Schizophrenia In Korea Research Articles

Efficacy and Safety of Lurasidone vs. Quetiapine XR in Acutely Psychotic Patients With Schizophrenia in Korea: A Randomized, Double-Blind, Active-Controlled Trial.

This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35-4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

COVID-19 coping experiences of individuals with schizophrenia: A grounded theory approach in Korea.

Humankind has responded to the profound medical, economic, social, and cultural consequences of coronavirus disease 2019 (COVID-19) by employing various strategies. However, although individuals with mental disorders, including schizophrenia, have suffered more challenges from the infectious disease spread, they have received inadequate attention and care. Hence, this study aimed to explore the experiences of individuals with schizophrenia coping with COVID-19; one-to-one interviews were conducted with 17 individuals diagnosed with schizophrenia in Korea. The data were analysed using grounded theory methodology. The results showed that individuals with schizophrenia became distanced from the routine care they received before COVID-19, faced a dual threat from their mental illness and the emerging infectious disease, and experienced inequity and paradoxical situations. Nevertheless, they strived to live their daily lives by utilizing non-face-to-face access, seeking support from mental health professionals, and devising self-help measures. Moreover, reflecting on their lives throughout the pandemic after returning to their regular daily lives provided an opportunity for healing and growth. This study's results can provide evidence for treating individuals with schizophrenia and other mental disorders during subsequent infectious disease spread. Practical policies and interventions tailored to their vulnerabilities are required.

The impact of the Mental Health Act revision for deinstitutionalization in Korea on the crime rate of people with schizophrenia

This study examined changes in the crime rates of people with schizophrenia in Korea in comparison with the general population after the Mental Health Act revision for deinstitutionalization in 2017. The crime rates of people with schizophrenia and the general population were calculated from 2012 to 2021 using the Korean National Police Agency crime statistics. The effects of the law revision in 2017 on the crime rates were assessed using the interrupted time series and difference-in-difference analyses. The crime rates of people with schizophrenia tended to be lower than the general population except for murder and arson, which were 5.3 and 11.4 times, respectively, that of the general population. While no significant effect of the revision was found in the interrupted times series analysis, the difference-in-differences analysis indicated that the total crime rates and the rates of violence and public order crime increased among people with schizophrenia compared with the general population. The revision of the Mental Health Act for deinstitutionalization did not lead to an increase in the murder rate of people with schizophrenia as is commonly thought. However, the increases in overall crime and violence rates of people with schizophrenia suggest that the deinstitutionalized patients may not have been successfully relocated into the community. The increase in crime after the revision should be interpreted as a call for well-resourced community care rather than the reason for re-transfer of patients to hospitals.

Current and Future Trends in Hospital Utilization of Patients With Schizophrenia in Korea: A Time Series Analysis Using National Health Insurance Data.

Objective This study aimed to investigate trends in hospital utilization of patients with schizophrenia during the last 10 years in Korea and to predict future trends using time series analysis. Methods We determined the numbers of patients receiving outpatient or inpatient treatment for schizophrenia per month between 2010 and 2019, using National Health Insurance claims data. Facebook’s Prophet was used to fit time series models based on observations for the previous 120 months, and to predict trends over the next 36 months. Results The number of hospitalized patients per month has declined rapidly since 2015, but the monthly number of outpatient visits has steadily increased. Monthly hospital utilization has increased in patients aged ≤29 and ≥50 years, but has declined rapidly since 2014–2015 in patients in their 30s and 40s. The upward trend in overall hospital utilization has slowed considerably in recent years. These trends are expected to continue over the next few years. Conclusion This study revealed some notable changes in the hospital utilization patterns of patients with schizophrenia in recent years. There is a need to closely monitor and anticipate potential problems caused by these changing trends.

조현병 관련 국내 동향 연구 분석

본 연구의 목적은 지난 10년간 국내 학술 진흥재단(KCI)에 등재된 학술지를 중심으로 조현병 관련 연구 동향을 살펴보는 데 있다. 본 연구를 위한 범위 및 대상은 2011년 11월에서 2020년 12월까지 KCI에 등재된 논문 중에서 최종 124편의 논문을 선정하여 일반적 동향과 내용적 동향으로 분석하였다. 연구 결과 일반적 동향의 연도별 동향은 연평균 10여 편이 발표되었고, 방법별 동향은 양적연구가 주를 이루었으며, 대상별 동향은 혼합 성별 및 40대 대상자가 가장 높았고, 측정 도구별 동향은 조현병 양성 및 음성증상을 파악하는 PNSS가 가장 많이 활용되었다. 내용적 동향의 주요어별 동향은 조현병 임상증상이 가장 높고, 주제별 동향은 프로그램(내적 완화)이 가장 높았다. 연구 결과를 토대로 추후 조현병 관련 연구 방향을 모색하고 제안하는 논의를 하였다.

