Temperament Clusters in Patients With Panic Disorder in Relation to Character Maturity.

OBJECTIVE: This study explored whether temperament profiles are associated with psychological functioning and whether character maturity affects this association in patients with panic disorders (PD). METHODS: A total of 270 patients with PD were enrolled in this study. Measurements included the Temperament and Character Inventory-revised-short (TCI-RS), a self-report version of the Panic Disorder Severity Scale (PDSS-SR), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Cluster analysis was used to define the patients' temperament profiles, and the differences in discrete variables among temperament clusters were calculated using a one-way analysis of variance. An analysis of covariance was conducted to control for the impact of character maturity on psychological functioning among clusters. RESULTS: We identified four temperament clusters of patients with PD. Significant differences in the PDSS-SR, BDI-II, STAI-state, and STAI-trait scores among the four clusters were detected [F(3, 262)=9.16, p<0.001; F(3, 266)=33.78, p<0.001; F(3, 266)=19.12, p<0.001; F(3, 266)=39.46, p<0.001]. However, after controlling for the effect of character maturity, the effect of cluster type was either eliminated or reduced ([STAI-state] cluster type: F(3, 262)=0.94, p>0.05; SD+CO: F(1, 262)=65.95, p<0.001, ηp2 =0.20). CONCLUSION: This study enabled a more comprehensive and integrated understanding of patients by exploring the configuration of all temperament dimensions together rather than each temperament separately. Furthermore, we revealed that depending on the degree of character maturity, the psychological functioning might differ even within the same temperament cluster. These results imply that character maturity can complement inherently vulnerable temperament expression.

Association between Heart Rate Variability Indices and Depressed Mood in Patients with Panic Disorder.

Objective: Heart rate variability (HRV) reflects the regulation of the autonomic nervous system. Panic disorder is highly associated with autonomic dysfunction, and is often accompanied by depression. The aim of this study is to determine the association between depression and HRV indices in patients with panic disorder. Methods: A total of 110 outpatients diagnosed with panic disorder participated in this study. The medical records of patients with panic disorder who visited the outpatient clinic of Konkuk University Hospital between December 2018 and March 2020 were retrospectively reviewed. Measurements used in this study include the Panic Disorder Severity Scale-Self Report, Beck Depression Inventory (BDI-II), Insomnia Severity Index, and HRV. Patients were divided into depressive and non-depressive groups based on their BDI-II scores. The association between HRV indices and depressive symptoms was statistically analyzed. Results: The low frequency/high frequency (LF/HF) ratio was reduced in patients with depression (mean = -0.095, p = 0.004 in the above moderate depressive group, mean = -0.120, p = 0.020 in the severe depressive group). Significant correlations were found between depressive symptoms and standard deviation of NN interval (SDNN) (ms) (-0.19, p = 0.044), very low frequency (VLF) (ms2/Hz) (-0.22, p = 0.021), LF (-0.25, p = 0.008), HF (-0.19, p = 0.043), and LF/HF (-0.25, p = 0.009). Multiple linear regression analysis showed that BDI predicted SDNN (ms), VLF (ms2/Hz), LF, HF, and LF/HF. Conclusion: We confirmed that the LF/HF ratio decreases when depression is accompanied by panic disorder. HRV indices may be useful markers for detecting depressive symptoms in patients with panic disorder.

A network analysis of panic symptoms in relation to depression and anxiety sensitivity in patients with panic disorder.

