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Objective: This study aimed to investigate prescription patterns in patients with insomnia who still met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria despite having already been taking hypnotics, and to determine which drug(s) and what combination therapies were preferred. Methods: Sixty-three patients were enrolled in this study. Patients were selected from participants registered at six university hospitals for a prospective study to evaluate the efficacy of melatonin (Circadin).Results: The prescribed hypnotics were clonazepam (n=33), trazodone (n=23), zolpidem (n=22), quetiapine (n=14), mirtazapine (n=12), lorazepam (n=10), alprazolam (n=7), triazolam (n=5), doxepin (n=5), diazepam (n=3), etizolam (n=2), and flunitrazepam (n=1). There were five types of monotherapies (benzodiazepine, zolpidem, trazodone, mirtazapine, and doxepin) and 18 types of combination therapies. The total number of hypnotics used ranged from one to six. The frequency of benzodiazepine use was quite high, at 51/63. Conclusion: This study showed that insomnia can be treated in a wide variety of ways. In particular, 63% of the insomnia treatments in this study used combination therapy. This means that the gap between evidence-based pharmacotherapy and pharmacotherapy used in clinical practice is substantial. This also means that insomnia is still not fully understood and is a heterogeneous condition. In the future, more studies are needed to deepen our understanding of the pathophysiology of insomnia.

Objective Owing to prolonged social distancing and the resultant isolation, the prevalence of depression and suicidality has increased during the COVID-19 pandemic. This study aimed to investigate the severity of depression and suicidality in Korean community populations and examine their awareness of suicide and suicide prevention during the pandemic.Methods This study surveyed a community population in 2020 and 2021, involving 668 participants. We evaluated the severity of depression and suicidality using the Patient Health Questionnaire-9 and Beck Scale for Suicidal Ideation as well as questions about awareness of suicide. We performed a correlation analysis to confirm the association between variables, and compared participants’ suicide awareness according to the severity of depression.Results The severity of depression and suicidality in the community population decreased in 2021 compared to 2020. Awareness of the importance of suicide prevention increased in 2021, but the percentage reporting that it is possible decreased slightly. The group with higher depressive symptoms reported a lower possibility of suicide prevention.Conclusion Increasing social interest in suicide, as well as awareness of suicide prevention, is important for reducing suicide rates. Suicide prevention campaigns, education, and social policies are needed, particularly during the pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has caused changes in the daily lives of Korean adolescents and affected their emotional well-being. This study compared lifestyle factors and the mental health status of adolescents before and during the COVID-19 pandemic.We conducted a secondary analysis using data from a national cross-sectional cohort (Korean Youth Risk Behavior Web-based Survey, KYRBS) collected in 2019 before the COVID-19 outbreak and in 2020 during the pandemic. This study included 57,303 students from the 2019 KYRBS and 54,948 from the 2020 KYRBS. Lifestyle factors such as dietary habits, physical activity levels, time spent studying, duration of Internet use, and mental health status, including perceived stress, experience of depressive mood, and suicidal ideation and attempts, were included in the analyses.The perceived stress levels, self-reported depressive mood, and suicidal thoughts and attempts were lower in the students surveyed in 2020 during the COVID-19 pandemic than in the students surveyed in 2019 before the COVID-19 outbreak. The time spent studying and sleep duration decreased compared to before the pandemic, and sleep satisfaction increased during the COVID-19 pandemic.Our results showed an improvement in mental health status in Korean adolescents during the pandemic, but caution is needed when interpreting these results. Future research is needed to determine the effects of a long-lasting pandemic on mental health and lifestyle factors in adolescents.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by abnormal movement during REM sleep. Violent motor behaviors correlated with dreams commonly result in sleep-related injuries, which are sometimes life-threatening, to patients and their bed partners. The current guidelines for RBD treatment include counseling, modifying the sleep environment to prevent sleep-related injury, and pharmacological therapy. This paper focuses on current pharmacotherapy options for the treatment of RBD, including clonazepam and melatonin, which represent the mainstay of RBD therapy. Acetylcholinesterase inhibitors and dopamine-agonists have been used, as RBD is usually associated with other neurodegenerative diseases, with encouraging results in preliminary clinical trials. More randomized controlled trials with objective outcome measures are needed to assess both short-term and long-term effects of these medications and their efficacy in RBD. Understanding the exact mechanisms involved in decreasing RBD symptoms could provide future approaches in new drug development.

