Moon-Doo Kim

Suicide risk in relation to social class : A national register-based study of adult suicides in Korea, 1999-2001

Background: Few controlled studies have examined social class as a risk factor for suicide in Korea. Aim: The objective of the present study was to investigate the effects of social class on suicide risk in Korea. Methods: A case-control design was constructed from cause-of-death statistics for the period 1999 to 2001, in Korea, as published by the Korean National Statistical Office. The cases were defined as people aged between 20 and 64 who died by suicide, while the controls were defined as those who died of natural causes in the same age groups. Results and conclusions: The proportions and odds ratios for suicide were higher in young people than in elderly people, and higher for divorced subjects than for cohabitants. They were also higher for residents of rural areas, as opposed to residents of Seoul and other metropolitan areas, and for people in social classes III and IV, than they were for those in social class I. To control the variables that influence risk of suicide, such as age, marital status and area of residence, we used multiple logistic regression. Compared with class I, risk of suicide was higher in social classes III and IV, in both sexes. The principal conclusion of this study is that, regardless of sex, lower social class constitutes a high risk for suicide in Korea, even after controlling for variables such as age, marital status and area of residence. We conclude that a well-controlled and balanced social welfare system could reduce suicide risk, especially among people in lower social class.

Caregiver burden among caregivers of Koreans with dementia.

Background: Most studies on caregiver burden have been conducted in Western countries, while few studies on the correlates of caregiver burden have been performed in Korea. Objective: To suggest better policies for the care of dementia patients by using a nationwide database to identify factors that affect caregiver burden in Korea. Methods: The database of the Korean National Health Insurance (KNHI) and National Medical Aid (NMA) programs, which covers all Koreans, was used. A sample of 609 dementia patients and their caregivers was selected from a total of 85,281 dementia patients in 2004 and interviewed to evaluate the total cost of care and caregiver burden. Stepwise multiple linear regression analysis was then performed to identify significant independent predictors of caregiver burden. Results: Among caregiver-related factors, caregiver burden was higher in those who were female, had a history of home care during the previous year, and had less education. Among patient-related factors, poor ADL/IADL function was significant. The most interesting result was that subjective sense of socioeconomic status (good/fair/poor) was a stronger predictor of caregiver outcome than actual economic costs. Conclusion: The results of this study suggest that interventions to assist patients with dementia should focus on female caregivers, especially those considered likely to be suffering from an economic burden. Interventions should also aim to improve the ADL and IADL capacities of patients.

Validity of the telephone interview for cognitive status (TICS) and modified TICS (TICSm) for mild cognitive imparment (MCI) and dementia screening

This study aimed to validate the TICS and modified TICS (TICSm) in Korean elderly population and to compare MCI and dementia screening ability between TICS and TICSm. TICS and TICSm were administered to 70 cognitively normal (CN), 75 MCI, and 85 dementia subjects, with mini-mental state examination (MMSE) and other cognitive and functional measures. TICS and TICSm scores were highly correlated with other global cognitive and functional scores. The CN vs. dementia discrimination ability of both instruments was as excellent as that of MMSE (sensitivity/specificity at optimal cutoff: 87.1/90.1 for TICS; 88.2/90.0 for TICSm). Although their CN vs. MCI discrimination performances were comparable to that of MMSE, they were far from perfect (sensitivity/specificity: 69.3/68.6 for TICS; 73.3/67.1 for TICSm). There was no significant difference in dementia or MCI screening accuracy between TICS and TICSm. Both of them also showed high test-retest reliability. Our findings indicate that TICS and TICSm are reliable and as valid as MMSE in regard of screening cognitively impaired elderly. In terms of the comparison between TICSm and TICS, however, TICSm has little advantage over TICS for screening dementia and even MCI, in spite of longer administration time and more efforts required.

