Promoting Mental Health Literacy at Schools in South Korea.

The onset of many lifelong mental illnesses is during childhood and adolescence. There has been an increase in these conditions among children and adolescents especially, during the COVID-19 pandemic. It is essential to promote mental health literacy (MHL) as a preventive and universal intervention for children and adolescents. Positive mental health status in adolescence is related to an increased level of MHL, and various MHL programs at schools have been reported to be effective for adolescent students worldwide. Recently, MHL programs have been developed in South Korea to be used by schoolteachers. There is a need for active dissemination and development of future programs. For continuous and effective education, it is desirable to include MHL education in regular school curricula.

Hippocampal Subfields Volume Reduction in High Schoolers with Previous Verbal Abuse Experiences.

OBJECTIVE: Reduced hippocampal volume and alterations in white matter tracts have been frequently reported in adults having the history of emotional maltreatment. We investigated whether these structural change occur in adolescents with previous verbal abuse (VA) experiences. METHODS: Hippocampal subfield volume and white matter structural connectivity measures were assessed in 31 first year male high school students with various degrees of exposure to parental and peer VA. RESULTS: The high VA group showed significant volume reduction in the left cornu ammonis (CA) 1 and left subiculum compared to the low VA group (p＜0.05). Volumes of left hippocampal subfields CA1 and subiculum were negatively correlated with previous VA experiences (p＜0.05). Increased mean diffusivity (MD) of the splenium of the corpus callosum was related to high VA score across all subjects (p＜0.05). There was an inverse relationship between volume of the CA1 and subiculum and MD of the splenium (p＜0.05). CONCLUSION: Exposure to parental and peer VA may affect development of the left hippocampal subfields and the splenium of corpus callosum. These structural alterations can be discernible during adolescence.

Treatment effect of methylphenidate on intrinsic functional brain network in medication-naïve ADHD children: A multivariate analysis.

Methylphenidate is a first-line therapeutic option for treating attention-deficit/hyperactivity disorder (ADHD); however, elicited changes on resting-state functional networks (RSFNs) are not well understood. This study investigated the treatment effect of methylphenidate using a variety of RSFN analyses and explored the collaborative influences of treatment-relevant RSFN changes in children with ADHD. Resting-state functional magnetic resonance imaging was acquired from 20 medication-naïve ADHD children before methylphenidate treatment and twelve weeks later. Changes in large-scale functional connectivity were defined using independent component analysis with dual regression and graph theoretical analysis. The amplitude of low frequency fluctuation (ALFF) was measured to investigate local spontaneous activity alteration. Finally, significant findings were recruited to random forest regression to identify the feature subset that best explains symptom improvement. After twelve weeks of methylphenidate administration, large-scale connectivity was increased between the left fronto-parietal RSFN and the left insula cortex and the right fronto-parietal and the brainstem, while the clustering coefficient (CC) of the global network and nodes, the left fronto-parietal, cerebellum, and occipital pole-visual network, were decreased. ALFF was increased in the bilateral superior parietal cortex and decreased in the right inferior fronto-temporal area. The subset of the local and large-scale RSFN changes, including widespread ALFF changes, the CC of the global network and the cerebellum, could explain the 27.1% variance of the ADHD Rating Scale and 13.72% of the Conner's Parent Rating Scale. Our multivariate approach suggests that the neural mechanism of methylphenidate treatment could be associated with alteration of spontaneous activity in the superior parietal cortex or widespread brain regions as well as functional segregation of the large-scale intrinsic functional network.

Altered Function of Ventrolateral Prefrontal Cortex in Adolescents with Peer Verbal Abuse History.