BackgroundWrist-worn actigraphy can objectively measure sleep, and has advantages over self-report, particularly for people with Bipolar Disorder (BD) for whom self-reports might be influenced by affect. Clinically useful data reduction approaches are needed to explore these complex data.MethodsWe created a composite score of sleep metrics in BD based on 51 BD and 80 healthy comparison (HC) participants. Subjects wore an actigraph for up to 14 consecutive 24-h periods, and we assessed total sleep time (TST), wake after sleep onset (WASO), percent sleep (PS), and number of awakenings (NA). We focused on participants who had at least 5 nights of actigraphy data. We computed z-scores for within-person means of sleep measures for BD subjects versus HCs, which were averaged to create a composite measure. We correlated this composite with participant characteristics, and used LASSO regression to identify sleep measures best explaining variability in identified correlates.ResultsSleep measures and the composite did not differ between BDs and HCs; however, there was considerable variability in z-scores among those with BD. In BDs, the composite score was higher in women (t(49)=2.28, p=0.027) and those who were employed (t(34)=2.34, p=0.025), and positively correlated with medication load (r=0.41, p=0.003) while negatively correlated with Young Mania Rating Scale (YMRS; r=-0.35, p=0.030). In LASSO regression, TST and NA best explained medication load while PS best explained employment and YMRS.ConclusionWhile a composite score of sleep metrics may provide useful information about sleep quality globally, our findings suggest that selection of theory-driven sleep measures may be more clinically meaningful.

Objective The relation between female emotional laborers’ sleep quality and autonomic nervous system activity was investigated.Methods Thirty-three subjects’ heart rate variability (HRV) data and results of self-reported scale on sleep, depression, anxiety and suicidality, were collected. Subjects were classified into good sleeper (GS) and poor sleeper (PS) groups relying on sleep quality. Changes of HRV between working time and resting time in each group were compared.Results The PS group showed significantly lower difference in root mean square of successive differences (RMSSD), percentage of successive normal-to-normal intervals that differ by more than 50 ms (pNN50), and natural logarithm high-frequency (LnHF) when they were working as compared to when they were resting, which means decreased function of the parasympathetic nervous system (PNS). Repeated measures analysis of covariance showed that the group effect was significant only for LnHF, with score of depression scale as a covariate.Conclusion Female emotional laborers who complain of sleep difficulty may have decreased function of the PNS. Therefore, good sleep quality is essential for maintaining and promoting mental and physical health of women engage in emotional labor.

Background Adolescents may experience several changes in their lifestyle, such as social activity and school life, which makes them vulnerable to developing a depressive disorder. Therefore, the present study aimed to identify the factors affecting the experience of depressive symptoms during adolescence. Methods We conducted a secondary analysis using the 2019 Korean Youth Risk Behavior Web-based survey data, including a total of 57,303 middle and high school students selected from among 400 schools. Factors such as dietary habits, physical activity levels, time spent studying, duration of internet use, and other health risk behaviors were included in the analysis. Logistic regression analysis was performed to identify factors that predict the risk of experiencing depressive symptoms. Results The perceived stress of Korean adolescents showed a tendency to increase with age, and high school seniors and girls were more likely to report depressive symptoms. Perceived health status, academic performance, time spent studying, physical activity, duration of internet use, and effort to control weight were associated with individual experiences of depressive symptoms. Conclusion We identified factors that influence the experience of depressive symptoms in adolescents. Our results suggest the possibility that the purpose of students’ physical activities and their leisure activity preferences may be related to their emotional status. We suggest that activities that are appropriate to the culture and lifestyle of adolescents should be recommended to reduce the occurrence of depressive symptoms.

Depressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults.Data from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level.Older adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25-2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta = -0.162, P 0.001; high income: beta = -0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms.Our findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment.

Objective This study aimed to demonstrate that the Patient Health Questionnaire (PHQ)-8 is not less useful than the PHQ-9 as a screening test for major depressive disorder (MDD). Methods We performed a retrospective analysis of 567 patients in psychiatric outpatient units. The Mini International Neuropsychiatric Interview was used to diagnose MDD. We derived the validity and reliability of the PHQ-8 and PHQ-9. To evaluate the ability of the PHQ-8 and PHQ-9 to discriminate MDD, we drew receiver operating characteristic (ROC) curves and compared the areas under the curves (AUCs). Results Of the 567 participants, 207 (36.5%) were diagnosed with MDD. Cronbach's αs for the PHQ-8 and PHQ-9 were 0.892 and 0.876, respectively. Similar to the PHQ-9, the PHQ-8 was also associated with scores on the Hamilton Depression Rating Scale in a correlation analysis. When we drew ROC curves for the PHQ-8 and PHQ-9, there was no statistically significant difference in the AUCs. With a cutoff score of 10, the PHQ-8 showed a sensitivity of 58.3%, specificity of 83.1%, positive predictive value of 53.4%, and negative predictive value of 85.7%. Conclusion In a psychiatric outpatient sample, the PHQ-8 was as useful as the PHQ-9 for MDD screening.

Disasters have numerous harmful effects on the mental health status of trauma-exposed people. We investigated the differences in the association between trauma-related psychopathologies and posttraumatic growth according to the perceived social support level among victims of the Sewol Ferry disaster on April 16, 2014, in South Korea. Data from 241 bereaved family members, survivors, and family members of survivors were used. The Duke-UNC Functional Social Support Questionnaire, Posttraumatic Growth Inventory, PTSD Checklist-5, Posttraumatic Embitterment Disorder Self-Rating Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 were used to evaluate perceived social support, posttraumatic growth, and trauma-related psychopathologies. We found that the severity of depression and anxiety showed inverse correlations with posttraumatic growth only in the low-social support group, while they did not demonstrate significant correlations in the high-social support group. The social support level had correlations with posttraumatic growth and the severity of posttraumatic stress disorder and posttraumatic embitterment disorder only in female respondents. Furthermore, there was a mediation pathway from social support level to posttraumatic growth through depressive symptoms. This study explored the complex relationship between social support, posttraumatic growth, trauma-related psychopathologies, and gender among trauma-exposed individuals in the aftermath of the Sewol Ferry disaster.

