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To investigate not only differential patterns of functional connectivity of core brain regions between implicit and explicit verbal memory tasks underlying negatively evoked emotional condition, but also correlations of functional connectivity (FC) strength with clinical symptom severity in patients with generalized anxiety disorder (GAD).Thirteen patients with GAD and 13 healthy controls underwent functional magnetic resonance imaging for memory tasks with negative emotion words.Clinical symptom and its severities of GAD were potentially associated with abnormalities of task-based FC with core brain regions and distinct FC patterns between implicit vs. explicit memory processing in GAD were potentially well discriminated. Outstanding FC in implicit memory task includes positive connections of precentral gyus (PrG) to inferior frontal gyrus and inferior parietal gyrus (IPG), respectively, in encoding period; a positive connection of amygdala (Amg) to globus pallidus as well as a negative connection of Amg to cerebellum in retrieval period. Meanwhile, distinct FC in explicit memory included a positive connection of PrG to inferior temporal gyrus (ITG) in encoding period; a positive connection of the anterior cingulate gyrus to superior frontal gyrus in retrieval period. Especially, there were positive correlation between GAD-7 scores and FC of PrG-IPG (This study clarified differential patterns of brain activation and relevant FC between implicit and explicit verbal memory tasks underlying negative emotional feelings in GAD. These findings will be helpful for an understanding of distinct brain functional mechanisms associated with clinical symptom severities in GAD.

Objective This study assessed the associations of the abnormal brain activation and functional connectivity (FC) during memory processing and brain volume alteration in conjunction with psychiatric symptom severity in patients with obsessive-compulsive disorder (OCD).Methods Twenty-OCD patients and 20-healthy controls (HC) underwent T1-weighted and functional imaging underlying explicit memory task.Results In memory encoding, OCD patients showed higher activities in right/left (Rt./Lt.) inferior temporal gyrus (ITG), medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), compared with HC. In task-based FC, caudate (Cd) was positively connected with DLPFC and ITG in OCD, while HC showed different connectivities of Cd-ACC and Rt.-Lt. ITG. In memory retrieval, only Cd was activated in OCD patients. Cd was positively connected with DLPFC and vmPFC in OCD, but negatively connected between same brain areas in HC. OCD patients showed increased gray matter (GM) volumes of cerebellum, DLPFC, orbitofrontal cortex (OFC), hippocampus, Cd and ITG, and concurrently, increased white matter volumes of DLPFC. In OCD patients, GM volumes of Cd and OFC were positively correlated with HAMA and Y-BOCS. Functional activity changes of Cd in OCD were positively correlated with Y-BOCS.Conclusion Our findings support to accessing clinical symptom and its severity linked by brain structural deformation and functional abnormality in OCD patients.

Objectives This study aimed to evaluate the reliability and validity of the Korean Form of the Premonitory Urge for Tics Scale (K-PUTS). Methods Thirty-eight patients with Tourette's disorder who visited Jeonbuk National University Hospital were assessed with the K-PUTS. Together with the PUTS, the Yale Global Tic Severity Scale (YGTSS), the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the attention-deficit/hyperactivity disorder (ADHD) rating scale (ARS), and the Adult ADHD Self-Report Scale (ASRS) were implemented to evaluate concurrent and discriminant validity. Results The internal consistency of items on the PUTS was high, with a Cronbach's α of 0.79. The test-retest reliability of the PUTS, which was administered at 2 weeks to 2 months intervals, showed high reliability with a Pearson correlation coefficient of 0.60. There was a significant positive correlation between the overall PUTS score and the YGTSS score, showing concurrent validity. There was no correlation between the PUTS, CY-BOCS, and ASRS scores, demonstrating the discriminant validity of the PUTS. Factor analysis for construct validity revealed three factors: "presumed functional relationship between the tic and the urge to tic," "the quality of the premonitory urge," and "just right phenomena." Conclusion The results of this study indicate that the K-PUTS is a reliable and valid scale for rating premonitory urge of tics.

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.

Objectives: The study compared the intelligence test profiles of Tourette’s Disorder (TD), attention-deficit hyperactivity disorder (ADHD), and TD with ADHD (TD+ADHD) groups. Methods: The Korean Wechsler Intelligence Scale for Children-third edition (K-WISC-III) and Korean Wechsler Intelligence Scale for Children-fourth edition (K-WISC-IV) were administered to 13 children and adolescents with TD, 17 children and adolescents with ADHD, and 15 children and adolescents with TD+ADHD. Each parameter was compared among the groups using the Kruskal-Wallis test. Results: The mean scores of the freedom from distractibility/working memory index (FD/WMI) and the digit span and arithmetic subtests of the TD+ADHD group were significantly lower than those of the TD group. Conclusion: According to the intelligence test results, the comorbid ADHD+TD group showed a significant decrease in working memory compared to the TD group. These findings are similar to those of previous research on cognitive functions and suggest that the TD+ADHD comorbid and TD alone groups exhibit different endophenotypes. The results also imply that WISC-III and WISC-IV, the most commonly used intelligence tests clinically, are effective in evaluating cognitive functions such as attention. Further research is required to confirm these results.

COVID-19 has spread worldwide. People are struggling to adjust to a new normal, but changes in their daily routines are also causing stress. A person may feel depressed, uneasy, or suicidal and may complain of symptoms such as panic attacks, post-traumatic stress disease (PTSD), psychosis, obsessive–compulsive disorder, or paranoia when personal resilience cannot effectively process the stress. Children, adolescents, and health care workers are especially psychologically vulnerable groups in the pandemic calamity situation; therefore, a long-term intervention plan is necessary for them. When intervening with children and adolescents, it should be considered that each individual has different ways of expressing stress according to the developmental level of cognition, language, and emotion, and taking into account these developmental levels, it is necessary to help them achieve developmental tasks appropriate for their age. Health care workers feel psychological pain from problems such as the risk of becoming infected, the risk of passing the virus to their families, overwork, isolation, and stigma. Therefore, it is necessary to help them recover themselves by supplying personal protective equipment and providing the most basic resources necessary for adequate rest, work-life balance, and childcare.

