Autonomic dysfunction commonly occurs in patients with dementia and is typically reported in patients with Alzheimer’s disease and Lewy body dementia. The clinical presentation of autonomic dysfunction includes symptoms related to orthostatic hypotension (manifested as dizziness, falls, and syncope, etc.), constipation, and urinary tract symptoms. Non- pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management includes the administration of midodrine (selective α1-adrenoceptor agonist), droxidopa (norepinephrine prodrug), or atomoxetine (selective noradrenaline reup-take inhibitor). Management of constipation includes the administration of probiotics, osmotic laxatives (e.g. macrogol), and type-2 chloride channel activators (e.g. lubiprostone), and management of urinary tract symptoms includes the administration of mirabegron (selective β 3-adrenergic receptor). Autonomic dysfunction interferes with daily activities and negatively affects patients’ and caregivers’ quality of life. Therefore, early diagnosis of autonomic dysfunction and prompt initiation of optimal treatment are important to improve patients’ quality of life and prognosis.

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABA A benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the shortterm treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABA A benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the shortterm treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

Selective serotonin reuptake inhibitors (SSRIs) are used worldwide as the first-line pharmacological treatment for depression. Although SSRI use can increase the risk of suicide, fractures, and infertility, the nature of these relationships is controversial. This review reports confounding by indication and confounding by severity for SSRI side effects in previously published observational studies. The PubMed and Google Scholar databases were searched for English-language articles published from 2005 to 2022. SSRIs are often prescribed for depressive symptoms, and depression is associated with an increased risk of side effects. Therefore, confounding by indication, whereby patients are selected for a particular treatment depending on their diagnosis or severity of illness, may lead to erroneous treatment conclusions, resulting in an adverse outcome. The side effects of SSRIs that can be considered due to confounding by indication or severity include suicide, fractures, infertility, atrial fibrillation, stroke, autism spectrum disorder, and congenital malformation. When prescribing SSRIs for depression, physicians must consider confounding by indication and severity in the management of side effects. In addition, medication discontinuation should be carefully considered when side effects occur during the treatment.

Objectives: ：Depression is known to be very common for coexistence with physical diseases, but reports of this are not well known in Korea. The purpose of this study is to investigate demographic factors related to adult depression in Korea and the association between physical diseases and depression. Methods: ：This study used raw data from the 7th National Health and Nutrition Survey of the Korea Centers for Disease Control and Prevention in 2016 and 2018, and analyzed by integrating data from adults over the age of 19. Patient Health Questionnaire-9 was applied to the diagnosis of depression. Cross-analysis and logistic regression analysis were used for the association with depression according to socio-demographic characteristics and health-related characteristics. Results: ：The point-prevalence of depression in Korea using Patient Health Questionnaire-9 is 5.4%. Regarding sociodemographic characteristics, risks of depression were increased among the elderly, women, people with low household income, and people with low education levels. It was analyzed that the risk of coexistence of depression with physical diseases such as diabetes, stroke, myocardial infarction, arthritis, asthma, thyroid disease, renal failure, and cirrhosis was significantly high. Conclusions ：In this study, the presence of chronic diseases greatly increased the risk of depression, and it was confirmed that certain groups were at high risk for depression.

Objectives: The aim of this study is to identify the prevalence of parasuicide and deliberate suicide attempts in the general population of Korea, as well as their associations with sociodemographic risk factors and mental disorders. Methods: This study utilized data from the 2021 National Mental Health Survey of Korea. The survey was conducted between June and August 2021, involving 5,511 respondents aged 18 to 79 years living in communities. The Korean version of the Composite International Diagnostic Interview (K-CIDI) was used as the survey instrument. Logistic regression analysis was employed for statistical analysis. Results: The prevalence of parasuicide was 1.1%, and that of deliberate suicide attempts was 0.9%. The risk of parasuicide increased among younger age, while no significant associations with other sociodemographic factors were found.The risk of deliberate suicide attempts was associated with being divorced, separated or widowed and low income. Both parasuicide and deliberate suicide attempts were associated with depressive disorders, anxiety disorders, alcohol use disorders and nicotine use disorders. Conclusions The sociodemographic risk factors of parasuicide and deliberate suicide attempts are distinct. This study provides valuable insights into the mental disorder-related traits associated with parasuicide and deliberate suicide attempts, which could be useful in developing future suicide prevention programs.

