Reliability and Validity of the Korean Version of Clinician-Administered Posttraumatic Stress Disorder Scale for DSM-5.

BACKGROUND: For diagnosis of post-traumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS) is one of the most widely used structured diagnostic interviews. METHODS: In this study, we aimed to develop and validate the Korean version of CAPS for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ([DSM-5] K-CAPS-5). Seventy-one subjects with PTSD, 74 with mood disorder or anxiety disorder, and 99 as healthy controls were enrolled. The Korean version of the structured clinical interview for DSM-5-research version was used to assess the convergent validity of K-CAPS-5. BDI-II, BAI, IES-R, and STAI was used to evaluate the concurrent validity. RESULTS: All subjects completed various psychometric assessments including K-CAPS-5. K-CAPS-5 presented good internal consistency (Cronbach's α = 0.92) and test-retest reliability (r = 0.91). K-CAPS-5 showed strong correlations with the structured clinical interview for DSM-5 PTSD (k = 0.893). Among the three subject groups listed above there were significant differences in the K-CAPS-5 total score. The data were best explained by a six-factor model. CONCLUSION: These results demonstrated the good reliability and validity of K-CAPS-5 and its suitability for use as a simple but structured instrument for PTSD assessment.

A Brief Screening Tool for PTSD: Validation of the Korean Version of the Primary Care PTSD Screen for DSM-5 (K-PC-PTSD-5).

The purpose of this study was to develop and evaluate psychometrically the Korean version of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual-fifth edition (K-PC-PTSD-5). In total, 252 participants were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual-fifth edition-research version (SCID-5-RV). The K-PC-PTSD-5 showed good internal consistency (α = 0.872), test-retest reliability (r = 0.89), and concurrent validity (r = 0.81). A score of 3 was identified as the threshold for clinically significant posttraumatic stress disorder (PTSD) symptoms. Overall, the results indicate that the K-PC-PTSD-5 is a useful, timesaving instrument for screening PTSD symptoms.

Reliability and Validity of the Korean Version of the Symptom Checklist-Post-Traumatic Stress Disorder Scale.

The Symptom Checklist - Post-Traumatic Stress Disorder Scale (SCL-PTSD), also known as Crime-Related PTSD Scale has been validated in survivors of interpersonal trauma in the general population. However, the psychometric properties have not been investigated in a clinical setting for patients with PTSD from diverse traumatic events. This study investigates the reliability and validity of the Korean version of the SCL-PTSD among 104 psychiatric outpatients with PTSD, caused by interpersonal (n = 50) or non-interpersonal trauma (n = 54). Self-report data of the SCL-PTSD, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Impact of Events Scale-Revised (IES-R) were gathered. The Korean version of the SCL-PTSD showed excellent internal consistency and moderate-to-good four-week temporal stability in both the interpersonal and non-interpersonal trauma groups. In comparison with other diagnostic groups, the scores of the SCL-PTSD were significantly higher compared to those of adjustment disorder, depression, other anxiety disorders, and schizophrenia, demonstrating its criteria-related validity. Convergent validity was confirmed because the scores of the SCL-PTSD were significantly correlated with BDI, SAI and TAI scores. Concurrent validity was demonstrated by significant correlation with the IES-R score. This study demonstrated the favorable psychometric prosperities of the Korean version of the SCL-PTSD, supporting its use in clinical research and practice.

Regional brain metabolism and treatment response in panic disorder patients: an [18F]FDG-PET study.

BACKGROUND: Panic disorder (PD) is a common and often chronic psychiatric condition that can lead to considerable disability in daily life. Using [(18)F]fluorodeoxyglucose-PET, we examined brain baseline glucose metabolism in PD patients in comparison with normal controls and the changes in glucose metabolism after 12 weeks of escitalopram treatment. METHODS: Fifteen patients with PD were compared to 20 normal controls using [(18)F]FDG-PET at baseline and brain metabolism after 12 weeks of escitalopram treatment was compared to pretreatment in the patient group using voxel-based statistical analysis and post hoc region-of-interest analysis. RESULTS: Patients with PD showed decreased metabolism in both the frontal, right temporal, and left posterior cingulate gyruses. After 12 weeks of escitalopram treatment, treatment responders showed metabolic increases in global neocortical areas as well as limbic areas whereas nonresponders did not. CONCLUSION: Abnormal neocortical function appears to be associated with the pathophysiology of PD and escitalopram exerts its therapeutic action by modulating brain activity at the level of the neocortex and limbic system, notably the amygdala and parahippocampal gyrus.

