Case report: Periventricular heterotopia and early-onset bipolar disorder in adolescent patient with history of childhood attention deficit hyperactivity disorder.

Periventricular heterotopia (PH) is a developmental malformation in the brain. Because the clinical symptoms are heterogeneous, few studies have investigated the psychiatric symptoms associated with PH. We describe the case of a 17-year-old male with bipolar disorder (BD), who had been treated for attention deficit-hyperactivity disorder (ADHD) and developmental delay in childhood. He had experienced depression for 1 year and was admitted to the emergency room following a suicide attempt. He was admitted to the psychiatric ward for further evaluation and treatment for elated mood, decreased need for sleep, increased sexuality, and delusion. The patient was diagnosed with BP-I disorder and PH via brain magnetic resonance imaging. After combined treatment with valproic acid and aripiprazole, his manic symptoms stabilized. To our knowledge, this is the first report of an adolescent PH case with a history of early onset BD and ADHD in childhood.

Association between suicidal ideation and cognitive function in young patients with schizophrenia spectrum disorder.

Introduction: Suicide is a major concern for patients with recent-onset schizophrenia. We hypothesized that preserved cognitive function might be associated with a higher level of suicidality in patients with schizophrenia. We investigated the associations between cognitive function and suicidal ideation (SI) in young patients recently diagnosed with a psychotic disorder. Methods: This study analyzed data from a naturalistic clinical cohort study that comprised 402 patients with schizophrenia spectrum disorder. Patients with a treatment duration of ≤5 years and an age range of 15-39 years were enrolled. Participants were categorized into two groups based on SI as assessed by the Columbia Suicidal Severity Rating Scale. We collected demographic and clinical data and administered psychiatric, neurocognitive, and social cognitive measures. Results: Among participants, 52% reported experiencing SI. Patients with SI were significantly younger and had a longer duration of untreated psychosis (DUP) than those without it. The Positive and Negative Syndrome Scale-general psychopathology score was significantly higher in the SI group. Scores on the Calgary Depression Scale for Schizophrenia, Perceived Stress Scale, Beck Depression Inventory (BDI), and Beck Hopelessness Scale were significantly higher among patients with SI, while scores on the Subjective Well-being Under Neuroleptics-Short Form and Brief Resilience Scale were significantly lower compared to those without it. Patients with SI demonstrated significantly higher scores on the verbal and visual learning test, false belief task, picture stories task, and Controlled Oral Word Association Test. They also completed the Trail Making Test (TMT) parts A and B in significantly less time than those without it. After adjusting for age, DUP, and scores on the BDI, group differences in scores on the verbal and visual learning tests, TMT (parts A and B), and the false belief task, and the picture story task remained significant. Discussion: Our results suggest that along with traditional risk factors, better cognitive function may also be a major risk factor for suicidality in patients with schizophrenia. Providing psychological support and cognitive interventions is essential for young patients with recent-onset schizophrenia spectrum disorders, particularly those with high levels of depression, hopelessness, perceived stress, low resilience, and good cognitive function.

Inflammatory markers of symptomatic remission at 6 months in patients with first-episode schizophrenia.

Neuroinflammation contributes to the pathophysiology of various mental illnesses including schizophrenia. We investigated peripheral inflammatory cytokines as a biomarker for predicting symptomatic remission in patients with first-episode schizophrenia. The study included 224 patients aged 15-60 years who fulfilled the criteria for schizophrenia spectrum disorder with a treatment duration ≤6 months. Serum levels of tumor necrosis factor (TNF) -α, interferon-γ, interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, and IL-12 were measured. Psychotic symptoms, depressive symptoms, and general functioning were assessed using the Positive and Negative Syndrome Scale, Beck Depression Inventory (BDI), Calgary Depression Scale for Schizophrenia, and Personal and Social Performance scale, respectively. Duration of untreated psychosis (DUP) was also recorded. We investigated the factors associated with remission for each sex in logistic regression analysis. In total, 174 patients achieved remission at the 6-month follow-up (females, 83.5%; males, 70.9%). Remission was associated with older age and lower BDI scores in male patients and with lower TNF-α levels and shorter DUP in female patients. Our findings suggest that peripheral inflammatory cytokines may impede early symptomatic remission in female patients with schizophrenia. In addition, depressive symptoms in males and long DUP in females may be poor prognostic factors for early remission in patients with first-episode psychosis.

