• Korean Journal of Psychosomatic Medicine
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• v.28 no.1
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• pp.29-35
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• 2020

Objectives : Evidence regarding the association between untreated depression in adolescence and suicidal risk in male young adults is scarce. We aimed to assess the effect of untreated illness during adolescence on the suicidal risk and attempt after that first episode. Methods : As part of a cross-sectional study, between May 2017 and April 2018, a total of 260 patients with currently unipolar or bipolar depression were included in the final analysis. Multiple linear and logistic regression analysis were performed to evaluate the association between untreated mood disorder in adolescence and its effect on the suicidal risk and attempt. Results : In total 260 patients, 189 were classified as untreated group. The proportion of suicide attempts, total depression score, suicidal risk and number of suicide attempts were significantly higher in the untreated group. The most predictive factors of suicide attempts were history of untreated depression [Adjusted Odds Ratio (AOR)=4.19, 95% Confidence Interval (CI)=2.25-7.81, p<0.001] and diagnosis of bipolar depression (AOR=2.60, 95% CI=1.52-4.46, p<0.001). Conclusions : Although the untreated depression suggests higher rates of suicidality, a significant proportion (86.7%) of adolescent depression in this study did not receive psychiatric treatment. Future research should be needed to find better ways to decrease barriers in using mental health treatment and its contribution to reduction and prevention of adverse outcome.

• Anxiety and mood
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• v.12 no.2
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• pp.113-118
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• 2016

Objective : Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is known to reduce the quality of sleep and is associated with various psychiatric disorders. The aim of this study was to investigate the relationship of PMS with depression, sleep qulity and sleep pattern in Korean female adolescents. Methods : Out of 867 high school female students, 400 female subjects were included in this study. All participants completed self-report questionnaires that included demographic variables, shortened premenstrual assessment form (SPAF), patient health questionnaire-9 (PHQ-9), Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), insomnia severity index (ISI) and Korean translation of composite scale (CS). A total of 394 individuals who completed the questionnaires were analyzed. Results : As score of SPAF, 143 subjects was defined PMDD group. They had more prevalence of eveningness, more depressive symptom, poorer sleep quality, and more excessive sleepiness than non-PMDD groups. Although the PMDD groups showed more menstrual dysmenorrhea, no difference was found in bleeding duration and cycle. PMS symptom had correlations with depression, poorer sleep quality and excessive sleepiness during the daytime. There was no difference in sleep duration between two groups, but PMS might have a relationship with eveningness of chronotype. Conclusions : Among Korean female high school students, the PMS might have an association with depression and poor sleep quality, and it might lead to daytime impairment due to excessive sleepiness. An appropriate evaluation of PMS could be helpful in determining the mental health condition of adolescents.

• Korean Security Journal
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• no.10
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• pp.293-322
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• 2005

The culpability of a person, as determined by due process of law, for any of his actions that are defined as criminal. Determination of such responsibility is a legal function, not a psychiatric one, although a psychiatrist may be called upon to present evidence to the court in order to aid the judge or jury in reaching a decision as to responsibility. Determination of responsibility varies with the laws of the state in which the accused is being tried, but in general all states base their laws on three famous judicial decisions concerning criminal responsibility. 1. the M'Naghten(McNaughton) rule(a. to establish such a defense the accused, at the time the act was committed, must be shown to have been laboring under such defect of reason as not to know the nature and quality of the act he was doing, b. if he did know it, he did or know that what he was doing was wrong). 2. the irresistible impulse test. 3. the Durham decision. Under the Durham test, however, the psychiatrist may give any relevant testmony concerning the mental illness at issue. The psychological and behavioral appearance of a person, in clinical psychiatry this term is commonly used to refer to the results of the mental examination of a patient. The written report of the mental status usually contains specific references to the following areas: I. Attitude and General Behavior (1)General health and appearance. (2)General habits of dress. (3)Personal habits. (4)General mood. (5)Use of leisure time. (6)Degree of sociability. (7)Speech. II. Attitude and Behavior during interview (1)Co-operativeness. (2)Poise. (3)Facial expression. (4)Motor activity. (5)Mental activity. (6)Emotional reactions. (7)Trend of thought. III. Sensorium, mental grasp, and capacity (1)Orientation. (2)Memory and retention. (3)Estimate of intelligence. (4)Abstraction ability. (5)Tests of absurdity, interpretation of proverbs. (6)Judgment.

