Incidence and Direct Medical Cost of Acute Stress Disorder and Post-traumatic Stress Disorder in Korea: Based on National Health Insurance Service Claims Data from 2011 to 2017.

BACKGROUND: We aimed to investigate the annual incidence of trauma and stress-related mental disorder including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) using the National Health Insurance Service Database. In addition, we estimated direct medical cost of ASD and PTSD in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems code for ASD (F43.0) and PTSD (F43.1) and had not been diagnosed in the previous 360 days, from 2010 to 2017. We estimated annual incidence and the number of newly diagnosed patients of ASD and PTSD. Annual prevalence and direct medical cost of ASD and PTSD were also estimated. RESULTS: The number of newly diagnosed cases of ASD and PTSD from 2011 to 2017 totaled 38,298 and 21,402, respectively. The mean annual incidence of ASD ranged from 8.4 to 13.7 per 100,000 population and that of PTSD ranged from 4.2 to 8.3 per 100,000 population, respectively. The incidence of ASD was found more in females and was highest among the 70-79 years of age group and the self-employed individuals group. The incidence of PTSD was also more common in the female group. However, the incidence of PTSD was highest in the 60-69 years of age group and in the medical aid beneficiaries group. The annual estimated medical cost per person of ASD ranged from 104 to 149 US dollars (USD). In addition, that of PTSD ranged from 310 to 426 USD. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of ASD and PTSD in Korea were increased. Proper information on ASD and PTSD will not only allows us to accumulate more knowledge about these disorders themselves but also lead to more appropriate therapeutic interventions by improving the ability to cope with these trauma related psychiatric sequelae.

Psychiatric Symptoms and Clinical Diagnosis in High School Students Exposed to the Sewol Ferry Disaster.

BACKGROUND: Two hundred and fifty 11th grade students and teachers from Danwon High School drowned, during a school trip, in the Sewol Ferry Disaster. The goal of this study was to investigate the experiences of the psychiatrists who volunteered and provided psychiatric services to the students at Danwon High School. METHODS: From the second day to the 138th day after the disaster, pro bono psychiatrists provided post-disaster interventions to the 10th and 12th-grade Danwon High School students who did not attend the trip. Officially, 167 psychiatrists conducted outreach in approximately 550 encounters. The study questionnaires were distributed retrospectively to psychiatric volunteers who conducted outreach at Danwon High School. We surveyed the pro bono psychiatrists about their experiences, including the students' chief complaints, psychiatric problems, clinical diagnoses, and psychiatrists' treatment recommendations. RESULTS: We reached 72 (43.1%) of the 167 volunteers, and they reported on 212 (38.6%) of the 550 encounters. The common chief complaints were mental health problems, companion problems, and family problems. The most frequent psychiatric symptoms were anxiety (76.89%), depressive mood (51.42%), and concentration difficulty (50.94%). The most frequent clinical diagnoses of the students were normal reaction (41.04%), acute stress disorder (24.53%), adjustment disorder (17.92%), anxiety disorders (9.43%), and posttraumatic stress disorder (6.60%). More than half of the students needed "additional counseling/therapy" (41.04%) or "referral to psychiatric treatment" (14.15%). CONCLUSION: During the acute aftermath of the Sewol Ferry Disaster, volunteer psychiatrists were able to provide services. These services included psychiatric assessments, crisis counseling, psychological first aid, and referrals for ongoing care. More than half of the students were perceived to have a psychiatric diagnosis, and a substantial proportion of students needed further treatment. Future research should focus on the short- and long-term effects of psychiatric interventions and the characterization of post-disaster mental health needs and service provision patterns.

Prescription Trends of Psychotropics in Children and Adolescents with Autism Based on Nationwide Health Insurance Data.

