OBJECTIVES: The purpose of this study was to test the reliability and validity of the Korean translation of Gambling Symptom Rating Scale (KG-SAS). METHODS: Using self-report sampling, we eventually included 231 subjects and analysed 70 subjects. These subjects were tested for KG-SAS and the Korean version of Barratt Impulsiveness Scale (BIS). RESULTS: In the reliability test, Cronbach's alpha coefficient was .913 which provided the evidence for the internal consistency. Content validity was assessed with factor analysis and two factors were extracted. Compared with the original scale, both scales embody the same theoretical conceptualization. To assess the validity of the KG-SAS, correlation coefficient was calculated between the KG-SAS and the Korean version of BIS. We got the result that there was a correlation between the KG-SAS and the Korean version of BIS (p<0.01). CONCLUSION: The results of the present study support that the KG-SAS is a reliable and valid scale for evaluating pathological gambling symptom assessment. Based on the results, this study suggests that KG-SAS would be a promising measurement to treat and study pathological gambling.
Gambling* ; Reproducibility of Results* ; Symptom Assessment* ; Weights and Measures

OBJECTIVE: Treating patients with acute manic episode has many problems such as recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent developments of medication, including atypical antipsychotics and new mood stabilizers, make it difficult to choose the appropriate pharmacological options. The Korean Society of Psychopharmacology and Korean Academy of Schizophrenia have started to develop a Korean algorithm project to treat major mental disorders including manic patients with the better pharmacological treatments. METHODS: The first survey was performed with a questionnaire used in `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000' (translated in Korean). Forty-eight members of the review committee completed the survey. However, there were some instances of non-consensus and gaps between research data and clinical usage in some steps. Hence we carried out a second survey to clarify these aspects and other minor problems. RESULTS: The first-line pharmacological treatment for acute manic episode is the initiation of either lithium plus an atypical antipsychotic, or divalproex plus an atypical antipsychotic. In the case of euphoric mania, monotherapy with lithium or divalproex can be first-line treatment, as well as in combination with an atypical antipsychotic. In the case of psychotic mania, we decided to recommend typical and atypical antipsychotics with a mood stabilizer as first-line treatment. For mixed and dysphoric episodes, according to the result of the second survey, carbamazepine also can be used as a first-line mood stabilizer. Alternative mood stabilizers include new anticonvulsants such as lamotrigine and topiramate. Clozapine can be used for refractory cases and electroconvulsive therapy (ECT) can be used at any time, if needed, on the clinician's discretion. CONCLUSION: Based on the results of two surveys, discussion in executive committee and review of journals about pharmacological treatment of acute mania, we developed the algorithm presented here for manic episode. As this algorithm may retain problems and shortcomings, we will continue to revise these issues.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder ; Carbamazepine ; Clozapine ; Consensus ; Drug Therapy ; Electroconvulsive Therapy ; Humans ; Lithium ; Mental Disorders ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Schizophrenia ; Valproic Acid

OBJECTIVE: It is well-known that antipsychotics are widely used in the treatment of bipolar disorder. So, the aim of this study was to examine the subjective response to antipsychotics in acute manic patients. METHODS: Data were gathered through the study for feasibility testing of Korean Medication Algorithm for Bipolar Disorder (KAMP-BP), which 17 nationwide clinical centers were entered into the study. A total 126 bipolar patients were enrolled and then 92 were treated according to the treatment algorithm. The data of 58 patients were completely recorded from baseline to 2 weeks of treatment and were entered into analysis. Drug Attitude Inventory-10 (DAI-10) was used for evaluating patient's subjective response to antipsychotics and patients were grouped as subjective non-dysphoric and dysphoric as the total score of DAI-10. For assessing the clinical status, Young Mania Rating Scale (YMRS), Clinical Global Impression- Severity scale (CGI-S), Hamilton Rating Scale for Depression (HAM-D), Global Assessment of Functioning (GAF) and Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) were used. RESULTS: Dysphoric group was younger and has more females in sex distribution than non-dysphoric group. YMRS and CGI-S were severer in dysphoric group. The prescription patterns were not different between two groups: Combinations of mood stabilizers and antipsychotics were administered to all patients and atypical antipsychotics were prescribed over 90% of the patients. At 2 weeks of treatment, more patients were turned into remission in non-dysphoric group. Dysphoric patients showed more changes of positive subjective response in DAI-10 from baseline and more patients turned toward the non-dysphoric group. CONCLUSION: Although the subjective response to antipsychotics using DAI-10 was not typically characterized in acute manic patients, it seems that atypical antipsychotics may have a role in determining the subjective feelings of the acute bipolar manic patients.
Antipsychotic Agents* ; Bipolar Disorder ; Depression ; Female ; Humans ; Prescriptions ; Sex Distribution

