A woman in her twenties with schizophrenia developed immediate-onset mania after taking oral aripiprazole and receiving aripiprazole long-acting injection (ALAI). The dosage of aripiprazole was rapidly increased due to inadequate stimulating effect of low-dosage aripiprazole, but her manic symptomatology worsened. Clinicians should therefore carefully monitor for the induction of mania by oral aripiprazole and ALAI. Her manic symptomatology improved after adding 20 mg of blonanserin, 3 mg of risperidone, and 300 mg of quetiapine.
Aripiprazole ; Bipolar Disorder ; Female ; Humans ; Quetiapine Fumarate ; Risperidone ; Schizophrenia

BACKGROUND: Individual attitudes toward suicide are known to markedly influence suicidal ideation and suicidal behavior. Therefore, this study aimed to determine the factors associated with attitudes toward suicide.METHODS: This study was conducted on 3,213 adult men and women living in a province of Korea. After excluding 281 participants because of unreliable responses, the remaining 2,932 were included in the data analysis. Demographic factors were investigated, and psychological factors were evaluated. Attitudes toward suicide were evaluated using the Attitudes Towards Suicide-20, physical symptoms were evaluated using the Patient Health Questionnaire-15 (PHQ-15), self-compassion was evaluated using the Korean Self-Compassion Scale, and stress was evaluated using the Global Assessment of Recent Stress (GARS) scale. One-way analysis of variance was used to examine the psychological characteristics of attitudes toward suicide.RESULTS: Differences in various factors based on demographic characteristics were observed regarding attitudes toward suicide. Significant differences in attitudes toward suicide were observed based on severity of suicide, acceptability (F=20.332, p<0.001), prevention of suicide (F=7.700, p<0.001), and universality (F=13.741, p<0.001). The duration of suicidal ideation, self-kindness, self-judgment, common humanity, isolation, and over-identification showed differences, as did the GARS and PHQ-15 scores.CONCLUSION: This study explored the demographic and psychological factors affecting attitudes toward suicide. Adequate mediation of these factors is needed to prevent suicidal ideation and behavior.
Adult ; Demography ; Empathy ; Female ; Humans ; Korea ; Male ; Negotiating ; Psychology ; Statistics as Topic ; Stress, Psychological ; Suicidal Ideation ; Suicide

BACKGROUND: The purpose of this study was to investigate the relationship between metabolic syndrome and depressive symptoms by administering the nine-item depression module from the Patient Health Questionnaire-9 (PHQ-9) to participants from the general population of Korea.METHODS: In total, 8,150 adults participated in the 1st year of the 7th Korea National Health and Nutrition Examination Survey, which was conducted in 2016. Of them, 5,556 participants underwent tests pertaining to the criteria for metabolic syndrome and responded to PHQ-9; 2,594 respondents were excluded. Analysis of covariance was performed to analyze the relationship between the presence of metabolic syndrome and the PHQ-9 score after adjusting for the effects of demographic and hematologic characteristics and underlying diseases.RESULTS: The total PHQ-9 score (mean=2.98) was significantly higher in participants with metabolic syndrome than in those without it (mean=2.59) (p=0.002). Among the individual PHQ-9 items, changes in sleep, thoughts of suicide or self-harm, and depressive mood showed the greatest differences.CONCLUSION: The PHQ-9 scores in Korea were higher in adults with metabolic syndrome, suggesting an association between metabolic syndrome and depressive symptoms.
Adult ; Depression ; Humans ; Korea ; Nutrition Surveys ; Suicide ; Surveys and Questionnaires

BACKGROUND: The factor structure of the Hamilton Depression Rating Scale (HDRS) is well validated for patients with major depressive disorder (MDD). We examined whether HDRS factors can measure the anxious distress specifier in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in patients with MDD.METHODS: A retrospective chart review of patients with MDD between March 2012 and June 2015 was conducted. We extracted data on anxious distress symptoms and detailed clinical information and examined how the 5 HDRS factors (anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia, and appetite) were related to the anxious distress specifier using the receiver operating characteristic (ROC) curve analysis and the area under the ROC curve analysis.RESULTS: We observed significant differences in the HDRS and Beck Depression Inventory scores between anxious distress and non-anxious distress groups at the index episode. The score for guilt/agitation factor was significantly higher than that for other factors in the anxious distress group and exhibited good predictive efficiency at baseline.CONCLUSION: Further investigation of the anxious distress specifier as a diagnostic entity would be worthwhile. In addition, the scores for guilt/agitation factor on the HDRS might be a promising marker for distinguishing patients with anxious distress from those with other subtypes of major depression, especially for the index episode.
Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Retrospective Studies ; ROC Curve ; Sleep Initiation and Maintenance Disorders

The purpose of this study was to investigate the specific cognitive emotion regulation strategies affecting the development and maintenance of post-traumatic stress symptoms by reviewing the related literature. A literature search was conducted using Google Scholar, PubMed, DBPia, and RISS for investigating the relationship between cognitive emotion regulation strategies and post-traumatic stress symptoms in people with post-traumatic stress disorder (PTSD) or in those who had experienced severe trauma. Catastrophizing and rumination were associated with more post-traumatic stress symptoms and higher psychological distress. On the other hand, positive reappraisal, refocus on planning, and acceptance were associated with fewer post-traumatic stress symptoms and lower psychological distress. We propose that catastrophizing and rumination contribute to both the development and maintenance of post-traumatic stress symptoms. Therefore, in the prevention and treatment of PTSD symptoms, catastrophizing and rumination need to be targeted and positive reappraisal needs to be increased.
Catastrophization ; Hand ; Stress Disorders, Post-Traumatic

