The Association of Plasma Inflammatory Cytokines with Dementia and Mild Cognitive Impairment / 생물치료정신의학

OBJECTIVES: The aim of this study was to investigate the association of plasma levels of inflammatory cytokines with dementia and mild cognitive impairment.METHODS: We compared serum levels of tumor necrosis factor-alpha(TNF-alpha), interleukin-6(IL-6), and insulin-like growth factor-1(IGF-I) in patients with dementia(n=8), mild cognitive impairment(MCI, n=15) and normal elderly (n=14). The diagnosis of dementia was made by the Diagnostic Statistical Manual of Mental Disorders-4th edition (DSM-IV). MCI was diagnosed based on the criteria of the National Institute of Aging and Alzheimer Association(NIA-AA) working group.RESULTS: When compared with normal controls, the levels of TNF-alpha and IL-6 were increased and level of IGF-I was decreased in MCI and dementia. Higher levels of TNF-alpha and IL-6 and lower level of IGF-I were also associated with increased age. However, when adjusted for age, the association between diagnosis and TNF-alpha, Il-6 and IGF-I was not significant.CONCLUSION: The difference in plasma levels of inflammatory cytokines in dementia and MCI may be associated with aging.

Association between Impulsivity and Medical Lethality of Suicide Attempts among Suicide Attempters

OBJECTIVES: Although impulsivity has long been thought as an important factor influencing suicidal behaviors, it is unknown whether impulsivity increases the risk of dying from suicidal behaviors and what specific component among constructs of impulsivity contributes to the risk of dying among suicide attempters. METHODS: To elucidate the association between impulsivity and medical lethality of suicide attempt among suicide attempters, we consecutively recruited 46 suicide attempters who visited an emergency room of a general hospital located in a metropolitan area, Seoul, Republic of Korea, due to suicide attempts and consented to participate in this study. Then we assessed medical lethality with the Beck Lethality Scale (LS) and impulsivity with the Korean version of the Barratt Impulsiveness Scale-11-Revised (BIS). Demographic variables were obtained from medical records and structured social work reports for suicide attempters. RESULTS: Although total scores of the BIS did not correlate with LS scores, only the scores of self-control, that is one of the Barret's six theoretical constructs of impulsivity in which the higher score indicates less self-control and more impulsivity, had a significant positive correlation with scores of LS (p = 0.003). The association remained significant after adjusting for variables known to affect suicide lethality such as job status, recent alcohol consumption, diagnosis of depressive disorders, and having a plan for suicide (β = 0.429, p = 0.009). CONCLUSIONS: Not impulsivity in general, but poor self-control, in particular, predicts lethal suicidal behaviors among suicide attempters. The degree of self-control should be evaluated when assessing patients with elevated suicide risk, and proper measures should be installed to prevent possible future lethal suicide attempts.

Non-Adherence to Psychiatric Intervention in Work Related Burns

PURPOSE: Patients with work related burns suffer from anxiety, depression, insomnia and suicide ideation etc. Psychiatric symptoms could be reduced by treatment. Almost all patients are referred to psychiatric intervention in our hospital. However, a number of patients show non-adherence. The aim of this study is to figure out the reason of non-adherence and psychiatric symptoms of work related burns patients. METHODS: 123 patients participated in this study. Startle, Physiological arousal, Anger, and Numbness (SPAN), Feeling Suicide, Patient Health Questionnaire-2 (PHQ-2) were administered as screening tool. Questions about psychiatric intervention and reasons to refuse psychiatric intervention were asked. RESULTS: 32% patients were depressed, 34% patients had suicide ideation and 59% had PTSD after work related burns. However, 46% of burn patients had not been treated. Stigma of psychiatric intervention and concerns about dependency were major reasons for non-adherence. CONCLUSION: There are gap between necessity and reality of psychiatric intervention on work related burn patients.