Background Adolescence is a period that witnesses many changes in lifestyle, such as in social activity and school life, and it is vulnerable to the depressive disorder. Therefore, we intended to evaluate the factors affecting the onset of depressive episodes. Methods We conducted a secondary analysis using the 2019 Korean Youth Risk Behavior Web-based survey data, including a total of 57,303 subjects from the first year of middle school to the third year of high school and selected among 400 schools. Factors including dietary habits, physical activity, study time, internet use time and other health risk behaviors were included in the analysis. Logistic regression analysis was performed to evaluate the risk of occurrence of depressive episodes. Results Physical activity, internet use for more than three hours on weekdays, and a study time of more than two hours on weekends were assessed as risk factors of depressive episodes. On the other hand, internet use on weekends and having breakfast regularly were suggested as a protective way to reduce risk in Korean students. Conclusion We identified the factors influencing the depressive episode of adolescents. We suggest that activities appropriate to the culture and lifestyle of adolescents should be recommended in order to reduce the occurrence of depressive episodes.

Actigraphy can objectively measure sleep in studies on Bipolar Disorder (BD) where subjective sleep ratings might be influenced by affect. Actigraphy data are complex necessitating data reduction approaches. We created a composite score of actigraphy sleep metrics (total sleep time [TST], wake after sleep onset [WASO], and percent sleep [PS]) in BD. We computed z-scores of sleep measures for n=51 BD vs. n=80 healthy subjects and averaged scores. We examined associations with participant characteristics and used LASSO to identify metrics best explaining composite variability. Higher composite scores (better sleep) were seen in employed vs. unemployed (t=2.40, df=34, p=0.02), and correlated with higher medication load (r=0.41, p=0.004), lower mania symptomatology (r=-0.33, p=0.04) and lower interleukin (IL)-6 levels (r=-0.32, p=0.02). TST best explained variability in medication load and PS best explained employment, mania symptoms and IL-6. Given observed specificity of associations, selecting theory-driven sleep metrics may be more appropriate than a composite.

This study examined the validity and reliability of the Korean version of the Generalized Anxiety Disorder-7 (GAD-7) scale. The GAD-7 was standardized with data from 112 patients at a psychiatric outpatient clinic. The GAD-7 revealed high internal consistency, good test-retest reliability, and convergent validity. The ROC analysis resulted in poor sensitivity and specificity for detecting anxiety disorders in a psychiatric setting. The GAD-7 may not be useful in diagnosing anxiety disorders in a psychiatric setting, even though it appears to be a reliable, efficient, and valid measurement tool for evaluating anxiety symptoms.

Background The Patient Health Questionnaire-9 (PHQ-9) has been standardized in several populations and is widely used in clinical practice and health care. However, it has not been appropriately standardized in the Korean general population, and no normative data have been presented. The aim of this study was to provide the normative data and psychometric properties of the PHQ-9 in the nationally representative population of Korea. Methods We used the nationwide cross-sectional survey data of Korea from 2014 to 2016. The data of 10,759 individuals aged over 19 years were analyzed in this study. As the distribution of the PHQ-9 scores was not normative, the percentile ranks for raw scores were provided. The survey questionnaires included the PHQ-9, The EuroQol-5 Dimension (EQ-5D), and demographic characteristics. We analyzed the construct validity and internal consistency of the PHQ-9. Results The normative data of the PHQ-9 were generated according to the sex and different age categories. The correlation coefficient between the sum of the PHQ-9 scores and the EQ-5D index was 0.44, which was moderate. The most appropriate model was the two-factor model with five ‘affective-somatic’ labeled items and four ‘cognitive’ labeled items. Cronbach’s α for the PHQ-9 was 0.79. Conclusions Our result supports reliability and validity with two-factor structure of PHQ-9 for measuring depression in the Korean nationally representative population. The Korean normative data on the PHQ-9 according to percentile rank can assist in interpreting and comparing scores with other populations.

Background We investigated the interactive effects of depressive symptoms and chronic diseases on health care utilization among elderly people and explored the potential moderating effect of gender and the mediating effect of self-rated health (SRH) on the association between depressive symptoms and health care utilization. Method We analyzed data from 5223 people aged 60 years or older living in the community from the Korea Welfare Panel Study in 2015. Depressive symptoms were measured using an 11-item version of the Center for Epidemiologic Studies Depression (CES-D-11) Scale and morbidity within 28 disease categories was assessed. Health care utilization was evaluated as the number of outpatient visits (OV), number of hospitalizations (NH), and number of days spent in the hospital (DH) during past year. Hierarchical moderated regression analyses were applied to investigate the interactive effects. We also adopted the mediation analysis method by Hayes and Preacher. Results A significant interactive effect of CES-D-11 score and chronic disease on OV was found. A positive correlation between CES-D-11 score and OV was only observed in those with chronic disease. Gender had a moderating effect on the association of depression symptoms with OV, NH, and DH among elderly people with chronic disease. SRH had mediating effects on the association of CES-D-11 with OV, NH, and DH only among those with chronic disease. Limitations The severity or multimorbidity of chronic diseases, which could affect health care utilization among elderly were not considered. Conclusions We elucidated the complex aspects of the relationship between depressive symptoms and chronic disease and their interactive effects on health care utilization among elderly people, and identified important roles of gender and SRH.

