Publications by authors named "Youl-Ri Kim"

41 Publications

Oxytocin: A Potential Therapeutic for Obesity.

J Obes Metab Syndr 2021 Apr 5. Epub 2021 Apr 5.

Institute of Eating Disorders and Mental Health, Inje University, Seoul, Korea.

Oxytocin is a neuropeptide involved in the homeostasis of food consumption and energy; it affects hedonic eating. Studies in obese or binge-eating patients reported the hypophagic effect of oxytocin, which reduced caloric intake after administration. Several studies have demonstrated the effect of oxytocin's increasing energy intake, decreasing food consumption, and contributing to weight loss. Oxytocin's effects on food intake and metabolism suggest its therapeutic potential for treating obesity and binge eating.
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http://dx.doi.org/10.7570/jomes20098DOI Listing
April 2021

A school-based eating disorder prevention program (Me, You & Us) for young adolescents in Korea: A 3-year follow-up study.

Int J Eat Disord 2021 Feb 21;54(2):168-173. Epub 2020 Dec 21.

Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea.

Objective: The study aimed to examine the feasibility and long-term effects of a school-based eating disorder prevention program for young adolescents in Korea.

Method: We followed up the students (n = 133) who had participated in the prevention program at 3 years ago to evaluate changes in body esteem and self-esteem between postintervention and 3-year follow-up, with investigating whether gender moderated the effect of time.

Results: Boys showed no decline in body esteem and self-esteem from postintervention to 3-year follow-up, indicating that the prevention program alleviated decreases in body esteem and self-esteem over time. Girls showed decreases in body esteem and self-esteem from postintervention to 3-years follow-up.

Discussion: This study provides evidence supporting the feasibility of the school-based eating disorder prevention program targeting mixed-sex, young adolescents in Korea. Given the developmental trajectories of decrease in body esteem and self-esteem during adolescence, the program may be efficient for boys over time. Boosters and/or complementary prevention approaches across gender are needed.
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http://dx.doi.org/10.1002/eat.23447DOI Listing
February 2021

Introduction to a special issue on eating disorders in Asia.

Int J Eat Disord 2021 Jan 19;54(1):3-6. Epub 2020 Dec 19.

Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.

Objective: It is our pleasure to introduce a special issue of the International Journal of Eating Disorders on eating disorders (EDs) in Asia.

Method: We received such a robust response to the special edition that we were able to fill two issues. Contributions focused on seven main themes: (1) prevalence, (2) time trends, (3) healthcare systems, (4) treatment, (5) risk factors, (6) assessment, and (7) orthorexia.

Results: New prevalence and time trend data from China, Iran, Singapore, Japan, and Taiwan suggest that EDs are increasingly common in Asia but are not always detected in healthcare settings. Only a minority of individuals with EDs in Singapore receive treatment, and psychosocial treatment and prevention interventions that are evidence-based in the West may require cultural adaptation before they can be fully implemented in Japan, Singapore, China, and South Korea. Psychological risk factors for EDs are more similar than different in Iran, India, Japan, and China, but biological risk factors are understudied across the continent. Psychometrically sound assessment tools are available in many Asian languages.

Discussion: We hope this special issue provides a catalyst and blueprint for global collaboration to relieve the burden of suffering of EDs in Asia and beyond.
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http://dx.doi.org/10.1002/eat.23444DOI Listing
January 2021

A Retrospective Analysis Evaluating the Outcome of Parenteral Nutrition in the Treatment of Anorexia Nervosa in Korea.

J Clin Med 2020 Nov 19;9(11). Epub 2020 Nov 19.

Institute of Eating Disorders and Mental Health, Inje University, Seoul 14551, Korea.

The objective of this study was to investigate the clinical efficacy of parenteral nutrition (PN) as supplemental feeding for patients with anorexia nervosa (AN). This study was conducted by reviewing the medical records of patients with AN who were hospitalized at a non-specialized ward. A total of 129 patients with AN were recruited, consisting of 67 patients received PN with oral refeeding and 62 patients received oral refeeding alone. We compared the weight gain at discharge and after discharge between the groups. As a result, at admission, the patients given supplementary PN had lower body mass indices and lower caloric intake than the patients without PN. The mean duration of PN was 8.5 days, which amounted to about a third of the average hospital stay with no difference between the groups. Both groups had similar weight gains during hospitalization, but the patients with PN had higher weight gains than the patients without PN at one and three months after discharge. In conclusion, the results suggest that supplementary PN in the early stage of refeeding might initiate weight gain in AN when nasogastric tube feeding is not possible. Randomized controlled trials are needed to be further tested of PN in treatment of AN.
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http://dx.doi.org/10.3390/jcm9113711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699278PMC
November 2020

Transcultural adaptation of cognitive behavioral therapy (CBT) in Asia.