A Study on the Communication Gap and Different Understandings between Doctor and Patient about Burn Treatment in the Burn Center of a University Hospital

PURPOSE: Burn is an unusual medical situation with limited information open to common people. This study was designed to evaluate the communication gap and different understandings between doctor and patient about burn treatment and to improve quality of the treatment. METHODS: Cross-sectional studies were done with interview and questionnaire. 25 doctors and nurses of burn ward and 50 burn patients in Han-gang Sacred Heart Hospital Burn Center were participated. To understand the communication gap and different perception between doctors' and patients' on 1) burn sequela and recovery, 2) disease course and prognosis, 3) healing environment, cost, hospitalization, 4) nurse-physician collaboration, 5) psychiatric consultation, 6) extra incentive were analyzed. RESULTS: Patients tend to expectation positive answer about their prognosis from their physician but they have recognized chronic and negative prognosis of burn treatment. Patients want to know clear and detailed explanation about their test result or treatment methods. Physicians thought that it is important to consider patients' economic status and provide different treatment principle. Short duration of hospitalization is not related to the anxiety of rehabilitation. Patients thought that nurses could manage superficial or repeated treatment. It is more likely that physicians warn the disadvantages of psychiatric consultation than patients. Both groups thought that extra incentive or gratitude money is not helpful for the doctor patient relationship. CONCLUSION: Given the discrepant views of physicians and patients on the burn treatment, physician should be aware of the discrepancies and attempts to resolve any differences.

Pathways Analysis for Depression in Hospitalized Acute Burn Patients

PURPOSE: The goal of this study was to develop a model of risk factors for depression in hospitalized burned patients. METHODS: Seventy-seven patients over 20 tears of age who were admitted to the Hangang Sacred Heart Hospital for burn injury, completed Structured Interview Post-traumatic stress disorder (PTSD), Beck Depression Inventory (BDI), Visual Analogue Scale (VAS) for pain and itching after 1 month from burn. A path analytic strategy was used to develop a model of risk factors for depression in burned patients. RESULTS: Two pathways to depression were developed. 1) From sleep disturbance and then to depression 2) from burn pain to PTSD and then to depression. It was revealed that sleep disturbance and PTSD had a direct effect on depression, pain had both direct and indirect effect on depression. CONCLUSION: Sleep disturbance and PTSD are associated with depression in burned patients. The identification of two developmental pathways suggests the importance of establishing preventive interventions for depression.

Optimising Antidepressant Use in Clinical Practice: Considering External Factors / 신경정신의학

Depressive illness is a major public health problem with important medical, social and economic implications. The efficacy of various antidepressants in treating depression has been demonstrated in randomized controlled trials (RCTs). However, these studies do not adequately address the complexities of clinical practice. Although most of RCTs assumed there was no difference in efficacy between the tricyclic antidepressants (TCAs) and serotonin specific reuptake inhibitors (SSRIs), naturalistic studies show that patients who take TCAs often receive subtherapeutic doses for inadequate duration than those with SSRIs. Because the benefits of the implementation of current guidelines are limited, the optimal choice of medication must be guided by detailed history and careful consideration of the real-world efficacy of antidepressants and long-term health care costs.

Fixation for Reattachment of Trochanteric Fragment in Pertrochanteric Fracture Treated with Bipolar Hemiarthroplasty

Purpose: To retrospectively compare the fixation methods for reattaching a trochanteric fragment in a pertrochanteric fracture treated with bipolar hemiarthroplasty. Materials and methods: Forty cases of an unstable femur pertrochanteric fracture were analyzed and followed up for average of 19(6~40) months. There were 18 cases fixed with tension band wiring (group 1), 7 cases treated using modified tension band wiring with K-wires (group 2) and 15 cases treated with the GTRD (Greater Trochanteric Reattachment Device) (group 3). Result: Group 1 was treated with simple a surgical procedure and the results were good. The second group had firm fixation postoperatively but required additional surgery in two cases to remove the K-wires because of wire migration after ambulation. Group 3 had relatively good results but required more dissection and a longer operating time. Conclusion: Tension band wiring or GTRD are good fixation methods for reattaching trochanteric fragments in pertrochanteric fractures. Moreover, tension band wiring is recommended for old osteoporotic patients due to a simple procedure and firm fixation. The use of modified tension band wiring using K-wire or a Steinmann-pin should not be used due to the possibility of distant migration.

