Validity of the Korean Version of the Brief Irritability Test in Psychiatric Patients

Objective@#This study aimed to investigate the validity and reliability of the Korean version of the Brief Irritability Test (BITe) and adapt it for Korean patients with psychiatric disorders. @*Methods@#A total of 296 patients at the Department of Psychiatry of Hanyang University Guri Hospital completed the BITe, Korean Beck Depression Inventory-II, Korean Beck Anxiety Inventory, the Korean version of the State-Trait Anger Expression Inventory, and Barratt Impulsiveness Scale-11. Construct validity was confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability testing included assessments of internal consistency (Cronbach’s α) and item-total correlations. Convergent validity was examined through correlational analyses with variables such as anxiety, depression, anger, and impulsivity. @*Results@#First, the scale had good internal consistency with a Cronbach’s α of 0.88. Second, EFA indicated a single dimensionality of the BITe, and CFA demonstrated a reasonable fit for the single-factor model (comparative fit index=0.97, Tucker-Lewis Index=0.95, normed fit index=0.97, goodness-of-fit index=0.96, root mean square error of approximation=0.12, standardized root mean residual=0.03). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and anger, except for anger control, which is a sub-variable of anger. @*Conclusion@#The results showed that the Korean version of the BITe had good psychometric properties, and might serve as a valuable tool for assessing irritability in Korean patients with psychiatric disorders.

Efficacy and Safety of Lurasidone vs. Quetiapine XR in Acutely Psychotic Patients With Schizophrenia in Korea: A Randomized, Double-Blind, Active-Controlled Trial

Objective@#This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. @*Methods@#Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. @*Results@#Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. @*Conclusion@#Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

A Validation of the Korean Version of Ultra-Short Suicidal Ideation Scale / 신경정신의학

Objectives@#An accurate and easy-to-identify form is needed for the early evaluation of suicidal ideation in high-risk patients. Therefore, this study examined the validity and reliability of a Korean version of the Ultra-Short Suicidal Ideation Scale (K-USSIS). @*Methods@#A total of 161 psychiatric university-affiliated general hospital patients completed the K-USSIS. The data were analyzed using correlation, internal consistency, and confirmatory factor analyses. @*Results@#First, the scale had good internal consistency with a Cronbach’s α of 0.94. Second, the confirmatory factor analysis demonstrated that the single-factor model had a reasonable fit (comparative fit index=0.99, Tucker–Lewis index=0.98, standardized root mean squared residual=0.01, and root mean square error of approximation=0.10). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and hopelessness. @*Conclusion@#The findings suggest that the K-USSIS has good psychometric properties and can serve as a valuable tool for screening for suicidal ideation to ensure early intervention in Korean psychiatric patients.

Relationship Between Sleep Quality and Depression Symptoms in Psychiatric Patients: Mediating Effect Interpretation Bias for Ambiguity and Anxiety Symptoms / 정신신체의학

Objectives@#：This study was designed to investigate the effect of sleep quality on depression symptoms and the mediating effect of interpretation bias and anxiety symptoms in psychiatric patients. @*Methods@#：Data accumulated for outpatients and inpatients in the Department of Mental Health Medicine at Hanyang University Guri Hospital were used. The measurement tools were Pittsburgh Sleep Quality Index (PSQI), Ambiguous/Unambiguous Situations Diary-Extended Version (AUSD-EX), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II). Correlation analysis and bootstrapping analysis were conducted using SPSS 25.0 and SPSS Macro based on 162 patient data. @*Results@#：As a result of the study, the double mediating effect of interpretation bias for Ambiguity and anxiety symptoms was significant in the relationship between sleep quality and depression symptoms. @*Conclusions@#：In this study, it was confirmed that low sleep quality sequentially affects anxiety and depression symptoms through interpretation bias for ambiguity. Based on this, it is expected that the development of other psychiatric symptoms can be prevented by preferentially performing therapeutic intervention on preceding symptoms.

Clinical Characteristics of Formal Thought Disorder in Schizophrenia

Objectives@#Our study aimed to present the distinctive correlates of formal thought disorder in patients with schizophrenia, using the Clinical Language Disorder Rating Scale (CLANG). @*Methods@#We compared clinical characteristics between schizophrenia patients with (n = 84) and without (n = 82) formal thought disorder. Psychometric scales including the CLANG, the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), the Calgery Depression Scale for Schizophrenia (CDSS) and the Word Fluency Test (WFT) were used. @*Results@#After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the abnormal syntax (p = 0.009), lack of semantic association (p = 0.005), discourse failure (p < 0.0001), pragmatics disorder (p = 0.001), dysarthria (p < 0.0001), and paraphasic error (p = 0.005) items than those without formal thought disorder. With defining the mentioned item scores as covariates, binary logistic regression model predicted that discourse failure (adjusted odds ratio [aOR] = 5.88, p < 0.0001) and pragmatics disorder (aOR = 2.17, p = 0.04) were distinctive correlates of formal thought disorder in patients with schizophrenia. @*Conclusions@#This study conducted Clinician Rated Dimensions of Psychosis Symptom Severity (CRDPSS) and CLANG scales on 166 hospitalized schizophrenia patients to explore the sub-items of the CLANG scale independently related to formal thought disorders in schizophrenia patients. Discourse failure and pragmatics disorder might be used as the distinctive indexes for formal thought disorder in patients with schizophrenia.