Asia Pac Psychiatry 2021 Mar 25;13(1):e12442. Epub 2020 Oct 25.

Department of Psychiatry, Kowloon Hospital, Kowloon, Hong Kong.

Background: Cognitive behavior therapy (CBT) is an evidence based therapy and is now recommended by national organizations in many high income countries. CBT is underpinned by the European values and therefore for it to be effective in other cultures it needs to be adapted.

Aims: This paper describes an evidence based approach to culturally adapt CBT in Asian context, areas of focus for such adaptation and lessons learned.

Methods: An environmental scan of the literature, description of local CBT associations and perspectives from these organizations.

Results: Cultural adaptation of CBT focuses on three main areas; 1 awareness of culture and related issues, 2 assessment and 3 adjustment in therapy techniques.

Conclusions: The last decade has seen an increase in culturally adapted CBT in Asia, however, more work needs to be done to improve access to CBT in Asia.
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http://dx.doi.org/10.1111/appy.12442DOI Listing
March 2021

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study.

Eur Eat Disord Rev 2020 11 20;28(6):871-883. Epub 2020 Sep 20.

FITA Foundation, Barcelona, Spain.

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.
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http://dx.doi.org/10.1002/erv.2784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537123PMC
November 2020

A comparison of patients with anorexia nervosa and women who are constitutionally thin.

Eur Eat Disord Rev 2020 11 25;28(6):633-642. Epub 2020 Aug 25.

Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea.

Objective: Many of the clinical features of anorexia nervosa (AN) can be secondary problems associated with malnutrition, which mask the primary features of AN. This study aimed to investigate the intrinsic features of AN by comparing AN patients to women who are constitutionally thin (CT).

Method: Twenty-six patients with AN and 53 CT women of similar body mass index (AN: 17.13 ± 1.73 kg/m , CT: 16.62 ± 0.61 kg/m ) participated in the study. We examined medical findings, psychiatric features, and disturbed body image between the two groups.

Results: Patients with AN had earlier menarche but less frequent menstrual periods compared to CT women. They had lower blood pressure, lower triiodothyronine, and fasting glucose levels than CT women. Patients with AN had more disturbed body images and restricted diet patterns and also had higher neuroticism compared to CT women.

Conclusions: The patients with AN viewed their current body shape as fatter and had more restrained eating than the CT women. The results suggest that the disturbed body image may be a salient feature of AN differentiating from CT women, the underlying neural mechanism of which requires further study.
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http://dx.doi.org/10.1002/erv.2777DOI Listing
November 2020

Personality Assessment Questionnaire for ICD-11 personality trait domains: Development and testing.

Personal Ment Health 2021 02 7;15(1):58-71. Epub 2020 Jul 7.

Department of Psychology, Chungbuk National University, Cheongju, Korea.

Background: We aimed to develop a questionnaire suitable for the assessment of trait domains in the forthcoming International Classification of Diseases 11th Revision (ICD-11). This questionnaire, the Personality Assessment Questionnaire for ICD-11 (PAQ-11) personality trait domains, was intended as a short and reliable self-report measure.

Method: The initial items were derived from the relevant traits of an established version of the Personality Assessment Schedule. In Phase 1, item selection and scale construction proceeded iteratively using data from 334 female university students and 75 psychiatric patients (combined N = 409) in Korea. In Phase 2, a validation study of the scale was conducted in a subset of the sample from Phase 1, who were deemed to be at high risk of personality disorders (N = 210).

Results: Exploratory and confirmatory factor analyses of the Personality Assessment Schedule items created a 17-item scale. This scale, PAQ-11, demonstrated adequate convergent and discriminant validity with the five-factor model, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition traits model and emotional difficulties. The results were consistent with its underlying theoretical structure.

Conclusions: The PAQ-11 appears to be potentially promising in terms of clinical utility to assess the five domains of ICD-11 personality disorders. More research must be conducted in other cultural backgrounds with gender-balanced populations. © 2020 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pmh.1493DOI Listing
February 2021

Shared genetic risk between eating disorder- and substance-use-related phenotypes: Evidence from genome-wide association studies.

Addict Biol 2021 01 16;26(1):e12880. Epub 2020 Feb 16.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.

Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa and problem alcohol use (genetic correlation [r ], twin-based = 0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge eating, AN without binge eating, and a bulimia nervosa factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], smoking initiation, current smoking, cigarettes per day, nicotine dependence, cannabis initiation, and cannabis use disorder) from eight studies were included. Significant genetic correlations were adjusted for variants associated with major depressive disorder and schizophrenia. Total study sample sizes per phenotype ranged from ~2400 to ~537 000 individuals. We used linkage disequilibrium score regression to calculate single nucleotide polymorphism-based genetic correlations between eating disorder- and substance-use-related phenotypes. Significant positive genetic associations emerged between AUD and AN (r = 0.18; false discovery rate q = 0.0006), cannabis initiation and AN (r = 0.23; q < 0.0001), and cannabis initiation and AN with binge eating (r = 0.27; q = 0.0016). Conversely, significant negative genetic correlations were observed between three nondiagnostic smoking phenotypes (smoking initiation, current smoking, and cigarettes per day) and AN without binge eating (r = -0.19 to -0.23; qs < 0.04). The genetic correlation between AUD and AN was no longer significant after co-varying for major depressive disorder loci. The patterns of association between eating disorder- and substance-use-related phenotypes highlights the potentially complex and substance-specific relationships among these behaviors.
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http://dx.doi.org/10.1111/adb.12880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429266PMC
January 2021

Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa.

Nat Genet 2019 08 15;51(8):1207-1214. Epub 2019 Jul 15.

Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Padova, Italy.

Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness, affecting 0.9-4% of women and 0.3% of men, with twin-based heritability estimates of 50-60%. Mortality rates are higher than those in other psychiatric disorders, and outcomes are unacceptably poor. Here we combine data from the Anorexia Nervosa Genetics Initiative (ANGI) and the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED) and conduct a genome-wide association study of 16,992 cases of anorexia nervosa and 55,525 controls, identifying eight significant loci. The genetic architecture of anorexia nervosa mirrors its clinical presentation, showing significant genetic correlations with psychiatric disorders, physical activity, and metabolic (including glycemic), lipid and anthropometric traits, independent of the effects of common variants associated with body-mass index. These results further encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.
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http://dx.doi.org/10.1038/s41588-019-0439-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779477PMC
August 2019

The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics.

Annu Rev Clin Psychol 2019 05 2;15:481-502. Epub 2019 Jan 2.

Centre for Psychiatry, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; email: ,

The nomenclature of personality disorders in the 11th revision of the represents the most radical change in the classification history of personality disorders. A dimensional structure now replaces categorical description. It was argued by the Working Group that only a dimensional system was consistent with the empirical evidence and, in the spirit of clinical utility, the new system is based on two steps. The first step is to assign one of five levels of severity, and the second step is to assign up to five prominent domain traits. There was resistance to this structure from those who feel that categorical diagnosis, particularly of borderline personality disorder, should be retained. After lengthy discussion, described in detail here, there is now an option for a borderline pattern descriptor to be selected as a diagnostic option after severity has been determined.
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http://dx.doi.org/10.1146/annurev-clinpsy-050718-095736DOI Listing
May 2019

Mobile Self-Help Interventions as Augmentation Therapy for Patients with Anorexia Nervosa.

Telemed J E Health 2019 08 25;25(8):740-747. Epub 2018 Oct 25.

3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.

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http://dx.doi.org/10.1089/tmj.2018.0180DOI Listing
August 2019

Determinants of binge eating disorder among normal weight and overweight female college students in Korea.

Eat Weight Disord 2018 Dec 8;23(6):849-860. Epub 2018 Sep 8.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.

Purpose: The aim of the present study was to describe the clinical features of binge eating disorder (BED) in normal weight and overweight undergraduate Korean women.

Methods: 117 overweight (BMI ≥ 25 kg/m) and 346 normal weight (18 kg/m ≤ BMI < 25 kg/m) undergraduate Korean women completed questionnaires to assess for BED. Their emotional eating behaviors, binge eating-related behaviors, a spectrum of compulsive behaviors such as substance abuse and obsessive-compulsive disorder, and psychological profiles were evaluated through personal interviews and questionnaires. The features of those with BED were compared to those without BED in the overweight and normal weight groups.

Results: Both normal weight and overweight BED women had higher levels of functional impairment, eating disorder psychopathology including emotional and external eating behaviors, and neuroticism than their non-BED counterparts. In the normal weight group, BED women had more frequent alcohol consumption and obsessive-compulsive symptoms than non-BED women. In the overweight group, BED women had higher levels of depression and lower extraversion than non-BED women.

Conclusions: BED is associated with global functional impairment and mental health problems. Thus, the association with high functional impairments and psychiatric comorbidities suggest that people with BED may benefit from treatment.

Level Iii: Evidence obtained from well-designed case-control analytic studies, from more than one center.
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http://dx.doi.org/10.1007/s40519-018-0574-2DOI Listing
December 2018

Effects of intranasal oxytocin on the attentional bias to emotional stimuli in patients with bulimia nervosa.

Psychoneuroendocrinology 2018 05 3;91:75-78. Epub 2018 Mar 3.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.

Background: Bulimia nervosa (BN) is characterized by binge eating and emotional dysregulation including increased negative affectivity (anger, anxiety). The aim of this study was to examine the effect of oxytocin on attentional processes towards anger in patients with BN.