Emotional labor is strongly correlated with negative consequences in psychological well-being and mental health status in workers. We investigated the associations of emotional labor with depressive mood and perceived usual stress level according to gender and its interactions with job autonomy in service and sales workers. The data from 2,055 service and sales workers from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2007 to 2009 were analyzed. High emotional labor was associated with increased risk for depressive mood in female workers (adjusted odds ratio [aOR] = 2.19, 95%, confidence interval [CI] = 1.56–3.07). Emotional labor and job autonomy showed interactive effects on depressive mood in that high emotional labor was associated with depressive mood only in the presence of low job autonomy in male workers (aOR = 2.85, 95% CI = 1.13–7.17). A significant mediation pathway between high emotional demand and prevalence of depressive mood through higher stress level was observed in female workers. In conclusion, female workers had high vulnerability to depressive symptoms due to emotional labor, and high job autonomy can act as a buffer against the detrimental effect of emotional labor in male workers.

Insomnia is prevalent in bipolar disorder (BD) even during periods of euthymic mood. We compared resting state brain activity and cognitive function between euthymic BD with and without insomnia, and secondarily to healthy individuals. BD patients with insomnia symptoms showed a significantly lower functional connectivity within the task-positive network, compared to those without insomnia. They also showed significantly slower cognitive processing speed. These two features of BD with insomnia appeared relatively independent of each other. Preliminary findings suggest that exploration of the mechanisms of sleep disturbance in BD could lead to improved understanding and treatment of inattention in BD.

A growing body of evidence has suggested that social capital is an upstream social determinant of mental health. We investigated the association of cognitive social capital, including interpersonal trust and reciprocity, with depressive symptoms in the elderly. We also explored the mediating role of cognitive social capital in the association between socioeconomic status (SES) and depressive symptoms and the moderating effect of SES on the relationship between social capital and depressive symptoms. Data from the 2012 Korea Welfare Panel Study (KOWEPS) was analyzed for 5969 participants aged 60 years or older. Cognitive components of social capital, including interpersonal trust and reciprocity, were evaluated using single-item questionnaires. Socioeconomic and health-related characteristics were investigated and depressive symptoms were evaluated by an 11-item version of the Center for Epidemiologic Studies Depression Scale. Low interpersonal trust and reciprocity levels were significantly associated with depressive symptoms in the elderly. Reciprocity level mediated the association between household income level and depressive symptoms. We did not observe any significant moderating effect of SES on the association between cognitive social capital and depressive symptoms. A significant association between cognitive social capital and depressive symptoms in Korean elderly was found. We elucidated how SES interacted with depressive symptoms through the mediation pathway of cognitive social capital using a representative sample of the Korean elderly population.

Objective The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. Methods We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. Results Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. Conclusion This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Although panic disorder (PD) and phobic disorders are independent anxiety disorders with distinct sets of diagnostic criteria, there is a high level of overlap between them in terms of pathogenesis and neural underpinnings. Functional connectivity research using resting-state functional magnetic resonance imaging (rsfMRI) shows great potential in identifying the similarities and differences between PD and phobias. Understanding common and distinct networks between PD and phobic disorders is critical for identifying both specific and general neural characteristics of these disorders. We review recent rsfMRI studies and explore the clinical relevance of resting-state functional connectivity (rsFC) in PD and phobias. Although findings differ between studies, there are some meaningful, consistent findings. Social anxiety disorder (SAD) and PD share common default mode network alterations. Alterations within the sensorimotor network are observed primarily in PD. Increased connectivity in the salience network is consistently reported in SAD. This review supports hypotheses that PD and phobic disorders share common rsFC abnormalities and that the different clinical phenotypes between the disorders come from distinct brain functional network alterations.

Background Evaluation of olfactory function is valuable for the detection of pre-motor state of Parkinson's disease (PD). PD patients have an increased risk of associated dementia and one-third of PD patients have mild cognitive impairment (MCI) at the time of diagnosis. However, the characteristics of olfactory dysfunction in PD-MCI patients are unclear. This study examined the relationship between olfactory dysfunction and cognitive function in drug-naive PD at the time of diagnosis with the patterns of olfactory function in PD-MCI patients using the Korean version of the Sniffin’ stick test II (KVSS II). Methods A total of 66 drug-naive PD patients were enrolled. A neuropsychiatric assessment battery and KVSS II were performed. For the statistical analyses, univariate, multivariable linear regression and Student's t-test were used to determine the relationship between the variables and olfactory function. Results Olfactory dysfunction was more prevalent in the PD-MCI group than in the PD-normal cognition (PD-CN) group. Each domains of odor threshold, discrimination, identification and total olfactory score were more impaired in the PD-MCI group than the PD-CN group. Whether cognitive impairment was single or multiple domain was not affected. Conclusion PD-MCI is more likely to be associated with severe olfactory impairment than PD-CN. There may be more extensive neurodegenerative processes affecting olfaction in PD-MCI patients. With further investigation and validation using neuropathological data, an objective olfactory function test could be used as a tool to evaluate disease progression. Further studies with prospective design investigating the prognostic value of olfactory dysfunction in PD-MCI patients are essential.

