Differences in Social and Clinical Characteristics between Readmission and Dehospitalization in Long-Term Inpatients with Schizophrenia / 대한정신분열병학회지

Objectives@#Dehospitalization of long-term inpatients with schizophrenia can be difficult because of complex factors such as chronic symptoms and low family and social support. The aim of this study was to identify factors related to dehospitalization and readmission of long-term inpatients with schizophrenia. @*Methods@#This retrospective study reviewed the medical records of patients discharged from a psychiatric hospital in Yongin, South Korea, from February 1, 2016, to July 31, 2017. Patients who were hospitalized for over 3 months were divided into two groups: readmission (n=47) and dehospitalization (n=55). Differences in sociodemographic and clinical factors were analyzed between the two groups. @*Results@#Regarding sociodemographic characteristics, female sex, familylessness, discharge to nursing homes, and discharge after symptom improvement were more prevalent in the dehospitalization group, whereas male sex, having a sibling as next of kin, and discharge because of other problems were more prevalent in the readmission group. Among clinical characteristics, hospital stay was longer in the readmission group. @*Conclusion@#In this study, patients without a family showed a tendency to not be readmitted when they were discharged to nursing homes after symptom improvement. Expansion of social welfare support may encourage dehospitalization of long-term inpatients with schizophrenia.

Clinical Characteristics and Heart Rate Variability of Foreign Domestic Violence Victims in Korea / 수면정신생리

OBJECTIVES: Domestic violence is related to many psychiatric diseases, such as depression, anxiety disorder, and PTSD. Heart rate variability (HRV) is an index of autonomic control of the heart and is related to cardiovascular and emotional disorders. Although there have been some studies on the effects of domestic violence on women's mental health, relatively little information is available on HRV in this population. The aim of this study is to investigate demographic data, psychological features, and HRV in female victims of domestic violence and difference between Korean and foreign female victims. METHODS: A total of 210 female victims of domestic violence (166 Korean women and 44 foreign women) were recruited for this study. Psychological symptoms were measured using the Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), and Impact of Event Scale-Revised (IES-R). HRV measures were assessed by time-domain and frequency-domain analyses. RESULTS: The mean score of HAM-A was 13.81, that of HAM-D was 12.92, and that of IES-R was 33.61 ; there were no significant differences between Korean and foreign women in these measures. In HRV time domain analyses, approximate entropy (ApEn) was significantly increased in foreign women compared to the Korean women. The square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) was significantly decreased in foreign women compared to Korean women. There were no significant differences in the other HRV variables between Korean and foreign women. CONCLUSION: Female victims of domestic violence in Korea are associated with depression, anxiety, and PTSD symptoms. The physiologic factors of a female victim's nationality could be related to higher ApEn and lower RMSSD in foreign female victims. These findings have important implications for future study to study the relationships among ethnic and environmental factors and HRV variables.

Temperament and Character Traits, Heart Rate Variability and Occupational Stress in New Nursing Employees / 신경정신의학

OBJECTIVES: Nursing is a job with high stress. This study investigated the relationship between temperament and character traits, heart rate variability, and the severity of occupational stress in new nursing employees. METHODS: Ninety-seven nurses newly employed in a Seoul Medical Center from April 2014 to September 2015 were included to the study. Before beginning employment, all subjects were asked to complete a sociodemographic questionnaire and Temperament and Character Inventory (TCI). After they were employed for a month, we administered a heart rate variability test and Korean Occupational Stress Scale (KOSS). RESULTS: Harm avoidance (r=0.334, p=0.001), self-transcendence (r=0.224, p=0.028) and KOSS scores were positively correlated. Self-directedness (r=-0.278, p=0.006) and cooperativeness (r=-0.263, p=0.009) were negatively correlated with KOSS scores. In multiple regression analyses, harm avoidance and cooperativeness were risk factors for severe occupational stress. Physical parameters of total power (r=0.303, p=0.003), very low frequency (VLF ; r=0.318, p=0.002), and standard deviation of the NN interval (r=0.220, p=0.030) were significantly associated with higher KOSS scores. In multiple regression analysis, VLF was significant correlated with KOSS scores. CONCLUSION: Individual factors, such as personality trait or autonomic function, may affect the occupational stress vulnerability on this study. Harm avoidance, cooperativeness in TCI parameters are associated with severity of the occupational stress.

