Background: Acute deterioration of patients in general wards often leads to major adverse events (MAEs), including unplanned intensive care unit transfers, cardiac arrest, or death. Traditional early warning scores (EWSs) have shown limited predictive accuracy, with frequent false positives. We conducted a prospective observational external validation study of an artificial intelligence (AI)-based EWS, the VitalCare - Major Adverse Event Score (VC-MAES), at a tertiary medical center in the Republic of Korea. Methods: Adult patients from general wards, including internal medicine (IM) and obstetrics and gynecology (OBGYN)—the latter were rarely investigated in prior AI-based EWS studies—were included. The VC-MAES predictions were compared with National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) predictions using the area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), and logistic regression for baseline EWS values. False-positives per true positive (FPpTP) were assessed based on the power threshold. Results: Of 6,039 encounters, 217 (3.6%) had MAEs (IM: 9.5%, OBGYN: 0.26%). Six hours prior to MAEs, the VC-MAES achieved an AUROC of 0.918 and an AUPRC of 0.352, including the OBGYN subgroup (AUROC, 0.964; AUPRC, 0.388), outperforming the NEWS (0.797 and 0.124) and MEWS (0.722 and 0.079). The FPpTP was reduced by up to 71%. Baseline VC-MAES was strongly associated with MAEs (P<0.001). Conclusions The VC-MAES significantly outperformed traditional EWSs in predicting adverse events in general ward patients. The robust performance and lower FPpTP suggest that broader adoption of the VC-MAES may improve clinical efficiency and resource allocation in general wards.

Objective: The purpose of this study was to classify patients with suicidal tendencies into suicide attempts (SA), suicidal ideation (SI), and non-suicidal self-injury (NSSI) and to identify differences in temperaments and characters of the groups. It also aimed to identify difference between the groups and non-suicidal tendencies. Methods: Using psychiatric diagnostic data of 195 patients, temperaments and characters were measured with the Temperament and Character Inventory, and the level of depression was measured with the Beck Depression Inventory. The subjects were classified into SA, SI, NSSI, psychiatric patients without suicidal tendencies (PP), and non-patient (Normal) groups, and multivariate analysis of variance and multinomial logistic regression were conducted. Results: The NSSI group had higher novelty seeking compared to the SI group, while having higher harm avoidance, lower persistence, and lower self-directedness compared to the SA group. Furthermore, low persistence was a better predictor for the SA group between SA and NSSI groups, and low novelty seeking was found to be a better predictor for the SI group between the SI and NSSI groups. Conclusion As a result, the group differences in temperaments and characters were found, which would be useful to identify patients with suicidal tendencies and provide appropriate interventions tailored to the temperaments and characters of each group.

Objectives: ：This study was designed to investigate the effect of sleep quality on depression symptoms and the mediating effect of interpretation bias and anxiety symptoms in psychiatric patients. Methods: ：Data accumulated for outpatients and inpatients in the Department of Mental Health Medicine at Hanyang University Guri Hospital were used. The measurement tools were Pittsburgh Sleep Quality Index (PSQI), Ambiguous/Unambiguous Situations Diary-Extended Version (AUSD-EX), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II). Correlation analysis and bootstrapping analysis were conducted using SPSS 25.0 and SPSS Macro based on 162 patient data. Results: ：As a result of the study, the double mediating effect of interpretation bias for Ambiguity and anxiety symptoms was significant in the relationship between sleep quality and depression symptoms. Conclusions ：In this study, it was confirmed that low sleep quality sequentially affects anxiety and depression symptoms through interpretation bias for ambiguity. Based on this, it is expected that the development of other psychiatric symptoms can be prevented by preferentially performing therapeutic intervention on preceding symptoms.

Objectives: This study aimed to identify central symptoms of depression in elderly cognitive disorder patients through network analysis. Methods: A total of 222 participants, 61 male and 104 female suffering from a cognitive disorder, participated in the dementia screening test and were given Mini-Mental Status Examination in the Korean Version of the CERAD Assessment Packet or Mini-Mental Status Examination for Dementia Screening and Korean Form of Geriatric Depression Scale (GDS-K) at a public health center in Gyeonggi-do, Korea. This study used network analysis to identify the centrality in the symptom network of depression among elderly cognitive disorder patients. Results: Among 30 nodes included in our network analysis, 435 edges were available, and 50 edges had a meaningful relationship. According to the centrality results of the study, we found that GDS-K item 16, “Do you feel depressed and discouraged?” item 3, “Do you feel like you’re living in vain?” and item 15, “Do you enjoy being alive?” were the key symptoms. Also, there was a difference in symptom correlations between cognitive disorder patients and normal participants. Conclusion The results suggest that depressive mood, discouragement, worthlessness and loss of pleasure should be the priority intervention goals in intervening in depressive symptoms of the elderly with cognitive disabilities.

