Tae Young Choi

Objective Historical theological frameworks, particularly those rooted in Christianity, have conceptualized guilt as a defining component of melancholy. This study compared the network structures of depressive symptoms in guilt-rich and guilt-free presentations of depression using a large-scale cross-national Asian dataset.Methods We analyzed data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 (REAP-AD3), which included patients with depressive disorders from 11 Asian countries. Network analysis was used to estimate symptom interactions and identify the central symptoms in each group. Participants were dichotomized according to the presence or absence of prominent guilt symptoms, as determined by the “feeling bad about yourself” item of the Patient Health Questionnaire-9 (PHQ-9).Results The network structures of the two groups differed substantially. In the guilt-rich group, depressed mood was the central node that was closely linked to self-blame. By contrast, the guilt-free group exhibited centralized networks with a loss of energy.Conclusion Variations in symptom network structures can be partly explained as broadly consonant with early ideas of Richard Baxter and Robert Burton on melancholia. Clinically, symptoms related to moral judgment and self-criticism may indicate potentially different specific therapeutic attention from individuals with significant guilt. Conversely, for those without pronounced guilt, interventions targeting physical and motivational symptoms such as fatigue might inform hypothesis-driven treatment strategies.

Objective Non-suicidal self-injury (NSSI), prevalent among children and youth, is a risk factor for future suicidal behavior. Nonetheless, the neurobiological mechanisms of NSSI remain under-explored. This study compares the cortical thickness in female youth with NSSI and a healthy control (HC) group using brain magnetic resonance imaging (MRI) and ascertains its associations with relevant factors.Methods The NSSI group comprised inpatients meeting NSSI diagnostic criteria according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, while the HC group included youth without psychiatric symptoms. Both groups included female adolescents and young adults aged 9–24 years. Clinical data were collected for the NSSI group, and brain MRIs were obtained for both groups. Cortical thickness differences between groups were explored, adjusting for age, and correlations between cortical thickness and clinical variables in the NSSI group were analyzed.Results Both groups included 32 participants, with no statistically significant difference in average age (NSSI group: mean age 15.47± 3.20 years; HC group: mean age 15.56±4.83 years; p>0.05). Significant intergroup differences in mean cortical thickness were observed in both the left and right hemispheres (both p=0.001). Specifically, the NSSI group exhibited significantly thinner cortical thickness in the right cingulate cortex compared to the healthy HC group (corrected p<0.05). However, correlation analysis between the cortical thickness of the right cingulate cortex and anxiety (State Anxiety Inventory for Children: r=-0.547, p=0.053) (Trait Anxiety Inventory for Children: r=-0.257, p=0.396) and Children’s Depression Inventory (r=-0.231, p=0.447) scales in the NSSI group did not reveal statistically significant correlations.Conclusion The study identified a noteworthy reduction in cortical thickness in the right cingulate cortex in the NSSI group.

Lee E, et al. J Korean Med Sci. 2026 May;41:e139. https://doi.org/10.3346/jkms.2026.41.e139