The cost-of-illness trend of schizophrenia in South Korea from 2006 to 2016.

Globally, about one in four people develop a psychiatric disorder during their lifetime. Specifically, the lifetime prevalence of schizophrenia is about 0.48%, and schizophrenia can have detrimental effects on a patient's life. Therefore, estimating the economic burden of schizophrenia is important. We investigated the cost-of-illness trend of schizophrenia in South Korea from 2006 to 2016. The cost-of-illness trend was estimated from a societal perspective using a prevalence-based approach for direct costs and a human capital approach for indirect costs. We utilized information from the following sources: 1) National Health Insurance Service, 2) Korean Statistical Information Service, Statistics Korea, 3) the National Survey of Persons with Disabilities, 4) Budget and Fund Operation Plan, Ministry of Justice, 5) Budget and Fund Operation Plan, Ministry of Health and Welfare, and 6) annual reports from the National Mental Health Welfare Commission. Direct healthcare costs, direct non-healthcare costs, and indirect costs by sex and age group were calculated along with sensitivity analyses of the estimates. The cost-of-illness of schizophrenia in Korea steadily increased from 2006 to 2016, with most costs being indirect costs. Individuals in their 40s and 50s accounted for most of the direct and indirect costs. Among indirect costs, the costs due to unemployment were most prevalent. Our estimation implies that schizophrenia is associated with a vast cost-of-illness in Korea. Policymakers, researchers, and physicians need to put effort into shortening the duration of untreated psychosis, guide patients to receive community-care-based services rather than hospital-based services and empower lay people to learn about schizophrenia.

Effects of Psychotic Symptoms and Social Cognition on Job Retention in Patients with Schizophrenia in Korea.

This research examined the relationship between psychotic symptoms, social cognition, and job retention among people with schizophrenia in Korea. Participants (158 people with schizophrenia from 15 mental health institutions) were divided into two groups: those with a job retention period of less than six months (n = 75), and those with a job retention period of six months or more (n = 83). Participants completed a survey packet containing the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF) Scale, Interpersonal Relationship Functioning Assessment Scale, Basic Empathy Scale, Hinting Task, and Ambiguous Intention Hostility Questionnaire (AIHQ), and provided their job retention status. We used binomial logistic regression analysis to examine whether job retention was affected by participants’ demographic, clinical, and vocational characteristics, as well as the three components of social cognition, i.e., theory of mind, empathy, and attribution style. Results showed that theory of mind (ToM), attribution style, and psychotic symptoms explained 52.7% of the variance in job retention. A higher theory of mind means a higher ability to grasp the intentions of others. The higher theory of mind, the lesser attribution style, and the lesser psychotic symptoms were related to a longer period of job retention.

Crimes by people with schizophrenia in Korea: comparison with the general population

BackgroundThis study was performed to describe the prevalence of crimes committed by persons with schizophrenia using population-based data and to compare the crime prevalence of persons with schizophrenia and the general population.MethodsThe number of crimes was obtained from the Korean National Police Agency (KNPA) crime statistics (2012–2016), which provide the number of crimes in terms of the criminal’s mental status and mental health conditions. For the number of persons with schizophrenia, estimates were used which had been calculated from the inpatient and outpatient claims from the National Health Insurance Service. The crime prevalence in persons with schizophrenia was calculated according to the types of crimes, and a comparison with the general population was conducted.ResultsThe overall crime prevalence of persons with schizophrenia was 72.7 to 90.3 per 10,000 from 2012 through 2016, which was about one fifth that of the general population. While the crime rates of the persons with schizophrenia were lower than the general population in most types of crimes including violence, intellectual crimes, and theft, the prevalence of murder, arson, and drug-related crimes in persons with schizophrenia was about five times, six times, and two times that of the general population respectively.ConclusionThe higher prevalence of serious offences among persons with schizophrenia suggests the need for closer and more appropriate care for the population, which would be achieved through effective continuity of institutional and community care.

Effects of Renaming Schizophrenia in Korea: from "Split-Mind Disorder" to "Attunement Disorder".