Objective Restless legs syndrome (RLS) is a highly heritable and common neurological sensorimotor disease disturbing sleep. The objective of study was to investigate significant gene for RLS by performing GWA and replication study in a Korean population. Methods We performed a GWA study for RLS symptom group (n=325) and non-RLS group (n=2,603) from the Korea Genome Epidemiology Study. We subsequently performed a replication study in RLS and normal controls (227 RLS and 229 controls) to confirm the present GWA study findings as well as previous GWA study results. Results In the initial GWA study of RLS, we observed an association of rs11645604 (OR=1.531, p=1.18×10-6) in MPHOSPH6 on chromosome 16q23.3, rs1918752 (OR=0.6582, p=1.93×10-6) and rs9390170 (OR=0.6778, p=7.67×10-6) in UTRN on chromosome 6q24. From the replication samples, we found rs9390170 in UTRN (p=0.036) and rs3923809 and rs9296249 in BTBD9 (p=0.045, p=0.046, respectively) were significantly associated with RLS. Moreover, we found the haplotype polymorphisms of rs9357271, rs3923809, and rs9296249 (overall p=5.69×10-18) in BTBD9 was associated with RLS. Conclusion From our sequential GWA and replication study, we could hypothesize rs9390170 polymorphism in UTRN is a novel genetic marker for susceptibility to RLS. Regarding with utrophin, which is encoded by UTRN, is preferentially expressed in the neuromuscular synapse and myotendinous junctions, we speculate that utrophin is involved in RLS, particularly related to the neuromuscular aspects.

Substance P (SP) has been implicated in major depressive disorder (MDD), with SP antagonists being studied as potential antidepressants. Although impaired neural plasticity is considered a key mechanism in MDD pathophysiology, the association between SP and brain structural changes in depression has not been investigated. We investigated the correlations between SP levels and white matter (WM) integrity in 42 medication-naive patients with MDD and 57 healthy controls (HCs). Plasma levels of SP were determined, and diffusion tensor imaging (DTI) was performed to investigate microstructural changes in WM tracts. In patients, negative correlations between SP levels and fractional anisotropy (FA) values of the forceps minor of the corpus callosum, and positive correlations between SP levels and radial diffusivity (RD) and mean diffusivity (MD) values of the right corticospinal tract (CST) were observed, with no significant correlations in HCs. Linear regression analyses showed SP levels to significantly predict FA values of the forceps minor, and RD and MD values of the right CST in patients, but not in HCs. We consider our findings to contribute to the neurobiological evidence on the association between SP and brain structural changes in depression, which may be related with the pathophysiology and treatment of MDD.

The genetic variant of the vesicular monoamine transporter 1 gene (VMAT1) has been suggested to be associated with monoaminergic signaling and neural circuit activity related to emotion processing. We aimed to investigate microstructural changes in white matter tracts of patients with major depressive disorder (MDD), and examined the interaction effect between VMAT1 Thr136Ile (rs1390938) polymorphism and MDD on white matter integrity. Diffusion tensor imaging (DTI) and VMAT1 Thr136Ile (rs1390938) genotyping were performed on 103 patients diagnosed with MDD and 83 healthy control participants. DTI was used to investigate microstructural changes in white matter tracts in patients compared to healthy controls. The possible interaction effect between rs1390938 and MDD on white matter integrity was also assessed. Patients with MDD exhibited lower fractional anisotropy (FA) values of the forceps major (p

Objective This study was aimed at evaluating the diagnostic validity of the Korean version of the Clinically Useful Depression Outcome Scale (CUDOS) with varying follow-up in a typical clinical setting in multiple centers. Methods In total, 891 psychiatric outpatients were enrolled at the time of their intake appointment. Current diagnostic characteristics were examined using the Structured Clinical Interview for DSM-IV (41% major depressive disorder). The CUDOS was measured and compared with three clinician rating scales and four self-report scales. Results The CUDOS showed excellent results for internal consistency (Cronbach’s α, 0.91), test-retest reliability (patients at intake, r=0.81; depressed patients in ongoing treatment, r=0.89), and convergent and discriminant validity (measures of depression, r=0.80; measures of anxiety and somatization, r=0.42). The CUDOS had a high ability to discriminate between different levels of depression severity based on the rating of Clinical Global Impression for depression severity and the diagnostic classification of major depression, minor depression, and non-depression. The ability of the CUDOS to identify patients with major depression was high (area under the receiver operating characteristic curve=0.867). A score of 20 as the optimal cutoff point was suggested when screening for major depression using the CUDOS (sensitivity=89.9%, specificity=69.5%). The CUDOS was sensitive to change after antidepressant treatment: patients with greater improvement showed a greater decrease in CUDOS scores (p

