Attachment Insecurity and Stigma as Predictors of Depression and Anxiety in People Living With HIV

Objective@#The purpose of this study was to examine whether attachment insecurity, stigma, and certain demographic and medical factors predict depression and anxiety in people living with HIV (PLWH). @*Methods@#Participants were 147 PLWH who visited the outpatient infection clinic in Kyungpook National University Hospital (KNUH; Daegu, South Korea) between June 2020 and January 2021. We measured HIV-related stigma, attachment anxiety and avoidance, depressive symptoms, and anxiety symptoms. @*Results@#Logistic regression analysis showed that unemployment, longer time receiving antiretroviral therapy, higher attachment avoidance, and higher attachment anxiety were significant predictors of depression. Results also showed that longer time receiving antiretroviral therapy, higher attachment anxiety, and concern with public attitudes were significant predictors of anxiety. @*Conclusion@#In addition to education to reduce public stigma, interventions to reduce PLWH’s self-stigma should continue. We suggest attachment-based psychotherapy as an effective intervention to improve PLWH’s mental health.

Fall Risk Assessment and Fall Prevention Intervention in Elderly Psychiatric Patients / 생물치료정신의학

The fall rate in geriatric psychiatric patients is higher than in adult patients with other diseases. Although the incidence of deaths and severe injuries from falls has decreased over the past several decades, falls remain an issue requiring clinical attention, considering the impact of falls on patients’ performance of daily living and the burden of fall-related injury.The author reviewed studies published over the past ten years to learn about falls in geriatric psychiatric patients. Many studies showed that physical functions such as gait, balance ability, and muscle strength were important fall risk factors in geriatric psychiatric patients. Clinicians should comprehensively evaluate fall risk through screening using an appropriate measure for psychiatric patients, physical function examination, and medication review. Fall prevention can be achieved effectively through environmental interventions considering the characteristics of psychiatric treatment settings and individual interventions focusing on the patient’s modifiable factors.

Association Between the Need for Mental Health Intervention and Mental Health Problems Among the General Population During the COVID-19 Pandemic / 생물치료정신의학

Objectives@#During the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of anxiety and depression in the general population was higher than before the pandemic. Identifying subjects at high risk for mental disorders may be necessary for effective mental health intervention. This study examines the prevalence of anxiety, depression, and anger and the related factors in the general population living in Daegu City one year after the COVID-19 pandemic. @*Methods@#This study collected data on sociodemographic variables, the need for mental health intervention, Generalized Anxiety Disorder Assessment, Patient Health Questionnaire-9, and State-Trait Anger Expression Inventory state anger from 1,000 subjects. This study performed independent samples t-test, one-way ANOVA, post hoc analysis, chi-square tests, and binary logistic regression analyses to examine the relationship between sociodemographic variables including the need for mental health intervention and depression, anxiety, and anger. @*Results@#The prevalence rates of depression, anxiety, and anger were 22.4%, 31.3%, and 42.3%. The need for mental health intervention was associated with the prevalence of depression, anxiety, and anger (p<0.001). Additionally, the risk of depression, anxiety, and anger was higher in the group with the need for mental health intervention compared to those without the need (odds ratio [95% confidence interval]; anxiety, 3.270 [2.337–4.575], p<0.001; depression, 4.475 [3.284– 6.097], p<0.001; anger, 4.225 [3.121-5.718], p<0.001). @*Conclusions@#One year after the COVID-19 pandemic, the prevalence of anxiety, depression, and anger in the general population of Daegu City was high. The subject’s perceived need for mental health intervention is associated with the prevalence of anxiety, depression, and anger and helps identify subjects requiring additional mental health intervention.

