Neuroablative Intervention for Refractory Obsessive-Compulsive Disorder

Objective@#This review aims to investigate the progression of neuroablation, along with documented clinical efficacy and safety, in the management of treatment-resistant obsessive-compulsive disorder (OCD). @*Methods@#We searched and compiled clinical research results of neuroablation therapy reported to date. We extracted outcomes related to clinical efficacy, side effects, and surgical complications. Additionally, we summarized key claims and findings. @*Results@#Neuroablative intervention is a potential treatment approach for refractory OCD. Recent advancements, such as real-time magnetic resonance monitoring and minimally invasive techniques employing ultrasound and laser, offer distinct advantages in terms of safety and comparative efficacy when compared to conventional methods. However, the absence of randomized controlled trials and long-term outcome data underscores the need for cautious consideration when selecting neuroablation. @*Conclusion@#Neuroablative intervention shows promise for refractory OCD, but vigilant consideration is essential in both patient selection and surgical method choices due to the potential for rare yet serious complications.

Examining the Psychometric Properties and Clinical Correlates of the Korean Version of the Family Accommodation Scale-Self-Rated Version for Obsessive-Compulsive Disorder

Objective@#We aimed to develop a Korean version of the Family Accommodation Scale-Self-Rated (FAS-SR), to investigate its reliability and validity and to study the clinical correlates of family accommodation in families with obsessive compulsive disorder (OCD) patient. @*Methods@#The FAS-SR was translated into Korean under the original author’s supervision. Forty-two patients with OCD and their closest relatives participated. The internal consistency was estimated using Cronbach’s alpha and the split half method. Convergent and divergent validity were identified by measuring with other clinical variables. Test-retest reliability was also calculated. @*Results@#The reliability analyses showed that Korean version of the FAS-SR demonstrated excellent internal consistency (Cronbach’s alpha=0.91) and test-retest reliability (Intraclass correlation coefficient=0.93). It showed good convergent validity when simultaneously assessed OCD symptom severity, global functioning and relative’s psychological distress. @*Conclusion@#The findings suggest that Korean version of the FAS-SR is a reliable and valid tool for assessing family accommodation in Korean patients with OCD in both research and clinical settings.

Lethality-Associated Factors in Deliberate Self-Poisoning

Objectives@#Deliberate self-poisoning (DSP) is the most common suicide method and can be life-threatening. The purpose of this study was to investigate the factors related to the lethality of DSP and the characteristics of the adolescent group. @*Methods@#A retrospective study was conducted on patients who had visited an academic hospital’s regional emergency medical center between 2015 and 2018. The data reviewed through their medical records included sociodemographic factors, clinical variables, and psychiatric treatment. Four groups (Q1–Q4) were categorized by descriptive analysis using the risk-rescue rating scale. @*Results@#A total of 491 patients were enrolled in this study. This study showed that high lethality had statistically significant associations with male sex, older age, admitting suicidal intentions, and the use of herbicides for suicide. Logistic regression analyses showed a significant association between high-lethality and female [odds ratio (OR)=0.50, 95% confidence interval (CI)=0.30–0.81, p=0.01], non-psychiatric drugs (over-the-counter drug: OR=2.49, 95% CI=1.08–5.74, p=0.03; herbicide: OR=8.65, 95% CI=3.91–19.13, p<0.01), and denial of suicide intent (OR=0.28, 95% CI=0.15–0.55, p<0.01). @*Conclusion@#This study showed the clinical factors associated with the high lethality of DSP and suggested that efforts were needed to care for and thoroughly examine patients with DSP.

Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients

OBJECTIVE: Although various clinical factors that affect medication adherence in schizophrenia have been studied, the role of the therapeutic alliance has not been studied in detail. Accordingly, we investigated the association between medication adherence and therapeutic alliance in patients with schizophrenia treated in a community outpatient clinic in Korea. METHODS: In this cross-sectional study, 81 outpatients who met the DSM-IV-TR criteria for schizophrenia were analyzed. Therapeutic alliance was measured via patient-self-report questionnaires consisting of 12 questions, which evaluate both “affective bond” and “collaborative bond” of alliance. We investigated the relationship between medication adherence and therapeutic alliance through correlation and regression analyses. RESULTS: Overall therapeutic alliance was weakly associated with medication adherence (r=0.268, p<0.05). Among two factors of therapeutic alliance, “affective bond” was associated with adherence (r=0.302, p<0.05), but collaborative was not. Regression analysis showed that therapeutic alliance significantly predicted medication adherence even after adjustment for duration of treatment, insight, and symptom severity. CONCLUSION: Maintaining a favorable therapeutic alliance is associated with medication adherence in schizophrenia. Further, treating patients in a frank and genuine manner might be important to improve adherence.