Objectives: The aim of this study is to identify the prevalence of parasuicide and deliberate suicide attempts in the general population of Korea, as well as their associations with sociodemographic risk factors and mental disorders. Methods: This study utilized data from the 2021 National Mental Health Survey of Korea. The survey was conducted between June and August 2021, involving 5,511 respondents aged 18 to 79 years living in communities. The Korean version of the Composite International Diagnostic Interview (K-CIDI) was used as the survey instrument. Logistic regression analysis was employed for statistical analysis. Results: The prevalence of parasuicide was 1.1%, and that of deliberate suicide attempts was 0.9%. The risk of parasuicide increased among younger age, while no significant associations with other sociodemographic factors were found.The risk of deliberate suicide attempts was associated with being divorced, separated or widowed and low income. Both parasuicide and deliberate suicide attempts were associated with depressive disorders, anxiety disorders, alcohol use disorders and nicotine use disorders. Conclusions The sociodemographic risk factors of parasuicide and deliberate suicide attempts are distinct. This study provides valuable insights into the mental disorder-related traits associated with parasuicide and deliberate suicide attempts, which could be useful in developing future suicide prevention programs.

Objectives: The aim of this study is to identify the prevalence of parasuicide and deliberate suicide attempts in the general population of Korea, as well as their associations with sociodemographic risk factors and mental disorders. Methods: This study utilized data from the 2021 National Mental Health Survey of Korea. The survey was conducted between June and August 2021, involving 5,511 respondents aged 18 to 79 years living in communities. The Korean version of the Composite International Diagnostic Interview (K-CIDI) was used as the survey instrument. Logistic regression analysis was employed for statistical analysis. Results: The prevalence of parasuicide was 1.1%, and that of deliberate suicide attempts was 0.9%. The risk of parasuicide increased among younger age, while no significant associations with other sociodemographic factors were found.The risk of deliberate suicide attempts was associated with being divorced, separated or widowed and low income. Both parasuicide and deliberate suicide attempts were associated with depressive disorders, anxiety disorders, alcohol use disorders and nicotine use disorders. Conclusions The sociodemographic risk factors of parasuicide and deliberate suicide attempts are distinct. This study provides valuable insights into the mental disorder-related traits associated with parasuicide and deliberate suicide attempts, which could be useful in developing future suicide prevention programs.

Objectives: ：The aim of this study was to investigate the lifetime prevalence of psychotic experiences (PEs) and the association of PEs with a range of psychiatric disorders in the Korean general population. Methods: ：Multi-stage cluster sampling was adopted in this study. Interviews were conducted face-to-face with 18-year-old and older people living in the community from June to November 2016. Korean version of Composite International Diagnostic Interview (K-CIDI) was applied to assess the prevalence of psychiatric disorders. Psychotic experiences were assessed with 21 items (15 items for hallucinations and 6 items for delusions) in the CIDI psychosis module. Results: ：Mean lifetime prevalence (standard error) of ever having a PEs was 3.3% (0.3) with 2.2% (0.2) of hallucinatory experiences and 1.7% (0.2) of delusional experiences. The lifetime prevalence of PEs was higher in young people and in persons with unemployment or part-time-job. PEs were associated with an increase in the lifetime prevalence of anxiety disorders [Adjusted odd ratio (AOR)=6.3 ; p<0.001], mood disorders (AOR=4.9 ; p<0.001), alcohol use disorders (AOR=2.4 ; p<0.001), and nicotine use disorders (AOR=2.4 ; p<0.001) after controlling for sociodemographic variables. Conclusion ：PEs are related to various non-psychotic disorders as well as psychotic disorders. Clinicians should pay more attention to the mental health of individuals with PEs.

Objective: This study aims to investigate the prevalence of the addictive use of the internet, smartphone, and alcohol in medical students, the association of this addictive use with stress, and the mediating roles of resilience and self-esteem in this association. Methods: A total of 866 medical students completed measures of three addictive uses as well as psychological scales for stress, resilience, and self-esteem. Correlation analyses and parallel mediation analysis were carried out. Results: The prevalence of potential-risk and high-risk users was 5.8% and 1.7% for internet use, 5.4% and 2.2% for smartphone use, 22.6% and 5.3% for alcohol use, respectively. All three addictive behaviors tended to increase in terms of prevalence or mean score according to an increase in a students’ grade. Stress was positively correlated with internet use (r=0.324, p<0.001) and smartphone use (r=0.347, p<0.001). Resilience and self-esteem were found to be mediators in the association between stress and internet use or smartphone use. Conclusion These findings suggest that addictions in medical students are as prevalent as in a general population and that internet use and smartphone use may be better explained by a stress-addiction model with resilience and self-esteem as mediators than alcohol use.