OBJECTIVE: Posttraumatic embitterment disorder (PTED) is characterized by states of “embitterment”, characteristically similar to “Hwa-byung”, which is a Korean culture-bound syndrome. The present study aimed to assess diagnostic relationships between PTED and Hwa-byung. METHODS: A total of 290 participants completed our survey. PTED and Hwa-byung were diagnosed using a diagnostic interview and scale. Scales for depression, suicide ideation, and anger were used for evaluation. Fisher's exact tests and Mann-Whitney U tests were performed to evaluate diagnostic overlap between PTED and Hwa-byung, and associations of scale scores for depression, suicide ideation, and anger between the PTED, Hwa-byung, and non-diagnosed groups. Associations of these scales between the depressive and non-depressive groups, and suicidal and non-suicidal groups were also evaluated. RESULTS: Among the participants, 1.7% of the sample fit the diagnostic criteria for PTED and 2.1% fit the criteria for Hwa-byung. No individual fit the criteria for both. Anger scores were significantly higher in the Hwa-byung group than in the non-diagnostic group. There were not any significant differences in anger scores between the PTED and non-diagnostic groups. Depression scores were significantly higher in the PTED than in the non-diagnostic groups. In contrast, no significant differences were observed between depression scores in the Hwa-byung and non-diagnostic groups. CONCLUSION: These results suggest that PTED may be a disorder category that is distinct from Hwa-byung.
Anger ; Asian Continental Ancestry Group ; Depression ; Ethnopsychology ; Humans ; Suicide ; Weights and Measures

Correction for incorrect control groups (A, B, and C) at a Fig. 3. and Fig. 4. respectively. NPS 2014 20(4): 251-257.

OBJECTIVE: Bipolar disorder patients often show excessive goal-directed and pleasure-seeking behavior during manic episodes and reduced hedonic capacity during depressive episodes, indicating that bipolar disorder might involve altered reward processing. As such, bipolar disorder subjects have been reported to show impaired reward learning in situations requiring integration of reinforcements over time. In this study, we examined characteristics of reward learning in euthymic patients with bipolar disorder using a probabilistic reward task. METHODS: We recruited 23 euthymic patients with bipolar disorder and 47 healthy subjects for the probabilistic reward task. This task is a reward-based paradigm to produce a response bias, in which correct identifications of two ambiguous stimuli are differently rewarded. The other dependent measures were the discriminability, hit rate and reaction time. RESULTS: Relative to comparison subjects, bipolar patients showed a reduced acquisition of response bias toward the more frequently rewarded stimulus (p<0.01). The overall reward learning was positively correlated with state and trait anxiety levels in bipolar patients (p<0.01). No significant differences of discriminability, hit rates, and reaction time were found between bipolar patients and controls. CONCLUSION: These findings suggest that euthymic patients with bipolar disorder may have deficits in reward learning related to anxiety.
Anxiety ; Bias (Epidemiology) ; Bipolar Disorder ; Humans ; Learning ; Reaction Time ; Reinforcement (Psychology) ; Reward

OBJECTIVE: The development of treatment guidelines has emerged as an important element so as to standardize treatment and to provide clinicians with algorithms. From the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP): rapid cycling in 2002, we revised that in 2006. METHODS: The questionnaire to survey the expert opinion of medication for rapid cycling was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 7 questions, and each question includes various options. We classified the expert opinion to 3 categories based on the lowest category in which the confidence interval fell (6.5 < or = for first-line and 3.5< or = for second-line treatment). RESULTS: Generally, 'treatment of choice' for rapid cycling was not demonstrated. The first-line treatment is the combination of a mood stabilizer and an atypical antipsychotic. Combination of two mood stabilizers was preferred as next strategy. Divalproex and lithium were the first-line choice as mood stabilizer. Compared to the surveys in 2002, the preference for lamotrigine and atypical antipsychotics has increased while that of carbamazepine and antidepressant has decreased. CONCLUSION: With the result of the survey, the discussion in executive committee, and the evidences from clinical studies, we have revised KMAP-BP for rapid cycling.
Advisory Committees ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Expert Testimony ; Lithium ; Psychiatry ; Publications ; Surveys and Questionnaires ; Valproic Acid