The Effect of Psychological Factors on Postoperative Pain in Gastric Tumor Patients after Endoscopic Submucosal Dissection / 정신신체의학

OBJECTIVES: Since pain in cancer patients is an important factor that greatly affects the quality of life and prognosis, many attempts have been actively made to reduce the pain. Despite continuous effort on reducing pain after Endoscopic submucosal dissection (ESD), research has not been done on psychological factors as much as on biological factors affecting pain. The objective of this study is to investigate the psychological factors affecting postoperative pain in gastric tumor patients who underwent gastric ESD. METHODS: 91 gastric tumor patients who visited National Health Service Ilsan Hospital in Korean between May 2015 and June 2016, and received ESD were evaluated. Baseline characteristics including sociodemographic factors, anxiety, depression, and resilience were evaluated before the procedure. Multivariate logistic regression was done to analyze factors affecting postoperative pain. RESULTS: The group with high postoperative pain showed lower alcohol consumption and higher depressive symptom scores than the group with low postoperative pain. Also, the group with high postoperative pain showed lower total resilience score with lower subtotal scores in self-control and positive item. Multivariate logistic regression analysis of the postoperative pain showed that patients with lower score in self-control of resilience [odd ratio (OR), 0.911 ; 95% CI, 0.854–0.971, p=0.004) reported more pain after ESD. CONCLUSIONS: This study showed that patients with lower self-control ability of resilience felt more pain after ESD. Among the psychological factors evaluated in this study, resilience of an individual seems to have effect on pain.

Antipsychotic Prescribing Patterns in First-episode Schizophrenia: A Five-year Comparison

OBJECTIVE: Early treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively. METHODS: We reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5. RESULTS: The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic poly-pharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003). CONCLUSION: The practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.

The Reliability and Validity of the Korean Version of Medication Adherence Rating Scale / 대한정신약물학회지

OBJECTIVE: Finding out patient's non-adherence to medication is an important work for treating schizophrenia. The Medication Adherence Rating Scale is a self-report form, which can simply measure medication adherence in psychosis. We evaluated the reliability and validity of the Korean version of Medication Adherence Rating Scale (KMARS). METHODS: Eighty-one individuals with schizophrenia completed the self-administered questionnaires including KMARS, Brief Adherence Rating Scale (BARS), Korean version of Drug Attitude Inventory-10 (KDAI-10) and Korean version of Medication Adherence Questionnaire (KMAQ). Psychometric properties of the KMARS were analyzed. RESULTS: The KMARS has an acceptable internal consistency (alpha=0.71). The KMARS total scores are moderately correlated with BARS (r=0.44, p<0.01), KDAI-10 (r=0.55, p<0.01) and KMAQ (r=0.62, p<0.01). As the result of factor analysis, the structure of the KMARS is different from original scale, but the KMARS can assess not only adherence behavior but also subjective response to medication. Among the questions item 5, "I take my medication only when I am sick", should be used carefully, because it has ambiguous meaning in Korean. CONCLUSION: KMARS is a simple and reliable tool for measuring medication adherence in psychosis.

Recent Trends of Antipsychotics Polypharmacy in Schizophrenia / 대한정신약물학회지

Antipsychotics polypharmacy is a common practice in clinical settings despite the opposition of most guidelines for treatment of schizophrenia. This article reviews the evidence of antipsychotics polypharmacy and summarizes advantages and disadvantages shown in clinical trials. Clinicians choose antipsychotics polypharmacy to control the positive and negative symptoms more effectively especially in treatment resistant patients or to reduce adverse effects. There are some theoretical possibilities that antipsychotics polypharmacy affects a broader range of receptors, enhances D2-receptor blockade and optimizes pharmacokinetic effects. Clinical evidence suggests that clozapine co-administered with risperidone, sulpiride, or amisulpride reduces psychotic symptoms in treatment-resistant patients and that aripiprazole with other antipsychotics reduces metabolic side effects. On the other hand, antipsychotics polypharmacy is associated with problems such as dose-dependent side effects, metabolic problems, increased mortality and treatment cost. Considering pros and cons, antipsychotics polypharmacy must be started after close scrutiny of the patient's medication history not just by clinical judgment. Also, changing the regimen from polypharmacy to monotherapy should be considered as a reasonable option to schizophrenic patients in stationary status.