Children with autism are often medicated to manage emotional and behavioral symptoms; yet, data on such pharmacotherapy is insufficient. In this study, we investigated the Korean National Health Insurance Claims Database (NHICD) information related to autism incidence and psychotropic medication use. From the 2010-2012 NHICD, we selected a total of 31,919,732 subjects under 19 years old. To examine the diagnostic incidence, we selected patients who had at least one medical claim containing an 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for pervasive developmental disorder, F84, not diagnosed in the previous 360 days. Psychotropics were categorized into seven classes. Then, we analyzed the data to determine the mean annual diagnostic incidence and psychotropic prescription trends. Diagnostic incidence was 17,606 for the 3 years, with a mean annual incidence per 10,000 population of 5.52. Among them, 5,348 patients were prescribed psychotropics. Atypical antipsychotics were the most commonly used, followed by antidepressants. An older age, male sex, and the availability of medical aid were associated with a higher rate of prescription than observed for a younger age, female sex, and the availability of health insurance. Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Therefore, medication-related safety data and policies for psychotropic drugs in autism should be prepared.

Naturalistic Pharmacotherapy Compliance among Pediatric Patients with Attention Deficit/Hyperactivity Disorder: a Study Based on Three-Year Nationwide Data.

We examined short- and long-term medication compliance among youth with attention-deficit hyperactivity disorder (ADHD), using data from the National Health Insurance database in Korea. Of the 5,699,202 6-14-year-old youth in 2008, we chose those with at least 1 medical claim containing an ICD-10 code for diagnosis of ADHD (F90.0) and no prescription for ADHD within the previous 365 days. We tracked the data every 6 months between 2008 and 2011, to determine treatment compliance among newly diagnosed, medicated patients. Further, we checked every 1 month of the 6 months after treatment commencement. Treatment continuity for each patient was calculated by sequentially counting the continuous prescriptions. For measuring compliance, we applied the medication possession ratio (MPR) as 0.6, 0.7, and 0.8, and the gap method as 15- and 30-days' intervals. There were 15,133 subjects; 11,934 (78.86%) were boys. Overall 6-month treatment compliance was 59.0%, 47.3%, 39.9%, 34.1%, 28.6%, and 23.1%. Monthly drop-out rates within the first 6 months were 20.6%, 6.5%, 4.7%, 3.7%, 3.0%, and 2.5%, respectively. When applying MPR more strictly or shorter gap days, treatment compliance lessened. This is the first nationwide report on 36-month treatment compliance of the whole population of 6-14-year-olds with ADHD. We found the beginning of the treatment, especially the first month, to be a critical period in pharmacotherapy. These results also suggest the importance of setting appropriate treatment adherence standards for patients with ADHD, considering the chronic course of ADHD.

Differences in Utilization Patterns among Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: a 36-Month Retrospective Study Using the Korean Health Insurance Review and Assessment Claims Database.

We evaluated the differences in utilization patterns including persistence and adherence among medications in children and adolescents with attention deficit hyperactivity disorder (ADHD). The current study was performed using data from the Korean Health Insurance Review and Assessment claims database from January 1, 2009 to December 31, 2013. Our study sample consisted of 10,343 children and adolescents with ADHD who were not given their newly prescribed medication in 360 days before the initial claim in 2010. Data were followed up from the initiation of treatment with ADHD medications in 2010 to December 31, 2013. Discontinuation rates for 4 ADHD medications in our sample ranged from 97.7% for immediate-release methylphenidate to 99.4% for atomoxetine using refill gap more than 30 days and from 56.7% for immediate-release methylphenidate to 62.3% for extended-release methylphenidate using refill gap more than 60 days. In the number of discontinued, we found significant differences among medications using refill gap more than 30 days. Among 4 ADHD medications, extended-release methylphenidate and atomoxetine had more days than immediate-release methylphenidate and osmotic-controlled oral delivery system methylphenidate. In logistic regression analyses, extended-release methylphenidate, osmotic-controlled oral delivery system methylphenidate, and atomoxetine showed less discontinuation compared to immediate-release methylphenidate group when a refill gap more than 30 days was used. In logistic regression analysis of adherence, we could not find any differences among 4 medication types. We suggest that the utilization patterns should be assessed regularly in order to improve future outcomes in children and adolescents with ADHD.

