Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Artificial intelligence (AI) is widely used as an auxiliary device to diagnosis and treat mental illness, and the scope of its use is gradually expanding. It is widely used as a tool to assist diagnosis in various fields such as radiology and ophthalmology. Meanwhile, in psychiatry, the use of AI has been limited so far due to the lack of a specific objective test for diagnosis and the reliability of medical records for sensitive records such as suicide attempts. However, AI can detect people’s behavior and facial expressions changes more sensitively and more accurately find the correlation between quantitative neurophysiological test results and behavior and emotions. Nowadays, AI is useful as an auxiliary tool in diagnosing not only pediatric and adolescent mental disorders such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), but also affective disorders and psychotic disorders. AI is also actively used to treat insomnia, ASD, ADHD, cognitive dysfunction, depression, anxiety disorders, substance use disorders, and schizophrenia. Many psychiatrists are still cautious about the use of AI. There are concerns that AI cannot replace the doctorpatient relationship, which is the most important element of traditional psychotherapy. Nevertheless, AI can diagnose psychiatric disorders more accurately and can also be useful in improving patients’ symptoms and quality of life through AI or digital treatments. I hope that psychiatrists to contribute to the treatment of human mental illness by becoming users, supervisors, and monitors of AI.

Background: Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group. Methods: Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18–64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group. Results: Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01). Conclusion Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.

Objective: This study aimed to use deep learning (DL) to develop a cost-effective and accessible screening tool to improve the detection of cognitive decline, a precursor of Alzheimer’s disease (AD). This study integrating a comprehensive battery of neuropsychological tests adjusted for individual demographic variables such as age, sex, and education level. Methods: A total of 2,863 subjects with subjective cognitive complaints who underwent a comprehensive neuropsychological assessment were included. A random forest classifier was used to discern the most predictive test combinations to distinguish between dementia and nondementia cases. The model was trained and validated on this dataset, focusing on feature importance to determine the cognitive tests that were most indicative of decline. Results: Subjects had a mean age of 72.68 years and an average education level of 7.62 years. The DL model achieved an accuracy of 82.42% and an area under the curve of 0.816, effectively classifying dementia. Feature importance analysis identified significant tests across cognitive domains: attention was gauged by the Trail Making Test Part B, language by the Boston Naming Test, memory by the Rey Complex Figure Test delayed recall, visuospatial skills by the Rey Complex Figure Test copy score, and frontal function by the Stroop Test Word reading time. Conclusion This study showed the potential of DL to improve AD diagnostics, suggesting that a wide range of cognitive assessments could yield a more accurate diagnosis than traditional methods. This research establishes a foundation for future broader studies, which could substantiate the approach and further refine the screening tool.

Objective: We aimed to identify the expectations and preferences for medication and medical decision-making in patients with major psychiatric disorders. Methods: A survey was conducted among patients with major psychiatric disorders who visited psychiatric outpatient clinics at 15 hospitals between 2016 and 2018 in Korea. The survey consisted of 12 questions about demographic variables and opinions on their expectations for medication, important medical decision-makers, and preferred drug type. The most preferred value in each category in the total population was identified, and differences in the preference ratio of each item among the disease groups were compared. Results: A total of 707 participants were surveyed. In the total population, patients reported high efficacy (44.01%±21.44%) as the main wish for medication, themselves (37.39%±22.57%) and a doctor (35.27%±22.88%) as the main decision makers, and tablet/capsule (36.16%±30.69%) as the preferred type of drug. In the depressive disorders group, the preference ratio of high efficacy was significantly lower, and the preference ratio of a small amount was significantly higher than that of the psychotic disorder and bipolar disorder groups. The preference ratio of a doctor as an important decision maker in the bipolar disorder group was higher compared to the other groups. Conclusion This study revealed the preference for medications and showed differences among patients with psychiatric disorders. Providing personalized medicine that considers a patient’s preference for the drug may contribute to the improvement of drug compliance and outcomes.

