Publications by authors named "Seon-Cheol Park"

104 Publications

Lifestyle Changes that Impact Personal Quality of Life in the COVID-19 Pandemic in South Korea.

Psychiatry Investig 2021 Jul 22;18(7):701-707. Epub 2021 Jul 22.

Department of Psychiatry, Dong-A University Hospital, Busan, Republic of Korea.

Objective: We investigated which factors in psychological changes positively or negatively affect the quality of life to suggest desirable directions in the period of the COVID-19 pandemic.

Methods: Online survey was conducted with 1,011 adults more than 19 years old in Busan, South Korea. Quality of life was measured using the World Health Organization Quality of Life-BREF. Questions regarding the psychological changes were about COVID-19-related concerns, distress in complying with quarantine guidelines, and interest in seeking something to do alone.

Results: Quality of life was perceived to be below average (mean±SD, 2.86±0.53). The more economic worries there were, the lower the quality of life in psychological, social relationships and environmental domains. The more distress one experienced when maintaining their personal hygiene, the higher the quality of life related to their physical health. Likewise, the more difficult it was to maintain social distances, the higher the quality of life associated with psychological and social relationships. The more interested someone was in how to spend time alone, the higher the quality of life in all domains significantly.

Conclusion: We can minimize the negative impacts of COVID-19 by maintaining economic stability, maintaining prosocial behaviors related to personal hygiene and making good use of personal time.
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http://dx.doi.org/10.30773/pi.2021.0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328828PMC
July 2021

Internet Addiction and Its Associations with Clinical and Psychosocial Factors in Medical Students.

Psychiatry Investig 2021 May 30;18(5):408-416. Epub 2021 Apr 30.

Department of Psychiatry, College of Medicine, Chosun University, Gwangju, Republic of Korea.

Objective: Excessive internet use has been associated with various psychiatric symptoms and psychosocial factors. This study aimed to investigate the prevalence of internet addiction (IA) and its associations with clinical (depression/social anxiety) and psychosocial (self-esteem/perceived social support) factors in medical students.

Methods: In total, 408 medical students at one university in Korea were included in this study. IA symptoms were assessed with Young's Internet Addiction Test, and scores of 50 or higher were considered to indicate IA. Participants were asked to complete the Beck Depression Inventory, Social Phobia Inventory, Rosenberg Self-Esteem Scale, and Duke-University of North Carolina Functional Social Support Questionnaire. A logistic regression model was constructed to examine the impact of clinical and psychosocial factors on IA.

Results: Forty-seven participants (11.5%) were identified as having IA. Self-esteem was associated with a lower risk of IA, whereas depression and social anxiety were associated with a higher risk of IA. Depression, social anxiety, low self-esteem, and low perceived social support were found to be significant correlates of IA. Young's Internet Addiction Test score positively correlated with Beck Depression Inventory and Social Phobia Inventory scores, but negatively correlated with Rosenberg Self-Esteem Scale and Duke-University of North Carolina Functional Social Support Questionnaire scores. Furthermore, the prevalence of IA was highest in first-year medical students.

Conclusion: This study revealed the possible risk and protective factors of IA. Our findings indicate that strengthening self-esteem and reducing depression and social anxiety may contribute to the prevention and management of IA in medical students.
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http://dx.doi.org/10.30773/pi.2020.0405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169337PMC
May 2021

Smoking and the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.

Nicotine Tob Res 2021 08;23(10):1787-1792

Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.

Introduction: It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection.

Methods: A matched case-control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status.

Results: A total of 4167 patients with SARS-CoV-2 infection and 20 937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50-0.62). When ex-smokers and current smokers were analyzed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28-0.38; ex-smoker OR = 0.81, CI = 0.72-0.91).

Conclusions: This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution.

Implications: It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.
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http://dx.doi.org/10.1093/ntr/ntab079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135532PMC
August 2021

Challenges and Strategies for Current Classifications of Depressive Disorders: Proposal for Future Diagnostic Standards.

Adv Exp Med Biol 2021 ;1305:103-116

Department of Psychiatry, Korea University Ansan Hospital, College of Medicine, Ansan, Republic of Korea.

The Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) was revised based on a combination of a categorical and a dimensional approach such that in the DSM, Fifth Edition (DSM-5), depressive disorders have been separated as a distinctive disease entity from bipolar disorders, consistent with the deconstruction of Kraepelinian dualism. Additionally, the diagnostic thresholds of depressive disorders may be reduced due to the addition of "hopelessness" to the subjective descriptors of depressed mood and the removal of the "bereavement exclusion." Manic/hypomanic, psychotic, and anxious symptoms in major depressive disorder (MDD) and other depressive disorders are described using the transdiagnostic specifiers of "with mixed features," "with psychotic features," and "with anxious distress," respectively. Additionally, due to the polythetic and operational characteristics of the DSM-5 diagnostic criteria, the heterogeneity of MDD is inevitable. Thus, 227 different symptom combinations fulfill the DSM-5 diagnostic criteria for MDD. This heterogeneity of MDD is criticized in view of the Wittgensteinian analogy of language game. Depression subtypes determined by disturbances in monoamine levels and the severity of the disease have been identified in the literature. According to a review of the Gottesman and Gould criteria, neuroticism, morning cortisol, cortisol awakening response, asymmetry in frontal cortical activity on electroencephalography (EEG), and probabilistic reward learning, among other variables, are evidenced as endophenotypes for depressive disorders. Network analysis has been proposed as a potential method to compliment the limitations of current diagnostic criteria and to explore the pathways between depressive symptoms, as well as to identify novel and interesting relationships between depressive symptoms. Based on the literature on network analysis in this field, no differences in the centrality index of the DSM and non-DSM symptoms were repeatedly present among patients with MDD. Furthermore, MDD and other depressive syndromes include two of the Research Domain Criteria (RDoC), including the Loss construct within the Negative Valence Systems domains and various Reward constructs within the Positive Valence Systems domain.
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http://dx.doi.org/10.1007/978-981-33-6044-0_7DOI Listing
April 2021

Body mass index as a predictor of mortality in bronchiectasis: A nationwide population-based study.

Respir Med 2021 Apr-May;180:106370. Epub 2021 Mar 13.

Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address:

Introduction: The prognosis of bronchiectasis is not well known. The purpose of this study was to evaluate the association between body mass index (BMI) and mortality in bronchiectasis using a large nationwide population-based cohort.

Material And Methods: Using the National Health Insurance Service-Health Screening Cohort in Korea, individuals with bronchiectasis were identified from 2004 to 2006 and monitored for up to 10 years. Mortality in bronchiectasis was analyzed based on a BMI score <18.5 kg/m (underweight), 1.85-22.9 kg/m (normal weight), 23.0-24.9 kg/m (overweight), and >25.0 kg/m (obese).

Results: A total of 2769 individuals with bronchiectasis were included. The underweight, normal weight, overweight, and obese accounted for 5.1%, 40.4%, 25.4%, and 29.3% of all patients with bronchiectasis, respectively. Compared to normal weight, underweight in bronchiectasis was associated with increased all-cause mortality (hazard ratio [HR] = 2.60; 95% confidence interval [CI] = 1.92-3.54), while obese was associated with decreased all-cause mortality (HR = 0.71; 95% CI = 0.55-0.93). This relationship between BMI and mortality was more prominent in respiratory disease-related mortality.

Conclusions: BMI is a predictor of mortality in bronchiectasis. Underweight is associated with increased mortality among individuals with bronchiectasis while obese is associated with decreased mortality.
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http://dx.doi.org/10.1016/j.rmed.2021.106370DOI Listing
March 2021

Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections: a nationwide population-based study.

Ann Transl Med 2021 Feb;9(3):211

Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.

Background: The coronavirus disease 2019 (COVID-19) has rapidly turned into a public health emergency worldwide; however, the risk factors for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well-described. We aimed to identify the clinical risk factors for SARS-CoV-2 infections in Korea, where social distancing and face masks have been strongly recommended.

Methods: The data of individuals who underwent the reverse transcription polymerase chain reaction test for SARS-CoV-2 between January 3 and May 31, 2020 were retrieved from the Health Insurance Review and Assessment Service dataset. We used multivariable logistic regression models to identify the risk factors for SARS-CoV-2 infections in the population.

Results: We retrieved the results of 219,729 SARS-CoV-2 tests, of which 7,333 were positive results. In the multivariable analysis, female sex was associated with a higher risk of testing positive for SARS-CoV-2 [odds ratio (OR) =1.30, 95% confidence interval (CI): 1.24-1.37, P<0.0001]. Additionally, populations living in areas that had large outbreaks of COVID-19 were at an increased risk of testing positive for SARS-CoV-2 (OR =6.87, 95% CI: 6.55-7.21, P<0.0001). The odds of a positive test were greater for the Medical Aid beneficiaries (OR =1.99, 95% CI: 1.82-2.18, P<0.0001) than for the National Health Insurance beneficiaries. Individuals with diabetes mellitus (DM) were more likely to test positive (OR =1.15, 95% CI: 1.07-1.24, P=0.0002).

Conclusions: Women, individuals living in areas with large outbreaks of COVID-19, Medical Aid beneficiaries, and individuals with DM might have greater risks of contracting SARS-CoV-2 infections despite practicing social distancing and using face masks.
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http://dx.doi.org/10.21037/atm-20-5958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940880PMC
February 2021

Neural Circuitry-Neurogenesis Coupling Model of Depression.

Int J Mol Sci 2021 Feb 28;22(5). Epub 2021 Feb 28.

Department of Psychiatry, Hanyang University Guri Hospital, Guri 11923, Korea.

