Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024.This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels—high, moderate, limited, or insufficient—while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as “convincingly supports” (“evidence established” in the 2024 NASEM report), “favors acceptance,” “favors rejection,” or “inadequate to accept or reject.” The CoVaSC has established an independent committee to conduct causality assessments using the weightof-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-ofevidence framework and to detail the considerations involved in its practical application in the CoVaSC.

This systematic review evaluated psychiatric adverse events (AEs) following vaccination against coronavirus disease 2019 (COVID-19). We included studies that reported or investigated psychiatric AEs in individuals who had received an approved COVID-19 vaccine in the Republic of Korea. Systematic electronic searches of Ovid-Medline, Embase, CENTRAL, and KoreaMed databases were conducted on March 22, 2023. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-randomized Studies 2.0. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023449422). Of the 301 articles initially selected, 7 were included in the final analysis. All studies reported on sleep disturbances, and 2 highlighted anxiety-related AEs. Sleep disorders like insomnia and narcolepsy were the most prevalent AEs, while depression was not reported. Our review suggests that these AEs may have been influenced by biological mechanisms as well as the broader psychosocial context of the COVID-19 pandemic. Although this study had limitations, such as a primary focus on the BNT162b2 vaccine and an observational study design, it offered a systematic, multi-vaccine analysis that fills a critical gap in the existing literature. This review underscores the need for continued surveillance of psychiatric AEs and guides future research to investigate underlying mechanisms, identify risk factors, and inform clinical management.

The COVID-19 Vaccine Safety Research Committee (CoVaSC) was established in November 2021 to address the growing need for independent, in-depth scientific evidence on adverse events (AEs) following coronavirus disease 2019 (COVID-19) vaccination. This initiative was requested by the Korea Disease Control and Prevention Agency and led by the National Academy of Medicine of Korea. In September 2022, the COVID-19 Vaccine Safety Research Center was established, strengthening CoVaSC’s initiatives. The center has conducted various studies on the safety of COVID-19 vaccines. During CoVaSC’s second research year, from September 29, 2022 to July 19, 2023, the center was restructured into 4 departments: Epidemiological Research, Clinical Research, Communication & Education, and International Cooperation & Policy Research. Its main activities include (1) managing CoVaSC and the COVID-19 Vaccine Safety Research Center, (2) surveying domestic and international trends in AE causality investigation, (3) assessing AEs following COVID-19 vaccination, (4) fostering international collaboration and policy research, and (5) organizing regular fora and training sessions for the public and clinicians. Causality assessments have been conducted for 27 diseases, and independent research has been conducted after organizing ad hoc committees comprising both epidemiologists and clinical experts on each AE of interest. The research process included protocol development, data analysis, interpretation of results, and causality assessment. These research outcomes have been shared transparently with the public and healthcare experts through various fora. The COVID-19 Vaccine Safety Research Center plans to continue strengthening and expanding its research activities to provide reliable, high-quality safety information to the public.

With the introduction of coronavirus disease 2019 (COVID-19) vaccines, the Korea Disease Control and Prevention Agency (KDCA) commissioned the National Academy of Medicine of Korea to gather experts to independently assess post-vaccination adverse events. Accordingly, the COVID-19 Vaccine Safety Research Committee (CoVaSC) was launched in November 2021 to perform safety studies and establish evidence for policy guidance. The CoVaSC established 3 committees for epidemiology, clinical research, and communication. The CoVaSC mainly utilizes pseudonymized data linking KDCA’s COVID-19 vaccination data and the National Health Insurance Service’s claims data. The CoVaSC’s 5-step research process involves defining the target diseases and organizing ad-hoc committees, developing research protocols, performing analyses, assessing causal relationships, and announcing research findings and utilizing them to guide compensation policies. As of 2022, the CoVaSC completed this research process for 15 adverse events. The CoVaSC launched the COVID-19 Vaccine Safety Research Center in September 2022 and has been reorganized into 4 divisions to promote research including international collaborative studies, long-/short-term follow-up studies, and education programs. Through these enhancements, the CoVaSC will continue to swiftly provide scientific evidence for COVID-19 vaccine research and compensation and may serve as a model for preparing for future epidemics of new diseases.

Objective: The cerebello-thalamic tract is the only efferent white matter (WM) bundle of the cerebellum that connects the cerebellum to the thalamus and has recently attracted much attention in obsessive-compulsive disorder (OCD) with its integral role in higher order cognitive functions commonly impaired in OCD patients. Previous neuroimaging studies have shown that the cerebello-thalamic circuit is functionally impaired in OCD patients. However, the WM integrity of the cerebello-thalamic tract in OCD, which may underly functional abnormalities of the cerebello-thalamic circuit, is not yet sufficiently understood. Therefore, the current study aimed to elucidate whether compromised cerebello-thalamic WM integrity is observed in medication-free OCD patients. Methods: In this study, diffusion tensor imaging was acquired from 106 medication-free OCD patients and 105 matched healthy controls (HCs). Probabilistic tractography was then used to reconstruct the cerebello-thalamic tract with accurate anatomical features. Three diffusion indices (fractional anisotropy, FA; mean diffusivity, MD; radial diffusivity, RD) were measured from the reconstructed bilateral cerebello-thalamic tract and then compared between groups. Results: We found that patients with OCD showed significantly increased MD and RD in the right cerebello-thalamic tract compared to HCs, and there was no difference in FA between groups. Conclusion Our findings may indicate the underlying structural abnormalities of the dysfunctional cerebello-thalamic circuit in OCD patients. Therefore, our findings are expected to provide novel insights into the pathophysiology of OCD on the cerebello-thalamic WM architecture, extending our knowledge from the existing functional neurobiological model of OCD.