OBJECTIVE: In 2002, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2002) was published to make clinical guidelines to understand and treat bipolar disorder, but due to recent reports of various studies and application of new drugs, the revision of treatment algorithm was inevitable. Therefore, we revised the KMAP-BP 2002 focused on the treatment strategies of bipolar depression. METHOD: The methods of this survey were similar to those of the KMAP-BP 2002. The review committee consisted of 70 experienced psychiatrists. Among the total 37 questions, 15 questions for bipolar depression were evaluated. We classified the expert opinions to 3 categories according to its confidence interval; first, second, and third line. Results: Compared to the previous algorithm, combination of mood stabilizers (MS) or atypical antipsychotics (AAP) and antidepressants is generally more recommended than antidepressant monotherapy for bipolar depression. Lithium and divalproex are the first-line treatment choices as well as MS. The preference for lamotrigine is increased, while that for carbamazepine is decreased. Olanzapine and quetiapine are preferred as the first-line AAP. Most antidepressants are not recommended as the first-line drug. The strategy for breakthrough of depression is changed into adding an antidepressant and/or AAP after combination of 2 MS. CONCLUSION: These results suggest that treatment of bipolar depression should be different from that of unipolar depression. The advanced new algorithm is considered to be useful and practical in the treatment of bipolar depression.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Depression ; Depressive Disorder ; Expert Testimony ; Lithium ; Psychiatry ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: As clinician, it is very difficult to choose the pharmacotherapeutic strategies of bipolar disorder because of various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recently, rapid development in the research of bipolar disorder and psychopharmacology, including atypical antipsychotics and new anticonvulsants, make it more difficult to choose the appropriate pharmacological options. Therefore, we decided to revise the Korean Medication Algorithm Project for Bipolar Disorder 2002 (KMAP-BP 2002) in order to provide more proper guideline for clinicians. METHODS: Like the previous version, KMAP-BP 2002, we performed the first survey using questionnaire comprising 37 special clinical situations and 645 selection items. Fifty-three members of the review committee completed the first survey. After the discussion of the results at the review committee meeting, we performed the second adjunctive survey. Finally, the executive committee analyzed the results and discussed the final production of algorithm considering scientific evidences. RESULTS: The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and atypical antipsychotics, monotherapy of mood stabilizer, or monotherapy of atypical antipsychotics. As mood stabilizers, divalproex and lithium are accepted as the first-line agents. As atypical antipsychotics, quetiapine, olanzapine and risperidone are recommended as the first-line. Overall, atypical antipsychotics and combination therapy are accepted more widely than before. Among mood stabilizers, the preference of divalproex are increasing and that of carbamazepine are decreasing. CONCLUSION: Based on the results of two surveys, the discussion in executive committee and review of evidences, we developed new algorithm presented here for manic episode. We expect this algorithm may provide clinicians good informations and advices about the treatment of bipolar disorder, manic episode.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Risperidone ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: Since the publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision due to rapid progress in the management for bipolar disorder. We revised KMAP-BP in 2006. METHODS: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 37 questions, and each question includes various sub-items. A part regarding treatment strategies for hypomanic episode and maintenance was newly investigated in this revision. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line) by chi-square-test. RESULTS: For acute manic episode, the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) is the optimal first-line treatment. Most reviewers recommended divalproex or lithium as a MS. Among AAPs, olanzapine, quetiapine and risperidone were most preferred. On breakthrough manic episode, the optimization of MS or adding AAP was recommended. For moderate bipolar depressed patients, a MS monotherapy or MS with an antidepressant was preferred. Combination of a MS and an antidepressant was recommended as a first-line treatment in severe non-psychotic depression. MS with an AAP and the triple combination of MS, AAP and an antidepressant were recommended for severe bipolar depression with psychotic features. Lithium and divalproex were the first-line choice as MS. Most antidepressants were recommended as a second-line drug. The strategy for breakthrough depression was changed to adding antidepressant after combination of two MS. The combination therapy (MS+AAP or MS+MS) was the most preferred treatment for rapid cycling bipolar patients. There was no 'treatment of choice' in maintenance treatment. In case of bipolar I mania without history of depression, a MS monotherapy was a firstline treatment. In maintenance management for bipolar II disorder, a MS monotherapy or the combinations of a MS and an AAP was preferred. Overall, the preference for lamotrigine and AAP was increased compared to the KMAP-BP 2002. Olanzapine and quetiapine were preferred as the first-line AAP. The carbamazepine and typical antipsychotics were markedly less favored in KMAP-2006 than KMAP-BP 2002. CONCLUSION: These results suggest that the medication strategies of bipolar disorder are rapidly changing and it reflects the recent studies and clinical experiences.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Depression ; Expert Testimony ; Humans ; Lithium ; Psychiatry ; Publications ; Surveys and Questionnaires ; Risperidone ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: Seoul National University Bundang Hospital is the first full digital hospital with electronic medical record(EMR) system in Korea. We evaluated the user's satisfaction on the EMR system at 15 months from its beginning. METHODS: A total of 105 doctors and 503 nurses participated in this study. The questionnaire was composed of four domains: user satisfaction between paper records and EMR, User perceived improvement of work efficiency with EMR, user interface satisfaction and advantage/ disadvantage of EMR. A Likert-type 5-point scale was used for the degree of satisfaction, with 5 indicating 'very satisfied'. RESULTS: Doctors were more satisfied with EMR system than paper records, especially on editing (3.33 vs. 2.73, p<0.05) and retrieval (3.68 vs. 2.23, p<0.05). However, the degree of satisfaction was not significantly different from that of paper records in terms of input (3.22 vs. 3.03, p>0.05). Nurses were more satisfied with EMR system than paper records, e.g., editing (3.51 vs. 2.74, p<0.05), retrieval (4.07 vs. 2.51, p<0.05) and input (3.82 vs. 2.90, p<0.05). Also, doctors and nurses showed satisfaction for most of user interfaces. CONCLUSION: Users seem to be satisfied with the EMR system. EMR system should have a flexible system to improve the input system, the structured forms, and the standardized terminology according to the need of users.
Electronic Health Records* ; Electronics, Medical ; Korea ; Surveys and Questionnaires ; Seoul*

