• Anxiety and mood
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• v.8 no.2
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• pp.93-98
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• 2012

Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.

• Korean Journal of Psychosomatic Medicine
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• v.23 no.2
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• pp.100-106
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• 2015

Objectives : The purpose of this study was to find out the clinical and sociodemographic characteristics of elderly suicide attempters visiting emergency room, compared to non-elderly adult suicide attempters. Methods : We enrolled suicidal attempters who were treated in the emergency room of the Inje University Ilsan Paik Hospital between June 2013 and July 2015. We conducted a retrospective chart review of 336 suicidal attempters, and compared sociodemographic and clinical characteristics between elderly and non-elderly adult suicide attempters. Results : During the study period, 336 patients visited the emergency room of the medical center after suicide attempts. Among these, there were 71 elderly(21.2%) and 265 non-elderly adult(79.8%) suicide attempters. The suicidal methods among elderly were poisoning(73.3%), hanging(19.7%), cutting(5.6%), and jumping(1.4%). Those in non-elderly were poisoning(73.2%), cutting(17.0%), hanging(6.8%), and jumping(3.0%). The elderly suicide attempters had the tendency to choose more dangerous methods and showed higher lethality compared to adult suicide attempters(20.6% vs. 1.9%, ${\chi}^2=34.565$, p<0.05). On the other hand, premorbid psychiatric disorders had been more commonly diagnosed in non-elderly adults than elderly suicide attempters(49.8% vs. 26.8%, ${\chi}^2=12.024$, p<0.05). Conclusions : The results provide evidence of different sociodemographic and clinical characteristics of elderly suicide attempters compared to non-elderly ones visiting the emergency room. Through this study, it can be seen that the suicide attempt in the elderly tends to be severer than in the non-elderly, but only a small portion of them seek for help from psychiatric intervention. Further study is required to provide effective suicide prevention programs for elderly population.

• Health Policy and Management
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• v.29 no.2
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• pp.105-111
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• 2019

On December 31, 2018, an incident occurred where a doctor was attacked and killed by a patient carrying a lethal weapon in the outpatients' clinic of the psychiatric department of a tertiary general hospital. The suspect was diagnosed with bipolar affective disorder (manic depressive disorder) and has been hospitalized and cared for in the psychiatric ward of this hospital. This incident illustrates the necessity of more active cures and therapeutic intervention for mental patients with intellectual developmental disorders who require treatment considering the fact that a radical outcome has been caused by such a patient. However, on the other hand, there is also a need for an approach and analysis from the perspective of crime prevention for all medical departments. The reason for this is that even a tertiary general hospital equipped with the largest human resources, medical devices, facilities, and so forth, is susceptible to violence. As for illegal actions perpetrated against health and medical service personnel in medical institutions, such as verbal abuse, assault, injury, etc. there have neither been understanding shown for the current extent of damage in detail, nor discussions of active institutional improvement related to the seriousness of the act. It can be said that violence in the field of medical treatment is a realm requiring serious discussion and appropriate remedial actions. This is because when such incidents take place, if a patient who is supposed to get treatment from the damaged health care provider is in an urgent situation or on the waiting list of serious cases, he or she could suffer serious damage caused by deprivation of treatment opportunity, or secondary damage might be caused to the patient and/or a guardian who can hardly have an opportunity to take action. Accordingly, in this review, we would like to help create the necessary conditions for both health and medical service personnel and patients/guardians, respectively, to provide and receive medical treatment in a more secure environment. Therefore, objective assessment of the institution and issues relating to this aforementioned incident and general cases of violence occurring in medical institutions, and by suggesting legal and institutional improvements and solutions.