Depression is characterized by the disruption of both neural circuitry and neurogenesis. Defects in hippocampal activity and volume, indicative of reduced neurogenesis, are associated with depression-related behaviors in both humans and animals. Neurogenesis in adulthood is considered an activity-dependent process; therefore, hippocampal neurogenesis defects in depression can be a result of defective neural circuitry activity. However, the mechanistic understanding of how defective neural circuitry can induce neurogenesis defects in depression remains unclear. This review highlights the current findings supporting the neural circuitry-regulated neurogenesis, especially focusing on hippocampal neurogenesis regulated by the entorhinal cortex, with regard to memory, pattern separation, and mood. Taken together, these findings may pave the way for future progress in neural circuitry-neurogenesis coupling studies of depression.
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http://dx.doi.org/10.3390/ijms22052468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957816PMC
February 2021

Impact of COPD on COVID-19 prognosis: A nationwide population-based study in South Korea.

Sci Rep 2021 02 12;11(1):3735. Epub 2021 Feb 12.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Underlying chronic respiratory disease may be associated with the severity of coronavirus disease 2019 (COVID-19). This study investigated the impact of chronic obstructive pulmonary disease (COPD) on the risk for respiratory failure and mortality in COVID-19 patients. A nationwide retrospective cohort study was conducted in 4610 patients (≥ 40 years old) infected with COVID-19 between January 20 and May 27, 2020, using data from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The clinical course and various clinical features were compared between COPD and non-COPD patients, and the risks of respiratory failure and all-cause mortality in COPD patients were analyzed using a multivariate logistic regression model. Among 4610 COVID-19 patients, 4469 (96.9%) and 141 (3.1%) were categorized into the non-COPD and COPD groups, respectively. The COPD group had greater proportions of older (≥ 60 years old) (78.0% vs. 45.2%, P < 0.001) and male (52.5% vs. 36.6%, P < 0.001) patients than the non-COPD group. Relatively greater proportions of patients with COPD received intensive critical care (7.1% vs. 3.7%, P = 0.041) and mechanical ventilation (5.7% vs. 2.4%, P = 0.015). Multivariate analyses showed that COPD was not a risk factor for respiratory failure but was a significant independent risk factor for all-cause mortality (OR = 1.80, 95% CI 1.11-2.93) after adjustment for age, sex, and Charlson Comorbidity Index score. Among COVID-19 patients, relatively greater proportions of patients with COPD received mechanical ventilation and intensive critical care. COPD is an independent risk factor for all-cause mortality in COVID-19 patients in Korea.
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http://dx.doi.org/10.1038/s41598-021-83226-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880985PMC
February 2021

A nationwide population-based study of incidence and mortality of lung cancer in idiopathic pulmonary fibrosis.

Sci Rep 2021 01 28;11(1):2596. Epub 2021 Jan 28.

Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.

Idiopathic pulmonary fibrosis (IPF) is an independent risk factor for lung cancer (LC) development; however, there are currently no clinical guidelines for LC surveillance in IPF. This study aimed to investigate the cumulative incidence and survival outcomes of LC in IPF. Using the National Health Insurance Service database, including medical information on people aged ≥ 40 years between 2011 and 2016, we identified IPF patients and confirmed the presence of comorbid LC. Patients diagnosed with IPF in 2011 were washed out, and mortality data were analyzed from 2012 to 2018. A total of 7277 newly diagnosed IPF patients were identified among Korean citizens aged ≥ 40 years (about 50 million people) between 2011 and 2016. Their average age was 71.5 years and 72.8% of them were male. The prevalence of LC in the IPF cases was 6.4%. The cumulative incidence rates of LC in IPF patients who did not have LC at the time of IPF diagnosis were 1.7%, 4.7%, and 7.0%, at 1, 3, and 5 years, respectively. The median time from IPF diagnosis to LC development was 16.3 (Interquartile range, 8.2-28.8) months. The survival rate was significantly lower in the IPF with LC group than the IPF without LC group (P < 0.001). We concluded that IPF increases LC risk, and LC weakens survival outcomes in IPF. Close surveillance for LC development is mandatory for patients with IPF.
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http://dx.doi.org/10.1038/s41598-021-82182-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843601PMC
January 2021

Network Analysis of the Symptoms of Depressive Disorders Over the Course of Therapy: Changes in Centrality Measures.

Psychiatry Investig 2021 Jan 19;18(1):48-58. Epub 2021 Jan 19.

Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea.

Objective: Network analysis can be used in terms of a novel psychopathological approach for depressive syndrome. We aimed to estimate the successive network structures of depressive symptoms in patients with depressive disorder using data from the Clinical Research Center for Depression study.

Methods: We enrolled 1,152 South Korean adult patients with depressive disorders who were beginning treatment for first-onset or recurrent depressive episodes. We examined the network structure of the severities of the items on the Hamilton Depression Rating Scale (HAMD) at baseline and at weeks 2, 12, 25, and 52. The node strength centrality of all the HAMD items at baseline and at week 2, 12, 25, and 52 in terms of network analysis.