OBJECTIVE: This study aims to describe the basic features of Electronic Medical Records at the Seoul National University Hospital and Seoul National University Bundang Hospital and to discuss the process we developed and adopted the system. We also aim to suggest potential risks and success factors in our processes. METHODS: Seoul National University Hospital, a tertiary teaching hospital with 100-year-old history, 1000 medical staffs, and 1700 in-patient beds has successfully adopted Electronic Medical Records system from October 2004 and runs very well for more than one year. Our system is fully integrated with Computerized Physician's Order Entry (CPOE) and Picture Archiving and Communication System (PACS). RESULTS: We identified that the key step for the successful adoption of the full system was to overcome physicians' resistance to their use of Electronic Medical Records and to help their earlier accommodation to new practice environment. We then found that five important success factors were the clinical leadership, adoption strategy, young doctors' participation, outsourcing of the department of information technology and the accumulated domain knowledge. Our experience shows it is important to expose young medical staffs to the change before the main Electronic Medical Records system opens and "patient-centered" was the most important concept to make these reform processes successful. CONCLUSION: Development and adoption of Electronic Medical Records at large teaching hospital are not easy but are very important and powerful tool for patient-centered medical practice.
Electronic Health Records* ; Hospitals, Teaching ; Humans ; Leadership ; Medical Staff ; Outsourced Services ; Seoul*

OBJECTIVES: This study aims to test the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), a screening instrument for bipolar disorder. METHODS: A total of 238 subjects (126 DSM-IV bipolar outpatients and 112 controls without psychiatric history) completed the K-MDQ. RESULTS: The Cronbach's alpha, used to measure the internal consistency of the scale, was high (0.88). Principal component analysis with varimax rotation revealed three factors, which explained 59.5% of the variance. Individual item correlations with the total score were all statistically significant (p<0.001). The mean total score of the K-MDQ was 8.48 in bipolar disorder and 4.51 in non-clinical participants. A total K-MDQ score of 7 or more excluding further two questions was chosen as the optimal cutoff, as it provided good sensitivity (0.75) and specificity (0.69). CONCLUSION: The results of this study showed adequate validity of the K-MDQ, suggesting that this instrument is useful for screening of bipolar disorder.
Bipolar Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders* ; Outpatients ; Principal Component Analysis ; Surveys and Questionnaires ; Sensitivity and Specificity