• Korean Journal of Biological Psychiatry
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• v.7 no.2
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• pp.191-197
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• 2000

Objectives : Risperidone is a new antipsychotic drug developed to overcome the therapeutic limitation of conventional antipsychotics. It responses to negative as well as positive symptoms by blocking both dopaminergic and serotonergic receptors, causing no significant side effects such as agranulocytosis and seizure. It is, however, not known whether it induces any serious cardiovascular side effects as evoked by other conventional antipsychotic drugs. The aims of this study were to evaluate the effect of risperidone on cardiovascular function, and to discuss the factors affecting the cardiovascular function. Methods : For 42 patients(22 males and 20 females) diagnosed as schizophrenia, schizophreniform disorder or schizoaffective disorder according to the DSM-IV classification, the cardiovascular fuctions such as heart rate, systolic and diastolic blood pressure, PR interval, QRS interval and QT interval were successively checked before and after 2 weeks and 4 weeks risperidone administration. Furthermore, variables such as body weight, Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGI), Extrapyramidal Symptom Rating Scale(ESRS), Anticholinergic Rating Scale(ARS), serum cholesterol level, serum triglyceride level, serum high-density-lipoprotein level, serum WBC, serum Hb, serum platelet level, prothrombin time and partial thromboplastin time were also analyzed before and after 2 weeks and 4 weeks risperidone administration. Results : 1) Risperidone treatment resulted in a significantly decreased heart rate and increased QT interval after 4 weeks administration(p<0.005 respectively). 2) The scores of BPRS and CGI were significantly decreased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). The scores of ESRS and ASRS were significantly increased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). 3) There were positive correlations between heart rate after 4 weeks and total dose(P<0.05). Blood pressure was significantly(p<0.05) correlated with sex(higher in male) and significantly(p<0.05) positive correlated with body weight. QT interval was significantly(p<0.05) correlated with sex(longer in female) and smoking history(shorter in smokers). Conclusions : Risperidone could induce significant change in heart rate and Q-T interval. Therefore, the cardiovascular safety for risperidone should be reconsidered according to the duration and dosage increase.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.21 no.3
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• pp.174-181
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• 2010

Objectives: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). Methods: A retrospective medical record review of 239 ADHD patients (mean age $9.3{\pm}2.6$ years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. Results: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. Conclusion: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

• Korean Journal of Biological Psychiatry
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• v.19 no.2
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• pp.106-113
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• 2012

Objectives : The purpose of this study is to investigate the relationship between the triallelic serotonin transporter gene and stressful life events to determine their effect on depression with alcohol dependence. Methods : Ninety-five hospitalized patients with alcohol dependence (73 male, 22 female) were enrolled in this study. Thirty-two (33.7%) of the total patients were diagnosed with major depressive disorder and dysthymic disorder by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV. The characteristics of stress were evaluated using the stressful life events scale, and depressive symptoms were assessed using the depression scale (Beck Depression Inventory, BDI). Alcoholism with depression (n = 32) and alcoholism without depression (n = 63) were genotyped for the triallelic serotonin transporter gene ($L_A$ : higher expressing allele, $L_G$/S : lower expressing allele). Results : There was no significant difference in the allele frequency between the depression group and the non-depression group (${\chi}^2$ = 0.345, p = 0.619). $L_G$/S alleles had more comorbid depression in the higher score of stressful life events scale [Mental-Haenszel (MH)-${\chi}^2$ = 4.477, p = 0.034]. But there was no significant difference in the comorbidity according to the scores from the stressful life event scale in the $L_A$ alleles (MH-${\chi}^2$ = 0.741, p = 0.399). In the results, alcohol-dependent individuals with $L_G$/S alleles had more comorbid depression than those with $L_A$ alleles when they had experienced severe stressful life events (MH-odds ratio = 2.699, p = 0.028). Conclusions : These results suggest that there is no direct relationship between triallelic serotonin transporter gene and depression in the alcohol dependent patients. But alcohol dependent individuals with the lower expressing alleles of the serotonin transporter gene were more susceptible to depression than those with the higher expressing alleles in response to stressful life events.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.14 no.2
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• pp.218-228
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• 2003