Objective To report the development and validation of the National Cancer Center Psychological Symptom Inventory (NCC-PSI). Methods Psychometric properties of the NCC-PSI were examined by using multicenter surveys involving 400 patients with cancer in 5 cancer-treatment hospitals throughout Korea. Related measures including the Mini-International Neuropsychiatric Interview were administered. Results Convergent validity was supported by NCC-PSI's significant associations with related measures. Known-group validity was proven with higher scores of helplessness/hopelessness and anxious preoccupation on the Mini-Mental Adjustment to Cancer in the depression and anxiety diagnosis group, defined by the NCC-PSI. Cutoff scores for insomnia, anxiety, and depression were identified. Overall, the screening performance of the NCC-PSI was comparable to that of the distress thermometer and Patient Health Questionnare-2. Conclusions The NCC-PSI represents a meaningful effort to develop a distress screening tool that addresses specific psychological symptoms common in cancer, which are tailored to the local oncology care system with varying degrees of psychosocial care resources.

Objective Brain-derived neurotrophic factor (BDNF), one of the most abundant and important neurotrophins, is known to be involved in the development, survival, maintenance, and plasticity of neurons in the nervous system. Some studies have suggested that BDNF may play a role in the pathophysiology of several psychiatric illnesses such as depression and schizophrenia. Similarly, it is likely that the alteration of BDNF may be associated with the neuro-modulation that contributes to the development of somatization disorder. Methods The purpose of this study was to determine whether there is an abnormality of plasma BDNF levels in patients with somatization disorder, and to analyze the nature of the alteration after pharmacotherapy using an enzyme-linked immunosorbent assay (ELISA). Results The plasma BDNF levels of the patients with a somatization disorder were significantly lower compared with those of the control volunteers (83.61±89.97 pg/mL vs. 771.36±562.14 pg/mL); moreover, the plasma BDNF levels of those patients who received an antidepressant were significantly increased after the treatment (118.13±91.45 pg/mL vs. 72.92±88.21 pg/mL). Conclusion These results suggest that BDNF may play a role in the pathophysiology of somatization disorder.

The objective of this study was to investigate the risk factors of suicidal ideation and their population attributable fraction (PAF) in a representative sample of the elderly population in Korea.We examined the data set from the Survey of Living Conditions and Welfare Needs of Korean Older Persons, which was conducted by the Korea Institute for Health and Social Affairs (KIHASA) in 2011. In that survey, 10,674 participants were randomly selected from those older than age 65. Simultaneous multivariate logistic regression was used to investigate the risk factors of suicidal ideation in terms of their sociodemographic and health-related variables. Subsequently, the PAF was calculated with adjustment for other risk factors.The weighted prevalences of depression and suicidal ideation were 30.3% and 11.2%, respectively. In multivariate analysis, factors significantly associated with decreased risk of suicidal ideation included old-old age (odds ratio [OR] = 0.66 for 75 to 79 years, OR = 0.52 for 80 to 84 years, OR = 0.32 for older than 85 years), economic status (OR = 0.59 for 5th quintile; more than US$25,700 per year), whereas those associated with increased risk included poor social support (OR = 1.28), currently smoking (OR = 1.42), sleep problems (OR = 1.74), chronic illness (OR = 1.40), poor subjective health (OR = 1.56), functional impairment (OR = 1.45), and depression (OR = 4.36). Depression was associated with a fully adjusted PAF of 45.7%, followed by chronic illness (19.4%), poor subjective health status (18.9%), sleep problems (14.1%), functional impairment (4.9%), poor social support (4.2%), and currently smoking (3.6%).Preventive strategies focused particularly on depression might reduce the impact of suicidal ideation in the elderly population. Also, specific mental health centers focused on the specific needs of the elderly population should be established to manage suicidal risk.

Background Generalized anxiety disorder (GAD) is associated with brain function and morphological alterations. This study investigated explicit verbal memory impairment in patients with GAD in terms of brain functional deficits in combination with morphologic changes. Methods Seventeen patients with GAD and 17 healthy controls matched for age, sex, and education level underwent high-resolution T1-weighted MRI and fMR imaging at 3 T during explicit verbal memory tasks with emotionally neutral and anxiety-inducing words. Results In response to the neutral words, the patients showed significantly lower activities in the regions of the hippocampus (Hip), middle cingulate gyrus (MCG), putamen (Pu) and head of the caudate nucleus (HCd) compared with healthy controls. In response to the anxiety-inducing words, the patients showed significantly higher activities in the ventrolateral prefrontal cortex and precentral gyrus. However, they showed lower activities in the Hip, MCG, Pu and HCd. In addition, patients with GAD showed a significant reduction in gray matter volumes, especially in the regions of the Hip, midbrain, thalamus, insula and superior temporal gyrus, compared with healthy controls. Limitations This study examined a small sample sizes in each of the groups, and there was no consideration of a medication effect on brain activity and volume changes. Conclusions This study provides evidence for the association between brain functional deficits and morphometric alterations in an explicit verbal memory task for patients with GAD. This finding is helpful for understanding explicit verbal memory impairment in connection with GAD symptoms.

