Objective : This study aimed to investigate the general process from the symptom onset to the psychiatric treatment in Korean panic patients and the effect of improved public awareness on it. Methods : This study has a retrospective design. The subjects were the new patients with panic disorder who visited the psychiatric outpatient clinic in twelve university-affiliated hospitals all across Korea. The medical chart was reviewed retrospectively and the data were collected including chief complaints of symptoms, recent stressors, the time to visit the psychiatric outpatient clinic, and visit of other departments and diagnostic approaches for their symptoms. Results : A total of 814 participants were included in the study. The most common department other than psychiatry the panic patients visited were cardiology (28.3%), general internal medicine (16.0%) and neurology (11.4%). The most frequently used diagnostic tests were a echocardiography (17.9%), 24-hour Holter monitoring (11.2%), and brain MRI (8.2%). Only 37.3% of participants visited psychiatric clinic directly. About 80% of participants visited psychiatric department within 1 year after their first panic symptoms and it took $13.8{\pm}13.7weeks$ on average. Comparing before and after 2012, the number of participants increased who visit directly the psychiatric clinic without visiting other departments (p=0.002) and without visiting emergency room (p<0.001). Conclusions : Our results suggest that a substantial number of patients visit departments other than psychiatry when they experience first panic symptoms. However, most patients begin psychiatric treatment within 1 year after their first symptoms and the number of patient are increasing who visit psychiatric department directly without visiting other departments.

Objective : The goal of this study was to investigate the characteristics of early maladaptive schemas (EMSs), and associated neurocognitive functions as seen in visitors for military designation process. Methods : This retrospective study included 111 males aged 18 to 24 years among three groups: 41 visitors for military designation process (VMD), 21 patients with obsessive-compulsive disorder (OCD), and 49 healthy subjects. We collected the results of the Young Schema Questionnaire, Symptom Checklist-90-Revised, three neurocognitive tests as well as their clinicodemographic data. We analyzed the differences in EMSs between these three groups, and the correlations among the identified EMSs and neurocognitive performances within the VMD group. Results : Compared with both the OCD and healthy groups, the evaluation of the VMD group showed significantly higher scores in mistrust/abuse (F=6.4, p=0.002), vulnerability to harm (F=6.6, p<0.0001) and negativity/pessimism schema (F=7.3, p<0.0001), even when controlling for depression scores and levels of education. These three schemas also exhibited significant negative correlations with the score of Stroop test with r ranging from -0.34 to -0.44. Conclusion : These findings suggest that people who are likely to have difficulties adjusting to living in a military life may have psychological vulnerabilities related to certain EMSs. Further studies are warranted to test the clinical potentials of these findings, such as a treatment target and a predictor factor.

Objective : This study aims to investigate the relationship between negative sexual experience and psychiatric symptoms by gender and compare the effects of sexual assault and unwanted sexual experiences on psychiatric symptoms in patients with depression or anxiety disorders. Methods : A total of 204 respondents who have had negative sexual experiences of outpatients diagnosed with depression or anxiety disorders were evaluated with AUDIT, PSS, STAI, BDI, and SSI. Independent samples t-test was performed to compare the psychiatric symptom scale scores between male and female and identify the difference of the psychiatric symptom scale scores between those who have had sexual assault and those who have had only unwanted sexual experience. Results : There was no difference in psychiatric symptom scale scores except for AUDIT between male and female in 204 patients with negative sexual experience. There was also no significant difference in AUDIT, PSS, and STAI scores between those who experienced sexual assault and those who experienced only unwanted sexual experiences. BDI and SSI scores are significant higher in those who experienced sexual assault than those who experienced only unwanted sexual experiences. Conclusion : This suggests that male and female may have similar levels of psychiatric symptoms after experiencing negative sexual experiences. Psychiatric symptoms caused by sexual assault may have differences from the psychiatric symptoms caused by unwanted sexual experience. Understanding the differences in psychiatric symptoms according to the type of negative sexual experience may helpful to direct the therapeutic plans.

