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Usefulness of LDAEP to Predict Tolerability to SSRIs in Major Depressive Disorder: A Case Report.

Young Min PARK ; Seung Hwan LEE ; Eun Jin PARK

Psychiatry Investigation.2012;9(1):80-82.

We report here a patient with major depressive disorder who experienced severe adverse effects after the administration of SSRIs (serotonin selective reuptake inhibitors) without improvement of his depressive symptoms. These adverse effects disappeared and his depressive symptoms improved after discontinuation of the SSRIs and the administration of tianeptine. The patient exhibited a low value for the loudness dependent of auditory evoked potentials (LDAEP) -0.14 at baseline, which means that his central serotonergic neurotransmission was already highly active. We assumed that it was this high serotonergic activity that rendered him unresponsive to SSRIs, and brought on him the adverse effects, and that the tianeptine was effective due to the lack of serotonin reuptake inhibitory action. Thus, we suggest that LDAEP can be used to predict an individual patient's tolerability and clinical response to SSRIs in major depression.
Depression ; Depressive Disorder, Major ; Evoked Potentials, Auditory ; Humans ; Serotonin ; Synaptic Transmission ; Thiazepines

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Comparison of Treatment Adherence between Selective Serotonin Reuptake Inhibitors and Moclobemide in Patients with Social Anxiety Disorder.

Se Won LIM ; Yong Seok KWON ; Juwon HA ; Hyeng Geun YOON ; Seung Min BAE ; Dong Won SHIN ; Young Chul SHIN ; Kang Seob OH

Psychiatry Investigation.2012;9(1):73-79.

OBJECTIVE: With respect to the pharmacotherapy of social anxiety disorder (SAD), it has been suggested that treatment duration is an important factor that can significantly predict responses. The present study aimed to compare the treatment adherence of SAD patients who were taking either SSRIs or reversible inhibitors of MAO-A (moclobemide) by measuring treatment duration and all-cause discontinuation rates of pharmacotherapy in a natural clinical setting. METHODS: We retrospectively analysed the data of 172 patients diagnosed with SAD. Depending on their medication, we divided the patients into two groups, SSRI (n=54) or moclobemide (n=118). The expected number of all-cause discontinuation every 2 weeks after starting treatment was calculated by life table survival methods. A multi-variable Cox proportional hazard regression was used to analyze the potential influence of explanatory variables. RESULTS: Treatment duration was significantly longer in the SSRI group [46.41+/-56.96, median=12.0 (weeks)] than in the moclobemide group [25.53+/-34.74, median=12.0 (weeks), Z=2.352, p=0.019]. Overall, all-cause discontinuation rates were significantly lower with SSRIs (81%) than moclobemide (96%, chi2=4.532, p=0.033). CONCLUSION: The SSRI group had a longer treatment duration and lower all-cause discontinuation rate than moclobemide. Further, only the type of medication had a significant effect on all-cause discontinuation rates and therefore, we could predict better treatment adherence with the SSRIs in the treatment of SAD.
Anxiety ; Anxiety Disorders ; Humans ; Life Tables ; Moclobemide ; Monoamine Oxidase ; Retrospective Studies ; Serotonin Uptake Inhibitors

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The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome.

Man Kyu SONG ; Jee Hyun HA ; Seung Ho RYU ; Jaehak YU ; Doo Heum PARK

Psychiatry Investigation.2012;9(1):65-72.

OBJECTIVE: This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS). METHODS: 176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices. RESULTS: The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis. CONCLUSION: The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.
Aging ; Blood Pressure ; Body Mass Index ; Heart ; Heart Rate ; Humans ; Linear Models ; Male ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

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Impaired Design Fluency Is a Marker of Pathological Cognitive Aging; Results from the Korean Longitudinal Study on Health and Aging.

