본 종설에서는 현재까지 진행된 강박장애에서의 tDCS의 임상연구에 대하여 체계적으로 고찰하였다. tDCS는 비침습적이고 비교적 안전한 치료법으로, 치료 저항성을 보이는 강박장애 환자를 대상으로 적용한 다수의 실험 연구 및 사례 보고에서 중대한 이상반응 없이 치료 효과를 나타내었다. 다만 최근 연구에 따르면 치료저항성이 없는 환자에 대해 기존 치료를 대체할 수 있는 수준의 효과를 보이지는 못했으므로, 치료저항성이 없는 환자에서 어느 정도의 효과를 보일 것인지에 대해서는 추가적인 연구가 필요할 것으로 보인다. 강박장애 치료에 있어서 tDCS 활용의 프로토콜은 완전히 정립되지는 않았다. 현 시점까지 출판된 문헌을 토대로 분석하였을 때 대부분의 연구는 2 mA, 세션당 20~30분, 총 10~20 세션으로 이루어졌다. 최근 출판된 근거-기반 tDCS 치료지침에서는 양극 pre-SMA tDCS를 다른 방법보다 우선 채택하였으나, 그 극성에 따른 효과는 아직 논란의 여지가 있는 것으로 보인다. 다만, 해당 치료지침에 포함된 연구 이후에 다수의 RCT 연구들이 출판되었으므로, 연구 결과들을 종합해보면 pre-SMA를 표적으로 한 양극 tDCS 외에 좌측 OFC에 대한 음극 tDCS도 치료 방식의 후보로서 고려를 해볼 수 있을 것으로 보인다. 그 외 DLPFC와 소뇌 등도 tDCS의 표적 위치로 연구된 바가 있어 추가적인 연구가 필요할 것으로 생각된다. 현재까지 진행된 연구를 바탕으로 더욱 더 많은 연구가 진행된다면 tDCS가 추후 치료 저항성 강박장애 환자에서 시도될 수 있는 치료법 중 하나로 정립될 수 있는 가능성이 높을 것으로 기대된다.

Objective : We aimed to examine the demographic factors and personal resources that affect medical students' perceived stress. In particular, the extent to which coping strategies and social support influenced perceived stress was investigated. Methods : A total of 321 medical students, which consisted of 116 first-year students, 100 second-year students, and 105 third-year students, participated in the present study. The levels of perceived stress, coping style, and perceived social support were measured by the perceived stress scale, the ways of coping scale, and the multi-dimensional scale of perceived social support, respectively. The influence of coping style and social support on perceived stress was examined by multiple linear regression, after controlling for age, sex, grade, and medical school entrance type. Results : The perceived stress level was significantly different between undergraduate-entry and graduate-entry medical students (18.39 vs. 16.38, t=2.625, p=0.009). Other sociodemographic factors did not affect the extent to which medical students experienced stress. The multiple regression model was significant (p<0.001), and active problem-focused coping (p<0.001) and social support from friends (p=0.003) were associated with a lower level of perceived stress. Conclusion : Our results suggest that problem-focused strategies and supportive relationships with friends may play a role in reducing medical students' stress levels. These findings have implications for teaching students how to approach stressful situations and encouraging students to build communities among themselves may help students manage stress during medical school effectively.

Objective : Although cognitive-behavioral conceptualization of obsessive-compulsive disorder (OCD) has been well supported, cognitive constructs do not entirely explain the OCD symptoms. Based on the recently applied psychological model of acceptance-commitment therapy (ACT) in OCD, this study aimed to investigate the relationships among experiential avoidance, cognitive fusion, and OCD symptoms in patients with OCD. Methods : Seventy patients with OCD and 85 normal controls completed the Acceptance and Action Questionnaire-II (AAQ-II) for experiential avoidance, Cognitive Fusion Questionnaire (CFQ), and several symptom measures for OCD symptoms and depression. Results : AAQ-II and CFQ scores were higher in OCD patients than in normal controls, even after controlling for depression. Both AAQ-II and CFQ scores were significantly related to obsessing symptoms and responsibility to harm as well as unacceptable thoughts dimensions. Regression analyses showed that two variables of AAQ-II and CFQ accounted for over 25% of variances in these two symptom dimensions, with AAQ-II being the only significant predictor. Conclusion : These results suggest that two psychopathologies in ACT, termed, experiential avoidance and cognitive fusion are particularly important in explaining obsessing symptoms and its corresponding symptom dimensions such as unacceptable thoughts and responsibility to harm dimensions.

