OBJECTIVES: Adverse effects on sexual functions induced by antidepressant medications including selective serotonin reuptake inhibitors(SSRIs) have been reported. The reported incidences of sexual dysfunctions varies with the way of questioning, with relatively low on self reporting and high on direct questioning and symptom questionnaires. The purpose of this study was to evaluate the frequency and nature of sexual dysfunctions during SSRIs treatment in outpatients with depressive disorder and anxiety disorder. METHODS: Seventy seven patients on SSRI therapy(fluoxetine, sertraline, and paroxetine) were enrolled in this study. The six aspects of sexual function were investigated:sexual desire, sexual excitement, sexual pain, orgasm, erection and ejaculation. BDI, S-A, T-A and questionnaires on sexual side effects and on other side effects of SSRIs were measured. The frequency and the severity of sexual dysfunctions were measured. Sexual side effects and other side effects of SSRIs were analyzed in association with the duration and the dose of SSRI treatment and the severity of depression and anxiety. RESULTS: The frequency of sexual dysfunction during SSRI use in our study was 38.96%. Women reported more sexual dysfunction(sexual desire, sexual excitement, orgasm). Also, women's sexual dysfunction was more intense. The most common sexual dysfunction was delayed orgasm(or anorgasmia) in women and ejaculatory difficulty in men. In patients with depressive disorder, the frequency of sexual dysfunctions was higher than in patients with anxiety disorder, which was not statistically significant. CONCLUSIONS: These findings suggest that SSRIs-associated female sexual dysfunction occurs substantially higher and is more severe than expected. It is important to pay attention to female sexual dysfunction during treatment with SSRIs. The sexual problems must be questioned directly for prompt detection of them and promotion of treatment compliance with SSRIs.
Anxiety ; Anxiety Disorders ; Compliance ; Depression ; Depressive Disorder ; Ejaculation ; Female ; Humans ; Incidence ; Male ; Orgasm ; Outpatients ; Surveys and Questionnaires ; Self Report ; Serotonin* ; Sertraline

OBJECTIVES: To investigate the frequency and clinical characteristics of premenstrual syndrome(PMS)/premenstrual dysphoric disorder(PMDD) in high school students, and determine the correlates of PMS/PMDD in association with comorbid depression and anxiety. METHODS: A total of 1688 students were recruited from 5 high schools in Seoul, Korea. Subjects completed the questionnaire composed of scales to measure premenstrual symptoms, depression, and anxiety, as well as sociodemographic and reproductive variables. Subjects were categorized into 3 groups by using the Premenstrual Symptom Screening Tool(PSST) to determine the frequency and clinical characteristics of PMS/PMDD. Multivariate logistic regression was used to identify the correlates of PMS/PMDD. RESULTS: The frequency of moderate to severe PMS and PMDD was 20.1% and 6.4%, respectively. Irritability (78.8%), fatigue(76.4%), and emotional sensitivity(69.8%) were common premenstrual symptoms, and functional impairment in academic performance(67.1%) was dominant. Dysmenorrhea[odd ratio(OR)=3.68, 95% confidence interval(CI) 2.45-5.55], family history of PMS(OR=1.91, 95% CI 1.35-2.71), and use of oral contraceptive (OR=1.85, 95% CI 1.16-2.94) were associated with the increased risk of PMS/PMDD after adjustment for depression and anxiety. Negative attitude to menses(OR=15.60, 95% CI 3.61-67.42) was associated with the increased risk of PMS/PMDD, particularly in subjects without depression and anxiety. CONCLUSIONS: PMS was common, as the frequency of PMS more than moderate severity including PMDD exceeded 25%, and disrupted daily functioning in adolescents. PMS is associated with various sociodemographic and menstrual characteristics, and these associations are affected by comorbid depression and anxiety.
Adolescent ; Anxiety ; Depression ; Humans ; Korea ; Logistic Models ; Mass Screening ; Premenstrual Syndrome ; Questionnaires ; Weights and Measures

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.
Comorbidity ; Delivery of Health Care ; Depression ; Female ; Humans ; Korea ; Life Style ; Logistic Models ; Mass Screening ; Mental Health ; Questionnaires ; Risk Factors ; Smoke ; Smoking