Yeon Kyung CHI ; Tae Hui KIM ; Ji Won HAN ; Seok Bum LEE ; Joon Hyuk PARK ; Jung Jae LEE ; Jong Chul YOUN ; Jin Hyung JHOO ; Dong Young LEE ; Ki Woong KIM

Psychiatry Investigation.2012;9(1):59-64.

OBJECTIVE: We investigated neuropsychological markers that can be used to discriminate pathological cognitive aging from normal cognitive aging. METHODS: We administered frontal lobe function tests including the Wisconsin Card Sorting Test (WCST), digit span test, lexical fluency test, fixed condition design fluency test, and Trail Making Test B (TMT-B) to 92 individuals with pathological cognitive aging (PCA) and 222 individuals with normal cognitive aging (NCA). We examined the main effects of participants' diagnoses (PCA, NCA) and age (65-69 years old, 70-74 years old and 75 years old or over) on their test performance using multivariate analysis of variance. RESULTS: The main effects of both the diagnosis (F=2.860, p=0.002) and the age group (F=2.484, p<0.001) were significant. The PCA group showed lower performance on the backward digit span test (F=14.306, p<0.001), fixed condition design fluency test (F=8.347, p=0.004) and also exhibited perseverative errors in the WCST (F=4.19, p=0.042) compared with the NCA group. The main effect of the diagnosis on the backward digit span test and the fixed condition design fluency test remained significant after Bonferroni correction. The main effect of age remained significant in the TMT-B (F=8.737, p<0.001) after Bonferroni correction. Other test scores were not influenced by diagnosis or age. CONCLUSION: The design fluency task may be a good neuropsychological marker to assess pathological cognitive aging.
Aging ; Frontal Lobe ; Humans ; Longitudinal Studies ; Mild Cognitive Impairment ; Multivariate Analysis ; Passive Cutaneous Anaphylaxis ; Trail Making Test ; Wisconsin

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A Comparison of Reliability and Construct Validity between the Original and Revised Versions of the Rosenberg Self-Esteem Scale.

Wongpakaran TINAKON ; Wongpakaran NAHATHAI

Psychiatry Investigation.2012;9(1):54-58.

OBJECTIVE: The Rosenberg Self-Esteem Scale (RSES) is a widely used instrument that has been tested for reliability and validity in many settings; however, some negative-worded items appear to have caused it to reveal low reliability in a number of studies. In this study, we revised one negative item that had previously (from the previous studies) produced the worst outcome in terms of the structure of the scale, then re-analyzed the new version for its reliability and construct validity, comparing it to the original version with respect to fit indices. METHODS: In total, 851 students from Chiang Mai University (mean age: 19.51+/-1.7, 57% of whom were female), participated in this study. Of these, 664 students completed the Thai version of the original RSES - containing five positively worded and five negatively worded items, while 187 students used the revised version containing six positively worded and four negatively worded items. Confirmatory factor analysis was applied, using a uni-dimensional model with method effects and a correlated uniqueness approach. RESULTS: The revised version showed the same level of reliability (good) as the original, but yielded a better model fit. The revised RSES demonstrated excellent fit statistics, with chi2=29.19 (df=19, n=187, p=0.063), GFI=0.970, TFI=0.969, NFI=0.964, CFI=0.987, SRMR=0.040 and RMSEA=0.054. CONCLUSION: The revised version of the Thai RSES demonstrated an equivalent level of reliability but a better construct validity when compared to the original.
Asian Continental Ancestry Group ; Humans ; Reproducibility of Results

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Korean Anxiety Sensitivity Index-3: Its Factor Structure, Reliability, and Validity in Non-Clinical Samples.

Young Jin LIM ; Ji Hae KIM

Psychiatry Investigation.2012;9(1):45-53.

