1.Factors Affecting Clozapine Adherence in Patients With Schizophrenia: A Qualitative Study
Sung Moon CHOI ; Myung Jae BAIK ; Won Sub KANG ; Ah Rah LEE ; Jong Woo PAIK ; Sang Min LEE
Journal of Korean Neuropsychiatric Association 2025;64(4):277-288
Objectives:
This study examined the psychosocial factors that influence the continuation of clozapine use among individuals with schizophrenia. This examination was conducted through indepth qualitative interviews.
Methods:
Thirty-one adults diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) who had been taking Clozapine ® for at least 3 months were interviewed. Data were collected from May to October 2024 and analyzed using Braun and Clarke’s thematic analysis.
Results:
Two overarching themes emerged: 1) transformation of perceptions and engagement with treatment, including initial resistance stemming from severe symptoms and lack of insight, experiences of coercive interventions, rebuilding trust in the mental health system, and evolving attitudes toward psychiatric medications; and 2) personal recovery and social support, encompassing coping with side effects, recognizing symptom improvement and renewed hope, and the pivotal roles of family and therapeutic alliance. Trust in healthcare providers and emotional support from family were central to sustained adherence to clozapine.
Conclusion
Sustained clozapine use in schizophrenia patients is influenced by intertwined psychological, relational, and contextual factors. Acceptance of treatment was supported by symptom improvement, family support, and trust in healthcare providers. These elements contributed to medication adherence and broader functional recovery. A person-centered, integrated approach is essential to promote continued use and long-term outcomes.
2.Association Between Gene Polymorphisms of RSPO2 of the Wnt Signaling Pathway and Schizophrenia in the Korean Population
Ah Rah LEE ; Hae Jeong PARK ; Won Sub KANG ; Jong Woo KIM
Psychiatry Investigation 2025;22(12):1339-1349
Objective:
The study aimed to investigate whether RSPO2 gene polymorphisms are associated with schizophrenia susceptibility, focusing on five specific single nucleotide polymorphisms (SNPs). Additionally, the study evaluated the expression of Rspo2 in a schizophrenic-like mouse model and examined its relationship with clinical symptoms.
Methods:
The study included 159 schizophrenia patients and 448 controls. Clinical symptoms were assessed using the Operational Criteria Checklist for Psychotic Illness. Genotyping of five RSPO2 SNPs was performed to identify potential genetic associations with schizophrenia. Rspo2 mRNA expression levels were measured in the brains of MK-801-induced schizophrenic-like mice. Functional analysis of the rs374810 SNP was conducted using a luciferase assay to evaluate its effect on gene activity. Statistical analyses were used to compare genotype and allele frequencies and assess correlations with clinical outcomes.
Results:
Significant associations were found between schizophrenia and two SNPs, rs374810 and rs423940. The A allele of rs374810 and the T allele of rs423940 were linked to an increased risk of schizophrenia (p=0.0049 and p=0.0044, respectively). Functional analysis revealed that the A allele of rs374810 significantly increased luciferase activity compared to the G allele, indicating a potential functional role. RSPO2 expression was also altered in the schizophrenic-like mouse model, suggesting its involvement in schizophrenia pathogenesis.
Conclusion
The findings indicate that RSPO2 gene polymorphisms, particularly rs374810 and rs423940, may contribute to schizophrenia susceptibility. Therefore, RSPO2 expression may be associated with the susceptibility to schizophrenia in the Korean population.
3.Characteristics of High-Risk Groups for Suicide in Korea Before and After the COVID-19 Pandemic: K-COMPASS Cohort Study
Jeong Hun YANG ; Dae Hun KANG ; C. Hyung Keun PARK ; Min Ji KIM ; Sang Jin RHEE ; Min-Hyuk KIM ; Jinhee LEE ; Sang Yeol LEE ; Won Sub KANG ; Seong-Jin CHO ; Shin Gyeom KIM ; Se-Hoon SHIM ; Jung-Joon MOON ; Jieun YOO ; Weon-Young LEE ; Yong Min AHN
Journal of Korean Neuropsychiatric Association 2024;63(4):246-259
Objectives:
This study examined the changes in the characteristics of high-risk suicide groups in South Korea before and after the COVID-19 pandemic using the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) cohort.