The Validity of the Assessment Tools for the Korean Long-Term Care System

OBJECTIVES: For the further development of the Korean Long-Term Care System, we analyzed the validity of the assessment tools of cognitive impairment and behavioral problems for the Korean Long-Term Care System. METHODS: We investigated 326 elderly people who were residing in Onyang 4-dong and Dogo-myun, Asan-si, Chungcheongnamdo. Our research team visited their residence and performed the assessment tools for the Korean Long-Term Care System and Korean version of the Mini-Mental State Examination (MMSE-K), Neuropsychiatric Inventory-Questionnaire (NPI-Q) and Seoul-Instrumental Activities of Daily Living (S-IADL). RESULTS: The correlation between the cognitive function tests and MMSE-K (r=0.579, p<0.001) and that between the behavioral problem tests and NPI-Q (r=0.688, p<0.001) were not as good as we expected. Moreover, if the items of the behavioral problem tests were decreased to 10 items as the government wanted, we got much lower correlation coefficiency. The cognitive function tests could not detect early cognitive deterioration in dementia. CONCLUSION: The assessment tools of cognitive impairment and behavioral problems for the Korean Long-Term Care System need modifications to promote validity.

Development of the List of Core Skill and Knowledge in Clinical Practice of Neuropsychiatry / 신경정신의학

The purpose of this study is to develop the list of core skill and knowledge in clinical practice of neuropsychiatry. The author consider some aspects in preparing for developing the list of core skill and knowledge of neuropsychiatry. The author examined the status of the clinical practice in universities briefly, and we presented some practical problems about the extent of clinical practice of neuropsychiatry, the goals and principles of developing the target of study, the target of clinical practice of neuropsychiatry, and some examples of skill and knowledge and attitude by referencing 'Korean Journal of Medical Education', 'Workshop reports in Korean Neurosychiatric Association' and 'OSCEs in psychiatry'. We pointed out the problem that whether behavioral science, diagnosis, 'patients, doctor and society' (PDS), and communication were included in clinical practice of neuropsychiatry or in other subjects and emphasized. We could discuss about 60 OSCE lists in Psychiatric department of University of Cambrige including examining cranial nerve, fundoscopy, interpreting ECG, calling the on-call consultant, requesting an EEG, discussing an MRI brain scan report, assessing suicide risk, and assessing testamentary capacity. In the examples of attitude and skill, the process of establishing rapport and giving empathy is as follow. If the students are well aware and carrying out the process, they will be respectable medical doctors. 1) Establish a rapport with the patient : Greet the patient by name, shake the patient's hand and smile. Introduce yourself warmly. Be courteous. make the patient comfortable and at ease. Explain the purpose of the contact. Ask permission to take a history or to do an examination. Thank the patients for co-operating. 2) Empathy : Remember that the patient is as human as you are. If you believe that the patient is as important as you are, you are mistaken. The patient is more important than you are. Your career depends on how well you can get on with patients and make them feel good about you. for their medical care, you are just one of the many choices. Hence, be sensitive and show warmth, empathy, concern and consideration for the patient.'s feelings. Try to see how you would have felt if you were in the patient's shoes. Convey your understanding and acceptance of the patient's situation. Explain them. Respect the patient's dignity. Do not ignore questions from the patient. Ask permission to speak to partner, children or parents if indicated. We anticipated that fine lists were developed by active progression of developing lists of skill and knowledge after our investigation.