Method: The study design consisted of a double-blind, placebo-controlled within-subject crossover, single dose experiment. Sixty-four women (31 patients with BN and 33 healthy comparisons) completed self-reported measures to evaluate emotional difficulties and were administered a single dose of intranasal oxytocin (40IU) or placebo followed by a visual probe detection task to examine attentional orienting to angry or happy faces.

Results: Patients with BN reported higher emotional dysregulation and more difficulties in controlling anger compared to the healthy comparison group. Patients with BN and the healthy women exhibited similar attentional bias to angry faces in the placebo condition. Intranasal oxytocin reduced the attentional bias towards angry faces in both the BN patients and the healthy women.

Conclusions: We found that a single dose of oxytocin reduced vigilance towards angry faces in patients with BN as well as healthy women. The results showed that patients with BN are not different from healthy women in terms of vigilance towards threat.
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http://dx.doi.org/10.1016/j.psyneuen.2018.02.029DOI Listing
May 2018

Feasibility and acceptability of a prevention program for eating disorders (Me, You and Us) adapted for young adolescents in Korea.

Eat Weight Disord 2018 Oct 4;23(5):673-683. Epub 2017 Sep 4.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.

Purpose: The aim of this study was to assess the adaptability and acceptability of a prevention program.

Methods: A total of 169 Korean students (83 boys and 86 girls) with a mean age of 12.3 years from a 6th grade class at an elementary school participated in the study. Mental health social workers delivered Me, You and Us, a school-based body image intervention program originally developed in the UK, through a set of six sessions. The participants were assessed in terms of their body satisfaction and self-esteem before the program, after the program, and at 1-month follow-up. They were also surveyed about their satisfaction and acceptability levels after the program.

Results: At baseline, girls had lower body satisfaction and self-esteem than boys, and their body satisfaction and self-esteem improved after the program. The improved body satisfaction was maintained at the 1-month follow-up. The efficacy of the program on body satisfaction was positively correlated with the frequency of their baseline level of "fat talk." The program was more effective in girls with possible symptoms of an eating disorder at baseline. 93.7% of boys and 77.4% of girls responded that they enjoyed the program.

Conclusions: The program Me, You and Us was well-accepted by early adolescents in Korea and it can play a role in increasing body satisfaction and self-esteem by reducing "fat talk" in 6th grade students.

Level Of Evidence: Level III, cohort study with intervention.
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http://dx.doi.org/10.1007/s40519-017-0436-3DOI Listing
October 2018

Meta-analytic review of the effects of a single dose of intranasal oxytocin on threat processing in humans.

J Affect Disord 2018 01 17;225:167-179. Epub 2017 Aug 17.

King's College London, Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychological Medicine, London, United Kingdom.

Background: Heightened threat sensitivity is a transdiagnostic feature in several psychiatric disorders. The neuropeptide oxytocin has been shown to reduce fear related behaviours and facilitated fear extinction in animals. These findings have led to increasing interest to explore the effects of intranasal oxytocin on threat processing in humans.

Methods: The review included 26 studies (N = 1173), nine of which included clinical populations (N = 234). The clinical groups included were people with borderline personality disorder (BPD), anorexia nervosa, bulimia nervosa, depression, anxiety, and alcohol dependence disorder. We examined the effects of a single dose of intranasal oxytocin on startle response, attentional responses, and behavioural responses to threat.

Results: A single dose of intranasal oxytocin significantly increased the physiological startle response to threat in healthy people with a small effect size. However, oxytocin did not have significant effects on attentional bias towards social or disorder-specific threat, fixation towards threatening stimuli among healthy or clinical populations, or on threat related behavioural approach or avoidance responses.

Limitations: No studies investigated the effects of oxytocin on the startle response to threat among clinical populations. Additionally, only one of the reviewed studies had sufficient power to detect at least a moderate effect of oxytocin according to our criterion.

Discussion: The synthesis of literature suggest that oxytocin may influence the salience of threatening stimuli among healthy individuals, increasing the startle response to threat. It would be of interest to investigate the effects of oxytocin on the startle response to threat among clinical populations.
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http://dx.doi.org/10.1016/j.jad.2017.08.041DOI Listing
January 2018

Schedule for personality assessment from notes and documents (SPAN-DOC): Preliminary validation, links to the ICD-11 classification of personality disorder, and use in eating disorders.

Personal Ment Health 2016 05;10(2):106-17

Centre for Mental Health, Department of Medicine, Imperial College, London, UK.

Background: The underlying core of personality is insufficiently assessed by any single instrument. This has led to the development of instruments adapted for written records in the assessment of personality disorder.

Aims: To test the construct validity and inter-rater reliability of a new personality assessment method.

Method: This study (four parts) assessed the construct validity of the Schedule for Personality Assessment from Notes and Documents (SPAN-DOC), a dimensional assessment from clinical records. We examined inter-rater reliability using case vignettes (Part 1) and convergent validity in three ways: by comparison with NEO Five-Factor Inventory in 130 Korean patients (Part 2), with agreed ICD-11 personality severity levels in two populations (Part 3) and determining its use in assessing the personality status in 90 British patients with eating disorders (Part 4).