Results: In the severity networks, the anxiety (psychic) item was the most centrally situated in the initial period (baseline and week 2), while loss of weight was the most centrally situated item in the later period (weeks 25 and 52). In addition, the number of strong edges (i.e., edges representing strong correlations) increased in the late period compared to the initial period.

Conclusion: Our findings support a period-specific and symptom-focused therapeutic approach that can provide complementary information to the unidimensional total HAMD score.
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http://dx.doi.org/10.30773/pi.2020.0367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897865PMC
January 2021

Impact of comorbid asthma on severity of coronavirus disease (COVID-19).

Sci Rep 2020 12 11;10(1):21805. Epub 2020 Dec 11.

Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.

The severity of the coronavirus disease (COVID-19) is associated with various comorbidities. However, no studies have yet demonstrated the potential risk of respiratory failure and mortality in COVID-19 patients with pre-existing asthma. We selected 7272 adult COVID-19 patients from the Korean Health Insurance Review and Assessment COVID-19 database for this nationwide retrospective cohort study. Among these, 686 patients with asthma were assessed by their severities and evaluated by the clinical outcome of COVID-19 compared to patients without asthma. Of 7272 adult COVID-19 patients, 686 with asthma and 6586 without asthma were compared. Asthma was not a significant risk factor for respiratory failure or mortality among all COVID-19 patients (odds ratio [OR] = 0.99, P = 0.997 and OR = 1.06, P = 0.759) after adjusting for age, sex, and the Charlson comorbidity score. However, a history of acute exacerbation (OR = 2.63, P = 0.043) was significant risk factors for death among COVID-19 patients with asthma. Asthma is not a risk factor for poor prognosis of COVID-19. However, asthma patients who had any experience of acute exacerbation in the previous year before COVID-19 showed higher COVID-19-related mortality, especially in case of old age and male sex.
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http://dx.doi.org/10.1038/s41598-020-77791-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733453PMC
December 2020

Impact of comorbid asthma on severity of coronavirus disease (COVID-19).

Sci Rep 2020 12 11;10(1):21805. Epub 2020 Dec 11.

Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.

The severity of the coronavirus disease (COVID-19) is associated with various comorbidities. However, no studies have yet demonstrated the potential risk of respiratory failure and mortality in COVID-19 patients with pre-existing asthma. We selected 7272 adult COVID-19 patients from the Korean Health Insurance Review and Assessment COVID-19 database for this nationwide retrospective cohort study. Among these, 686 patients with asthma were assessed by their severities and evaluated by the clinical outcome of COVID-19 compared to patients without asthma. Of 7272 adult COVID-19 patients, 686 with asthma and 6586 without asthma were compared. Asthma was not a significant risk factor for respiratory failure or mortality among all COVID-19 patients (odds ratio [OR] = 0.99, P = 0.997 and OR = 1.06, P = 0.759) after adjusting for age, sex, and the Charlson comorbidity score. However, a history of acute exacerbation (OR = 2.63, P = 0.043) was significant risk factors for death among COVID-19 patients with asthma. Asthma is not a risk factor for poor prognosis of COVID-19. However, asthma patients who had any experience of acute exacerbation in the previous year before COVID-19 showed higher COVID-19-related mortality, especially in case of old age and male sex.
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http://dx.doi.org/10.1038/s41598-020-77791-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733453PMC
December 2020

An alternative approach to future diagnostic standards for major depressive disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2021 03 10;105:110133. Epub 2020 Oct 10.

Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. Electronic address:

During the period extending from 1780 to 1880, the conceptualization of melancholia changed from an intellectual to a mood model. The modern view of depression, based on Kraepelinian dualism, has reflected changes in opinion on psychiatric taxonomy of individual melancholia. From the point of view of an "operational revolution," the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) were based on a neoKraepelinian approach rooted in disease essentialism. In the revision process from the DSM-IV to the DSM-5, a combined dimensional and categorial approach was used. In the DSM-5, the diagnostic criteria for major depressive disorder are polythetic and operational in approach reflecting the heterogeneity of major depressive disorder. Although 227 different symptom combinations fulfilling the diagnostic criteria for major depressive disorder can be theoretically calculated, certain symptom combinations are more prevalent than others in real clinical situations. The heterogeneity of these operational criteria for major depressive disorder have been criticized in a manner informed by the Wittgensteinian analogy of the language game. Herein, our network analysis proposes a novel perspective on the psychopathology of major depressive disorder. The novel approach suggested here may lay the foundation for a redefinition of the traditional taxonomy of depression.
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http://dx.doi.org/10.1016/j.pnpbp.2020.110133DOI Listing
March 2021

An alternative approach to future diagnostic standards for major depressive disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2021 03 10;105:110133. Epub 2020 Oct 10.

Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. Electronic address:

During the period extending from 1780 to 1880, the conceptualization of melancholia changed from an intellectual to a mood model. The modern view of depression, based on Kraepelinian dualism, has reflected changes in opinion on psychiatric taxonomy of individual melancholia. From the point of view of an "operational revolution," the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) were based on a neoKraepelinian approach rooted in disease essentialism. In the revision process from the DSM-IV to the DSM-5, a combined dimensional and categorial approach was used. In the DSM-5, the diagnostic criteria for major depressive disorder are polythetic and operational in approach reflecting the heterogeneity of major depressive disorder. Although 227 different symptom combinations fulfilling the diagnostic criteria for major depressive disorder can be theoretically calculated, certain symptom combinations are more prevalent than others in real clinical situations. The heterogeneity of these operational criteria for major depressive disorder have been criticized in a manner informed by the Wittgensteinian analogy of the language game. Herein, our network analysis proposes a novel perspective on the psychopathology of major depressive disorder. The novel approach suggested here may lay the foundation for a redefinition of the traditional taxonomy of depression.
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http://dx.doi.org/10.1016/j.pnpbp.2020.110133DOI Listing
March 2021

Relationship Between Body Mass Index and Extrapyramidal Symptoms in Asian Patients with Schizophrenia: The Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP).

Psychiatr Danub 2020 ;32(2):176-186

Department of Psychiatry, Inje University Haeundae Paik Hospital, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea,

Background: Although an inverse relationship between body mass index (BMI) and Parkinson disease (PD) has been repeatedly reported, to our knowledge, the relationship between BMI and antipsychotic-induced extrapyramidal symptoms (EPS) has rarely been studied in patients with schizophrenia. Our study aimed to evaluate the relationship between BMI and EPS in patients with schizophrenia.

Subjects And Methods: Using data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) study, we compared the prevalence of EPS in 1448 schizophrenia patients stratified as underweight, normal range, overweight pre-obese, overweight obese I, overweight obese II, and overweight obese III according to the World Health Organization (WHO) classification system for body weight status, and with underweight, normal range, overweight at risk, overweight obese I, and overweight obese II according to the Asia-Pacific obesity classification.

Results: In the first step of the WHO classification system for body weight status, adjusting for the potential effects of confounding factors, the multinomial logistic regression model revealed that underweight was significantly associated with greater rates of bradykinesia and muscle rigidity, and a lower rate of gait disturbance. In the second step of the Asia-Pacific obesity classification, adjusting for the potential effects of confounding factors, the multinomial logistic regression model revealed that underweight was significantly associated with a higher rate of muscle rigidity.

Conclusion: Findings of the present study consistently revealed that underweight was associated with a greater rate of muscle rigidity in a stepwise pattern among Asian patients with schizophrenia. Although the mechanism underlying the inverse relationship between BMI and muscle rigidity cannot be sufficiently explained, it is speculated that low BMI may contribute to the development of muscle rigidity regardless of antipsychotic "typicality" and dose in patients with schizophrenia.
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http://dx.doi.org/10.24869/psyd.2020.176DOI Listing
September 2020

QT interval prolongation noted in one percent of 2553 Asian patients with schizophrenia: Findings from the REAP-AP survey.

Kaohsiung J Med Sci 2020 Dec 9;36(12):1030-1037. Epub 2020 Aug 9.

Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea.

Although the association between antipsychotic use and corrected QT interval (QTc) prolongation has been repeatedly confirmed, the relationship has been rarely studied in a practical setting. Using data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) survey, our study aimed to investigate the prevalence and clinical correlates of QTc prolongation in 2553 Asian patients with schizophrenia. After adjusting for the potential effect of confounding factors, the baseline and clinical characteristics of the schizophrenia patients with and without QTc prolongation were compared using analyses of covariance and binary logistic analyses. In addition, a binary logistic analysis model with a forward selection method was used to identify the distinctive clinical correlates of QTc prolongation. QTc prolongation was noted in 1.1% of Asian patients with schizophrenia. Schizophrenia patients were characterized by lower proportions of disorganized speech and negative symptoms; higher use of amisulpride and clozapine; and higher proportions of rigidity, hypercholesterolemia, and sedation than those without QTc prolongation. Finally, a binary logistic mode showed that amisulpride, clozapine, rigidity, and hypercholesterolemia might be the distinctive clinical correlates of QTc prolongation in Asian patients with schizophrenia. These findings indicate the clinical implications that the uses of amisulpride and clozapine and the occurrences of rigidity and hypercholesterolemia may be potential risk factors for QTc prolongation of schizophrenia patients.
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http://dx.doi.org/10.1002/kjm2.12280DOI Listing
December 2020

Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study.

Hum Psychopharmacol 2020 11 1;35(6):1-7. Epub 2020 Aug 1.

Vietnam Psychiatric Association (VPA), Hanoi, Vietnam.

Objective: Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses).

Methods: Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates.

Results: Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social-occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses.

Conclusions: Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.
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http://dx.doi.org/10.1002/hup.2752DOI Listing
November 2020

Network Analysis of Language Disorganization in Patients with Schizophrenia.

Yonsei Med J 2020 Aug;61(8):726-730

Department of Psychiatry, Hanyang University Guri Hospital, Guri, Korea.

Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptom of schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structure of language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluate the network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17 of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosure failure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within the network structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorder in schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning of language disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., duration of illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.
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http://dx.doi.org/10.3349/ymj.2020.61.8.726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393296PMC
August 2020

Dyskinesia is most centrally situated in an estimated network of extrapyramidal syndrome in Asian patients with schizophrenia: findings from research on Asian psychotropic prescription patterns for antipsychotics.

Nord J Psychiatry 2021 Jan 25;75(1):9-17. Epub 2020 Jun 25.

Department of Psychiatry and Psychobiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan.

Background: Network analysis provides a new viewpoint that explicates intertwined and interrelated symptoms into dynamic causal architectures of symptom clusters. This is a process called 'symptomics' and is concurrently applied to various areas of symptomatology.

Aims: Using the data from Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), we aimed to estimate a network model of extrapyramidal syndrome in patients with schizophrenia.

Methods: Using data from REAP-AP, extrapyramidal symptoms of 1046 Asian patients with schizophrenia were evaluated using the nine items of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). The estimated network of the ordered-categorical DIEPSS items consisted of nodes (symptoms) and edges (interconnections). A community detection algorithm was also used to identify distinctive symptom clusters, and correlation stability coefficients were used to evaluate the centrality stability.

Results: An interpretable level of node strength centrality was ensured with a correlation coefficient. An estimated network of extrapyramidal syndrome showed that 26 (72.2%) of all possible 35 edges were estimated to be greater than zero. Dyskinesia was most centrally situated within the estimated network. In addition, earlier antipsychotic-induced extrapyramidal symptoms were divided into three distinctive clusters - extrapyramidal syndrome without parkinsonism, postural instability and gait difficulty-dominant parkinsonism, and tremor-dominant parkinsonism.

Conclusions: Our findings showed that dyskinesia is the most central domain in an estimated network structure of extrapyramidal syndrome in Asian patients with schizophrenia. These findings are consistent with the speculation that acute dystonia, akathisia, and parkinsonism could be the risk factors of tardive dyskinesia.
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http://dx.doi.org/10.1080/08039488.2020.1777462DOI Listing
January 2021

Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region.

Asia Pac Psychiatry 2020 Dec 29;12(4):e12393. Epub 2020 May 29.

Vietnam Psychiatric Association (VPA), Thuong Tin, Hanoi, Vietnam.

Introduction: Patterns of clinical use of long-acting injectable (LAI) antipsychotic drugs in many countries, especially in Asia, for treatment of patients diagnosed with chronic psychotic disorders including schizophrenia are not well established.

Methods: Within an extensive research consortium, we evaluated prescription rates for first- (FGA) and second-generation antipsychotic (SGA) LAI drugs and their clinical correlates among 3557 subjects diagnosed with schizophrenia across 15 Asian countries and region.

Results: Overall, an average of 17.9% (638/3557; range: 0.0%-44.9%) of treated subjects were prescribed LAI antipsychotics. Those given LAI vs orally administered agents were significantly older, had multiple hospitalizations, received multiple antipsychotics more often, at 32.4% higher doses, were more likely to manifest disorganized behavior or aggression, had somewhat superior psychosocial functioning and less negative symptoms, but were more likely to be hospitalized, with higher BMI, and more tremor. Being prescribed an FGA vs SGA LAI agent was associated with male sex, aggression, disorganization, hospitalization, multiple antipsychotics, higher doses, with similar risks of adverse neurological or metabolic effects. Rates of use of LAI antipsychotic drugs to treat patients diagnosed with schizophrenia varied by more than 40-fold among Asian countries and given to an average of 17.9% of treated schizophrenia patients. We identified the differences in the clinical profiles and treatment characteristics of patients who were receiving FGA-LAI and SGA-LAI medications.

Discussion: These findings behoove clinicians to be mindful when evaluating patients' need to be on LAI antipsychotics amidst multifaceted considerations, especially downstream adverse events such as metabolic and extrapyramidal side effects.
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http://dx.doi.org/10.1111/appy.12393DOI Listing
December 2020

Secondary Emotional Reactions to the COVID-19 Outbreak Should Be Identified and Treated in Korea.

J Korean Med Sci 2020 05 4;35(17):e161. Epub 2020 May 4.

Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200177PMC
May 2020

Treatment Rate of Schizophrenia in China: a Meta-Analysis of Epidemiological Studies.

Psychiatr Q 2020 09;91(3):863-875

Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.

