Efficacy of aripiprazole as adjunctive therapy in major depressive disorder with somatic symptoms: A randomized, double-blind, placebo-controlled trial with clinical and electroencephalography evidence.

BACKGROUND: Somatic symptoms, which are common in major depressive disorder (MDD), are associated with a worse prognosis and increased health costs. AIMS: This randomized, double-blind, placebo-controlled study evaluated the efficacy of aripiprazole augmentation in MDD patients with somatic symptoms. METHODS: In all, 41 MDD patients with somatic symptoms completed the study. Participants who had been on a stable dose of antidepressants for at least 1 month were randomly assigned to receive an 8-week adjunctive treatment with either aripiprazole or placebo. The initiation dose of aripiprazole was 2 mg/day, which was later adjusted to 1-10 mg/day. The primary endpoint was the change in the Symptom Checklist-90-Revised-Somatization (SCL-90-R-SOM) score. We collected quantitative electroencephalogram data and performed spectral analyses to obtain the absolute power of frequency bands. RESULTS/OUTCOMES: The aripiprazole group (n = 20; 2.98 ± 1.75 mg/day) showed a significant improvement in SCL-90-R-SOM scores compared to the placebo group (n = 21; F = 8.56, p = 0.006), without significant differences in changes in depression and anxiety symptoms. Compared to the control, the aripiprazole group showed a greater decrease in total alpha power (F = 7.03, p = 0.01). Changes in frontal alpha power were positively correlated with changes in SCL-90-R-SOM scores in the aripiprazole group (r = 0.53, p = 0.014). CONCLUSIONS/INTERPRETATION: Aripiprazole adjunctive to antidepressants in patients with MDD and somatic symptoms improved somatic symptom severity without significant safety concerns, and this improvement correlated with a decrease in total and frontal alpha power.Trial Registration: https://cris.nih.go.kr; identifier: KCT0004607.

Association Between Adolescent Internet Gaming and Adult Problematic Web-Based Board Gaming.

Introduction: The results of studies comparing the characteristics of Internet gaming with those of Internet gambling have been controversial. We hypothesized that problematic web-based board gaming behaviors are associated with psychological and social interaction factors. We also hypothesized that non-problematic adolescent Internet gaming is a protective factor against problematic web-based board gaming and that problematic Internet gaming is a predictive factor for problematic web-based board gaming. Methods: We recruited 104 adults who reported engaging in web-based gaming. All participants were asked to complete the Problematic Web Board Gameplay Scale, Center for Epidemiologic Studies Depression Scale (CESD), State-Trait Anxiety Inventory (STAI), Adult Attention Deficit/Hyperactivity Disorder Self-Report Scale (K-AADHD), Family Environmental Scale (FES), Social Avoidance and Distress Scale (SADS), and questionnaires on their web-based board gaming patterns and Internet gaming history. Results: Problematic web-based board gamers showed a lower history of adolescent Internet gaming but a greater rate of problematic Internet gaming compared with healthy web-based board gamers. Moreover, problematic web-based board gamers showed an increase in CES-D, STAI, K-AADHD, and SADS scores but decreased FES scores compared with healthy web-based board gamers. Joblessness; less experience as an Internet gamer; a history of problematic Internet gaming; higher CES-D, STAI, and K-AADHD scores; and lower FES scores were significant predictors of problematic web-based board gaming. Discussion: Psychological, social, and environmental factors can positively influence problematic Web-based board gaming. Healthy Internet gaming during adolescence may play a preventive role in adult problematic web-based board gaming. However, because adolescent problematic Internet gaming tends to lead to problematic web-based board gaming, measures should be taken to prevent it.

Resilience as a Protective Factor for Suicidal Ideation among Korean Workers.

OBJECTIVE: This study aimed to investigate resilience as a protective factor for suicidality among Korean workers. METHODS: Participants were workers from 26 organizations in Korea, aged 18 to 63 years, who completed a self-reported questionnaire comprising items on sociodemographic factors, job stress, resilience, and suicidality. Completed questionnaires were collected from 4,405 persons, with 4,389 valid responses. Hierarchical logistic regression analyses were performed using suicidality as the dependent variable. RESULTS: Results of the logistic regression analyses indicated that among the sociodemographic factors, older age, being female, and being single were statistically significantly associated with suicidal ideation. A high level of job stress, depressive mood, and anxiety, in addition to a short job duration, were also associated with suicidal ideation. Resilience was a significant protective factor for suicidal ideation after adjusting for all other variables. Older age and high anxiety levels were associated with having a suicide plan among participants with suicidal ideation. The association of resilience with suicide plans and suicide attempts was non-significant. CONCLUSION: In this study, we found that a high level of resilience was associated with a low incidence of suicidal ideation in Korean workers. Based on these results, we suggest the need to develop and implement interventions to improve resilience in the workplace, thereby protecting workers, especially those with a high level of work stress, from suicidal ideation.