Results: Internal consistency (alpha = .90) and inter-rater reliability (intraclass correlation coefficient ≥ .88) were satisfactory. Each factor in the five-factor model of personality was correlated with conceptually valid SPAN-DOC variables. The SPAN-DOC domain traits in those with eating disorders were categorized into 3 clusters: self-aggrandisement, emotionally unstable, and anxious/dependent.

Conclusions: This study provides preliminary support for the usefulness of SPAN-DOC in the assessment of personality disorder. Copyright © 2016 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pmh.1335DOI Listing
May 2016

Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. Proposed trait domains.

Personal Ment Health 2015 Nov 7;9(4):298-307. Epub 2015 Sep 7.

Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.

This field trial examines the discriminant validity of five trait domains of the originally proposed research algorithm for diagnosing International Classification of Diseases (ICD)-11 personality disorders. This trial was carried out in South Korea where a total of 124 patients with personality disorder participated in the study. Participants were assessed using originally proposed monothetic trait domains of asocial-schizoid, antisocial-dissocial, anxious-dependent, emotionally unstable and anankastic-obsessional groups of the research algorithm in ICD-11. Their assessments were compared to those from the Personality Assessment Schedule interview, and the five-factor model (FFM). A total of 48.4% of patients were found to have pathology in two or more domains. In the discriminant analysis, 64.2% of the grouped cases of the originally proposed ICD-11 domains were correctly classified by the five domain categories using the Personality Assessment Schedule, with the highest accuracy in the anankastic-obsessional domain and the lowest accuracy in the emotionally unstable domain. In comparison, the asocial-schizoid, anxious-dependent and the emotionally unstable domains were moderately correlated with the FFM, whereas the anankastic-obsessional or antisocial-dissocial domains were not significantly correlated with the FFM. In this field trial, we demonstrated the limited discriminant and the convergent validities of the originally proposed trait domains of the research algorithm for diagnosing ICD-11 personality disorder. The results suggest that the anankastic, asocial and dissocial domains show good discrimination, whereas the anxious-dependent and emotionally unstable ones overlap too much and have been subsequently revised.
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http://dx.doi.org/10.1002/pmh.1305DOI Listing
November 2015

The Impact of Oxytocin on Food Intake and Emotion Recognition in Patients with Eating Disorders: A Double Blind Single Dose Within-Subject Cross-Over Design.

PLoS One 2015 24;10(9):e0137514. Epub 2015 Sep 24.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.

Background And Aim: Social difficulties and problems related to eating behaviour are common features of both anorexia nervosa (AN) and bulimia nervosa (BN). The aim of this study was to examine the impact of intranasal oxytocin on consummatory behaviour and emotional recognition in patients with AN and BN in comparison to healthy controls.

Materials: A total of 102 women, including 35 patients with anorexia nervosa (AN), 34 patients with bulimia nervosa (BN), and 33 healthy university students of comparable age and intelligence, participated in a double-blind, single dose placebo-controlled cross-over study. A single dose of intranasal administration of oxytocin (40 IU) (or a placebo) was followed by an emotional recognition task and an apple juice drink. Food intake was then recorded for 24 hours post-test.

Results: Oxytocin produced no significant change in appetite in the acute or 24 hours free living settings in healthy controls, whereas there was a decrease in calorie consumption over 24 hours in patients with BN. Oxytocin produced a small increase in emotion recognition sensitivity in healthy controls and in patients with BN, In patients with AN, oxytocin had no effect on emotion recognition sensitivity or on consummatory behaviour.

Conclusions: The impact of oxytocin on appetite and social cognition varied between people with AN and BN. A single dose of intranasal oxytocin decreased caloric intake over 24 hours in people with BN. People with BN showed enhanced emotional sensitivity under oxytocin condition similar to healthy controls. Those effects of oxytocin were not found in patients with AN.

Trial Registration: ClinicalTrials.gov KCT00000716.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0137514PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581668PMC
June 2016

Association between the oxytocin receptor gene polymorphism (rs53576) and bulimia nervosa.

Eur Eat Disord Rev 2015 May 15;23(3):171-8. Epub 2015 Mar 15.

Department of Neuropsychiatry, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea.

Objective: Oxytocin circuits are implicated in the regulation of appetite and weight. Variants in the oxytocin receptor (OXTR) gene have been associated with bulimic behaviour. This study aimed to investigate the association between the OXTR gene and eating disorders.

Method: We genotyped six single nucleotide polymorphisms, rs53576, rs237879, rs2228485, rs13316193, rs2254298 and rs1042778, located within the OXTR gene in Korean patients with eating disorders using the single-base extension method. We studied a total of 262 women, including 69 patients with anorexia nervosa, 90 patients with bulimia nervosa (BN), and 103 healthy women.