Comparison of Aripiprazole and Other Atypical Antipsychotics for Pediatric Bipolar Disorder: A Retrospective Chart Review of Efficacy and Tolerability

OBJECTIVE: This study compared the efficacy and tolerability of aripiprazole with that of other atypical antipsychotics by examining patients with pediatric bipolar disorder (PBD) at a child and adolescent psychiatric clinic in a university hospital in Korea. METHODS: We reviewed the medical records of 127 pediatric patients with bipolar disorder aged 4-18 years treated at Department of Child and Adolescent Psychiatric, Yonsei University Severance Hospital between January 2010 and October 2011 to collect demographic and clinical data. Using the Clinical Global Impression (CGI) scales, we evaluated levels of severity of and improvements in symptoms at the first, second, third, fourth, and fifth hospital visits. RESULTS: The mean age of patients was 12.29+/-3.47 years. The sample included 91 (71.7%) male and 36 (28.3%) female patients. Aripiprazole was prescribed to 62 (48.8%) patients, risperidone to 52 (40.9%), quetiapine to 11 (8.7%), and paliperidone to two (1.6%). Patients treated with aripiprazole had lower CGI-Severity (CGI-S) scores than did patients treated with other atypical antipsychotics at the second and third visits. The CGI-Improvement (CGI-I) scores of patients treated with aripiprazole were lower at the second visit. Treatment with atypical antipsychotics was well tolerated, and no serious or fatal side effects were observed. CONCLUSION: The present retrospective chart review suggests that atypical antipsychotics may be effective and safe for the treatment of patients with PBD. In particular, treatment with aripiprazole may be more effective than treatment with other atypical antipsychotics in the early phase. These results should be verified in future multi-center controlled studies.

Antipsychotic Polypharmacy in the Treatment of Patients with Related Psychoses at a University Hospital / 대한정신약물학회지

OBJECTIVE: The practice of antipsychotic polypharmacy is common, despite lack of supporting evidence. The aims of this study were to estimate the prevalence of antipsychotic polypharmacy in a psychiatric university hospital in Korea and find out the clinical factors associated with antipsychotic polypharmacy. METHODS: We reviewed medical records of the patients discharged from Severance Mental Health Hospital (SMH) for the period of 1, January to 31, December 2010. Patients should be diagnosed as having schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder or psychotic disorder not otherwise specified. RESULTS: In 2010, 260 patients in SMH were prescribed with antipsychotics and 47.3% (n=123) of them were discharged under antipsychotic polypharmacy treatment. The most commonly prescribed antipsychotics for combination therapy was quetiapine (n=64). The most prevalent combination of drugs was risperidone plus quetiapine (n=20). Logistic regression analysis showed that the use of high-dose antipsychotics, first-generation antipsychotics, and long hospital duration were significantly associated with antipsychotic polypharmacy. CONCLUSION: Although the controlled evidence for efficacy and safety as a strategy remains inconclusive, antipsychotic polypharmacy is a common pharmacological strategy as it is illustrated in our study. Considering high antipsychotic doses related with antipsychotic polypharmacy, careful monitoring of side effect and efficacy is needed.

Improving Medication Adherence in Patients with Severe Mental Illness / 대한정신약물학회지

Adherence to treatment in mental health is generally regarded as central for optimizing recovery. However, poor adherence of patients with psychiatric disorders can have devastating consequences such as relapse, rehospitalization and poor quality of life. Adherence problems are likely to be multi-determined and related to different factors in different individuals. Combining subjective and objective quantitative assessment with a more qualitative interview might help assess adherence better in patients with mental illness to determine the presence of adherence problems and investigate their cause. The therapeutic relationship between patient and clinician has been found to be important for treatment adherence. Adherence problems should be regarded not as the result but as the process of the treatments to facilitate the therapeutic alliance. Clinicians and patients need to cooperate with each other in a model of shared decision-making to choose the best treatment option for the specific individual. Psychoeducation might provide information about the risk and benefit of the medication to patients and their family. The collaborative approach is helpful for the clinicians to have an open dialogue about what patients think and perceive about the treatment.