Virtual Reality in Current and Future Psychiatry

Virtual reality technology is now being used in neuropsychological assessment and real-world applications of many psychiatric disorders, including anxiety disorders, schizophrenia, child psychiatric disorders, dementia, and substance related disorders. These applications are growing rapidly due to recent evolution in both hardware and software of virtual reality. In this paper, we review these current applications and discuss the future work of clinical, ethical, and technological aspects needed to refine and expand these applications to psychiatry.ope

Assessment of Abdominal Fat and Mid-Thigh Low-Density Muscle Areas in Patients with Schizophrenia

Objective : Patients with schizophrenia are at a higher risk for developing insulin resistance and type 2 diabetes mellitus (T2DM). However, few studies have examined abdominal fat and mid-thigh low-density muscle areas, which are known risk factors for insulin resistance and T2DM, in patients with schizophrenia. Therefore, we measured the abdominal fat and mid-thigh low-density muscle areas of schizophrenics and compared them with normal controls. Methods：Nineteen (four men and 15 women) drug-naive or -free subjects who met the DSM IV criteria for schizophrenia and 19 age- and sex-matched controls were recruited. We measured weight, height, waist circumference, and percent body fat, and calculated the body mass index (BMI). Abdominal fat and mid-thigh low-density muscle areas were evaluated using computed tomography. Results：There was no significant difference in terms of age and BMI between the two groups. The areas of abdominal fat (262.4±101.8 vs. 257.1±93.8 ㎠；p=0.919), subcutaneous fat (182.4±72.8 vs. 180.5±75.1 ㎠；p=0.988), visceral fat (79.9±47.2 vs. 76.6±49.3 ㎠； p=0.872), and mid-thigh low-density muscle (15.0±9.9 vs. 15.4±5.2 ㎠, p=0.373) did not differ between schizophrenics and controls. Conclusion：Abdominal obesity is a well-recognized risk factor for developing certain medical conditions such as insulin resistance and T2DM. We demonstrated that drug-naive or- free patients with schizophrenia do not have increased visceral fat or mid-thigh low-density muscle areas, which might have explained the higher prevalence of insulin resistance and T2DM in these patients.ope

Diagnostic validity and development of virtual reality system for visuospatial function in patients