BACKGROUND: Panic disorder is an anxiety disorder presenting panic attacks as a defining feature, with cognitive and behavioral symptoms that are associated with the panic attacks. Recently, the use of network analysis is increasing to determine the symptoms and mutual reinforcing patterns that conceptualize a mental disorder. This study aimed to improve our understanding of panic disorder by estimating a network structure of its symptoms. METHOD: Data from 257 patients diagnosed with panic disorder who visited the outpatient psychiatric clinic from 2018 to 2020 were collected. Panic attacks, cognitive and behavioral symptoms concerning the panic attacks, depression, and anxiety sensitivity dimensions such as fear of cardiovascular symptom, fear of publicly observable anxiety reaction, fear of respiratory symptom, and fear of cognitive dyscontrol were computed. Bootstrapping was applied to estimate the 95% confidence intervals for each edges. RESULTS: The resulting network indicated fear of cognitive dyscontrol, impairment in social functioning, phobic avoidance of situations, and panic-focused anticipatory anxiety to be central symptoms in panic disorder. Interestingly, panic attacks and distress during panic did not emerge as central. Depression was strongly linked to fear of cognitive dyscontrol. LIMITATIONS: The sample size limits network comparison tests between those with comorbid depression or agoraphobia. In addition, the cross-sectional design limits the opportunity to draw causal conclusions regarding the symptoms. CONCLUSIONS: These results have implications in etiology of panic disorder and support the efficaciousness of Cognitive Behavioral Therapy. Future network analyses may employ longitudinal designs to investigate causal relationships between the symptoms.

Psychological predictors of bipolarity in panic disorder.

BACKGROUND: Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses. AIM: To investigate the psychological characteristics of panic disorder patients related to bipolarity. METHODS: A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics. RESULTS: Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, n = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, n = 126). The BP+ group were more likely to be unmarried (single 56.2% vs 44.4%, P = 0.008) and younger (30.78 ± 0.59 vs 37.11 ± 3.21, P < 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score. CONCLUSION: The result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.

The Mediating Effect of Insomnia on the Relationship between Panic Symptoms and Depression in Patients with Panic Disorder.

BACKGROUND: This study aimed to determine if sleep disturbances may mediate the relationship between panic symptoms and depression in patients with panic disorder (PD). METHODS: Electronic medical records were retrospectively reviewed for 110 consecutive patients with diagnosed PD in an outpatient clinic between October 2018 and December 2019. Measurements include the PD Severity Scale, Beck Depression Inventory-II (BDI-II) and Insomnia Severity Index (ISI). Statistical analyses were performed to assess any potential relationship between PD, insomnia and depression. RESULTS: Of the PD patients, 88 (80%) and 89 (80.9%) had comorbid depression (BDI-II ≥ 14) and insomnia (Korean version of the ISI ≥ 8), respectively. In a mediation model using insomnia as the mediating variable, the total effect of panic symptom severity on depression was significant (t = 7.23, P < 0.001). There were significant effects of panic symptoms on insomnia (t = 4.62, P < 0.001) and of insomnia on depression (t = 6.69, P < 0.001). The main effect of panic symptom severity on depression was also significant, after controlling for the effect of insomnia (t = 5.10, P < 0.001), suggesting partial mediation. CONCLUSION: Both depressive symptoms and insomnia are common in patients with PD and depression was partially mediated by insomnia in these patients. These results suggest that an intervention for insomnia in patients with PD might help prevent the development of depression.

Predictors of Psychiatric Outpatient Adherence after an Emergency Room Visit for a Suicide Attempt.

OBJECTIVE: This study aimed to investigate the potential correlation between baseline characteristics of individuals visiting an emergency room for a suicide attempt and subsequent psychiatric outpatient treatment adherence. METHODS: Medical records of 525 subjects, who visited an emergency room at a university-affiliated hospital for a suicide attempt between January 2017 and December 2018 were retrospectively reviewed. Potential associations between baseline characteristics and psychiatric outpatient visitation were statistically analyzed. RESULTS: 107 out of 525 individuals (20.4%) who attempted suicide visited an outpatient clinic after the initial emergency room visit. Several factors (e.g., sober during suicide attempt, college degree, practicing religion, psychiatric treatment history) were significantly related to better psychiatric outpatient follow-up. CONCLUSION: Several demographic and clinical factors predicted outpatient adherence following a suicide attempt. Therefore, additional attention should be given to suicide attempters who are at the risk of non-adherence by practitioners in the emergency room.