Psychiatric disorders are too multifactorial to be defined as a primarily inflammatory disorder, and increased inflammatory response is not specific to mental disorder only. Numerous factors are involved in neuroinflammation, and there also are many confounding variables, making it difficult to obtain consistent outcomes. Therefore, it is necessary to specify genetic, physiological, and epidemiological attributes of particular population groups vulnerable to inflammatory response as well as the disease subtypes. As of now, definitive inflammatory markers for psychiatric disorders have not been identified, but they could be very useful in patients with minimal vulnerability. In addition, it is possible to use inflammatory markers as depression biomarkers in subtypes of depression, which can serve as bases to develop medications to treat the disorder.

Study ObjectivesTo investigate the association between weekend catch-up sleep (WCS) and the levels of high-sensitivity C-reactive protein (hsCRP)—a serum inflammatory maker—in adultsMethodsData of 5,506 adults aged 19 years or older were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2016. Serum hsCRP level, weekday and weekend sleep durations, and sociodemographic and health-related characteristics were assessed. Participants whose weekend sleep duration was more than 1 h longer than their weekday sleep duration were included in the WCS group. hsCRP level was categorized into quartiles (i.e. highest, middle-high, middle-low, and lowest). Obesity was defined by body mass index ≥ 25.0 kg/m2.ResultsThe WCS group included 1,901 participants (34.5%). In the logistic regression analysis controlling for all variables, adults in the WCS group were significantly less likely to show the highest hsCRP level (versus the lowest level) compared with those without WCS in the complete sample (adjusted odds ratio = 0.795, 95% confidence interval [CI] = 0.662 to 0.955). In a subgroup analysis, this association was significant only for those with weekday sleep duration of 6 h or lower. Longer WCS (≥3 h) was not associated with hsCRP levels. Non-obese people with WCS demonstrated a lower risk for high hsCRP levels, while there was no significant difference in obese people with WCS.ConclusionsOur findings indicate that WCS may be beneficial for low-grade systemic inflammation in adults, particularly among those with shorter weekday sleep durations. WCS may also interact with obesity.

Objective The cognitive, Affective, and Somatic Empathy Scale (CASES) suggests novel three components structure of empathy. Although CASES developed to assess the trait empathy of both children and adult, the validation in adult sample is not yet conducted. This study developed Korean version of CASES (CASES-K) and examined the psychometric properties in young adult for first time. Methods Confirmatory factor analysis was conducted to test whether the factor structure suggested in initial development study is valid in Korean young adult population. 350 young adults participated, and 44 of them also answered to other empathy scales for validation. The construct validity was ascertained through a series of correlational analysis with widely used trait empathy scales. Results The result of confirmatory factor analysis supports the three-factor model of empathy consists of affective, cognitive and somatic facets. The construct validity was ascertained through a series of correlational analysis with widely used trait empathy scales. The result of correlational analysis supports the validity of CASES-K, and especially the separation of somatic empathy from affective empathy. Conclusion The current study provides the first evidence of the validity and utility of the CASES-K in young adult population. The result also supports the commonality of three factor structure of empathy in both East Asian and Caucasian, from the children to adults.

Background Sleep disturbances are common in bipolar disorder (BD) and are often assessed by self-report at clinic visits over the course of BD treatment. Self-report may be subject to recall bias based upon current mood/affect states. This study sought to identify the degree of inaccuracy between subjective and objective measures of sleep duration in those with and without BD, and to assess the demographic and clinical correlates of this inaccuracy. Methods Thirty-one individuals with BD and 54 healthy control (HC) participants reported on the number of hours slept a night over the past month and subsequently completed up to 14 days/nights of wrist actigraphy which provided an objective measure of sleep duration. We compared the subjective rating to the average of all nights of objective sleep duration, and correlated the magnitude of inaccuracy with demographic and clinical characteristics in the BD and HC groups. Results On average, both BD and HC groups overestimated their sleep, and there were no differences in inaccuracy between groups. In the BD group, greater inaccuracy was associated with lower functioning, even after controlling individually for objective and subjective sleep measures. Limitations Cross-sectional study, only focus on sleep duration, and less severe bipolar symptoms of sample. Conclusions Inaccuracy in reports of sleep duration was associated with lower functioning among BD patients. Better identifying discrepancies in reports of sleep duration in clinical practice could help in more efficient monitoring and management of BD symptoms.

Psychiatric disorders are too multifactorial to be defined as a primarily inflammatory disorder, and increased inflammatory response is not specific to mental disorder only. Numerous factors are involved in neuroinflammation, and there also are many confounding variables, making it difficult to obtain consistent outcomes. Therefore, it is necessary to specify genetic, physiological, and epidemiological attributes of particular population groups vulnerable to inflammatory response as well as the disease subtypes. As of now, definitive inflammatory markers for psychiatric disorders have not been identified, but they could be very useful in patients with minimal vulnerability. In addition, it is possible to use inflammatory markers as depression biomarkers in subtypes of depression, which can serve as bases to develop medications to treat the disorder.