Objectives The objective of this cross-sectional study was to investigate the relationship between depression in elderly individuals and chronic illness, subjective health status, and cognitive impairment. Method This study used the dataset of the Survey of Living Conditions and Welfare Needs of Korean Older Persons, which was conducted by the Korea Institute for Health and Social Affairs in 2011. Participants (n = 10 674) were randomly selected from a pool of individuals aged 65 years and older. Elderly depression was evaluated by the short version of the Geriatric Depression Scale. Multivariate logistic regression was used to investigate factors associated with depression in terms of their sociodemographic and health-related characteristics. Results Our results revealed that chronic illness, subjective health status, and cognitive impairment were significant factors associated with depression. In particular, subjective health status showed the highest odds ratio (OR) (OR for bad subjective health status = 4.290, P < 0.001), followed by chronic illness (OR for three or more chronic illnesses = 1.403, P < 0.01) and cognitive impairment (OR = 1.347, P < 0.001) in the final model. Interestingly, the significant association between chronic illness and depression was attenuated (OR for three or more chronic illnesses = 1.403, P = 0.01) or even disappeared (OR for two chronic illnesses = 1.138, P = 0.274; OR for one chronic illnesses = 0.999, P = 0.996) after adjustment for subjective health status in the final model; this may be attributable to the close relationship among the variables studied: chronic illness, subjective health status, and depression. Conclusions Development and implementation of prevention strategies, including management of chronic illness, individual's perception of health status, and cognitive impairment, could possibly reduce the impact of depression.

Objective:Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients.Method:A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered.Results:The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94,p< 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services.Significance of results:Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.

Objective The neural correlates underlying the effects of emotional distraction during working memory (WM) tasks in patients with schizophrenia have yet to be clearly identified. Thus, the present study employed functional magnetic resonance imaging (fMRI) to investigate the effects of emotional distraction involving fear during WM maintenance in patients with schizophrenia. Methods This study included 17 patients with schizophrenia who were diagnosed based on Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision (DSM-IV-TR) criteria and 17 matched healthy controls. Event-related fMRI data were acquired while the participants performed a delayed-response WM task that included neutral and fearful distractors. Results Patients with schizophrenia may have tried to maintain WM function during the presentation of task-irrelevant fearful distractors that induced interruption and required attention. Compared to healthy controls, the schizophrenia patients exhibited significantly increased activity in the dorsolateral prefrontal cortex, medial prefrontal cortex, superior temporal gyrus, middle temporal gyrus, insula, hippocampus, caudate nucleus, and postcentral gyrus in a delayed-response WM task when presented with fearful relative to neutral distractors. In addition to its series of increased brain activations, prefrontal areas exhibited interconnections with more caudal brain regions, including temporal areas and the hippocampus and insula. Conclusion The present study identified specific brain areas associated with the interaction between emotional regulation and cognitive functioning during fearful distractors presented while patients with schizophrenia performed a WM maintenance task. These findings further the current understanding of the neural correlates underlying the effects of emotional distraction on cognitive functioning in patients with schizophrenia.

Objective The purpose of this study is to examine the validity of primary screening tools for attention deficit hyperactivity disorder (ADHD) in a community-based sample of children using the Korean version of the Child Behavior Checklist (K-CBCL) and the Korean version of the ADHD Rating Scale (K-ARS). Methods A large-scale community-based study for ADHD screening was conducted in the Jeollabuk province in the Republic of Korea. In 2010-2011, we surveyed a total of 49,088 first- and fourth-grade elementary school students. All of the participants in this study were assessed by the K-ARS-Parent version (K-ARS-P) and the K-ARS-Teacher version (K-ARS-T) as the primary screening instruments. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used for confirming the diagnosis of ADHD. DISC-IV was administered to subjects who received top 10% scores in the K-ARS-P or K-ARS-T tests. Results Of the 3,085 subjects who completed the DISC-IV, 1,215 were diagnosed as having ADHD. A reasonable level of sensitivity, specificity, and negative predictive value were obtained when the total K-ARS-P scores were ≥90th percentile. The positive predictive value and specificity increased significantly when the total K-ARS-P scores were ≥90th percentile, T scores were ≥60 in the attention problems of K-CBCL, and T scores were ≥63 in the total problems of K-CBCL. Conclusion These results suggested that the K-ARS-P could effectively serve as a primary screening tool to identify elementary school children with ADHD in the community. Also, there might be some increment in the effectiveness of K-ARS-P when combined with K-CBCL-A and K-CBCL-T as a secondary screening tool.

To evaluate the associations between cyberbullying behaviors and problematic internet use, and to compare psychopathologic symptoms in victims, perpetrators, and victims-perpetrators of cyberbullying to those in youths who were not involved in cyberbullying. A total of 4531 youths (11-14 years of age) were recruited from elementary and middle schools. Among 4531 youths, 9.7% were involved in cyberbullying; 3.3% were only victims; 3.4% were only perpetrators; and 3.0% were victims-perpetrators. Cyberbullying behaviors were associated with problematic internet use as well as various psychopathologic symptoms. Depressive symptoms were associated with cyberbullying victimization, and rule-breaking behaviors and aggressive behaviors have relevance to cyberbullying perpetration. Greater attention needs to be paid to identify youths earlier who are involved in cyberbullying and prevent serious adverse consequences in them. Language: en

Objectives:It has been reported that higher percentage of B cells react with monoclonal D8/17 antibody in patients with rheumatic fever, childhood onset obsessive-compulsive disorder, Tourette's disorder, or prepubertal anorexia nervosa. The pur- pose of this study is to replicate the previous studies in a Korean young population with tic disorder and to identify any relation- ship between D8/17 and clinical symptoms. Methods:The binding of D8/17 to B cells was determined in patients with tic disorder (N=21) and healthy controls (N=9) by Fluorescence-Activated Cell Sorter analysis. Results:In the sample examined by this study, the average percentage of B cells expressing D8/17 in tic disorder was 2.05%; healthy controls was 3.15%. No statistically significant differences were found in the mean percentages of D8/17 between the two groups. Conclusion:The expression of D8/17 in B cells was very low in this study. No subjects with tic disorder or healthy controls was above 12% in D8/17 positive proportion. Further studies, including higher number of patients and control group members, should be performed.