Results: We found a positive association between the G allele of OXTR rs53576 and BN. In the BN group, the G carriers showed a high score on the behavioural inhibition system.

Conclusions: These findings suggest the involvement of the oxytocinergic system in the mechanism that underlies BN.
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http://dx.doi.org/10.1002/erv.2354DOI Listing
May 2015

A systematic review of the global prevalence of personality disorders in adult Asian populations.

Personal Ment Health 2014 Oct 2;8(4):264-75. Epub 2014 Sep 2.

King's College London, UK.

Background: No systematic reviews have been conducted into the prevalence of personality disorders (PD) in Asian populations. This review aims to investigate the prevalence of all PD subtypes within community and clinical Asian (Chinese, Indian, Japanese and South Korean) populations worldwide.

Method: Seven databases were searched in addition to manual examination and reference tracking. Exclusion criteria were applied with the remaining studies subjected to quality appraisal.

Results: Nineteen studies were included for review. Results were grouped by community studies in Asian countries, clinical studies in Asian countries and comparative studies. Prevalence of PD assessed by clinical judgement was lower than that by diagnostic tools. The highest rates of PD were found in suicidal cohorts within the various countries. Four of the five comparative studies found lower prevalence rates of PD in Asians compared with the overall sample.

Conclusion: Insufficient consistent research has been published to ascertain the prevalence of PD in Asians and whether it is higher or lower than in Western cohorts. Asians presenting with suicidal ideation may benefit from PD assessment.
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http://dx.doi.org/10.1002/pmh.1270DOI Listing
October 2014

Intranasal Oxytocin Lessens the Attentional Bias to Adult Negative Faces: A Double Blind within-Subject Experiment.

Psychiatry Investig 2014 Apr 11;11(2):160-6. Epub 2014 Apr 11.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.

Objective: Oxytocin is a neuropeptide that is involved in social emotional processing. A leading hypothesis is that oxytocin facilitates positive prosocial behaviors; the peptide may also play a more general role in inhibiting withdrawal-related social behaviors. The present study examined these possibilities.

Methods: A double-blind, placebo controlled crossover design was used with 31 healthy women. Forty-five minutes following the administration of 40 IU of intranasal oxytocin or a placebo, the participants were presented with two dot probe tests with pairs of face stimuli depicting emotional and neutral faces in adults.

Results: Oxytocin specifically reduced the attention bias toward the location of the faces of adults showing negative emotions, particularly in the case of disgust. Oxytocin did not enhance the attentional bias toward adult happy faces. The effect of oxytocin toward adult negative emotion was correlated with the sensitivity of the drive in the behavioral motivational system.

Conclusion: Oxytocin reduces attention to negative social emotions in adults, which supports oxytocin serves to inhibit withdrawal-related social behaviour.
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http://dx.doi.org/10.4306/pi.2014.11.2.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023090PMC
April 2014

Intranasal oxytocin attenuates attentional bias for eating and fat shape stimuli in patients with anorexia nervosa.

Psychoneuroendocrinology 2014 Jun 13;44:133-42. Epub 2014 Mar 13.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.

We examined the impact of oxytocin on attentional processes for eating, shape, and weight stimuli in patients with anorexia nervosa (AN). A double-blind, placebo-controlled within-subject crossover design was used. Intranasal oxytocin or placebo followed by a visual probe detection task with food, weight, and shape images was administered to 64 female subjects: 31 patients with AN and 33 control students. The AN group showed significant reductions in the attentional biases toward eating-related stimuli (p=0.030, d=0.516) and toward negative shape stimuli (p=0.015, d=0.498) under the influence of intranasal oxytocin. The effect of oxytocin was correlated with autistic spectrum traits in the AN group. Oxytocin had no effect on the amount of juice consumed in either group. The results of this study suggest that oxytocin attenuates the attentional vigilance to eating and fat shape stimuli in patients with AN. Further studies using oxytocin as a form of intervention for patients with AN are needed.
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http://dx.doi.org/10.1016/j.psyneuen.2014.02.019DOI Listing
June 2014

The impact of intranasal oxytocin on attention to social emotional stimuli in patients with anorexia nervosa: a double blind within-subject cross-over experiment.

PLoS One 2014 6;9(6):e90721. Epub 2014 Mar 6.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.

Background And Aim: Social factors may be of importance causally and act as maintenance factors in patients with anorexia nervosa. Oxytocin is a neuromodulatory hormone involved in social emotional processing associated with attentional processes. This study aimed to examine the impact of oxytocin on attentional processes to social faces representing anger, disgust, and happiness in patients with anorexia nervosa.

