Objective : The present study aims to investigate differences in anger-related features in patients with somatic symptom disorder (SSD) compared to healthy controls, and to examine whether anger trait and anger regulation strategy are associated with clinical characteristics in patients with SSD. In addition, we examined the relationship between childhood adversity and SSD. Methods : 26 patients with SSD and 28 healthy controls were included. Anger-related features were assessed with State-Trait Anger Expression Inventory (STAXI). Clinical somatic symptoms were assessed using the somatization subscale of the Symptom Checklist-90-Revised and the Somatosensory Amplification Scale. Childhood adversity was assessed by the Childhood Traumatic Events Scale. Multivariate analysis of covariance was performed. Results : Disease status of SSD had a significant overall effect on anger-related features (Wilks λ=0.725, F(5, 44)=3.332, p=0.012). Patients with SSD showed a significantly high Trait-Anger (p=0.017) and they had a high score in both Anger-Out (p=0.013) and Anger-In (p=0.001) of anger expression styles. In particular, a directed inward style of anger expression was significantly associated with somatization symptom severity (p=0.003). Regarding childhood adversity, more childhood extreme illness was experienced by the SSD group than the control group (p=0.012). Within the SSD group, childhood extreme illness was associated with higher Trait-Anger (p=0.027) and Anger-Out (p=0.001). Conclusion : The present findings suggest that trait anger, anger expression styles, and childhood adversity of extreme illness may be involved in SSD. Further studies are needed to explore the role of anger-related features and its relationship with childhood adversity in the pathophysiology of SSD.

Particular matter is steadily increasing due to environmental factors at domestic and abroad such as industry and economy. Recently, the exposure particular matters has been reported to increase the risk not only for morbidity and mortality, but also for diseases of the respiratory system, cardiovascular system and central nervous system/neuropsychiatric disorder. Although the causes of neuropsychiatric diseases are genetic and environmental factors, it is necessary to pay more attention to environmental factors in terms of prevention. We mainly describe environmental factors that affect neuropsychiatric disorders, mainly on particular matter, which is one of harmful environmental substances. In the current study, we reviewed evidence for the presence of particular matter or particular matter related harmful air pollutants-O₃, SO₂, NO₂/NOx, traffic related air pollution, that may represent risk factors for the development of neuropsychiatric disorder.

Objective : Previous studies have shown that depression, anxiety and embitterment are highly related to suicide. This study aims to investigate the mediating effect of embitterment between depression, anxiety and suicide. Methods : A total of 174 participants with depressive and anxiety disorders were evaluated with STAI-S, STAI-T, PHQ-9, PTED scale, SSI and suicide attempt history. A mediation analysis using bootstrapping was utilized in order to estimate the indirect effects of depression and anxiety on suicide through embitterment. Results : Embitterment significantly mediated the relationship between depression and suicidal ideation [b=0.291, 95% CI(0.18, 0.40)], and also it mediated the relationship between depression and suicide attempt [b=0.066, 95% CI(0.02, 0.16)]. Although a direct effect of anxiety on suicide attempt was not significant, but embitterment significantly mediated the relationship between anxiety and suicide attempt Conclusion : This suggests that embitterment may be a significant important factor to consider in the relationship between depression, anxiety and suicide. Understanding the mediating role of embitterment on suicide may helpful to prevent suicide.

Objective : Heart rate variability (HRV) is known to reflect autonomic nervous system activity. Individuals with posttraumatic stress disorder (PTSD) are reported to have lower HRVs. We attempted to find HRV indices with head up tilt position that reflect the symptoms well in order to evaluate PTSD symptoms. Methods : Sixty-seven patients with PTSD and 72 patients without PTSD were assessed using the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory, the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index. HRV was measured in the head-up tilt position. We collected data regarding heart rate (HR), standard deviation of the NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), log low-frequency (LNLF) and log high-frequency (LNHF). Results : The value of LNHF was different according to presence or absence of PTSD after head-up tilt position. In the findings of the association between PTSD symptoms and HRV indices as based on head-up tilt, LNHF had a significant correlation with the total score of PCL-5. Conclusion : The reduction of the high-frequency component of HRVs in the PTSD group might reflect more PTSD symptoms.