• Anxiety and mood
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• v.18 no.2
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• pp.39-47
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• 2022

Objective : This study investigated brain functional connectivity in male firefighters who showed subclinical post-traumatic stress disorder (PTSD) symptoms. Methods : We compared the data of 17 firefighters who were not diagnosed with PTSD and 18 healthy controls who had no trauma exposure. The following instruments were applied to assess psychiatric symptoms: Korean version of the Post-traumatic stress disorder Checklist for DSM-5 (PCL-5-K), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI). For all subjects, functional magnetic resonance imaging was performed, and functional connectivity was compared between the two groups (family-wise error-corrected p<0.05). Additionally, correlations between psychiatric symptoms and functional connectivity were explored. Results : The following connectivity was higher than that of healthy controls: 1) the central opercular cortex-superior temporal gyrus, 2) planum polare-parahippocampal gyrus, 3) angular gyrus-amygdala, and 4) temporal fusiform cortex-parahippocampal gyrus. The functional connectivity of 1) the lateral occipital cortex-inferior temporal gyrus, 2) superior parietal lobule-caudate, and 3) middle temporal gyrus-thalamus were lower in firefighters. In firefighters, the connectivity of the planum polare-parahippocampal gyrus showed a negative correlation with the severity of arousal symptoms (rho=-0.586, p=0.013). The connectivity of the middle temporal gyrus-thalamus showed a positive correlation with the severity of intrusion (rho=0.552, p=0.022) and arousal symptoms (rho=0.619, p=0.008). The connectivity of the temporal fusiform cortex-parahippocampal gyrus was negatively correlated with intrusion (rho=-0.491, p=0.045) and arousal (rho=-0.579, p=0.015). Conclusion : Our results indicate that the brain functional connectivity is associated with occupational trauma exposure in firefighters without PTSD. Therefore, this study provides evidence that close monitoring and early intervention are important for firefighters with traumatic experience even at a subthreshold level.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.1
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• pp.26-41
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• 1999

The perceived stress response inventory(PSRI) was developed to measure 4 types of current stress responses : emotional, somatic, cognitive, and behavioral responses. 242 patients with psychiatric disorders(71 patients with anxiety disorders, 73 patients with depressive disorders, 47 patients with somatoform disorders, 51 patients with psychosomatic disorders) and 215 healthy subjects completed the questionnaire including the PSRI. Global assessment of recent stress(GARS) scale, perceived stress questionnaire(PSQ) and symptom checklist-90-revised(SCL-90-R) were also administered at the same time. Factor analysis for each of 4 types of stress responses yielded 8 factors : negative emotional responses, general somatic symptoms, specific somatic symptoms, lowered cognitive function and general negative thinking, self-depreciative thinking, impulsive-aggressive thinking, passive-responsive and careless behavior, and impulsive-aggressive behavior. Both test-restest reliability(r= .83 -.93) and internal consistency(Cronbach's alpha : .79 -.96 for each of 8 subscales and .98 for total items of the scale) were all at statistically significant levels. Total scores of the PSRI significantly correlated with total scores of GARS scale, PSQ, and global indicies of SCL-90-R, respectively. The patient group had significantly higher scores than healthy subjects in each of all the subscales except impulsive-aggressive behavior subscale. These results suggest that the PSRI is a reliable and valid tool stable over time which may be effectively used for the research in stress-related field including psychosomatic medicine.

• Korean Journal of Psychosomatic Medicine
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• v.5 no.2
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• pp.176-184
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• 1997

Abnormal illness behavior in patients with somatoform disorders were known formed by their traditional disease concepts and somatization-prone socio-cultural factors. The authors evaluated the characteristics of abnormal illness behavior in patients with somatoform disorders(who had somatization) by using abnormal illness behavior questionnaire. Methods : 29 somatoform disorders(SD) and 57 disease controls were compared by clinical characteristics, severity of pain, state anxiety(by Spielberger's State & Trait Anxiety Inventory), depression(by Beck's Depression Inventory) and level of psychosocial stess(by DSM-III-R). The illness behavior was measured by illness Behavior Questionnaire(IBQ). Results SD group had longer period of somatic symptoms with less severity in pain. The degree of anxiety and depression were higher in SB compared with controls. However, the degree of psychosocial stress was almost same between both groups. In IBQ, SD showed higher scores in general hypochondriasis, disease conviction, and affective disturbance subscales compared to control group. Conclusion: High disease conviction and hypochondriacal nature revealed by IBQ seemed to be a role in making somatization by way of somatic focusing and hypervigilance. And those tended to lead patients visit hospital frequently and report various somatic complaints. Evaluating abnormal illness behavior in somatoform disorders would be not only helpful in understanding the natures of somatoform disorders but also useful differentiating SD with other psychiatric conditions.