Methods:
The K-COMPASS is a longitudinal cohort study that started in 2015. The participants included suicide attempters and individuals with suicidal ideation from various hospitals and mental health centers in South Korea. This study compared the sociodemographic and psychiatric characteristics of 800 participants from the first cohort (2015–2019) with 511 participants from the second and third cohorts (2019–2024). Data were collected through structured interviews and validated scales.
Results:
The second and third cohort participants were younger, had a higher proportion of females, and exhibited more severe psychiatric symptoms and higher suicidal risk than the first cohort. The prevalence of physical illnesses decreased, while the use of psychiatric medications and the severity of mental health issues increased. In addition, significant sociodemographic changes were observed, such as higher educational levels and urban residency.
Conclusion
Significant shifts in the characteristics of high-risk suicide groups were observed during the COVID-19 pandemic, highlighting the need for targeted mental health interventions focusing on younger individuals and females to prevent suicide in high-risk groups.
4.Breast Cancer Statistics in Korea, 2021
Chihwan David CHA ; Chan Sub PARK ; Hee-Chul SHIN ; Jaihong HAN ; Jung Eun CHOI ; Joo Heung KIM ; Kyu-Won JUNG ; Sae Byul LEE ; Sang Eun NAM ; Tae In YOON ; Young-Joon KANG ; Zisun KIM ; So-Youn JUNG ; Hyun-Ah KIM ;
Journal of Breast Cancer 2024;27(6):351-361
The Korean Breast Cancer Society (KBCS) has collected nationwide registry data on clinicopathologic characteristics and treatment since 1996. This study aimed to analyze the clinical characteristics of breast cancer in Korea and assess changes in breast cancer statistics for 2021 using data from the KBCS registry and the Korean Central Cancer Registry. In 2021, 34,628 women were newly diagnosed with breast cancer. The median age of women diagnosed with breast cancer was 53.4 years, with the highest incidence occurring in the 40–49 age group. The most common molecular subtype was hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative, accounting for 69.1% of cases, while HER2-positive subtypes comprised 19.3%. During the coronavirus disease 2019 pandemic, the national breast cancer screening rate declined. However, the incidence of early-stage breast cancer (stages 0 and I) continued to increase, accounting for 65.6% of newly diagnosed cases in 2021. Our results showed that the overall survival rate for patients with breast cancer has improved, primarily due to a rise in early-stage diagnoses and advancements in treatment.
5.Characteristics of High-Risk Groups for Suicide in Korea Before and After the COVID-19 Pandemic: K-COMPASS Cohort Study
Jeong Hun YANG ; Dae Hun KANG ; C. Hyung Keun PARK ; Min Ji KIM ; Sang Jin RHEE ; Min-Hyuk KIM ; Jinhee LEE ; Sang Yeol LEE ; Won Sub KANG ; Seong-Jin CHO ; Shin Gyeom KIM ; Se-Hoon SHIM ; Jung-Joon MOON ; Jieun YOO ; Weon-Young LEE ; Yong Min AHN
Journal of Korean Neuropsychiatric Association 2024;63(4):246-259
Objectives:
This study examined the changes in the characteristics of high-risk suicide groups in South Korea before and after the COVID-19 pandemic using the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) cohort.
Methods:
The K-COMPASS is a longitudinal cohort study that started in 2015. The participants included suicide attempters and individuals with suicidal ideation from various hospitals and mental health centers in South Korea. This study compared the sociodemographic and psychiatric characteristics of 800 participants from the first cohort (2015–2019) with 511 participants from the second and third cohorts (2019–2024). Data were collected through structured interviews and validated scales.
Results:
The second and third cohort participants were younger, had a higher proportion of females, and exhibited more severe psychiatric symptoms and higher suicidal risk than the first cohort. The prevalence of physical illnesses decreased, while the use of psychiatric medications and the severity of mental health issues increased. In addition, significant sociodemographic changes were observed, such as higher educational levels and urban residency.