OBJECTIVE: Previous studies showing the association of exposure to peer (PeVA) and parental verbal abuse in childhood with structural alterations in the young adult brain suggest functional changes in adolescence. In this functional MRI study, we investigated the effects of exposure to PeVA, during elementary and middle school periods, on brain response to emotional words, in high school students. METHODS: An emotional Stroop task consisting of swear, negative, positive, and neutral words was performed during functional MRI scan for 23 subjects who were divided into low- and high exposure groups to PeVA. RESULTS: High-PeVA group had a higher depression score, greater left ventrolateral prefrontal cortex (VLPFC) activity, and higher left VLPFC-left hippocampus connectivity in swear word conditions. The VLPFC activity and left VLPFC-left hippocampus connectivity was negatively related to the severity of anxiety and depressive symptoms, respectively. CONCLUSION: These preliminary findings support the hypothesis that exposure to PeVA, during childhood, is an aversive stimulus associated with meaningful functional change in emotional regulation network, showing hypersensitivity to swear words, at middle adolescence.

Neural correlates of text-based emoticons: a preliminary fMRI study.

INTRODUCTION: Like nonverbal cues in oral interactions, text-based emoticons, which are textual portrayals of a writer's facial expressions, are commonly used in electronic device-mediated communication. Little is known, however, about how text-based emoticons are processed in the human brain. With this study, we investigated whether the text-based emoticons are processed as face expressions using fMRI. METHODS: During fMRI scan, subjects were asked to respond by pressing a button, indicating whether text-based emoticons represented positive or negative emotions. Voxel-wise analyses were performed to compare the responses and contrasted with emotional versus scrambled emoticons and among emoticons with different emotions. To explore processing strategies for text-based emoticons, brain activity in the bilateral occipital and fusiform face areas were compared. RESULTS: In the voxel-wise analysis, both emotional and scrambled emoticons were processed mainly in the bilateral fusiform gyri, inferior division of lateral occipital cortex, inferior frontal gyri, dorsolateral prefrontal cortex (DLPFC), dorsal anterior cingulate cortex (dACC), and parietal cortex. In a percent signal change analysis, the right occipital and fusiform face areas showed significantly higher activation than left ones. In comparisons among emoticons, sad one showed significant BOLD signal decrease in the dACC, the left AIC, the bilateral thalamus, and the precuneus as compared with other conditions. CONCLUSION: The results of this study imply that people recognize text-based emoticons as pictures representing face expressions. Even though text-based emoticons contain emotional meaning, they are not associated with the amygdala while previous studies using emotional stimuli documented amygdala activation.

Aberrant function of frontoamygdala circuits in adolescents with previous verbal abuse experiences.

Previous studies reported an association of depressive disorder and structural alteration of frontolimbic brain regions in subjects with emotional abuse experiences during childhood and adolescence. The results suggest that aberrant function of the frontolimbic circuit and its relation with psychiatric symptoms can be found in adolescents with preclinical status. We investigated functional changes of frontolimbic networks during implicit negative emotional face processing and their relationships with depressive symptoms in adolescents with previous verbal abuse experiences. We designed a gender discrimination task using emotional faces to induce an implicit level of emotional exposure, and was completed by 31 preclinical male adolescents during an fMRI scan. The right amygdala activity and its functional connectivity with the rostral anterior cingulate cortex (ACC) during implicit processing of negative emotional faces showed a significant relationship with previous verbal abuse experiences. The hierarchical regression analyses showed that their current depressive symptoms were associated with aberrant functional interaction between the right amygdala activity and right amygdala-rostral ACC connectivity. Our findings of verbal abuse-related functional changes in the right frontoamygdala circuit may be related to vulnerability to future mood disorder.

The psychometric properties of the korean version of the verbal abuse questionnaire in university students.