Psychiatric Understanding and Treatment Consideration in HIV Infection / 생물치료정신의학

Following the development of human immunodeficiency virus (HIV) treatments, the mean lifespan of patients with an HIV infection has increased to a level comparable to the general population. Patients receiving HIV treatment can achieve viral suppression and perform routine activities without the risk of infection transmission. Recently, the quality of life (QoL) and mental health of patients are becoming the primary outcomes in HIV treatment. The objective of this review was to investigate psychiatric disorders in patients with an HIV infection and available treatment programs. A search for clinical studies and scientific publications was performed. Patients with an HIV infection had a higher prevalence of psychiatric disorders than the general population. The psychopathological factors in HIV infection included neurobiological changes of infection, side-effects of medications, negative social perception, and unresolved intrapsychic conflicts. Severe and unmanaged psychiatric disorders with HIV infection negatively impacted HIV infection transmission and treatment adherence. However, psychiatric treatment programs and referrals to a psychiatric professional were found to be insufficient in most countries. This review revealed a need for psychiatric interventions in clinical practice to improve patients’ mental health and HIV treatment adherence. Psychiatric interventions integrated with conventional HIV treatment can be efficacious to achieve this goal. In addition, clinicians need to investigate and recognize HIV-related stigma as the relationship between patients and clinicians has a significant role in the patient’s treatment adherence.

Factors Affecting the Onset of Hyperactive Delirium in Terminally Ill Cancer Patients in Hospice Care / 생물치료정신의학

Objectives@#：Hyperactive delirium is a state of acute mental confusion including aggressive and impulsive behavior and it is burdensome for the family and caregivers of terminal cancer patients. Therefore, predicting the symptoms of hyperactive delirium can provide benefits to care terminal cancer patients. In this study, several risk factors were evaluated during hospitalization for predicting delirious symptom in terminal cancer patients. @*Methods@#：Patients who died of cancer in a palliative care unit from January 2011 to September 2012 were investigated by retrospective chart review. Clinical and laboratory data were collected to identify the factors associated with hyperactive delirium. Univariate and multivariate analysis by logistic regression were applied. Additional survival analysis was conducted to measure the onset of delirium symptoms after pneumonia. @*Results@#：During hospitalization, 49 of 201 patients showed the symptoms of hyperactive delirium (24.4%). Developing a delirious symptom was associated with male (OR=3.36, p=0.002), bone metastasis (OR=3.70, p=0.002), pneumonia during hospitalization (OR=3.17, p=0.02) and depressive mood (OR=2.53, p80.011). In additional survival analysis, half of patients developed symptoms of delirium within 3 days after pneumonia. @*Conclusion@#：Our results suggest that male, bone metastasis, depressive mood, and pneumonia are risk factors that can affect hyperactive delirium in terminally ill cancer patients. In addition, many patients with pneumonia abruptly developed the symptoms of hyperactive delirium within 3 days. Our finding may provide clues for predicting hyperactive delirium, and it can be helpful to manage delirium symptoms.

e Prevalence of Psychotic Experiences in the Korean General Population and its Association with Psychiatric Disorders / 생물치료정신의학

Objectives@#：The aim of this study was to investigate the lifetime prevalence of psychotic experiences (PEs) and the association of PEs with a range of psychiatric disorders in the Korean general population. @*Methods@#：Multi-stage cluster sampling was adopted in this study. Interviews were conducted face-to-face with 18-year-old and older people living in the community from June to November 2016. Korean version of Composite International Diagnostic Interview (K-CIDI) was applied to assess the prevalence of psychiatric disorders. Psychotic experiences were assessed with 21 items (15 items for hallucinations and 6 items for delusions) in the CIDI psychosis module. @*Results@#：Mean lifetime prevalence (standard error) of ever having a PEs was 3.3% (0.3) with 2.2% (0.2) of hallucinatory experiences and 1.7% (0.2) of delusional experiences. The lifetime prevalence of PEs was higher in young people and in persons with unemployment or part-time-job. PEs were associated with an increase in the lifetime prevalence of anxiety disorders [Adjusted odd ratio (AOR)=6.3 ; p<0.001], mood disorders (AOR=4.9 ; p<0.001), alcohol use disorders (AOR=2.4 ; p<0.001), and nicotine use disorders (AOR=2.4 ; p<0.001) after controlling for sociodemographic variables. @*Conclusion@#：PEs are related to various non-psychotic disorders as well as psychotic disorders. Clinicians should pay more attention to the mental health of individuals with PEs.

