OBJECTIVES: The objective of this study is to investigate differences in clinical characteristics between female panic disorder (PD) patients with abortion history (PD+A) and without abortion history (PD−A).METHODS: We examined data from 341 female patients diagnosed with PD. We divided the patients with PD into PD+A (82 patients) and PD−A (259 patients) to compare demographic and clinical characteristics. The following instruments were applied : stress coping strategies, NEO-neuroticism, the Anxiety Sensitivity Index-Revised (ASI-R), the Albany Panic and Phobia Questionnaire (APPQ), the Beck Depression Inventory, the Beck Anxiety Inventory (BAI) and the Sheehan Disability Scale.RESULTS: Compared to the PD−A, the PD+A group showed no significant difference in coping strategies. However, significantly higher scores in neuroticism, the ASI-R, the APPQ and the BAI were observed. In terms of health-related disability, the PD+A group did not show significant difference.CONCLUSIONS: Our results suggest that the PD+A group may differ from the PD−A group in trait markers such as neuroticism and anxiety sensitivity, and abortion history may be associated with panic-related symptom severity. Our study suggests that further consideration is needed on such clinical characteristics in PD patients with abortion history.
Abortion, Induced ; Anxiety ; Depression ; Female ; Humans ; Panic Disorder ; Panic ; Phobic Disorders

Topical corticosteroids are widely prescribed and used. As interest in the use of corticosteroids grows, people are increasingly exposed to misinformation that causes an excessive fear of side effects. Topical corticosteroids mainly have vasoconstrictive, anti-inflammatory, immunosuppressive, and anti-proliferative effects. Corticosteroids are prescribed based on the patient's age, the site and severity of the lesion, and patient compliance. Adverse reactions include skin atrophy, telangiectasia, hypopigmentation, and steroid-induced acne. To prevent the side effects of topical corticosteroids and to minimize phobias about topical corticosteroids in the future, we suggest providing proper information and education for both physicians and patients about the safety, efficacy, and proper use of topical steroids. In this article, we review basic information about topical corticosteroids and guidelines for their use.
Acne Vulgaris ; Adrenal Cortex Hormones ; Atrophy ; Education ; Humans ; Hypopigmentation ; Patient Compliance ; Phobic Disorders ; Skin ; Steroids ; Telangiectasis

OBJECTIVE: To observe the effectiveness of acupuncture on claustrophobia, and to explore the effects of acupoint specificity on claustrophobia. METHODS: This was an evaluator-blinded randomized controlled trial. One hundred and sixty patients who presented with claustrophobia during magnetic resonance imaging examination were randomized into an acupoint group, a non-acupoint group, a sham-acupoint group and a blank group, 40 cases in each one. The patients in the acupoint group were treated with acupuncture at Zhaohai (KI 6), Taichong (LR 3), Lingdao (HT 4), Neiguan (PC 6), Shenmen (HT 7), Danzhong (CV 17), Baihui (GV 20) and Fengchi (GB 20). The patients in the non-acupoint group were treated with acupuncture at points 0.5 next to the acupoints above. The patients in the sham-acupoint group were treated with acupuncture at acupoints not closely correlated to claustrophobia in corresponding segment. All the acupuncture was given once. No treatment was used in the blank group. The state anxiety questionnaire (S-AI) was observed in all the patients at the end of MRI examination before and after treatment. The clinical therapeutic effects were compared among four groups. RESULTS: Compared before treatment, the S-AI score was reduced in the acupoint group, non-acupoint group and sham-acupoint group after treatment (<0.05, <0.01); the differences of S-AI score before and after treatment in the blank group were not statistically significant (>0.05). After treatment, the S-AI scores in the acupoint group, non-acupoint group and sham-acupoint group was lower than that in the blank group (<0.05, <0.01), and the differences of S-AI score were higher than that in the blank group (<0.01). The S-AI score in the acupoint group was lower than that in the non-acupoint group and sham-acupoint group (<0.05), and the difference of S-AI score was higher than those in the non-acupoint group and sham-acupoint group (<0.05). The difference of S-AI score in the non-acupoint group was higher than that in sham-acupoint group (<0.05). The total effective rate was 92.5% (37/40) in the acupoint group, which was significantly superior to 25.0% (10/40) in the non- acupoint group, 17.5% (7/40) in the sham-acupoint group and 5.0% (2/40) in the blank group (<0.05, <0.01). CONCLUSION Acupuncture showes superior effect on claustrophobia, and its tranquilizing effect may be related with acupoint specificity.
Acupuncture Points ; Anxiety ; Humans ; Phobic Disorders ; therapy ; Surveys and Questionnaires

