Sexual Problems of Healthy and Dementic Elderly in Korea / 신경정신의학

OBJECTIVES: The aging process can influence sexual functions by physiological, pathological, behavioral and psychosocial changes. Studies on sex among elderly are scarce. However, sexual activities remain throughout life in different forms. The aim of this study was to identify sexual problems and dysfunctions among dementia patients and compare with healthy aged persons. METHODS: The sexual problems and affecting factors were evaluated by structured interview and sexual problem screening instruments for 46 dementia patients according to DSM-IV and 60 healthy Koreans aged over 60. RESULTS: 1) Frequency of erection was less than once a day in 68.0% of controls, while more than once a day in 47.6% of dementia. Trouble in attaining erection was found in 50.0% of dementia as compared with 65.4% of controls. Awake with erection was less than once a week in 37.8% of controls, while less than once a week in 22.2% and more than once a week in 10.0% of dementia. Maintaining erection was better in controls (92.0%) as compared with dementia (55.0%)(pactivity). Satisfaction in sex life (41.7%), partner's satisfaction (31.8%), satisfaction with partner (45.5%) and men's interest in sex decline with age (54.5%) were higher in dementia (p<0.001, respectively). 2) The recognition of sexual problems was higher in healthy elderly (74.1%). Most of sexual dysfunctions except sexual desire disorder (83.3% in controls vs 40.0% in dementia) was higher in demetia, that is, erectile disorder (30.0%), premature ejaculation (20.0%), and orgasmic disorder (10.0%). The duration over 5 years of sexual problems was the most in both (46.7% in controls vs 53.3% in dementia). 3) Problematic sexual behaviors seen among dementia patients were obscene remarks/sexual hallucination (30.8%, respectively), public exposure (15.4%), inappropriate contact/physical contact with others/sexual seduction toward other patients (1.7%, respectively) in that order. Appea-rance time of sexual problems was over 1 year of dementia (50.0%), within 1 year of dementia (32.4%), and with the initiation of dementia (17.6%). The frequency was more than once a week in 60.0% and less than once a week in 40.0% of dementia. Place of sexual misbehavior was one's own room (68.6%), other place (22.9%), toilet (5.7%), activity therapy room (2.9%) in that order. Targets of sexual misbehavior were other patients (40.0%), caregivers (31.4%), medical personnel/others (14.3%, respectively) in that order. For the management of sexual misbehavior, most of the doctors chose non-pharmacological methods (83.9%). CONCLUSION: The sexual activity among Korean elderly with age over 60 was more active in healty controls than dementic patients, while sexual dysfunction except sexual desire disorder was more in dementic patients than healthy controls. Therefore, special interest and proper management was needed toward hypersexuality as well as sexual hypoactivity, and most of all, conceptual changes of doctors and caregivers toward sexual problems in the elderly must be preceded.

Change in the QTc Interval after Quetiapine Administration / 대한정신약물학회지

OBJECTIVE: Among causes of sudden death presumed to be related with use of atypical antipsychotics, all drugs which could induce torsade de pointes had been known to prolong QTc interval. Therefore, to monitor the changes of QTc interval on EKG seemed to be an important marker for the antipsychotic-induced cardiotoxicity, further to prevent sudden death due to fatal ventricular arrythmia. There are several studies and case reports about cardiac toxicity in some patients who were administered newly developed atypical antipsychotics. The aims of this study were to know whether quetiapine causes changes in QTc interval, and to identify affecting factors. METHODS: For the 31 inpatients (21 females, 10 males) with schizophrenia (N=25) or schizoaffective disorder (N=5), schizophreniform disorder (N=1) according to DSM-IV, the EKG monitoring was successively taken on baseline and the 2nd, 4th and 6th weeks after quetiapine administration, and serial changes of every EKG parameters including QTc interval was comparatively analyzed. Furthermore, variables such as cardiovascular risk factors (weight gain, hyperlipidemia, thyroid function, etc.), dose of drugs, drug combination, severity of psychotic symptoms, changes in the activity of autonomic nervous system despite of sex and age were also successively assessed on baseline and the 2, 4, and 6 weeks after quetiapine administration. RESULTS: 1) Every EKG parameters (heart rate, PR interval, QRS and QT) including QTc interval and diastolic blood pressure were not changed significantly on the 2, 4, and 6 weeks after quetiapine administration as compared with baseline. The systolic pressure was significantly declined form the 2 weeks after quetiapine administration as compared with baseline (p<0.05). 2) Among variables affecting the EKG parameters including QTc interval, age, dose of drugs, hyperlipidemia and thyroid function were not correlated with. However, the body weight on the 6 weeks after quetiapine administration had significant negative correlation with QT (gamma=-0.427)and QTc interval (gamma=-0.406), and the drug combination on the 6 weeks after quetiapine treatment had significant positive correlation with QRS (gamma=0.393) and QT (gamma=0.415), while severity of psychotic symptoms on the 4th week had correlation with QT (gamma=0.380) (p<0.05, respectively). Otherwise, the QTc interval on the 6 weeks after was significantly prolonged in female patients (p<0.05). CONCLUSION: Even though the administration of quetiapine did not cause significant changes in the QTc interval in this study, we need to pay attention toward the possibly related factors.

