Yu Sang Lee

Johyeonbyung (attunement disorder): Renaming mind splitting disorder as a way to reduce stigma of patients with schizophrenia in Korea

The term schizophrenia, which comes from the Greek roots skhizein and phren, was translated as Jungshinbunyeolbyung in East Asian Countries, including Japan, Korea, and China. The term literally means mind-splitting disease. This term has generated a misconception of the disorder as an untreatable chaotic personality, thus instilling stigma and causing suffering in patients and their families. This socio-cultural connotation has impeded medical treatment of schizophrenia. Recent neuroscience research has suggested neural network dysfunction in schizophrenia. Accordingly, a new term, Johyeonbyung (attunement disorder), was coined in South Korea. This term literally refers to tuning a string instrument, and metaphorically it describes schizophrenia as a disorder caused by mistuning of the brains neural network. We expect that the term Johyeonbyung will incite less prejudice and that its metaphoric description of the disorder may help patients to access medical treatment in the early phase. The name of a psychiatric disorder can influence others attitudes toward patients; thus, discretion is crucial in naming psychiatric disorders.

Prevalence of Metabolic Syndrome in Patients with Schizophrenia in Korea: A Multicenter Nationwide Cross-Sectional Study.

Objective We designed a nationwide study with limited exclusion criteria to investigate the prevalence of metabolic syndrome (MetS) in Korea and its relationship with antipsychotic medications. Methods This multicenter, cross-sectional, and observational study included patients diagnosed with schizophrenia or schizoaffective disorder. Sixteen hospitals enrolled 845 patients aged 18 to 65 years prescribed any antipsychotic medication between August 2011 and August 2013. MetS was diagnosed using the criteria of the modified Adult Treatment Panel III of the National Cholesterol Education Program with the Korean abdominal obesity definition (waist circumference ≥85 cm in women, ≥90 cm in men). Results The prevalence of MetS in all patients was 36.5% and was significantly higher in men than women (men, 40.8%; women, 32.2%) and was significantly correlated with age [odds ratio (OR) 1.02] and duration of illness (OR 1.03). The prevalence of MetS across antipsychotic drugs in the major monotherapy group was as follows: 18.8% for quetiapine, 22.0% for aripiprazole, 33.3% for both amisulpride and paliperidone, 34.0% for olanzapine, 35% for risperidone, 39.4% for haloperidol, and 44.7% for clozapine. Conclusion The prevalence of MetS is very high in patients with schizophrenia or schizoaffective disorder. Screening and monitoring of MetS is also strongly recommended.

Linkage and Association Analyses of Schizophrenia with Genetic Variations on Chromosome 22q11 in Koreans

Objective Chromosome 22q11 has been implicated as a susceptibility locus of schizophrenia. It also contains various candidate genes for which evidence of association with schizophrenia has been reported. To determine whether genetic variations in chromosome 22q11 are associated with schizophrenia in Koreans, we performed a linkage analysis and case-control association study. Methods Three microsatellite markers within a region of 4.35 Mb on 22q11 were genotyped for 47 multiplex schizophrenia families, and a non-parametric linkage analysis was applied. The association analysis was done with 227 unrelated patients and 292 normal controls. For 39 single nucleotide polymorphisms (SNPs) spanning a 1.4 Mb region (33 kb interval) containing four candidate schizophrenia genes (DGCR, COMT, PRODH and ZDHHC8), allele frequencies were estimated in pooled DNA samples. Results No significant linkage was found at any of the three microsatellite markers in single and multi-point analyses. Five SNPs showed suggestive evidence of association (p<0.05) and two more SNPs showed a trend for association (p<0.1) in pooled DNA association analysis. Individual genotyping was performed for those seven SNPs and four more intragenic SNPs. In this second analysis, all of the 11 SNPs individually genotyped did not show significant association. Conclusion The present study suggests that genetic variations on chromosome 22q11 may not play a major role in Korean schizophrenia patients. Inadequate sample size, densities of genetic markers and differences between location of genetic markers of linkage and association can contribute to an explanation of the negative results of this study.