Prevalence of depression and correlates of depressive symptoms for residents in the urban part of Jeju Island, Korea

Aims: This study examined the prevalence of depression and depressive symptoms, and the correlates of depressive symptoms, and proposes some methods for reducing risk of depression in residents of the urban part of Jeju Island in Korea. Methods: In all, 1050 residents were selected using multiphasic cluster sampling to represent each district. Of the 981 respondents, 413 were men and 568 were women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depression (CES-D score over 25) and depressive symptoms (CES-D score over 21). Multiple logistic regression analysis was performed for comparisons. Results: The prevalence of depression in males and females was comparable, at 9.47 and 11.36%, respectively. The prevalence of depressive symptoms in men was 15.01%, while in women the level rose to 18.37%. Those with high self-assessed level of stress scores were significantly more likely to have depressive symptoms than those with low self-assessed level of stress scores (odds ratio (OR) = 5.73 (95% confidence interval (95%CI), 1.29–25.36)). Residents at high risk of problem drinking (CAGE score over 3) were significantly more likely to have depressive symptoms than those with a CAGE score under 1 (OR = 3.43 95%CI, 1.77–6.66). Respondents who slept poorly had more depressive symptoms than respondents who slept well (OR = 2.11 95%CI, 1.37–3.23). Females were significantly more likely to have more depressive symptoms than males (OR = 1.70 95%CI, 1.08–2.68). Conclusions: The prevalence of depression and depressive symptoms in urban Jeju Island is similar to that in a nation-wide sample. By providing intensive mental health services to those who have high stress levels, problem drinking, and poor health behavior, early detection of depressive symptoms in the community will be important for improving general health status.

Prevalence and Correlates of Depressive Symptoms among North Korean Defectors Living in South Korea for More than One Year

Objective This study examined the prevalence and correlates of depressive symptoms in North Korean defectors who have been living in South Korea for more than one year. Methods We used questionnaires developed by the authors to collect sociodemographic data in addition to the Center for Epidemiologic Studies Depression Scale (CES-D), the Psychosocial Well-being Index to measure stress, and a social support scale. A total of 367 subjects were included in this study. Results The results showed that 30.5% of the men and 34.7% of the women reported depressive symptoms, and 33.1% of the men and 36.1% of the women exhibited signs of severe distress. Correlates of depressive symptoms were lack of occupation [odds ratio (OR)=2.198, 95% confidence interval (CI), 1.247-3.873], having escaped without family (OR=1.725, 95% CI, 1.006-2.959), and a poor subjective sense of health status (OR=3.111, 95% CI, 1.591-6.085). Conclusion Continuing vocational training and career management, psychological support programs, and intensive physical health services are needed to improve the mental health of this population.

Phenidone, a dual inhibitor of cyclooxygenases and lipoxygenases, ameliorates rat paralysis in experimental autoimmune encephalomyelitis by suppressing its target enzymes

This study examined whether phenidone, a dual inhibitor of cyclooxygenase (COX) and lipoxygenase (LOX), affects the clinical symptoms of experimental autoimmune encephalomyelitis (EAE) in the rat, and the expression of both COX-1/-2 and 5-LOX in EAE spinal cords. Oral phenidone (200 mg/kg) significantly suppressed the incidence and clinical severity of EAE paralysis. Western blot analysis showed that phenidone significantly inhibited the increases in COX-1/-2 and 5-LOX in the spinal cords of rats with EAE. This finding was paralleled by immunohistochemical observations. Overall, these findings suggest that COX-1/-2 and 5-LOX are important inflammatory mediators in the pathogenesis of EAE, and that the inhibition of both COX and LOX ameliorates the autoimmune disorder of the central nervous system.

Prevalence and correlates of attention-deficit hyperactivity disorder symptoms in Korean college students

Background Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in a high proportion of cases, causing social difficulties and affective problems. We evaluated the prevalence of symptoms of ADHD and the correlates thereof in Korean college students. Methods A total of 2,172 college students, stratified to reflect geographical differences, were asked to complete self-report questionnaires on ADHD symptoms, depression, and related factors. Results ADHD symptoms were found in 7.6% of college students. Univariate analysis revealed that younger students had higher rates of ADHD symptoms than did older students. We found significant associations between ADHD symptoms and problematic alcohol use, depression, and lifetime suicidal behavior. Multivariate analysis revealed that ADHD symptoms in adults were significantly associated with depression (odds ratio [OR] =4.69; 95% confidence interval [CI] 3.23–6.80; P<0.001) and overweight or obesity (OR =1.50; 95% CI 1.02–2.22; P=0.040), after controlling for sex and age. Conclusion These results have implications in terms of the mental health interventions required to assess problems such as depression, alcohol use, obesity, and suicidality in young adults with ADHD symptoms.

