Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years.

Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis.

The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels.

Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.

Social anxiety disorder (SAD) is characterized by anxiety regarding social situations, avoidance of external social stimuli, and negative self-beliefs. Virtual reality self-training (VRS) at home may be a good interim modality for reducing social fears before formal treatment. This study aimed to find neurobiological evidence for the therapeutic effect of VRS.

Fifty-two patients with SAD were randomly assigned to a VRS or waiting list (WL) group. The VRS group received an eight-session VRS program for 2 weeks, whereas the WL group received no intervention. Clinical assessments and functional magnetic resonance imaging scanning with the distress and speech evaluation tasks were repeatedly performed at baseline and after 3 weeks.

The post-VRS assessment showed significantly decreased anxiety and avoidance scores, distress index, and negative evaluation index for ‘self’, but no change in the negative evaluation index for ‘other’. Patients showed significant responses to the distress task in various regions, including both sides of the prefrontal regions, occipital regions, insula, and thalamus, and to the speech evaluation task in the bilateral anterior cingulate cortex. Among these, significant neuronal changes after VRS were observed only in the right lingual gyrus and left thalamus.

VRS-induced improvements in the ability to pay attention to social stimuli without avoidance and even positively modulate emotional cues are based on functional changes in the visual cortices and thalamus. Based on these short-term neuronal changes, VRS can be a first intervention option for individuals with SAD who avoid society or are reluctant to receive formal treatment.

We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.

A 635-bed, tertiary-care hospital in Daegu, South Korea.

To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.

From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).

Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.

Schizophrenia is highly familial neuropsychiatric disorder with heritability estimated at 60-90%. Even unaffected first-degree relatives of schizophrenia manifested some neuropsychological abnormalities as well as neurologic soft sign and morphologic anomalies. the aim of this study was to evaluate personality profile in first-degree relatives of schizophrenia compared to their schizophrenia probands and healthy controls and whether personality profile might be endophenotype of schizophrenia.

The subjects were 97 first-degree relatives of schizophrenia, 48 their schizophrenia probands, and 106 healthy controls, who completed Temperament and Character Inventory (TCI) scale. Relatives were further divided into presumed carriers and pesumed non-carriers by schizophrenia genetic loading. Group difference in TCI scores were compared by general linear model using age and gender as covariates.

1. 1. There were significant group differences in HA scores between healthy controls, relatives, and probands after controlling age and gender, in that HA scores were increased by healthy controls, relatives, and probands in order.

2. 2. Presumed carriers have higher HA scores than presumed non-carriers and healthy controls.

3. 3. Proband group showed significantly lower RD and lower P in temperament dimension and lower SD, lower C, and higher ST in character dimension compared to other groups.

We found that HA scores of first-degree relatives of schizophrenia is intermediate level between schizophrenia probands and healthy controls. Considering increase of HA with schizophrenia genetic loading, HA may be potential endophenotype of schizophrenia. Further research with longitudinal follow up is needed to elucidate the clinical implication of high HA observed in schizophrenia family.

This cross-sectional study was aimed to investigate the factors associated with bipolar disorder in pregnant female, including sociodemographic parameters, social support, social conflict, suicidal idea and sleep.

A total of 84 pregnant female were recruited. They filled out self-completing questionnaires on sociodemographic factors, obstetric history, depressive symptoms and bipolarity. Depressive symptoms were assessed using the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Bipolarity was assessed using the Korean version of the Mood Disorder Questionnaire (K-MDQ).

Nineteen participants (22.6%) had positive K-MDQ scores, suggesting the present of bipolarity. Positive EPDS group had twenty subjects (25%) who had depressive symptoms. The diathesis of bipolar disorder was associated with marital dissatisfaction, social conflict, depression and sleep. The multiple logistic regression analysis revealed that the only poor sleep was a risk of bipolarity.

Pregnant female with bipolarity were more depressed and sleep problems than those without bipolarity. The results showed that the most important factor of influencing bipolarity was sleep.

This study aimed to explore thedifference in emotional recognition of musical auditory stimulation and artfulvisual stimulation between helathy people and patients with schizophrenia.