의학과/박사[한글] 인구 구조의 고령화가 세계적으로 심화되며 치매에 대한 관심도 증가하고 있다. 비교적 최근 소개된 개념인 경도인지장애는 치매의 전단계로서, 나이에 비해 저하된 기억력 외에는 다른 인지적 능력이나 기능적 활동이 비교적 보존되어 있고 치매 진단에는 합당하지 않은 상태를 말한다. 이미 치매로 진행된 후에는 완치 및 회복에 어려움이 크기 때문에 그 전단계인 경도인지장애에 대한 연구가 활발히 진행되고 있다. 경도인지장애 환자의 시공간적 인지기능에 대한 평가는 주로 그림을 이용한 지필검사에 의존하고 있는데, 이는 평면적 자극을 사용하는 한계가 있다. 이에 본 연구에서는 3차원적인 시공간적 자극을 제시할 수 있는 가상현실 방사형 미로를 노인 들이 쉽게 수행할 수 있도록 제작하여 경도인지장애 환자 및 경도의 알츠하이머병 환자의 시공간 기억력을 측정하고 정상 노인과 비교함으로써 경도인지장애에서의 진단적 타당성을 알아보는 것을 목적으로 하였다. 정신과학 연구 분야의 새로운 도구로 소개되고 있는 가상현실 기술의 이용에 대한 문헌 고찰을 통해 가상현실의 정신의학적 유용성을 살펴 보았고, 가상현실 개발 방법론에 따라 동물 실험 모델을 기초로 가상방사형 미로를 개발하여 정상노인, 경도인지장애 노인, 초기 알츠하이머병 노인 각 20명을 기존의 신경심리검사와 함께 검사하였다. 연구 결과는 다음과 같다. 1. 가상방사형미로 검사는 기존의 신경심리검사 중 시공간 인지기능과 관련된 검사들에서 높은 상관성을 보였으나 언어적 인지기능과 관련된 검사 등에서는 상관성을 보이지 않았다. 2. 과제가 반복 됨에 따라 피험자 들의 과제 완수 시간이 줄어 들었는데, 대조군 집단이 경도인지장애 환자군 보다 수행 시간이 빨랐으나 (p=0.002), 경도인지장애 환자군이 경도 알츠하이머병 환자군 보다 과제를 더 빠르게 수행하지는 않았다 (p=0.18). 3. 가상공간에서 한 과제를 완수하기 위해 움직인 거리는 세 집단에서 유의한 차이를 보였는데 (p <0.001), 정상 대조군이 경도인지장애 환자군 보다 짧았고, 경도인지장애 환자군이 경도 알츠하이머병 환자군 보다 짧았다. 이는 경도인지장애 환자군이 보상을 발견하는데 있어 경도의 알츠하이머병 환자군 만큼 느리지만, 보다 효율적으로 보상을 발견하는 것으로 해석할 수 있다. 4. 기억 오류에 있어 경도인지장애 환자군은 보상을 찾는 데 있어 정상 대조군과 작동기억 오류의 차이를 보이지 않았으나 (p=0.1), 초기 알츠하이머병 환자군 보다는 적은 작동기억 오류를 보였다 (p=0.02). 경도인지장애 환자군은 보상을 찾는 데 있어 정상 대조군 보다 많은 참조기억 오류를 보였으나 (p=0.001), 경도의 알츠하이머병 환자군 과는 차이를 보이지 않았다 (p=0.4). 이는 경도인지장애 환자군이 정상 대조군에 비해 작동기억의 장애 보다 참조기억에 장애가 많은 것으로 해석 된다. 결론적으로 건망형 경도인지장애 환자를 진단하는데 있어 가상현실 컴퓨터 검사를 이용하여 시공간 인지 기능을 측정 함으로써 기존의 지필검사를 이용한 신경심리검사의 한계인 3차원적인 사실적 자극 제시가 가능했고 피험자의 반응을 실시간으로 수치화 할 수 있어 시공간 인지 기능을 다차원적으로 파악할 수 있었다. 이에 따라 지필 검사에서 볼 수 없었던 변수 들을 통해 경도인지장애의 시공간적 인지 기능 장애에 대한 이해의 폭을 넓힐 수 있었다. 향후 기능적 뇌영상 연구를 통해 가상방사형미로 검사의 신경상관자를 규명하고, 나아가 코호트 연구를 통해 경도인지장애에서 치매 환자로의 이환에 있어 가상방사형미로 검사의 특정 변수의 진단적 유용성을 밝히는 추적 연구가 필요하다고 사료된다. [영문] Accurate prediction of the development of Alzheimer disease (AD) early in the course of the disease might be important for early intervention or prevention of the disease. In general, AD is preceded by a presymptomatic stage called mild cognitive impairment (MCI). MCI is considered to be a transitional stage between aging and AD. There were many evidences of hippocampal structural abnormality in MCI and AD. The hippocampus plays a crucial role in spatial memory. Especially, there have been some studies that the hippocampus is involved during visuospatial navigation. The aim of this study was to develop the virtual reality system for visuospatial function in patients with amnestic mild cognitive impairment and to validate it. All participants were allocated to one of three groups, i.e., 20 to a normal control (NC) group, 20 to the MCI group, and 20 to the mild AD group. The study subjects were administered Korean mini-mental state examination (K-MMSE) and below neuropsychological tests by one trained psychologist. Verbal memory was tested by 10 word verbal learning test (VLT). Visuospatial memory was tested by Simplified Rey Figure Test (SRFT) and working memory was tested using visuospatial span forward and backward tasks. Upon virtual radial arm maze test, participants were told to retrieve the three rewards as soon as possible. And the computer system recorded the participants’ behavior and trajectory. NC subjects found the rewards more quickly than MCI subjects (p=0.002). And MCI subjects did not found the rewards more quickly than AD subjects (p=0.18). NC subjects found the rewards with shorter distance than MCI subjects (p=0.01). And MCI subjects found the rewards with shorter distance to AD subjects (p=0.02). Results showed that MCI subjects were more impaired in reference memory than in working memory compared to NC subjects. And all the variables of virtual radial arm maze test were significantly correlated with all neuropsychological tests except spatial span forward and verbal recognition memory in number of working memory errors, and number of reference memory errors of VRAM. The present study found that MCI subjects showed spatial working memory deficits, with preserved spatial reference memory, whereas AD subjects had deficits in both spatial working memory and spatial reference memory using VRAM test. This is conformable to recent animal study. In addition, MCI subjects were as slow as AD subjects to find the rewards, but they found the rewards more efficiently than AD subjects. Future study about neural correlates of this new test and key variable for the diagnosis of MCI is expected.ope

(A) study on the satisfaction of the clients who visited a mental health counseling web site of a university hospital.