BPSD (behavioral and psychological symptoms of dementia) are common remediable cause of excess morbidity and lead to significant impairment in quality of life for both patients and their caregivers, as well as an increased risk of institutionalization. The most common treatment of BPSD is neuroleptic medication. Compared to other agents, conventional neuroleptics have been studied with relatively rigorous placebo-controlled trials. Efficacy is modest, but concerns regarding side effects, such as extrapyramidal symptoms, tardive dyskinesia, and emotional withdrawal, have often limited their uses. Treatment of BPSD with atypical antipsychotics such as risperidone or olanzapine is potentially advantageous in view of their tendency to cause considerably fewer side effects. But elderly demented patients may be particularly sensitive to untoward side effects of psychotropic drugs. The different atypical antipsychotics do have their own side effects and other limitations. Clinicians who prescribe antipsychotics for BPSD should start with a low initial dose, increasing this dose slowly until the lowest effective dose is reached. It is important to remember that although antipsychotics provide symptomatic relief, they do not cure underlying dementia. Clinicians should try to avoid prescribing multiple drugs with anticholinergic or sedative effects. Further study to determine more specific drug-responsive symptoms is needed to maximize benefits of atypical antipsychotics.
Aged ; Antipsychotic Agents* ; Caregivers ; Dementia* ; Humans ; Hypnotics and Sedatives ; Institutionalization ; Movement Disorders ; Psychotropic Drugs ; Quality of Life ; Risperidone

OBJECTIVES: We aimed to explore the relationship among fatigue and perceived stress, depressive mood in the working population. We also examined associations with demographic and life style factors and investigated the effect of individual coping skills on these associations. METHODS: Fatigue Severity Scale(FSS), Perceived Stress Scale(PSS), Brief Encounter Psychosocial Instrument - Korean version(BEPSI-K), Beck Depression Inventory(BDI), Stress Coping Skill Questionnaire were administered to 621 civil servants. All of above and other demographic factors are self-administered questionnaire survey and this study is cross sectional. RESULTS: Mean FSS score was 3.04 which was lower than 3.22, the severity cut off score. FSS, PSS, BEPSI-K, BDI were all higher in female. Subjects with active coping skills showed relatively low fatigue, perceived stress, depressive mood than those with passive coping skills. Logistic regression analyses indicated that the PSS, BDI, BEPSI-K in working population increase the risk of fatigue and regular exercise lowers the risk. CONCLUSIONS: Adults who were afflicted by stress, experienced depressive mood or were physically inactive were at much higher risk of feeling fatigue. Since no other large data sets are available for fatigue, the results from this study could serve a very useful purpose, to furnish a basis for comparison with future research results based on more complete data.
Adaptation, Psychological ; Adult ; Dataset ; Demography ; Depression ; Fatigue* ; Female ; Humans ; Life Style ; Logistic Models ; Questionnaires

OBJECTIVE: Recently, there are many reports that glutamate receptors have close relationships with a pathophysiology of schizophrenia. The purpose of this study was to assess the effects of D-cycloserine, which is glycine site partial agonist in NMDA receptor on psychopathologic symptoms and cognitive functions. METHODS: This study was done for chronic schizophrenic inpatients taking typical antipsychotics for more than 4 months. Exclusion criteria were patients with over 8 points according to Simpson-Angus scale for EPS or those with over 17 points of Hamilton Depression Scale. Patients were randomized to classify into two groups; D-cycloserine group (n=13) and placebo group (n=13). Each group received D-cycloserine 100 mg or placebo separately for 8 weeks. Psychopathology was evaluated with PANSS at baseline, 2nd week, fourth week and eighth week. Cognitive function was evaluated with KWIS at baseline and eighth week. RESULTS: Total 26 patients completed this trial. The average period of morbidity was 10.39+/-3.87 years and the average doses of antipsychotic was 1228.35+/-720.30 mg based on chlorpromazine equivalent. In positive subscale, negative subscale, general psychopathology subscale, total PANSS scale and KWIS, there were no significant differences between D-cycloserine and placebo groups. However, negative subscale scores had decreased from 24.92+/-3.64 (Baseline) to 23.46+/-3.41 (week 8) (p=0.077). CONCLUSION: There were no clear changes in positive symptom, negative symptom, memory, language function, and performance intelligence when D-cycloserine 100 mg was given with antipsychotic medication. However, some patients showed clear improvement in negative symptom, especially blunted affect. Therefore, D-cycloserine combination therapy could be effective for negative symptom. In future, study that can show effectiveness in psychopathology and cognitive function according to drug dosage is needed.
Antipsychotic Agents ; Chlorpromazine ; Cognition* ; Depression ; Glycine ; Humans ; Inpatients ; Intelligence ; Memory ; N-Methylaspartate ; Psychopathology ; Receptors, Glutamate ; Schizophrenia*