A psychometric evaluation of the National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD) among Korean psychiatric outpatients.

The National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD) is a brief screening measure for DSM-5 PTSD that has not been evaluated for its psychometric properties in clinical population. We developed a Korean version of the original English scale through translation-back translation process and examined its reliability and validity among treatment-seeking adults at a psychiatric outpatient unit of a university-affiliated hospital in South Korea. The sample comprised adults diagnosed with PTSD (n = 100) and other psychiatric disorders (n = 134). The NSESSS-PTSD, the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI) were used to determine validity and reliability. The findings show modest test-retest reliability (r = .43), good internal consistency (Cronbach's α = .81), high convergent validity (r = .78) with PCL-5 and good concurrent validity with the BDI (r = .55) and BAI (r = .50), respectively. A cut-off score of 16 best predicted PTSD from other psychiatric disorders with specificity of .90 and sensitivity of .87. This study reveals sound psychometric properties of the Korean version of the NSESSS-PTSD and supports its use in the clinical population.

La Encuesta Nacional de Eventos Estresantes para PTSD- Escala Corta (NSESSS-PTSD por sus siglas en inglés) es una medida de tamizaje breve para el TEPT del DSM-5 cuyas propiedades psicométricas no se han evaluado en la población clínica. Desarrollamos una versión coreana de la escala original en inglés a través de un proceso de traducción-retrotraducción y examinamos su confiabilidad y validez entre adultos que buscaban tratamiento en una unidad de consulta ambulatoria psiquiátrica de un hospital afiliado a la universidad en Corea del Sur. La muestra incluía adultos diagnosticados con TEPT (n = 100) y otros trastornos psiquiátricos (n = 134). Se utilizaron la NSESSS-PTSD, la lista de Chequeo del TEPT según el DSM-5 (PCL-5), el Inventario de Depresión de Beck-II (BDI-II) y el Inventario de Ansiedad de Beck (BAI) para determinar su validez y confiabilidad. Los resultados muestran una modesta confiabilidad test-retest (r = .43), una buena consistencia interna (α de Cronbach = .81), una alta validez convergente (r = 78) con el PCL-5 y una buena validez concurrente con el BDI (r = .55) y el BAI (r = .50), respectivamente. Una puntuación de corte de 16 predijo mejor el TEPT de otros trastornos psiquiátricos con una especificidad de .90 y una sensibilidad de .87. Este estudio revela sólidas propiedades psicométricas de la versión coreana de la NSESSS-PTSD y apoya su uso en la población clínica.

Development of Korean Version of PTSD Checklist for DSM-5 (K-PCL-5) and the Short Form (K-PCL-5-S).

OBJECTIVE: This study presents the reliability and validity of the Korean version of the post-traumatic stress disorder (PTSD) checklist for the Diagnostic and Statistical Manual for Mental Disorders-fifth edition (DSM-5) (K-PCL-5) and the short form (K-PCL-5-S). METHODS: Seventy-one subjects with PTSD, 74 subjects with mood or anxiety disorders, and 99 healthy controls were enrolled. The Korean version of the Structured Clinical Interview for DSM-5-research version was used to confirm the presence of PTSD. The Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Impact of Event Scale-Revised (IES-R), and Spielberger State Trait Anxiety Inventory (STAI) were used to evaluate the concurrent validity of the K-PCL-5 and K-PCL-5-S. RESULTS: It presented good internal consistency (Cronbach's α=0.93) and test-retest reliability (r=0.90). The K-PCL-5 and K-PCL-5-S were highly correlated with the BDI-II, BAI, IES-R, STAI-S, and STAI-T. The suggested cutoff score for PTSD was 33 for the K-PCL-5 with a sensitivity of 88.51 and specificity of 89.09, and 6 for the K-PCL-5-S with a sensitivity of 91.95 and specificity of 89.09. The data were best explained with a one-factor model. CONCLUSION: These results demonstrated the good reliability and validity of the K-PCL-5 and K-PCL-5-S, and their suitability as simple tools for PTSD assessment.

Development and characterization of reinforced poly(L-lactide) scaffolds for bone tissue engineering.