보건정보관리학과/석사[한글] 그 편리함으로 우리의 생활 구석구석을 변화시키고 있는 인터넷은 정신과 상담의 영역까지 이미 들어와 있다. 인터넷상의 건강 상담에 대한 연구가 있기는 하지만, 사례분석과 만족도를 동시에 시행한 경우는 드물고 상담과 가장 밀접한 진료과임에도 정신과 영역에 서는 더욱 그렇다. 이에 1999년 11월 24일부터 2002년 4월 30일사이에 연세대학교 의과대학 세브란스병원 홈페이지의 정신과 온라인 상담실에서 행하여진 상담을 대상으로 전자우편 설문을 시행하고 전문가가 상담사례를 분석하여 만족도에 영향을 미치는 요인을 알아 보았다. 설문에 응답한 내담자는 271명이었고 주로 젊은층, 고학력자, 그리고 여성이 정신과 온라인 상담실을 많이 이용하는 것으로 나타났다. 주로 병원 방문의 필요성을 알아보는 것이 방문 목적이었는데, 문의된 주된 질환은 기분 및 불안장애였다. 내담자들은 주로 정보를 제공받은 것에 만족했으며, 인터넷 상담에 대해서는 그 간편성과 수고와 비용절감 효과를 장점으로 평가했다. 만족도를 묻는 질문에대해 불만족스럽다고 답한 경우가 반이 넘었고, 매우 불만족한 경우는 9.6%로 강한 비판의 예가 많이 보여 현 정신과 온라인 상담실의 개선이 시급함을 보여주고 있었다. 답변은 일주일 이내에 하는 것이 만족도가 높았고 답변의 길이는 한글 100자 내외에서 높은 만족도를 보였는데, 이보다 길다고 해서 만족도가 높지는 않았다. 본 연구를 통해 정신과 온라인 상담에 있어 내담자의 목적을 명확하게 파악, 원하는 바를 원하는 형식으로 빠르고 정확하게 제공해주는 것이 만족도를 높이는 방법이라는 것을 확인하게 되었다. 그 구체적인 실천 방안을 객관적 자료의 분석을 통해 알아 보고 온라인 건강 상담 연구의 효과적인 틀을 제시한 것이 본 연구의 의의라고 할 수 있다. [영문] Thanks to its convenience and easy accessbility, internet has become a important part of our everyday life and it effects almost every area, including psychiatry consultation. There has been previous study about health advicement on line but not many studies included case analysis and safistaction. This is also true in area of psychiatry, which is most closely related to advicement. This study performed survey through e-mail to those who used online psychiatry consultation on Severance Hospital Homepage, between November 11, 1999 and April 30, 2002, and also analyzed the psychiatrist''s answer to find out which factors influenced satisfaction. 271 complied to the survey, and people who use on line advicement turned out to be female, young, and educated. The user wanted to know whether they needed to see a doctor about their problem, and most commonly they had mood or anxiety disorders. They were satisfied that they were provided with information and pointed convenience, effort saving, and less money consuming as positive factors of on line consultation. To question about whether they were satisfied, more than half answered ''unsatisfactory'' and those who answered ''very unsatifactory'' were 9.6%. Overall they were critical about the satisfaction and this data shows that on line psychiatry consultation needs immediate change. To question about how many days was satifactory to get an answer, many answered 1 week and length of answer was most satisfactory when within 100 Korean words. Long answer did not always brought more satisfaction. Through this study, we found out that to increase satisfaction the purpose of using on line advicement should be clearly understood and deliver what they want through ways they want, in prompt and exact way. This study is significant in that it offers specific ways to improve on line consultation, based on data analyzed and that it suggests effective structure of health consultation study.ope

Development of Web-based Paper Submission and Review System of a "Journal of Korean Neuropsychiatric Association"

The electronically archived online journals may connected together and eventually evolved to the global health information server in the near future. This paper describes an online paper submission and peer-review system for the publication of a biomedical journal. The authors conducted a systematic workflow analysis for the submission and review process of a biome­dical journal and developed a web-based publication system. New media will require new format. Therefore, we have to make continuous effort to improve the format best fitted for the new media improve our ability to adapt ourselves to the con­tinuously changing age of information.ope

Practice of a Web-Based Paper Submission and Review System of a "Journal of Korean Neuropsychiatric Association".