Objectives: Various sensory symptoms have been recognized after COVID-19 vaccination. Here, we aimed to explore the association between the suggestive symptom of restless legs syndrome (RLSss) and COVID-19 vaccination using an online survey. Methods: We prospectively studied participants who were working in our hospital after at least the first dose of the ChAdOx1 or BNT162b2 mRNA vaccine. The participants were invited via smartphone messages and voluntarily filled out an online questionnaire that included adverse events after vaccination. We considered the participants as having RLSss if they reported that they had three or more symptoms in the restless legs syndrome (RLS) diagnostic criteria. Results: A total of 628 participants (506 female; mean age, 37.7±12.4 years) responded fully to our online survey. 588 participants (93.6%) received the first dose of the ChAdOx1 vaccine (BNT162b2 mRNA vaccine for 40 participants). A total of 44 out of the 628 participants (7.0%) reported that they had RLSss. Myalgia was more common in participants with RLSss than in those without RLSss (97.7% vs. 67.3%, p<0.001). Multivariate testing showed that age (odds ratio, 1.037 per 1 year increase; 95% CI, 1.004–1.071) and the presence of myalgia (odds ratio, 20.479; 95% CI, 4.266–368.206) were associated with the presence of RLSss. Conclusions This pilot study explored RLSss after COVID-19 vaccination and the results suggested that RLS might be one of the causes of adverse symptoms after COVID-19 vaccination. Further studies are required to confirm the relationship between RLS and COVID-19 vaccination.

Methods: Patients were recruited from the department of psychiatry at a university hospital.Participants were diagnosed using DSM-5 criteria by board certified psychiatrists. Their medical records were reviewed, and participants were put into three groups (Depression with suicide attempt, Depression with suicide ideation, and Normal as a control group). For statistical comparison, MANCOVA with gender as a covariate was used. Results: Similar to pervious research, the two Depression groups with high suicide risk showed significantly higher Emotional/Internalizing Dysfunction, Negative Emotionally/Neuroticism-Revised, Demoralization, Dysfunctional Negative Emotions, Suicidal/Death Ideation, Helplessness/ Hopelessness, Self-Doubt, Stress/Worry, and Cognitive complaints than the normal group. In the Depression with suicide attempt group, Behavioral/Externalizing Dysfunction scales were significantly higher than the Depression with suicide ideation group. Conclusion The results show the significant prediction of MMPI-2-RF scales for suicide risk.Severity of mental pain (EID) and impulsive acting-out tendency of mental pain (BXD) were identified as important psychological characteristics of depression patients with suicide risk. The limitations of this study and suggested directions for future research are also discussed.

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.

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.

To date, documentation of two doses of measles-containing vaccine (MCV) has been accepted as confirmation of measles immunity among healthcare workers (HCWs). However, we encountered measles in an HCW who had received two doses of MCV. A patient with measles was admitted to our hospital. Among 62 exposed HCWs, one nurse who had previously received two doses of MCV was shown to be negative for anti-measles immunoglobulin G (IgG), and was confirmed to have measles 14 days after exposure. Based on this experience, we suggest that all HCWs should be tested for anti-measles IgG to confirm their immunity to measles.

Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disorder that affects mainly salivary and lacrimal glands, but its cause remains largely unknown. Clinical data indicating that SS occurs in a substantial proportion of patients with lupus points to common pathogenic mechanisms underlying the two diseases. To address this idea, we asked whether SS develops in the lupus-prone mouse strain sanroque (SAN). Owing to hyper-activation of follicular helper T (Tfh) cells, female SAN mice developed lupus-like symptoms at approximately 20 wk of age but there were no signs of SS at that time. However, symptoms typical of SS were evident at approximately 40 wk of age, as judged by reduced saliva flow rate, sialadenitis, and IgG deposits in the salivary glands. Increases in serum titers of SS-related autoantibodies and numbers of autoantibody-secreting cells in cervical lymph nodes (LNs) preceded the pathologic manifestations of SS and were accompanied by expansion of Tfh cells and their downstream effector cells. Thus, our results suggest that chronic dysregulation of Tfh cells in salivary gland-draining LNs is sufficient to drive the development of SS in lupus-prone mice.
Animals ; Autoantibodies ; Autoimmunity ; Disease Models, Animal ; Female ; Humans ; Immunoglobulin G ; Lacrimal Apparatus ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Mice ; Saliva ; Salivary Glands ; Sialadenitis