Suicide and Non-Suicidal Self-Injury From Internet Addiction Among Korean Adolescents.

Objectives: This study examined the associations between Internet addiction and suicide and non-suicidal self-injury (NSSI) among South Korean adolescents. Methods: We conducted a cross-sectional study of 1694 Korean adolescents. The suicidal Ideation Questionnaire and Deliberate Self- Harm Inventories were used to identify high-risk suicide and NSSI groups, respectively. Internet addiction was assessed using the Internet Addiction Scale. Other questionnaires included sociodemographic data, perceived academic stress, and daily life-related factors. We also performed a logistic regression analysis using the high suicide risk and NSSI groups as dependent variables. Results: The high suicide risk and NSSI prevalence rates among participants were 11.8% and 28.3%, respectively. A multivariable logistic regression analysis revealed that Internet addiction is associated with higher suicide risk and NSSI. Additionally, being female and academic stress were significant suicide risk factors, while male participants had a higher NSSI prevalence. Conclusion: Our results suggest that monitoring adolescents' Internet use and providing education to prevent Internet addiction would lower high suicide and NSSI risk. Moreover, suicide and NSSI risk screening in adolescents with Internet addiction and providing suitable interventions will be essential for the preventing suicide and NSSI.

Effectiveness of group metacognitive training and cognitive-behavioural therapy in a transdiagnostic manner for young patients with psychotic and non-psychotic disorders.

AIM: To investigate group metacognitive training and cognitive-behavioural therapy (MCT/CBT) prospectively in a young population with various psychiatric disorders, including psychotic and mood disorders. METHODS: This was a prospective study to investigate the effectiveness of group MCT/CBT on quality of life, psychotic symptoms, depression, self-esteem, perceived stress, social function and social cognition. The objective measures included the Positive and Negative Syndrome Scale (PANSS), clinical global impression (CGI), personal and social performance scale for social functioning, a computerized continuous performance test for sustained attention and a computerized emotional recognition test for social cognition. Self-report measures administered included the Subjective Well-being under Neuroleptics for quality of life, Ambiguous Intentions Hostility Questionnaire for suspiciousness, Drug Attitude Inventory, Beck Depression Inventory, Perceived Stress Scale, Brief Resilience Scale, Rosenberg Self-esteem Scale and visual analogue scale for the EQ-5D. RESULTS: Among 110 young patients with early psychosis and mood disorders who participated, 82 (74.5%) completed the study. Social functioning, quality of life, self-esteem, resilience, depression, suspiciousness, social cognition, sustained attention and scores on the PANSS and CGI improved significantly after completing group MCT/CBT. Perceived stress, resilience and suspiciousness improved significantly only in participants with a non-psychotic disorder. Improvements in subjective well-being of the participants were associated with increases in self-esteem and resilience and decreases in depression and perceived stress. CONCLUSIONS: Our study showed that group transdiagnostic MCT/CBT for young patients with mental illness improved subjective wellbeing, self-esteem, resilience, social cognition and social functioning and significantly diminished suspiciousness, perceived stress and depression.

Association between Peripheral Inflammatory Cytokines and Cognitive Function in Patients with First-Episode Schizophrenia.

In this study, we investigated the impact of inflammatory cytokines on the cognitive performance of patients with schizophrenia. The included patients met the criteria for schizophrenia spectrum disorder and were aged between 15 and 40 years, with a duration of illness ≤1 year. Plasma tumor necrosis factor (TNF)-α; interferon-γ; and interleukin (IL)-1ß, IL-6, IL-8, IL-10, and IL-12 levels were measured. A computerized neurocognitive battery, measures for social cognitive function, and clinical measures were administered. A total of 174 patients with first-episode psychosis were enrolled. The TNF-α level was negatively correlated with scores on the digit span, verbal learning, and Wisconsin card sorting tests, and the number of correct responses on the continuous performance test (CR-CPT), whereas a positive correlation was detected with the trail making test (TMT)-B time. The interferon-γ level was negatively correlated with performance on the false belief and visual learning tests. The IL-1ß level was positively correlated with the TMT-A time and CPT reaction time, whereas it was negatively correlated with the CR-CPT and performance on the visual learning and social cognitive tests. The IL-12 level was negatively correlated with the CR-CPT and false belief test. Our results suggest that proinflammatory cytokines are associated with cognitive impairment in patients with schizophrenia.