Background: Autism spectrum disorder (ASD) and social communication disorder (SCD) are neurodevelopmental disorders characterized by deficits in social communication that hinder social adaptation, with limited pharmacological options for therapy owing to the absence of identified biomarkers. Individuals with ASD or SCD require lifelong interventions tailored to their development stages. However, most existing interventions primarily focus on early childhood, leaving adolescents relatively underserved. Moreover, timely access to interventions is often limited by geographic and economic barriers as specialized clinics and therapists tend to be concentrated in major urban areas. Objective: This pilot randomized clinical trial aimed to evaluate the initial safety and efficacy of NDTx-01, a digital therapeutic (DTx) for adolescents with ASD or SCD. NDTx-01 was designed to overcome the accessibility limitations by integrating cognitive behavioral therapy principles, story-based interventions, and gamification elements. Methods: We introduce a protocol for a multicenter, prospective, assessor-blinded pilot randomized clinical trial involving children and adolescents aged 10 to 18 years diagnosed with ASD or SCD. Participant enrollment was conducted at 3 major medical hospitals. Enrolled participants were randomly assigned to either the intervention group (NDTx-01 and treatment as usual [TAU]) or the control group (TAU only). TAU included medications and therapeutic services. Participants were instructed to use the app approximately 10 minutes per day, 5 days a week. To evaluate the efficacy of NDTx-01, standardized tools were administered, including the Korean version of the Vineland Adaptive Behavior Scales, Second Edition (K-VABS-II); the Social Responsiveness Scale, Second Edition; Clinical Global Impressions–Severity (CGI-S); Clinical Global Impressions–Improvement (CGI-I); the Social Communication Questionnaire; and the Korean version of the Stress Index for Parents of Adolescents. Assessments were conducted in weeks 0, 1, 2, 4, and 6, except for K-VABS-II, CGI-S, and CGI-I, which were administered only in weeks 0, 4, and 6. Statistical analyses were conducted using the SAS software. Between-group differences were assessed using independent 2-tailed 2-sample t tests or Wilcoxon rank sum tests. Within-group changes were evaluated using paired t tests or Wilcoxon signed rank tests. Results: From August 2024 to December 2024, a total of 42 individuals were screened, 39 (93%) participants who met the inclusion criteria were enrolled, and 1 participant withdrew consent; the remaining participants completed the study. The pilot randomized clinical trial was successfully completed, and the results were published in April 2025. As of 2025, we are conducting a confirmatory clinical trial at 5 major hospitals across South Korea. Conclusions: The results of this pilot clinical trial provided important insights into the initial safety and efficacy of DTx as interventions for adolescents with ASD and SCD. Both groups demonstrated statistically significant improvements in adaptive skills and socialization. Trial Registration: Clinical Research Information Service KCT0009140; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26713 International Registered Report Identifier (IRRID): DERR1-10.2196/66419

Aim: Adolescents diagnosed with autism spectrum disorder (ASD) or social communication disorder (SCD) experience social communication difficulties. Social skills training (SST) for this population has proven effective, although its use remains restricted due to limited accessibility. This multicenter, parallel, open‐label, assessor‐blinded, randomized controlled pilot trial evaluated the efficacy of NDTx‐01, a mobile application game integrating SST, in patients aged 10 to 18 years diagnosed with ASD or SCD.Methods: A total of 39 participants fulfilled the eligibility criteria and were randomly assigned to two groups. While the control group received treatment as usual (TAU), the intervention group (INT + TAU) engaged with TAU plus NDTx‐01 for 10 minutes, five times per week, for 6 weeks. The primary outcome measure included changes in the adaptive behavior composites (ABC) of the Korean Vineland Adaptive Behavior Scale‐II. Secondary measures included Social Responsiveness Scale‐2 (SRS‐2) scores, anxiety levels, and parenting stress.Results: One participant in the INT + TAU group withdrew consent. Thirty‐eight patients remained for analysis. Compared with the TAU group (n = 19, 18 males; age, 13.58 ± 2.14 years), the INT + TAU group (n = 19, 16 males; age, 13.42 ± 2.36 years) exhibited significant improvements (INT + TAU 5.89 ± 5.61 vs TAU 1.21 ± 5.99) in the ABC (P = 0.037) after 6 weeks. Additionally, a significant reduction in restricted interests and repetitive behaviors (INT + TAU −9.11 ± 10.26 vs TAU −2.89 ± 7.13) in SRS‐2 scores was found (P = 0.037). No adverse events were reported in participants.Conclusion: The mobile game–based SST has demonstrated effectiveness in adaptive functioning in young patients with ASD or SCD. A further confirmatory study with power estimate is required to validate the effects of NDTx‐01.Clinical Trial Registration Information: This randomized controlled study was registered in Clinical Research Information Service, National Center for Medical Information and Knowledge, Republic of Korea (Registration Number: KCT0009140, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26713&search_page=L).

BACKGROUND Autism spectrum disorder (ASD) and social communication disorder (SCD) are characterized by deficits in social communication that hinder social adaptation, with limited pharmacologic options for therapy due to the absence of identified biomarkers. OBJECTIVE Recognizing the need for accessible and cost-effective interventions, we developed the digital therapeutic NDTx-01, integrating cognitive behavioral therapy principles, story-based interventions, and gamification elements. METHODS This study introduces a protocol for evaluating the efficacy and safety of NDTx-01 through a multicenter, prospective, randomized, assessor-blinded pilot trial involving adolescents aged 1018 years. Participant recruitment and enrollment will be executed in three major medical hospitals, where inter-reliability will be managed by the study team. Enrolled participants, divided into intervention and control groups, will undergo a 6-week intervention with NDTx-01 and usual care or maintain usual care, respectively. The intervention, implemented by NDTx-01, will be structured to last for 6 weeks, with sessions of approximately 10 minutes daily, 5 days a week. Following this, data analysis, including frequency analysis, descriptive statistical analysis, and tests for within-group and between-group differences, will be undertaken. RESULTS As of August 2024, we enrolled 39 patients, and this clinical trial has been successfully completed. CONCLUSIONS Anticipated results, to be published in April 2024, aim to contribute crucial insights into the effectiveness of digital therapeutics as interventions for ASD and SCD in adolescents.