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

F35. PRESCRIPTION PATTERN OF ANTIPSYCHOTICS FOR CHILDREN AND ADOLESCENTS WITH SCHIZOPHRENIA IN KOREA BASED ON NATIONWIDE DATA

BackgroundThis study aimed to analyze the extent and pattern of antipsychotic prescription for Korean children and adolescents with schizophrenia using population-based data.MethodsOur data was retrieved from the Korean National Health Insurance Review & Assessment Service-National Sample for 2013, which was a stratified sampling from the entire population under the Korean national health insurance program. Among 0.2 million children and adolescents aged 6–18 years from data, subjects who had received any antipsychotic medication in the year were investigated for the prescribed medication and concomitant psychotropic medication.ResultsA total of 91 children and adolescents (mean age 16.2 ± 2.2 years, 53 boys) received antipsychotic medication. Among the prescriptions, risperidone (n = 59, 35.3%) and aripiprazole (n = 34, 20.4%) were the two most frequently prescribed antipsychotics. Of 91 patients, 80 (87.9%) have prescribed with antipsychotic monopharmacy (mean 134.9 ± 11.1 day), 33 (36.3%) with bipharmacy (mean 136.9 ± 20.2 days), and 12 (13.2%) with polypharmacy (more than three antipsychotics) (mean 32.5 ± 7.3 days) in the year. Mood stabilizers (n=48, 52.7%), and antidepressants (n=35, 38.5%) were co-medicated in the year.DiscussionOur study shows the prescription pattern of antipsychotics for children and adolescents with schizophrenia in Korea.

Risk factors for relapse in patients with first-episode schizophrenia: Analysis of the Health Insurance Review and Assessment Service data from 2011 to 2015

BackgroundSchizophrenia is a recurrent, debilitating disease that is rarely curable. Rapid intervention after the first episode of schizophrenia has been shown to positively affect the prognosis. Unfortunately, basic data is scarce on first-episode schizophrenia in Korean patients making it difficult to create a comprehensive list of risk factors for relapse. This study aims to investigate the demographic characteristics and institutional factors of patients with first-episode schizophrenia in order to identify risk factors for relapse.MethodsData from the Health Insurance Review & Assessment Service (HIRA) was used for this study to represent the Korean patient population. To identify factors affecting relapse, we explored gender, age, geographic location, medical benefits, type of medical institution, type of medication used, medication adherence, and the severity of symptoms. Data analysis was performed using the Cox proportional hazard model.ResultsThe number of patients diagnosed with first-episode schizophrenia in Korea over a 2-year period was 4567 of which 1265 (27.7%) patients experienced a relapse during the observational period. Factors affecting relapse included age, type of medical institution, type of medication used, medication adherence, and type of treatment (inpatient or outpatient) after the initial diagnosis, which varied depending upon the severity of symptoms.ConclusionsIt was found that environmental and institutional factors as well as the type of medical treatment were crucial in determining whether patients with first-episode schizophrenia subsequently relapsed. The results of this study can be utilized as source material for directing therapeutic interventions and improving mental health policies in the future.

Benzodiazepine Use among Patients with Schizophrenia in Korea: Analysis of Database of Health Insurance Review Agency

Benzodiazepine Use among Patients with Schizophrenia in Korea: Analysis of Database of Health Insurance Review Agency

Minnesota Multiphasic Personality Inventory Characteristics of Parricide Offenders with Schizophrenia in Korea.

ObjectiveThis study aims to examine the personality characteristics in parricide offenders, by using the Minnesota Multiphasic Personality Inventory (MMPI) test, which is commonly used in clinical medicine.MethodsA total of 73 parricide offenders with schizophrenia who were admitted to National Forensic Hospital in Gongju city between September 2014 and February 2015, and 104 comparison schizophrenia patients who had been admitted to Dankook University Hospital in Cheonan city the same hospital, completed the Korean version of the MMPI.ResultsThe parricide offender group showed significantly higher on L, F, Hs, Hy and Pd than the comparison group. The result of the regression analysis indicated that Pd and Si significantly increased the odd ratio of the sexual offender group by 2.77 times and 0.32 times, respectively (p=0.029 and p=0.023). The offenders of parricide may have developed the following characteristics: hypochondriasis, hysteria and psychopathic deviate.ConclusionThese results suggested that the psychopatholgy in the offenders of parricide might be different, compared to the control group.

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

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

Cognitive rehabilitation for patients with schizophrenia in Korea.

Psychosocial rehabilitation programs received mental health professional support in addition to traditional medication therapy. Many psychosocial programs were developed since the 1990s, including cognitive remediation therapy. In this review, we focus on cognitive remediation therapy in Korea since the 1990s. We review several cognitive rehabilitation programs developed in Korea and their outcome studies and suggest future research directions and prospects. We reviewed cognitive rehabilitation programs including social cognitive training as well as more recent forms of computerized cognitive rehabilitation. Although there are differences in cognitive domains by training targets, almost all neurocognitive remediation trainings in Korea have beneficial effects on early visual processing, various attention types, and executive function. Future studies need to investigate the mechanisms and various mediators underlying the relationships between cognitive functions and functional outcomes. With more comprehensive cognitive and social cognitive programs, we can enhance both cognition and functional outcomes of the patients with schizophrenia.