Review of Court-Ordered Treatment in New York State / 신경정신의학

In recent decades, laws for involuntary treatment have evolved in ways that protect human rights as well as public safety. Globally, many nations have legislation for psychiatric patients that provide procedural advocacy during their involuntary treatment while a court or another independent organization reviews its lawfulness. In contrast, people with severe mental illness in Korea risk encountering human rights violations and loss of timely treatment, because their involuntary admissions are primarily initiated by family members and civil doctors and not by courts or government. The Mental Health Promotion and Welfare Act, revised in 2016, does not address this fundamental weakness, instead restricting involuntary admission criteria and bypassing the implementation of any procedural assistance programs. Subsequently untreated patients lead to clinical aggravation and even serious felony offenses. This paper introduces New York State’s court-ordered treatment system via the Mental Hygiene Law as a model for the revision of Korean legislation. The findings show that involuntary admissions in New York State are initiated by many parties as well as familial relatives and may be held up to 60 days without any court order.However, patients are assigned legal counsel for the ability to request for a court hearing at any time during their admission. The Assisted Outpatient Program is another legal intervention that requires a person with a mental illness that would likely result in serious harm to self or others to receive supervised outpatient treatment. We argue that the New York State model can be implemented effectively in Korea considering its current medical and judicial status.

Psychological Characteristics of Patients in Depression with High Suicide Risk: Using MMPI-2-RF / 신경정신의학

Methods@#Patients were recruited from the department of psychiatry at a university hospital.Participants were diagnosed using DSM-5 criteria by board certified psychiatrists. Their medical records were reviewed, and participants were put into three groups (Depression with suicide attempt, Depression with suicide ideation, and Normal as a control group). For statistical comparison, MANCOVA with gender as a covariate was used. @*Results@#Similar to pervious research, the two Depression groups with high suicide risk showed significantly higher Emotional/Internalizing Dysfunction, Negative Emotionally/Neuroticism-Revised, Demoralization, Dysfunctional Negative Emotions, Suicidal/Death Ideation, Helplessness/ Hopelessness, Self-Doubt, Stress/Worry, and Cognitive complaints than the normal group. In the Depression with suicide attempt group, Behavioral/Externalizing Dysfunction scales were significantly higher than the Depression with suicide ideation group. @*Conclusion@#The results show the significant prediction of MMPI-2-RF scales for suicide risk.Severity of mental pain (EID) and impulsive acting-out tendency of mental pain (BXD) were identified as important psychological characteristics of depression patients with suicide risk. The limitations of this study and suggested directions for future research are also discussed.

Review of Court-Ordered Treatment in New York State / 신경정신의학

In recent decades, laws for involuntary treatment have evolved in ways that protect human rights as well as public safety. Globally, many nations have legislation for psychiatric patients that provide procedural advocacy during their involuntary treatment while a court or another independent organization reviews its lawfulness. In contrast, people with severe mental illness in Korea risk encountering human rights violations and loss of timely treatment, because their involuntary admissions are primarily initiated by family members and civil doctors and not by courts or government. The Mental Health Promotion and Welfare Act, revised in 2016, does not address this fundamental weakness, instead restricting involuntary admission criteria and bypassing the implementation of any procedural assistance programs. Subsequently untreated patients lead to clinical aggravation and even serious felony offenses. This paper introduces New York State’s court-ordered treatment system via the Mental Hygiene Law as a model for the revision of Korean legislation. The findings show that involuntary admissions in New York State are initiated by many parties as well as familial relatives and may be held up to 60 days without any court order.However, patients are assigned legal counsel for the ability to request for a court hearing at any time during their admission. The Assisted Outpatient Program is another legal intervention that requires a person with a mental illness that would likely result in serious harm to self or others to receive supervised outpatient treatment. We argue that the New York State model can be implemented effectively in Korea considering its current medical and judicial status.

Network Analysis of Language Disorganization in Patients with Schizophrenia

Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptom of schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structure of language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluate the network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17 of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosure failure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within the network structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorder in schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning of language disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., duration of illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.

Korean Treatment Guideline on Pharmacotherapy of Co-existing Symptoms and Antipsychotics-related Side Effects in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The current study covers a secondary revision of the guidelines for the pharmacotherapy of schizophrenia issued by the Korean Medication Algorithm for Schizophrenia (KMAP-SCZ) 2001, specifically for co-existing symptoms and antipsychotics-related side-effects in schizophrenia patients. METHODS: An expert consensus regarding the strategies of pharmacotherapy for positive symptoms of schizophrenia, co-existing symptoms of schizophrenia, and side-effect of antipsychotics in patients with schizophrenia was retrieved by responses obtained using a 30-item questionnaire. RESULTS: For the co-existing symptoms, agitation could be treated with oral or intramuscular injection of benzodiazepine or antipsychotics; depressive symptoms with atypical antipsychotics and adjunctive use of antidepressant; obsessive-compulsive symptoms with selective serotonin reuptake inhibitors and antipsychotics other than clozapine and olanzapine; negative symptoms with atypical antipsychotics or antidepressants; higher risk of suicide with clozapine; comorbid substance abuse with use of naltrexone or bupropion/ varenicline, respectively. For the antipsychotics-related side effects, anticholinergics (extrapyramidal symptom), propranolol and benzodiazepine (akathisia), topiramate or metformin (weight gain), change of antipsychotics to aripiprazole (hyperprolactinemia and prolonged QTc) or clozapine (tardive dyskinesia) could be used. CONCLUSION: Updated pharmacotherapy strategies for co-existing symptoms and antipsychotics-related side effects in schizophrenia patients as presented in KMAP-SCZ 2019 could help effective clinical decision making of psychiatrists as a preferable option.