A Survey on Petition and Process for the Extension of Hospitalization in Mental Hospital / 신경정신의학

OBJECTIVES: The authors performed this survey to find out current status of petition and process for the extension of hospitalization of patients who were hospitalized more than 6 months. METHODS: Authors designed a questionnaire named 'Questionnaire for Survey of Current Status and Process of Petition for Extension of Hospitalization of Psychiatric Patients' and distributed it to 242 psychiatric facilities with closed wards for psychiatric patients. The psychiatric facilities includes 4 categories;psychiatric department of university hospital, psychiatric department of general hospital, psychiatric hospital and small sized private clinic. The period of survey was from Jan. 1 to Dec. 31 of 2002. RESULTS: Among 84 psychiatric facilities responded, 2,615 petitions for extension of hospitalization were submifted to the Local Mental Health Tribunal, and the dissent rate was 4.1%. The most of petitions were from psychiatric hospitals (2,265). The psychiatric departments of general hospitals favored the discharge-readmission method rather than applying extension by due process of the Mental Health Act when further admission was needed after 6 months hospitalization (280 vs. 106). The main reason for the petitions for extension of hospitalization was "no improvement" (72.7%) than "dangerousness to self or others" (14.7%). Against doctor's recommendation for discharge agter improvement, many patients couldn't be discharged becanse of guardians' refusal or cut off from caregiver or guardian. In cluded were these patients applied petitions for extension of hospitalization. CONCLUSION: This study suggests that hospitalization of some patients are extended improperly in view of the spirif of the Mental Health Act. The authors proposea new system of ambulatory treatment, reinforcement of psychiatric rehabilitation, legal control of the neglected patient by guardians.

A Three Month Placebo-Controlled Clinical Trial of INM 176 in the Old Aged Subjects with Memory Impairment / 신경정신의학

OBJECTIVES: We examined the effects of INM 176 (K-1107) compared with placebo on the cognitive functions of 92 old aged subjects with cognitive impairment. METHODS: This was a prospective, 12 week, double-blind, placebo-controlled clinical trial. The elderly who achieved a score of less than 25 points on the K-MMSE or showed a high risk of Alzheimer's disease from the 7-Minute Neurocognitive Screening Battery were considered to have objective impairment and were selected as subjects for this study. The subjects were randomized to placebo or INM 176 group. The outcome measures were from the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Instrumental Activities of Daily Living (IADL) and the Korean Geriatric Depression Scale (KGDS) and two kinds of computerized priming tests. After setting the total error score in the Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-cog) as the repeated measurement factor, an analysis of variance of the combined factor design was done between the placebo and INM 176 group. RESULTS: The interaction effect of time (pre- and post- trial) and group (placebo and INM 176 group) was significant in the analysis of the ADAS-cog's total error score. The INM 176 group's total error score in the ADAS-cog decreased significantly (p<0.01), whereas the placebo group showed a slight increase. The mean changes in IADL and GDS from baseline scores favored in the INM 176 group than in the placebo group. Outcome changes of ADAS-cog, IADL, KGDS scores during the 12 week clinical trail of INM 176 and placebo demonstrated favorable responses in the INM176 administered group. CONCLUSIONS: This is a preliminary clinical trial result of INM176 as a memory pill. Based on these results, INM176 may be a candidate molecule for the improvement of cognitive functions, including memory. Further clinical trial should demonstrate its efficacy.

A Survey on The Current Status of Mental Health Act Application / 신경정신의학

OBJECTIVES: The purpose of this study is to find out how the Mental Health Act(MHA) which was enacted in 1995 has been practiced in reality since it was enforced. This study focuses on the following provisions of this law; admission procedures in relation to the protection of patients' rights, discharge procedures in view of the human rights, and the conditions of the restriction of the patients' rights in hospital. METHODS: The questionnaire on "the current state of the application of the MHA" was designed by the authors and was distributed by mail to 213 psychiatric hospitals and general hospitals which operate psychiatric closed wards as of 1999. RESULTS: One hundred ten hospitals responded to the survey(51.6%) and 92.5% of the total admission to the closed ward were by 'admission by agreement of guardian'(article 24 of MHA). It was reported that a written agreement paper of guardian was filed in 98% and the official document(for the article 14 of rule for enforcement of MHA) for legal guardianship was filed in 85 % of these ad-missions respectively. However, the rate of filling the official document is actually below 85% accor-ding to the direct telephone confirmation. Other kind of admissions such as 'admission by the order of head of prefecture(article 25 of MHA) and 'emergency admission'(article 26 of MHA) were not performed except in several psychiatric hospitals. There cases no report regarding the patient's or guardian's appeal for the improvement of patient's right and better treatment and/or disagreement to involuntary admission. Sixty three percent of hospitals reported that the patients were free to use telephone, and 18.1% reported that the official forms to appeal human right violation of the institute were accessible to patients. However, the actual rates are suspected to be lower than the reports by the institutes. Petition for extension of hospital stay requested by the doctor in charge(article 24-3 of MHA) was submitted mostly by psychiatric hospitals, and its rejection rate was 3.7%. CONCLUSION: In case of 'admissions by agreement of guardian', the required qualification for guardianship and the accompanying document to prove the legal guardianship should be amended to make it more realistic. For other kinds of admissions, such as 'emergency admission' and 'admission by order of head of prefecture', admission procedure should be modified to make it more efficient and practical. The rules and regulations for the human rights of psychiatric patients are not observed properly, which needs much improvement. As this study was done by a survey, it has limitation in understanding how the MHA is actually applied and therefore msufficient as data for the use of revising the Act. However, it appears that MHA is not properly observed with problems in applying MHA in practice. The information obtained from this study suggests that extensive study on national level should be done to find out how the MHA is practiced in reality with much discussion on improving the MHA on the basis of its finding.