Parental quality of life and depressive mood following methylphenidate treatment of children with attention-deficit hyperactivity disorder.

AIM: This naturalistic study investigated the associations between quality of life and depressive mood in parents and symptom changes in attention-deficit hyperactivity disorder (ADHD) children. METHODS: At baseline and at weeks 4 and 8, the parents evaluated their children, who were receiving treatment with osmotic-release oral system methylphenidate (mean dosage 36.3 ± 15.5 mg/day), using the Swanson, Nolan, and Pelham - Fourth Edition (SNAP-IV-18) scale. The parents evaluated themselves using the Beck Depression Inventory (BDI) and the World Health Organization Quality of Life Assessment, Brief Version (WHOQOL-BREF). RESULTS: A significant reduction in SNAP-IV-18 scores and improvements in parental BDI scores and parental WHOQOL-BREF scores were observed. The decrease in BDI scores from baseline to 8 weeks was significantly associated with increases in WHOQOL-BREF sub-domain scores from baseline to 8 weeks, with a greater decrease at 4 weeks and after. The decrease in the SNAP-IV-18 hyperactivity-impulsivity score was significantly associated with increases in WHOQOL social sub-domain scores from baseline to 8 weeks. For those patients who showed a 25% or greater decrease in the SNAP-IV-18 total scores from baseline to 8 weeks, the decreases in the SNAP-IV-18 total score and in the inattention and hyperactivity-impulsivity scores were significantly associated with a decrease in BDI scores from baseline to 8 weeks. CONCLUSION: Methylphenidate treatment for ADHD was associated with both symptom alleviation in children with ADHD and improvement in parental depressive mood and quality of life, suggesting that the effects of treatment could go beyond symptom improvement in ADHD.

Korean Clinical Guideline for Autism Spectrum Disorder - Clinical Features, Course, Epidemiology, and Cause.

Autism spectrum disorder (ASD) is a heterogeneous developmental disorder characterized by impairments in two core areas: 1) social communication and interaction and 2) restricted and repetitive patterns of behaviors and interests. In general, ASD is known to be a lifelong disorder. Follow-up studies from childhood to adulthood have reported that the severity of the key symptoms ASD decreases over time. However, chronic health problems including mental health occur in many patients with ASD. The prevalence of ASD has increased from around 0.04% in the 1970s to 2.8% at present. The average age of diagnosis in developed countries is 38-120 months of age. Recent evidence suggests that biological factors which include genetic, congenital, immunological, neuroanatomical, biochemical, and environmental ones are important in causing autism. Until now, early signs and various risk factors of ASD have been suggested.

Methylphenidate-osmotic-controlled release oral delivery system treatment reduces parenting stress in parents of children and adolescents with attention-deficit/hyperactivity disorder.

OBJECTIVE: The aim of the current study was to investigate the effect of methylphenidate-osmotic release oral delivery system (MPH-OROS) treatment on parenting stress in parents of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: Four hundred and ninety-five children and adolescents (391 boys and 104 girls), aged 7 to 18 years who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for ADHD, were recruited at 48 psychiatric outpatient clinics across South Korea. Children's symptoms, parenting stress, and parental depression were assessed at baseline, week 4, and week 8 of MPH-OROS treatment using the Korean version of the DuPaul's ADHD Rating Scale (ARS), the Beck's Depression Inventory (BDI), and the Parenting Stress Index, Short Form (PSI-SF). RESULTS: We found significantly decreased scores of ARS, parental BDI, and PSI-SF from baseline to week 4 and from week 4 to week 8. Also, there were positive correlations among baseline PSI-SF, ARS, and BDI scores. The changes in BDI and ARS scores were significantly associated with the PSI score changes, accounting for 20.1% and 10.0%, respectively. CONCLUSIONS: We suggest that the increased parenting stress and depression in parents of children and adolescents with ADHD can be improved following the treatment with MPH-OROS.

