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Structural Changes in the Hippocampal Subfields in Early-Onset Mild Cognitive Impairment

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):67-73.

Objectives: ：The aim of this study was to examine the structural change in the hippocampal subfields in early-onset (EO) mild cognitive impairment (MCI) patients associated with the APOE ε4 carrier state. Methods: ：This study had 50 subjects aged 55-63 years, all of whom were diagnosed with amnestic MCI at baseline via the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K). The EO-MCI patients were divided into the MCI continued (MCIcont) and Alzheimer’s disease (AD) converted (ADconv) groups 2 years later. The volumes of hippocampal subfields were measured for all the subjects. The calculations were based on the change of the volumes between the 2-year-interval brain Magnetic resonance image (MRI) scans between MCIcont and ADconv groups according to the Apolipoprotein ε4 (APOE ε4) carrier state. Results: ：There was a significant correlation between APOE ε4 allele and structural changes in several hippocampal subfields. The volume reduction in cornus ammonis 1 (CA1) field and subiculum, especially in the APOE ε4 carriers. The significance was more prominent in ADconv group. Conclusion ：These results suggest that the possession of APOE ε4 allele may lead to significantly greater predilection for the structural changes in hippocampal subfields, showing significant changes, especially in the ADconv patients compared with MCIcont patients.

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Exploratory Study on the Characteristics of Students Attempting to Quit Smoking

Nayeong KONG ; Hee Jin KIM ; Wan Seok SEO

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):59-66.

Objectives: ：Adolescents cigarette smoking is a major public health concern, because it is highly associated with physical and mental development of adolescents. This study examines the psychosocial variables affecting smoking behaviors and smoking cessation plan. Methods: ：A total of 74 (35 smokers and 40 non-smokers) students in Daegu metropolitan city were included in this study. 35 smokers visited smoking cessation center between September 2019 and November 2019. Subjects were asked to complete a self-reported questionnaire evaluating smoking status, self-esteem, parent-adolescent communication, parent and peer attachment, and peer relationship quality. The independent t-test was conducted to determine the difference in psychological variables between smoker and non-smoker. Additionally, logistic regression analysis was done to identify the factors that affect smoking cessation plan and willingness. Results: ：The majority of adolescent smoker was male (94.3%) and middle school students (82.9%). Twenty-four smokers (68.5%) started smoking at sixth and seventh grade. The smoking amount and smoking days were related to plan and willingness of smoking cessation in logistic regression analysis and the number of friends who smoke was related to smoking cessation plan. The openness of communication in smoking students was significantly higher than that of non-smoking students. Conclusion ：Our findings indicate that the environmental factors such as peer or parental smoking is important in adolescents smoking. In addition to individual factors such as smoking amount and days, openness of communication related with impulsivity and susceptibility in peer pressure can affect plan or willingness of smoking cessation.

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Designing a Mobile Intervention Platform to Help Alleviate Insomnia Symptoms in College Students

Sungkyu PARK ; Sang Won LEE ; Donghyun AHN ; Meeyoung CHA

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):50-58.

Objectives: ：An increasing number of people are affected by sleep problems every year. The current study presents findings from experiments that utilize a mobile application-based cognitive-behavioral treatment for insomnia (CBT-I). Methods: ：Our application aims to alleviate insomnia symptoms by providing real-time and direct interventions in people’s daily lives. We recruited 50 participants to test the effectiveness of the app via a six-week-long prospective experiment. Results: ：We find that insomnia symptoms are reduced significantly for both the treatment group, who used the app, and the control group, who watched educational videos [F(2,39)=60.82, p<0.001]. Sleep efficiency improved more quickly in the treatment group than in the control group. Participants who followed higher compliance to the intervention reduced their wake after sleep onset (WASO) time more substantially. Conclusion ：Our results suggest that app-based CBT-I interventions may have additional benefits for enhancing objective sleep quality, including sleep efficiency or WASO, compared to sleep hygiene education. The preliminary findings of the current research shed light on future mobile intervention apps’ design choices for insomnia.

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The Effect of Adult ADHD Tendency on Cognitive Functions in Young Male Adults with Depression

So Jeong SHINN ; Yang Tae KIM ; Sung Won JUNG ; Ho Jun LEE

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):40-49.

Objectives: ：The purpose of this study was to investigate the effect of adult Attention-Deficit/Hyperactivity Disorder (ADHD) tendency on cognitive functions in the group of depression. Methods: ：117 male patients with depression (51 with adult ADHD and 66 with adult non-ADHD) were recruited in this study. All patients were subject to the following tests : Korean Wechsler Adult Intelligence Scale-IV (K-WAIS-IV), Executive Intelligence Test, Rey-Kim memory test, Beck’s Depression Inventory II (BDI-II), and Beck’s Anxiety Inventory (BAI), Adult ADHD Self-Report Scale (ASRS), Lee Ji-Yeon’s adult ADHD scale. Results: ：Compared to the adult non-ADHD group, the adult ADHD group showed lower score in Rey-Kim memory test. Several test scores were negatively correlated with ASRS (free recall test trial 2 : r=-0.184, p=0.047, trial 3 : r=-0.277, p=0.002, trial 4 : r=-0.242, p=0.009, trial 5 : r=-0.264, p=0.004, delayed recall test : r=-0.187, p=0.044, recognition test : r=-0.209, p=0.024). No significant correlation was found between depression, anxiety and Rey-Kim memory test even though there is a meaningful correlation between adult ADHD tendency the severity of depression and anxiety. Conclusion ：In this study, we found the adult ADHD with depression group has difficulties in retaining information and maintaining attention. Interestingly, it was proved the difference comes from ADHD tendency, not from the severity of depression or anxiety.