OBJECTIVE: The aim of the present study was to examine the psychometric properties of the Korean Verbal Abuse Questionnaire (K-VAQ) that consists of 15 items related with life-time verbal aggression exposure. METHODS: A total of 5814 university students who agreed to take part in the study completed the K-VAQ, the Korean version of the Life Event CheckList (LEC-K) and Impact of Event Scale-Revised (K-IES-R). Internal consistency was checked by using item-total item correlation and Cronbach's alpha coefficient. Exploratory and confirmatory factor analyses were performed, and convergent and concurrent validity levels were examined. Finally, a cluster analysis was conducted to verify the validity of the cutoff point of the K-VAQ. RESULTS: The Cronbach's alpha correlation coefficient was 0.9. The K-VAQ showed a single factor structure which explained 55.34% of the total variance. The K-VAQ was significantly associated with the LEC-K (r=0.24) and K-IES-R (r=0.28), indicating good convergent validity and concurrent validity. The cluster analysis provided four clusters of trauma experiences: high, moderate, low, and minimal, with K-VAQ ranges of 43-81, 20-42, 7-19, and 0-6, respectively. In a further investigation, a K-VAQ score of 40 was found to be the appropriate cutoff point to delineate the highly verbally abused group, as used in the previous studies. A sum of 36.5% of the highly verbally abused group reported to show substantial symptoms of PTSD (K-IES-R score >22). CONCLUSION: The present findings suggest that the K-VAQ has good psychometric properties for assessing verbal aggression among the Korean population.

School refusal behavior in South Korean first graders: A prospective observational community-based study.

Refusing to attend school is a serious problem that could lead to psychopathology. We aimed to: (1) prospectively observe the actual development of school refusal behavior according to a history of separation anxiety symptoms (SAS) and (2) explore factors for predicting school refusal behavior in children who were just beginning primary school. The participants were 277 children, aged 6-7 years, who were expected to enter primary school in 2 months. The parents were surveyed about the child׳s history of SAS and their behavior. The children were questioned about anxiety symptoms. The children were surveyed about whether school refusal behavior developed or not after they entered primary school. Of the 248 children who responded to the follow-up survey, 7.66% of children met the criteria for school refusal behavior during the 3 months after entering school. We found no significant differences in the occurrence of school refusal behavior according to the children׳s SAS history. Familial risk factors for school refusal behavior included low parental educational level and a working mother. School refusal behavior by first graders cannot be fully explained by the expression of SAS and could be implicated in a more complex psychopathology.

The effect of word imagery on priming effect under a preconscious condition: an fMRI study.

Semantic priming is affected by the degree of association and how readily a word is imagined. In the association effect, activity in the perisylvian structures including the bilateral inferior frontal gyrus, the left middle temporal gyrus, and the supramarginal gyrus was correlated. However, little is known about the brain regions related to the effect of imagery word under the preconscious condition. Forty word pairs for high (HA)-, low (LA)-, and nonassociation (NA), nonword (NW) conditions were presented. Each 40 association word pairs (HA and LA) included 20 high (HI) and 20 low (LI) imagery prime stimuli, using a visually presented lexical decision task. A trial consisted of 30 ms prime, 30 ms mask, 500 ms probe, and 2-8 s stimulus onset asynchrony. Brain activation was measured using functional magnetic resonance imaging during word discrimination. Behavioral data indicated that the shortest response time (RT) was given for HA words, followed by LA and NA, and NW showed the longest RT (P < 0.01). RT was faster in HI than LI within HA, but not LA conditions (P < 0.01). Functional neuroimaging showed that differential brain regions for high imagery (HI) and low imagery (LI) words within low prime-target word association were observed in the left precuneus, left posterior cingulate gyrus, and right cuneal cortex. The present findings demonstrate that the effect of the degree of imagery on semantic priming occurs during the early stage of language processing, indicating an "automatic imagery priming effect." Our paradigm may be useful to explore semantic deficit related to imagery in various psychiatric disorders.

Effect of osmotic-release oral system methylphenidate on learning skills in adolescents with attention-deficit/hyperactivity disorder: an open-label study.

