Level of Psychological and Somatic Symptoms Predict Perimenopausal Syndrome Severity Better Than Obstetric and Psychiatric History Do Among Korean Women

Objective@#Menopause symptoms can vary in type, duration, and severity. The purpose of this study was to investigate the key factors predicting severe symptoms among Korean perimenopausal women with various demographic data, obstetric and psychiatric histories, and menopausal symptoms screening scale scores. @*Methods@#Data were collected from 1,060 women, and 4 latent classes were identified using latent profile analysis, with 6 major categories of menopausal complaints. Among the 4 classes, we selectively used data from the “all unimpaired” and “all impaired” groups. Menopause rating scale (MRS), sociodemographic, obstetric, and psychiatric factors were assessed, and hierarchical logistic regression analyses were conducted with the “all impaired” group as a dependent variable. @*Results@#Marital status and scores on the psychological and somatic subscales of the MRS were statistically related to being in the “all impaired” group. Otherwise, family history of menopausal symptoms, menarche age, and history of other psychiatric disorders were not statistically significant predictors of being in the “all impaired” group. @*Conclusion@#The psychological and somatic subscales of the MRS predict the severity of perimenopausal syndrome better than obstetric and psychiatric history do among Korean perimenopausal women. Psychological and somatic symptoms as well as genitourinary symptoms in menopausal patients should be closely evaluated.

Effects of Repetitive Transcranial Magnetic Stimulation on Improvement of Mental Health and Clinical Parameters in Depressed Hemodialysis Patients: a Pilot Study

Background@#This study aimed to evaluate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) as a nonpharmacologic treatment in depressed hemodialysis patients. @*Methods@#Patients who scored ≥ 5 on the Patient Health Questionnaire-9 were randomized to either the rTMS (n = 7) or sham group (n = 7). The rTMS group was stimulated with a 110% motor threshold and 10 Hz on the left dorsolateral prefrontal cortex for 20 minutes, three times a week, for 4 weeks. In the sham group, the “1-wing 90-degree method” was used. We analyzed clinical indices before and after the intervention, as well as data from quantitative electroencephalography (frontal alpha asymmetry [FAA]), and various psychiatric questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory [BAI], Symptom Checklist-90-Revised Somatization Subscale [SCL-90R-SOM]), and Perceived Stress Scale. @*Results@#One month after rTMS, the changes in hemoglobin A1c levels in the rTMS group were significantly greater than those in the sham group (F = 6.687, P = 0.032). The changes in BAI scores in the rTMS group were significantly greater than those in the sham group (F = 6.700,P = 0.025), and the changes in SCL-90R-SOM scores in the rTMS group were greater than those in the sham group (F = 4.943, P = 0.048). In addition, the changes in the FAA value at the F7 and F8 electrodes in the rTMS group were greater than those in the sham group (F = 6.468, P = 0.027). @*Conclusion@#In depressed hemodialysis patients, rTMS may improve anxiety and somatization symptoms, which may lead to improvements in clinical measures.

A Comparison of Risk and Protective Factors for Excessive Internet Game Play between Koreans in Korea and Immigrant Koreans in the United States

BACKGROUND: Studying immigrants may have the potential to explore how cultural and environmental changes affect the internet game play patterns of individuals in the two countries. We planned to compare risk and preventive factors for Internet Gaming Disorder (IGD) between Korean adolescents in Korea and immigrant Koreans in the US. METHODS: Ninety-four Koreans and 133 immigrant Koreans were recruited. Independent factors consisted of five domains including demographic data, physical activity, academic, art, and music activities, psychological factors, and game and media play. The dependent variable in the current study was the high-risk group of IGD, which was assessed with Young’s Internet Addiction Scale scores. To determine the protective and risk factors for IGD, we performed a multiple logistic regression analysis using the high-risk group as the dependent variable. RESULTS: Five domains affected the risk for IGD in Korean and immigrant Korean groups. Vigorous physical activity was the strongest protective factor for IGD in the Korean group, while media activity was the strongest protective factor for IGD in immigrant Koreans in the US. CONCLUSION: The results indicate that internet gaming problems might be affected by environmental factors and it is recommended that gaming activity is substituted with physical activity, extracurricular classes, books, and music.

Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients

BACKGROUND: Non-adherence and comorbidities are prevalent among hemodialysis patients and are associated with increased mortality and financial burden. We aimed to investigate the influence of major coping strategies (CSs) on non-adherence and comorbidities in hemodialysis patients. METHODS: A total of 49 patients were enrolled. We collected participant data including CS measured by a Korean version of the ways of coping questionnaire (K-WCQ), comorbidities measured by age-adjusted Charlson comorbidity index (CCI), and adherence measured by the 8-item Morisky medication adherence scale (MMAS-8). RESULTS: Regarding major CS, 61.2% of participants reported use of support-seeking CS (SUP group), 14.3% reported use of problem-focused CS (PRO group), and 24.5% reported use of hopeful-thinking CS (HOP group). The mean MMAS-8 score was higher in the PRO group than in the HOP group (P = 0.024). The mean CCI score was lower in the PRO group than in the HOP group (P = 0.017). In the HOP group, the severity of somatic symptoms was positively correlated with the scores for the emotion-focused CS subscale (r = 0.39, P = 0.029) and the hopeful-thinking CS subscale (r = 0.38, P = 0.036) of the K-WCQ. The level of life satisfaction positively correlated with the score for the problem-focused CS subscale in the HOP group (r = 0.40, P = 0.027). CONCLUSION: We should pay more attention to the CSs of hemodialysis patients and provide interventions that promote problem-focused CSs, especially for nonadherent patients with high comorbidity rates who mainly use a hopeful-thinking CS.

Comparison of QEEG Findings between Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) without Comorbidity and ADHD Comorbid with Internet Gaming Disorder

Internet gaming disorder (IGD) is often comorbid with attention deficit hyperactivity disorder (ADHD). In this study, we compared the neurobiological differences between ADHD comorbid with IGD (ADHD+IGD group) and ADHD without comorbidity (ADHD-only group) by analyzing quantitative electroencephalogram (QEEG) findings. We recruited 16 male ADHD+IGD, 15 male ADHD-only adolescent patients, and 15 male healthy controls (HC group). Participants were assessed using Young's Internet Addiction Scale and ADHD Rating Scale. Relative power and inter- and intra-hemispheric coherences of brain waves were measured using a digital electroencephalography (EEG) system. Compared to the ADHD-only group, the ADHD+IGD group showed lower relative delta power and greater relative beta power in temporal regions. The relative theta power in frontal regions were higher in ADHD-only group compared to HC group. Inter-hemispheric coherence values for the theta band between F3–F4 and C3–C4 electrodes were higher in ADHD-only group compared to HC group. Intra-hemispheric coherence values for the delta, theta, alpha, and beta bands between P4–O2 electrodes and intra-hemispheric coherence values for the theta band between Fz–Cz and T4–T6 electrodes were higher in ADHD+IGD group compared to ADHD-only group. Adolescents who show greater vulnerability to ADHD seem to continuously play Internet games to unconsciously enhance attentional ability. In turn, relative beta power in attention deficit in ADHD+IGD group may become similar to that in HC group. Repetitive activation of brain reward and working memory systems during continuous gaming may result in an increase in neuronal connectivity within the parieto-occipital and temporal regions for the ADHD+IGD group.

Comparison of Electroencephalography (EEG) Coherence between Major Depressive Disorder (MDD) without Comorbidity and MDD Comorbid with Internet Gaming Disorder

Internet gaming disorder (IGD) has many comorbid psychiatric problems including major depressive disorder (MDD). In the present study, we compared the neurobiological differences between MDD without comorbidity (MDD-only) and MDD comorbid with IGD (MDD+IGD) by analyzing the quantitative electroencephalogram (QEEG) findings. We recruited 14 male MDD+IGD (mean age, 20.0 ± 5.9 years) and 15 male MDD-only (mean age, 20.3 ± 5.5 years) patients. The electroencephalography (EEG) coherences were measured using a 21-channel digital EEG system and computed to assess synchrony in the frequency ranges of alpha (7.5–12.5 Hz) and beta (12.5–35.0 Hz) between the following 12 electrode site pairs: inter-hemispheric (Fp1–Fp2, F7–F8, T3–T4, and P3–P4) and intra-hemispheric (F7–T3, F8–T4, C3–P3, C4–P4, T5–O1, T6–O2, P3–O1, and P4–O2) pairs. Differences in inter- and intra-hemispheric coherence values for the frequency bands between groups were analyzed using the independent t-test. Inter-hemispheric coherence value for the alpha band between Fp1–Fp2 electrodes was significantly lower in MDD+IGD than MDD-only patients. Intra-hemispheric coherence value for the alpha band between P3–O1 electrodes was higher in MDD+IGD than MDD-only patients. Intra-hemispheric coherence values for the beta band between F8–T4, T6–O2, and P4–O2 electrodes were higher in MDD+IGD than MDD-only patients. There appears to be an association between decreased inter-hemispheric connectivity in the frontal region and vulnerability to attention problems in the MDD+IGD group. Increased intra-hemisphere connectivity in the fronto-temporo-parieto-occipital areas may result from excessive online gaming.