Conclusion
Significant shifts in the characteristics of high-risk suicide groups were observed during the COVID-19 pandemic, highlighting the need for targeted mental health interventions focusing on younger individuals and females to prevent suicide in high-risk groups.
6.Characteristics of High-Risk Groups for Suicide in Korea Before and After the COVID-19 Pandemic: K-COMPASS Cohort Study
Jeong Hun YANG ; Dae Hun KANG ; C. Hyung Keun PARK ; Min Ji KIM ; Sang Jin RHEE ; Min-Hyuk KIM ; Jinhee LEE ; Sang Yeol LEE ; Won Sub KANG ; Seong-Jin CHO ; Shin Gyeom KIM ; Se-Hoon SHIM ; Jung-Joon MOON ; Jieun YOO ; Weon-Young LEE ; Yong Min AHN
Journal of Korean Neuropsychiatric Association 2024;63(4):246-259
Objectives:
This study examined the changes in the characteristics of high-risk suicide groups in South Korea before and after the COVID-19 pandemic using the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) cohort.
Methods:
The K-COMPASS is a longitudinal cohort study that started in 2015. The participants included suicide attempters and individuals with suicidal ideation from various hospitals and mental health centers in South Korea. This study compared the sociodemographic and psychiatric characteristics of 800 participants from the first cohort (2015–2019) with 511 participants from the second and third cohorts (2019–2024). Data were collected through structured interviews and validated scales.
Results:
The second and third cohort participants were younger, had a higher proportion of females, and exhibited more severe psychiatric symptoms and higher suicidal risk than the first cohort. The prevalence of physical illnesses decreased, while the use of psychiatric medications and the severity of mental health issues increased. In addition, significant sociodemographic changes were observed, such as higher educational levels and urban residency.
Conclusion
Significant shifts in the characteristics of high-risk suicide groups were observed during the COVID-19 pandemic, highlighting the need for targeted mental health interventions focusing on younger individuals and females to prevent suicide in high-risk groups.
7.Breast Cancer Statistics in Korea, 2021
Chihwan David CHA ; Chan Sub PARK ; Hee-Chul SHIN ; Jaihong HAN ; Jung Eun CHOI ; Joo Heung KIM ; Kyu-Won JUNG ; Sae Byul LEE ; Sang Eun NAM ; Tae In YOON ; Young-Joon KANG ; Zisun KIM ; So-Youn JUNG ; Hyun-Ah KIM ;
Journal of Breast Cancer 2024;27(6):351-361
The Korean Breast Cancer Society (KBCS) has collected nationwide registry data on clinicopathologic characteristics and treatment since 1996. This study aimed to analyze the clinical characteristics of breast cancer in Korea and assess changes in breast cancer statistics for 2021 using data from the KBCS registry and the Korean Central Cancer Registry. In 2021, 34,628 women were newly diagnosed with breast cancer. The median age of women diagnosed with breast cancer was 53.4 years, with the highest incidence occurring in the 40–49 age group. The most common molecular subtype was hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative, accounting for 69.1% of cases, while HER2-positive subtypes comprised 19.3%. During the coronavirus disease 2019 pandemic, the national breast cancer screening rate declined. However, the incidence of early-stage breast cancer (stages 0 and I) continued to increase, accounting for 65.6% of newly diagnosed cases in 2021. Our results showed that the overall survival rate for patients with breast cancer has improved, primarily due to a rise in early-stage diagnoses and advancements in treatment.
8.Can Pre-Transplant Psychometric Testing Predict Tacrolimus Intrapatient Variability After Living Kidney Transplantation?
Ah Rah LEE ; Sang Min LEE ; Won Sub KANG ; Ah Rang CHO ; Jong Woo KIM ; Jin Kyung PARK
Psychiatry Investigation 2024;21(7):718-725
Objective:
Tacrolimus intrapatient variability (Tac IPV) has been considered a marker for post-graft risk. We investigated pre-transplant psychometric testing to predict Tac IPV after living kidney transplantation.