OBJECTIVES: Middle aged women with depression often experience hot flush symptoms. It is still unclear about the association between depression and hot flush symptoms. Therefore, we investigated hormonal profile, functional somatic symptoms, coping styles and attitude for menopause between depressed women with hot flush and those without hot flush. METHODS: This study included 33 depressed patients with hot flush symptoms and 33 depressed patients without hot flush symptoms. Hot flush was confirmed through prospective daily symptom ratings for a week. Subjects' coping styles were assessed by the stress coping checklist. Somatic symptoms were assessed by the Patient Health Questionnaire-15(PHQ-15). Sex hormonal levels were assayed by a radioimmunoassay. The Brief World Health Organization Quality of Life Assessment Instrument(WHOQOL-BREF) was used to evaluate quality of life. RESULTS: In coping style, depressed women with hot flush symptoms used less ‘problem-centered coping’(13.15±3.17) and ‘search for social support’(11.83±2.84) than those without hot flush symptoms(15.17±3.1, p=0.028 ; 14.25±3.22, p=0.009 ; respectively). Depressed women with hot flush symptoms showed more negative attitude toward post-menopause, but its statistical significance was marginally insufficient(p=0.059). We did not find any group differences in sex hormonal levels and somatic complaints assessed by the PHQ-15. The score of social relationship domain of WHOQOL-BREF was significantly lower in subjects with hot flush symptoms(8.62±2.04) than subjects without hot flush symptoms(9.71±1.65 ; p=0.044). CONCLUSIONS: Among middle aged women with depression, the manifestation of hot flush symptoms was associated with coping styles and attitude for menopausal transition. Hot flush symptoms in depressed women negatively influence quality of life, so clinicians actively perform therapeutic approach in case of depressed patients with hot flush symptoms. In case of depressed patients who present hot flushes, cognitive behavior therapy or stress management might be an effective treatment option in company with antidepressants or hormonal treatment. Later, longitudinal study will be needed to evaluate risk factor, cause and effect associated with hot flush and depression.
Antidepressive Agents ; Checklist ; Cognitive Therapy ; Depression ; Female ; Humans ; Longitudinal Studies ; Menopause ; Middle Aged ; Postmenopause ; Prospective Studies ; Quality of Life ; Radioimmunoassay ; Risk Factors ; World Health Organization

OBJECTIVES: We developed a Korean version of the Brief Measure of Worry Severity(BMWS), and examined its reliability, validity, and factor structures. We also explored the associations of pathological worry with depression and anxiety. METHODS: Three hundreds fifty-two subjects including community population and college students completed the BMWS, and 27 subjects repeated the scale three weeks later. Reliability was assessed by Cronbach's coefficient alpha and test-retest correlation. The external validity was examined by the correlation of the BMWS score with the scores of Beck Depression Inventory(BDI), Patient Health questionnaire-2(PHQ-2), State Anxiety Inventory(SAI), and Trait Anxiety Inventory(TAI). And principal component analysis was performed to evaluate the construct validity. The associations of pathological worry with depression and anxiety were explored using partial correlation analysis. RESULTS: Cronbach's coefficient alpha for the BMWS was 0.904 and test-retest correlation was 0.56(P<0.01). The Spearman correlation coefficients of the BMWS score with the scores of BDI, PHQ-2, SAI, and TAI were 0.60(P<0.01), 0.42(P<0.01), 0.36(P<0.01), and 0.59(P<0.01), respectively. The BMWS showed unifactorial construct. When controlling for TAI score, the correlation coefficient between the BMWS score and the BDI score was 0.357(P<0.01), and when controlling for BDI score the correlation coefficient between the BMWS score and the TAI score was 0.446(P<0.01). CONCLUSION: The Korean version of the BMWS was found to be a reliable and valid questionnaire for measuring pathological worry. And we could identify the associations of the pathological worry with depression as well as anxiety.
Anxiety ; Depression ; Humans ; Principal Component Analysis ; Questionnaires