Personality Types as Predictors of Breast Cancer Screening Compliance in Korean Patients: A Mixed-Method Approach

Objective@#The purpose of this study is to identify personality types that can influence breast cancer screening (BCS) compliance among Korean women with breast cancer using a mixed-method approach. @*Methods@#The participants consisted of 93 women who underwent surgery for breast cancer between July 2010 and March 2012. The demographic and medical characteristics of the participants were evaluated through structured interviews. To identify personality types, in-depth interviews were performed and the transcribed interviews were evaluated using interpretive phenomenological analysis. The participants were categorized into two groups (compliance and non-compliance) based on compliance with the Korean Breast Cancer Society recommendations for BCS. @*Results@#Five personality types were identified through phenomenological analysis. There were significant differences in the chi-square test results for the BCS compliance and non-compliance groups according to age (p=0.048), cancer stage (p<0.001), and personality types (p=0.018). Logistic regression showed that the odds ratio for compliance with BCS was 9.35 (p=0.01) for individuals with a cautious-organized personality type, 9.38 (p=0.02) for those with a cautious-dependent personality, and 10.58 (p=0.04) for those with a sensitive-downcast personality compared to those with a cautious personality type. @*Conclusion@#Participants with cautious-organized, cautious-dependent, and sensitive-downcast personality types were less likely to follow the BCS recommendations than those with a cautious personality type. This study provides a basis for the future development of an effective questionnaire to investigate the personality types of individuals with breast cancer in order to predict compliance with BCS.

A Pathophysiological Validation of Collagenase II-Induced Biochemical Osteoarthritis Animal Model in Rabbit

BACKGROUND: Current dilemma working with surgically-induced OA (osteoarthritis) model include inconsistent pathological state due to various influence from surrounding tissues. On the contrary, biochemical induction of OA using collagenase II has several advantageous points in a sense that it does not involve surgery to induce model and the extent of induced cartilage degeneration is almost uniform. However, concerns still exists because biochemical OA model induce abrupt destruction of cartilage tissues through enzymatic digestion in a short period of time, and this might accompany systemic inflammatory response, which is rather a trait of RA (rheumatoid arthritis) than being a trait of OA. METHODS: To clear the concern about the systemic inflammatory response that might be caused by abrupt destruction of cartilage tissue, OA was induced to only one leg of an animal and the other leg was examined to confirm the presence of systemic degenerative effect. RESULTS: Although the cartilage tissues were rapidly degenerated during short period of time upon biochemical induction of OA, they did not accompanied with RA-like process based on the histology data showing degeneration of articular cartilage occurred only in the collagenase-injected knee joint. Scoring evaluation data indicated that the cartilage tissues in non-induced joint remained intact. Neutrophil count transiently increase between day 8 and day 16, and there were no significant change in other complete blood count profile showing a characteristics of OA disease. CONCLUSION: These study shows that biochemically induced cartilage degeneration truly represented uniform and reliable OA state.

Five Month-Persistent Extrapyramidal Symptoms following a Single Injection of Paliperidone Palmitate: A Case Report

Long-acting injectable (LAI) antipsychotics are useful in the treatments for schizophrenic patients with poor adherence due to their maintaining feature of therapeutic plasma level without daily administrations. However, their long-lasting property can cause complicated problems such as a long-lasting side effect. We report a patient who experienced LAI-induced extrapyramidal symptoms (EPSs) for 5 months after a single injection. During that period, every trial to ameliorate this condition turned out to be a failure. The 3-month formulation of paliperidone palmitate is now close at hand. We have to be aware of possible long-lasting adverse events and confirm the tolerability to LAI before use.