Objective Following the coronavirus disease-2019 (COVID-19) outbreak, the importance of addressing acute stress induced by psychological burdens of diseases became apparent. This study attempted to evaluate the effectiveness of a new mode of psychiatric intervention designed to target similar psychological crises.Methods Participants included 32 out of 114 COVID inpatients at a hospital in Daegu, Korea, who were assessed between March 30 and April 7, 2020. Multiple scales for screening psychological difficulties such as depressed mood, anxiety, insomnia, acute stress, and suicidality were done. Psychological problem evaluations and interventions were conducted in the form of consultations to alleviate participants’ psychological challenges via telepsychiatry. The interventions’ effects, as well as clinical improvements before and after the intervention, were analyzed.Results As a result of screening, 21 patients were experiencing psychological difficulties beyond clinical thresholds after COVID-19 infection (screening positive group). The remaining 11 were screening negative groups. The two groups differed significantly in past psychiatric histories (p=0.034), with the former having a higher number of diagnoses. The effect of the intervention was analyzed, and clinical improvement before and after the intervention was observed. Our intervention was found to be effective in reducing the overall emotional difficulties.Conclusion This study highlighted the usefulness of new interventions required in the context of healthcare following the COVID-19 pandemic.

Objective Incontrovertible disease markers are absent in delirium. This study investigated the usefulness of quantitative electroencephalography (qEEG) in diagnosing delirium.Methods This retrospective case-control study reviewed medical records and qEEG data of 69 age/sex-matched patients (delirium group, n=30; control group, n=39). The first minute of artifact-free EEG data with eyes closed was selected. Nineteen electrodes’ sensitivity, specificity, and correlation with delirium rating scale-revised-98 were analyzed.Results On comparing the means of absolute power by frontal, central, and posterior regions, the delta and theta powers showed significant differences (p<0.001) in all regions, and the magnitude of the absolute power was higher in the delirium group than in the control group; only the posterior region showed a significant (p<0.001) difference in beta power. The spectral power of theta at the frontal region (area under the curve [AUC]=0.84) and theta at the central and posterior regions (AUC=0.83) showed 90% sensitivity and 79% specificity, respectively, in differentiating delirious patients and controls. The beta power of the central region showed a significant negative correlation with delirium severity (R=-0.457, p=0.011).Conclusion Power spectrum analysis of qEEG showed high accuracy in screening delirium among patients. The study suggests qEEG as a potential aid in diagnosing delirium.

Aim: The high comorbidity rates of internet gaming disorder (IGD) and gaming disorder (GD) with other psychiatric disorders are concerning. A follow‐up study of gamers from clinical and nonclinical samples with and without diagnoses of IGD or GD was conducted to investigate the changes in diagnoses over a 1‐year period, compare their diagnostic stability, and examine the patterns of co‐occurrence between IGD and GD with other psychiatric disorders over the same period.Methods: Baseline and 1‐year follow‐up data of 279 participants, including 120 problematic gaming patients and 159 gamers from the general population, were analyzed. Information on demographics, gaming habits, and self‐reported psychological status was collected. Additionally, a structured interview was conducted using the Gaming Diagnostic Interview and the Mini‐International Neuropsychiatric Interview.Results: Although there was no significant difference between the changes in IGD/GD diagnosis during the 1‐year period, 34.7% of the participants had a change in IGD diagnosis, while the number of GD cases increased to 60.4%. When evaluating the fixed effects of comorbidity on IGD and GD, attention‐deficit/hyperactivity disorder had the highest odds ratio for both IGD (75.23; 95% confidence interval [CI], 10.67–530.61) and GD (117.02 × 10⁶; 95% CI, 2.23 × 10⁶–6132.64 × 10⁶).Conclusion: These results reveal that a GD diagnosis might be more prone to change than an IGD diagnosis. GD was also found to be more affected by comorbid psychiatric disorders.