OBJECTIVE: The aim here is to examine the factorial structure, internal consistency, and concurrent validity of the Korean version of the Anxiety Sensitivity Index-3 (K-ASI-3) in student samples in Korea. Also, we investigated the cross-cultural differences in the Social Concerns factor. METHODS: K-ASI-3 was administered to non clinical samples in Korea. Internal consistency, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were undertaken to examine the factorial structure and reliability of the K-ASI-3. RESULTS: Results from CFA comparing our data to factor solutions commonly reported as representative of European-American samples indicated an adequate fit. The K-ASI-3 showed good performance on the indices of internal consistency and concurrent validity. In addition, using regression analyses, we found the Social Concerns factor is most strongly related to life satisfaction and worry. However, we found no evidence that Korean college students express more Social Concerns than their European Caucasian counterparts. CONCLUSION: The authors demonstrate that the K-ASI-3 has highly internally consistent and psychometrically sound items, and that it reliably measures three lower-order domains assessing Physical, Social, and Cognitive Concerns.
Anxiety ; Fibrinogen ; Humans ; Korea

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Development and Validation of a Screening Scale for Depression in Korea: The Lee and Rhee Depression Scale.

Seon Hee HWANG ; Min Kyu RHEE ; Rhee Hun KANG ; Hwa Young LEE ; Byung Joo HAM ; Young Sun LEE ; Min Soo LEE

Psychiatry Investigation.2012;9(1):36-44.

OBJECTIVE: The aim of this study was to develop a culturally sensitive instrument that addressed how individuals express and experience depression to detect this disorder in Koreans. We also assessed the validity, reliability, and diagnostic utility of this scale (Lee and Rhee Depression Scale; LRDS). METHODS: The sample consisted of 3,697 normal adults selected from 12 administrative districts (Do) and 448 Korean patients diagnosed with depression using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Reliability was calculated using Cronbach's alpha. Construct validity, discriminant validity, and concurrent validity were also measured. Receiver-operator-characteristic (ROC) analysis was employed to evaluate diagnostic efficiency. RESULTS: The LRDS was found to be a reliable instrument (Cronbach's alpha=0.95) consisting of six factors: negative thinking about the future, negative thinking about the self, worry and agitation, depressed mood, somatization, and loss of volition. Comparison of LRDS scores discriminated the group of patients with depression from the normal individuals in the control group. The measure showed good concurrent validity in that scores were significantly and strongly correlated with scores on established scales such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), and the D scale of the Minnesota Multiphasic Personality Inventory-second edition (MMPI-2). Diagnostic efficiency was 77.7%, and the cut-off scores were 65 for males and 70 for females. CONCLUSION: To our knowledge, this is the first study to develop a depression-screening scale on the basis of Korean patients' complaints about the disorder. As a culturally sensitive tool, the LRDS will be useful in clinical and research settings in Korea.
Adult ; Axis, Cervical Vertebra ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Dihydroergotamine ; Factor Analysis, Statistical ; Humans ; Korea ; Male ; Mass Screening ; Minnesota ; Thinking ; Volition ; Weights and Measures

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The Relationship between Religion and Mental Disorders in a Korean Population.

Jong Ik PARK ; Jin Pyo HONG ; Subin PARK ; Maeng Je CHO

Psychiatry Investigation.2012;9(1):29-35.

OBJECTIVE: The question of whether religion has beneficial or detrimental effects on the mental well-being of the adult individual is debatable. Because most Korean citizens are free to select their own religion, there is a higher proportion of non-believers than believers among the Korean population. The aim of this research was to investigate the association between spiritual values and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders in Korea across all types of belief systems, including Koreans not affiliated with a particular religion. METHODS: The Korean version of the Composite International Diagnostic Interview 2.1 was used to interview 6,275 people across South Korea in 2001. While controlling for age and sex, we used logistic regression to analyze the relationship between mental disorders (both current and past) and the types of religion and spiritual values. RESULTS: Strong spiritual values were positively associated with increased rates of current depressive disorder and decreased rates of current alcohol use disorder. Using "atheist" as the reference category, Catholics had higher lifetime odds of single episodes of depression whilst Protestants had higher lifetime odds of anxiety disorder and lower lifetime odds of alcohol use disorders. CONCLUSION: The results of this study suggest that depressive episodes often lead to a search for spirituality and that religion may be helpful in overcoming depression or becoming less vulnerable to relapsing. The associations between religion, spiritual values, and mental health have not been fully elucidated and warrant further exploration.
Adult ; Anxiety Disorders ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Logistic Models ; Mental Disorders ; Mental Health ; Prevalence ; Protestantism ; Republic of Korea ; Spirituality

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Psychosocial Aspects in Girls with Idiopathic Precocious Puberty.