20 songs and 20 paintings thatcontained sad or cheerful emotions were presented to 123 patients withschizophrenia and 224 healthy people as control group. The subjects were askedto tell about their emotions that they had felt from each musical auditorystimulation and artful visual stimulation. To measure such emotions, the Emotional Empathy Scale was used. The level of psychopathology in patientsgroup were evaluated with the Positive and Negative Syndrome Scale and the Formal Thought Disorder Rating Scale.

The correct answer rate to musical auditoryand artful visual stimulation of the patient group was significantly lower than that of thecontrol group. Thepatient group showed lower emotional empathic ability compared to the controlgroup. In the patient group, the correct answer rate to musical and artfulstimulation showed a negative correlation with score with Formal ThoughtDisorder Rating Scale.

Patients with schizophrenia have difficulties inprecise emotional recognition to auditory and visual stimulations, and this isassociated with lowered empathic ability and thinking disorder of patients withschizophrenia. If an psychosocial rehabilitation program or psychotherapy isimplemented to patients with schizophrenia, it is deemed to be necessary to make a mediation to improve the emotional recognition and expression ability of patients with schizophrenia.

This study was aimed to discover the correlation between those getting tattoos and their psychopathology relating to their delinquent behavior and emotional problems.

Date for this study was collected from 19-year-old men who were receiving a physical examination for conscription at the Korea Military Manpower Administration. 400 data sheets were collected among them. All of sjubjects were evaluated on the following measures: sociodemographic variants, Juvernile delinquency scale, State-trait anger expression inventory, Beck depression inventory, State-triat anxiety inventory, and Positive affect and negative affect schedule.

In comparison with those without tattooes, those with a tattoo scored higher in the scales that were related to delinquency, anger, depression, and negateive emotion. Furthermore, there were positive correlations between the number of tattoos and the scores for the Juvenile delinquent tendency and behavior scale as well as on the State-triat anxiety scale.

Those with tattoos had experienced anger, anxiety, and depression more strongly in comparison with those without tattoos. These reults recommended that tattooed males should be evaluated more on their regrading psychopathology compared to those without tattoos.

The aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital.

A retrospective chart review was performed and data of 188 cases (2009–2012) and 118 cases (1998–2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed.

The proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased.

Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.

Despite the advance in pharmacotherapy for posttraumatic stress disorder (PTSD), poor treatment adherence to pharmacotherapy for PTSD is a critical issue.

We intended to evaluate the predictors of premature discontinuation of psychiatric outpatient treatment after discharge for noncombat-related PTSD.

This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with non-combat-related posttraumatic stress disorder.

We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder.

Fifty-five percent of subjects prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge.

The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge.

This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics.

Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics.

In 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity.

The development of bipolar disorder's psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

The purpose of this study was to evaluate the occurrence of the suicidal ideation and associated factors with self-reported suicidal ideation within the last 12 months among Korean adolescents.

A total of 1533 adolescents were recruited from middle schools (age range: 13-14 years) in Korea. According to existence of suicidal ideation, they were divided 2 group – suicidal ideation group and non-suicidal ideation group, and the differences between groups in terms of various characteristics, including depression (Kovacs’ Children’s Depression Inventory), school and family factors, and health related conditions.

A total of 501 (32.7%) middle school students reported suicidal ideation, and the rate of suicidal attempt was 6.9% (n=106). The associated factors of suicidal ideation were female (OR= 2.42, p<0.001), below average academic achievement (OR=1.43, p=0.007), perceived low parental support (OR=2.09, p=0.001), depression (OR=3.25, p<0.001), current alcohol use (OR=2.37, p=0.003), self reported poor health (OR=1.54, p =0.043), and school bullying (OR=1.91, p =0.005).

These results may have important implications for the strategies and specified intervention in preventing suicidal ideation in Korean adolescents.

We evaluated the difference in sleep skills between patients with and without need of hypnotics after sleep CBT.

Total 131 insomnia patients' sleep disturbances were assessed by visual analogue scales. Patients received 9 sessions of sleep CBT and were prescribed hypnotics for prn during 3 months. Sleep CBT was focused on the sleep hygiene and sleep stimulus-control guidelines. Sleep hygiene guidelines were Limit the time spent in bed (SH1), Get regular exercise (SH2), Avoid light at night (SH3), Avoid heavy meals or drinking (SH4), Quiet, dark, and comfortable bedroom (SH5), Avoid caffeine, alcohol, and nicotine (SH6), Relaxing bedtime routine (SH7),Llight bedtime snack (SH8), Remove the bedroom clock (SH9). Sleep stimulus-control guidelines were Go to bed only when sleepy (SSC1), Use the bed for sleeping or sex (SSC2), Get out of bed when unable to sleep (SSC3), Get up at the same time (SSC4), Avoid napping (SSC5). Each sleep skill state was evaluated by Likert scale, and they were compared between before and after CBT. Patients were divided into two groups: still need of hypnotics and no need of hypnotics after 3 months.