Factors Associated With Depression and Anxiety in Korean Adolescents During the COVID-19 Pandemic.

OBJECTIVE: This study was performed to identify factors associated with depression and anxiety among Korean adolescents during the coronavirus disease (COVID-19) pandemic. METHODS: We conducted a cross-sectional study of 1,898 Korean adolescents (55.2% male, 44.8% female) ranging in age from 12 to 17 years (mean±standard deviaion age, 15.4±2.6 years). Depression and anxiety were defined as a Patient Health Questionnaire-9 score ≥10 and Generalized Anxiety Disorder-7 score ≥10, respectively. Other questionnaires included sociodemographic data, psychosocial stresses, and experiences in association with COVID-19. Psychiatric scales included Gratitude Questionnaire-6, Perceived Stress Scale-10, and UCLA Loneliness Scale-3. RESULTS: The prevalence rates of depressive and anxiety symptoms among participants were 13.8% and 21.0%, respectively. Multivariable logistic regression analysis revealed that female sex, fear of COVID-19 infection, low gratitude were risk factors for depression. Fear of COVID-19 infection, increased TV watching time, and academic-related stress were risk factors for anxiety. CONCLUSION: Depression and anxiety were prevalent during the pandemic in Korean adolescents, and were associated with fear of COVID-19 infection. Providing appropriate information on COVID-19, helping adolescents manage academic-related stress and maintain daily life patterns, and implementing interventions to foster gratitude are important for preventing depression and anxiety in Korean adolescents.

Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality.

OBJECTIVE: The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality. METHODS: A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality. RESULTS: The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores. CONCLUSION: We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak.

BACKGROUND: During the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses. METHODS: A cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress. RESULTS: The mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (ß = 0.829, p < 0.001). CONCLUSIONS: Psychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.

Association between Childhood Trauma and Suicidal Behavior in the General Population.

This study aimed to investigate the associations between various types of childhood trauma and suicidal behavior in the general population in South Korea. This mental health survey included a total of 1,490 general citizens living in a metropolitan South Korean city who completed a questionnaire that assessed respondents' histories of childhood trauma before the age of 12 years, including bullying victimization, emotional abuse, sexual abuse, and physical abuse, as well as suicidal behavior, including current suicidal ideation and histories of suicide planning and attempts. The following psychiatric scales were administered: Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (R-SES), Connor-Davidson Resilience Scale (CD-RISC), Perceived Stress Scale (PSS), and visual analogue scale of EuroQol 5D (EQ-5D). Participants who experienced any childhood trauma had significantly higher HADS and PSS scores, and significantly lower EQ-5D scores. Additionally, participants with any type of childhood trauma were significantly more likely to have current suicidal ideation and histories of planned and attempted suicide. Multivariate analyses adjusted for confounding variables indicated that bullying victimization and sexual abuse were associated significantly with all types of suicidal behavior. Physical abuse was associated significantly with histories of suicide planning and attempts. The present findings showed that any type of childhood trauma was associated with higher levels of suicidality, anxiety, depression, and perceived stress, as well as lower health-related quality of life, in the general population. In particular, associations between childhood trauma and suicidality were identified after adjustment for confounding variables.

Network study of responses to unusualness and psychological stress during the COVID-19 outbreak in Korea.

