This paper reports a patient with Moyamoya disease who developed a psychotic disorder following a stroke. A 47-year-old female with Moyamoya disease without a psychiatric history experienced persecutory delusion and auditory hallucinations after eight months of intracranial hemorrhage in the right temporal lobe. The adult was managed with low-dose antipsychotics, risperidone. A brief Psychiatric Rating Scale was performed weekly after hospitalization, and psychotic symptoms eventually were under control after three weeks following the initiation of psychotropic medication. This case suggests that low-dose antipsychotics would be effective in patients with psychosis newly developed from a stroke secondary to Moyamoya disease.

We report the case of a 78-year-old female patient with dementia with Lewy bodies accompanying severe psychotic and parkinso-nian symptoms. The patient's symptoms did not improved with various antipsychotics, and cardiac and pulmonary side effects pre-vented adequate doses of the drugs from being administered. As an alternative approach, we performed electroconvulsive therapy, which can be conducted relatively safely in elderly patients with underlying medical conditions. The patient received 10 sessions of electroconvulsive therapy across a 4-week period. Remarkable improvements in psychotic and parkinsonian symptoms proven with validated scales were observed following the repeating electroconvulsive therapy sessions. This is the first case report describing the use of electroconvulsive therapy in a patient with dementia with Lewy bodies in Korea. This case report may help to establish new guidelines for the treatment of patients with dementia with Lewy bodies, which is still considered a difficult disease to treat.

We report the case of a 54-year-old female who was diagnosed with clinical dementia and recovered to normal cognition in only 11 days through appropriate intervention. The patient was on a complicated regimen of psychiatric medications for underlying depression and panic disorder. The patient noted increased deterioration in executive function gradual memory impairment starting in early 2020.As a result of the neuroimaging, prominent neurodegeneration and in vivo brain pathology were not observed. During outpatient clinic follow-up, severe obstructive sleep apnea (OSA) was confirmed. Based on the diagnostic results, a clinical impression was made for reversible dementia due to psychiatric drugs and OSA. During hospitalization for 10 days, the patient’s regimen of psychiatric medications with anticholinergic effects was changed, and long-acting benzodiazepines were reduced. The patient also underwent continuous positive airway pressure titration to ameliorate OSA. The patient reported subjective cognitive improvement and a comprehensive neuropsychiatric test performed at discharge later showed a normal range in all cognitive domains, and the patient's activity of daily living evaluated at the outpatient clinic after discharge had recovered.

Background: and Purpose: The National Responsibility Policy for Dementia Care was implemented in September 2017 in Korea. This study aimed to compare dementia incidence in Seoul and Gangwon-do before and after the implementation of this policy. Methods: We extracted insurance claim data from the Korean Health Insurance Review and Assessment Service for people diagnosed with diabetes, hypertension, or dyslipidemia for the first time in Seoul and Gangwon-do, Korea. We defined two enrollment groups based on the policy implementation date: 1) January 1, 2015 to December 31, 2016 (Index 1, pre-implementation), and 2) January 1, 2017 to December 31, 2018 (Index 2, postimplementation). Each group was followed up for 1 year from the time of enrollment. Then, we calculated hazard ratios to compare the incidence of dementia between the two groups, and between Seoul and Gangwon-do. Results: In Seoul, the incidence of dementia was significantly lower in Index 2 than in Index 1 (hazard ratio [HR], 0.926; 95% confidence interval [CI], 0.875–0.979). However, the incidence rate did not differ between the 2 groups (HR, 1.113; 95% CI, 0.966–1.281) in Gangwon-do. In Index 1, the incidence of dementia did not differ between Seoul and Gangwon-do (HR, 1.043; 95% CI, 0.941–1.156), but in Index 2, was significantly higher in Gangwon-do than in Seoul (HR, 1.240; 95% CI, 1.109–1.386). Conclusions After implementing the National Responsibility Policy for Dementia Care, the dementia incidence rate decreased significantly in Seoul, consistent with other studies, but not in Gangwon-do.