Clinical implications of agoraphobia in patients with panic disorder.

Agoraphobia is frequently accompanied by panic disorder and causes considerable suffering. The aim of this study was to compare clinical features and treatment courses between patients with and without agoraphobia in panic disorder.In this retrospective study, 87 patients with panic disorder were divided into two groups depending on the presence of agoraphobia: patients with agoraphobia (PDA, n = 41) and patients without agoraphobia (PD, n = 46). Agoraphobia subscale score of the Albany Panic and Phobia Questionnaire was used to identify correlations between agoraphobia and panic and affective symptoms.The PDA group showed more severe panic and affective symptoms than the PD group. Patients with PDA were more likely to be younger at the age of onset, take benzodiazepines for longer durations, and be treated with antipsychotics augmentation. Agoraphobia subscale was associated with panic symptoms, depression, anxiety, and the duration of benzodiazepines use.The findings suggest that patients with PDA experienced more severe panic symptoms, more profound psychiatric comorbidity, and worse illness progression than those with PD.

Mature Defense Mechanisms Affect Successful Adjustment in Young Adulthood-Adjustment to Military Service in South Korea.

OBJECTIVE: A defense mechanism is an automatic psychological process necessary for successful adaptation. It reflects adaptive capacity. The purpose of this study is to explore the relationship between the adaptation ability of individuals who face mandatory military service and the pattern of defense mechanisms. METHODS: The subjects were 69 men (21.4±2.2 years) who expressed psychological difficulties in three military service situations. Control group was 36 men (24.0±1.4 years) who had successfully completed military service. We examined psychiatric history, the pattern of defense mechanisms, and depression and anxiety levels. Defense mechanisms were compared between two groups. RESULTS: The maladjusted group used immature defenses more frequently than the control group did. There were no differences in the defense patterns according to diagnosis. The control group used more identification and rationalization, classified as immature defenses. The temporarily maladjusted group used more somatization, regression, and avoidance. CONCLUSION: Using mature defense mechanisms helped young adults to adapt to a particular situation. The maturity of the defense is more valuable than the psychiatric diagnosis. Some immature defenses are also helpful to adapt. We cautiously assume that some defenses can be protective or risk factors in adapting to stressful situations by young adults.

Reversed Hand Movement during Sleep in Patients with Obstructive Sleep Apnea.

OBJECTIVE: Previous findings suggest that hand movement laterality is reversed during sleep. The present study aimed to verify this phenomenon and evaluate whether the extent of reversal is correlated with the severity of sleep apnea. METHODS: A total of 184 participants (mean age: 44.5±13.0 years; 81.5% males) wore actigraphs on both hands during sleep, and nocturnal polysomnography was simultaneously performed. RESULTS: Actigraphic indices of hand movement were significantly higher for the left hand than those for the right hand (p<0.001), including total activity score, mean activity score, mean score in active periods and fragmentation index. Additionally, calculated differences between the fragmentation index for the left versus right hands were significantly correlated with the apnea-hypopnea index (AHI, r=0.149, p=0.032). The AHI was not significantly correlated with differences in hand movement between both hands movement assessed by total activity score (r=0.004, p=0.957), mean activity score (r=0.011, p=0.876), mean score in active periods (r=-0.080, p=0.255). CONCLUSION: More severe symptoms of obstructive sleep apnea was associated with larger degree of hand movement reversal at night. This result support the theory that homeostatic deactivation occurs in the dominant hemisphere during sleep.

Asymmetrical Electroencephalographic Change of Human Brain During Sleep Onset Period.