Method: A double-blind, placebo-controlled within-subject crossover design was used. Intranasal oxytocin or placebo followed by a visual probe detection task with faces depicting anger, disgust, and happiness was administered to 64 female subjects: 31 patients with anorexia nervosa and 33 control students.

Results: Attentional bias to the disgust stimuli was observed in both groups under the placebo condition. The attentional bias to disgust was reduced under the oxytocin condition (a moderate effect in the patient group). Avoidance of angry faces was observed in the patient group under the placebo condition and vigilance was observed in the healthy comparison group; both of these information processing responses were moderated by oxytocin producing an increase in vigilance in the patients. Happy/smiling faces did not elicit an attentional response in controls or the patients under either the placebo or oxytocin conditions.

Conclusion: Oxytocin attenuated attentional vigilance to disgust in patients with anorexia nervosa and healthy controls. On the other hand, oxytocin changed the response to angry faces from avoidance to vigilance in patients but reduced vigilance to anger in healthy controls. We conclude that patients with anorexia nervosa appear to use different strategies/circuits to emotionally process anger from their healthy counterparts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090721PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946210PMC
February 2015

Field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 1. Severity of personality disturbance.

Personal Ment Health 2014 Feb 21;8(1):67-78. Epub 2013 Nov 21.

Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea.

This preliminary field trial examines the reliability and validity of a proposed research algorithm for diagnosing International Classification of Diseases (ICD)-11 personality disorders and its association with other psychiatric assessments for the primary classification of a single dimension of the five severity levels of personality dysfunction. In total, 137 psychiatric patients (119 with personality disorders and 18 without personality disorders) in Korea were assessed. In the first part of the study, inter-rater reliability was evaluated with an independent assessment of personality (personality assessment schedule). In the second part of the study, (1) the algorithm that identified any personality disturbance was compared with the ICD-10 and DSM-IV personality disorder diagnostic equivalents, and (ii) the four levels of severity were examined for their associations with clinical pathology and social functioning. The results showed good agreement between the algorithm and the test instruments for identifying a personality disorder. A graded increase in clinical pathology and social dysfunction was observed with increasing severity of personality disorder. These findings suggest that a simple algorithm for recording severity of a personality disturbance had both construct validity and was useful in practice, which supports severity classification as a valuable concept. These findings need to be confirmed in other cultures and ethnic groups.
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http://dx.doi.org/10.1002/pmh.1248DOI Listing
February 2014

Differential methylation of the oxytocin receptor gene in patients with anorexia nervosa: a pilot study.

PLoS One 2014 11;9(2):e88673. Epub 2014 Feb 11.

Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.

Background And Aim: Recent studies in patients with anorexia nervosa suggest that oxytocin may be involved in the pathophysiology of anorexia nervosa. We examined whether there was evidence of variation in methylation status of the oxytocin receptor (OXTR) gene in patients with anorexia nervosa that might account for these findings.

Methods: We analyzed the methylation status of the CpG sites in a region from the exon 1 to the MT2 regions of the OXTR gene in buccal cells from 15 patients and 36 healthy women using bisulfite sequencing. We further examined whether methylation status was associated with markers of illness severity or form.

Results: We identified six CpG sites with significant differences in average methylation levels between the patient and control groups. Among the six differentially methylated CpG sites, five showed higher than average methylation levels in patients than those in the control group (64.9-88.8% vs. 6.6-45.0%). The methylation levels of these five CpG sites were negatively associated with body mass index (BMI). BMI, eating disorders psychopathology, and anxiety were identified in a regression analysis as factors affecting the methylation levels of these CpG sites with more variation accounted for by BMI.

Conclusions: Epigenetic misregulation of the OXTR gene may be implicated in anorexia nervosa, which may either be a mechanism linking environmental adversity to risk or may be a secondary consequence of the illness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0088673PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921190PMC
October 2014

Medical findings in women with anorexia nervosa in a korean population.

Psychiatry Investig 2013 Jun 30;10(2):101-7. Epub 2013 May 30.

Department of Neuropsychiatry, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea. ; Institute for Gender Research, Seoul National University, Seoul, Republic of Korea.

Objective: Eating disorders are a common clinical problem among young women in Asian countries. The aim of this study is to determine the medical effects of anorexia nervosa (AN) in the Korean population.

Methods: We comprehensively investigated medical complications including haemodynamic, haematologic, endocrine, and bone density abnormalities in 67 Korean women with AN, together with 194 healthy Korean women of comparable age with a cross-sectional design.

Results: In AN, 36.9% were anaemic, 50.8% were leukopenic, 35.5% were hypoproteinemic, 7.9% were hypokalemic, 9.5% had increased alanine aminotransferase, 6.3% were hyperbilirubinemia, 14.5% were hypercholesterolemia, 14.8% had decreased triiodothyronine. Osteopenia at any one site was identified in 43.3% and an additional 13.4% had osteoporosis. The lowest-ever body mass index was the main determinant of bone mineral density.