Objectives: To assess the satisfaction of dementia patients with telemedicine services. Underlying factors were extracted from a satisfaction dataset, and possible associations among factors were investigated to determine their statistical relevances. Methods: A survey was conducted using a questionnaire to determine satisfaction with telemedicine services of patients with dementia in 9 public health centers and 5 designated hospitals in 8 provinces in Gangwon-do from 20 July 2020 to 31 October 2020. Four hundred and ninety-seven users responded to the survey. Factor analysis was performed on survey data and multiple linear regression was used to extract relevant factors. Results: The percentage of subjects satisfied with telemedicine services was 78.8%. Thirty-five items of the satisfaction survey indicated that the five factors, that is, necessity (Cronbach’s α 0.952), satisfaction (Cronbach’s α 0.929), medical system reliability (Cronbach’s α 0.924), medical staff reliability (Cronbach’s α 0.924), and geographic vulnerability (Cronbach’s α 0.922), were related to satisfaction with telemedicine services, and that of these, geographic vulnerability was most associated with the need for telemedicine services. Conclusion This study shows that dementia patients with experience of telemedicine services were generally satisfied with treatment. Despite its limitations, the satisfaction survey was found to provide a reliable and valid scale for assessing user satisfaction.

Objectives: The aim of this study was to identify risk and protective factors of suicidality among Korean military officers. Methods: This study was conducted on 3162 military officers. Data were collected by online survey after obtaining informed consent. Demographic characteristics, depression, anxiety, suicidality, social support, stress, and attitude toward suicide were evaluated using structured instruments and self-report questionnaires. Suicidality was defined as having a suicidal idea, a suicide plan, or attempting suicide. Statistical analysis was performed using logistic regression to investigate associations between potential risk and protective factors and suicidality. Results: Depression (odds ratio [OR]=16.313, 95% confidence interval [CI]=10.028–26.539), anxiety (OR=14.377, 95% CI=8.680–23.812), and stress (OR=8.116, 95% CI=4.637–14.207) were positively associated with suicidality. On the other hand, good social networks and an unaccepting attitude toward suicide were negatively associated with suicidality (OR=0.131, 95% CI=0.072–0.240). No significant correlation was observed between living status and suicidality (OR=0.991, 95% CI=0.598–1.642). Conclusion Depression, anxiety, and stress were found to be risk factors of suicidality among Korean military officers. In contrast, good social networks and unaccepting attitudes toward suicide acted as protective factors. Hence, preventive interventions that place focus on risk and protective factors should be developed and implemented to mitigate suicidality.

Background: The frequencies of South Korean soldiers' depression and resulting suicide are increasing every year. Thus, this study aimed to develop and confirm the reliability and validity of a simple short form depression screening scale for soldiers. Methods: This study was conducted as part of a 2013 research project named ‘The Epidemiological Study on the Prevalence of Depression in Military Service and a Search for High Risk Group Management.’ Clinical depression was diagnosed using the Korean version of the Mini International Neuropsychiatric Interview and suicide risk was assessed through the Korean version of the Composite International Diagnostic Interview. Furthermore, the Center for Epidemiological Studies for Depression Scale (CES-D), the Stress Response Inventory, and the Barret Impulsiveness Scale were employed. Of the 20 CES-D items, three of the most correlated items with clinical diagnosis were derived to form the short form scale.Analyses for internal consistency, concurrent validity, and factor analysis were implemented for its validation. We performed a receiver operating curve (ROC) analysis using a clinical diagnosis of depression as a gold standard to calculate the area under the curve (AUC) value, cut-off score, and corresponding sensitivity and specificity to that cut-off score. Results: According to the results of the correlation analysis, 7, 18, and 4 were selected to be on our scale. The three-item scale was reliable with a Cronbach's alpha value of 0.720, and a factor was derived from the factor analysis. The ROC analysis showed a high discriminant validity, with an AUC value of 0.891. The sensitivity and specificity were 84.8% and 78.2%, and 71.7% and 91.6%, respectively, for each when the selected cut-off scores were 2 and 3, respectively. Depression screened through the scale when the cut-off score was 2 or 3 was significantly associated with suicidality, stress, and social support. Conclusion The depression screening questionnaire for Korean soldiers developed through this study demonstrated high reliability and validity. Since it comprises only three items, it can be utilized easily and frequently. It is expected to be employed in a large-scale suicide prevention project targeting military soldiers in the future; it will be beneficial in selecting high-risk groups for depression.