Development of the List of Core Skill and Knowledge in Clinical Practice of Neuropsychiatry / 신경정신의학

The purpose of this study is to develop the list of core skill and knowledge in clinical practice of neuropsychiatry. The author consider some aspects in preparing for developing the list of core skill and knowledge of neuropsychiatry. The author examined the status of the clinical practice in universities briefly, and we presented some practical problems about the extent of clinical practice of neuropsychiatry, the goals and principles of developing the target of study, the target of clinical practice of neuropsychiatry, and some examples of skill and knowledge and attitude by referencing 'Korean Journal of Medical Education', 'Workshop reports in Korean Neurosychiatric Association' and 'OSCEs in psychiatry'. We pointed out the problem that whether behavioral science, diagnosis, 'patients, doctor and society' (PDS), and communication were included in clinical practice of neuropsychiatry or in other subjects and emphasized. We could discuss about 60 OSCE lists in Psychiatric department of University of Cambrige including examining cranial nerve, fundoscopy, interpreting ECG, calling the on-call consultant, requesting an EEG, discussing an MRI brain scan report, assessing suicide risk, and assessing testamentary capacity. In the examples of attitude and skill, the process of establishing rapport and giving empathy is as follow. If the students are well aware and carrying out the process, they will be respectable medical doctors. 1) Establish a rapport with the patient : Greet the patient by name, shake the patient's hand and smile. Introduce yourself warmly. Be courteous. make the patient comfortable and at ease. Explain the purpose of the contact. Ask permission to take a history or to do an examination. Thank the patients for co-operating. 2) Empathy : Remember that the patient is as human as you are. If you believe that the patient is as important as you are, you are mistaken. The patient is more important than you are. Your career depends on how well you can get on with patients and make them feel good about you. for their medical care, you are just one of the many choices. Hence, be sensitive and show warmth, empathy, concern and consideration for the patient.'s feelings. Try to see how you would have felt if you were in the patient's shoes. Convey your understanding and acceptance of the patient's situation. Explain them. Respect the patient's dignity. Do not ignore questions from the patient. Ask permission to speak to partner, children or parents if indicated. We anticipated that fine lists were developed by active progression of developing lists of skill and knowledge after our investigation.

Clinical Features of Elderly Patients Referred to Neuropsychiatric Department

OBJECTIVE: As the geriatric admission and geropsychiatric consultation increase, more study was needed about geropsychiatric consultation. This comparative study investigates the character of geropsychiatric consultation in general hospital. METHOD: We compared 22 young patients (25(age<45) with 55 elderly patients ((65) who are consulted to neuropsychiatry department for the first time for 3 months (2004. 1. 1-2004. 3. 31) in Kang-Dong Sacred Heart Hospital, Hallym University. Data on patterns of consultation, demography, psychiatric and physical illness were collected and analyzed. RESULT: 1) The rate of psychiatric consultations for elderly patients was 6.2%, and this rate was much higher than 1.9% of young patients. 2) There were no significant difference in referral department between the elderly group and the control group, and internal medicine was the most common referral department in both groups. 3) The main reasons of consultations were alcohol related problems and psychiatric follow up in order in control group, but sleep disturbance and disorientation in order in elderly group. 4) In elderly group, the most frequent psychiatric diagnoses made by consultants were organic brain disorder such as dementia and delirium, but in control group, they were functional psychiatric disorder such as alcohol related disorder and psychosis. 5) Psychotropic drug and follow-up consultation were two most frequent recommendations from consultants in both group. But recommendations for psychotherapy and psychosocial management were rare in both groups. 6) There were significant difference only in psychiatric transfer among compliance for psychiatric consultation between the elderly group and the control group. Compliance for recommendations were low in both groups. 7) In both group, only one follow up consultation was done. And OPD follow up after discharge was rare in both groups. CONCLUSION: Elderly patients need more psychiatric consultations than younger patients and has different characteristics in pattern of consultations. Further studies are warranted on geropsychiatric consultation in Korea.

Associations between Serotonin Transporter Linked Promoter Region Polymorphism and Personality Traits-Normal Female Population Study / 대한정신약물학회지