Conclusion: Our data in Korean patients with AN show high frequencies of laboratory abnormalities for medical complications. This study emphasizes the importance of recognizing AN as a medical risk in young Korean women.
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http://dx.doi.org/10.4306/pi.2013.10.2.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687042PMC
June 2013

Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial.

Clin Psychopharmacol Neurosci 2012 Apr 30;10(1):44-8. Epub 2012 Apr 30.

Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: Panic disorder is characterized by recurrent panic attacks, persistent concerns about additional attacks, and worry about the implications of the attack or significant changes in behavior related to the attacks. We examined the efficacy of 24-week naturalistic, open-label escitalopram treatment in terms of the response and remission rates and functional disability in 119 adult Korean patients with panic disorder from 6 clinical centers in South Korea.

Methods: Clinical severity and functional impairment were assessed at baseline and at 4, 12, and 24 weeks after the treatment using the Panic Disorder Severity Scale and Sheehan Disability Scale. Ninety-six patients (80.7%) showed a treatment response, and 87 patients (73.1%) had attained remission after 24 weeks of escitalopram treatment.

Results: Continuous improvement in the Panic Disorder Severity Scale and Sheehan Disability Scale scores was found over the 24 weeks of treatment.

Conclusion: These findings suggest that escitalopram treatment is very effective for panic disorder in terms of both response and remission rates and that long-term pharmacotherapy with escitalopram continuously improved panic symptoms and functional disability in Korean patients with panic disorder.
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http://dx.doi.org/10.9758/cpn.2012.10.1.44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569153PMC
April 2012

Psychological characteristics of early remitters in patients with panic disorder.

Psychiatry Res 2012 May 26;197(3):237-41. Epub 2012 Feb 26.

Department of Psychiatry, Samsung Biomedical Research Institute, Seoul, South Korea.

We aimed to examine whether anxiety sensitivity and agoraphobic fear could affect the time taken to remission after 24 weeks of open-label escitalopram treatment of patients with panic disorder (PD). We recruited 158 patients, and 101 patients completed the study. Clinical severity and psychological characteristics were assessed at baseline and 4, 12, and 24 weeks after the treatment, using the Clinical Global Impression-Severity (CGI-S), the Hamilton Rating Scales for Anxiety and Depression, the Anxiety Sensitivity Index-Revised (ASI-R), the Albany Panic and Phobia Questionnaire (APPQ), and the Panic Disorder Severity Scale (PDSS). Remission was defined as the absence of full panic attacks and PDSS scores of 7 or less. Completing patients were stratified according to the time taken to remit: early (n=20) and late (n=58) remission and non-remission groups (n=23). There were no significant differences among the three groups at baseline on the CGI-S and the PDSS mean scores. However, early remitters had significantly lower scores than late remitters and non-remitters on the ASI-R and APPQ. In conclusion, anxiety sensitivity and agoraphobic fear can affect the time to remission after pharmacotherapy, and clinicians should consider the psychological characteristics of PD patients in order to achieve an optimal response to pharmacotherapy.
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http://dx.doi.org/10.1016/j.psychres.2011.11.001DOI Listing
May 2012

Relationship between Personality and Insomnia in Panic Disorder Patients.

Psychiatry Investig 2011 Jun 8;8(2):102-6. Epub 2011 Apr 8.

Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: Panic disorder (PD) is frequently comorbid with insomnia, which could exacerbate panic symptoms and contribute to PD relapse. Research has suggested that characteristics are implicated in both PD and insomnia. However, there are no reports examining whether temperament and character affect insomnia in PD. Thus, we examined the relationship between insomnia and personality characteristics in PD patients.

Methods: Participants were 101 patients, recruited from 6 university hospitals in Korea, who met the DSM-IV-TR criteria for PD. We assessed sleep outcomes using the sleep items of 17-item Hamilton Depression Rating Scale (HAMD-17)(item 4=onset latency, item 5=middle awakening, and item 6=early awakening) and used the Cloninger's Temperament and Character Inventory-Revised-Short to assess personality characteristics. To examine the relationship between personality and insomnia, we used analysis of variance with age, sex, and severity of depression (total HAMD scores minus sum of the three sleep items) as the covariates.

Results: There were no statistical differences (p>0.1) in demographic and clinical data between patients with and without insomnia. Initial insomnia (delayed sleep onset) correlated to a high score on the temperamental dimension of novelty seeking 3 (NS3)(F(1,96)=6.93, p=0.03). There were no statistical differences (p>0.1) in NS3 between patients with and without middle or terminal insomnia.

Conclusion: The present study suggests that higher NS3 is related to the development of initial insomnia in PD and that temperament and character should be considered when assessing sleep problems in PD patients.
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http://dx.doi.org/10.4306/pi.2011.8.2.102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149103PMC
June 2011