Bon Hoon Koo

Sleep patterns and their age-related changes in elementary-school children.

OBJECTIVES This study aimed to evaluate childrens bedtime, wake-up time, total sleep duration (TSD), sleep latency, and daytime napping by age and gender. Its secondary aim was to compare sleep duration among demographic and lifestyle factors. METHODS We performed a cross-sectional study of 3639 children in Daegu, Korea, comparing bedtimes, wake-up times, TSDs, daytime naps, and sleep latency according to age and gender, as well as comparing sleep duration according to the childrens demographic and lifestyle factors. RESULTS Bedtime and TSD varied significantly by age. But wake-up time differences were not as large, as the differences in bedtimes and TSDs. There were no gender differences in any sleep parameters. The percentage of the children who took naps decreased until age 9 and began increasing again at age 10. Children who lived in apartments got less sleep than did those living in other types of housing. Extracurricular academic activities, duration and timing of television-watching, and computer playing were also related to the childrens sleep duration. CONCLUSIONS Older children sleep less than younger children; the main reason is late bedtimes. Late bedtimes may be due to socio-cultural factors, high levels of nighttime and recreational activities, and/or excessive academic activities.

Effect of Methylphenidate on Sleep Parameters in Children with ADHD

Objective The primary aim of this study was to investigate the acute impact of methylphenidate (MPH) on sleep parameters in attention-deficit/hyperactivity disorder (ADHD) children. The second aim was to investigate the different effects of intermediate- and longacting MPH on sleep parameters. The third aim was to test the different effects of dose and age on sleep parameters. Methods Ninety-three ADHD children were enrolled and randomized to two different MPH preparations. Baseline and daily sleep diaries were evaluated for four weeks after taking medication. Weekday and weekend bedtimes, wake-up times, sleep latencies and total sleep times were compared by weeks. Results After taking MPH, there was a significant delay in bedtimes and a significant reduction of total sleep time (TST) both on weekdays and at weekends. There was also a significant delay in wake-up time on weekdays. However, the difference was applied to younger age group children only. There was no difference in changes of TST between metadate-CD and OROS-MPH. There also was no difference in changes of TST with different doses of MPH. Conclusion MPH had negative impacts on sleep among young ADHD children, but different preparations and doses did not affect the result.

Two Cases of Hypersexuality Probably Associated with Aripiprazole

Sexual dysfunction is a common side effect in patients treated with antipsychotics but significant differences exist across different compounds. We report hypersexuality symptoms in two female patients with schizophrenia who were receiving treatment with aripiprazole. The patients experienced more frequent sexual desire and greater sexual preoccupation after taking aripiprazole. We discuss the potential neuro-chemical mechanisms for this and argue that aripiprazoles unique pharmacological profile, partial agonism with high affinity at dopamine D2-receptor, may have contributed to the development of these symptoms.

Impairment of Concept Formation Ability in Children with ADHD: Comparisons between Lower Grades and Higher Grades

Objective We investigated executive functions (EFs), as evaluated by the Wisconsin Card Sorting Test (WCST), and other EF between lower grades (LG) and higher grades (HG) in elementary-school-age attention deficit hyperactivity disorder (ADHD) children. Methods We classified a sample of 112 ADHD children into 4 groups (composed of 28 each) based on age (LG vs. HG) and WCST performance [lower vs. higher performance on WCST, defined by the number of completed categories (CC)] Participants in each group were matched according to age, gender, ADHD subtype, and intelligence. We used the Wechsler intelligence Scale for Children 3rd edition to test intelligence and the Computerized Neurocognitive Function Test-IV, which included the WCST, to test EF. Results Comparisons of EFs scores in LG ADHD children showed statistically significant differences in performing digit spans backward, some verbal learning scores, including all memory scores, and Stroop test scores. However, comparisons of EF scores in HG ADHD children did not show any statistically significant differences. Correlation analyses of the CC and EF variables and stepwise multiple regression analysis in LG ADHD children showed a combination of the backward form of the Digit span test and Visual span test in lower-performance ADHD participants significantly predicted the number of CC (R2=0.273, p<0.001). Conclusion This study suggests that the design of any battery of neuropsychological tests for measuring EF in ADHD children should first consider age before interpreting developmental variations and neuropsychological test results. Researchers should consider the dynamics of relationships within EF, as measured by neuropsychological tests.

Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study

Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ2 test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001) and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry.

Potential Relationship between Season of Birth and Clinical Characteristics in Major Depressive Disorder in Koreans: Results from the CRESCEND Study

We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ2 tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ2=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.