How Are Autism Spectrum Disorder and Savant Skills Treated in Cinematographic Works? A Study Focusing on Korean Movies and TV Series.

Numerous films and TV series worldwide have depicted characters with autism spectrum disorder (ASD) and savant skills. This study describes the portrayal of ASD and savant skills in Korean films and dramas. Starting with the 2005 film Marathon, characters with ASD have been featured in five films and four dramas. Most portrayals were based on the diagnostic criteria and pathogenesis of ASD, as outlined in the DSM-5. Of the 10 characters with ASD in these films and dramas, seven were male and three were female, with seven of them possessing savant skills. In the future, caution and guidance on the general characteristics of ASD from experts should be provided with the release of ASD-based films and TV dramas in Korea; in addition, critiques and social discourse pertinent to the reality of ASD should be provided by people with ASD, their families, and relevant experts.

Prevalence and Medical Costs of Intellectual Disabilities and Pervasive Developmental Disorder in Korea: Based on National Health Insurance Service Claims Data from 2007 to 2019.

OBJECTIVE: We aimed to investigate the annual prevalence of intellectual disabilities (ID) and autism spectrum disorder employing claims data registered in Korean National Health Insurance Service. We also estimated the annual average of medical costs incurred from these disorders using same datasets. METHODS: In order to obtain the prevalence, we selected patients diagnosed with ID and pervasive and specific developmental disorders (PDD) from 2007 to 2019. The ensuing annual average of medical costs was also estimated from these patients. RESULTS: The annual prevalence of ID and PDD (per 100,000) between 2007 and 2019 ranged from 56.7 to 78.6 and from 22.0 to 44.6 respectively. Regarding the annual average of total medical expenditure per a patient, the expenditure of the ID group was higher than that of PDD throughout the years, as shown that the ID expenditure ranged from 769.7 to 1,501.2 US dollars as opposed to the PDD expenditure in the range of 312.5 to 570.7 US dollars. The further comparison in relation to income levels elaborated that the medical aid beneficiary group constitutes the highest one and the difference of the expenditure across the remaining income groups was not prominent although the very low group generally ranked the highest over the years. CONCLUSION: The prevalence of ID and PDD constantly increased and the same trend was displayed in ensuing health expenditures throughout the period. This implies that increasing needs exist across these patients with regards to therapeutic interventions, thereby contributing to prioritizing medical policies on national perspectives.

How Must We Prepare in the Next Decades When Caring for Those With Developmental Disabilities: "Grown Up" (2018).

The Guarantee of Rights and Support for Persons with Developmental Disabilities Act was enacted and revised in 2014. However, national measures for persons with developmental disabilities remain insufficient. In the film, "Grown Up," director Hyeyoung Jang filmed the daily life of her sister, who has developmental disabilities. She raised not only the issue of institutionalization in people with developmental disabilities in Korea but also the issue of a lack of policies that would be essential to them and their family members. In the future, I hope that as experts, child and adolescent psychiatrists in Korea will pay more attention to the lives of people with developmental disabilities outside the clinic and propose policies to help them and their family members.

Association Among Self-Injury, Suicidal Tendency, and Personality and Psychological Characteristics in Korean Adolescents.