Objective : The aim of this study was to examine the relationship between occupational stress and depression, as it is seen to be corresponding with the work characteristics of local government officials. Methods : The data of 671 local government officials who participated in this study from July to December 2015 as a part of an occupational stress management program, were analyzed retrospectively in this study. Likewise, the participants completed questionnaires, including a short form of the Korean Occupational Stress Scale (KOSS), and the Beck Depression Inventory-II (BDI-II) the results of which were evaluated and reviewed. Results : The study noted that the subscales of occupational stress related to depression were varied, according to the work characteristics of the participants, after adjusting for age and job grade. It was found that the participant's variables of job insecurity, lack of reward, organizational system and occupational climate were significantly related to the development of a depressed mood in the participant in a general sense. Notably, the factor of interpersonal conflict was significantly related to depressed mood among the general administrative group; meanwhile, lack of reward in the welfare group and insufficient job control in the technical group were significantly associated with the likelihood of developing a depressed mood in participants reviewed. In the operation and maintenance of facilities group, job insecurity was significantly related with depressed mood, whereas job demand was related more with the incidence of depression in the field work group. Conclusion : This study revealed that the influence of occupational stress on depression varied according to the occupational characteristics experienced by the participants in the work environment. These findings may be used to enhance the occupational stress management program for local government officials according to their work characteristics, to bring awareness to this issue.

Objective : The purpose of this study was to investigate differences in anxiety and depression symptoms, comorbidity according to the patterns of temperament and character in patients with posttraumatic stress disorder (PTSD). Methods : The temperament and character inventory (TCI), beck depression inventory (BDI) and beck anxiety inventory (BAI) were administered to 151 PTSD patients classified into four groups of adaptation, vulnerable temperament, immature personality and composite vulnerability according to the results of the Temperament and Character Inventory (TCI). MANOVA and Chi-square tests were conducted to analyze differences in BDI, BAI, temperament and character scores and rate of comorbid disorders between the four groups. Results : The immature character and complex vulnerability group showed the higher rate of comorbid depression disorder. Anxiety and depression severity were significantly different among groups, especially depression severity had higher scores in the immature character and complex vulnerability groups and anxiety severity had higher scores in the complex vulnerability group than adaptive group. The immature character and complex vulnerability groups showed significantly lower score on the temperament scale of reward dependence and persistent. Conclusion : The results demonstrate the significance of adaptive characteristics on anxiety and depression symptoms regardless of vulnerable temperaments, and its consequent role in the management of character factors relative to intervention regarding PTSD.

Objective : This study aimed to investigate the associations of anxiety symptoms with behavior and attention in elementary school children with attention-deficit/hyperactivity disorder (ADHD). Methods : A total of 195 elementary school children with ADHD participated in the study. The Korean Version of ADHD Rating Scale (K-ARS) and Behavior Assessment System for Children(BASC-2) were used to measure the children's behavior. Anxiety and attention was assessed with State-Trait Anxiety Inventory for Children (STAIC) and ADHD Diagnostic System (ADS), respectively. Children with ADHD were categorized to two groups of ADHD with low anxiety (ADHD-LA) and ADHD with high anxiety (ADHD-HA) according to the total STAIC scores. Scores on K-ARS, BASC-2 and ADS were compared between two groups of ADHD-LA and ADHD-HA. Results : The Scores on K-ARS total and both subscales in ADHD-HA group were significantly higher than ADHD-LA group. Scores on the BASC-2 subscales including hyperactivity, aggression, conduct problem, anxiety, depression, somatization, withdrawal, attention problems were also significantly higher in ADHD-HA group compared to ADHD-LA group. In contrary, scores on ADS subscales were not significantly different between the both groups. Conclusion : Our study identified that the anxiety accompanied with ADHD was associated with the negative behavioral aspect in children with ADHD. However, the performances on attention task were not affected by the anxiety comorbid with ADHD. Future studies to reveal underlying mechanism are needed for further understanding the association with anxiety and ADHD.