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The Long-Term Outcomes of Alzheimer’s Disease Patients Treated with Anti-Dementia Medications According to Baseline Dementia Severity

Heewon SEO ; Yuri PARK ; Insun KWON ; Jeong Lan KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):33-39.

Objectives: ：To describe the differences in long-term outcomes in Alzheimer’s disease (AD) patients according to initial dementia severity. Methods: ：A retrospective chart review of AD patients from a dementia clinic at the University Hospital in Korea was conducted from April 2010 to March 2017. There were 168 patients enrolled, who were divided into three groups based on initial Clinical Dementing Rating (CDR). There were 55 in the very mild group (CDR=0.5 ; mean age 80.64±6.57), 93 in the mild group (CDR=1 ; mean age 80.57±7.28) and 20 in the moderate group (CDR=2 ; mean age 83.00±9.07). Participants were treated with donepezil±memantine. The observation period was 2.44±0.50 years. Cognitive function and severity of dementia were initially assessed by the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery (CERAD-NP) and were annually assessed by Mini-Mental State Exam (MMSE), CDR and CDR-Sum of boxes (CDR-SB). Results: ：The annual decline rate of MMSE score was -0.82 and those of very mild, mild, moderate groups were -0.63, -0.80, -1.96 respectively, while the annual change in CDR-SB score was 0.98, very mild group 0.86, mild group 1.03, moderate group 1.26. Education level, male, initial CDR were found to be significant potential factors in the annual change in MMSE, while initial CDR was a significant potential factor in the annual change in CDR-SB. Conclusion ：It is meaningful that we studied long-term outcomes of anti-dementia medications in real-world clinical setting. The higher the initial severity of AD, the higher the cognitive decline rate.

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Relationship between Burnout and Turnover Intention among Community-Based Mental Health Workers : The Mediating Effects of Perceived Work Value

In-Hoo PARK ; Min-Ju OH ; Mina KIM ; Yu-Ri LEE ; Min JHON ; Ju-Yeon LEE ; Sung-Wan KIM

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):25-32.

Objectives: ：The turnover rate of mental health workers in community mental health institutes is remarkably high.We explored the mediating effects of perceived work value on the relationship between burnout and turnover intention among mental health professionals working for community mental health centers and addiction centers. Methods: ：A total of 161 mental health workers completed this survey. We administered the Maslach Burnout Inventory-General Survey (MBI-GS) and the Michigan Organizational Assessment Questionnaire (MOAQ) (which explores turnover intention). Perceived work value was assessed using two items of the Scale of Resilience to Burnout.Associations were sought using the t-test, analysis of variance, correlation analyses, and hierarchical regression analyses. Results: ：The burnout level was significantly negatively correlated with perceived work value. Burnout was significantly positively correlated with turnover intention, and perceived work value significantly negatively correlated. Bootstrapping showed that perceived work value partially mediated the relationship between burnout and turnover intention. Conclusion ：Perceived work value may buffer turnover intention caused by burnout. Creation of an environment in which mental health workers feel that their work is valuable is important to prevent resignations.

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Long Term Follow-Up of Metabolic Syndrome in Patients with Severe Mental Illness among Korean Population : A 10-Year Follow-Up Study (2011-2020)

Sung-Hoon KIM ; Kyung-Min KIM ; Bo-Hyun YOON ; Ha-Ran JEONG ; Yu-Ran JEONG ; Hyun-Ju YUN ; Yong-Ho CHA ; Je-Heon SONG ; Young-Hwa SEA

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):12-24.

Objectives: ：This study was aimed to investigate the changes in metabolic syndrome (MetS) status and long-term impact of its components over a 10-year period in severe mental illness (SMI) patients in a national mental hospital. Methods: ：A total of 93 patients (schizophrenia=88, bipolar disorder=5) who met the diagnosis of Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) and participated in the MetS study in 2011 were included. MetS was defined by revised National Cholesterol Education Program-Adult Treatment Panel III (revised NCEP-ATP-III) guidelines. Results: ：The prevalence of MetS was significantly increased from 40.9% in 2011 to 60.2% in 2020. There were significant differences in admission status and hospitalization months, compared to the groups with and without MetS. Upon reviewing the changes over a decade, systolic blood pressure (SBP) was a significant factor in the group without MetS. In the group with MetS, SBP, waist circumference, and BMI (body mass index) were significant factors. Multiple logistic regression analysis revealed that hospitalization during follow-up periods [odds ratio (OR)=0.969, 95% confidence interval (CI): 0.948-0.991] and BMI (OR=1.426, 95% CI: 1.196-1.701) were significantly associated with MetS in subjects. Conclusion ：The prevalence of MetS in patients with SMI significantly increased over time. The admission status and hospitalization were also confirmed to be the significant values of MetS.

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Analysis of Circadian Rhythms in the Research of Psychiatric Disorders

Soo Yeon KIM ; Eunsoo MOON ; Hee Jeong JEONG

Journal of the Korean Society of Biological Therapies in Psychiatry.2021;27(1):5-11.

In the field of psychiatry, studies on circadian rhythms are increasing. This research trend is based on the emerging evidence on the relationship between circadian rhythm and pathophysiology and prognosis of psychiatric disorders.As performing the research on this area, the difficulty in analyzing large amount of data that are sequentially collected according to time change exists. In order to properly analyze the data in research on the circadian rhythm, it is necessary to effectively apply analysis methods of time series data. Therefore, this review aimed to summarize the analysis methods of circadian rhythms that show time series data. Understanding the analysis method of circadian rhythm will be useful for utilizing clinical data in the form of a time series data in the smart medical field in the future.

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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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