Community Psychiatry Training for Psychiatry Residents: A National Survey / 신경정신의학

OBJECTIVES: There is a increasing need to recruit and retain more psychiatrists who can plan and implement organized programs to work with chronic mentally ill patients in community settings. The aim of study is to discover what training is currently in place to prepare psychiatrist for work in "community" or "public" settings. METHODS: Survey questionnaires were mailed to 85 residency training directors and 10 leaders of community mental health in 2005. Response rate was 75%. RESULTS: Academic seminar about community mental health were not administered to residents in 63% of training hospitals. Forty one out of 64 training hospitals had community mental health rotation programs. Community mental health center (50%) and day hospital (36%) were the most common type of programs. Few general hospital had affiliation with community mental health programs. The amount of time for clinical rotation varied from less than three months part time to 6 months fulltime, with most frequent form of one day per week for three month in second or third year of psychiatry residents. CONCLUSION: Further steps are needed to improve residency training curricula and to encourage well qualified psychiatrist to choose careers in community psychiatry.

The Reliability and Validity of the Korean Version of Family Questionnaire: A Questionnaire Measuring Expressed Emotion / 신경정신의학

OBJECTIVES: The present study was designed to assess the reliability and validity of Korean version of Family Questionnaire (FQ-K), a brief questionnaire measuring expressed emotion (EE). METHODS: A sample of 84 first-order relatives of schizophrenics completed the FQ-K and the data were analyzed for internal consistency and factor structure. Additionally non-random subset of participants (n=34) refilled FQ-K after two weeks for testretest reliability and naturalistic follow-up data of 36 were obtained for any re-hospitalization events to assess predictive validity. RESULTS: Internal consistency of FQ-K was good (Cronbach's alpha=.819) and principal component factor analysis revealed the two-factor structure (criticism and emotional overinvolvement) identical to previously reported for the FQ. The FQ-K also showed reasonable test-retest reliability and excellent predictive validity was indicated in that outcome of re-hospitalization was superior for low expressed emotion patients at six-month naturalistic follow-up. CONCLUSION: The Korean version of FQ proved to be a reliable and valid instrument measuring expressed emotion in relatives of Korean patients with schizophrenia.

An Estimation of Optimal Medical Manpower in Mental Hospital / 신경정신의학

OBJECTIVES: The purpose of this study is to surmise appropriate level of medical manpower of mental hospital from the perspectives of clinical experts, psychiatrist and psychiatric nurse. METHODS: First, we wlleded data on medical manpower of domestic mental hospitals and foreign mental hospitals. Next, psychiatrists and psychiatric nurses were asked to complete a survey. We estimated the optimal level of medical manpower examining appropriate volume of medical services that should be provided for psychiatric patients, and analizying the survey carried out by direct questions. RESULTS: The number of psychiatrists of group A of private mental hospitals was 1.7 times more than that of public mental hospitals; when the number of psychiatrists in public mental hospitals was regarded as 1.0, and group B of private mental hospitals was 0.5 times, and the university hospitals 8.2 times. The number of psychiatric of group A of private hospitals was 1.5 times more than that of public mental hospitals; when the number of psychiatric nurses in public mental hospitals was regarded as 1.0, the group B of private mental hospitals was 0.6 times and university hospitals was 2.6 times. The foreign mental hospitals had more medical manpowers in all occupations than domestic mental hospitals. The number of psychiatrists estimated according to the first method was 11.1 persons and the number of psychiatric nurses was 26.3 persons per 100 beds, and the number of psychiatrists estimated according to the second method was 4.3 persons per and the number of psychiatric nurses was 20.8 persons per 100 beds. CONCLUSION: The estimated optimal number of psychiatrists for mental hospital is 4.3 persons and of psychiatric nurses was 20.8 persons per 100 beds. However, these numbers can be flexible depending on the ratio of short-term acute patients and long term chronic patients.