Heat shock protein 27 upregulation and phosphorylation in rat experimental autoimmune encephalomyelitis

Following stress or inflammation, the 27-kDa heat shock protein (HSP27) is induced in various cell types, where it promotes cell survival and inhibits inflammatory reactions. We examined the expression of HSP27 and phosphorylated HSP27 (p-HSP27) in the spinal cords of Lewis rats with experimental autoimmune encephalomyelitis (EAE). Western blotting analysis revealed low levels of HSP27 and p-HSP27 in the normal spinal cords and significantly higher levels in EAE-affected spinal cords. Immunohistochemistry revealed that HSP27 was expressed constitutively in the neurons and some fibrous astrocytes of the spinal cords of normal rats. However, in EAE-affected spinal cords, HSP27 immunoreactivity was higher and located primarily in the fibrous astrocytes of the white matter, whereas few of the inflammatory cells were immunopositive for HSP27. Immunoreactivity for p-HSP27 was detected predominantly in the fibrous astrocytes of the normal controls and was markedly increased in EAE-affected spinal cords. Therefore, the levels of HSP27 expression and phosphorylation of HSP27 were increased primarily during reactive astrogliosis of spinal white matter affected by EAE. These observations suggest that in rat EAE, the increased expression and elevated activation of HSP27 modulate host cell activity, survival, and inflammation to counter the autoimmune inflammatory injury. Our results also suggest that HSP27 plays a role in spontaneous recovery from EAE-induced paralysis.

Korean Medication Algorithm Project for Bipolar Disorder: third revision

Objective To constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014). Methods A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey. Results The treatment of choice (TOC) for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP); the TOC for acute mild depression was monotherapy with MS or AAP; and the TOC for moderate or severe depression was MS plus AAP/antidepressant. The first-line maintenance treatment following mania or depression was MS monotherapy or MS plus AAP; the first-line treatment after mania was AAP monotherapy; and the first-line treatment after depression was lamotrigine (LTG) monotherapy, LTG plus MS/AAP, or MS plus AAP plus LTG. The first-line treatment strategy for mania in children and adolescents was MS plus AAP or AAP monotherapy. For geriatric bipolar patients, the TOC for mania was AAP/MS monotherapy, and the TOC for depression was AAP plus MS or AAP monotherapy. Conclusion The expert consensus in the KMAP-BP 2014 differed from that in previous publications; most notably, the preference for AAP was increased in the treatment of acute mania, depression, and maintenance treatment. There was increased expert preference for the use of AAP and LTG. The major limitation of the present study is that it was based on the consensus of Korean experts rather than on experimental evidence.

Tardive Dyskinesia: Treatment with Aripiprazole

Tardive dyskinesia is characterized by choreiform movements, or rhythmic abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs. It is frequently associated with the use of neuroleptic medications. The choreiform movements are irreversible in some patients, even after the drug is withdrawn. Although no reliable treatment for tardive dyskinesia exists, atypical antipsychotics are associated with a significantly lower incidence of tardive dyskinesia than typical antipsychotics. Moreover, recent reports suggest that atypical antipsychotics may have a beneficial effect on tardive dyskinesia remission. Until recently, evidence for the effectiveness of aripiprazole on tardive dyskinesia has been mixed. Aripiprazole has a unique mechanism of action and has various effects in tardive dyskinesia. The drug acts as a partial D2 receptor agonist that can stabilize D2 up-regulation, and as a partial 5-HT1A receptor agonist and a 5-HT2A receptor antagonist, and can increase the release of dopamine in the striatum.