Objective: This study explored the negative emotional impact of peer suicide on adolescent students during the early stages of becoming aware of suicide and examined the adverse effects of related environmental and mental health factors. Methods: This study was conducted from March 1, 2020 to December 31, 2021, targeting students enrolled in middle and high schools where student suicide occurred. Emotional impact was assessed using the Korean version of the Impact of Event Scale-Revised (IES-R-K), State-Trait Anxiety Inventory-X, Center for Epidemiologic Studies-Depression Scale (CES-D), and Beck’s Scale for Suicide Ideation (SSI). χ2 test and Pearson’s correlation analysis were performed to analyze subgroup differences and explore relationships between scale scores, respectively. Results: Of the 2,382 participants, 25.1% belonged to the post-traumatic stress disorder (PTSD) or PTSD tendency group on the IES-R-K, and 22.2% showed abnormalities in the State-Trait Anxiety Inventory-State. Students in the same class as the deceased student and those in the same grade but in different classes had higher risk rates than those in different grades. Boarding school students had 1.9 times higher odds of experiencing emotional impacts than non-boarding students. On the CES-D, 10.4% of the students showed potential depression, with 3.7 times higher odds of experiencing emotional impact than those with normal scores. Moreover, 4.5% of the students reported suicidal ideation on the SSI, with those experiencing mild suicidal ideation having 1.9 times higher odds of experiencing emotional impact than those with normal scores. Conclusion A significant proportion of students experienced negative impacts of peer suicide. Students in close-knit environments, such as the same class, grade, and boarding school as the deceased, or those with depression or anxiety experienced a more pronounced negative impact.

Objective: This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. Results: When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st–2nd) (p=0.045). After COVID-19 (2nd–3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. Conclusion Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.

Objectives: The purpose is to investigate personality characteristics according to reports of suicide risk among students in the 2nd step evaluation of the Student Emotional Behavior Test conducted in one district of Daegu in 2022. Methods: A total of 99 students’ school level, gender, and rate of suicide risk reporting were investigated, and sub-factors of Personality Assessment Inventory-Adolescent (PAI-A) were compared according to suicide risk reporting. We also analyzed the factors that have the most significant influence on suicide risk reporting among PAI-A. Results: There was no gender difference in suicide risk reporting, but there was a significant difference at the school level. Among the PAI-A clinical scales, significant differences between groups were found in somatic complaints (SOM), anxiety (ANX), anxiety-related disorder (ADR), depression (DEP), paranoia (PAR), borderline features (BOR), suicide ideation (SUI), nonsupport (NON) and treatment rejection (RXR). Suicide risk reporting was higher in high school students than middle school, and students with high scores of NON on the PAI-A. Conclusions Reports of suicide risk show differences in internalization factors of personality traits. This means that adolescents are more likely to report suicide risk as they frequently experience inherent negative emotions such as depression and anxiety or as their interpersonal relationships become strained. In addition, it can be said that identifying social networks and forming support resources are important factors in preventing self-harming or suicidal ideation that occur during early adolescence.

Objective: Attention-deficit/hyperactivity disorder (ADHD) is prevalent in adults, and psychiatric comorbidities are common in adults with ADHD. We aimed to examine the prevalence of adult ADHD with several common psychiatric conditions in a community sample in Korea and the association between adult ADHD and risk of psychiatric comorbidities. Methods: This study used a cross-sectional survey design. We provided supplementary and optional self-report questionnaires, including the Korean version of the World Health Organization Adult ADHD Self-Report Scale (ASRS) short screening scale, Patient Health Questionnaire-9 for screening for depression, Alcohol Use Disorders Identification Test alcohol consumption questions, and the Korean version of the Mood Disorders Questionnaire, to Korean adults who visited one of six centers of a large private healthcare company for the National General Health Examination. Results: A total of 17,799 subjects included in this study, and 430 (2.4%) were positive on the ASRS screen. ADHD was significantly associated with the 19−30-year-old age group (odds ratio [OR] = 3.938), lower income (OR = 1.298), depression (OR = 11.563), and bipolar disorder (OR = 3.162). Conclusion Adult ADHD was highly associated with depression and bipolar disorder, suggesting that clinicians should carefully evaluate and treat such psychiatric disorders in adults with ADHD symptoms.

Objectives: There has been increased use of medications in treating depressive disorders.Nowadays, patient value is an important part of prescribing medications. This study examines depressive patients’ perspectives on the side effects of medications. Methods: We administered questionnaires nationwide to 364 patients with depressive disorders. Intent or willingness to endure 21 side effects from the Antidepressant Side-Effect Checklist (ASEC) were examined and compared in patients who are less than mildly ill and who are more than moderately ill. Results: In the population, decreased appetite, yawning, increased body temperature, dry mouth, sweating, and constipation are regarded as generally endurable side effects. In contrast, dizziness, light-headedness, nausea or vomiting, headaches, disorientation, problems with urination, and difficulty sleeping are hard to endure. There were differences between patients who are less than mildly ill and those who are more than moderately ill regarding the willingness to endure drowsiness, decreased appetite, sexual dysfunction, palpitations, and weight gain. Conclusion This nationwide study revealed a general willingness in depressed patients to endure side effects. Sensitive and premeditative discussions of patient value with regard to medications might contribute to finding successful treatments.