Objective : The purpose of this study was to investigate changes in the satisfaction levels and mental health among North Korean defectors over two years. Methods : At the beginning of the study, the subjects were comprised of 300 North Korean defectors registered with a regional adaptation center (the Hana Center) in South Korea. Participants reported self-questionnaires including socio-demographic variables and self-rating scales for satisfaction levels, depression symptoms, trauma-related symptoms, resilience and alcohol use behavior. In the follow up study after two years, 189 North Korean defectors participated in an online survey, responding to the same questionnaires as at baseline. Results : The self-rated scores for satisfaction with one's overall life (p=0.008), sense of autonomy (p=0.001), sense of physical health (p<0.001), and expected life satisfaction five years later (p<0.001) had all decreased significantly at follow-up after two years. Depression symptoms (p<0.01) and trauma-related symptoms (p<0.001) increased significantly over two years, and the resilience score (p<0.01) decreased significantly during the same period. No significant differences in alcohol use behavior (p=0.059) were observed at follow-up. Conclusion : Satisfaction levels among North Korean defectors gradually decreased over the follow-up period, and this may be due to the difficulties encountered in the process of assimilating to daily life in South Korea. Economic, medical, and psychological support is needed for successful assimilation of North Korean defectors.

Objective : The purpose of this study was to investigate prevalence of psychiatric symptoms and determine predictors of emotional distress of military hospital surgical patients. Methods : This study examined 104 orthopedic patients admitted to the Armed Forces Military Hospital September-November 2018. For the study, every subject completed self-assessment inventories regarding depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), sleep problems (Pittsburgh Sleep Quality Index), problematic alcohol and tobacco use (Cut off, Annoyed, Guilty, Eye-opener screening), and psychiatric history. We performed the Student's t-test and the chi-square test for the collected data to investigate the prevalence of psychiatric symptoms, including emotional distress. Logistic regression analysis was used to examine the risk factors related to emotional distress of hospitalized military personnel. Results : There were no significant differences in socio-demographic and psychiatric symptoms between soldiers and officers. The prevalence of depressive and/or anxiety symptoms (emotional distress) was 21.2% (n=21). In the logistic regression analysis, psychiatric history [Adjusted Odds Ratio (AOR)=18.99 ; 95% Confidence Interval (CI)=1.42-253.57 ; p=0.026] and low military life satisfaction (AOR=15.67; 95% CI=1.46-168.11 ; p=0.023) correlated with emotional distress. Conclusion : Soldiers admitted to the military hospital showed similar prevalence of emotional distress as those at general hospitals. Considering military circumstances, it is necessary to detect and intervene regarding soldiers with a psychiatric history and low military life satisfaction to promote mental health at military hospitals.

Objective : Dynamic proteolysis, through the ubiquitin-proteasome system, is an important molecular mechanism for the constant regulation of synaptic plasticity and stress responses in humans. In this study, we examined whether genetic variants in the ubiquitin-specific peptidase (USP) genes were associated with psychological traits of resilience and susceptibility to neuropsychiatric disorders for each gender. Methods : A total of 344 Korean healthy youths (190 males, 154 females) were included in the study. A genotyping of rs2241646 of USP2 and rs346006 of USP46 was performed. The Connor-Davidson Resilience Scale and Brief Fear of Negative Evaluation Scale were administered for measuring trait resilience and social anxiety, respectively. The genetic associations of the USP variants were tested using multiple analyses of covariance with psychological traits as dependent variables after controlling for age in each gender. Results : For USP2 rs2241646, women with the TT genotype showed significantly higher resilience and lower social anxiety, as compared to those carrying the C allele. There were no associations between USP46 rs346005 and the psychological traits in both genders. Conclusions : The present study showed a possible genetic association between the USP2 rs2241646 and stress resilience and trait anxiety in women. The findings suggest that ubiquitin-proteasome system may be related to the resilience and susceptibility to stress-related neuropsychiatric disorders such as anxiety disorders, possibly through the regulation of dynamic proteolysis responses to stress.