OBJECTIVE: To compare mental health problems and personality characteristics between adolescents with self-injury (SI) and suicidal tendency (ST), including suicidal ideation and suicide planning. METHODS: The participants completed the Adolescent Personality and Mental Health Problems Screening Questionnaire, Third version (AMPQ-III), and Korean version of the Strengths and Difficulties Questionnaire (SDQ-Kr), and gave their demographic information. Based on the answered SI and ST items in AMPQ-III, the participants were divided into groups: without SI and ST, with SI and without ST, without SI and with ST, and with SI and ST. Analysis of variance (ANOVA) and post-hoc Scheffe test were used to determine group differences, stepwise multiple linear regression, and factors associated with SI and ST. RESULTS: ANOVA yielded results for all categories of mental health problems. Significant differences were observed between the four groups. Conversely, for personality characteristics, only the sense of community item between the group without SI and with ST and the group without SI and ST were significantly different; sense of community was associated with ST (ß=-0.054, p=0.005). Among the mental health subscales, SI was significantly associated with conduct problems (ß=0.211, p<0.001), emotional problems (ß=0.173, p<0.001), peer problems (ß=0.085, p<0.001), and prosocial behavior (ß=0.073, p<0.001). ST was significantly associated with emotional symptoms (ß=0.317, p<0.001), peer problems (ß=0.130, p<0.001), conduct problems (ß=0.106, p<0.001), hyperactivity (ß=0.050, p=0.010), and prosocial behavior (ß=0.062, p<0.001). CONCLUSION: The findings highlight the necessity of assessing psychological strength, difficulties, and personality characteristics for the prevention and early intervention of adolescent SI.

Incidence and Direct Medical Cost of Adjustment Disorder and in Korea Using National Health Insurance Service Claims Data From 2011 to 2017.

OBJECTIVE: We aimed to investigate the annual incidence and direct medical cost of adjustment disorder in general population using the National Health Insurance Service Database (NHID) in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim for adjustment disorder and had not been diagnosed in the previous 365 days, from 2010 to 2017. RESULTS: The number of newly diagnosed cases of adjustment disorder from 2011 to 2017 were total 101,922. Annual incidence of adjustment disorder was ranged from 22.0 to 36.8 per 100,000 persons. The incidence of adjustment disorder was found more in female and highest among 70-79 years of age group and medical aid beneficiaries group. Annual prevalence of adjustment disorder was in the range from 95.4 to 116.4 per 100,000 persons. Estimated annual medical cost per person of adjustment disorder was ranged from 162 to 231.4 US dollars. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of adjustment disorder in Korea were increased. Proper information on adjustment disorder will not only allows us to accumulate more knowledge but also lead to more appropriate therapeutic interventions.

Temperament and character among Korean children and adolescents with anxiety disorders.

The purpose of this study was to evaluate the temperament and character of children and adolescents with anxiety disorders in samples from Korean community. The study subjects were children and adolescents diagnosed with social phobia (n = 66), separation anxiety disorder (n = 47), specific phobia (n = 415), and obsessive-compulsive disorder (n = 42) with the diagnostic interview schedule for children, version IV (DISC-IV) in representative community samples. Among these, we excluded other psychiatric disorder comorbid samples, with the exception of externalizing disorders. We assessed the subjects of each anxiety group using the junior temperament and character inventory (JTCI). Social phobias were significantly associated with high harm avoidance and low self-directedness on the JTCI. The association of specific phobias with high harm avoidance, and obsessive-compulsive disorder with low self-directedness was also significant. Separation anxiety disorder was not associated with any temperament and character on the JTCI. Children and adolescents with anxiety disorders have different temperaments and character profiles in accordance with diagnostic groups, which implies the specific pathophysiological mechanism of each anxiety disorder.

Full syndrome and subthreshold attention-deficit/hyperactivity disorder in a Korean community sample: comorbidity and temperament findings.