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.
Autopsy ; Child ; Child Development ; Death, Sudden ; Diagnosis ; Forensic Pathology ; Humans ; Infant ; Infant Death ; Needles ; Phlebotomy ; Phobic Disorders ; Reflex ; Seizures

PURPOSE: There is an unmet need for the treatment of moderate-to-severe atopic dermatitis (AD), leading to variation in management strategies. To investigate distinct features and treatment modalities according to physicians' specialties, we collected data on the current treatment approach to moderate-to-severe AD among allergists, pediatric allergists and dermatologists in Korea. METHODS: This questionnaire-based study was administered to physicians from the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI), Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD), and Korean Atopic Dermatitis Association (KADA). RESULTS: A total of 93 physicians participated in the study; 64.5% were pediatric allergists and 31.2% were dermatologists. The major patient age groups were “less than 5 years” for 100% of pediatric allergists and “6–12 years old” for 38% of dermatologists. The proportion of patients with moderate-to-severe AD was higher for dermatologists and allergists compared to pediatric allergists. Physicians agreed on the necessity of education including demonstration of basic skin care and application of topical therapies (88.2%), nutritional consultation (83.9%) and psychological counseling (75.3%). However, less than half were able to educate and counsel their patients in real practice. There were noticeable differences in first-line treatment among physician groups. For pediatric allergists, the order of preferred systemic treatment was wet wrap therapy, systemic corticosteroids and oral cyclosporin. Dermatologists ranked cyclosporin, phototherapy, and systemic corticosteroids as first-line treatment regimens. Major reported barriers to proper management were steroid phobia, unproven complementary and alternative medicine, lack of education, and the unreasonable insurance system. CONCLUSIONS: Our findings suggest there are distinct differences in moderate-to-severe AD treatment according to physicians' specialties. Medical policy changes along with governmental supports are required in order to implement the ideal approach in real practice. For moderate-to-severe AD, a consensus on the approach to optimal management should be reached for the best outcomes, based on further randomized controlled trials.
Adrenal Cortex Hormones ; Allergy and Immunology ; Asthma ; Complementary Therapies ; Consensus ; Counseling ; Cyclosporine ; Dermatitis, Atopic* ; Education ; Humans ; Hypersensitivity ; Insurance ; Korea* ; Phobic Disorders ; Phototherapy ; Skin Care