Little is known about the risk factors for the fear of falling in elderly Korean individuals. Thus, the present study aimed to investigate the risk factors for fear of falling in a representative elderly population of over 10,000 individuals aged 65 years and older. A multivariate multinomial analysis revealed that the risk factors associated with a severe fear of falling were being female [odds ratio (OR)=4.396], older age (OR=5.550 for those aged ≥85 years), lower level of education (OR=0.719 for those with ≥13 years of schooling), chronic illness (OR=2.788 for those with more than three chronic illnesses), poor subjective health (OR=6.268), functional impairments (OR=2.340), a history of falling (OR=7.062), and depression (OR=1.774). The ORs for each of these risk factors were particularly high in participants with a severe fear of falling. Particularly, a history of falling and/or poor subjective health status had strong independent associations with the fear of falling. The present findings may help health care professionals identify individuals that would benefit from interventions aimed at reducing the fear of falling.

ObjectiveWe performed functional magnetic resonance imaging (fMRI) to discriminate the differential brain activation patterns in patients with obsessive compulsive disorder (OCD) and healthy controls during implicit retrieval tasks with emotionally neutral and unpleasant words.MethodsSixteen patients with OCD (mean age: 31.4±10.1 years) and 16 healthy controls (mean age: 32.6±5.8 years) with no history of neurological or psychiatric illness underwent 3-T fMRI. The stimulation paradigm consisted of the following cycle: rest, encoding of a string of two-syllable words, rest, and retrieval of the previously encoded words with the first consonant omitted.ResultsDuring the implicit retrieval task with emotionally neutral words, no distinct brain activity was observed in either the patients with OCD or healthy controls. On the other hand, during the retrieval task with unpleasant words, the patients with OCD showed predominant activity in the superior/middle temporal pole, medial superior frontal gyrus, and orbitofrontal cortex (uncorrected pConclusionThis study revealed the differential brain activation patterns between patients with OCD and healthy controls during implicit memory tasks with unpleasant words. Our results suggest that the impact of negative emotion on implicit memory task may be associated with the symptomatology of OCD. This finding may be helpful for understanding the neural mechanisms that underlie implicit memory retrieval, particularly the interaction between emotion and cognition, in patients with OCD.

Objectives : This study examined the current prevalence rate of school bullying and its related psychopathology. Methods : A total of 3,550 elementary/middle school students and their parents were recruited for this study. A self-report questionnaire on perpetration and victimization in school bullying was used for collection of data regarding prevalence and the present state of school bullying. For evaluation of associated psychopathology, self report forms, including the Children`s Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), attention-deficit hyperactivity disorder Rating Scale (ARS), Korean-Child Behavior Checklist (K-CBCL), Korean-Youth Self Report (K-YSR), and the Korean Eppendorf Schizophrenia Inventory (K-ESI) were applied. Samples were classified according to four subtype groups (control, victim, perpetrator, and victim-perpetrator) and characteristics of each group were compared. Results : Overall, the prevalence rate for bullying perpetration was 64.4% and the prevalence rate for bullying victimization was 63.4%, indicating involvement of more than half of students in school bullying. Bully-victims reported high social immaturity and depressive and suicidal tendency, whereas bully-perpetrators reported less social immaturity and more externalizing problems. Among the subtype groups, the victim-perpetrator group showed the most prominent depressive/anxiety tendency and behavioral problems. Conclusions : Both victimization and perpetration of bullying are common problems for child and adolescent groups and several psycho-social problems were found to be related. The results of this study will guide direction of future study and development of strategies for prevention of bullying.

Objective Several studies have reported that ethnic differences influence psychiatric diagnoses. Some previous studies reported that African Americans and Hispanics are diagnosed with schizophrenia spectrum disorders more frequently than Caucasians, and that Caucasians are more likely to be diagnosed with affective disorders than other ethnic groups. We sought to identify associations between sociodemographic factors and psychiatric diagnosis. Methods We retrospectively examined the medical records of all psychiatric inpatients (ages over 18 years) treated at Kern county mental hospital (n=2,051) between July 2003 and March 2007 for demographic, clinical information, and discharge diagnoses. Results African American and Hispanic males were more frequently diagnosed with schizophrenia spectrum disorders than Caucasians, whereas Caucasian females were more frequently diagnosed with affective disorders than females in the other ethnic groups, suggesting that patient ethnicity and gender may influence clinical diagnoses. Demographic variables, that is, a lower education, failure of marriage, homelessness, and low quality insurance, were found to be significantly associated with a diagnosis of schizophrenia spectrum disorders after adjusting for clinical variables. And, the presence of a family psychiatric history, failure of marriage, not-homelessness, and quality insurance were found to be associated with a diagnosis of affective disorders. Conclusion Our results show that these demographic factors, including ethnicity, have effects on diagnoses in psychiatric inpatients. Furthermore, these variables may help prediction of psychiatric diagnoses.