Cognitive Dysfunctions and Soft Neurological Signs in Schizophrenic Patients / 신경정신의학

OBJECTIVES: Clinical studies have shown cognitive dysfunctions and soft neurological signs in schizophrenic patients and these findings have been suggested as evidence of organic bases in the pathophysiology of schizophrenia. This study was intended to investigate the characteristics of cognitive deficits and soft neurological signs in schizophrenia and, to determine whether any abnormality in these functions can be regarded as a trait marker of the illness which is independent of antipsychotic treatment and clinical improvement. We also investigated the correlation between cognitive deficits and soft neurological signs reflecting cognitive dysmetria, respectively. METHODS: Twenty schizophrenic patients were assessed for the soft neurological signs and cognitive functions before and after neuroleptic treatment. The patients had been medicated for at least 3 weeks with one of the atypical neuroleptics. Cognitive functions were evaluated by Trail making A, B, Stroop test and Word fluency test. Soft neurological signs were assessed by Cambridge Neurological Inventory(Part 2). Positive and Negative Syndrome Scale(PANSS) and Clinical Global Impression(CGI) were used to assess the clinical severity and Extrapyramidal Symtoms Rating Scale was used to estimate the extrapyramidal symptoms. Cognitive functions and soft neurological signs of twenty normal controls were assessed with the same scale. RESULTS: Before treatment, schizophrenic patients showed significant impairments on cognitive function tests(Trail Making A, B, Stroop Test) and soft neurological sign tests(8 items:Grasp reflex, Go/no-go, Finger thumb opposition, Rhythm tapping, Finger agnosia, Fist-edge-palm, Left-right orientation, Extinction). Although significant clinical improvements were observed after the treatment, there were no significant changes in cognitive functions and soft neurological signs(except for Go/no-go test and Finger agnosia). Among the soft neurological signs of the patients, abnormality in Rhythm tapping was significantly correlated with cognitive deficits. CONCLUSION: Schizophrenic patients showed characteristic cognitive deficits and soft neurological signs which were independent of medication and clinical symptoms. And these two characteristics were partly correlated with each other.

Visual Information-Processing in Deficit and Nondeficit Schizophrenic Patients / 신경정신의학

OBJECTIVES: Previous studies of cognitive impairment in schizophrenia suggest that negative syndrome can be characterized by specific impairments in visual information-processing. We examined the possibility of such cognitive impairments as a a trait marker of 'deficit' syndrome group characterized by persistent primary negative symptoms or schizophrenic patients as a whole. METHODS: The subjects were 35 schizophrenic patients in partial or full remission state and the controls were 25 volunteers screened for major mental illnesses in their 2nd degree relatives. The patients were divided into deficit & nondeficit groups based on Schedule for the Deficit Syndrome and they showed positive, depressive or extrapyramidal symptoms of minimal to mild degree. Performance on various cognitive tasks associated with visual information-processing was examined. RESULTS: Deficit and nondeficit groups showed no significant difference in age of onset, duration of illness, the severity of positive and depressive symptoms and dose of antipsychotics. Deficit group performed significantly less well than normal control group on Continuous Attention Test. Significant difference was found between the patients groups and normal control group on Vigilance Test, Signal-Detection Test, and in decision time of Reaction Unit Tests. There were no significant differences among three groups on the tasks of visual immediate memory, visual analysis, motor reaction, and fine motor control. No cognitive variable was correlated to duration of illness, the severity of positive and depressive symptoms, general psychopathology, and dose of antipsychotics. CONCLUSIONS: The results suggest that deficit syndrome might be characterized by the impairment of continuous attention to simple visual stimuli. Impaired vigilance to infrequent visual stimuli, selective auention to visual stimuli and delayed decision time in simple information-processing tasks which were not related to various clinical variables were suggested to be cognitive markers of schizophrenia.