OBJECTIVE: The personality traits are substantially heritable, and therefore very likely result from the interplay of genetic variations with environmental influences. Recently, there is a growing enthusiasm for biological approaches to personality, especially genetic research on identifying responsible genes. So, the aim of this study is to investigate the associations between serotonin transporter promoter linked region (5-HTTLRP) polymorphism and personality traits. METHODS: We recruited unrelated normal 114 female subjects. The Korean version of temperament and character inventory (TCI) were used to assess personality traits. From the blood, DNA was isolated using standard techniques and the 5-HTTLPR polymorphism was genotyped by polymerase chain reaction and electrophoresis. We classified the subject as s/s, s/l, and l/l group according to their genotype. The differences of TCI scores between l allele non-carrier group (s/s genotype) and l allele carrier group (s/l+l/l genotype) were tested after inclusion of age as covariate in the analysis of variance (ANCOVA). RESULTS: Under the control of age, there were no associations between harm avoidance, novelty seeking, reward dependence, cooperativeness, and self-transcendence scores and genotypes. But, persistence and self-directedness score of l allele non-carrier group was significantly higher than that of l allele carrier group. CONCLUSION: The 5-HTTLPR polymorphism may be associated with persistence and self-directedness score of TCI in normal Korean female population.

The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(I): Comparison of Therapeutic Effecacy / 신경정신의학

OBJECTIVES: This randomized, multicenter, open-label, parallel clinical trial was carried to compare the therapeutic efficacy and the proportion of successful switch between 'direct switching method' and 'start-tapering switching method' when switching an antipsychotic to olanzapine. METHODS: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10 from 13 hospitals, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The therapeutic efficacy was measured with PANSS, BPRS, and CGI-Severity. A successful switching was defined as the completion of the 6 week trial without either worsening of the symptom(i.e. CGI-S score becomes worse twice consecutively) or the exacerbation of extrapyramidal symptoms(i.e. Simpson-Angus Scale scores becomes worse). RESULTS: 103 schizophrenic patients were participated in this study. There were no differences in baseline characteristics such as the demographic variables, the severity of symptoms, the history of previous antipsychotics treatments, the dosage of olanzapine used and the compliance between two groups. The proportion of successful switch was 71.1% for "direct switching method" and 82.2% for "start-tapering switching method", and there was no significant difference between the two switching methods. Also response rates to olanzapine based on total PANSS total scores were not different between the two groups(26.9% vs. 31.1%). At the time of completion of the trial, the scores of PANSS total, PANSS subscales, CGI-S and BPRS have significantly decreased after switching to olanzapine. But the changes of all scales measuring therapeutic efficacy in both endpoint and weekly analyses were not significantly different between the two switching methods. CONCLUSION: Although this study trial has many limitations and problems as an open clinical trial, the results may suggest that there were no significant differences between the two switching methods in the therapeutic efficacy. It was also found that the additional therapeutic benefits could be obtained by switching their antipsychotics to olanzapine.

The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(II): Comparison of Safety / 신경정신의학

OBJECTIVES: This multicenter clinical trial involving 13 hospital sites compared the safety of switching to olanzapine between 'direct switching method' and 'start-tapering switching method'. METHOD: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The safety of switching to olanzapine was measured with vital signs including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS), Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). RESULTS: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in 'direct switching method' group, and the concomitant use of anticholinergics was comparatively greater in 'start-tapering switching method' group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. CONCLUSION: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

Effect of Dexamethasone and 1,25(OH)2D3 on Proliferation and Osteogenic Differentiation of Cultured Human Bone Marrow Stromal Cells / 대한내분비학회지