Gender Differences between Metabolic Syndrome and Mental Health Problems in Adults Using Community Health Services / 신경정신의학

OBJECTIVES: The objective of this study was to examine the and gender difference between metabolic syndrome and clinical psychiatric characteristics. METHODS: This study was conducted in local habitants who visited one community health service from July to August 2014. 318 local habitants who have not been diagnosed with psychiatric disorders were evaluated using Center for Epidemiological Studies-Depression Scale (CES-D), Reynold Suicidal Ideation Questionnaire (SIQ, Reynolds), Rosenberg Self-Esteem Scale (SES), Korean version of WHO Quality of Life Scale-Abbreviated Version (WHOQOL-BREF), and EuroQol-5 Dimension (EQ-5D). Differences in demographic characteristics of both gender were analyzed. RESULTS: In women, the group with metabolic syndrome showed significantly lower alcohol drinking frequency (p<0.001), educational level (p<0.001) compared to the group without syndrome. Women with metabolic syndrome had lower scores for physical health (p=0.002), environment (p=0.007) on WHOQOL-BREF than those without the syndrome. However, CES-D, EQ-5D, SIQ, Reynolds, and SES show no differences. Among men, no difference was observed in all scales. In addition, in women, logistic regression analysis showed that after adjusting for confounders, metabolic syndrome group had lower score for physical health (p=0.009), environment (p=0.042) on WHOQOL-BREF than the group without syndrome. CONCLUSION: Our study showed an association of metabolic syndrome with poor physical health, environment in women.

A Study on Satisfaction with Mental Health Services and Quality of Life among Patients with Schizophrenia in the Community Mental Health Center / 대한정신분열병학회지

OBJECTIVES: The purpose of this study was to investigate client satisfaction with mental health services across sociodemographical and service utilization characteristics and to identify the predictors for quality of life for schizophrenic patients who registered in community mental health center. METHODS: One hundred five schizophrenic patients who had received intensive or continuing care completed questionnaires, which included Consumer Satisfaction Scale and the Korean version of World Health Organization Quality of Life Assessment Instrument-Brief (WHOQOL-BREF). Subject's sociodemographic and service utilization characteristics were compared using t-test or one-way analysis of variance. To examine the influence of these variables on quality of life, stepwise multiple regression was conducted. RESULTS: Consumer satisfaction scores differed significantly depending on the length of contact with a current mental health staff. In a stepwise multiple regression model, service relevance and occupation together explained 20.5% of variance in quality of life. CONCLUSION: The results suggest that continuity in contact with a current mental health staff was important in consumer satisfaction. Service relevance and occupation had an impact on quality of life.

Sleep and Suicidal Risk Factors in Korean High School Students / 수면정신생리

OBJECTIVES: Sleep problems has been consistently reported as a suicidal risk factor in adults and, recently, also in adolescents. In this study, dividing study subjects by the previous suicidal behaviors (suicidal vs non-suicidal), we compared the group differences of suicidal risk factors, and examined the possibility of sleep as a suicidal risk factor. METHODS: Study subjects were 561 (271 boys and 290 girls) from a community sample of high school students. Suicidal Risk Behavior Checklist, Center for Epidemiological Study-Depression (CES-D), Symptom Checklist-90-Revision (SCL-90-R) Anxiety and Aggression subscale, Pittsburg Sleep Quality Index (PSQI) were done. RESULTS: Forty six students (8.1%) reported previous actual self-harm behavior as a suicidal attempt, 181 students (32.4%) reported having suicidal thought only. Three hundred thirty four students (59.5%) reported no previous suicidal behavior (thought and attempt, both). Suicidal behavior group showed higher score on risk behaviors such as school violence, substance use and internet addiction. CES-D, SCL-90-R, PSQI showed significant group difference. Logistic regression analysis showed suicidal risk were significantly associated with depression, stress in suicidal risk factors and sleep latency, daytime dysfunction in PSQI. Analysis of variance (ANOVA) shows the most prolonged sleep latency and increased index of all PSQI components except sleep efficiency in suicidal attempt group. CONCLUSIONS: Sleep Problems had a strong association with the suicidal risk behavior in adolescents. Sleep problems, especially, prolonged sleep latency, daytime dysfunction might be important markers for suicidal behavior. Screening for sleep problems in adolescents are encouraged for the parents, school teachers, and related medical physicians.