Objective : The purpose of the study was to investigate the relationship between temperament and character inventory (TCI) temperament, characteristics, and personality psychopathology in the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in psychiatric patients. Methods : The TCI and MMPI-2-RF data of 240 psychiatric patients were used in this study. The data were classified according to the aspects of vulnerable temperament and immature character into four groups. Multivariate analysis of variance (MANOVA) was performed to investigate the TCI and MMPI-2-RF scores between the four groups. Results : All five personality psychopathologies were significantly different between the four groups. However, the diagnosis rate of multiple mental disorders was not significantly different between the four groups. Conclusion : The findings suggest that acquired personality traits play an important role in the adaptation of the individual, and personality pathological factors appear differently according to temperament and character types.

Objective : The questionnaire-based study model has a problem in that there is no information on diseases and drugs to determine the association between mood disorders and the severity of comorbid diseases in cancer survivors. This study used claim data collected by the National Health Insurance Corporation over nine years to identify risk factors of mood disorders in breast cancer survivors Methods : 2,065 patients were included in this study, excluding someone who were diagnosed mood disorders one year before breast cancer diagnosis. All statistical analysis was performed with R4.0.0 Chi-Square test and Cox's proportional hazards model was performed. Results : Chi-square test was performed to confirm the general characteristics of the subjects. There were 461 (22.32%) patients with mood disorders and 1,604 (77.67%) patients with no mood disorders. In the univariate Model 1 according to the CCI, the HR in the case of CCI 2 was analyzed as 1.629(95% CI, 1.15-2.30), CCI≥3 was analyzed as 2.031(95% CI 1.48-2.78), compared to the study subjects with CCI=0. The age and survivorship adjusted Model 2 HR, CCI=2 was 1.615(95% CI, 1.14-2.28), CCI≥3 was analyzed as 1.924 (95% CI 1.40-2.65). The fully adjusted Model 3 HR, CCI=2 was 1.599 (95% CI, 1.12-2.28), CCI≥3 was analyzed as 1.760 (95% CI 1.25-2.49). Conclusion : In order to improve the long-term quality of life for breast cancer survivors in the future, it is necessary to manage survivorship, the severity of comorbidities, which are identified as risk factors for the development of mood disorders.

Objective : The purpose of this study was to investigate the impairment of working memory in patients with panic disorder through neuropsychological examination. Methods : A total of 38 patients who met the DSM-5 criteria for panic disorder and 40 healthy controls were recruited in this study. Controls and patients were matched for age, sex, and education. The Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale (HAMD), and the Panic Disorder Severity Scale (PDSS) were used to evaluate the severities of anxiety, depression, and panic disorder. Further, the digit span task was performed to assess working memory. In addition, a sub-analysis was performed after excluding participants with clinical depressive symptoms. Finally, a sub-analysis by the education level was performed. Results : The HAMA, HAMD, and PDSS scores were significantly higher for patients with panic disorder compared to controls. The scores of digit span forward, digit span backward, digit span sequencing, and total digit span were significantly lower for patients with panic disorder compared to controls. In the sub-analyses excluding patients with depression and by education level, the score of total digit span was significantly lower for patients with panic disorder compared to controls. Conclusion : In this study, patients with panic disorder had deficits in working memory compared to healthy controls.