We evaluated the effect of osmotic-release oral system (OROS) methylphenidate on learning skills in adolescents with attention-deficit/hyperactivity disorder (ADHD). In an open-label study, 121 adolescents with ADHD were administered flexible doses of OROS methylphenidate for 12 weeks. The efficacy of methylphenidate on ADHD symptoms was evaluated by ADHD Rating Scale (ARS) and Clinical Global Impression Scale (CGI). Learning Skills Test (LST) was used to measure the learning skills of the participants at the baseline and the endpoint. Continuous performance test, visuospatial and verbal working memory, verbal fluency, and inhibition were evaluated before and after the 12 weeks of treatment. The mean total and subscores of LST were significantly increased after the 12-week treatment with OROS methylphenidate. Executive functions were also improved during the trial, with the exception of inhibition measured by the Stroop Test. To the best of our knowledge, this is the first study to examine the influence of OROS methylphenidate on learning skill. As a result, OROS methylphenidate was effective in enhancing learning skills in adolescents with ADHD.

Two different solicitation methods for obtaining information on adverse events associated with methylphenidate in adolescents: a 12-week multicenter, open-label study.

OBJECTIVE: We explored two different methods of determining adverse events (AEs) among methylphenidate (MPH)-treated adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: We performed a 12-week open label study of osmotic-release oral system (OROS) MPH in adolescents with ADHD who were recruited from four child and adolescent psychiatric outpatient clinics. The AEs were evaluated via a two-step procedure at weeks 1, 3, 6, and 12. The first step was to ask a general question to subjects and their parents regarding AEs. The second step included an AE evaluation process by the investigators, which was performed using a drug-specific checklist. One-way repeated measures ANOVA were used to compare the number of AEs reported by patients and their parents compared with the number reported by clinicians. This statistical technique was also used to compare the number of AEs reported by various sources (i.e., patients, parents, and clinicians) at weeks 1, 3, 6, and 12. RESULTS: Of the 55 participants (43 males, 12 females) between the ages of 12 and 18 enrolled in this study, 47 participants completed the trial. When the number of AEs reported by patients, parents and clinicians were compared, there were no statistically significant differences. When the numbers of AEs obtained from the three different information sources at each study visit were compared, we noted differences. At week 6, the number of AEs evaluated by clinical investigators was higher than those reported by patients and their parents (p=0.003). Although the results did not reach statistical significance, the number of AEs reported by clinical investigators appeared to be greater than those obtained from patients or parents at weeks 3 and 12. The number of AEs reported by patients and their parents were similar at every visit. There were some differences in the pattern of AEs reported between patients and their parents. CONCLUSIONS: Clinicians should supplement the subjective report on AEs from patients or their parents with a more drug-specific checklist to obtain drug side effects more effectively. As there are some differences in the pattern of AEs reported by patients and their parents, it is generally recommended that clinicians obtain information from both parties when possible.

Aberrant development of functional connectivity among resting state-related functional networks in medication-naïve ADHD children.

OBJECTIVE: The aim of this study was to investigate the compromised developmental trajectory of the functional connectivity among resting-state-related functional networks (RSFNs) in medication-naïve children with attention-deficit/hyperactivity disorder (ADHD). SUBJECTS AND METHODS: Using both independent component analysis and dual regression, subject-specific time courses of 12 RSFNs were extracted from both 20 medication-naïve children with ADHD, and 20 age and gender-matched control children showing typical development (TDC). Both partial correlation coefficients among the 12 RSFNs and a resting-state resource allocation index (rsRAI) of the salience network (SN) were entered into multiple linear regression analysis to investigate the compromised, age-related change in medication-naïve ADHD children. Finally, correlation analyses were performed between the compromised RSFN connections showing significant group-by-age interaction and rsRAI of SN or clinical variables. RESULTS: Medication-naïve ADHD subjects failed to show age-related increment of functional connectivity in both rsRAI of SN and two RSFN connections, SN-Sensory/motor and posterior default mode/precuneus network (pDMN/prec)--anterior DMN. Lower SN-Sensory/motor connectivity was related with higher scores on the ADHD Rating Scale, and with poor scores on the continuous performance test. The pDMN/prec-aDMN connectivity was positively related with rsRAI of SN. CONCLUSIONS: Our results suggest that medication-naïve ADHD subjects may have delayed maturation of the two functional connections, SN-Sensory/Motor and aDMN-pDMN/prec. Interventions that enhance the functional connectivity of these two connections may merit attention as potential therapeutic or preventive options in both ADHD and TDC.