Novel reinforced poly(L-lactic acid) (PLLA) scaffolds such as solid shell, porous shell, one beam and two beam reinforced scaffolds were developed to improve the mechanical properties of a standard PLLA scaffold. Experimental results clearly indicated that the compressive mechanical properties such as the strength and the modulus are effectively improved by introducing the reinforcement structures. A linear elastic model consisting of three phases, that is, the reinforcement, the porous matrix and the boundary layer was also introduced in order to predict the compressive moduli of the reinforced scaffolds. The comparative study clearly showed that the simple theoretical model can reasonably predict the moduli of the scaffolds with three phase structures. The failure mechanism of the solid shell and the porous shell reinforced scaffolds under compression were found to be buckling of the solid shell and localized buckling of the struts constructing the pores in the porous shell, respectively. For the beam reinforced scaffolds, on the contrary, the primary failure mechanism was understood to be micro-cracking within the beams and the subsequent formation of the main-crack due to the coalescence of the micro-racks. The biological study was exhibited that osteoblast-like cells, MC3T3-E1, were well adhered and proliferated on the surfaces of the scaffolds after 12 days culturing.

Platelet serotonin transporter function after short-term paroxetine treatment in patients with panic disorder.

Dysfunctions in serotonin neurotransmission have been implicated in some psychiatric disorders, and in particular, altered serotonin transporter function has been noted in panic disorder. In this study, the authors compared platelet [(3)H]serotonin uptake parameters, including maximum velocities (V(max)) and affinity constants (K(m)), in patients with panic disorder not undergoing treatment (n=21) and in healthy subjects (n=20). V(max) and K(m) values were re-examined after 12 weeks of paroxetine treatment. Values of V(max) and K(m) were lower in panic disorder patients at baseline than in healthy subjects. After treatment, K(m) normalized in panic patients, whereas V(max) did not change. A significant inverse correlation was found between increased K(m) and changes in anxiety levels. These results support a hypothesis of serotonergic transporter abnormalities in panic disorder, and suggest that increased K(m) values of platelet serotonin transporters parallel clinical improvement after short-term pharmacotherapy in panic disorder.

Platelet serotonin transporter function and heart rate variability in patients with panic disorder.

Many studies showed abnormal serotonin transporter (5-HTT) function and heart rate variability (HRV) in panic disorder patients. The present study investigated the relationship between HRV power spectral analysis findings and platelet serotonin uptake in panic disorder patients. Short-term HRV over 5 min and platelet serotonin transporter uptake parameters (V(max) and K(m)) were measured both in 45 patients with panic disorder and in 30 age-matched normal healthy control subjects. Low frequency power (LF) normalized unit (nu) and LF/high frequency power (HF) were significantly higher, whereas HF and HF nu were lower in the patient group than in the control group. V(max) and K(m) were all significantly lower (i.e., reflects decreased 5-HTT function) in patients with panic disorder than in normal controls. In the patient group, K(m) was negatively correlated with LF/HF and LF nu whereas no such correlations between them were found in the control group. By multivariate analysis based on multiple hierarchical linear regression, a low K(m) independently predicted an increased LF nu even after controlling for age, sex, and body mass index in the patient group. These results suggest that impaired 5-HTT function is closely related to dysregulation of autonomic nervous system in panic disorder.

Mirtazapine versus venlafaxine for the treatment of somatic symptoms associated with major depressive disorder: a randomized, open-labeled trial.

Somatic symptoms are often important in the treatment of major depressive disorder (MDD). The aim of this open-labeled trial was to examine the efficacy of mirtazapine for the treatment of MDD with clinically significant somatic symptoms, as compared with venlafaxine. A total of 126 patients with MDD (score >/=18 on the Hamilton Rating Scale for Depression-17) were included in both the intent-to-treat (n=73 in the mirtazapine group and n=53 in the venlafaxine group) and completer analysis (n=51 and n=37, respectively). After treatment, both treatment groups showed similar improvements in depressive symptoms. Repeated measures analysis of variance for the intent-to-treat population revealed that there were no significant differences in mean change of the Symptom Check List-90-Revised (SCL-90-R) somatization subscores between the two groups. For completers, there was a significant timextreatment interaction in the SCL-90-R somatization subscores, but the differences between the two groups at endpoint did not reach statistical significance in post-hoc analysis. In conclusion, this study suggests that overall efficacies of mirtazapine and venlafaxine are similar for the treatment of overall symptoms in MDD, and both drugs may be useful for the treatment of somatic symptoms in MDD patients.

Effect of biofeedback-assisted autogenic training on headache activity and mood states in Korean female migraine patients.

Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine. This study aimed to examine the effect of biofeedback treatment on headache activity, anxiety, and depression in Korean female patients with migraine headache. Patients were randomized into the treatment group (n=17) and monitoring group (n=15). Mood states including anxiety and depression, and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls (n=21). We found greater treatment response rate (defined as > or =50% reduction in headache index) in patients with biofeedback-assisted autogenic training than in monitoring group. The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment. Moreover, the decrease in their anxiety levels was significantly related to the treatment outcome. This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level.