Associations of Temperament and Character with Coping Strategies among Office Workers.

OBJECTIVE: Coping can be defined as the reactions to harm or distress individuals take to reduce stress. This study aimed to determine how an individual's temperament and character is correlated with the person's main coping method. METHODS: The Korean version of the Ways of Coping Questionnaire and Temperament and Character Inventory-Revised-Short Version were used to evaluate the coping strategies and temperament and character of 1,035 people. Four hierarchical linear regression analyses with the scores of each coping strategy subscale as a dependent variable were performed. RESULTS: High persistence, cooperativeness, self-transcendence, and low harm avoidance were associated with using a problem-focused coping strategy. Being female, high novelty seeking, reward dependence, and self-transcendence were associated with using a supportseeking coping strategy. High novelty seeking, self-transcendence, and low self-directedness were associated with using emotion-focused coping strategy. Being female, high novelty seeking, persistence, cooperativeness, and self-transcendence were associated with using a hopeful-thinking coping strategy. CONCLUSION: Our results show that there may be specific personality features guiding what kind of coping strategy an individual might use in a given situation.

Resilience as a Protective Factor for Depressive Mood and Anxiety among Korean Employees.

BACKGROUND: This study aimed to investigate resilience as a protective factor for depressive mood and anxiety among Korean employees. METHODS: Participants were employees of eight private and local government organizations in Korea, aged 19 to 65 years. A self-report questionnaire that included items on resilience, job stress, levels of depression and anxiety, and socio-demographic factors, was administered to 1,079 Korean employees, with 1,076 valid responses. We performed hierarchical linear regression analyses with the levels of depression and anxiety scores as dependent variables. RESULTS: Being women and having a high level of job stress were associated with greater depressive mood and anxiety. In contrast, resilience was negatively related to depressive mood and anxiety, after adjusting for demographic variables and the level of job stress. Among the five factors for resilience, "support" and "hardiness" were protective factors for depressive mood and anxiety after adjusting for demographic variables and the level of job stress. CONCLUSION: Based on the results of the current study, we suggest that focusing on the resilience of employees, especially on "support" and "hardiness," factors as well as developing and engaging in interventions that increase resilience in the workplace, can protect against depressive mood and anxiety, especially for those with high levels of job stress.

Brain Functional Connectivity in Patients With Somatic Symptom Disorder.

OBJECTIVE: The aim of the study was to evaluate whether individuals with somatic symptom disorder (SSD) display increased resting-state functional connectivity (FC) within and between the sensorimotor network (SMN), default mode network (DMN), salience network, and dorsal attention network (DAN). METHODS: Eighteen patients with SSD and 20 age- and sex-matched healthy control participants underwent resting-state functional magnetic resonance imaging. We used a seed-based correlation approach for the four brain networks. RESULTS: Patients with SSD had higher scores on the Somato-Sensory Amplification Scale (z = 5.22, p < .001) and Symptom Checklist-90-Revised-Somatization (z = 4.94, p < .001) and greater FC within the SMN, DMN, and salience network than healthy control participants. Patients with SSD also had increased FC between the SMN and DMN, SMN and salience network, SMN and DAN, and salience network and DAN (t = 5.10-7.47, all false discovery rate q < .05). The Somato-Sensory Amplification Scale scores correlated with FC between the SMN and salience network and between the SMN and DAN (r = .61-.82, all p < .003). CONCLUSIONS: Based on the results of the FC analysis between the SMN and salience network, we suggest that SSD may be associated with alterations of sensory-discriminative processing of pain and other somatic symptoms, which is influenced by affective processing. Based on the results of the FC analysis of the SMN and DAN, we suggest that patients with SSD have a deficit in attention, leading to misperception of external stimuli and failure to regulate bodily functions aimed at interactions with external stimuli.