Heart Rate Variability and Lipid Profile in Patients with Major Depressive Disorder / 수면정신생리

OBJECTIVES: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. METHODS: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. RESULTS: In serum lipid profile test, MDD group showed higher cholesterol (197.68+/-42.94 mg/dL vs. 176.85+/-34.68 mg/dL, p=0.044), TG (139.45+/-92.54 mg/dL vs. 91.4+/-65.68 mg/dL, p=0.018), LDL (130.03+/-33.18 vs. 106.62+/-27.08, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant (32.82+/-14.33 ms vs. 40.36+/-21.40ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group (1.13+/-0.11 vs. 0.91+/-0.18, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). CONCLUSION: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.

Comparative Study of Efficacy and Safety between Aripiprazole and Quetiapine in the Treatment of Delirium / 대한정신약물학회지

OBJECTIVE: Haloperidol, a typical antipsychotic, has been the preferred agent for the pharmacological treatment of delirium. Recent studies have shown that atypical antipsychotics can be as effective as haloperidol in managing delirium. However, there are few comparative studies between atypical antipsychotics in the treatment of delirium. We investigated the efficacy and side effects of aripiprazole and quetiapine for the treatment of patients with delirium. METHODS: Forty two inpatients with delirium according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Text Revision and Korean version of Delirium Rating Scale-Revised-98 (K-DRS-98) criteria were included. They were assigned to either aripiprazole or quetiapine groups, with a flexible dosing schedule. K-DRS-98 and Clinical Global Impression-Severity (CGI-S) were used for evaluating the severity of delirium. The degree of sedation was assessed by using the Richmond Agitation-Sedation Scale (RASS) six times per day. The severity of side effect was evaluated with the Drug-Induced ExtraPyramidal Symptoms Scale and the Barnes Akathisia Rating Scale. K-DRS-98 and RASS were conducted daily until the remission of delirium while other measurements were conducted twice at the point of baseline and remission. For statistical analysis, t-test, Fisher's exact test, Mann-Whitney test, analysis of covariance were conducted. RESULTS: The scores of K-DRS-98 in both groups significantly decreased after treatment (p or =-3 (p=0.034). The scores on sleep cycle of K-DRS-98-severity more significantly decreased in the quetiapine group than aripiprazole group (F=4.291, p=0.045). There were no significant side effects both groups including extrapyramidal symptoms. CONCLUSION: These results suggest that both aripiprazole and quetiapine appear to be effective and tolerable in the treatment of delirium. Aripiprazole may be less sedative than quetiapine and it may be more useful than aripiprazole in sleep problem of delirium. To validate our results, further studies with double-blind, placebo-controlled with a large sample will be required.

The Association between Economic Status and Depressive Symptoms: An Individual and Community Level Approach

OBJECTIVE: The study was conducted to investigate the association between economic status and depressive symptoms by comparing the prevalence rates of depressive symptoms at community level and analyzing the possibility of depressive symptoms at individual level. METHODS: A survey was conducted from November, 2006 to November, 2007 on 966 and 992 representative subjects recruited by stratified clustered sampling in two regions located in Seoul. We used a standardized questionnaire including the Center for Epidemiologic Studies-Depression and questions on the socioeconomic characteristics. The adjusted prevalence rates of depressive symptoms were compared at community level, and multiple logistic regression analysis was performed to determine the association between depressive symptoms and economic statuses at individual level among each region. RESULTS: The adjusted prevalence of depressive symptoms was higher in the region with a high socioeconomic status (23.1%) than in the region with a lower economic status (16.6%)(p<0.001). However, logistic regression analysis of individual level revealed that a higher economic status was significantly associated with a lower possibility of depressive symptoms among the females in the low economic status region. This tendency was not observed among the males in both of the regions. CONCLUSION: The association between economic status and depressive symptoms was found to be different when it was approached at community level or individual level. In addition, the association of two variables was different by gender at individual level. Further studies that consider the third mediators are needed to determine the association between the two variables.