Effective and prompt medication treatment is essential for schizophrenia patients to alleviate psychotic symptoms and improve prognosis. The treatment rate of schizophrenia usually varies greatly across studies. This is a meta-analysis that examined the overall treatment rate of schizophrenia in China. Both international (PubMed, EMBASE, PsycINFO, Web of Science) and Chinese (CNKI, WanFang and Sinomed) databases were searched. The random effects model was used to analyze the data. Fifteen studies with 1,219,472 patients were included. This meta-analysis found that 73% (95%CI: 66%, 80%) of schizophrenia patients received treatment in any type of medical institutions, while 31.0% (95%CI = 21.0%, 41.0%) received treatment in psychiatric institutions. Studies conducted in middle region of China (76.8% for any type of medical institutions; 42.6% for psychiatric institutions) and those published before 2007 (74.6% for any type of medical institutions; 31.3% for psychiatric institutions) reported significantly higher treatment rates. Studies using combined diagnostic instruments had a higher treatment rate of schizophrenia (72.0%) in any type of medical institutions, while using the Chinese classification of Mental Disorders (47.7%) and including both rural and urban areas (35.7%) had higher treatment rates of schizophrenia in psychiatric institutions. The treatment rate of schizophrenia was relatively high in China, but most treatments were delivered in non-psychiatric medical institutions. Greater efforts should be made to improve the provision of accessible mental health services for schizophrenia patients in this part of the world.
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http://dx.doi.org/10.1007/s11126-020-09740-7DOI Listing
September 2020

The Centrality of Depression and Anxiety Symptoms in Major Depressive Disorder Determined Using a Network Analysis.

J Affect Disord 2020 06 15;271:19-26. Epub 2020 Apr 15.

Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea. Electronic address:

Background: Comorbid anxiety symptoms are highly prevalent and closely linked with poorer treatment outcomes, chronicity, and hospitalization in major depressive disorder (MDD). Our study aimed to estimate the network of depression and anxiety symptoms that was developed based on a sample of MDD patients.

Methods: We constructed a network of the 21 Beck Depression Inventory (BDI) symptoms and 21 Beck Anxiety Inventory (BAI) symptoms in 223 patients with MDD who were beginning psychiatric treatment. In addition, each of the depression and anxiety symptoms was considered to be an ordered categorical variable ranging in value from 0 to 3.

Results: The three depression symptoms including loss of energy, loss of interest, and worthlessness and the seven anxiety symptoms including faintness or lightheadedness, feeling of choking, feeling scared, fear of the worst happening, nervousness, inability to relax, and feeling shaky were identified as the ten most central nodes within a network of depression and anxiety symptoms. The inter-connection between irritability and nervousness was a strong trans-diagnostic edge within the network of depression and anxiety symptoms.

Limitations: Because our study was designed in a cross-sectional manner, the networks were estimated undirectionally.

Conclusions: Our findings show that depression symptoms are not more central than anxiety symptoms within an estimated network structure of symptoms in patients with MDD. Moreover, the inter-connection between irritability and nervousness may suggests a probable trans-diagnostic association in MDD symptomatology.
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http://dx.doi.org/10.1016/j.jad.2020.03.078DOI Listing
June 2020

Karl Jaspers' General Psychopathology (Allgemeine Psychopathologie) and Its Implication for the Current Psychiatry.

Authors:
Seon-Cheol Park

Psychiatry Investig 2020 02 25;17(2):177. Epub 2020 Feb 25.

Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.

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http://dx.doi.org/10.30773/pi.2018.12.19.2eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046993PMC
February 2020

Mental Health Care Measures in Response to the 2019 Novel Coronavirus Outbreak in Korea.

Psychiatry Investig 2020 Feb 25;17(2):85-86. Epub 2020 Feb 25.

Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea.

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http://dx.doi.org/10.30773/pi.2020.0058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047003PMC
February 2020

Network analysis of the depressive symptom profiles in Asian patients with depressive disorders: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD).

Psychiatry Clin Neurosci 2020 Jun 5;74(6):344-353. Epub 2020 Mar 5.

Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan.

Aim: We aimed to estimate the network structures of depressive symptoms using network analysis and evaluated the geographic regional differences in theses network structures among Asian patients with depressive disorders.

Methods: Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD), the network of the ICD-10 diagnostic criteria for depressive episode was estimated from 1174 Asian patients with depressive disorders. The node strength centrality of all ICD-10 diagnostic criteria for a depressive episode was estimated using a community-detection algorithm. In addition, networks of depressive symptoms were estimated separately among East Asian patients and South or Southeast Asian patients. Moreover, networks were estimated separately among Asian patients from high-income countries and those from middle-income countries.

Results: Persistent sadness, fatigue, and loss of interest were the most centrally situated within the network of depressive symptoms in Asian patients with depressive disorders overall. A community-detection algorithm estimated that when excluding psychomotor disturbance as an outlier, the other nine symptoms formed the largest clinically meaningful cluster. Geographic and economic variations in networks of depressive symptoms were evaluated.

Conclusion: Our findings demonstrated that the typical symptoms of the ICD-10 diagnostic criteria for depressive episode are the most centrally situated within the network of depressive symptoms. Furthermore, our findings suggested that cultural influences related to geographic and economic distributions of participants could influence the estimated depressive symptom network in Asian patients with depressive disorders.
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http://dx.doi.org/10.1111/pcn.12989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318233PMC
June 2020

Anxiety Disorders in the DSM-5: Changes, Controversies, and Future Directions.