OBJECTIVES: The objective of this study was to investigate the differences in sociodemographic and clinical characteristics, temperaments, and quality of life between panic disorder (PD) patients with and without major depressive disorder (PD+MDD and PD−MDD patients, respectively). METHODS: We compared 411 PD−MDD and 219 PD+MDD patients. All patients who were drug-free for at least 1 month were assessed at initial outpatient visits before the administration of medication. The following instruments were used for assessment: the NEO Personality Inventory-Neuroticism (NEO-N) ; the Temperament and Character Inventory-Harm Avoidance (TCI-HA) ; the State-Trait Anxiety Inventory (STAI) ; the Intolerance of Uncertainty Scale-Short (IUS); the Anxiety Sensitivity Index-Revised (ASI-R); the Beck Depression Inventory (BDI) ; the Beck Anxiety Inventory (BAI); the Penn State Worry Questionnaire (PSWQ) ; the Generalized Anxiety Disorder for 7 item (GAD-7) ; the Albany Panic and Phobia Questionnaire (APPQ) ; the Panic Disorder Severity Scale (PDSS) ; the Early Trauma Inventory Self Report-Short Form (ETISR-SF) ; the Scale for Suicidal Ideation (SSI) ; the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) ; the Sheehan Disability Scale (SDS) ; and the Short Form health survey (SF-36). RESULTS: Compared to the PD−MDD patients, the PD+MDD patients were younger and more likely to be unmarried. They showed higher rates of unemployment, lower levels of education and income, younger age of onset, more previous suicide attempts, a greater incidence of agoraphobia, and more previous treatments. The PD+MDD patients showed significantly higher scores on the NEO-N, the TCI-HA, the STAI, the IUS, the ASI-R, the BDI, the BAI, the PSWQ, the GAD-7, the APPQ, the PDSS, the ETISR-SF, and the SSI. In addition, the PD+MDD patients showed significantly lower quality of life than did the PD−MDD patients. In contrast with previous studies, we observed no significant differences between the two groups in terms of gender, duration until treatment, and psychiatric comorbidities. CONCLUSIONS: This study showed that the PD+MDD patients have more early trauma experiences, higher levels of anxiety-related temperaments, more severe panic and depressive symptoms, and lower quality of life than the PD−MDD patients.
Age of Onset ; Agoraphobia ; Anxiety ; Anxiety Disorders ; Comorbidity ; Depression ; Depressive Disorder, Major* ; Education ; Health Surveys ; Humans ; Incidence ; Outpatients ; Panic Disorder* ; Panic* ; Phobic Disorders ; Quality of Life ; Single Person ; Suicidal Ideation ; Suicide ; Temperament ; Uncertainty ; Unemployment ; World Health Organization

OBJECTIVES: This study aimed to identify the process of psychosocial assessment, the experience of intervention, and the improvement after the disaster that Danwon high school students survived from the sinking of the Motor Vessel (MV) Sewol in South Korea on April 16, 2014. METHODS: We conducted in-depth qualitative research using individual interviews from January to February 2017. Twenty-one of 75 Danwon high school students survived by the MV Sewol disaster were studied. Two interviewers participated in the in-depth interview. Interviews were transcribed verbatim, coded, and analyzed through content analysis based on psychosocial assessment and intervention after the disaster. RESULTS: Twenty-one participants were 20 years old, where 10 were male (47.62%), and 11 were female (52.38%). More than 75% of the interviewed students felt that mental health services were needed, and more than 85% required mental health assessments. Regarding psychiatric symptoms, the students reported that they suffered depression and insomnia (19.05%), anxiety (14.29%), nightmares and phobias (9.52%), and difficulties regarding concentration, aggression, and game addiction (4.76%). CONCLUSION: Despite survivors experiencing the same disaster, there were differences in their responses to mental health assessments and interventions experienced during the three years, and conflicting opinions were reported. In planning future evaluations and interventions, it is necessary for strategies to cope with flexibly to consider the characteristics and symptoms of the survivors while maintaining principles.
Aggression ; Anxiety ; Depression ; Disasters* ; Dreams ; Female ; Humans ; Korea ; Male ; Mental Health Services ; Mental Health* ; Phobic Disorders ; Qualitative Research ; Sleep Initiation and Maintenance Disorders ; Survivors*

OBJECTIVE: The present study aimed to identify risk factors for future SI and to predict individual-level risk for future or persistent SI among college students. METHODS: Mental health check-up data collected over 3 years were retrospectively analyzed. Students were categorized as suicidal ideators and non-ideators at baseline. Logistic regression analyses were performed separately for each group, and the predicted probability for each student was calculated. RESULTS: Students likely to exhibit future SI had higher levels of mental health problems, including depression and anxiety, and significant risk factors for future SI included depression, current SI, social phobia, alcohol problems, being female, low self-esteem, and number of close relationships and concerns. Logistic regression models that included current suicide ideators revealed acceptable area under the curve (AUC) values (0.7–0.8) in both the receiver operating characteristic (ROC) and precision recall (PR) curves for predicting future SI. Predictive models with current suicide non-ideators revealed an acceptable level of AUCs only for ROC curves. CONCLUSION: Several factors such as low self-esteem and a focus on short-term rather than long-term outcomes may enhance the prediction of future SI. Because a certain range of SI clearly necessitates clinical attention, further studies differentiating significant from other types of SI are necessary.
Anxiety ; Area Under Curve ; Depression ; Female ; Humans ; Logistic Models ; Mass Screening* ; Mental Health* ; Phobic Disorders ; Retrospective Studies ; Risk Factors ; ROC Curve ; Suicidal Ideation* ; Suicide