BACKGROUND: The aim of this study was to determine the effects of out-door activities in the forest environment, the so-called "forest therapy program," among children with atopic dermatitis (AD).METHODS: A total of 40 children with moderate-severity AD were enrolled in this study. All subjects were divided into either the "forest group" participating in the forest therapy program or the control group. The vitamin D level and quality of life (QOL) were measured at the initial visit and 8-week final visit.RESULTS: The SCORing Atopic Dermatitis (SCORAD) index was reduced significantly more in the forest group than in the control group (39.17±4.48 vs. 27.00±4.87); however, it did not reach statistical significance. The vitamin D (25(OH)-D₃) level was increased significantly more in the forest group than in the control group (p>0.001). The mean QOL score was not significantly decreased in the forest group.CONCLUSION: The forest therapy program was proven to be associated with the reduction of the SCORAD index and the increase of vitamin D level. However, QOL measures did not show statistically significant improvement. Thus, the forest therapy program may have a positive trend of biological and psychosocial effects in children with AD.
Child ; Dermatitis, Atopic ; Forests ; Humans ; Quality of Life ; Vitamin D

BACKGROUND: School bullying is considered the most common type of bullying, and bullying related to stressful relationships is a significant risk factor for college students' depression and suicide. However, bullying is often overlooked in college students. Therefore, we investigated the prevalence of peer victimization in Korean college students and identified factors associated with bullying victimization.METHODS: From the Jeju area, 941 college students were included in this study. The students were divided into two groups according to whether they had experienced bullying. Sociodemographic and clinical characteristics, including depression (Beck Depression Inventory) and health-related conditions, were compared between groups.RESULTS: In total, 82 students (8.7%) reported being bullied by other students. Factors associated with bullying were low socioeconomic status (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.10–3.64), obesity (OR, 2.20; 95% CI, 1.13–4.29), body dissatisfaction (OR, 3.92; 95% CI, 2.36–6.50), and depression (OR, 2.42; 95% CI, 1.53–3.85).CONCLUSION: Our findings might have important implications for development of strategies and interventions to prevent bullying among college students.
Bullying ; Crime Victims ; Depression ; Humans ; Obesity ; Prevalence ; Risk Factors ; Social Class ; Suicide

BACKGROUND: Lesch types 2 (L2, anxiety model) and 3 (L3, depressive model) of alcoholism exhibit different responses to anti-craving agents, and most treatment guidelines provide differential treatment strategies for bipolar depression (DEP) and unipolar DEP. We compare the psychological characteristics of L2 and L3 alcoholism and between the unipolar and bipolar subgroups.METHODS: We reviewed medical records of patients who were diagnosed with alcohol use disorder using the DSM-5 diagnostic criteria and classified as L2 and L3 using Lesch Alcohol typology software. All patients completed self-report scales (Alcohol Use Disorders Identification Test [AUDIT], Beck Anxiety Inventory [BAI], Beck Depression Inventory-II [BDI-II], and Korean Symptom Checklist-95 [KSCL95]). The data were analyzed using descriptive statistics, the Wilcoxon Rank-Sum test, and ANOVA.RESULTS: Of the 43 patients, 23 were assigned L2, and 20 were assigned L3. The scores for the KSCL95 subscales fell generally in the increasing order of the L2-unipolar (L2U, n=10), L2-bipolar (L2B, n=13), L3-unipolar (L3U, n=11), and L3-bipolar (L3B, n=9) types. The L3B scores were greater than the L3U scores for most KSCL95 subscales, by contrast with the DEP and BAI scores.CONCLUSION: We found psychological differences between L2 and L3 and identified the unique psychological characteristics for each subgroup by polarity. The psychological characteristics of these subgroups of alcohol use disorder may help improve the treatment success rates through individualized treatment strategies.
Alcoholism ; Anxiety ; Bipolar Disorder ; Depression ; Depressive Disorder ; Humans ; Medical Records ; Weights and Measures

Recently, melatonergic agents have been gaining much interest in the treatment of mood disorders. The elucidation of the underlying biological mechanisms related to the melatonergic system in mood disorders is warranted to ensure the proper use of melatonergic agents. Changes of the melatonergic system have been investigated in several studies of patients with bipolar disorder (BP) and depression. Accumulating evidence has indicated that patients with BP might exhibit abnormal melatonin secretion patterns, increased light-induced melatonin suppression, altered pineal gland volume, genetically abnormal melatonin synthesis enzyme, and modified melatonin receptors. In this review, the findings of studies performed to explore the association between the melatonergic system and BP are discussed. Moreover, the interpretations and limitations of these findings are described.
Bipolar Disorder ; Depression ; Humans ; Melatonin ; Mood Disorders ; Pineal Gland ; Receptors, Melatonin

BACKGROUND: Social anxiety and suicide are serious common problems in college students. However, there are few studies on the relationship between social anxiety symptoms and suicidal risk. Therefore, we evaluated the associationbetween social anxiety symptoms and suicidal risk in college students.METHODS: A total of 579 college students were recruited for a college-based cross-sectional survey in the Jeju area. The participants completed a questionnaire gathering sociodemographic information; they also completed the Korean Social Avoidance and Distress Scale (SADS) to assess social anxiety symptoms and the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms. To obtain information regarding suicidal risk, we administered the Korean version of the Suicide module of the Mini International Neuropsychiatric Interview (M.I.N.I.).RESULTS: The prevalence of higher levels of social anxiety symptoms among college students was 28.0% (n=162). A higher level of social anxiety symptoms resulted in a 2.10-times higher suicidal risk after adjusting for depression in college students (95% confidence interval, 1.05-4.23; p=0.037).CONCLUSION: Based on the results of this study, social anxiety symptoms should be managed and controlled to prevent suicidality in Korean college students.
Anxiety ; Cross-Sectional Studies ; Depression ; Epidemiologic Studies ; Humans ; Prevalence ; Suicide