MRI study on the functional and spatial consistency of resting state-related independent components of the brain network.

OBJECTIVE: Resting-state networks (RSNs), including the default mode network (DMN), have been considered as markers of brain status such as consciousness, developmental change, and treatment effects. The consistency of functional connectivity among RSNs has not been fully explored, especially among resting-state-related independent components (RSICs). MATERIALS AND METHODS: This resting-state fMRI study addressed the consistency of functional connectivity among RSICs as well as their spatial consistency between 'at day 1' and 'after 4 weeks' in 13 healthy volunteers. RESULTS: We found that most RSICs, especially the DMN, are reproducible across time, whereas some RSICs were variable in either their spatial characteristics or their functional connectivity. Relatively low spatial consistency was found in the basal ganglia, a parietal region of left frontoparietal network, and the supplementary motor area. The functional connectivity between two independent components, the bilateral angular/supramarginal gyri/intraparietal lobule and bilateral middle temporal/occipital gyri, was decreased across time regardless of the correlation analysis method employed, (Pearson's or partial correlation). CONCLUSION: RSICs showing variable consistency are different between spatial characteristics and functional connectivity. To understand the brain as a dynamic network, we recommend further investigation of both changes in the activation of specific regions and the modulation of functional connectivity in the brain network.

Reduced fractional anisotropy in the visual limbic pathway of young adults witnessing domestic violence in childhood.

Witnessing domestic violence (WDV) is a traumatic childhood experience associated with increased risk for depression, posttraumatic stress disorder and reduced IQ scores. Specific affects of WDV on brain development have not been assessed. We sought to ascertain whether WDV was associated with abnormalities in white matter (WM) tract integrity using diffusion tensor imaging (DTI). Twenty subjects who witnessed domestic violence (16F/4M, mean age 22.4 ± 2.48 years) but were not physically or sexually abused were compared to 27 healthy controls (19F/8M, 21.9 ± 1.97 years) without exposure to trauma or Axis I and II disorders. DTI images were acquired with a 3T Siemens Trio scanner. Group differences in fractional anisotropy (FA), covaried by age, gender, parental education, perceived financial sufficiency, IQ and degree of exposure to parental verbal aggression were assessed using tract-based spatial statistics (TBSS), which projects FA values onto an alignment-invariant fiber tract representation. FA values in the inferior longitudinal fasciculus of left lateral occipital lobe were significantly lower (P<0.05 corrected for multiple comparison) in the WDV group. FA values correlated inversely with ratings of depression, anxiety, somatization, 'limbic irritability' and neuropsychological measures of processing speed. Measures of radial but not axial diffusivity were affected suggesting alterations in myelination. Degree of FA reduction was associated with duration of witnessing interparental verbal aggression and with exposure between ages 7 and 13 years. The inferior longitudinal fasciculus connects occipital and temporal cortex and is the main component of the visual-limbic pathway that subserves emotional, learning and memory functions that are modality specific to vision. This finding is consistent with the hypothesis that exposure to childhood maltreatment is associated with alterations in fiber pathways that convey the adverse experience to frontal, temporal or limbic regions.

Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests.