Forty-six (35.1%) patients replied they needed not hypnotics any more, but 85 (64.9%) patients replied they still needed hypnotics after CBT. Sleep VAS (25.26±8.52 vs. 32.64±8.95, p<0.001), SH2 (3.67±0.92 vs. 2.76±1.06, p=0.030), SH7 (4.08±0.55 vs. 2.76±0.76, p<0.001) were different in two groups.

Among several CBT skills, regular moderate exercise in daytime and a relaxing bedtime routine seem to be key components.

The purpose of the study was to evaluate burden of main caregivers in children with epilepsy and to identify factors associated with caregiver burden.

Main caregivers of pediatric patients with epilepsy were enrolled four general hospitals in several cities of Korea. One hundred and twenty-fou caregivers of patients were included in this cross-sectional study. Sociodemograhic/clinical characteristics of patients and sociodemographic characteristics of caregivers were collected. The caregivers were assessed using the Korean version Zarit burden Interview (ZBI), Center for Epidemiological Studies of Depression Scale (CES-D) and social support/conflict scale. Multiple linear regression methods were used to evaluate factors contributing to burden of caregivers.

Of the 124 participants, 98(81.7%) were the mothers. The mean score on the ZBI and CES-D were 23.66 (± 19.15) and 13.87 (± 12.95) points, respectively. Factors affecting of caregiver burden were the number of antiepileptic drugs (AEDs), which patients are taking, and CES-D score by multiple linear regression analysis.

Higher number of AEDs prescribed and depression of caregivers are main factors contributing to burden of caregivers in children with epilepsy.

The authors have not supplied their declaration of competing interest.

The aim of this study was to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder by means of retrospective reviews of medical records.

The medical records of 250 patients with a diagnosis of major depressive disorder for at least 5 years were retrospectively reviewed for this study. We reviewed DSM-IV diagnosis and detailed clinical information at the index admission with assessments made every year after discharge to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder.

Receiver operating characteristic curve analysis indicated cut-off scores for recurrent depressive episode of more than three times (area under curve = 0.647, sensitivity = 0.435, specificity = 0.819, positive predictive value = 0.351, negative predictive value = 0.865).

These findings suggest that it could predict the best diagnostic conversion from unipolar depression to bipolar disorder when depressive episodes are recurrent more than three times. Based on these findings, it will be able to promote the accuracy of diagnosis and the efficiency of treatment.

The authors have not supplied their declaration of competing interest.

Despite patients with schizophrenia showed the deficits in the fronto-temporal and thalamo-frontal connectivity, the white matter connectivity in patients with schizotypal personality disorder had not been systemically investigated.

This study involved 40 neuroleptic-naïve patients with schizotypal personality disorder (SPD), 60 patients with schizophrenia (SCZ), and 100 healthy controls (HC), and scanned on the 3T MRI scanner. Probablistic tractography was performed using the FATCAT software in AFNI. The target brain regions (bilateral lateral frontal, medial frontal, orbitofrontal, temporal and thalamus) were extracted from the automated segmentation and cortical parcellation. Cross-sectional comparisons in mean fractional anisotropy (FA) performed on the thalamo-lateral frontal, thalamo-medial frontal, thalamo-orbitofrontal, lateral frontal-temporal and orbitofrontal-temporal pathway. We also analyzed the relationship between the white matter pathway and the Positive and Negative Syndrome Scale and GAF.

The diffusion tensor imaging showed that SCZ and SPD had decreased FA in the left thalamo-orbitofrontal pathway. However, SPD showed no alteration in the fronto-temporal pathway, despite SCZ showed decreased FA in the left temporo-orbitofrontal pathway. In SCZ, there were significant correlations between FA value in the left temporo-orbitofrontal pathway and negative symptoms score in PANSS and GAF score. However, SPD showed the trend level relationship between the GAF score and FA value in the left temporo-orbitofrontal pathway.