The dramatic changes in people's daily lives caused by the 2019 coronavirus (COVID-19) pandemic have had a huge impact on their emotions and behaviors. This study aimed to examine psychosocial responses to COVID-19 using network analysis. A total of 1,500 urban residents of South Korea, selected from an online public panel, were surveyed using self-rating questionnaires addressing daily life changes, fear of infection, and distress related to COVID-19. Participants also completed a 10-item Perceived Stress Scale survey. We constructed regularized partial correlation networks, estimated global and local network metrics, tested network accuracy and stability, and compared the estimated networks between men and women. The network of the psychosocial responses consisted of 24 nodes that were classified into five groups: 'fear of infection', 'difficulty with outside activities', 'economic loss', 'altered eating and sleeping', and 'adaptive stress'. The node centralities indicated that 'distress in obtaining daily necessities' and 'concern about harming others' were the most important issues in people's responses to COVID-19. These nodes were connected by a negative edge, reflecting individual- and community-level issues, respectively. The overall level of perceived stress was linked to the network by the connection node 'anger toward others or society', which was associated with economic problems in men, but with distress from changes in daily activities in women. The results suggest that two contrasting feelings-personal insecurity regarding basic needs and a collectivistic orientation-play roles in the response to unusual experiences and distress due to COVID-19. This study also showed that public anger could arise from the psychological stress under the conditions imposed by COVID-19.

Non-suicidal self-injury is associated with psychotic like experiences, depression, and bullying in Korean adolescents.

AIM: Non-suicidal self-injury (NSSI) is common among adolescents, and several different factors can affect its prevalence. The present study examined the associated characteristics predicting NSSI among adolescents in South Korea. METHODS: In total, 1674 high school students were recruited for a cross-sectional survey. They completed self-reported assessments, including the Deliberate Self-Harm Inventory (DSHI), the Center for Epidemiological Studies Depression Scale (CESD), the State-Trait Anxiety Inventory for Children (STAIC), and the Prodromal Questionnaire-16 (PQ-16), as well as their bullying experience. The NSSI group was defined as the sample group with at least one NSSI behaviour on the DSHI scale. A logistic regression analysis was performed using the NSSI group as the dependent variable. RESULTS: The prevalence of NSSI was 28.3% (boys, 30.4%; girls, 24.4%) among adolescents. The most common type of NSSI behaviour among adolescents was interference with wound healing and sex differences in the method were examined. The CES-D, STAIC-trait, and PQ-16 scores were significantly higher and the RSES score was significantly lower in the NSSI group than those in the non-NSSI group. Participants' experience with bullying, such as being victims, bullies, bully-victims, and witness to bullying, were more likely to be in the NSSI group. In a logistic regression analysis, NSSI was significantly associated with male sex, low academic achievement, higher depression, psychotic-like experiences, being bullied, and witnessing bullying. CONCLUSION: The results of this study suggest the need to identify and manage related psychologic factors in adolescents with NSSI, including psychotic-like symptoms.

Sociodemographic and clinical factors associated with breakfast skipping among high school students.

AIM: Breakfast plays an important role in the academic performance and mental health of adolescents. This study explored factors associated with breakfast skipping in high school students in South Korea. METHODS: A cross-sectional survey was completed by 1684 high school students. A logistic regression analysis was conducted to determine the factors associated with skipping breakfast, including sociodemographic factors, mental health problems (such as depression and anxiety), sleep and smartphone use patterns. RESULTS: A total of 29.2% of the adolescents reported skipping breakfast and girls were significantly more likely to skip breakfast than boys (P < .001). The breakfast skipping group spent more time using a smartphone on weekdays [mean (SD) = 186.2 (180.0) min/d] than the breakfast eating group [mean (SD) = 110.2 (111.5) min/d] (P < .001). The Korean scale for smartphone addiction (S-scale) score was higher in the breakfast skipping group (P = .006). Multivariate logistic regression analysis showed that female gender, poor academic performance (odds ratio (OR),  1.575; 95% CI,  1.166-2.126, P = .003), depression (OR,  1.023; 95% CI,  1.002-1.043, P = .031), time spent using a smartphone on weekdays (OR,  1.003; 95% CI,  1.002-1.004, P < .001), and low parental monitoring of smartphone use were significantly associated with skipping breakfast. CONCLUSIONS: Findings indicate that unhealthy lifestyle including smartphone overuse negatively affects breakfast eating in adolescents. School-based nutritional programs should be designed to assess and overcome various individual factors associated with breakfast skipping.