Epidemiologic research indicates that psychosis and depression most frequently develop during adolescence. Hence, an efficient strategy for improving youth mental health would be to focus on detection of early-stage psychosis and depression in adolescence. In this study, 1461 high school students were surveyed using self-report scales. Students who scored equal to or above the cut-off value on any of the scales and who agreed to a further examination proceeded to a second assessment, using the Kiddie Schedule for Affective Disorders and Schizophrenia and Comprehensive Assessment of At-Risk Mental States along with self-reporting scales. The estimated prevalence of adolescents at ultra-high risk (UHR) for psychosis and of depression-spectrum disorders was 1.26 and 3.69% respectively. Compared with the normal group, experiences of bullying, suicidal ideation, and suicide attempts were significantly higher in these two groups; the subjects at UHR for psychosis were found to have significantly lower academic performance and lower ratings on SCRS; and submissive behavior was more prevalent in the depression-spectrum group. Our results reveal several clinical features of adolescents at UHR for psychosis and with depression-spectrum disorder and underscore the importance of accurate assessment of and early appropriate care for these adolescents.

Aim This article compares the socio-demographic and clinical characteristics of patients with schizophrenia who recovered with those who achieved remission. Methods Participants were classified based on predetermined criteria for recovery and remission. Data on demographic characteristics, information on duration of untreated psychosis, and assessments of current and historical symptom profiles and socio-occupational functioning emerged from careful chart review and direct interviews. Cross-sectional assessments of clinical variables were derived from the Positive and Negative Syndrome Scale, the Scale for the Assessment of Negative Symptoms, the Personal and Social Performance Scale, the Social Functioning Questionnaire, the Schizophrenia Cognition Rating Scale (ScoRS), the Basic Empathy Scale, and the Brief Core Schema Scales (BCSS). Results We found no significant differences between recovered and remitted groups with respect to demographic variables or duration of untreated psychosis. Cognitive and total empathy scores, positive-self schema score on the BCSS, and global score on the ScoRS were significantly higher in the recovered than the remitted group. Furthermore, patients with good levels of empathy and positive-self schema and intact neurocognitive functioning were more likely to achieve recovery. Conclusion These results suggest that empathy, positive-self schema and neurocognitive functioning may serve as important clinical characteristics distinguishing those patients who have recovered from those who have achieved only remission.

The aim of this study was to investigate the efficacy and safety of ziprasidone in first-episode psychosis. This was an 8-week, open-label, multicenter trial. In total, 27 patients (14 male patients, 13 female patients) with a Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition diagnosis of schizophreniform disorder, schizoaffective disorder, schizophrenia, or psychotic disorder not otherwise specified comprised the study population. The initial recommended dose of ziprasidone was 40 mg/day. Within the first 2 weeks, the dose could be increased to 120-160 mg/day depending on the patient's condition. The primary outcome variables were scores on the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity scale; secondary measures included the Calgary Depression Scale for Schizophrenia and others. To assess safety, we measured drug-related adverse events, weight, lipid variables, prolactin, and corrected QT (QTc) interval. Among the 27 enrolled participants, 16 dropped out [lack of efficacy (n = 7), loss to follow-up (n = 7), withdrawn consent (n = 1), and serious adverse event (n = 1)]. The mean total daily and endpoint doses of ziprasidone were 120.30 ± 40.34 and 131.85 ± 51.22 mg/day, respectively. The administration of ziprasidone resulted in significant improvement in the PANSS (P < 0.0001) and CGI scores (P < 0.0001) over time. Significant improvement in the Calgary Depression Scale for Schizophrenia score (P < 0.0001) was also observed at week 8. The response rate (defined as a 30% or greater decrease in the PANSS total score from baseline to last observation) was 51.85%. No significant differences in extrapyramidal symptoms rating scale scores, and lipid and prolactin levels from baseline to last observation were found. However, modest side effects regarding the incidence of extrapyramidal symptoms and hyperprolactinemia, and weight change from baseline in male patients were observed. These results indicate that ziprasidone is effective in the treatment of the positive, negative, and depressive symptoms of first-episode psychosis and has a modest side-effect burden.

Objective The present study investigated subjective experiences related to secondary negative symptoms and cognitive performance in healthy volunteers in response to the repeated administration of paliperidone extended-release (ER) and risperidone in a double-blind, placebo-controlled trial. Methods Participants (n = 32) received a fixed dose of one of three study medications for three consecutive days: 6 mg of paliperidone ER, 3 mg of risperidone, or placebo. Subjects were evaluated at baseline and after the first and third administrations of the medications by using the Neuroleptic-Induced Deficit Syndrome Scale and the Scale for the Assessment of Negative Symptoms. Cognitive function was measured at baseline and after the third administration of the medications by using the computerized neuropsychological test. Results Risperidone was associated with more detrimental subjective experiences compared with paliperidone ER and placebo (p

Relapse following stabilization of acute psychotic symptoms is common. Psychosocial intervention following stabilization is essential to improve long-term outcome in patients with first-episode or recent-onset psychosis. The present study investigated the efficacy of group cognitive behavioral therapy (CBT) in further improving clinical status in stable outpatients with first-episode or recent-onset (≤5 years) psychosis. Twenty four patients participated in 12 weekly sessions. Clinical variables were assessed pre- and post-treatment. Primary outcome measures were the Ambiguous Intention Hostility Questionnaire, Positive and Negative Syndrome Scale, and Psychotic Symptoms Rating Scales. Secondary outcome measures included self-report scales evaluating emotion, functioning, insight, and schemas. Treatment significantly improved the primary and most of the secondary outcome measures. Insight was not significantly changed. Moderate correlations were observed between the primary and some secondary outcome measures. The results indicate that group CBT further improves the clinical status of stable outpatients with first-episode or recent-onset psychosis.

