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The Relationships among MMPI-2-RF Validity Scales, Premature Termination and Treatment Duration in Psychiatric Outpatients

Kyungwon KIM ; Yong Chon PARK ; Eunkyeong KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(1):56-64.

Objectives: ：This study aimed to examine the validity scales of Minnesota Multiphasic Personality Inventory–2 Restructured Form (MMPI-2-RF) in Predicting premature termination and treatment duration in psychiatric outpatients. Methods: ：The MMPI–2 was administered to 202 patients with psychiatric medication, and its data converted to MMPI-2-RF was used for analysis. An independent t-test used to determine whether there was a difference in validity scales between premature termination group and treatment continued group. Then, logistic regression analysis was performed to determine the degree of effect on premature termination. Moreover, correlation analysis and multiple regression analysis were performed to confirm the relationship between treatment duration and validity scales. Results: ：The premature termination group showed higher score in variable response inconsistency (Vrin-r), adjustment validity (K-r) and lower score in infrequent responses (F-r) compared to the treatment continued groups. In logistic regression analysis, however, none of MMPI-2-RF validity scales predicted premature termination. Also, it was found that higher K-r score was associated with shorter treatment duration. Conclusion ：The study showed that the MMPI-2-RF validity scales can predict whether to continue medication and treatment. Therefore, it is expected that more thorough studies of the attitudes toward treatment with respect to the validity scales provides the opportunity to find patients at high risk of premature treatment prior to medication and to strengthen their motivation for treatment, thereby leading to more effective and lasting treatment.

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Actigraphic Measurement of Sleep Quality and Physical Activity of Schizophrenic Inpatients with Metabolic Syndrome

Koo-Sang CHOI ; Yong-Ho CHA ; Bo-Hyun YOON ; Sun HUR ; Hyun-Ju YUN ; Bong-Hee JEON ; Ha-Ran JEONG

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(1):44-55.

Objectives: ：The authors examined the association of sleep quality and metabolic syndrome (MetS) in schizophrenic patients using actigraphy. Methods: ：A total of 101 schizophrenic patients were included in this study. Fifty-four (53.4%) patients met the criteria of MetS. Self-assessment of subjective sleep quality, daytime sleepiness, physical activities were measured using Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and International Physical Activity Questionnaire (IPAQ), respectively. Objective sleep quality and physical activity were measured by Actigraph (ActiGraph wGT3X-BT). Results: ：Total time in bed (TIB) (p=0.032), sleep latency (SL) (p=0.001), wake after sleep onset (WASO) (p<0.001) and average awakening (p=0.015) were significantly longer in patients with MetS than those of non-MetS. Results of multiple logistic regression showed that long sleep latency (OR 7.876, 95% CI 1.519, p=0.014) and low sleep efficiency (OR 9.902, 95% CI 1.111, p=0.040) were high risk factors for MetS. Conclusion ：This was the first study to find the correlations of sleep quality and MetS in schizophrenic patients by objective sleep measurements. Although long sleep latency and low sleep efficiency were associated with MetS in patients with schizophrenia, more extensive and complicated designed studies may be needed to the association of MetS and sleep problems in schizophrenic patients.

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Characteristics of Suicide Attempters Admitted to the Emergency Room and Factors Related to Repetitive Suicide Attempts

Jin-Hui CHOI ; Wan-Seok SEO ; Bon-hoon KOO ; Hye-Geum KIM ; Young-Ji LEE ; Eun-Jin CHEON

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(1):31-43.

Objectives: ：Suicide attempt history is one of the major suicide risk factors and the suicide mortality rate increases with the number of suicide attempts. This study aimed to compare demographic and clinical factors between first and multiple suicide attempters and investigate risk factors for multiple suicide attempts. Methods: ：Participants were 537 patients who were admitted to an emergency room after attempting suicide and divided into two groups (393 first attempters and 144 multiple attempters). Demographic factors, clinical characteristics, and suicide-related characteristics were compared between the two groups. Variables with a p-value lower than 0.1 were included in a multivariate logistic regression analysis. Logistic regression models were considered to identify independent risk factors for multiple suicide attempts. The significance level was set to 0.05. Results: ：Among demographic factors, the two groups differed in age, sex, education, occupation, and marital and cohabitation status. Multiple attempters were more likely to have a mental disorder, current use of psychiatric medication, interpersonal and psychiatric motivation for suicide, current suicidal thoughts, help seeking behavior, awareness of suicide, and agreement with psychiatric follow up. In the regression analysis, unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use emerged as significant risk factors of multiple suicide attempts. Conclusion ：The study’s findings suggested that there are differences in the demographic and clinical characteristics of first and multiple suicide attempters. Specific strategies that consider unmarried status, mental disorder, interpersonal or psychiatric stress, help seeking behavior, and antidepressant use may be valuable for future suicide prevention.

