• Sleep Medicine and Psychophysiology
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• v.17 no.2
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• pp.100-108
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• 2010

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 (PS-QI), 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${\pm}$12.78, 5.53${\pm}$3.04 and 16.72${\pm}$8.69, respectively. In higher grade students, average total sleep time was shorter (M2 426.20${\pm}$67.68 min. vs. H1 380.47${\pm}$62.57 min. vs. H2 354.67${\pm}$73.37 min., F=51.909, p<0.001), and PSQI (4.69${\pm}$3.14 vs. 5.42${\pm}$3.15 vs. 5.97${\pm}$2.83, F=8.871, p<0.001) CES-D (13.53${\pm}$8.37 vs. 16.96${\pm}$8.24 vs. 17.87${\pm}$8.84, F=12.373, p<0.001) scores were higher than those of lower grade students. Comparing variables among IA, OU and NA groups, computer using time not for study (96.36${\pm}$63.31 min. vs. 134.92${\pm}$86.79 min. vs. 213.57${\pm}$136.87 min., F=34.287, p<0.001) and portable device using time not for study (84.22${\pm}$79.11 min. vs. 96.97${\pm}$91.89 min. vs. 152.31${\pm}$93.64 min., F= 5.400, p=0.005) were different among groups. PSQI (5.26${\pm}$2.97 vs. 6.08${\pm}$2.97 vs. 7.50${\pm}$4.41, F=8.218, p<0.001) and CES-D scores (15.40${\pm}$8.08 vs. 19.05${\pm}$8.42 vs. 30.43${\pm}$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.

• Journal of Oriental Neuropsychiatry
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• v.20 no.3
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• pp.89-119
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• 2009

Objectives : This study was to investigate the association of Pittsburgh Sleep Quality Index(PSQI), Insomnia Questionaire(IQ), Beck Depression Inventory(BDI) and Diagnos system of oriental medicine(DSOM) in the Insomnia Patients. Methods : For this study, we carried out PSQI, IQ, BDI and DSOM of 37 patients with insomnia who have come to Donguei oriental hospital of Donguei university from November 2008 to May 2009. And Using cross tabulation analysis, verified the association of PSQI, IQ, BDI and DSOM. Results : 1. The most Frequent Pathogenic Factor is blood-deficiency(血虛) in total patients. 2. The score of BDI has positive correlation with sc10 of deficiency of qi(氣虛), damp(濕), kdney(腎) in total patients. 3. The score of PSQI has positive correlation with zp of liver(肝) in total patients. 4. The score of PSQI has positive correlation with sc10 and zp of insufficiency of Yin(陰虛), and the score of BDI has positive correlation with sc10 of blood stasis(血瘀) and zp of liver(肝) in female patients. 5. The score of PSQI has positive correlation with sc10 of deficiency of qi(氣虛) and zp of heart(心), and the score of IQ has positive correlation with sc10 of liver(肝) in male patients. 6. The duration from onset in the group of 22-59years are longer than the group of 60-80 years and the duration of using hypnotics have positive correlation with total sleep time in 22-59years group. 7. The score of PSQI has positive correlation with zp of liver(肝) in 22-59years group. 8. The score of PSQI has positive correlation with the score of BDI in 60-80years group. 9. The score of BDI has positive correlation with sc10 of deficiency of qi(氣虛) and zp of blood-deficiency(血虛), and the score of IQ has positive correlation with zp of coldness(寒) in 60-80years group. 10. The score of IQ has positive correlation with sc10 and zp of dryness(燥) in below 6 Months Group. 11. The score of PSQI has positive correlation with the score of BDI in over 6 Months Group. 12. The score of PSQI has positive correlation with zp of liver(肝) in over 6 Months Group. 13. The score of IQ has positive correlation with sc10 of dryness(燥) in BDI 2nd Grade Group. 14. The score of BDI has positive correlation with sc10 of kidney(腎) and the age has positive correlation with zp of heart(心) in BDI 3rd Grade Group. 15. The age has positive correlation with sc10 of damp(濕) in BDI 4th Grade Group. Conclusions : This study provides insights into the complicated associations of the pattern of insomnia with depression and Diagnos system of oriental medicine. And especially this study showed apparent correlation between insomnia and depression in 60-80years group and over 6 months group.

• Journal of Oriental Neuropsychiatry
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• v.28 no.4
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• pp.319-332
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• 2017

Objectives: The present study aimed to provide clinical evidence on the effect of herbal medicine, Hyeolbuchukeo-tang or Xuefu Zhuyu decoction for the treatment of primary insomnia using a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: This study included RCTs that verified the effects of Hyeolbuchukeo-tang or Xuefu Zhuyu decoction for the treatment of primary insomnia. Literature searches of English, Chinese and Korean databases were performed, and the selected literature was assessed for investigating the risk of bias. Results: The analysis included 10 RCTs. The Chinese Classification of Mental Disorders-3 was most frequently used to define the diagnostic criteria for Hyeolbuchukeo-tang or Xuefu Zhuyu decoction intervention in patients with primary insomnia. The effective rate was the most commonly used outcome measure. A meta-analysis revealed that the effective rate, the Pittsburgh Sleep Quality Index, and the Athens Insomnia Scale in the Modified Xuefu Zhuyu decoction (MXZD) group were higher compared to Western Medicine (WM) group (RR: 1.17, 95% Cl: 1.08 to 1.26, p<0.0001, $I^2$=0/MD: -1.29, 95% Cl: -2.09 to -0.49, p=0.002, $I^2$=0%/MD: -0.99, 95% Cl: -1.81 to -0.18, p=0.02, $I^2$=15%). The effective rate of the MXZD+WM group was significantly different compared to the WM group (RR: 1.28, 95% Cl: 1.11 to 1.47, p=0.0006, $I^2$=2%). The included RCTs were of relatively poor quality and had small sample sizes. Conclusions: Treatment with Hyeolbuchukeo-tang or Xuefu Zhuyu decoction was found to be effective in treating primary insomnia. However, the included RCTs were of relatively poor quality and had small sample sizes. It is hypothesized that this study could serve as a foundation for further clinical studies on the development of diagnosis and treatment methods for primary insomnia based on Korean medicine.