Methods:
Minnesota Multiphasic Personality Inventory-2 (MMPI-2) examined during pre-transplant evaluation by 102 recipients were analyzed. Subjects were divided into two groups, low IPV (L-IPV) and high IPV (H-IPV), by cutoffs of Tac IPV: median of 24 and value of 30. T-scores of MMPI-2 scales were used to analyze difference between L-IPV and H-IPV using independent t-tests. Stepwise multiple logistic regression was used to test whether MMPI-2 scales affected Tac IPV. Confusion matrix of logistic regression was used to explain statistical power. Cutoff values of significant scales for H-IPV were analyzed by constructing receiver operating characteristic curves.
Results:
Hysteria (Hy) and depression (D) scale scores and Tac IPV were associated in IPV 24 (odds ratio [OR]: 1.08, p<0.01 for Hy; OR: 0.93, p<0.01 for D) and IPV 30 models (OR: 1.09, p<0.01 for Hy; OR: 0.92, p<0.01 for D). Paranoia (Pa) scale scores were associated with Tac IPV in IPV 24 model (OR=1.10, p<0.01) and were significantly higher in H-IPV 24 (p<0.01). F1 scores of confusion matrix in IPV 24 and 30 models were 0.70 and 0.71, respectively. Cutoffs of Hy, D, and Pa scales were 51, 57, and 47, respectively.
Conclusion
MMPI-2 profile is suggested as a predictor for high Tac IPV after living kidney transplantation.
9.Development of a Clinical Guideline for Suicide Prevention in Psychiatric Patients Based on the ADAPTE Methodology
Jeong Hun YANG ; Jieun YOO ; Dae Hun KANG ; C. Hyung Keun PARK ; Sang Jin RHEE ; Min Ji KIM ; Sang Yeol LEE ; Se-Hoon SHIM ; Jung-Joon MOON ; Seong-Jin CHO ; Shin Gyeom KIM ; Min-Hyuk KIM ; Jinhee LEE ; Won Sub KANG ; Weon-Young LEE ; Yong Min AHN
Psychiatry Investigation 2024;21(10):1149-1166
Objective:
Suicide is a significant public health issue, with South Korea having the highest suicide rate among Organisation for Economic Cooperation and Development countries. This study aimed to develop clinical guidelines for suicide prevention in psychiatric patients in Korea using the ADAPTE methodology.
Methods:
The development process involved a comprehensive review of literature, expert consultations, and consensus-building using the Nominal Group Technique and Delphi method. The guidelines focus on evidence-based psychiatric treatments, including both pharmacological and non-pharmacological approaches, tailored to the Korean context. Key findings underscoring the need for standardized treatment protocols for patients with major psychiatric disorders, including bipolar disorder, major depressive disorder, and schizophrenia.
Results:
The guidelines incorporate treatments like lithium, clozapine, atypical antipsychotics, electroconvulsive therapy, and cognitive behavioral therapy, which have shown effectiveness in suicide prevention. Applicability and acceptability within Korea’s healthcare system were addressed, ensuring feasibility given the country’s medical insurance coverage and accessibility. The guidelines were validated through expert reviews and Delphi rounds, achieving consensus on the final recommendations.
Conclusion
The developed guidelines provide a structured, evidence-based approach to reducing suicide rates among psychiatric patients in Korea. Future research will focus on expanding these guidelines to include screening protocols for high-risk groups.
10.Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study
Jeong Hun YANG ; C. Hyung Keun PARK ; Sang Jin RHEE ; Dae Hun KANG ; Min Ji KIM ; Hyun Jeong LEE ; Sang Yeol LEE ; Se-Hoon SHIM ; Jung-Joon MOON ; Seong-Jin CHO ; Shin Gyeom KIM ; Min-Hyuk KIM ; Jinhee LEE ; Won Sub KANG ; Jieun YOO ; Weon-Young LEE ; Yong Min AHN
Journal of Korean Medical Science 2024;39(31):e226-
Background:
Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness.In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older.
Methods:
We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS).The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model.
Results:
In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years.
Conclusion
Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.

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