Development of a Clinical Guideline for Suicide Prevention in Psychiatric Patients Based on the ADAPTE Methodology.

OBJECTIVE: Suicide is a significant public health issue, with South Korea having the highest suicide rate among Organisation for Economic Cooperation and Development countries. This study aimed to develop clinical guidelines for suicide prevention in psychiatric patients in Korea using the ADAPTE methodology. METHODS: The development process involved a comprehensive review of literature, expert consultations, and consensus-building using the Nominal Group Technique and Delphi method. The guidelines focus on evidence-based psychiatric treatments, including both pharmacological and non-pharmacological approaches, tailored to the Korean context. Key findings underscoring the need for standardized treatment protocols for patients with major psychiatric disorders, including bipolar disorder, major depressive disorder, and schizophrenia. RESULTS: The guidelines incorporate treatments like lithium, clozapine, atypical antipsychotics, electroconvulsive therapy, and cognitive behavioral therapy, which have shown effectiveness in suicide prevention. Applicability and acceptability within Korea's healthcare system were addressed, ensuring feasibility given the country's medical insurance coverage and accessibility. The guidelines were validated through expert reviews and Delphi rounds, achieving consensus on the final recommendations. CONCLUSION: The developed guidelines provide a structured, evidence-based approach to reducing suicide rates among psychiatric patients in Korea. Future research will focus on expanding these guidelines to include screening protocols for high-risk groups.

Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study.

BACKGROUND: Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. METHODS: We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. RESULTS: In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. CONCLUSION: Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.

The association between insulin resistance and depressive symptoms - A national representative cross-sectional study.

OBJECTIVE: Increasing evidence suggests a positive association between insulin resistance (IR) and depression. However, whether sex-or body mass index-specific differences exist remains controversial, and only few studies have analyzed specific symptom domains. Thus, the present study aimed to analyze the association between IR and depressive symptom domains and to clarify the effects of sex and body mass index. METHODS: The study sample comprised 4007 participants, aged 19-79, from the Korea National Health and Nutrition Examination Study 2020. Participants completed health interviews and examinations, providing data on circulating insulin and glucose levels, the Patient Health Questionnaire-9 (PHQ-9), and related covariates. IR was calculated using the homeostasis model assessment of insulin resistance. Associations between IR and PHQ-9 were analyzed using negative binomial regression with adjustments for the complex survey design. RESULTS: The association between log-transformed IR and PHQ-9 total scores was statistically significant (incidence rate ratio [IRR] = 1.17, 95% confidence interval [CI] = 1.07-1.29, p = 0.001). Only body mass index specific differences were statistically significant, as the association was only significant in those without obesity (IRR = 1.21, 95% CI = 1.06-1.38, p = 0.005). IR was associated with cognitive/affective (IRR = 1.23, 95% CI = 1.08-1.41, p = 0.002) and somatic (IRR = 1.14, 95% CI = 1.04-1.25, p = 0.005) depressive symptom domains. Sensitivity analyses revealed similar results. CONCLUSIONS: IR was positively associated with cognitive/affective and somatic depressive symptoms in non-obese individuals.

New analysis method for functional brain imaging: White noise removed T2* variation mapping using multi-echo EPI.

BACKGROUND: Generally, the analysis of functional magnetic resonance imaging (fMRI) using echo-planar imaging (EPI) data is based on independent component analysis (ICA) and the general linear model (GLM). The application of these two approaches is highly independent, like GLM is for task-related activation mapping, and ICA is for resting-state imaging. Herein, we propose white noise-removed T2*-variation mapping as a new analysis method for fMRI that integrates the two conventional mapping approaches. NEW METHOD: We derived the standard deviation to the mean-square ratio of the true T2* signal from the multi-echo EPI (ME-EPI) dataset. For the true T2*-variation-based value, we removed the S0 (initial signal intensity) and white noise component from the variation in the EPI signal using signal-coherence analysis of the echo time (TE) dataset and slope analysis of the TE-variated coefficient of variation of the ME-EPI dataset. RESULTS: The activation mapping for a visual task and resting-state imaging by the proposed method showed the reliable activation map in the visual cortex area and area for the typical default mode network, with white noise and the S0 component removed. COMPARISON WITH EXISTING METHODS: Conventional analyses for fMRI cannot be applied to both activation mapping and resting-state imaging, with white noise removed, while the proposed method can be applied. CONCLUSIONS: We demonstrated white noise-removed true T2*-variation-based mapping as a new functional brain analysis approach. We expect the method allows studying in which that the association between task timing and brain activity is somewhat uncertain, such as studies of emotion and awareness.

Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy.

OBJECTIVE: Approximately half of patients with cancer have comorbidities, such as adjustment disorder, major depressive disorder, and delirium. Radiotherapy can cause psychological problems, e.g., the fear of treatment and its side effects, anxiety, depression, and social isolation. Health-related quality of life (QoL) must be determined to evaluate the effectiveness of cancer treatment. We analyzed the clinical, psychological, and sociodemographic factors influencing the QoL of patients with cancer who were undergoing radiotherapy. METHODS: Twenty-six patients undergoing radiotherapy (10 male, 16 female) were included. Sociodemographic and clinical data were collected prior to radiotherapy. Psychosocial factors were assessed by self-reported questionnaires before, immediately after, and 3 months after radiotherapy. A multivariate regression analysis identified factors affecting QoL at each time point. RESULTS: Patients' diagnoses were breast, cervical, prostate, endometrial, rectal, hypopharyngeal, laryngeal, liver, gallbladder, esophageal, ovarian, lung, and skin cancers. Before radiotherapy, better resilience was significantly associated with a higher QoL score (R2=0.199, p=0.033). Immediately after radiotherapy, financial difficulty was significantly associated with a lower QoL score (R2=0.274, p=0.010). Three months after radiotherapy, the presence of chronic disease (R2=0.398, p=0.002) and the severity of nausea and vomiting were significantly associated with a lower QoL score (R2=0.278, p=0.014). CONCLUSION: Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influenced the QoL of patients with cancer who were undergoing radiotherapy. Factors affecting QoL varied at each time point. Thus, patients with cancer should undergo regular mental health assessments, including assessments of QoL. Multidimensional (physical, psychological, and social) approaches and individualized time-based interventions are needed to improve the QoL of cancer patients undergoing radiotherapy.

Association Between Weight Misperception and Some Mental Health-Related Characteristics in Korean Adolescents.

BACKGROUND: Obesity in adolescents is associated with their mental as well as physical health. Adolescents tend to have negative or distorted perceptions about their body weight; however, the effects of such weight misperception on mental health remain unclear. This study investigated the association between weight misperception and mental health in Korean adolescents. METHODS: The analysis was based on the Korea Youth Risk Behavior web-based survey 2017 dataset, which included data from 62,276 middle and high school students at 800 schools throughout Korea. The students were divided into three groups according to whether they overestimated their body weight, underestimated it, or had no misperception. The mental health characteristics of the overestimation and no misperception groups were compared through multiple logistic regression analysis. RESULTS: Based on their body mass index, male adolescents were more likely to be overweight than female adolescents (p < 0.001) and less likely to have weight misperception. The female adolescents were more likely to overestimate their body weight and less likely to underestimate it (p < 0.001). The male adolescents and female adolescents who overestimated their body weight had significantly lower levels of subjective happiness than their peers had and were more likely to experience subjective stress, sadness/despair, suicidal ideation, and suicide planning. Compared with their peers who have no misperception, male adolescents with overestimation were less likely to drink alcohol (odds ratio [OR], 0.903) or smoke (OR, 0.871), whereas female adolescents with overestimation were more likely to drink alcohol (OR, 1.107) and smoke (OR, 1.130). CONCLUSION: Male and female adolescents who overestimated their body weight experienced more psychological problems. Thus, interventions to assist adolescents to gain realistic weight perception may be beneficial. Particularly, more attention needs to be given to female adolescents, who are more likely to overestimate their body weight compared with their male counterparts.