The effects of patient personality traits and family cohesion on the treatment delay for patients with first-episode schizophrenia spectrum disorder.

AIM: The duration of untreated psychosis (DUP) is an important prognostic indicator of schizophrenia. We explored the effects of patient personality and family relationships on delayed schizophrenia treatment. METHODS: We prospectively included data from 169 patients diagnosed with first-episode schizophrenia. Personality traits were investigated using the Big Five Inventory (BFI-10) and family relationship was assessed employing the Family Adaptability and Cohesion Evaluation Scale-III (FACES-III). We explored patient clinical characteristics using the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). The DUP was defined as the time between the first appearance of psychotic symptoms and commencement of adequate antipsychotic treatment. Subjects were divided into two groups by the 3-month median DUP cutoff. RESULTS: The average and median DUPs were 12 and 3 months, respectively. A longer DUP was associated with older age, a higher PANSS score, and a lower SOFAS score. The frequency of suicide attempts tended to be higher in the delayed treatment group (P = .055). The delayed treatment group scored significantly higher in conscientiousness factor of the BFI-10 and scored significantly lower family cohesion and adaptability factors of the FACES-III. Logistic regression showed that a longer DUP was significantly associated with higher-level conscientiousness on the BFI-10 and poorer family cohesion on the FACES-III. CONCLUSION: Treatment delay was associated with reduced family cohesion and higher patient conscientiousness, suggesting that the family plays a crucial role in terms of patient access to mental health services when early psychotic symptoms appear.

Mindlink: A stigma-free youth-friendly community-based early-intervention centre in Korea.

AIM: In many Asian countries, youth mental health services are not well-developed and access to treatment is generally delayed. Here, we present a community-based service model based on our experience with Mindlink, the first early-intervention centre of its kind in Korea. METHODS: We describe the history of this mental health early-intervention service and the characteristics of users, as well as its intervention programmes and research directions. We also propose ways to further develop youth mental health services. RESULTS: A community-based early-intervention service for youth was first introduced in 2012, when a special team was formed in a community mental health centre of Korea. As the numbers of young clients increased, a youth-friendly, early-intervention centre called Mindlink was opened in 2016. Mindlink targets those aged 15-30 years with mental illness less than 5 years in duration. Its goal is to detect mental illness in young people early and provide comprehensive multidisciplinary interventions. It provides intensive case management and group programmes including cognitive-behavioural therapy, family intervention, psychoeducation, behavioural activation and physical health promotion. The Korean government has officially announced that the Mindlink model is effective and is currently in the process of scaling it up on a national level. CONCLUSION: An accessible, youth-friendly, stigma-free, community mental health centre such as Mindlink allows early detection and appropriate management of mental illness in young patients.

Comparison of Psychosocial Distress in Areas With Different COVID-19 Prevalence in Korea.

Objectives: This study aimed to compare psychosocial distress in areas in Korea with different prevalence of coronavirus disease 2019 (COVID-19) after validating a questionnaire on psychological experiences and stress associated with the disease outbreak. Methods: Using an online-based survey, psychosocial distress associated with COVID-19 was investigated in three regions, which were selected according to their prevalence of COVID-19. A total of 1,500 people from an online public panel in the three regions participated in the study. The questionnaire included sociodemographic information, psychosocial experience and stress related to COVID-19, and the perceived stress scale (PSS), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder-7 (GAD-7). Those questionnaires and scales were compared by level of prevalence of COVID-19 after validating the questionnaire on psychosocial distress associated with COVID-19. Results: The 19 items on psychosocial experience associated with COVID-19 comprised 5 subscales, with favorable Cronbach's α ranging from 0.69 to 0.88. Six stress items related to COVID-19 had a Cronbach's α of 0.79. Disturbance in eating and sleeping, difficulty with outside activities, stress from COVID-19, and PSS scores were greater in the areas where COVID-19 was highly prevalent. Economic problems, daily activity changes, and anger toward society were higher in the higher-prevalence regions. Discussion: Psychosocial distress associated with COVID-19 was closely related to the prevalence of the disease in the areas where participants lived. Psychosocial interventions for distress associated with COVID-19 should be developed and prepared for people during this lengthy pandemic.