OBJECTIVES: This study aims to test the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), a screening instrument for bipolar disorder. METHODS: A total of 238 subjects (126 DSM-IV bipolar outpatients and 112 controls without psychiatric history) completed the K-MDQ. RESULTS: The Cronbach's alpha, used to measure the internal consistency of the scale, was high (0.88). Principal component analysis with varimax rotation revealed three factors, which explained 59.5% of the variance. Individual item correlations with the total score were all statistically significant (p<0.001). The mean total score of the K-MDQ was 8.48 in bipolar disorder and 4.51 in non-clinical participants. A total K-MDQ score of 7 or more excluding further two questions was chosen as the optimal cutoff, as it provided good sensitivity (0.75) and specificity (0.69). CONCLUSION: The results of this study showed adequate validity of the K-MDQ, suggesting that this instrument is useful for screening of bipolar disorder.
Bipolar Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders* ; Outpatients ; Principal Component Analysis ; Surveys and Questionnaires ; Sensitivity and Specificity

OBJECTIVES: This study aims to test the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), a screening instrument for bipolar disorder. METHODS: A total of 238 subjects (126 DSM-IV bipolar outpatients and 112 controls without psychiatric history) completed the K-MDQ. RESULTS: The Cronbach's alpha, used to measure the internal consistency of the scale, was high (0.88). Principal component analysis with varimax rotation revealed three factors, which explained 59.5% of the variance. Individual item correlations with the total score were all statistically significant (p<0.001). The mean total score of the K-MDQ was 8.48 in bipolar disorder and 4.51 in non-clinical participants. A total K-MDQ score of 7 or more excluding further two questions was chosen as the optimal cutoff, as it provided good sensitivity (0.75) and specificity (0.69). CONCLUSION: The results of this study showed adequate validity of the K-MDQ, suggesting that this instrument is useful for screening of bipolar disorder.
Bipolar Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders* ; Outpatients ; Principal Component Analysis ; Surveys and Questionnaires ; Sensitivity and Specificity

OBJECTIVE: Treating rapid cycling bipolar disorder has many clinical problems such as recurrence, treatment resistance, and unstable course. Recent developments of medications including atypical antipsychotics and new anticonvulsants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including rapid cycling to aid clinical decisions. METHODS: The first survey was performed with the questionnaire based on `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature to make a proper algorithm. RESULTS: Generally no `treatment of choice' were demonstrated. The first-line treatment is the single mood stabilizer or combination of a mood stabilizer and an atypical antipsychotic. Another mood stabilizer or an antidepressant can be added for the next treatment. Lithium, divalproex, and carbamazepine are preferred as a mood stabilizer than the third generation anticonvulsants. CONCLUSION: With the results of two surveys and discussion in executive committee, we developed the algorithm for rapid cycling bipolar disorder.
Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder ; Carbamazepine ; Consensus ; Drug Therapy ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Schizophrenia ; Valproic Acid

Fumaric aciduria(fumarase deficiency) is a rare inborn error of metabolism resulted from a deficiency of fumarase, one of the constituent enzymes of the Krebs tricarboxylic acid cycle. Enzyme deficiency causes excessive urinary excretion of fumaric acid due to a defective conversion of fumaric acid to malic acid. It usually presents early in infancy with a severe encephalopathy including hypotonia, developmental retardation and frequent seizures. We report a case of suspected fumarase deficiency presenting with persistent mild metabolic acidosis associated with moderate hydrocephalus in a newborn infant.
Acidosis* ; Citric Acid Cycle ; Fumarate Hydratase* ; Humans ; Hydrocephalus ; Infant, Newborn* ; Metabolism ; Muscle Hypotonia ; Seizures