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Relationship between Affective Empathy and Burnout Among Social Welfare Workers :Moderating Effects of Resilience

In-Hoo PARK ; Min-Ju OH ; Seunggi CHOI ; Young-Shin KANG ; Ju-Yeon LEE ; Sung-Wan KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(1):23-30.

Objectives: ：This study aimed to investigate the moderating effects of resilience on the relationship between affective empathy and burnout among social welfare workers. Methods: ：A total of 416 social welfare workers completed this survey. We administered the Korean version of the Questionnaire on Cognitive and Affective Empathy (2QCAE), the Korean version of the Connor–Davidson Resilience Scale (CD-RISC), and the Maslach Burnout Inventory-General Survey (MBI-GS). Collected data were analyzed by t-test, correlation analysis and hierarchical regression analysis using SPSS 23.0. Results: ：Affective empathy, measured by the 2QCAE, was significantly positively correlated with burnout, measured by the MBI-GS. CD-RISC scores were significantly negatively correlated with burnout. The hierarchical regression analysis showed that the relationship between affective empathy and burnout was moderated by resilience. Conclusion ：These findings underscore the need for programs to enhance the resilience of social welfare workers to reduce burnout at work.

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Factors Associated with Resilience in School-Aged Adolescents

Jong-Tae LEE ; Kyung-Min KIM ; Bo-Hyun YOON ; Young-Eun JUNG ; Moon-Doo KIM ; Young-Hwa SEA ; Yong-Ho CHA ; Hyun-Ju YUN ; Su-Hee PARK

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(1):14-22.

Objectives: ：The aim of this study was to examine socio-demographic variables and the correlation of their factors and mental health with resilience in adolescents. Methods: ：Participants were 4,325 middle and high school students living in Jeollanam-do, South Korea. Participants completed self-report questionnaires examining socio-demographic characteristics and including the following self-rating scales: the resilience test, the adolescent mental health and problem behavior screening questionnaire-II (AMPQ-II). Results: ：The resilience test scores were positively correlated with the adolescent mental health and problem behavior screening questionnaire-II scores (p<0.001). In multiple regression analysis, below average academic achievement (OR 4.05, 95%CI 2.62-6.27, p<0.001), perceived poor relationship with parents (OR 2.91, 95%CI 2.28-3.71, p<0.001), body dissatisfaction (OR 2.09, 95%CI 1.57-2.79, p<0.001), middle school students (OR 2.02, 95%CI 1.59-2.56, p<0.001), male (OR 1.95, 95%CI 1.55-2.46, p<0.001), low socioeconomic status (OR 1.68, 95%CI 1.11-2.52, p=0.014), low maternal education level (OR 1.64, 95%CI 1.09-2.48, p=0.018) showed significant negative correlation with resilience. Conclusion ：Resilience needs to be considered to promote mental health of adolescents. Specifically, interventions providing psychological support should target adolescents with factors correlated low resilience

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Depression and Anxiety Disorder in Perspective of Neurogenesis and Pattern Separation

Hyunsu LEE ; Yang-Tae KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2020;26(1):5-13.

Major depressive disorder (MDD) and anxiety disorder (AD) are mental disorders with a high social burden. Since the discovery of neurogenesis, one effect of anti-depressant was revealed as increasing the neurogenesis of the dentate gyrus (DG). Thus, many researchers have speculated that neurogenesis may correlate with the pathogenesis of depression and anxiety disorders. It was reasonable to hypothesize that neurogenesis would be essential for the therapeutic mechanism. We call this new hypothesis the neurogenic theory. In this review, we investigated the validity and evidence of neurogenic theory through post-mortem studies and animal models. As a result, it seems to be a lack of strong evidence to claim that the defect of neurogenesis itself causes MDD and AD. However, neurogenesis seems to be essential, at least for improving depressive or anxiety behaviors. From the algorithmic perspective, we also discussed the pattern separation, suggested function of neurogenesis of the DG, in the relationship with the symptoms of mental disorder. We tried to show that it is appropriate to interpret the relationship between neurogenesis and mental disorder using the term “overgeneralization” rather than the theoretical term “pattern separation”.Overgeneralization was especially beneficial for interpreting the relationship between the defect of neurogenesis and post-traumatic stress syndrome (PTSD) among AD. It is necessary to further investigate the effect of neurogenesis in the treatment of mental illnesses such as MDD and AD including PTSD, and in the prognosis of patients.