Disasters lead to mental health problems such as depressive disorder, anxiety disorder, and Post-Traumatic Stress Disorder. The purpose of this study was to assess the factors that affect the severity of indirect trauma based on the characteristics of human-made disasters. We also analyzed the degree of indirect trauma by region by comparing the disaster site and the control community. The severity of indirect trauma caused by the Sewol ferry incident, depressive symptoms, and anxiety symptoms was assessed in the survey. Gender (female), the presence of children, and a high level of monthly income were assessed as risk factors for increasing the severity of indirect trauma. The severity of indirect trauma was higher in the control community that was not involved in the Sewol ferry accident. We confirmed that the risk factors and protection factors are determined by the characteristics of the disaster and the victim in the case of a human-made disaster. To overcome indirect trauma, it is also necessary to provide social support and information for mental health recovery to those who indirectly encounter the disaster.

We investigated whether watching two-dimensional television (2DTV) or three-dimensional television (3DTV) resulted in differences in the brain’s processing of sensory information. We divided 25 participants into 2DTV (n = 13) and 3DTV (n = 12) groups. Participants watched 2DTV or 3DTV for 1, 2, or 3 h on different days. Before and at the end of each session, electroencephalography (EEG) was recorded for 10 min. The Simulation Sickness Questionnaire (SSQ) and the Visual Analog Scale (VAS) were used to assess general discomfort before and after watching. Each frequency band of the resting EEG was transformed into a standardized low-resolution electromagnetic tomographic (sLORETA) image. In the 2DTV group, 2 h of watching increased theta power in the central cortex and 3 h of watching increased beta power in the occipital cortex. In the 3DTV group, 3 h of watching increased delta power in the parahippocampal gyrus and middle frontal cortex. Theta power was significantly higher in the insular cortex after 3 h of 3DTV than after 3 h of 2DTV. SSQ scores were significantly higher after 1 h of 2DTV than after 1 h of 3DTV. Watching 2DTV vs. 3DTV triggered different time-dependent activity patterns. Watching 3DTV for 3 h increased slow-wave activity in the prefrontal cortex, while watching 2DTV increased fast-wave activity in the occipitoparietal cortex. Up to 2 h of 3DTV watching did not cause major changes in fatigue or EEG activity compared with 2DTV. Our findings promise to be useful in designing safety guidelines for watching 3DTV.

The tryptophan hydroxylase-2 (TPH2) gene is considered a promising genetic candidate regarding its association with a predisposition to major depressive disorder (MDD). Local gyrification reflects the early neural development of cortical connectivity, and is regarded as a potential neural endophenotype in psychiatric disorders. They aimed to investigate the alterations in the cortical gyrification of the prefrontal cortex and anterior cingulate cortex and their association with the TPH2 rs4570625 polymorphism in patients with MDD. One hundred and thirteen patients with MDD and eighty-six healthy controls underwent T1-weighted structural magnetic resonance imaging and genotyping for TPH2 rs4570625. The local gyrification index of 22 cortical regions in the prefrontal cortex and anterior cingulate cortex was analyzed using the FreeSurfer. The patients with MDD showed significant hypergyria in the right rostral anterior cingulate cortex (P = 0.001), medial orbitofrontal cortex (P = 0.003), and frontal pole (P = 0.001). There was a significant genotype-by-diagnosis interaction for the local gyrification index in the right rostral anterior cingulate cortex (P = 0.003). Their study revealed significant hypergyria of the anterior cingulate cortex and prefrontal cortex and an interactive effect between the diagnosis of MDD and the genotype in the anterior cingulate cortex. This might be associated with the dysfunction of neural circuits mediating emotion processing, which could contribute to pathophysiology of MDD. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.

Polymorphisms in human circadian genes are potential genetic markers that affect diurnal preference in several populations. In this study, we evaluated whether four polymorphisms in circadian genes CLOCK, ARNTL, PER2, and GNB3 were associated with diurnal preference in a Korean population. In all, 499 healthy subjects were genotyped for four functional polymorphisms in CLOCK, ARNTL, PER2, and GNB3. Composite scale of morningness (CSM) was applied to measure phenotype patterns of human diurnal preference. In addition, three subscale scores, i.e. "morningness," "activity planning," and "morning alertness," were extracted from the CSM. No significant associations were observed between CSM scores and CLOCK (rs1801260) genotype or T allele carrier status, CSM scores and ARNTL (rs2278749) C allele carrier status, and CSM scores and GNB3 (rs5443) genotype or C allele carrier status. However, total CSM scores and scores of its subscales were significantly associated with PER2 (rs934945) genotype (p = 0.010, p = 0.018, and p = 0.005 for total, morningness, and activity planning, respectively) and G allele carrier status (p = 0.003, p = 0.005, and p = 0.002 for total, morningness, and activity planning, respectively). The best model result obtained by performing multifactor dimensionality reduction analysis ([Formula: see text]