Objective This study used functional magnetic resonance imaging (fMRI) to contrast the differential brain activation patterns in response to visual stimulation with both male and female erotic nude pictures in male-to-female (MTF) transsexuals who underwent a sex reassignment surgery. Materials and methods A total of nine healthy MTF transsexuals after a sex reassignment surgery underwent fMRI on a 3.0 Tesla MR Scanner. The brain activation patterns were induced by visual stimulation with both male and female erotic nude pictures. Results The sex hormone levels of the postoperative MTF transsexuals were in the normal range of healthy heterosexual females. The brain areas, which were activated by viewing male nude pictures when compared with viewing female nude pictures, included predominantly the cerebellum, hippocampus, putamen, anterior cingulate gyrus, head of caudate nucleus, amygdala, midbrain, thalamus, insula, and body of caudate nucleus. On the other hand, brain activation induced by viewing female nude pictures was predominantly observed in the hypothalamus and the septal area. Conclusion Our findings suggest that distinct brain activation patterns associated with visual sexual arousal in postoperative MTF transsexuals reflect their sexual orientation to males.

Noncompliance and poor outcome in patients with schizophrenia are closely related to the negative symptoms secondary to antipsychotics. No controlled study has evaluated whether amisulpride and aripiprazole induce negative symptoms. The aim of this study was to assess the effects of single doses of amisulpride, aripiprazole, haloperidol, and risperidone in healthy volunteers. Seventy-eight young volunteers took part in this double-blind, randomized, placebo-controlled, parallel study of four antipsychotics: 400 mg amisulpride, 10 mg aripiprazole, 3 mg haloperidol, and 2 mg risperidone. Assessments of negative symptoms were done 4 h after administration using both subjective rating scales (Neuroleptic Induced Deficit Syndrome Scale and Subjective Deficit Syndrome Scale) and an objective rating scale (Scale for the Assessment of Negative Symptoms). Risperidone only produced significant increases on the avolition score of the Neuroleptic Induced Deficit Syndrome Scale and blunted affect and alogia scores of the Scale for the Assessment of Negative Symptoms compared with placebo. The effect on blunted affect persisted after controlling for mental sedation. Amisulpride, aripiprazole, and haloperidol did not induce negative symptoms. Aripiprazole and risperidone induced mild extrapyramidal symptoms. The most common adverse events were somnolence and cognitive slowing. These data indicate that a single risperidone dose induces negative symptoms in normal volunteers, whereas amisulpride, aripiprazole, and haloperidol do not. These characteristics of antipsychotics should be considered when choosing optimal drugs for patients with psychosis.

This study was performed to clarify the sexual orien-tation in a 19-year-old homosexual male and a 20-year-old homosexual female by using a functional magnetic resonance imaging (fMRI) with viewing male and female erotic nude pictures. The sex hor-mone levels of the homosexual male and female were in the normal range of healthy heterosexual males and females, respectively. In both homosexuals more significant brain activities were observed while view-ing the nude pictures of the same genetic sex than those of the opposite sex in the frontal cortex, parietal cortex, occipital cortex, anterior cingulate gyrus, amygdala, midbrain, hippocampus, orbitofrontal cortex, parahippocampal gyrus, thalamus, globus pallidus, and putamen, which are known to be re-sponsive to sexual arousal. The homosexual male and female showed a tendency toward higher sexual arousal to the same genetic sex as comparison with the opposite sex. This finding may be useful to un-derstand the different neural mechanisms on sexual arousal in homosexuals.

Objectives：This study was aimed at investigating the relationship between internet game addiction and emotional and behavioral characteristics of students both in the 5th and 6th grade of elementary school and in middle school. Methods：Two elementary schools and two middle schools were chosen to participate. The students completed self-report questionnaires designed by the authors, called the Internet Game Addiction Scale, Korean youth self-report (K-YSR). Results：Compared to previous studies, the rates of those in the obvious game addiction group were much lower in this study. We defined the upper 10% of internet game addiction scores as a high risk user group and the lower 10% as a control group. There were significant differences between the groups with respect to the the ages at which internet gaming began, the frequency of game play per week, and the average length of each game playing session. Significant associations were also found between the level of internet game addiction and the withdrawn and delinquency sub-scales of the K-YSR. However, the association between game addiction and the withdrawn subscale was found only in middle school students. Conclusion：The findings from this study suggested that withdrawn and delinquent behaviors could be predictors of internet game addiction. Results also suggested the importance of early childhood intervention for preventing the de-velopment of more severe psychopathology in early adolescence. KEY WORDS：Internet Game Addiction·K-YSR·Children·Adolescent.

Objective Serotonergic dysfunction is quite evident in panic disorder. We investigated whether the C(-1019)G polymorphism of 5-HT1A receptor gene may play a role in the pathogenesis of panic disorder in a Korean population. Methods The 5-HT1A receptor genotype for the single nucleotide polymorphism (SNP) C(-1019)G was analyzed in 94 patients and 111 healthy controls. The severity of the patients' symptoms was examined using the Spielberger State-Trait Anxiety Inventory (STAI), Panic Disorder Severity Scale (PDSS), Anxiety sensitivity index (ASI), Acute Panic Inventory (API) and Hamilton's Rating Scale for Anxiety (HAM-A). Results The distribution of the genotypes of the C/G polymorphism did not differ significantly from those predicted by Hardy-Weinberg equilibrium in patients as well as the controls. No association between the C(-1019)G polymorphism and panic disorder was detected in either the allele frequency or genotype distribution. There was no significant association with genotype distribution in the panic disorder with agoraphobia. However, there was a significant difference of symptom severity between C/C, C/G, and G/G genotype or between C and G allele in panic disorder patients without agoraphobia. PDSS scores were significantly higher in subjects with the G/G genotype or with G allele in patients without agoraphobia, not in total patients or patients with agoraphobia. Conclusion Although there were no significant differences in the genotype and allele distributions, we found a significant association between panic symptom severity and the serotonin 1A receptor gene. This result suggests that the serotonin 1A receptor and serotonin may play a role in the pathogenesis of panic disorder.