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Vibraimage Characteristics of Offenders with Schizophrenia Spectrum Disorder

Tae Sub LEE ; Sung Nam JO ; Kyoung Ok LIM ; So Yeong JANG ; Seung Min CHA ; Song Lee HAN

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(2):124-130.

Objectives: ：The purpose of this study was to identify characteristic Vibraimage parameters in schizophrenia spectrum and other psychotic disorders. Methods: ：This study retrospectively analyzed subjects who were referred to the National Forensic Hospital in Gongju city for psychiatric evaluation between April 2019 and October 2019. After divided into two groups; Schizophrenia Spectrum Disorders group and non-organic non-psychotic disorders group, Vibraimage parameters and MMPI-2 items were compared between the two groups. In addition, we investigated the relations between Vibraimage parameters and MMPI-2 items characteristic of schizophrenia spectrum and other psychotic disorders by using the Correlation analysis. Results: ：Compared to non-organic non-psychotic disorders group, Schizophrenia Spectrum Disorders group scored low at Aggression (t=-2.752, p=0.007), Tension (t=-2.106, p=0.039), and Suspects (t=-2.617, p=0.011); high at Neuroticism (t=4,215, p<0.001) in the Vibraimage, and the group scored comparatively high at Sc (Schizophrenia) (t=-2.099, p=0.039) and low at Hy (Hysteria) (t=-2.228, p=0.029) in the MMPI-2. The Sc (Schizophrenia) item in the MMPI-2 showed a negative correlation with Suspect parameter (r=0.242 p=0.035) and positive correlation with Neuroticism parameter (r=0.267, p=0.02) in the Vibraimage. Conclusion ：Our findings suggest that Suspect and Neuroticism parameters of the Vibraimage were characteristic in schizophrenia spectrum and other psychotic disorders, and showed potential as diagnostic tools, especially in psychiatric evaluations.

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The Comparison of Prevalence and Patterns of Sexual Dysfunction between Patients with Schizophrenia and Healthy Controls

Ji-Hwan YOON ; Dae-Up BACK ; Young-Myo JAE ; Sae-Heon JANG ; Kyoung-Hwan LEE ; Jin-Hyuk CHOI

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(2):112-123.

Objectives: ：Sexual dysfunction is common in both untreated and treated patients with schizophrenia and known as affecting the quality of life and drug compliance. The primary objective of this study is to estimate the prevalence of sexual dysfunction in Korean patients with schizophrenia treated with antipsychotic medications compared with healthy controls. Methods: ：Subjects were 75 patients who were recruited from outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR criteria, who had been stabilized on antipsychotic medications for more than three consecutive months. Control group consisted of 76 volunteers without history of any psychiatric disorder were excluded. We assessed for sexual dysfunction by the ASEX. Results: ：The prevalence of sexual dysfunction in the patient group was 57.33%, while that of the control group was 23.37%. Female gender and the use of antidepressants were best predictors of sexual dysfunction in patient group. Sexual difference at sexual drive observed in the control group diminished in the patient group. Conclusion ：The present study demonstrated a higher prevalence of sexual dysfunction in patient group than control. Clinicians should consider the differential sexual dysfunction effects of antipsychotics when prescribing medications.

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The Effect of Hormonal Changes During the Menstrual Cycle on the Brain: Focusing on Structural and Functional Neuroimaging Studies

Eunji HA ; Yumi SONG ; Jungyoon KIM ; Sujung YOON

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(2):97-111.

It is well known that sex hormones are potential modulators of brain functions and women experience dynamic hormonal changes during the menstrual cycle. Previous animal studies have reported that the variations in sex hormones over the menstrual cycle may affect cognitive function, emotion, and behavior by altering structures and functional connectivity of the brain. Considering the prevalence of certain neuropsychiatric disorders such as mood and anxiety disorders is relatively high in women, as compared with men, fluctuations of sex hormones over the menstrual cycle may influence the human brain and potentially underlie sex differences in clinical features of several neuropsychiatric disorders. There is, however, little evidence regarding the exact mechanisms underlying the effects of sex hormones on the human brain. In this review, we focused on studies to examine structural and functional changes over the menstrual cycles in women and aimed to provide an up-to-date overview of neuroimaging studies regarding the effects of sex hormonal fluctuations on the brain and behaviors.

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Zolpidem-Induced Complex Sleep-Related Behavior

Jimin LEE ; Sung Man CHANG

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(2):89-96.

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.

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