OBJECTIVE: The main objective of this study was to investigate the comorbid disorders and temperamental profiles of full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD). METHOD: A sample of 2,493 students was randomly selected from six representative elementary schools in Seoul, Korea. Among 245 children with full syndrome and subthreshold ADHD diagnosed by the diagnostic interview schedule for children-4th version, parents of 185 subjects (mean age 9.0 +/- 1.7 years) and of a random sample of 185 age- and gender-matched non-ADHD children have completed the parent's version of the children behavior checklist (CBCL) and the juvenile temperament and character inventory (JTCI). RESULTS: The prevalence rates of full syndrome and subthreshold ADHD were, respectively, 5.90% (95% confidence interval = 4.74-7.06) and 9.00% (95% confidence interval = 7.58-10.41). Subthreshold ADHD cases did not differ from full syndrome ADHD in any JTCI profile, showing high novelty seeking/low persistence/low self-directedness than controls. Subthreshold ADHD also showed increased risk for externalizing disorders and higher scores in eight CBCL scales (somatic complaints, anxious/depressed, social problems, attention problems, delinquent behaviors, aggressive behaviors, externalizing problems and total behavioral problems) compared to the controls. CONCLUSIONS: These results support the clinical relevance of subthreshold ADHD in Asian culture. Increased clinical awareness for children with subthreshold ADHD is needed.

The Association between Depressive Mood and Cholesterol Levels in Korean Adolescents.

OBJECTIVE: Previous studies have shown that there is a correlation between lipid levels and depressive mood, and that lipids could be useful biomarkers for depression. We conducted this study to clarify the association between lipid levels and depressive mood in adolescents, especially in community samples. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) that was conducted from 2013 to 2016. A total of 2,454 adolescents aged 12-18 years (1,273 boys, 1,181 girls) participated in the Survey. We conducted a cross-sectional study using multiple logistic regression, adjusting for age, household income, daily energy intake, daily fat intake, and daily cholesterol intake, to assess the association between depressive mood and serum lipid levels. RESULTS: Depressive mood was found in 8.7% of those included in the study. Borderline (110-129 mg/dL) and high (≥130 mg/dL) levels of low-density lipoprotein cholesterol (LDL-C) were significantly associated with depressive mood [Borderline level: odds ratio (OR)=5.55, 95% confidence interval (CI) 1.56-19.81, p=0.01; High level: OR=5.73, 95% CI 1.06-31.08, p=0.04]. However, this association was not found in girls. CONCLUSION: Our findings indicate that depressive mood in boys is associated with higher LDL-C levels. Further investigation regarding this relationship and the underlying biological mechanisms is needed.

Mental Health Interventions Provided by Volunteer Psychiatrists after the Sewol Ferry Disaster: April 16-November 30, 2014.

OBJECTIVE: The aim of this study was to examine the experience of volunteer psychiatrists who provided mental health interventions to adolescents and teachers of Danwon High School from April 16, 2014, to November 30, 2014. METHODS: Data for this study were collected from 72 volunteer psychiatrists about their intervention experiences for 212 adolescents and 32 teachers during the eight months following the disaster. Developmental survey themes were identified, and coding was used to analyze the data. In addition, qualitative data analysis was performed using ATLAS.ti (version 8.2, 2018, ATLAS.ti GmbH). RESULTS: A volunteer prepared with appropriate mental health interventions may facilitate the emergency response to a disaster. Intervention services included psychological first aid, psychoeducation, screening, anxiety reduction techniques, and group therapy. CONCLUSION: In the acute aftermath of the Sewol Ferry disaster of April 16, 2014, volunteer psychiatrists were able to provide mental health interventions in a disaster response setting. The outcomes from this study have important policy and mental health system implications for volunteer psychiatrists. The results of this study constitute the basis of a better understanding of the essential mechanisms of crisis interventions after a disaster.

Association between the alpha-2C-adrenergic receptor gene and attention deficit hyperactivity disorder in a Korean sample.