An Estimation of Optimal Medical Manpower in Mental Hospital / 신경정신의학

OBJECTIVES: The purpose of this study is to surmise appropriate level of medical manpower of mental hospital from the perspectives of clinical experts, psychiatrist and psychiatric nurse. METHODS: First, we wlleded data on medical manpower of domestic mental hospitals and foreign mental hospitals. Next, psychiatrists and psychiatric nurses were asked to complete a survey. We estimated the optimal level of medical manpower examining appropriate volume of medical services that should be provided for psychiatric patients, and analizying the survey carried out by direct questions. RESULTS: The number of psychiatrists of group A of private mental hospitals was 1.7 times more than that of public mental hospitals; when the number of psychiatrists in public mental hospitals was regarded as 1.0, and group B of private mental hospitals was 0.5 times, and the university hospitals 8.2 times. The number of psychiatric of group A of private hospitals was 1.5 times more than that of public mental hospitals; when the number of psychiatric nurses in public mental hospitals was regarded as 1.0, the group B of private mental hospitals was 0.6 times and university hospitals was 2.6 times. The foreign mental hospitals had more medical manpowers in all occupations than domestic mental hospitals. The number of psychiatrists estimated according to the first method was 11.1 persons and the number of psychiatric nurses was 26.3 persons per 100 beds, and the number of psychiatrists estimated according to the second method was 4.3 persons per and the number of psychiatric nurses was 20.8 persons per 100 beds. CONCLUSION: The estimated optimal number of psychiatrists for mental hospital is 4.3 persons and of psychiatric nurses was 20.8 persons per 100 beds. However, these numbers can be flexible depending on the ratio of short-term acute patients and long term chronic patients.

Impact of Age at Onset of Menarche on Subsequent Courses in Women with Schizophrenia / 신경정신의학

OBJECTIVES: The protective effects of estrogen against the development of schizophrenia have been investigated in various perspectives. Previous studies showed patients with earlier age of menarche had later onset of schizophrenia and less frequent admissions. This study was performed to evaluate the effect of the age of menarche on subsequent courses including hospitalizations, suicidal attempts, physical harm to others, and psychotic symptoms in women with schizophrenia. METHODS: Self-report menarche age, onset of psychotic symptoms, and clinical status were collected in a sample of 108 premenopausal women with the diagnosis of schizophrenia. RESULTS: There was significant correlation between the age of menarche and the frequency of admissions (r=.321, p=.006). Also, patients with history of physical harms to others showed later age of menarche than those without (t=2.025, df= 106, p=.045). CONCLUSION: In women with schizophrenia, the age of onset of menarche affects subsequent courses indicated by frequency of admissions and violent behaviors. It is suggested that identifying the age of menarche might be helpful to predict the courses in women with schizophrenia. Further investigations regarding the relationship between estrogen and the courses of schizophrenia in women are needed.

Impact of Age at Onset of Menarche on Subsequent Courses in Women with Schizophrenia / 신경정신의학

OBJECTIVES: The protective effects of estrogen against the development of schizophrenia have been investigated in various perspectives. Previous studies showed patients with earlier age of menarche had later onset of schizophrenia and less frequent admissions. This study was performed to evaluate the effect of the age of menarche on subsequent courses including hospitalizations, suicidal attempts, physical harm to others, and psychotic symptoms in women with schizophrenia. METHODS: Self-report menarche age, onset of psychotic symptoms, and clinical status were collected in a sample of 108 premenopausal women with the diagnosis of schizophrenia. RESULTS: There was significant correlation between the age of menarche and the frequency of admissions (r=.321, p=.006). Also, patients with history of physical harms to others showed later age of menarche than those without (t=2.025, df= 106, p=.045). CONCLUSION: In women with schizophrenia, the age of onset of menarche affects subsequent courses indicated by frequency of admissions and violent behaviors. It is suggested that identifying the age of menarche might be helpful to predict the courses in women with schizophrenia. Further investigations regarding the relationship between estrogen and the courses of schizophrenia in women are needed.