Objective : The suicide mortality rate among Koreans was ranked first among the OECD countries in 2018. Alcohol consumption is a significant risk factor for suicidal behavior. This study examined the relationship between the severity of subjects' drinking habits and the suicidal ideation among Koreans according to gender and age. Methods : The data of 113,602 people who visited the Kangbuk Samsung Hospital Health Screening Center from January 2013 to December 2014 were used. The severity of subjects' harmful drinking habits was assessed using the Korean version of the Alcohol Use Disorders Identification Test (AUDIT-K). The relationship between the severity of harmful drinking and suicidal ideation was compared using logistic regression analyses. We also examined the tendency through p for trend to identify a trend. Results : Of the 113,602 study subjects, 6,586 (5.8%) responded that they had thought of committing suicide. After controlling for gender, marriage, education, body mass index (BMI), depression and anxiety, the results showed that the higher the level of harmful drinking, the higher the suicidal ideation. Conclusion : This study found that, even after controlling depression and anxiety, the severity of drinking could be a significant risk factor for suicidal ideation.

Objective : The purpose of this study was to investigate the prevalence of social anxiety disorder (SAD) and its association with psychosocial factors including self-esteem, ego-resiliency, and social support in a sample of medical students. Methods : A total of 405 medical students were included in this study. Subjects were asked to complete a self-reported questionnaire, measures of the Social Phobia Inventory (SPIN), the Rosenberg's Self-Esteem Scale (RSES), the Ego-Resiliency Scale (ERS), and the Duke-UNC Functional Social Support Questionnaire (DUFSS). The SAD and non-SAD group were defined using the SPIN score of 25 as a cut-off. The multiple regression analyses were performed to examine the association of self-esteem, ego-resiliency, and social support with SAD symptoms. Results : A total of 79 subjects (19.5%) were identified with SAD. The total RSES score, ERS score, and DUFSS score were significantly lower in the SAD group than the non-SAD group. The total SPIN score negatively correlated with the total RSES score (r=-0.481, p<0.001), the ERS score (r=-0.417, p<0.001), and the DUFSS score (r=-0.406, p<0.001). In the multiple regression, SAD symptoms were associated with self-esteem (β=-0.549, p<0.001), ego-resiliency (β=-0.395, p<0.001), and social support (β=-0.346, p<0.001). Conclusion : This study revealed the prevalence of SAD and its negative association with self-esteem, ego-resiliency, and social support among medical students. Our findings indicate that improving self-esteem and ego-resiliency as well as perceived social support may contribute to the management of SAD symptoms among medical students.

Objective : Social anxiety disorder (SAD) is characterized by fear of social threat and exhibits limbic hyper-reactivity toward social stimuli such as emotional faces. A previous study identified the uncinate fasciculus (UF) sub-tract as particularly related to facial memory. To explore the white matter tract relating to face-specific brain regions, we investigated the UF sub-tract in SAD. Methods : The diffusion tensor images of 22 patients with SAD and 20 healthy controls were analyzed with tractography. The UF sub-tract was delineated using the regions of interest of face patches in the anterior temporal lobe and the orbitofrontal cortex, and fractional anisotrophy (FA) and total number of streamlines (ST) were analyzed. We examined the group comparison of FA and ST of the UF sub-tract and correlations of FA and ST with the social anxiety symptoms such as the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS) and the Fear of Negative Evaluation scale (FNE) in SAD. Results : There were no group differences in FA and ST of the UF sub-tract. However, negative correlations were observed between ST of the right UF sub-tract and severity of social anxiety symptoms (LSAS, r_s=-0.480, p=0.024; SIAS, r_s=-0.580, p=0.005; SPS, r_s=-0.590, p=0.004; FNE, r_s=-0.675, p=0.001) in patients with SAD. Conclusion : Although patients with SAD did not show quantitative abnormalities in the UF sub-tact connecting face-specific brain regions, this structure seems to play a role in the symptom severity of SAD.