• Journal of Oriental Neuropsychiatry
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• v.32 no.3
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• pp.185-206
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• 2021

Objectives: The objective of this study was to perform a systematic review and meta-analysis of pharmacopuncture treatment for insomnia disorder to derive clinical evidence and recommendation grades. Methods: Studies that verified effects of pharmacopuncture on primary insomnia were included. Characteristics and quality of included studies were assessed using Risk of Bias (RoB). Results: A total of 25 studies were selected. Pittsburgh Sleep Quality Index (PSQI) and effective rate were primarily used for outcome measurement. Vitamin B12 was the most used pharmacopuncture material. The most frequently used acupuncture point was Anmian (Ex-HN). The volume of the acupuncture solution ranged from 0.25 mL to 2 mL. Acupuncture treatment depth was 0.5 cm to 2 cm. In three studies, the procedure was performed at 16:00. Meta-analysis of studies revealed that the effective rate of the pharmacopuncture group was significantly higher than the group using sleeping pills group (RR: 1.21, 95% CI: 1.01 to 1.45, p=0.04, I²=69%). PSQI was decreased in the intervention group (MD=-2.19, 95% CI: -2.90 to -1.48, p<0.00001, I²=0%). Effective rates of pharmacopuncture and acupuncture groups were higher than that of the acupuncture group (RR: 1.11, 95% CI: 1.05 to 1.17, p=0.0002, I²=0%). PSQI was decreased in the intervention group (MD=-1.87, 95% CI: -2.36 to -1.38, p<0.00001, I²=0%). Although the effectiveness rate of the pharmacopuncture group was not significantly higher than that of the acupuncture group (RR: 1.12, 95% CI: 0.98 to 1.27, p=0.1, I²=9%), the PSQI was decreased in the pharmacopuncture group (MD=-2.10, 05% CI: -3.29 to -0.91, p=0.0005, I²=34%). The quality of clinical studies was poor. Conclusions: Based on results of this study, it is proper to use 0.5 to 2 mL of pharmacopuncture solution such as Danshen and Ciwujia with a depth of 0.5 to 2 cm at around 4 p.m. to treat insomnia disorder, focusing on Anmian (Ex-HN) and Sameumgyo (SP6).

• Journal of Oriental Neuropsychiatry
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• v.31 no.1
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• pp.1-12
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• 2020

Objectives: The purpose of this study was to evaluate the reliability and validity of the instrument on pattern identification for insomnia (PIT-Insomnia) and verify the correlation between PIT-Insomnia and psychological tests. Methods: Two evaluators examined the pattern identification of the participants who met insomnia disorder diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5) and took the Insomnia Severity Index (ISI) score over 15 once manually and twice using the PIT-Insomnia to measure the inter-rater and test-retest reliability. We also conducted the following surveys: the Pittsburgh Sleep Quality Index (PSQI), the Korean version of Beck's depression inventory (K-BDI), the Korean version of the State-Trait Anxiety Inventory (STAI-K), the Korean Symptom checklist-95 (KSCL-95), and the EuroQol-5 dimension (EQ-5D), to measure concurrent validity and correlation between the PTI-Insomnia and psychological tests. Results: 1. The test-retest reliability analysis of the pattern identification results showed moderate agreement, and test-retest reliability analysis of each pattern identification score showed agreements from poor to moderate. 2. The inter-rater reliability analysis of the pattern identification results via manual showed slight agreement, when analysis was performed with calibration, the inter-rater reliability analysis of the pattern identification results via manual showed fair agreement. 3. The concordance analysis between results via manual and the PIT-Insomnia showed poor agreement, when the analysis was performed with calibration, concordance analysis showed fair agreement. 4. The concordance analysis between the PIT-Insomnia and the PSQI showed positive linear correlation. 5. The concordance analysis between the PIT-Insomnia and the PSQI, K-BDI, STAI-K, KSCL-95, and EQ-5D showed that non-interaction between the heart and kidney have positive linear correlation with the K-BDI, anxiety item of KSCL-95, dual deficiency of the heart-spleen have positive linear correlation with somatization item of KSCL-95, paranoia item of KSCL-95, heart deficiency with timidity have positive linear correlation with stress vulnerability item of KSCL-95, parania item of KSCL-95, phlegm-fire harassing the heart have positive linear correlation with K-BDI, paranoia item of KSCL-95, depressed liver qi transforming into fire have positive linear correlation with the anxiety item of KSCL-95, parania item of KSCL-95, all pattern identification have negative linear correlation with EQ-5D. Conclusions: The PIT-Insomnia has moderate agreement of reliability and reflects the severity of insomnia since it has some concurrent validity with the PSQI. There are some correlations between the PTI-Insomnia with specific psychological tests, so we could suggest it can be used appropriately in the clinical situation.