Adv Exp Med Biol 2020 ;1191:187-196

Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, Ansan, Kyunggi Province, South Korea.

Under the partial influences of paradigm shift form category to dimension, the Diagnostic and Statistical Manual of Mental Disorder (DSM) was revised to the fifth edition (DSM-5); however, due to the lack of consistent biological makers and processes and the restricted availability of dimensional meta-structure, the revisions for the DSM-5 were based on a combination of categorical and dimensional approaches. Anxiety disorders were more clearly and consistently defined in the DSM-5 with the removal of obsessive compulsive, acute stress, and post-traumatic stress disorders. Differences between the childhood and adulthood categories of anxiety disorders were decreased, and overall, the symmetrical classification of anxiety subtypes was increased, since separation anxiety disorder and selective mutism were considered anxiety disorders, not neurodevelopmental disorders. Additionally, based on growing evidence, agoraphobia is distinct from panic disorder. Next, considering cultural syndromes including taijin kyofusho, khyal cap, trung gio attacks, and ataque de nervios, cultural influences are considered a significant factor for definitions and presentations of anxiety disorders. Controversies in the DSM-5 criteria for anxiety disorders are lowering the diagnostic thresholds of anxiety disorders and limiting the dichotomous view of anxiety and depression when defining generalized anxiety disorder. Further studies of alternative approaches to the restrictions of the DSM-5 criteria of anxiety disorders, including transdiagnostic specifiers and dimensional assessment tools, may be required.
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http://dx.doi.org/10.1007/978-981-32-9705-0_12DOI Listing
February 2020

Korea in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

J Korean Med Sci 2020 Jan 13;35:e6. Epub 2020 Jan 13.

Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955430PMC
January 2020

Reduced awareness of surroundings is the most central domain in the network structure of posttraumatic stress disorder symptoms.

Nord J Psychiatry 2020 May 19;74(4):235-243. Epub 2019 Dec 19.

Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea.

Network models suggest that co-occurring symptoms are conceptualized as a syndrome due to interactions, rather than a categorical entity with an underlying common cause. Our study aimed to examine the network structure and centrality of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV posttraumatic stress disorder (PTSD) symptoms, including essential and associated features. We constructed a network structure of 21 intertwined symptoms, evaluated with the Clinician-Administered PTSD Scale (CAPS), in 249 PTSD patients who have been exposed to various types of traumatic events (73% being traffic or other accidents) and were beginning psychiatric treatment. In addition, we estimated the centrality of the 21 symptoms through network analysis. Each of the symptoms was defined as ordered-categorical variables. The network, with 21 symptoms, demonstrated a strong correlation among difficulty concentrating, reduced awareness of surroundings, and derealization. In addition, reduced awareness of surroundings was estimated as the most central symptom, whereas inability to recall important aspects of trauma was estimated as the least central symptom in the subjects. A community-detection analysis estimated that the 21 PTSD symptoms were organized into three clinically meaning clusters. Although dissociative features have been defined as associative symptoms rather than essential symptoms for the DSM diagnostic criteria, reduced awareness of surroundings may be regarded as the most central symptom in patients in the early phase of PTSD. Thus, evaluation and intervention for dissociative features may be needed in clinical practice and studies on PTSD.
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http://dx.doi.org/10.1080/08039488.2019.1692234DOI Listing
May 2020

An Integrated Bio-psycho-social Approach to Psychiatric Disorders.

Adv Exp Med Biol 2019 ;1192:331-340

Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, 516, Gojan-dong, Ansan, Kyunggi Province, 425-707, Republic of Korea.

The biopsychosocial approach is a model of eclecticism, which consists of multidisciplinary academic fields, reacting against the "neuroscientification" of psychiatry. The biopsychosocial approach was proposed by George Engel following Adolf Meyer's psychobiological and Roy R. Ginker's eclectic approach to psychiatry. Although the use of the biopsychosocial approach is increasing, it has several limitations: First, specific practices cannot be guided by the biopsychosocial approach because it is considered to be "boundless psychiatry." Second, unlike an initial intention, the symptomatic use of psychotropic medications may be justified by the biopsychosocial approach. Third, the economic forces to enhance biological psychiatry cannot be hindered by the biopsychosocial approach. Hence, to overcome the limitations of the current biopsychosocial approach, potential new paradigms including evolutionary psychiatry, pragmatism, integrationism, and pluralism have been proposed. Above all, Eric Kandel presented the link between neuroscience and psychiatry from the perspective of integrationism. In accordance with integrationism and/or pluralism, based on the paradigm shift of the theoretical construct from chemical imbalance to dysfunctional circuit, next-generation treatments for mental disorders have been proposed by Thomas Insel. Thus, a more integrated biopsychosocial approach to managing psychiatric disorders including schizophrenia and panic disorder may be proposed.
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http://dx.doi.org/10.1007/978-981-32-9721-0_17DOI Listing
November 2019
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