OBJECTIVE: Human cerebral hemisphere is known to function asymmetrically with daytime left hemisphere superiority in most right-handed persons. It may have relevance to the localization of specific function of the brain. This study attempted to reveal whether the functional cerebral asymmetry in the wakeful state is still maintained throughout the sleep onset period. METHODS: Thirty-channel EEG was recorded in 61 healthy subjects. The EEG power spectra of each of the seven frequencies were compared between the two kinds of 30-second states; the wakeful stage and the late-sleep stage 1. RESULTS: The asymmetrical indices of sleep stage 1 at several fronto-central leads were decreased in the delta, theta, alpha-2, and all beta bands. Conversely, at parts of parieto-occipital leads showed an increase in the indices of the theta, alphas, beta-1, and beta-2 bands. Any fronto-central leads did not show an increase in the index, and no parieto-occipital leads showed a decrease. CONCLUSION: During the sleep onset period, power spectral asymmetry of the brain showed a different pattern from the wakeful stage. This asymmetrical pattern of EEG powers may suggest a reversal of the left hemispheric dominance during sleep.

Attitudes toward the mentally ill among community health-related personnel in South Korea.

BACKGROUND AND AIMS: Prejudice and negative attitudes toward mental illness are major obstacles in the rehabilitation and functional recovery of patients. The objective of this study was to evaluate the attitudes of health-related personnel toward mentally ill patients in a local urban community in South Korea. MATERIALS AND METHODS: In total, 401 participants (men, 132; women, 269; mean age, 37.3 ± 9.5 years) were recruited. The participants were health-related personnel in a district of Seoul, who were recruited from three different workplaces: a local administration office, a public health center, and a community welfare center. Sociodemographic data were gathered, and the community attitudes toward the mentally ill (CAMI) inventory were administered. Comparisons of the CAMI subscales were conducted among participants using statistical analysis. RESULTS: Community welfare center workers showed more authoritarianism and social restriction and less community mental health ideology than the other two groups. Among the demographic variables, a shorter working career, higher education, female gender, and younger age were also related to a more negative attitude toward mentally ill patients. CONCLUSION: Community health-related personnel who have contact with patients with mental illness should be encouraged to have a fair, hospitable, and open-minded attitude. It is advisable for these workers to receive interventions such as regular educational programs early in their careers.

Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder.

OBJECTIVE: Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS: A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS: On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. CONCLUSION: We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.

The Severity of Sleep Disordered Breathing Induces Different Decrease in the Oxygen Saturation During Rapid Eye Movement and Non-Rapid Eye Movement Sleep.

OBJECTIVE: To investigate how differences in oxygen saturation between non-REM (NREM) and REM sleep in patients according to the severity of sleep apnea. METHODS: We studied 396 male patients diagnosed with simple snoring or obstructive sleep apnea syndrome (OSAS) on nocturnal polysomnography. Patients were divided into groups by the OSAS severity. We compared the average oxygen saturation between REM and NREM sleep in each group. RESULTS: In the simple snoring group, average oxygen saturation was significantly greater during REM than during NREM sleep. In the severe OSA group alone, average oxygen saturation was greater in NREM than in REM sleep. The difference of NREM-REM average oxygen saturation correlated significantly with AHI in the severe OSA group. CONCLUSION: More severe hypoxemia was seen in REM than NREM sleep in the severe OSAS group. The differential oxygen decrease between REM and NREM sleep is likely due to the differentially occurring sleep breathing events in each sleep stage according to the SDB severity. The more AHI increases in the severe OSAS patients, the more prominent the hypoxemia of REM sleep compared with NREM sleep is likely to appear. This suggests that the pressure of continuous positive airway pressure should be increased to control the hypoxemia of REM sleep in extremely severe OSAS.

Nocturia Improvement With Surgical Correction of Sleep Apnea.

PURPOSE: To evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA). METHODS: A total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient's subjective judgment. RESULTS: The response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters. CONCLUSIONS: OSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA.

The Relationship between Type D Personality and Suicidality in Low-Income, Middle-Aged Adults.