The Effects of a Serious Game on Depressive Symptoms and Anxiety in Breast Cancer Patients with Depression: A Pilot Study Using Functional Magnetic Resonance Imaging.

Objective: Depression is common in cancer patients. We investigated the effects of playing a serious game in breast cancer patients with mild to moderate depression using functional neuroimaging. Materials and Methods: Thirty-five participants were randomly assigned to the Game group and the Nongame group, and fifteen participants in each group completed the study protocol. Participants in the Game group were asked to play a serious game, "Hit the Cancer" (RAW HAND, Seoul, Korea), for at least 30 minutes/day, 5 days/week, for 3 weeks. Participants in the Nongame group received usual care. At baseline and follow-up, all participants were assessed with the Beck Depression Inventory (BDI), Beck Anxiety Inventory, Stress Response Inventory (SRI), and 3-Tesla resting-state functional magnetic resonance imaging. Changes in functional connectivity (FC) between the brain regions in the default mode network (DMN) and salience network (SN) were analyzed. Results: After the intervention, BDI and SRI scores in the Game group greatly decreased compared with those in the Nongame group. In addition, compared with the Nongame group, the Game group showed decreased postintervention FC between the right posterior cingulate cortex (PCC) of the DMN and right insula of the SN. The improvement in BDI and SRI scores correlated with the decrease in FC between the right PCC and right insula. Conclusion: Selective attention training and repetitive stimulation of the insula by serious game play might cause normalization of the FC between the SN and DMN, thus improving depressive mood.

Visuospatial working memory assessment using a digital tablet in adolescents with attention deficit hyperactivity disorder.

BACKGROUND AND OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder hypothesized to involve impaired visuospatial working memory (VSWM). However, there are few studies utilizing neuropsychological tests to measure VSWM in ADHD adolescents. The Rey-Osterrieth complex figure test (ROCF) is commonly used as a neuropsychological test to assess visuospatial working memory for individuals with ADHD. We assessed working memory using the ROCF test on a digital Galaxy tablet with the technically new Gaussian filter method. METHODS: Thirty adolescents with ADHD and 30 healthy control adolescents were recruited for participation in the current study. All adolescents were assessed with K-WISC-IV, Children's depression inventory, and the Korean ADHD rating scale. All adolescents were asked to copy the ROCF from paper onto a Galaxy tablet screen using a wireless pen. RESULTS: There was a significant difference in representative value of the deviation of the original images from template images (R-value) in copy and delayed recall between ADHD adolescents and healthy adolescents. There was no significant difference in R-value of immediate recall between ADHD adolescents and healthy adolescents. In all adolescents (ADHD and healthy) and ADHD adolescents, the R-value of copy was negatively correlated with visuospatial index and working memory index, and the R-value of delayed recall was negatively correlated with WMI. The R-value of copy and delayed recall was positively correlated with K-ARS in all adolescents and ADHD adolescents. CONCLUSIONS: ADHD adolescents showed differences in the R-values of copy and delayed recall in the digital ROCF version compared to healthy adolescents. The digital ROCF assessment tool can represent different patterns of visuospatial working memory abilities in ADHD adolescents compared to healthy adolescents.

Comparison of Electroencephalography (EEG) Coherence between Major Depressive Disorder (MDD) without Comorbidity and MDD Comorbid with Internet Gaming Disorder.

Internet gaming disorder (IGD) has many comorbid psychiatric problems including major depressive disorder (MDD). In the present study, we compared the neurobiological differences between MDD without comorbidity (MDD-only) and MDD comorbid with IGD (MDD+IGD) by analyzing the quantitative electroencephalogram (QEEG) findings. We recruited 14 male MDD+IGD (mean age, 20.0 ± 5.9 years) and 15 male MDD-only (mean age, 20.3 ± 5.5 years) patients. The electroencephalography (EEG) coherences were measured using a 21-channel digital EEG system and computed to assess synchrony in the frequency ranges of alpha (7.5-12.5 Hz) and beta (12.5-35.0 Hz) between the following 12 electrode site pairs: inter-hemispheric (Fp1-Fp2, F7-F8, T3-T4, and P3-P4) and intra-hemispheric (F7-T3, F8-T4, C3-P3, C4-P4, T5-O1, T6-O2, P3-O1, and P4-O2) pairs. Differences in inter- and intra-hemispheric coherence values for the frequency bands between groups were analyzed using the independent t-test. Inter-hemispheric coherence value for the alpha band between Fp1-Fp2 electrodes was significantly lower in MDD+IGD than MDD-only patients. Intra-hemispheric coherence value for the alpha band between P3-O1 electrodes was higher in MDD+IGD than MDD-only patients. Intra-hemispheric coherence values for the beta band between F8-T4, T6-O2, and P4-O2 electrodes were higher in MDD+IGD than MDD-only patients. There appears to be an association between decreased inter-hemispheric connectivity in the frontal region and vulnerability to attention problems in the MDD+IGD group. Increased intra-hemisphere connectivity in the fronto-temporo-parieto-occipital areas may result from excessive online gaming.