Objectives：This study investigated the relationship among child's behavior problems, maternal depression, and parenting stress in children with psychiatric diagnoses and their mothers, and the effect of these variables to the mothers' parenting stress. Methods：Seventy-three children(31 externalizing, 24 internalizing, 18 mixed) and their mothers were involved in this study. The mothers of three groups completed MMPI, KPI-C(Korean Personality Inventory for Children), and PSI(Parenting Stress Index). To investigate the relationships among each variables, ANOVA, Pearson correlation, stepwise regression analysis were performed. Results：There was no significant difference in maternal depression among three groups of children. In 2-Way ANOVA, main effect of maternal depression was statistically significant on depression, parent health, and relationship with spouse subfactor in parent domain, parent domain total, and overall parenting stress. But the main effect of child group was statistically significant on distractability/hyperactivity subfactor in child domain only. In regression analysis, maternal depression explained the parent domain of parenting stress most effectively, and child's hyperactivity and anxiety explained the child domain of parenting stress significantly. Conclusion：These findings suggest that it is important to intervene maternal depression to reduce the parenting stress, along with the treatment of the child's behavior problems.

• Journal of Yeungnam Medical Science
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• v.24 no.1
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• pp.1-10
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• 2007

The chronic fatigue immune dysfunction syndrome (abbreviated CFIDS or CFS) is a disorder characterized by debilitating fatigue(over 6 months.), along with cognitive, musculoskeletal, and sleep abnormalities. The etiology of this illness is unlikely to be a single agent. Findings to date suggest that physiological and psychological factors work together to predispose and perpetuate the illness. Diagnosis is made difficult by the nonspecific clinical findings and no available diagnostic testing. With no known cause or cure for the chronic fatigue and immune dysfunction syndrome, treatment is based on relieving symptoms and improving the quality of life of affected patients. There is emerging evidence that chronic fatigue syndrome may be familial. In the future, studies will examine the extent to which genetic and environmental factors play a role in the development of chronic fatigue syndrome. Most patients with CFS have psychiatric problems such as a generalized anxiety disorder, or major or minor depression, therefore, these mental health disorders may be correlated with the pathophysiology of the CFS. The treatment for CFS must be individualized, due to the heterogeneity of the CFS population. Also the treatment of CFS is built on a foundation of patient-physician relationship, respect and advocacy.

• Korean Journal of Biological Psychiatry
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• v.26 no.2
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• pp.39-46
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• 2019

Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the non-psychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost- effectively than non-psychiatrists.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.14 no.1
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• pp.3-11
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• 2003

Attention-deficit/Hyperactivity disorder(ADHD) is the most common psychiatric disorder of childhood and among the most prevalent chronic health conditions affecting school-aged children. Children with ADHD experience significant functional problems, such as school difficulties, academic underachievement, troublesome interpersonal relationships with family members and peers, and low self-esteem. The most widely used pharmacological treatments for ADHD are psychostimulants, such as methylphenidate and amphetamine salts. These medications provide clinical efficacy by increasing the availability of catecholamines, primarily dopamine, in the frontal lobe of the brain. immediate-release(IR) formulations of sychostimulants were among the most effective psychotrophic medications in the psychopharmacological treatment. However, there are some limitations of IR formulations：the short half-life and duration of efficacy, which result in the need for multiple daily dosing and the poor compliance. These limitations have led to the development of once-daily, extended-release(ER) formulations of methylphenidate and amphetamine salts. However, these ER formulations may not be as immediately helpful to ADHD children due to delayed onset of action and the acute tolerance which is the failure to sustain the efficacy with the same concentration of drug as the initial stage of medication. OROS-methylphenidate(Concerta$^{\circledR}$) given once a day produces an ascending-pattern plasma drug level generated by the osmotically released, timed drug-delivery system. These new formulations of the psychostimulants have been shown to be a useful alternative to old stimulant medications through the evidence by the clinical trials.