T253. THE CORRELATION ANALYSIS BETWEEN RENAMING SCHIZOPHRENIA AND VISITING FREQUENCY OF MENTAL HEALTH SERVICES BY BIG DATA ANALYSIS (INTERNET SEARCHES AND NEWSPAPER ARTICLES) IN SOUTH KOREA

Abstract Background Korean Neuropsychiatric Association changed the Korean term for schizophrenia from ‘split-mind disorder’ to ‘attunement disorder’ in 2012, to dispel the stigma associated with name, and to promote early detection and treatment. Information on the internet affects the public awareness and attitude toward schizophrenia. The main purpose of this study was to investigate the correlation between renaming schizophrenia and the pattern of mental health services utilization by big data analysis of internet (newspaper articles and internet searches) in Korea. Methods From January 2016 to September 2017, newspaper articles on “attunement disorder” and “split-mind disorder” available on the internet were classified as related with negative images like crime and helpful or positive in dispelling the stigma. The relationship between the number of anti-stigma newspaper articles and newspaper articles of schizophrenia containing both positive and negative images was examined. In addition, using Naver, a major internet search engine in Korea, we investigated the total number of internet searches of both old and new name of schizophrenia by gender differences. Finally, the frequency of the visits of mental health services of patients with schizophrenia was measured using the Korean Healthcare Bigdata Hub (http://opendata.hira.or.kr/home.do#none) for 14 months and the correlation between the frequency of the visits and the above big data was examined. The data were analyzed using the SPSS/WIN 24.0. Pearson correlation coefficients were used to analyze correlations. Results The amounts of newspaper articles containing anti-stigma of schizophrenia were correlated with the amounts of newspaper articles containing negative images like crime of the new name (attunement disorder) of schizophrenia (r=0.528, p<0.01), which was greater than the amounts of newspaper articles containing the old name (split-mind disorder) of schizophrenia (r=0.300, p<0.01). We also found that a strong positive correlation between the number of articles about “attunement disorder” and search frequency about the term on the internet. In addition, the search frequency was more highly related to the number of articles containing negative images of the illness (e.g., related crimes, r = 0.910, p<0.01) than that of articles providing positive aspects of the illness (e.g., dispelling stigma, r = 0.423, p<0.01). There was no significant correlation between the number of schizophrenia-related newspaper articles in previous month and the visits of mental health services of patients with schizophrenia in next month. There were no gender differences in internet searches. The correlation between the internet search frequency for “attunement disorder” in the previous month and the visits of the mental health services of patients with schizophrenia (r = 0.185, p>0.05) in next month was larger than the correlation of “split-mind disorder” searches with mental health services utilization (r = 0.082, p>0.05). Discussion “Attunement disorder” rather than “split-mind disorder” was appeared more frequently in newspaper articles of the anti-stigma characteristics. “Attunement disorder” seems to be more useful for anti-stigma campaign. Renaming schizophrenia didn’t seem to affect the visiting frequency of mental health services. There was statistical limitation which was originated from the lack of numbers of patient’s information. It was because Korean Bigdata Hub provided patients information just for 14 months as monthly data. Also, it should be considered that the time period, the kinds of mental disorders and the search engine we investigated were limited. Future research needs to overcome these limitations.

Effects of Renaming Schizophrenia in Korea: from “Split-Mind Disorder” to “Attunement Disorder”

Objective Korean Neuropsychiatric Association changed the Korean name of schizophrenia from ‘Split-mind Disorder’ to ‘Attunement Disorder’ in 2012. This study assessed attitudes towards the renaming of schizophrenia among mental health practitioners (n=440), patients with schizophrenia and their guardians (n=396), and the university students (n=140) using self-administered questionnaires. Methods The questionnaire included items related to participants’ perception of the renaming of the disease, the nature of informing about the disease to confirm the effect of the name change. Results It was confirmed the notification rate of disease name by mental health practitioners was increased significantly after the renaming. Among patients and their guardians, 24.9% and 15.0%, respectively, perceived their own or the family member’s illness as ‘attunement disorder’. Conclusion Patients and their guardians continue to display a low awareness about the name of the disease as ‘attunement disorder.’ However, mental health practitioners were found to be able to easily use the name ‘attunement disorder’ as a result of the increased notification rate of the new disease name.