The Correlation between Clinical Symptoms, Serum Uric Acid Level and EEG in Patient with Bipolar I Disorder / 신경정신의학

OBJECTIVES: High uric acid level is related to increased locomotor activities and refractory mood swings. The purpose of this study is to examine the correlation between clinical symptoms of mania, serum uric acid level, and quantitative electroencephalography (QEEG) findings. METHODS: Twenty-four patients with bipolar disorder and 24 healthy control subjects agreed to participate in the study. When they were hospitalized, the degree of clinical symptoms, uric acid level in blood, and brain QEEG were measured. RESULTS: The bipolar disorder group showed higher scores on the Young Mania Rating Scale (YMRS ; z=6.02, p<0.05). Patients in their manic episodes showed higher plasma uric acid levels (4.9+/-1.3 mg/dL) than healthy control subjects (4.2+/-0.9 mg/dL ; z=2.14, p<0.05). Uric acid levels showed correlation with severity of manic symptoms as assessed using the YMRS in all participants (rho=0.28, p<0.05). The bipolar disorder group showed decreased relative delta and alpha activity in the fronto-temporo-occipital region compared to the control group (p<0.05). Relative beta in Fp1 (frontopolar), Cz (central mid-line), and Pz (parietal mid-line) and relative gamma in Fp1 were increased in the bipolar disorder group, relative to the control group (p<0.05). The relative beta (rho=0.47, p<0.05) and gamma (rho=0.41, p<0.05) in Fp1 electrodes showed positive correlation with the YMRS scores. CONCLUSION: Adenosinergic transmission dysfunction may lead to occurrence of manic symptoms, considering that a key role of central nervous system adenosinergic receptors is to inhibit the release of various neurotransmitters and limit neuronal excitability. In addition, QEEG appeared to indicate excitatory neuro-modulation in manic patients.

Spontaneous Unbuckling of the Adjustable Gastric Band; A Rare Complication

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.

Short-term Experience of Laparoscopic Greater Curvature Plication in Morbidly Obese Korean Patients

PURPOSE: Laparoscopic greater curvature plication (LGCP) is the new emerging surgical technique for treating morbid obesity. The short-term results of LGCP are not yet available in Korea. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected 18 patients' data with over 30 kg/m2 body mass index (BMI) who underwent LGCP from January 2013 to October 2014. Fifteen of these patients who had more than 3 months of follow-up were included in this report. LGCP was performed laparoscopically using interrupted and continuous sero-muscular suture from fundus to antrum over a 36-French bougie. RESULTS: Mean age at the time of surgery was 33.1+/-7.9 years in our patients. Mean weight was 98.9+/-15.5 kg and mean BMI was 35.7+/-4.1 kg/m2 preoperatively. The percentage of excess BMI loss (%EBL) in the postoperative first, third and sixth month was 33.6+/-9.1, 51.6+/-15.4 and 64.5+/-18.3%, respectively. There were no 30-day peri-operative mortality and major complications including bleeding, leakage and conversion bariatric surgery. CONCLUSION: These findings show that LGCP is a safe and effective weight loss option for morbidly obese Korean patients in short-term period. Randomized prospective control studies between gastric banding or sleeve gastrectomy and LGCP, are needed to confirm short-term weight loss effect and safety of LGCP in this group of patients.

Conversion Sleeve Gastrectomy for Pouch Dilatation and Band Scar Stenosis: 1 Case

Esophageal and gastric pouch dilatations are common complications that occur after laparoscopic adjustable gastric banding, often performed to treat morbid obesity. Most cases are treated by a gastric band deflation or a removal of band. Nevertheless, additional surgical procedures are rarely ever needed to treat persistent dysphagia and pouch dilatation. We report here, the case of a 38-year-old woman with constant vomiting and severe persistent epigastric pain despite the gastric band deflation, and a band scar stenosis, treated via laparoscopic conversion sleeve gastrectomy. Surgical band scar revision, or revision sleeve gastrectomy, may be considered if gastric pouch dilation and dysphagia are not treated by gastric band deflation.

Acute Gastric Band Slippage During the 3rd Trimester Gestation

Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure in South Korea, and the majority of female patients who receive LAGB are of childbearing age. Due to possible band-related complications, careful evaluation is required for those who become pregnant after LAGB procedures. A 28-year-old female, gravida 1, para 0, who had undergone LAGB two years earlier presented to the clinic at the 31st week of gestation. She had experienced acute epigastric pain and vomiting for one week. She was diagnosed with gastric band slippage. She underwent cesarean section and laparoscopic gastric band removal at the 35th week of gestation. Management of gastric band slippage during the third trimester is difficult, especially before the 34th week of gestation. We report on a case of medical and surgical treatment of gastric band slippage during the third trimester.