BACKGROUND: It is crucial, in the case of regenerating bone by tissue-engineering technique, that osteoblast progenitors are proliferated and induced to differentiate to osteoblasts sequentially at the proper time. Osteoblasts can be obtained from bone itself or from osteoblast progenitors in bone marrow, even though the amount of human marrow stromal cells in marrow aspirate is usually scanty. These cells, however, have been known demonstrate the potential to easily proliferate and differentiate in osteoblasts, chondroblasts or adipocytes according to different microenvironmental factors. We evaluated the effect of dexamethasone and 1,25(OH)2D3 on the proliferation, differentiation, and mineralization of human marrow stromal cells in vitro. METHODS: We used twelve bone marrow aspirates obtained from different healthy bone marrow donors. Culture plates were randomly divided into the following four experimental groups; group 1 was cultured with control medium only, group 2 with control medium containing 1,25(OH)2D3, group 3 with control medium containing dexamethasone, and group 4 with control medium containing both 1,25(OH)2D3 and dexamethasone. 3H-thymidine uptake, protein content of cell lysates, alkaline phosphatase activities and alkaline phosphatase histochemistries were measured. Alizarin Red-S staining and quantification of dissolved dye were also performed. RESULTS: Combined stimulation of marrow stromal cells with both 1,25(OH)2D3 and dexamethasone was found to be effective to maintain stable long-term culture of the cells and to increased differentiation and mineralization of the cells. Synthesis and mineralization of matrix were highest when the cells were stimulated with 1,25(OH)2D3 alone during the early culture phase. However, 1,25(OH)2D3 shortened the lifespan of the cells. Interestingly, mineralization was higher in female donor cells than in male donor cells when stimulated with dexamethasone alone or with both dexamethasone and 1,25(OH)2D3. Neither 1,25(OH)2D3 nor dexamethasone affected cell proliferation. CONCLUSION: Our results suggest that the synergistic effect of dexamethasone and 1,25(OH)2D3 is important in maintaining long-term culture and differentiation of human marrow stromal cells. It is preferable to administer 1,25(OH)2D3 after the attachment of cultured osteoblasts to biomaterials has been established, since it could shorten cell survival despite the great increase of mineralization at the early culture phase.

Relationships between Temperament and Character Dimensions, Family Environmental Factors and Antisocial Personality Traits in Detained Delinquent Adolescents / 신경정신의학

OBJECTIVES: The purpose of the study was to examine the relationships between temperament and character dimensions and family environments, and to investigate the influences of those factors on the antisocial personality traits in delinquent adolescents. METHODS: The subjects consisted of 160 male adolescents detained at the public prosecutor's office on the suspicion of crimes. To assess personality dimensions and family environmental factors, the Temperament and Character Inventory(TCI) and the Family Environment Scale(FES) were completed. Antisocial personality traits were assessed by the number of antisocial personality disorder symptoms of the Personality Disorder Questionnaire-Revised. RESULTS: Most of the TCI dimensions except Reward Dependence(RD) were highly correlated with the subscales of FES. Among temperament dimensions, Novelty Seeking(NS) and Persistence(P) were significantly affected by Organization, and Harm Avoidance(HA) was influenced by Expressiveness of FES. Self-Directednss(SD) was best predicted by Organization and Achievement-Orientation. While the Independence had significant effect on Cooperativeness, Expressiveness and Achievement-Orientation best predicted the level of Self-Transcendence(ST). On factor analysis, NS, HA, SD and ST were allocated to the same factors with subscales of FES. The level of antisocial personality trait was best predicted by NS, P and SD scores of TCI, and conflict subscale scores of FES. CONCLUSION: The findings of this study suggest that not only the character dimensions but also the temperament dimensions have close relationships with family environmental factors, and that the antisocial personality traits of delinquent adolescents may developed by the interaction between temperament/character dimensions and family environments.

The Understanding of Depression Subtypes

The debate about whether depressive disorders should be divided into categories or arrayed along a continuum has gone for decade, without resolution. In our review, there is more evidence consistent with the spectrum concept than there is with the idea that depressive disorders constitute discrete clusters marked by relatively discontinuous boundaries. First, "depression spectrum", "is there a common genetic factors in bipolar and unipolar affective disorder", "threshold model of depression" and "bipolar spectrum disorder" are reviewed. And, a new subtype of depression is so called SeCA depression that is a stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression. SeCA depression is discussed. But, there is with the idea that depressive disorders constitute discrete subtypes marked by relatively discontinuous boundaries. This subtypes of depressive disorder were reviewed from a variety of theoretical frames of reference. The following issues are discussed ; Dexamethasone suppression test(DST), TRH stimulation test, MHPG, Temperament Character Inventory(TCI), and heart rate variability(HRV).