Factors Related to the Morale of Korean Elders

OBJECTIVES: The aims of this study were to assess the morale of Korean elders, to analyze the affecting factors, and to look for the ways to raise their morale. METHODS: The structured interviews and measurements of depression (Four-Item Geriatric Depression Scale and Vulnerability Factors), cognitive function (Short Portable Mental Status Questionnaire) and morale(Measurement of Morale in the Elderly Scale, MMES) were taken for the 50 Korean elders (28 females and 22 males) with age over 65 who were visiting Jong Myo during January to February in 2004. RESULTS: 1) In Korean elders, the mean scores of total MMES were 100.82+/-12.36. According to the items, mean scores of Satisfaction were 43.52+/-5.14, Equanimity 36.80+/-7.53, Will-to-live 20.00+/-4.43. 2) The total MMES scores were significantly affected by variables such as income (p<0.05), economy (p<0.005), elder abuse (p<0.01) and depression (p<0.001). While other variables including age, residence, education, number of children, sex, religion, spouse, job, illness and cognitive function were not related. CONCLUSION: To encourage morale in the Korean elders, economic support by welfarism, socio-legal prevention of elder abuse, and active involvement of geropsychiatrists into the early detection and treatment of depression must be needed.

Measurement of Interuncal Distance in Mild Cognitive Impairment

OBJECTIVES: The hippocampal atrophy has been known to be an important biological marker for the early diagnosis of mild cognitive impairment (MCI). The aims of this study are to disclose the differerence in the interuncal distance (IUD) between MCI, dementia of the Alzheimer's type (DAT) and healthy aged controls, and to identify the affecting factors. METHODS: In transaxial plane, the IUDs at the level of the suprasellar cistern on the T1-weighted images on the brain MRI were measured in patients with MCI (N=30), those with DAT (N=34), and healthy aged controls (N=20). Furthermore, demographic data about age, sex, educational level as well as cerebrovascular factors were obtained by structured interviews and medical records, and the severity of cognitive disorders were assessed using the Mini-Mental Status Examination (MMSE), the Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS). RESULTS: 1) The mean (+/-S.D.) IUD of DAT group (26.52+/-3.37 mm) was significantly different from that of healthy aged controls (24.35+/-2.91 mm)(p=0.044). However, there were no significant differences between IUD of MCI group (25.60+/-2.66 mm) and that of DAT group (p=0.483) as well as that of healthy aged controls and that of MCI group (p=0.363). 2) Variables such as age, sex, educational level, cerebrovascular risk factors and severity of cognitive disorder were not related to the IUD. CONCLUSIONS: The measurement of IUD on the brain MRI did not seem to be a helpful biological marker for the early detection of MCI in clinical practice.

Caregiver Burden for Dementia Patients

OBJECTIVES: The caregiver burden means emotional, social, financial, psychological, physical problems which could be experienced by occupational caregivers or families who cared disable patients. The caregiver burden affected by primary stressors (severity of disability in dementia patients) and secondary stressors (withdrawal from society, conflict between job and caregiving, loss of personal identity) may result in physical ill-health, depression, anxiety for the caregivers. The aims of this study were to assess caregiver burden in dementia, and to identify affecting factors. METHOD: 30 caregivers for dementia patients who had been treated at the "Dementia-Geriatric Mental Health Clinic" in the Kosin University Gospel Hospital and 44 healthy volunteers were selected. Using the Screen for Caregiver Burden (SCB), the degree of caregiver burden was measured. The demographic data was obtained by structured interview. Primary and secondary stressors were also analyzed. The severity of depression and anxiety was assessed by the Hamilton Depression Scale (HDS) and Hamilton Anxiety Scale (HAS). The severity of cognitive dysfunction (MMSE, CDR, GDS), behavioral symtoms (Revised Memory and Behavior Problems Checklist, RMBPC), daily functional disability (ADL, IADL) for the dementia patients were evaluated. RESULTS: 1) The SCB scores were significantly (p<0.001) higher in dementia caregivers (8.71+/-4.90) than in controls (0.23+/-0.48). 2) The SCB scores were not correlated with age of caregivers (gamma=0.081), education (gamma=-0.163), duration of caregiving (gamma=0.275). The RMBPC scores had statistically significant positive correlation with SCB scores (gamma=0.545, p<0.01), while age of dementia patients (gamma=-0.234), onset age of dementia (gamma=-0.280), duration of dementia (gamma=0.029), CDR (gamma=0.080), GDS (gamma=-0.125), MMSE (gamma=-0.212), ADL (gamma=-0.315), IADL (gamma=0.155) had not. 3) The SCB scores had statistically significant positive correlation with degree of secondary stress (gamma=0.581, p<0.01) and anxiety (gamma=0.376, p<0.05). The degree of secondary stress had statistically significant positive correlation with degree of emotional stress (gamma=0.757, p<0.01), depression (gamma=0.482, p<0.01), anxiety (gamma=0.376, p<0.01). CONCLUSIONS: The caregiver burden in dementia seemed to be originated from primary stressors related to the behavioral symptoms as well as secondary stressors (degree of emotional stress, depression, anxiety, etc.). Therefore, active intervention by the geriatric specialists might be helpful to reduce their strain.