Eun Young KIM ; Moon In LEE

Psychiatry Investigation.2012;9(1):25-28.

OBJECTIVE: Precocious puberty leads to discrepancies between physical and chronological age. The aim of the present study was to evaluate behavioral patterns and social competences in 34 girls with idiopathic precocious puberty. METHODS: Height, body weight, and BMI were determined, and pubertal development was assessed. The Korean-child behavior checklist (K-CBCL) was completed by parents. RESULTS: 1) Body weight and BMI were significantly higher in precocious puberty group than in the control group. 2) T scores of total social competence and school scales of K-CBCL were significantly higher in the precocious puberty group than in the control group. 3) T scores of externalizing problems and total behavior problems of K-CBCL were also significantly higher in the precocious puberty group. 4) T scores of thought problems and attention problems of K-CBCL were significantly higher in the precocious puberty group than the control group. CONCLUSION: Although girls with precocious puberty had more behavioral problems, no significant differences were observed between the two study groups in terms of clinically-important T scores. However, the concerns of parents and patients regarding behavioral and emotional changes might be most important when evaluating psychosocial problems. Early recognition, sufficient understanding, communication with patients and parents regarding physical developmental difference from children in the same age, can improve the self-image of those with precocious puberty.
Body Height ; Body Weight ; Checklist ; Child ; Humans ; Mental Competency ; Parents ; Puberty, Precocious ; Weights and Measures

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Use of the Terms "Schizophrenia" and "Schizophrenic" in the South Korean News Media: A Content Analysis of Newspapers and News Programs in the Last 10 Years.

Jun Hyun PARK ; Young Min CHOI ; Bongseog KIM ; Dong Woo LEE ; Min Sook GIM

Psychiatry Investigation.2012;9(1):17-24.

OBJECTIVE: In this study, we explored the meaning attributed to the words "jungshinbunyeolbyung" (schizophrenia) and "jungshinbunyeol" (schizophrenic) in South Korean newspapers and news programs in the last 10 years. METHODS: We screened the websites of three national newspapers and the broadcasts of three nationwide television news programs from January 1, 2001, to December 31, 2010. We classified a total of 490 articles and 257 news segments by category and quantitatively and qualitatively analyzed them. The articles and news segments were assigned to one of the following categories based on their use of the term "schizophrenia": 1) negative, 2) neutral or positive, 3) incidental, and 4) metaphorical. RESULTS: The negative viewpoint accounted for 349 incidences (46.7%), while the neutral and positive viewpoints included 225 incidences (30.1%). Incidental uses accounted for 95 incidences (12.7%), and metaphorical uses accounted for 78 incidences (10.4%). The majority of the negative uses focused on violence or dangers posed by patients (137 mentions, 37.8%), while the metaphorical uses mainly focused on the idea of splitting (51 mentions, or 65%). CONCLUSION: This study showed that the South Korean news media do not provide balanced information about schizophrenia to the public. This study also showed that no significant move has been made toward a more positive use of the term since a previous study was conducted on the subject. Although the term schizophrenia has given way to "attunement disorder," it will be difficult to establish the new term as the standard if the South Korean media continue to use the term "schizophrenic symptom." Even though the term has been changed, guidelines are necessary to encourage the mass media to provide balanced articles and reduce prejudice.
Humans ; Incidence ; Mass Media ; Metaphor ; Periodicals ; Prejudice ; Schizophrenia ; Television ; Violence

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