Internet Addiction in Adolescents and its Relation to Sleep and Depression / 수면정신생리

OBJECTIVES: "Internet-addiction" came into common use not only in clinical setting but also in everyday life. But, pathophysiology and diagnostic criteria of the internet addiction remain unknown. Because adolescents are in developing period, they might be vulnerable to the internet addiction, depression and sleep-related problem. The objectives of this study were to investigate the characteristics of internet addiction and its association with sleep pattern and depression in Korean adolescence. METHODS: Subjects were 799 middle and high school students in Seoul, Korea. We administered a self-reported questionnaire including socio-demographic data, Korean versions of Young's Internet Addiction Scale (YIAS), Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies for Depression Scale (CES-D) and questions about internet using patterns. Data of 696 subjects were included in analysis. Chi-square tests were used to analyze proportional differences, and ANOVA with post-hoc tests were used to analyze differences among groups. Partial correlation analyses were performed to analyze the correlation of internet addiction with other variables (two-tailed, p<0.05). RESULTS: Of the 696 participants (grade 2 of middle school;M2 135 vs. grade 1 of high school;H1 238 vs. grade 2 of high school;H2 323), 2.0% (n=14) were internet-addicted (IA), 27.7% (n=193) were over-using (OU) and 70.3% (n=489) were not-addicted (NA). The mean scores of YIAS, PSQI and CES-D scores were 35.24+/-12.78, 5.53+/-3.04 and 16.72+/-8.69, respectively. In higher grade students, average total sleep time was shorter (M2 426.20+/-67.68 min. vs. H1 380.47+/-62.57 min. vs. H2 354.67+/-73.37 min., F=51.909, p<0.001), and PSQI (4.69+/-3.14 vs. 5.42+/-3.15 vs. 5.97+/-2.83, F=8.871, p<0.001) CES-D (13.53+/-8.37 vs. 16.96+/-8.24 vs. 17.87+/-8.84, F=12.373, p<0.001) scores were higher than those of lower grade students. Comparing variables among IA, OU and NA groups, computer using time not for study (96.36+/-63.31 min. vs. 134.92+/-86.79 min. vs. 213.57+/-136.87 min., F=34.287, p<0.001) and portable device using time not for study (84.22+/-79.11 min. vs. 96.97+/-91.89 min. vs. 152.31+/- 93.64 min., F=5.400, p=0.005) were different among groups. PSQI (5.26+/-2.97 vs. 6.08+/-2.97 vs. 7.50+/-4.41, F=8.218, p<0.001) and CES-D scores (15.40+/-8.08 vs. 19.05+/-8.42 vs. 30.43+/-13.69, F=32.692, p<0.001) were also different among groups. YIAS score were correlated with computer using time not for study (r=0.356, p<0.001) and portable device using time not for study (r=0.136, p<0.001). PSQI score (r=0.237, p<0.001) and CES-D score (r=0.332, p<0.001). YIAS score and PSQI score (r=0.131, p=0.001), YIAS and CES-D score (r=0.265, p<0.001), PSQI score and CES-D score (r=0.357, p<0.001) were correlated each other. CONCLUSION: These results suggested that adolescents' internet-addiction was correlated with not only computer and portable device using time not for study but also depression and sleep-related problems. We should pay attention to depression and sleep-related problems, when evaluating internet-addiction in adolescents.

Development of the Korean form of toddler temperament scale / 신경정신의학

No abstract available.