OBJECTIVE: The primary aim of this study was to compare electronic monitoring with other measures of adherence to Osmotic-controlled Release Oral delivery System methylphenidate in children with attention-deficit hyperactivity disorder (ADHD). The secondary aim was to analyze the relationships between adherence and clinical factors, including ADHD symptoms. METHODS: Thirty-nine children diagnosed with ADHD were monitored for adherence to medication over the course of eight weeks. Medication adherence was assessed using the Medication Event Monitoring System (MEMS), which is a bottle cap with a microprocessor that records all instances and times that the bottle is opened; patient self-report; clinician rating; and pill count. Information, including demographic and clinical characteristics, symptom rating scale, and psychological test results, were also collected. The relationships between adherence and clinical factors, including ADHD rating scores of baseline and of the changes, were assessed. RESULTS: The rate of non-adherence measured by the MEMS was found to be 46.2%, which was considerably higher than those of the patient self-report (17.9%), clinician rating (31.7%), and pill count (12.8%) of non-adherence. The rate of adherence measured by the MEMS was not significantly associated with baseline symptom severity or symptom changes over the eight weeks, although non-adherent group showed more severe baseline symptoms and inferior improvement. CONCLUSION: Adherence as measured by the MEMS showed a discrepancy with other measures of adherence in patients with ADHD. The symptom severity and level of improvement were not related to adherence with MEMS. Further studies are needed to evaluate the variables that may impact medication adherence in children with ADHD.
Attention Deficit Disorder with Hyperactivity ; Child ; Electronics ; Electrons ; Humans ; Medication Adherence ; Methylphenidate ; Micro-Electrical-Mechanical Systems ; Microcomputers ; Psychological Tests

OBJECTIVES: Haloperidol has been widely used for treating schizophrenia with somewhat limitation due to the side effects. Some of these side effects are anticholinergic side effects such as dry mouth, constipation, urinary difficulty, blurred vision, sexual dysfunction, etc. Some kinds strategies to minimize these side effects are tried, one of which is the use of bethanechol. The authors studied the effects of bethanechol on the anticholinergic side effects of typical antipsychotics. METHODS: The subjects of this study consisted of 60 chronic schizophrenics who had used haloperidol since 4 weeks before the study and whose score of 'Askers side effects rating scale' was above 7. They were assigned evenly to three groups (placebo group, bethanechol 40mg group, bethanechol 80mg group). Benztropin had been washed out for 2 weeks before the study. The authors measured ASRS for evaluating the anticholinergic side effect and BPRS for evaluating the effects of bethanechol on the psychopathology, at baseline, the 2nd week and the 4th week from baseline, respectively. RESULTS: At baseline, the mean age of patients was 38.00(+/- 10.55) years, the mean duration of illness was 11.12(+/- 8.09) years, and the mean dosage of the haloperidol was 15.07(+/- 6.03)mg. At baseline, mean score of BFRS was 50.25(+/- 5.24), and mean score of ASRS was 9.27 (+/- 3.04). There were no significant differences of ages, duration of illness, dosage of haloperidol, scores of BPRS and ASRS among 3 groups at baseline. There were no significant changes in BPRS at the 2nd week and the 4th week as compared with baseline, and also there were no changes among groups. The total sums of ASRS showed the statistically significant changes in the 80mg group at the 2nd week and the 4th week. The 80mg group showed statistically significant changes in dry mouth, constipation and urinary difficulty dom the 2nd week, and orthostatic symptoms from the 4th week. CONCLUSION: The authors found that the use of bethanechol for the chronic schizophrenics treating with haloperidol greatly improved the anticholinergic side effects with no change in psychopathology. The 80mg group showed more significant results than the placebo group and the 40mg group, especially in dry mouth, constipation, urinary diffculty and orthostatic symptoms. The authors suggest that high doses of bethanechol decrease the anticholinergic side effects and increase the drug compliance of chronic schizophrenics with anticholinergic side effects.
2,5-Dimethoxy-4-Methylamphetamine ; Antipsychotic Agents ; Bethanechol* ; Compliance ; Constipation ; Haloperidol* ; Humans ; Mouth ; Psychopathology ; Schizophrenia