Background: The frequencies of South Korean soldiers' depression and resulting suicide are increasing every year. Thus, this study aimed to develop and confirm the reliability and validity of a simple short form depression screening scale for soldiers. Methods: This study was conducted as part of a 2013 research project named ‘The Epidemiological Study on the Prevalence of Depression in Military Service and a Search for High Risk Group Management.’ Clinical depression was diagnosed using the Korean version of the Mini International Neuropsychiatric Interview and suicide risk was assessed through the Korean version of the Composite International Diagnostic Interview. Furthermore, the Center for Epidemiological Studies for Depression Scale (CES-D), the Stress Response Inventory, and the Barret Impulsiveness Scale were employed. Of the 20 CES-D items, three of the most correlated items with clinical diagnosis were derived to form the short form scale.Analyses for internal consistency, concurrent validity, and factor analysis were implemented for its validation. We performed a receiver operating curve (ROC) analysis using a clinical diagnosis of depression as a gold standard to calculate the area under the curve (AUC) value, cut-off score, and corresponding sensitivity and specificity to that cut-off score. Results: According to the results of the correlation analysis, 7, 18, and 4 were selected to be on our scale. The three-item scale was reliable with a Cronbach's alpha value of 0.720, and a factor was derived from the factor analysis. The ROC analysis showed a high discriminant validity, with an AUC value of 0.891. The sensitivity and specificity were 84.8% and 78.2%, and 71.7% and 91.6%, respectively, for each when the selected cut-off scores were 2 and 3, respectively. Depression screened through the scale when the cut-off score was 2 or 3 was significantly associated with suicidality, stress, and social support. Conclusion The depression screening questionnaire for Korean soldiers developed through this study demonstrated high reliability and validity. Since it comprises only three items, it can be utilized easily and frequently. It is expected to be employed in a large-scale suicide prevention project targeting military soldiers in the future; it will be beneficial in selecting high-risk groups for depression.

Objective: This study aimed to examine how marital status, occupational status, and individual personality influence suicidal ideation and suicide attempts among Korean middle-aged adults, and explore the effects of their interaction. Methods: A total of 2,464 middle-aged adults were surveyed about suicidality in the past year (1-year suicidality). Participants’ current marital and occupational status, including other demographic and clinical variables were investigated. Personality traits were assessed using the Big Five Inventory. The dependent variable was the presence of 1-year suicidality. Independent variables were current marital and occupational status. Generalized linear model (GLM) analysis was performed to adjust for other covariates. Results: The group with 1-year suicidality had significantly lower income. It had a lower proportion of full-time employment, and higher percentages of part-time employment and unemployment. The GLM analysis results showed that marital and occupational status had no significant association with 1-year suicidality. Neuroticism and openness were positively associated with 1-year suicidality, whereas conscientiousness and extraversion had a negative association. Interactions between marital status and neuroticism, conscientiousness, and occupational status were significant. Conclusion Individualized social and psychological interventions for suicide prevention are required according to individual personality traits.

Objective: Previous studies have shown the influence of visual and auditory sensory impairment on dementia incidence. In this study, we tested the hypothesis that the incidence of dementia will increase with visual and auditory impairments than with visual or auditory impairment. Methods: Data from the Korea National Health Insurance Service database were used, including disease and medication codes from 2009 to 2018, and the 2011 national health check-up results. Participants were grouped based on their sensory abilities: normal, visual impairment, auditory impairment, and both visual and auditory impairments (dual sensory impairment). To compare the incidence of dementia, hazard ratios were calculated for each group, with reference to the normal sensory (NS) group. Sensitivity analyses were performed comparing dementia incidence from 2014 to 2018, excluding the onset of the disease in 2012 and 2013. Results: We identified 8,289 cases of dementia during the seven-year follow-up. In the multiple Cox regression analysis, adjusted for sex, social economic status, age, comorbidities, smoking, alcohol consumption, and activity level, the auditory impairment (hazard ratio= 1.1908) and visual impairment (hazard ratio=1.3553) groups showed a significantly higher dementia incidence than the NS group. Dual sensory impairment (hazard ratio=1.5267) showed the highest incidence. The sensitivity analysis yielded similar results. Conclusion Visual and auditory impairments are associated with an increased risk of dementia, particularly in individuals with dual sensory impairment. Hence, visual and auditory impairments might have increased the risk of dementia through independent pathological processes. Therefore, preventing and correcting sensory impairment is necessary to reduce the risk of dementia.