These results suggest that the deficits in thalamo-frontal connectivity may be a trait marker of schizophrenia spectrum disorder, and the deficits in fronto-temporal connectivity may play a key role towards the vulnerability of psychosis.

The authors have not supplied their declaration of competing interest.

Obsessive compulsive disorder (OCD) is one of the most common psychiatric chronic disorders (prevalence 2–3%) and has been associated with various neurocognitive impairment, including visual memory function. Although the relapse rate of OCD is highly considerable, little is known regarding the relationship between neurocognitive dysfunction and the chronicity of the illness, mainly because there are confounding factors as the medication effect. Therefore, we compared the difference of neurocognitive functions of the first-episode, medication-naive OCD patents to chronic, medication-naïve OCD patients.

We defined the first-episode (FEOCD) if the illness duration was less than 3-year by DSM-IV criteria. Twenty-one FEOCD and 28 chronic OCD patients performed Korean version of the Wechsler Adult Intelligence Scale (K-WAIS), the Trail Making Test (TMT). All the participants were medication-naïve.

There was no differences in the severity of illness (YBOCS), depressive symptoms (Hamilton depression rating scale), general anxiety symptoms (Hamilton anxiety rating scale). FEOCD group showed significant impairment on the block design subtest of the K-WAIS (P = 0.04, t = 1.294).

These results suggest that visual spatial cognitive dysfunction in patients with OCD may deteriorate as the untreated duration of illness get longer.

The authors have not supplied their declaration of competing interest.

The Bipolar Depression Rating Scale (BDRS) is a scale for assessment of the clinical characteristics of bipolar depression. The primary aims of this study were to describe the development of the Korean version of the BDRS (K-BDRS) and to establish more firmly its psychometric properties in terms of reliability and validity.

The study included 141 patients (62 male and 79 female) who had been diagnosed with bipolar disorder, were currently experiencing symptoms of depression, and were interviewed using the K-BDRS. Other measures included the Montgomery and Asberg Depression Scale (MADRS), the 17-item Hamilton Depression Scale (HAMD), and the Young Mania Rating Scale (YMRS). Additionally, the internal consistency, concurrent validity, inter-rater reliability, and test-retest reliability of the K-BDRS were evaluated.

The Cronbach's α-coefficient for the K-BDRS was 0.866, the K-BDRS exhibited strong correlations with the HAMD (r = 0.788) and MADRS (r = 0.877), and the mixed symptoms score of the K-BDRS was significantly correlated with the YMRS (r = 0.611). An exploratory factor analysis revealed three factors that corresponded to psychological depressive symptoms, somatic depressive symptoms, and mixed symptoms.

The present findings suggest that the K-BDRS has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in patients with bipolar disorder.

The authors have not supplied their declaration of competing interest.

Obsession and delusion are theoretically distinct from each other in terms of reality testing. Despite such phenomenological distinction, no extant studies have examined the identification of common and distinct neural correlates of obsession and delusion by employing biologically grounded methods. Here, we investigated dimensional effects of obsession and delusion spanning across the traditional diagnostic boundaries reflected upon the resting-state functional connectivity (RSFC) using connectome-wide association studies (CWAS).

Our study sample comprised of 96 patients with obsessive–compulsive disorder, 75 patients with schizophrenia, and 65 healthy controls. A connectome-wide analysis was conducted to examine the relationship between obsession and delusion severity and RFSC using multivariate distance-based matrix regression.

Obsession was associated with the supplementary motor area, precentral gyrus, and superior parietal lobule, while delusion was associated with the precuneus. Follow-up seed-based RSFC and modularity analyses revealed that obsession was related to aberrant inter-network connectivity strength. Additional inter-network analyses demonstrated the association between obsession severity and inter-network connectivity between the frontoparietal control network and the dorsal attention network.

Our CWAS study based on the Research Domain Criteria (RDoC) provides novel evidence for the circuit-level functional dysconnectivity associated with obsession and delusion severity across diagnostic boundaries. Further refinement and accumulation of biomarkers from studies embedded within the RDoC framework would provide useful information in treating individuals who have some obsession or delusion symptoms but cannot be identified by the category of clinical symptoms alone.