectives : The high suicide rate in Korea is a continuous social burden, and it is therefore necessary to establish an effective suicide prevention policy. Attitude toward suicide can be defined as a consistent view of suicide held by an individual, and it has been reported that changing attitude towards suicide through education can be effective in encouraging positive behaviors regarding suicide prevention. Although mental health welfare centers in Korea have been managing the suicide high-risk group through various programs, there remains a lack of studies on attitudes toward suicide of patients with psychiatric disorders registered in mental health centers. In this study, we investigated the attitudes and perceptions toward suicide of patients registered at one mental health welfare center. Methods : Two hundred adults aged 19 years or over who registered and received mental health services from one mental health welfare center in an urban area were assessed using self-report questionnaires. The questionnaires consisted of sociodemographic and clinical characteristics, attitudes toward and perceptions of suicide, and attitudes toward mass media on suicide-related topics. Results : Many participants in this study showed a permissive attitude toward suicide, and their perception of social responsibility regarding suicide was low. The 60 years and older group viewed suicide as taboo (p<0.001) and unethical (p<0.001) more than younger groups, and the married or living together group also considered suicide taboo (p=0.005) and unethical (p=0.015) more than other groups. Compared to the group diagnosed with psychosis, the group diagnosed with neurosis showed a more accepting attitude toward suicide (p<0.001) and viewed suicide as less unethical (p=0.035). Similarly, the group receiving services from the suicide prevention center showed a more accepting attitude toward suicide (p=0.001) and viewed suicide as less unethical (p=0.029) than other groups. Conclusion : Patients with psychiatric disorders in the community surveyed in this study showed a permissive attitude toward suicide, and had a lack of awareness of social responsibility regarding suicide. The results of this study can be used as basic data for further studies exploring efficient policies for community mental health services.