The procedure of the online paper submission to the Journal of Korean Neuropsychiatric Association is consisted of seven steps:entering type, author, title, keyword and abstracts of the paper, author’s affiliation, uploading the paper file, and completion of submission. Six steps before the completion of submission could be reversed. But after this, no change will be possible. When editor decide that the paper is eligible, correspondence author will get the acceptance letter. The review of the paper will be done by selective reviewers. They will login to the system for the evaluation. The efficacy and the convenience of this system will be heightened by user’s feedback (ex, systemic error, inconvenience, improvements, and ideas).ope

Evidence-Based Psychiary

Evidence-based medicine (EBM) has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. EBM could be a meme in medicine that is transferred from one clinical filed to another. The knowledge base that informs clinical decision has been growing with a very rapid pace making it a difficult challenge for the busy clinician to keep up with this growing and high volume of research findings. To keep up to date with the best research evidence, clinicians need a set of strategies. EBM may be the solution of this challenge. The term, Evidence-Based Psychiatry (EBP) was introduced by Elliot Goldner and Dan Bilsker in 1995. The purposes of this review are to introduce EBP and to find the best way to adopt the evidence-based approach to the practice of psychiatry in Korea. For these purposes, we reviewed the practice of EBM and discussed the application of EBP in Korean psychiatric field of medicine.ope

Development of a computer-based behavioral assessment of checking behavior in obsessive-compulsive disorder.

OBJECTIVE: The goal of the current study was to develop and obtain preliminary psychometric data for a computer-based behavioral measure of compulsive checking behavior in a sample of patients with obsessive-compulsive disorder (OCD). METHOD: We examined performance on a novel behavioral measure in 30 patients with OCD and 27 matched healthy controls. In the computerized assessment, participants navigated through two virtual environments (home and office) using a joystick and head-mounted display. The experiment consisted of three phases: training, distraction, and the main task. After the training and distraction phases, participants were instructed to check the virtual environments freely as if they were in their natural environment. Primary dependent variables in the current study included several indices of frequency and duration of checking behaviors. We examined construct validity for the task by comparing the novel behavioral measures with standardized self-report and interviewer-rated measures. RESULTS: Results indicated that (1) OCD patients demonstrated significantly greater problems with compulsive checking compared to controls, and (2) performance on the task was positively correlated with both self-reported symptoms and interviewer-rated measures associated with OCD. CONCLUSIONS: This study provides preliminary data to support the use of this task as a new possible behavioral measure of compulsive checking behavior in OCD. If we merge the traditional behavioral research with this novel and ecologically valid method, it could improve the assessment of OCD in both clinical and research setting.ope

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage : Evaluated by the Korean Version of Neuropsychiatric Inventory

Objectives : This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. Methods : We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 de-mentia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency x seventy) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, seventy of the patients and activity of daily living. Results : The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. Conclusion : Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.ope

Comparison of checking behavior in adults with or without checking symptom of obsessive-compulsive disorder using a novel computer-based measure.

Easy to administer behavioral measures of checking are needed to improve the assessment of this hallmark feature of OCD. We recently developed a new computer-based behavioral assessment of OCD in a previous study. As a follow-up experiment for this method, the goal of this study was to examine whether the new computer-based behavioral assessment would be capable of differentiating behaviors in adults with OCD characterized by checking behavior from those without checking behavior. We compared 22 OCD patients with compulsive checking behaviors (OCD checkers), 17 OCD controls without checking behavior (OCD controls), and 31 healthy controls (HCs) on a novel computer-based behavioral measure of checking behavior. Despite similar levels of successfully completed tasks, OCD checkers demonstrated longer duration of checking behaviors than OCD controls or HCs. Interestingly, no differences were found between OCD controls and HCs in any of the dependent variables. Our new behavioral measure offers a novel, objective, and ecologically valid measure of checking behaviors in a sample of adults with OCD.ope