OBJECTIVE: Low-income adults are considered to be a group at high risk for suicide. We sought to examine the effect of type D personality and other socio-demographic factors on suicidality in low-income, middle-aged Koreans. METHODS: In total, 306 low-income, middle-aged Koreans [age: 49.16±5.24 (40-59) years, 156 males, 150 females] were enrolled from the Korean National Basic Livelihood Security System. Socio-demographic data, including employment status, income, health, marital status, and educational attainment, were gathered. Beck's 19-item Scale for Suicidal Ideation (SSI) was applied to evaluate suicidality, and the DS14 was used to assess type D personality. RESULTS: Unemployment (p<0.01) and absence of spouse (p=0.03) predicted higher SSI scores independent of other socioeconomic factors. All type D personality scores [i.e., negative affectivity (NA), social inhibition (SI), and total score] predicted higher SSI scores independent of all socioeconomic factors (all, p<0.001). Subjects with type D personality had higher SSI scores (p<0.001), and the association between suicidality and socio-demographic factors (employment or physical health) could be found only in subjects without type D personality. CONCLUSION: Type D personality was a risk factor for suicide in low-income Koreans, independently from socio-economic factors. In addition, the socio-demographic factors were less prominently associated with suicidality in those with type D personality.

Three-Dimensional Electroencephalographic Changes on Low-Resolution Brain Electromagnetic Tomography (LORETA) During the Sleep Onset Period.

Electroencephalographic (EEG) patterns during sleep are markedly different from those measured during the waking state, but the process of falling asleep is not fully understood in terms of biochemical and neurophysiological aspects. We sought to investigate EEG changes that occur during the transitional period from wakefulness to sleep in a 3-dimensional manner to gain a better understanding of the physiological meaning of sleep for the brain. We examined EEG 3-dimensionally using LORETA (low-resolution electromagnetic tomography), to localize the brain region associated with changes that occur during the sleep onset period (SOP). Thirty-channel EEG was recorded in 61 healthy subjects. EEG power spectra and intracortical standardized LORETA were compared between 4 types of 30-second states, including the wakeful stage, transition stage, early sleep stage 1, and late sleep stage 1. Sleep onset began with increased delta and theta power and decreased alpha-1 power in the occipital lobe, and increased theta power in the parietal lobe. Thereafter, global reductions of alpha-1 and alpha-2 powers and greater increases of theta power in the occipito-parietal lobe occurred. As sleep became deeper in sleep stage 1, beta-2 and beta-3, powers decreased mainly in the frontal lobe and some regions of the parieto-temporo-limbic area. These findings suggest that sleep onset includes at least 3 steps in a sequential manner, which include an increase in theta waves in the posterior region of the brain, a global decrease in alpha waves, and a decrease in beta waves in the fronto-central area.

Path analysis of suicide ideation in older people.

BACKGROUND: Suicide among older people is one of the most rapidly emerging healthcare issues. The objective of this study was to identify the factors associated with suicide ideation in the aged population in South Korea. METHODS: The study recruited 684 subjects older than 65 years old (males = 147, females = 537, mean age = 78.20±7.02 years), and trained interviewers performed the interviews. The study was performed as part of a community mental health suicide prevention program. The subjects' socio-demographic data, physical health, alcohol problems, social relationships, psychological well-being, and depression severity were all considered. The Korean version of the Beck Scale for Suicide Ideation (K-BSI) was used to evaluate the intensity of suicide ideation. Correlation and hierarchical multiple regression analyses were performed to identify the factors associated with the K-BSI. The study results were tested using a path analysis. RESULTS: Depression severity was positively correlated with suicide ideation, and economic status, psychological well-being, and social relationships were negatively correlated with suicide ideation. Depression severity had the largest direct impact, and economic status and social relationships had indirect impacts on suicide ideation. Psychological well-being exerted both direct and indirect influences. CONCLUSION: Depression severity was the most important predictor of suicide ideation among older people. Other direct and indirect factors played secondary roles. Effective suicide prevention strategies should focus on early detection and active intervention for depression. Socio-economic programs may also indirectly reduce suicide ideation among the aged population.