• 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.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.7 no.2
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• pp.203-212
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• 1996

In this thesis, we investigate the psychosocial variables within the family environments of Attention Deficit Hyperactivity Disorder with (ADHD+CD/ODD) or without (ADHD) externalizing symptoms. The subjects in this research were 86 boys and girls(aged range 6 to 14 years) consisted of 20 ADHD, 22 comorbid ADHD(ADHD+CD/ODD) and 44 normal control group(NC). We have collected data on children and their mothers. The psychosocial variables included in the analysis are socioeconomic status, parent's educational level, life stress event, and the rate of psychiatric disorders in relatives. The self-reported questionnaires marital discord(MAS), parenting stress(PSI), and parenting attitute(MBRI) completed by mothers. The results indicated that ADHD+CD/ODD is supposed to have higher level of family adversity suggested by the lower SES, lower parental educational level, higher life stress events, and more psychic disorders in relatives compared with ADHD or normal control group. In MAS, ADHD+CD/ODD group has significantly the lowest scores on each factor of the measure of marital adjustment. Parents of ADHD+CD/ODD are much more likely to have positive parenting stress when compared with the parents of ADHD. Especially, mothers of ADHD+CD/ODD have the lowest tendency in the mean score on affective, accepted attitudd. In an inapropriate parenting attitude perceived by children, father of ADHD+CD/ODD have the most negative, contradictory attitude and mothers of ADHD+CD/ODD have the most restrictive, negative and contradictory attitude.

• 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.

• Anxiety and mood
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• v.10 no.2
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• pp.95-102
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• 2014

Objective : Previous research showed that childhood trauma or domestic violence resulted in difficulties in controlling emotion and problem solving and vulnerability to psychiatric disorders. To understand the long term effect of childhood trauma, this study investigated their influences on cognitive processing of anger-evoking event and anger behavior among prisoners. Methods : All data were collected from 198 prisoners off our districts in Korea. After they consented to participate, prison officer distributed a questionnaire that included scales to demographic measure, childhood abuse (emotional abuse, physical abuse, and neglect), cognitive response of anger (attentional focus, suspicion, rumination, and hostile attitude) and behavior of anger (impulsive reaction, verbal aggression, physical confrontation, and indirect expression). For statistical analyses, SPSS 18.0 were used and path coefficients were evaluated from the structural equational modeling using LISREL 8.52. Results : Almost 50% of prisoners of our sample experienced one or more trauma during childhood. Then we tested the long term effect of childhood trauma on anger response by structural equation modeling. As expected, childhood trauma was associated with cognitive processing of anger-evoking event and anger behavior. More specifically, emotional abuse (${\beta}$=0.21, p<0.01) predicted suspicion which in turn associated with impulsive reaction (${\beta}$=0.73, p<0.001) and verbal aggression (${\beta}$=0.87, p<0.001). Emotional abuse (${\beta}$=0.24, p<0.01) also predicted hostile attitude which associated with physical confrontation (${\beta}$=0.80, p<0.001) and indirect expression (${\beta}$=0.80, p<0.001). Interestingly, physical abuse associated directly with impulsive reaction (${\beta}$=0.23, p<0.01) and indirect expression (${\beta}$=0.17, p<0.05). Neglect predicted rumination (${\beta}$=0.15, p <0.05) which associated with indirect expression marginally (${\beta}$=0.11, P<0.10). Conclusion : The results of this study, suggest longitudinal and harmful effect of childhood trauma on difficulties in controlling anger. Especially, it was revealed that childhood abuse related with processing anger evoking events more suspicious and hostile and then various anger-expressing behaviors.