Korean facial emotion recognition tasks for schizophrenia research.

ObjectiveDespite the fact that facial emotion recognition (FER) tasks using Western faces should be applied with caution to non-Western participants or patients, there are few psychometrically sound and validated FER tasks featuring Easterners' facial expressions for emotions. Thus, we aimed to develop and establish the psychometric properties of the Korean Facial Emotion Identification Task (K-FEIT) and the Korean Facial Emotion Discrimination Task (K-FEDT) for individuals with schizophrenia.MethodsThe K-FEIT and K-FEDT were administered to 42 Korean individuals with schizophrenia to evaluate their psychometric properties. To test the convergent and divergent validities, the Social Behavior Sequencing Task (SBST) and hinting task were administered as social-cognitive measures, and the Trail Making Test (TMT)-A and -B were administered as neurocognitive measures.ResultsAverage accuracy on the K-FEIT and K-FEDT were 63% and 74%, respectively, and internal consistencies of the K-FEIT and K-FEDT were 0.82 and 0.95, respectively. The K-FEIT and K-FEDT were significantly correlated with SBST and Hinting Task, but not with TMT-A and B.ConclusionFollowing replication studies in a larger sample, the K-FEIT and K-FEDT are expected to facilitate future studies targeting facial emotion recognition in schizophrenia in Korea. Limitations and directions for future research are discussed.

Prescription patterns for patients with schizophrenia in Korea: a focus on antipsychotic polypharmacy.

ObjectiveThis study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals.MethodsData from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified.ResultsOf the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), β-blockers (10.1%), and mood stabilizers (8.7%).ConclusionThe present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.

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

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

Patterns of antipsychotic prescription to patients with schizophrenia in Korea: results from the health insurance review & assessment service-national patient sample.

This study aimed to analyze the patterns of antipsychotic prescription to patients with schizophrenia in Korea. Using the Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS), which was a stratified sampling from the entire population under the Korean national health security system (2009), descriptive statistics for the patterns of the monopharmacy and polypharmacy, neuropsychiatric co-medications, and prescribed individual antipsychotic for patients with schizophrenia were performed. Comparisons of socioeconomic and clinical factors were performed among patients prescribed only with first- and second-generation antipsychotics. Of 126,961 patients with schizophrenia (age 18-80 yr), 13,369 were prescribed with antipsychotic monopharmacy and the rest 113,592 with polypharmacy. Two or more antipsychotics were prescribed to 31.34% of the patients. Antiparkinson medications (66.60%), anxiolytics (65.42%), mood stabilizers (36.74%), and antidepressants (25.90%) were co-medicated. Patients who were prescribed only with first-generation antipsychotics (n=26,254) were characterized by significantly older age, greater proportion of male, higher proportion of medicaid, higher total medical cost, lower self-payment cost, and higher co-medication rates of antiparkinson agents and anxiolytics than those who were prescribed only with second-generation antipsychotics (n=67,361). In this study, it has been reported substantial prescription rates of first-generation antipsychotics and antipsychotic polypharmacy and relatively small prescription rate of clozapine to patients with schizophrenia. Since this study has firstly presented the patterns of antipsychotic prescription to schizophrenic patients in Korean national population, the findings of this study can be compared with those of later investigations about this theme.

Smoking among Individuals with Schizophrenia in Korea: Gender Differences

ObjectiveThis study examined gender differences in smoking and quitting among individuals diagnosed with schizophrenia in Korea. In addition, the study investigated differences in caffeine use by gender and smoking status. MethodAn anonymous self-report survey was conducted with psychiatric inpatients. ResultsCompared to males, females were less likely to be current smokers (P<.001) and more likely to be former smokers (P<.01). Females were also less likely to be daily caffeine users (P<.001). Having more years of education (P<.05) and higher nicotine dependence scores (P<.05) were associated with decreased odds of intending to quit smoking, whereas having more previous quit attempts (P<.01) was associated with increased odds. These findings were significant even after adjusting for gender. Smokers were more likely to be daily caffeine users (P<.001) than their non-smoking counterparts. ConclusionNurses in Korea should play an active role in tobacco control for patients with schizophrenia by providing cessation counseling and educating the effect of caffeine use on cigarette consumption, while tailoring the service to gender differences found in this study.