Effectiveness of paliperidone extended-release for patients with schizophrenia: focus on subjective improvement.

OBJECTIVE: This study assessed whether the subjective experience of patients with schizophrenia improved after switching from an oral antipsychotic to flexibly-dosed paliperidone extended-release. METHODS: We conducted a 24-week, multicenter, non-comparative, open-label trial. A total of 387 patients with schizophrenia participated the study. The primary study outcome was the change in subjective symptoms measured by the Symptom Checklist-90-Revised version (SCL-90-R) from baseline. Visual analogue scales were used for sleep and daytime somnolence as secondary subjective assessments. The clinical global impression-schizophrenia-severity scale was used to assess overall symptom severity. Social functioning was evaluated by the personal and social performance scale. Adverse events were also evaluated. RESULTS: All subjective symptoms measured by the SCL-90-R improved significantly. The early responders, who achieved >20% reduction in the SCL-90-R within 1 week, maintained significantly lower severity through the 24 weeks. The clinical global impression-schizophrenia-severity scale and personal and social performance scores also improved significantly. The visual analogue scales revealed that daytime somnolence improved significantly, whereas nocturnal sleep quality was unaltered. CONCLUSION: Our results suggest that switching to paliperidone extended-release was associated with improvements in various subjective symptoms, decreased overall symptom severity, and increased social functioning. The results also suggest that early detection and reduction of subjective symptoms are important for treatment outcome.

Usefulness of Young's Internet addiction test for clinical populations.

BACKGROUND: Young's Internet Addiction Test (IAT) is one of the most widely used scales for assessing Internet addiction. AIMS: The purpose of the current study was to investigate the value of IAT for subjects clinically diagnosed with Internet addiction. METHODS: A total of 52 subjects, whose chief complaint and most serious behavioral problem was Internet addiction, were enrolled at an Internet-addiction clinic associated with a university hospital. The IAT was administered to assess the existence and severity of Internet addiction. Subjects were classified according to the severity guidelines of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) and according to the duration of their Internet addiction. RESULTS: The mean IAT score of our clinical subjects was 62.8 ± 18.2, which was below 70, the cut-off point indicating significant problems. The IAT detected only 42% of the clinical subjects as having significant problems with Internet addiction. No significant differences in IAT scores among those with mild, moderate and severe degrees of Internet addition were found, and no association between IAT scores and duration of illness was observed. CONCLUSIONS: IAT scores were not significant correlated with clinical severity and duration of illness in a clinical population. This instrument had limited clinical utility for evaluating the severity of Internet addiction. Considerable caution is required in interpretations of IAT scores.

The relationship between visceral adiposity and cognitive performance in older adults.

BACKGROUND: a direct association between visceral adiposity on abdominal computed tomography (CT) and cognitive performance has not been reported. OBJECTIVES: to investigate the associations between total and regional adiposity measured with abdominal CT, and cognitive performance in elderly persons and to explore their modification by age. DESIGN: cross-sectional study. SETTING: a health promotion centre of a tertiary university hospital. SUBJECTS: two-hundred and fifty individuals aged 60 years and above who underwent anthropometric measurements, abdominal CT and cognitive testing. METHODS: adiposity measures included body mass index (BMI), waist circumference and visceral and subcutaneous adiposity by abdominal CT. Poor cognitive performance was defined as Mini-Mental State Examination score being at or below 1 SD of age, sex and education-normative values. RESULTS: in multivariate logistic regression analyses obesity [odds ratio (OR) 2.61, 95% confidence interval (CI)=1.21-6.01, P=0.015] and being in the top tertile of the visceral adiposity area (OR: 2.58, 95% CI=1.001-6.62, P=0.045) were associated with poor cognitive performance in subjects younger than 70 years, but not in those 70 years and older. CONCLUSION: high adiposity, particularly visceral adiposity, was associated with poor cognitive functioning in younger elderly persons.