Features of Resting-State Electroencephalogram Theta Coherence in Somatic Symptom Disorder Compared With Major Depressive Disorder: A Pilot Study.

OBJECTIVE: Somatic symptom disorder (SSD) often co-occurs with major depressive disorder (MDD). Both conditions share common psychobiological and biobehavioral characteristics, but little is known about differential patterns in brain function. In this study, we compared resting-state functional brain connectivity between SSD and MDD using quantitative electroencephalography. METHODS: Fifteen patients with SSD (SSD group), 15 patients with MDD (MDD group), and 15 healthy volunteers (healthy control [HC] group) participated in this study. Participants were assessed with quantitative electroencephalography using a 21-channel electroencephalogram system. Electroencephalogram coherence in the theta frequency range (3.5-7.5 Hz) was assessed between the following seven electrode pairs: Fp1 and Fp2, F7 and T3, F8 and T4, T5 and P3, P4 and T6, P3 and Pz, and Pz and P4. Differences in coherence between groups were analyzed using analysis of variance. RESULTS: Theta coherence between the F7 and T3 electrodes was lower in the SSD group than the MDD and HC groups (F(2,42) = 6.67, p = .0030). Theta coherence between the T5 and P3 electrodes was lower in the SSD and MDD groups than the HC group (F(2,42) = 5.65, p = .0067). Theta coherence between the Pz and P4 electrodes was lower in the SSD group than the MDD group (F(2,42) = 6.41, p = .0037). CONCLUSIONS: Both SSD and MDD patients commonly showed decreased functional connectivity within the left temporoparietal junction, which has neurophysiological implications for cognitive-attentional processing and social interaction. Frontostriatal circuit dysfunction affects processes that control perception and emotion, as well as misperception of somatosensory data in the parietal somatosensory area, and is more likely to be a neuropathology of SSD than MDD.

Comparison of QEEG Findings between Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) without Comorbidity and ADHD Comorbid with Internet Gaming Disorder.

Internet gaming disorder (IGD) is often comorbid with attention deficit hyperactivity disorder (ADHD). In this study, we compared the neurobiological differences between ADHD comorbid with IGD (ADHD+IGD group) and ADHD without comorbidity (ADHD-only group) by analyzing quantitative electroencephalogram (QEEG) findings. We recruited 16 male ADHD+IGD, 15 male ADHD-only adolescent patients, and 15 male healthy controls (HC group). Participants were assessed using Young's Internet Addiction Scale and ADHD Rating Scale. Relative power and inter- and intra-hemispheric coherences of brain waves were measured using a digital electroencephalography (EEG) system. Compared to the ADHD-only group, the ADHD+IGD group showed lower relative delta power and greater relative beta power in temporal regions. The relative theta power in frontal regions were higher in ADHD-only group compared to HC group. Inter-hemispheric coherence values for the theta band between F3-F4 and C3-C4 electrodes were higher in ADHD-only group compared to HC group. Intra-hemispheric coherence values for the delta, theta, alpha, and beta bands between P4-O2 electrodes and intra-hemispheric coherence values for the theta band between Fz-Cz and T4-T6 electrodes were higher in ADHD+IGD group compared to ADHD-only group. Adolescents who show greater vulnerability to ADHD seem to continuously play Internet games to unconsciously enhance attentional ability. In turn, relative beta power in attention deficit in ADHD+IGD group may become similar to that in HC group. Repetitive activation of brain reward and working memory systems during continuous gaming may result in an increase in neuronal connectivity within the parieto-occipital and temporal regions for the ADHD+IGD group.