Dysfunction of the serotonergic system has been hypothesized to play an important role in panic disorder. We investigated the 5-HT2A receptor ( 5HTR2A ) and tryptophan hydroxylase ( TPH ) genes for an association with panic disorder (PD). Patients with PD ( n = 107) and control subjects ( n = 161) were genotyped for 5HTR2A 1438A/G, 5HTR2A 102T/C, and TPH218 A/C. The severity of their symptoms was measured using the Spielberger State-Trait Anxiety Inventory (STAI), Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index (ASI), Acute Panic Inventory (API), and Hamilton's Rating Scale for Depression (HAMD). There were no significant differences in the genotype distributions or allelic frequencies in the three serotonergic polymorphisms between PD patients and normal controls. However, we found a significant difference in symptom severity among the genotypes of both the 5HTR2A 1438A/G and 102T/C polymorphisms. Although there were no significant differences in the genotype and allele distributions, we found a significant association between panic symptom severity and the serotonin 2A receptor gene. This result suggests that 5HTR2A 1438A/G and 102T/C polymorphic regions can be associated with the phenotype or the pathogenesis of panic disorder.

Introduction Mental illness is closely related with sexual dysfunction. A number of investigators have reported that depressive women have difficulties in sexual arousal. Aim The purpose of this study was to compare the cerebrocortical regions associated with sexual arousal between the healthy and depressive women using functional magnetic resonance imaging (fMRI) based on the blood-oxygenation-level-dependent (BOLD) technique. Methods Together with nine healthy women (mean age: 40.3), seven depressive women (mean age: 41.7 years, mean Beck Depression Inventory: 35.6, mean Hamilton Rating Scale Depression-17: 34.9) underwent fMRI examinations using a 1.5T MR scanner (Signa Horizon; GE Medical Systems, Milwaukee, WI, USA). The fMRI data were obtained from seven oblique planes using gradient-echo EPI. Sexual stimulation paradigm began with a 1-minute rest and then 4-minute stimulation using an erotic video film. The brain activation maps and their resulting quantification were analyzed by the statistical parametric mapping (SPM99) program. The number of pixels activated by each task was used as brain activity, where the significance of the differences was evaluated by using independent t-test. Main outcome measures We measured brain activation areas using BOLD-based fMRI with visual sexual stimulation in healthy volunteers and depressive patients. Results Healthy women were significantly (P Conclusions This preliminary study performed by fMRI gives valuable information on differentiation of the activated cerebral regions associated with visually evoked sexual arousal between healthy and depressive women. In addition, these findings might be useful to understand neural mechanisms for female sexual dysfunction in depressive women.

Aims: The Short Post-traumatic Stress Disorder (PTSD) Rating Interview (SPRINT) is a validated, eight-item, brief global assessment scale for PTSD. This report investigated the psychometric properties of the Korean version of the SPRINT (K-SPRINT). Methods: Eighty-seven PTSD patients, 47 other psychiatric patients, and 63 healthy control subjects were enrolled in the study. All subjects completed a psychometric assessment package that included the K-SPRINT and the Korean versions of the Clinician-Administered PTSD Scale (CAPS), the Beck Depression Inventory (BDI), and the State Trait Anxiety Inventory (STAI). Results: The K-SPRINT showed good internal consistency (Cronbach's α = 0.86) and test–retest reliability (r = 0.82). K-SPRINT showed moderatecorrelations with CAPS (r = 0.71). An exploratory factor analysis produced one K-SPRINT factor. The optimal diagnostic efficiency (91.9%) of the K-SPRINT was found at a total score of 15, at which point the sensitivity and specificity were 90.8% and 92.7%, respectively. Conclusions: The present findings demonstrate that the K-SPRINT had good psychometric properties and can be used as a reliable and valid instrument for the assessment of PTSD.

Objective Mixed results exist regarding the role of vitamin D deficiency in depression and suicidal ideation. The present study investigated the relationships among vitamin D, depressive symptoms, and suicidal ideation in a large representative of the general population of Korea. Method The data from the fifth Korea National Health and Nutrition Examination Surveys conducted by the Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, from 2010 to 2012 were investigated. A total of 15,695 subjects aged 20 and older were included in analysis. Depressive symptoms and suicidal ideation were evaluated based on self-report information. The serum 25-hydroxyvitamin D concentrations were measured by radioimmunoassay. The associations among vitamin D, depressive symptoms, and suicidal ideation were explored using multivariate logistic regression analysis adjusting for various confounding variables including sociodemographic and health-related variables. Results Serum 25-hydroxyvitamin D concentrations were not significantly different depending on the depressive symptoms (participant with depressive symptom, n = 2085, 17.10 ng/ml; without depressive symptom, n = 13,610, 17.36 ng/ml; p = 0.142) and suicidal ideation (participant with suicidal ideation, n = 2319, 17.31 ng/ml; without suicidal ideation, n = 13,374, 17.33 ng/ml; p = 0.926). After adjustment for sociodemographic and health-related factors, this lack of relationship was held consistent in the multivariate logistic regression. Conclusions Significant associations were not observed among vitamin D, depressive symptoms, and suicidal ideation in Korean adults. Further studies are warranted to gain a better understanding of the association among vitamin D, depressive symptoms, and suicidal ideation.