OBJECTIVE: Tamoxifen is an estrogen receptor antagonist used to prevent recurrence of breast cancer, which may provoke depression and anxiety and increase follicle-stimulating hormone (FSH) to patients. We compared anxiety and depression symptoms and FSH levels who received conventional tamoxifen alone and combination treatment of goserelin, a gonadotropin-releasing hormone (GnRH) analogue, with tamoxifen. METHODS: Sixty-four premenopausal women with hormone receptor-positive early-stage breast cancer were included and were assigned randomly to receive either tamoxifen and goserelin combination or tamoxifen alone for 12 months. The participants were evaluated blindly using the Hamilton Depression and Anxiety Rating Scale, the Beck Depression Rating Scale, and the Albany Panic and Phobia Questionnaire (APPQ). Blood FSH levels were assessed at baseline, 6 and 12 months. RESULTS: A significant time×group difference was detected in the agoraphobia trends subscale of the APPQ and in FSH levels. The combination group showed significantly less increases in agoraphobia subscale of APPQ and greater decreases in FSH level than those in the tamoxifen-alone group from baseline to 12 months of treatment. No significant differences for age, tumor grade, body mass index, or family history were found at baseline between the two groups. CONCLUSION: Our results suggest that the combination treatment of tamoxifen and goserelin resulted in less agoraphobia than tamoxifen alone in premenopausal women with breast cancer, which may associated with FSH suppression of goserelin.
Agoraphobia* ; Anxiety ; Body Mass Index ; Breast Neoplasms* ; Breast* ; Depression ; Estrogens ; Female ; Follicle Stimulating Hormone* ; Gonadotropin-Releasing Hormone ; Goserelin* ; Humans ; Panic ; Phobic Disorders ; Prospective Studies* ; Recurrence ; Tamoxifen*

BACKGROUND: Topical and oral steroids are widely prescribed in dermatology. While interest in steroid use has increased rapidly, people have also acquired misinformation that causes rampant fears. OBJECTIVE: To identify fears and misunderstandings about steroid use by comparing doctors' attitudes and treatment and non-treatment group experiences with steroid use. METHODS: A total of 346 participants including outpatients who visited the Department of Dermatology at Hallym University Sacred Heart Hospital, physicians who work at the hospital, and visitors to its Department of Occupational and Environmental Medicine completed questionnaires. RESULTS: The topical treatment group had a high response rate of 46.7% regarding feeling “somewhat anxious” about using topical steroids, while the oral treatment group had a high response rate of 53.8% regarding feeling “somewhat anxious” about using oral steroids. With respect to information about the adverse effects of steroid use, those in the non-experience group obtained their information mostly from the Internet (67.5%) or the media (47.5%), whereas those in the topical treatment group obtained their information from product guides (48%) and doctors (38.7%). Meanwhile, the oral treatment group acquired information from acquaintances (39.7%) or doctors (32.1%). CONCLUSION: Dermatologists must evaluate the validity of the information that patients have about the adverse effects of topical and oral steroid use as well as the resulting phenomenon of steroid phobia. If the information possessed by patients is inaccurate, clinicians must provide a full understanding and proper education to enhance patient satisfaction and treatment compliance and success rates.
Compliance ; Dermatology ; Education ; Environmental Medicine ; Friends ; Heart ; Humans ; Internet ; Outpatients ; Patient Satisfaction ; Phobic Disorders ; Steroids