Preliminary Findings on the Effectiveness of Meaning-Centered Psychotherapy in Patients with Pancreatobiliary Cancer

Purpose This study investigated the effectiveness of meaning-centered psychotherapy (MCP), which is known to be a helpful psychotherapeutic intervention in distressing conditions, for patients with pancreatobiliary cancer. Materials and Methods We recruited 37 patients with pancreatobiliary cancer from three university general hospitals and assessed their psychological characteristics. Patients who reported clinically significant emotional distress were recommended to undergo MCP. Patients who consented to MCP were provided four sessions of the therapy. Patient psychological characteristics were assessed again 2 months after MCP. For statistical comparison, outcome variables included anxiety, depression, mental adjustment to cancer, and quality of life (QoL), as well as the degree of stress and physical symptoms. Results Sixteen patients completed the MCP and the final assessment 2 months later. In the initial assessment, the patients receiving MCP showed higher levels of anxiety and depression than those not receiving MCP, and QoL was also lower in terms of role function, emotional function, social function, and global QoL. At the 2-month follow-up, the MCP group showed a significant improvement in anxiety (p=0.007), depression (p=0.010), and anxious preoccupation (p<0.001). In addition, QoL significantly improved in the MCP group, while there was no significant change in the non-MCP group. Conclusion In this study, MCP showed potential therapeutic benefits against emotional distress in patients with pancreatobiliary cancer, improving their QoL.

Age-related clinical characteristics of major depressive disorder in Koreans: Results from the CRESCEND study

Age is one of the key factors when considering the clinical presentation and classification of major depressive disorder (MDD); however, there are inconsistencies in previous studies that reported such age‐ related features (Husain et al., 2005). Hence, we aimed to identify the age‐related clinical characteristics of MDD in Koreans. Using data from the Clinical Research Center for Depression (CRESCEND) study (Park et al., 2015) in South Korea and using the age group definitions in the STARD (Husain et al., 2005), 859 MDD patients were divided into 5 age groups: ages 18 to 25, 26 to 35, 36 to 50, 51 to 65, and 65 to 75. Subjects with a diagnosis of MDD and aged ≥18 and ≤75 years were recruited from January 2006 to August 2008 in 18 centers across South Korea. Diagnoses were made by clinical psychiatrists using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV) (American Psychiatric Association, 1994) and confirmed within 2 weeks using a Structured Clinical Interview based on DSM‐IV (SCID) Axis I Disorders (SCID‐I) (First et al., 1995). The Hamilton Depression Rating Scale (HAMD) (Hamilton, 1960), Hamilton Anxiety Rating Scale (HAMA) (Hamilton, 1959), Brief Psychiatric Rating Scale (BPRS) (Overall and Gorham, 1962), Clinical Global Impression item for severity (CGI‐s) (Guy, 1976), Scale for Suicidal Ideation (SSI‐Beck) (Beck et al., 1979), Social and Occupational Functioning Assessment Scale (SOFAS) (Goldman et al., 1992), WHO Quality of Life Questionnaire–abbreviated version (WHOQOL‐BREF) (the WHOQOL Group, 1988), and Alcohol Use Disorder Identification Test (AUDIT) (Conigrave et al., 1995) were used to assess depression, anxiety, overall psychiatric symptoms, global severity, suicidal ideation, social functioning, quality of life, and hazardous drinking, respectively. Using analysis of covariance for continuous variables and binary logistic regression analysis for discrete variables, differences between age groups were analyzed,

Effectiveness of Duloxetine Monotherapy Compared to Combination Therapy with Other Antidepressants in Patients with Major Depressive Disorder: A Short-Term, Retrospective Study

Objective The purpose of this study was to compare duloxetine monotherapy to combination therapy with other antidepressants in patients with major depressive disorder in a clinical, real world setting. Methods An eight-week, retrospective, multi-center study of outpatients with major depressive disorder was undertaken. After screening 415 patients, enrolled in this study from July 2009 to June 2014 were 82 patients from among three centers who had been taking duloxetine with or without other antidepressant and not administered with atypical antipsychotics. We compared the mean changes of the Clinical Global Impression-Severity Scale (CGI-S) as a primary measure and the discontinuation rate as a secondary measure between the duloxetine monotherapy group (n=36, 43.9%) and the combination therapy with other antidepressants group (n=46, 56.1%) at baseline, one, two, four and eight weeks. Results There were no significant differences across the demographic characteristics between two groups. There was, however, a statistically greater improvement on the CGI-S at weeks 2, 4 and 8 in the combination group compared with the monotherapy group. There were no significant differences in discontinuation rate and adverse events between two groups. No serious adverse events were reported in both groups during the study period. Conclusion This result suggests that the duloxetine combination therapy with other antidepressants could improve effectiveness and have comparable tolerability with the monotherapy in the treatment of outpatients with major depressive disorders in a naturalistic setting. Adequately powered, well-controlled clinical trials are strongly warranted to confirm our findings due to methodological shortcomings.