The potential relationship between Internet addiction and certain cognitive function problems has been suggested by several studies. However, few or no studies have examined the differences in cognitive functioning between persons addicted to the Internet and persons not addicted using a standard neuropsychological test. This study screened 253 middle school students and 389 high school students for Internet addiction and compared 59 Internet-addicted students with 43 non-addicted students using an IQ test. The Internet-addicted group had comprehension sub-item scores that were significantly lower than those of the non-addicted group. As the comprehension item reflects ethical judgement and reality testing, there may be a relationship between Internet addiction and weak social intelligence. Earlier onset of Internet addiction and longer addiction duration were associated with lower participant performance in areas related to attention. As this study is a cross-sectional study, it is not clear whether the persons who display weak cognitive functioning are susceptible to Internet addiction or if Internet addiction causes cognitive problems. However, as brain development remains active during adolescence, the possibility that Internet addiction adversely affects the cognitive functioning of adolescents cannot be ruled out.

Plasma concentration of prolactin, testosterone might be associated with brain response to visual erotic stimuli in healthy heterosexual males.

OBJECTIVE: Many studies have showed that excess or lack of sexual hormones, such as prolactin and testosterone, induced the sexual dysfunction in humans. Little, however, is known about the role of sexual hormones showing normal range in, especially, the basal state unexposed to any sexual stimulation. We hypothesized sexual hormones in the basal state may affect sexual behavior. METHODS: We investigated the association of the sexual hormones level in the basal hormonal state before visual sexual stimulation with the sexual response-related brain activity during the stimulation. Twelve heterosexual men were recorded the functional MRI signals of their brain activation elicited by passive viewing erotic (ERO), happy-faced (HA) couple, food and nature pictures. Both plasma prolacitn and testosterone concentrations were measured before functional MR scanning. A voxel wise regression analyses were performed to investigate the relationship between the concentration of sexual hormones in basal state and brain activity elicited by ERO minus HA, not food minus nature, contrast. RESULTS: The plasma concentration of prolactin in basal state showed positive association with the activity of the brain involving cognitive component of sexual behavior including the left middle frontal gyrus, paracingulate/superior frontal/anterior cingulate gyri, bilateral parietal lobule, right angular, bilateral precuneus and right cerebellum. Testosterone in basal state was positively associated with the brain activity of the bilateral supplementary motor area which related with motivational component of sexual behavior. CONCLUSION: Our results suggested sexual hormones in basal state may have their specific target regions or network associated with sexual response.

Preliminary evidence for white matter tract abnormalities in young adults exposed to parental verbal abuse.

BACKGROUND: Psychiatric sequelae of exposure to parental verbal abuse (PVA) appear to be comparable with that of nonfamilial sexual abuse and witnessing domestic violence. Diffusion tensor imaging (DTI) was used to ascertain whether PVA was associated with abnormalities in white matter (WM) tract integrity. METHODS: 1271 healthy young adults were screened for exposure to childhood adversity. Diffusion tensor imaging was collected on 16 unmedicated subjects with history of high-level exposure to PVA but no other form of maltreatment (4 male/12 female subjects, mean age 21.9 +/- 2.4 years) and 16 healthy control subjects (5 male/11 female subjects, 21.0 +/- 1.6 years). Group differences in fractional anisotropy (FA), covaried by parental education and income, were assessed using tract-based spatial statistics (TBSS). RESULTS: Three WM tract regions had significantly reduced FA: 1) arcuate fasciculus in left superior temporal gyrus, 2) cingulum bundle by the posterior tail of the left hippocampus, and 3) the left body of the fornix. Fractional anisotropy in these areas was strongly associated with average PVA scores (r(s) = -.701, -.801, -.524, respectively) and levels of maternal verbal abuse. Across groups, FA in region 1 correlated with verbal IQ and verbal comprehension index. Fractional anisotropy in region 2 was inversely associated with ratings of depression, dissociation, and limbic irritability. Fractional anisotropy in region 3 was inversely correlated with ratings of somatization and anxiety. CONCLUSIONS: Exposure to PVA may be associated with alteration in the integrity of neural pathways with implications for language development and psychopathology.