Background The functional neuroanatomy for explicit memory in conjunction with the major anxiety symptoms in patients with generalized anxiety disorder (GAD) has not yet been clearly identified. Purpose To investigate the brain activation patterns on the interaction between emotional and cognitive function during the explicit memory tasks, as well as its correlation with clinical characteristics in GAD. Material and Methods The participants comprised GAD patients and age-matched healthy controls. The fMR images were obtained while the participants performed an explicit memory task with neutral and anxiety-inducing words. Results Patients showed significantly decreased functional activities in the putamen, head of the caudate nucleus, hippocampus, and middle cingulate gyrus during the memory tasks with the neutral and anxiety-inducing words, whereas the precentral gyrus and ventrolateral prefrontal cortex were significantly increased only in the memory tasks with the anxiety-inducing words. Also, the blood oxygenation level-dependent (BOLD) signal changes in the hippocampus were positively correlated with the recognition accuracy for both neutral and anxiety-inducing words. Conclusion This study identified the brain areas associated with the interaction between emotional regulation and cognitive function in the explicit memory tasks in patients with GAD. These findings would be helpful to understand the neural mechanism on the explicit memory-related cognitive deficits and emotional dysfunction with GAD symptoms.

Jong-Hyun Jeong,1 Won-Myong Bahk,1 Young Sup Woo,1 Kyung-Uk Lee,1 Do Hoon Kim,2 Moon-Doo Kim,3 Won Kim,4 Jong-Chul Yang,5 Kwang Heun Lee6 1Department of Psychiatry, Yeouido StMary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 2Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, 3Department of Psychiatry, Jeju National University Hospital, Jeju, 4Department of Psychiatry, Stress Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, 5Department of Psychiatry, Chonbuk National University Medical School, Jeonju, 6Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, South Korea Objectives: The primary aim of this non-inferiority study was to investigate the clinical effectiveness and safety of generic escitalopram (Lexacure®) versus branded escitalopram (Lexapro®) for patients with major depressive disorder (MDD).Methods: The present study included 158 patients, who were randomized (1:1) to receive a flexible dose of generic escitalopram (n=78) or branded escitalopram (n=80) over a 6-week single-blind treatment period. The clinical benefits in the two groups were evaluated using the Montgomery–Åsberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impressions-Severity scale (CGI-S), and the Clinical Global Impressions-Improvement scale (CGI-I) at baseline, week 1, week 2, week 4, and week 6. The frequency of adverse events (AEs) was also assessed to determine safety at each follow-up visit.Results: During the 6-week study period, 30 patients (38.5%) from the generic escitalopram group and 28 patients (30.0%) from the branded escitalopram group dropped out of the study (P=0.727). The MADRS, HDRS, CGI-S, and CGI-I scores significantly decreased in both groups, and there were no significant differences between the groups. At week 6, 28 patients (57.1%) in the generic escitalopram group and 35 patients (67.3%) in the branded escitalopram group had responded to treatment (as indicated by a ≥50% decrease from the baseline MADRS score; P=0.126), and the remission rates (MADRS score: ≤10) were 42.9% (n=21) in generic escitalopram group and 53.8% (n=28) in the branded escitalopram group (P=0.135). The most frequently reported AEs were nausea (17.9%), sleepiness/somnolence (7.7%), weight gain (3.8%), and dry mouth (2.6%) in the generic escitalopram group and nausea (20.0%), sleepiness/somnolence (3.8%), weight gain (2.5%), and dry mouth (2.5%) in the branded escitalopram group.Conclusion: The present non-inferiority study demonstrated that generic escitalopram is a safe and an effective initial treatment for patients with MDD and may also be considered as an additional therapeutic option for this population. Keywords: depression, branded escitalopram, Lexapro®, generic escitalopram, Lexacure&reg

The aim of this study was to reveal a potential effect of emotion on cognitive control in the implicit memory task with emotionally neutral and unpleasant words in healthy controls and patients with schizophrenia using a 3.0 T functional MRI (fMRI). A total of 15 patients with schizophrenia and 15 healthy controls underwent the fMRI. fMRI data were obtained while the participants performed the implicit memory tasks with emotionally neutral and unpleasant words. During the implicit memory retrieval with emotionally neutral words, the predominant activation areas observed in patients in contrast to healthy controls included the precuneus, superior parietal gyrus, and dorsolateral prefrontal cortex (dlPFC). In the implicit memory retrieval with unpleasant words, patients with schizophrenia showed dominant activities in the superior and middle temporal gyri, fusiform gyrus, supramarginal gyrus, postcentral gyrus, occipital gyrus, lingual gyrus, parahippocampal gyrus, amygdala, and insula as well as precuneus, superior parietal gyrus, and dlPFC. Blood-oxygen-level-dependent signal changes in the dlPFC were correlated positively with the scores of the negative symptoms under the PANSS during implicit memory retrieval with unpleasant words in patients with schizophrenia. These findings would be useful to understand the neural mechanisms related to general impairment of cognitive and emotional functions commonly observed in schizophrenia.

Few studies have assessed the neural mechanisms of the effects of emotion on cognition in generalized anxiety disorder (GAD) patients. In this functional MRI (fMRI), we investigated the effects of emotional interference on working memory (WM) maintenance in GAD patients. Fifteen patients with GAD participated in this study. Event-related fMRI data were obtained while the participants performed a WM task (face recognition) with neutral and anxiety-provoking distracters. The GAD patients showed impaired performance in WM task during emotional distracters and showed greater activation on brain regions such as DLPFC, VLPFC, amygdala, hippocampus which are responsible for the active maintenance of goal relevant information in WM and emotional processing. Although our results are not conclusive, our finding cautiously suggests the cognitive-affective interaction in GAD patients which shown interfering effect of emotional distracters on WM maintenance.