OBJECTIVE: Treating depressive episode of bipolar disorder has many clinical problems such as recurrence, treatment resistance, switching and worsening of its course. Recent developments of medications including atypical antipsychotics and new antidepressants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including depressive episode of bipolar disorder to aid clinical decisions. METHODS: The first survey was performed with the questionnaire based on `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature about bipolar depression to make a proper algorithm. RESULTS: A mood stabilizer, such as lithium or divalproex, is recommended for treating mild bipolar depression. For moderate and nonpsychotic severe bipolar depression, the first-line treatment option is a combination of antidepressant and mood stabilizer, with which a high potency antipsychotic or atypical antipsychotic drug is combined for bipolar depression with psychotic features. In the case of poor or no response to the initial treatment, to add or change antidepressant is a next step of treatment strategy. In refractory bipolar depression, thyroid hormone, atypical antipsychotics, or other mood stabilizers are recommended. Electroconvulsive therapy (ECT) can be used at any point, if needed, by the decision of clinicians. CONCLUSION: With the results of two surveys and discussion in the executive committee, we developed the algorithm for depressive episode of bipolar disorder.
Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder ; Consensus ; Drug Therapy ; Electroconvulsive Therapy ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Schizophrenia ; Thyroid Gland ; Valproic Acid

OBJECTIVE: This study consists of a single open clinical trial to evaluate the treatment effects of paroxetine on symptoms of hwa-byung, a Korean culture-related anger syndrome. METHODS: Eighty-nine patients with depressive disorders, anxiety disorders, somatoform disorders, or self-labeled hwa-byung were treated with paroxetine (Paxil CR) 12.5-37.5 mg/day for 8 weeks. Treatment effects were evaluated using the Hamilton Depression Scale (HAMD), the State and Trait Anger Inventory (STAXI), and the Hwa-byung Scale. RESULTS: Scores on all items ; total score on the Hwa-byung Scale ; scores on state anger, trait anger, and anger-in ; total score on the STAXI ; and total score on the HAM-D decreased significantly after eight weeks of paroxetine treatment compared to baseline. CONCLUSION: Paroxetine was shown to be effective for treating symptoms of hwa-byung, a chronic anger syndrome.
Anger ; Anxiety Disorders ; Depression ; Depressive Disorder ; Humans ; Paroxetine ; Somatoform Disorders

OBJECTIVE: It is not easy to diagnose bipolar disorders accurately in the clinical setting. Although Korean version of the Mood Disorder Questionnaire (K-MDQ) is easily administered, it still has weakness regarding case finding. In this study, we suggest a new weighted version of the K-MDQ to increase its screening power. METHODS: Ninety-five patients with bipolar disorders and 346 controls (patients with schizophrenia, patients with depressive disorders, patients with anxiety disorders, and subjects without any psychiatric disease) were enrolled in this study. The subjects received brief information on the K-MDQ, and then independently completed the questionnaire. RESULTS: Using odds ratios, we constructed a new weighted K-MDQ (W-K-MDQ). Item 1 (feel so good or hyper) was weighted 7 times and item 4 (less sleep) 3.5 times. Item 7 (easily distracted) and item 11 (more interested in sex) were excluded. Part 2 (simultaneity) and 3 (functional impairment) were also excluded as in the original K-MDQ. The sensitivity of the W-K-MDQ with a cutoff value of 10 was enhanced to 0.789. The area under the receiver operating characteristic curve was increased to 0.837. CONCLUSION: We suggested a new formula for K-MDQ using 11 of its items. The W-K-MDQ can be easily applied with good sensitivity to screen for bipolar disorders in clinical settings in Korea. Further evaluations with larger samples are needed to establish the usefulness of the W-K-MDQ.
Anxiety Disorders ; Bipolar Disorder ; Depressive Disorder ; Diagnosis, Differential ; Humans ; Korea ; Mass Screening* ; Mood Disorders* ; Odds Ratio ; ROC Curve ; Schizophrenia