Research on the associations between the ratio of second-to-fourth digit lengths (2D:4D ratio) and psychological variables could be a useful method of confirming sex hormone effects on human behavior tendencies. This study investigated the correlations between the 2D:4D ratio and characteristics of temperament and character in an urban community population. We hypothesized that the 2D:4D ratio correlates more strongly with temperament than with character. A total of 728 healthy adults (330 men and 398 women) ranging in age from 20 to 45 years were tested. Subjects completed the Temperament and Character Inventory (TCI) and were examined by measuring the 2D:4D ratio using a direct measurement method. Correlations between the 2D:4D ratio and psychological characteristics were explored. For women only, significant positive correlations with the 2D:4D ratio were found in the TCI-Temperament dimension (TCI-T), particularly in the two subscales of harm avoidance scale. Women with higher 2D:4D ratios had higher fear of uncertainly scores (rpartial = 0.206, p = 0.028) and shyness with strangers scores (rpartial = 0.252, p = 0.024). The 2D:4D ratio shows stronger correlations with temperament than with character. A higher 2D:4D ratio of woman is expected to indicate harm avoidance.

Previous research has identified the biological, psychological, and social factors that confer an elevated risk for suicide. Evidence suggests that sleep disturbances are one of the risk factors that predict an increased risk for suicidal behaviors. Both sleep disorders and general sleep complaints are linked to higher levels of suicidal ideation and depression, as well as increased rates of suicide and suicide attempts. The causal mechanism of this association is not clear. For example, it is not known if insomnia is an independent phenomenon that if interrupted could prevent the emergence of a mental disorder, or if insomnia is a symptom of another developing illness. Hypofrontality, HPA dysfunction, and an impaired serotonergic system are potential mechanisms underlying the association of sleep disturbances and suicidal behavior. Future research is necessary to examine the specific mechanism of this association between sleep and suicide, which may lead to an effective intervention and diminished suicide risk. Copyright © 2016. Korean Association of Medical Journal Editors. Language: ko

Background Intimate partner violence (IPV) has a serious detrimental effect on mental health outcomes. We aimed to investigate the association of verbal or physical IPV with incidence of depressive symptoms in both married women and men according to the victim-perpetrator role. The potential mediating role of verbal or physical IPV in the association between satisfaction level with family relationships or childhood adversity and the incidence of depressive symptoms in married adults was also explored. Methods The Korea Welfare Panel Study (KOWEPS) in 2006 and 2007 dataset was analyzed for 9217 married respondents aged 19 years or older. Physical and verbal IPV was assessed according to victim-perpetrator role in 2006. Depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale, 11-item version in 2006 and 2007. Association of IPV with incidental depressive symptoms was investigated with logistic regression analysis fully-adjusted for all potential confounding factors. Results The bidirectional role of verbal IPV and victimization by physical IPV led to incidence of depressive symptoms in married women. Verbal IPV significantly mediated the association between satisfaction level with the family relationship and incidental depressive symptoms in women. Limitations We did not investigate the influence of premorbid depressive symptoms on new-onset IPV. Conclusions This study is the first to demonstrate that gender and the victim-perpetrator role are critical moderating factors in the association between IPV and depressive symptom incidence using a nationally representative sample

Exposure to artificial light at night (ALAN) has become increasing common, especially in developed countries. We investigated the effect of dALAN exposure during sleep in healthy young male subjects. A total of 30 healthy young male volunteers from 21 to 29 years old were recruited for the study. They were randomly divided into two groups depending on light intensity (Group A: 5 lux and Group B: 10 lux). After a quality control process, 23 healthy subjects were included in the study (Group A: 11 subjects, Group B: 12 subjects). Subjects underwent an NPSG session with no light (Night 1) followed by an NPSG session randomly assigned to two different dim light conditions (5 or 10 lux, dom λ: 501.4 nm) for a whole night (Night 2). We found significant sleep structural differences between Nights 1 and 2, but no difference between Groups A and B. Exposure to dALAN during sleep was significantly associated with increased wake time after sleep onset (WASO; F = 7.273, p = 0.014), increased Stage N1 (F = 4.524, p = 0.045), decreased Stage N2 (F = 9.49, p = 0.006), increased Stage R (F = 6.698, p = 0.017) and non-significantly decreased REM density (F = 4.102, p = 0.056). We found that dALAN during sleep affects sleep structure. Exposure to dALAN during sleep increases the frequency of arousals, amount of shallow sleep and amount of REM sleep. This suggests adverse effects of dALAN during sleep on sleep quality and suggests the need to avoid exposure to dALAN during sleep.

Human influenza is a contagious respiratory illness caused by the influenza virus. The influenza vaccination is recommended annually, but several adverse effects related to allergic reactions have been reported. Panic attacks are also known to occur, but no case of a panic attack adverse effect has been reported in South Korea. We present two cases of panic disorder patients whose symptoms were aggravated by the influenza vaccination. We assumed that dysregulation of T-lymphocytes in panic disorder patients could have a role in activating various kinds of cytokines and chemokines, which then can lead to panic attack aggravation.