Work-related burn injuries and claims for post-traumatic stress disorder in Korea.

OBJECTIVE: The objective of this study is to broaden our understanding of psychiatric disorders due to work-related burn injury compensated by the Industrial Accident Compensation Insurance operated by the Korea Workers' Compensation and Welfare Service (KCOMWEL). METHODS: Using the KCOMWEL electronic database, we collected data on psychiatric disorders due to work-related burn injury based on workers' compensation records from 2005 to 2014 and analyzed the characteristics of the claims. RESULTS: The average number of claims per year for post-traumatic stress disorder was 67 and the approval rate from 2005 to 2014 was 53.6%. Regarding occupation, 63 workers were elementary workers involved in the performance of simple and routine tasks which may require the use of hand-held tools and considerable physical effort and 59 were electrical and electronic equipment fitters and repairers. Acute stress disorder, nonorganic insomnia, and sexual dysfunction were the most commonly approved psychiatric disorders associated with work-related burn injury, followed by mixed anxiety-depressive disorder. CONCLUSIONS: We analyzed the characteristics of the psychiatric disorders due to work-related burn injury for which compensation was received from 2005 to 2014 according to the approved results. To gain a long-term understanding of the management of workers' compensation status for psychiatric disorders due to work-related burn injuries, we should gather accurate information on the risk factors involved in order to achieve the needed systematic improvements.

Clinical utility of heart rate variability during Head-up tilt test in subjects with chronic posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is characterized by psychophysiological abnormalities, such as an altered baseline heart rate and hyperarousal, implying dysfunctional arousal regulation. Heart rate variabilities (HRVs) is known to reflect autonomic nervous system activity. We examined the changes of HRVs in PTSD patients with head-up tilt position to closely investigate disease-specific changes in autonomic function in PTSD patients. Sixty-seven patients with PTSD and 72 patients without PTSD were assessed using the PTSD Checklist for DSM-5 (PCL-5) and psychiatric interview. Heart rate data including standard deviation of the NN intervals, the square root of the mean squared differences of successive NN intervals, log low-frequency and log high-frequency were collected for 10 min before and after tilting. Considering interactions between groups and head-up tilting, the head-up tilting induced reduction of the high-frequency component of HRVs was significantly greater in the PTSD group [F (1, 272) = 4.718, p = 0.031]. The change of HRVs in PTSD patients suggested the presence of autonomic dysfunction in despite of the posture.

Decision Making Regarding Key Elements of Korean Disaster Psychiatric Assistance Teams Using the Analytic Hierarchy Process.

OBJECTIVE: The purpose of this study was to determine the key components of Korean disaster psychiatric assistant teams (K-DPATs), to set up new mental health service providing system for the disaster victims. METHODS: We conducted an analytic hierarchy process (AHP) involving disaster mental health experts, using a pairwise comparison questionnaire to compare the relative importance of the key components of the Korean disaster mental health response system. In total, 41 experts completed the first online survey; of these, 36 completed the second survey. Ten experts participated in panel meetings and discussed the results of the survey and AHP process. RESULTS: It was agreed that K-DPATs should be independent of the existing mental health system (70.1%), funding for K-DPATs should be provided by the Ministry of Public Safety, and the system should be managed by the Ministry of Health (65.8%). Experts shared the view that K-DPAT leaders would be suitable key decision makers for all types of disaster, with the exception of those involving infectious diseases. CONCLUSION: K-DPAT, a new model for disaster mental health response systems could improve the insufficiency of the current system, address problems such as fragmentation, and fulfill disaster victims' unmet need for early professional intervention.

Heart rate variability of chronic posttraumatic stress disorder in the Korean veterans.

Patients with post-traumatic stress disorder (PTSD) have lower heart rate variability (HRV) than the general population, but findings in this area have been inconsistent. This study was conducted to investigate the characteristics of HRV in patients with PTSD and to evaluate associations between PTSD symptoms and HRV indices. Sixty-eight patients with PTSD and 73 controls without PTSD were evaluated. HRV was measured in all subjects after they completed self-reported questionnaires. Patients with PTSD had significantly more depressed moods, anxiety, and poorer sleep quality than individuals in the non-PTSD group. Standard deviations of NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), and log high-frequency (LNHF) were significantly lower in the PTSD group than in the non-PTSD group. Comparisons of HRV indices among four sub-groups according to presence/absence of PTSD and experiences of combat-related or other trauma indicated that individuals in the PTSD group who had experienced combat-related trauma had the lowest HRV indices. These indices included SDNN, RMSSD, and LNHF. Further, SDNN, RMSSD, and HF power were significantly associated with symptoms of hyperarousal. HRV measures might be useful physiological parameters in assessing and monitoring sympathovagal function in patients with PTSD.