Comparison of Therapeutic Effects actor Side Effects between Nemonapride and Haloperidol Treated Schizophrenic Patients / 대한정신약물학회지

OBJECTIVE: This open prospective study was performed to investigate the therapeutic efforts and side effects profiles of nemonapride in the schizophrenic patients, and was compared with one of typical anti-psychotics, haloperidol. METHOD: Sixty male or female schizophrenic patients were treated for 12 weeks with nemonapride(n=32) and haloperidol(n=28). The overall clinical therapeutic effects were assessed at baseline, 1st week, 2nd week, 4th week, 8th week and 12th week using the PANSS, the BPRS and the CGI scale. Also, the overall clinical side effects were assessed in the same time period using ESRS, UKU side effect rating scale and global assessment for side effect scale. RESULTS: There were not a significant differences in PANSS score(total, positive, negative and general psychopathology subscale), BPRS(total score), CGI scale score between nemonapride and haloperidol trial groups. And also, there were not a significant differences in the ESRS, the UKU side effect rating scale, the Global assessment far side effect stale score between nemonapride and haloperidol trial groups. 59% of the nemonapride-treated patients(n=32) were categorized as treatment responders, who showed at least a 20% decrease in total PANSS score at baseline state, was compared with 64% of haloperidol-treated patients(n=28). 72% of the nemonapride-treated patients were categorized as treatment responders, who showed at least a 20% decrease in total BPRS score at baseline state, compared with 68% of haloperidol-treated patients. There were not significant differences in these both treatment responder groups. CONCLUSION: There were no significant differences in the therapeutic effects and side effects profiles of nemonapride and haloperidol groups.

The Effect of Estrogen on Cognitive Functions in Schizophrenic Patients / 대한정신약물학회지

OBJECTIVE: This study was performed to evaluate the effect of estrogen on cognitive functions in schizophrenic patients. METHODS: Neuropsychological tests such as Paired Associate Learning Test, Complex Figure Test, Trail Making B Test, Performance IQ Test Subscales were applied to 15 normal controls, 16 estrogen treated schizophrenic patients and 15 control schizophrenic patients. The schizophrenic patients were retested with the same instruments after 4 weeks and 8 weeks of study period and psychopathology was assessed in the same patients before and at 2 weeks, 4 weeks, 6 weeks and 8 weeks of study using BPRS and PANSS. RESULTS: Cognitive impairment was found in each measure of memory, attention, executive function in schizophrenic patients as compared with the normal controls. After 8 weeks of estrogen treatment, significant improvement occurred in executive function and probable improvement occurred in memory and attention in schizophrenic patients. CONCLUSION: Short-term treatment with estrogen may possibly improve parts cognitive functions of schizophrenic patients and we expect, schizophrenic patients with long term estrogen treatment will be improved in other cognitive fuctions.

The Dopamine D2 Receptor Locus as a Modifying Gene in Korean Schizophrenia, Alcoholism and Drug Addiction

The authors attempted to examine the allelic association between the A1 allele of Dopamine D2 receptor and schizophrenia, alcoholism, drug addiction in Koreans. Schizophrenic patients(n=31), alcoholism(n=65), drug addiction(n=18) and controls(n=52) were examined by case-control study for distribution of the Taql polymorphism of the dopamine D2 receptor gene in Korean population to minimize the effect of racial differencies in gene frequencies. In schizophrenics, the numbers of schizophrenics with A1A1, A1A2, A2A2 were 9(29%), 15(48%) and 7(22%) respectively and in alcoholics with A1A1, A1A2, A2A2 were 14(21.5%), 36(55.4%) and 15(23.1%) respectively and in drug addiction with A1A1, A1A2, A2A2 were 4(7.6%), 24(46.2%) and 24(46.2%) respectively. The prevalence of the A1 allele in schizophrenics, alcoholics, drug addiction and controls were 77%, 76.9%, 67% and 53.8% respectively. And the frequency of the A1 allele in schizophrenics, alcoholics, drug addiction, and controls were 0.53 0.49, 0.39 and 0.31 respectively. There was significant difference in the frequency of the A1 allele between schizophrenics, alcoholics and controls. We also classified our alcoholic population. For classification by severity, we used the median MAST score 30 in our samples. There was also significant difference in the frequency of the A1 allele between less severe group(0.42) and more severe group(0.57). This data suggest that the A1 allele is associated with schizophrenia and alcoholism in Korean. Furthermore the prevalence of the A1 allele increased in more severely affected alcoholics. The authors conclude that our data support an allelic association between the A1 allele at dopamine D2 receptor and schizophrenia, alcoholism. These results suggest the A1 allele of the DRD2 gene is associated with a number of behavior disorders in which it may act as a modifying gene rather than as the primary etiological agent.