Findings from preclinical and clinical research support the involvement of central noradrenergic dysregulation in the etiology of attention deficit hyperactivity disorder (ADHD). Previous studies have suggested that the alpha-2C-adrenergic receptor gene (ADRA2C) is associated with ADHD. The aims of this study were to examine the association between the ADRA2C (GT)n repeat polymorphism (STR marker adra2c1) and ADHD in a Korean sample. In this case-control and family-based association study, we assessed 184 ADHD probands, 150 normal controls, and 98 trios. There were no significant differences in the allele frequencies of the ADRA2C polymorphism between the ADHD and control groups (p > 0.05). The overall allele-wise transmission disequilibrium test (TDT) analysis showed statistical significance (chi2 = 19.07, p = 0.025). We found a trend for preferential transmission of the 183-bp allele (chi2 = 3.72, p = 0.054), and a significantly lower-than-expected rate of transmission of the 187-bp allele (chi2 = 6.26, p = 0.012). With regard to the temperament profiles of the Junior Temperament and Character Inventory (JTCI), the ADHD subjects with the 183/183 genotype at the ADRA2C polymorphism showed a trend toward a lower score in the Novelty Seeking (p = 0.020) profile than did those with the other genotypes. Our findings provide important evidence that the ADRA2C polymorphism is involved in the etiology of ADHD in Korean subjects. In addition, our results provide evidence that the temperament of Novelty Seeking and ADHD might share molecular genetic characteristics related to the noradrenergic system.

No evidence of an association between norepinephrine transporter gene polymorphisms and attention deficit hyperactivity disorder: a family-based and case-control association study in a Korean sample.

Neurobiological and pharmacological research has suggested that dysregulation of the central noradrenergic systems might be involved in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Previous studies have demonstrated that the norepinephrine transporter gene (SLC6A2) is associated with ADHD. The aims of this study were to examine the association of the SLC6A2 G1287A and -3081(A/T) polymorphisms with ADHD in Korean children and adolescents, and to determine the relationships of the genotypes of these two polymorphisms with continuous performance test results and the Junior Temperament and Character Inventory profiles of ADHD. In a case-control study, we assessed 186 ADHD probands and 150 normal controls; 109 trios were studied in a family-based association analysis. There were no significant differences in the genotype or allele frequencies of the SLC6A2 G1287A and -3081(A/T) polymorphisms between the ADHD and control groups (p > 0.05). In the transmission disequilibrium test analyses, there was no evidence for biased transmission of any of the alleles of the SLC6A2 G1287A and -3081(A/T) polymorphisms. In the haplotype analyses of these two polymorphisms, the global and individual chi(2) tests showed no significant associations between any of the haplotypes and ADHD. There were no significant differences with respect to the continuous performance test results and the Junior Temperament and Character Inventory profiles in the ADHD probands according to the genotypes of the SLC6A2 G1287A and -3081(A/T) polymorphisms. Our findings do not support SLC6A2 as a major genetic susceptibility factor in ADHD.

Impact of lifetime subthreshold depression and major depression before internship on psychopathology and quality of life in Korean interns: 6 month follow-up study.

OBJECTIVE: The aim of the present study was to investigate the influences of lifetime subthreshold depression and major depression before internship on the changes in psychopathology and subjective quality of life during internship. METHOD: A total of 151 interns at Seoul National University Hospital completed questionnaires including World Health Organization Quality of Life Assessment Instrument, Brief Version (WHOQOL-BREF), Symptom Checklist-90-Revised (SCL-90-R), and Beck Depression Inventory (BDI) twice at an interval of 6 months. Their lifetime diagnosis of depression before internship was made using the Korean version of Mini International Neuropsychiatric Interview (MINI), Modified Form for Self-Administration. RESULTS: Significant changes over time were detected including total score in the BDI and the Somatization, Depression, Anxiety, and Phobic Anxiety dimension scores in the SCL-90-R as well as all four domain scores in WHOQOL-BREF. In addition, in all scores except Somatization dimension score, group difference existed. Post-hoc comparisons showed that interns without lifetime depression were significantly different from those with lifetime subthreshold depression and those with lifetime major depression. CONCLUSIONS: Even a subthreshold-level, lifetime depression before internship has an adverse effect on the psychopathology and the subjective quality of life during internship. Therefore, earlier detection, monitoring, and management of this population would be needed throughout the intern year and beyond.