May Objective Structure Clinical Examination and Clinical Skill Test Contribute to the Standardization of Clinical Clerkship in Multi-Campus Medical School? / 한국의학교육

If medical campus is composed of multi-campus, the standardization of the students' clinical clerkship is one of the major concerns in medical education, since it is very difficult to supervise the precise students' performances by the executive officers. To improve and to standardize the clinical clerkship, the objective structured clinical examination and the clinical skill test was done and its results were analyzed. On February 11, 2001, the 85 junior students of the College of Medicine, Hallym University, undertook the examinations with 10 items. Mean of the results was 72.73. There was no significant difference of scores according to sex, and group of examinees. There was significant difference according to the hospital of students' clerkship in spite of there was no significant difference of the scores of written examination and total score of clinical clerkship. There was a significant difference of experiences of clinical skills according to the hospital. There was a positive correlation between degree of experience of clinical skills and scores (r=0.3888). The most important factor influencing the scores is believed to be a experience of clinical skills in the hospital since it can be postulated that the students' ability was not different according to the hospital. Also the depth of the clinical skill was also may be another influencing factor to the scores. When students works in multi-campus hospitals, the professors or educational supervisors should check the clinical skills as the guideline indicated, for the standardization of the clinical clerkship.

Combined Anterior and Posterior Approach in Operating on Complex Acetabular Fractures / 대한정형외과학회잡지

PURPOSE: To report the results of a combined anterior and posterior approach to complex acetabular fractures and establish the guidelines for the operative treatment of complex acetabular fractures. MATERIALS AND METHODS: Thirteen fractures (8 both column, 5 T-shaped fractures) of thirteen patients (8 men, 5 women) were treated with this combined anterior and posterior approach from August 1995 to December 1999. We reviewed the clinical and radiological results for an average of 33months (range, 12-60) follow-up. RESULTS: This approach resulted in an anatomical reduction in ten (78%) patients and, two imperfect and one poor reduction. The average Harris hip score was 69.2 (range, 58-87) and the clinical results were good in eleven, very good in one and poor in one patient using the D'Aubigne/Postel clinical grading. A poor reduction occurred in one patient who had a both column fracture that extended to the ipsilateral sacroiliac joint combined with a joint subluxation. CONCLUSION: Overall clinical results for most complex acetabular fractures treated by a combined anterior and posterior approach were preferable to other approaches, but we must consider an extensile or extended ilioinguinal approach to be an alternative surgical approach in this complicated fracture that involves the sacroiliac joint.

The Preliminary Study of the Effects of Antidepressant Treatment on the Depressive Symptoms and the Nutritional Indexes in the Patients with Chronic Rena Failure on Maintenance Hemodialysis / 신경정신의학

OBJECTIVES: Depression is a common affective problem in patients with chronic medical illness. It has been well known that depression gives negative influence to medical outcome in patients with chronic renal failure (CRF). The purpose of this study is to reveal the effects of antidepressant treatment on depressive symptoms and nutritional indexes. We hope that this study could be a help to make a new model in the treatment of patients with CRF. METHODS: For this study, 30 depressive patients with CRF on maintenance hemodialysis were included. As affective variables, Hamilton Depression Rating Scale (HDS) and Zung's Self-Rating Depression Scale (SDS) were used. Medical outcomes were assessed with the following nutritional parameters: Kt/V, normalized protein catabolic rate (nPCR), serum albumin concentration, BUN, intracelluar fluid(ICF), extracellular fluid (ECF), lean body mass, fat mass, percent body fat, waisthip ratio (WHR), and body mass index(BMI). Paroxetine, one of the SSRI classes, was administered as antidepressant for 8 weeks. For statistical analysis paired t-test was used for each variables. RESULTS: The prevalences of depression were 75% from HDS and 80% from SDS (N=40). The mean+/-SD of HDS and SDS score were 12.35+/-7.45 and 59.43+/-11.89 respectively. HDS score significantly decreased (p< 05) after antidepressant treatment for 8 weeks. There was a significant increase (<.05) in such nutritional parameters as nPCR, serum albumin concentration, BUN, ICF, ECF, and WHR. CONCLUSION: Both nutritional indexes and depressive symptoms improved after 8 weeks of antidepressant treatment. We suggest that improvement of depressive symptoms should contribute to improved nutritional indexes. Long-term follow up and placebo-controlled double blind study are firmly required to confirm the results of this study.