Blonanserin Augmentation of Atypical Antipsychotics in Patients with Schizophrenia-Who Benefits from Blonanserin Augmentation?: An Open-Label, Prospective, Multicenter Study.

OBJECTIVE: The purpose of this study was to investigate the efficacy and tolerability of atypical antipsychotics (AAPs) with augmentation by blonanserin in schizophrenic patients. METHODS: aA total of 100 patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP were recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to their existing AAP regimen, which was maintained during the study period. Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at weeks 2, 4, 8, and 12. Predictors for PANSS response (≥20% reduction) were investigated. RESULTS: The PANSS total score was significantly decreased at 12 weeks of blonanserin augmentation (-21.0±18.1, F=105.849, p<0.001). Moreover, 51.0% of participants experienced a response at week 12. Premature discontinuation of blonanserin occurred in 17 patients (17.0%); 4 of these patients dropped out due to adverse events. The patients who benefited the most from blonanserin were those with severe symptoms despite a treatment with a higher dose of AAP. CONCLUSION: Blonanserin augmentation could be an effective strategy for patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP.

The Korean version of the Connor-Davidson Resilience Scale: an extended validation.

The Connor-Davidson Resilience Scale (CD-RISC) is a brief self-rating questionnaire for measuring resilience. The aims of the present study were to describe the development of a Korean version of the CD-RISC (K-CD-RISC) and to more firmly establish its psychometric properties in terms of reliability and validity. The participants consisted of a general population sample (n=194) and psychiatric outpatients (n=127) with non-psychotic mood or anxiety disorders. The K-CD-RISC score means (standard deviation) were 65.9 (13.6) in the general population and 50.4 (20.5) in the psychiatric outpatients. The mean score of the general population was significantly higher than that of the psychiatric outpatients. Exploratory factor analysis revealed five factors, and the obtained factor structure was verified through confirmatory factor analysis. In the general population, the Cronbach's α coefficient of the K-CD-RISC was found to be 0.92. Greater resilience was found to be associated with less perceived stress, anxiety and depression and with higher levels of positive affect and purpose in life. Taken together, our findings suggest that the K-CD-RISC has good psychometric properties and is a valid and reliable tool for assessing resilience.

Sympathetic nervous function and the effect of the catechol-O-methyltransferase Val(158)Met polymorphism in patients with panic disorder.

BACKGROUND: Sympathetic nervous function abnormalities have long been suggested to be a possible etiology of panic disorder (PD). Catechol-O-methyltransferase (COMT) affects sympathetic activities, and the COMT Val(158)Met polymorphism has been suggested to be related to PD. The authors examined the relationship between sympathetic nervous function and the COMT Val(158)Met polymorphism in PD patients. METHODS: Fifty-eight patients [Val/Val (51.7%) and Met allele carriers (48.3%)] and 58 age-matched normal control subjects [Val/Val (56.9%) and Met allele carriers (43.1%)] were compared in terms of finger skin temperature, which is known to be a useful marker of sympathetic nervous function. RESULTS: A significant COMT Val(158)Met polymorphismxdiagnosis interaction was found. Specifically, the met allele was found to be associated with a lower skin temperature in PD patients. CONCLUSION: These results suggest that the COMT Met allele is related to the higher sympathetic nervous function observed in PD.

Lymphocyte subsets and mood states in panic disorder patients.

This study was conducted to examine lymphocyte subset counts and mood states in panic disorder patients. Twenty patients with panic disorder and 20 age- and gender-matched normal healthy subjects were recruited for the study. We used the Spielberger State (STAIS) & Trait (STAIT) Anxiety Inventory, Hamilton Depression Rating scale (HAMD) and Hamilton Anxiety Rating scale (HAMA) to measure mood states in all subjects. Lymphocyte subsets counts were made by flow cytometry. Panic patients showed significantly higher scores for anxiety and depression than normal subjects. Panic patients showed no differences in terms of the numbers of immune cells, as compared with normal healthy subjects, other than a lower proportion of T suppressor cells and a higher T helper cell/T suppressor cell ratio. HAMA and STAIS scores were common factors that could predict T cell numbers and proportions, T helper cell numbers, and natural killer cell proportions in panic disorder patients. We suggest that anxiety levels are related to the T-cell population in panic disorder patients and that quantitative immune differences may reflect altered immunity in this disorder.