Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Bile leaks remain a significant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration with laparoscopy and ligation of the injured subvesical duct should be considered. We present herein the case of a 31-year-old woman with refractory bile leakage from a disrupted subvesical duct after cholecystectomy that could not be managed with endoscopic sphincterotomy and plastic-stent placement. A newly designed, fully covered, self-expandable metal stent (FC-SEMS) was successfully placed for the treatment of refractory bile leaks in this patient. It appears that temporary placement of an FC-SEMS is technically feasible and provides an effective alternative to surgical therapy for refractory bile leaks after cholecystectomy.

Accept or Refuse? A Pilot Study of Patients' Perspective on Participating as Imaginary Research Subjects in Schizophrenia

OBJECTIVE: The goal of the present study was to evaluate demographic and clinical factors that affect the intention to participate in commonly-conducted research in patients with schizophrenia. METHODS: Thirty-four outpatients with a diagnosis of schizophrenia were enrolled in this study. They were asked whether they would have any intention to participate in four imaginary studies: a simple questionnaire, a genetic study, a study of complex tasks and a risky study. We analyzed the differences in general psychopathology, insight and demographic characteristics of the participants according to their responses (acceptance or refusal) to the four proposed studies. RESULTS: Younger and better-educated patients tended to decline participation in a risky study. Patients with a longer duration of regular psychiatric follow-ups tended to willingly participate in the simple questionnaire. There were no overall statistical differences in general psychopathology and insight between patients who agreed or declined to participate in studies. CONCLUSION: Age and education level may be factors that influence decisions to participate in schizophrenia studies. Further research is needed to confirm and expand on the current findings.

Depressive Symptoms and Associated Factors in Caregivers of Patients with Chronic Mental Illness / 신경정신의학

OBJECTIVES: It has been reported that caregivers of patients with chronic mental illness including schizophrenia are in higher risk for psychological and physical health problem. This study was performed to evaluate the depressive symptoms and associated factors in caregivers of patients with chronic mental illness. METHODS: The subjects were 77 unaffected caregivers (30 parents, 30 siblings, 10 offspring, and 7 spouses) of patients with chronic mental illness (62 schizophrenia, 4 schizoaffective disorder, 11 bipolar disorder) and 100 healthy controls. Depressed mood was assessed by Beck Depression Inventory (BDI) in all subjects. For their sick family members, clinical factors including psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS), duration of illness, number of admission were assessed. RESULTS: The mean BDI score of the caregivers was significantly higher than that of control subjects (11.2+/-11.6 and 8.0+/-7.5). Given that 23.4% of family group and 23.0% of control group are attributed to mild to moderate depressed state and 22.0% of family group and 8.0% of control group to above moderate depressed state, significant depressive symptom is more frequently observed in family group. The mean BDI score of parent group was higher than that of sibling group controlling for sex and age. In the parent group, BDI scores are positively correlated with age while the offspring and spouse group had negative correlation between BDI scores and age. Higher age, lower socioeconomic state, more severe positive symptom scores of patients were potential predictors for BDI scores of caregivers. CONCLUSION: This study showed that caregivers of patients with chronic mental illness have significant depressive symptoms. It may be suggested that depressive symptoms of caregivers are associated with aging, low socioeconomic state, and severe positive symptom rather than chronicity of their sick family members.

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.

The MMPI Profile of Adult Schizophrenia with Childhood Physical or Sexual Abuse / 신경정신의학

OBJECTIVES: The symptomatic and behavioral correlates of childhood trauma in schizophrenia are beginning to emerge in the literature. This study aimed to investigate whether the association between personality traits and schizophrenia with childhood abuse can be replicated in Koreans using the Multiphasic Minnesota Personality Inventory (MMPI). METHODS: Eighteen schizophrenias with childhood abuse and 24 schizophrenic comparisons without abuse history were recruited at the inpatient units of two general hospitals and the subjects completed the MMPI. RESULTS: Subjects with schizophrenia plus childhood history of abuse had less educational years (p<.001). After controlling the educational year as a covariate, abused schizophrenic patients had higher scores in the Schizotypal (p=.003), Dependent (p=.014), Passive-aggressive (p=.034), Borderline (p=.045) subscales. For the validity and clinical subscales, significant differences were found in the F scale (p=.036), Hypochondriasis (p=.042), Depression (p<.001), Hysteria (p=.002), Personality disorder (p=.001), Paranoia (p=.024), Psychasthenia (p=.001) and Schizophrenia (p=.006) subscales. CONCLUSION: Our findings suggest that childhood abuse in schizophrenia is associated with more complex features of personality characteristics rather than specific cluster B personality traits.

The Korean Version of 4th Revision of Schizophrenia Quality of Life Scale: Validation Study and Relationship with PANSS / 신경정신의학

OBJECTIVES: The present study was performed to verify the validity and value of 4th revision of Schizophrenia Quality of Life Scale (SQLS-R4) as an assessment tool in a Korean-language version (SQLS-R4K). METHODS: The subjects for present study were 174 patients with a diagnosis of schizophrenia as defined by DSM-IV. The SQLS-R4K was administered together with self-report Korean version of World Health Organization Quality of Life-Brief Scale (WHOQOL-BREF) to assess validity. A subset of respondents also completed the SQLS-R4K for a second time to assess test-retest reliability. To evaluate the relationship SQLS-R4K and clinical characteristics, psychotic symptoms and general functioning were evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning Scale (GAF) score respectively. RESULTS: All the scales of SQLS-R4K showed good internal consistency reliability. The correlations of items with their scale total revealed that all items were significantly correlated with their own scale score. In test-retest reliability, paired t-tests indicated that responses did not alter significantly between the two assessment. There was moderate correlation between WHOQOL-BREF sub-scores and SQLS-R4K score total. Also relevant correlations between PANSS, current GAF and SQLS-R4K were proved. CONCLUSION: From the results of the testing the reliability and validity of the SQLS-R4K, it is concluded that the SQLS-R4K is a simple and reliable scale for measuring quality of life in schizophrenic patients.

Temperament Characteristics of Internet Addiction in Adults / 신경정신의학

OBJECTIVES: Since mid-90s there have been numerous studies to understand and establish the concept of internet addiction as one of diagnostic classifications in psychiatry. Among them, many studies on the personality characteristics of internet addiction have been conducted. Recently, interests are expanding to temperament characteristics of internet addictors but the subjects have been limited to adolescents. In this study, the temperament characteristics of internet addiction in adults were investigated using Tridimensional Personality Questionnaire (TPQ). METHODS: 430 participants (189 males, 241 females) answered the on-line and off-line questionnaires from January to December in 2005. Participants completed questionnaires on demography and the onset of internet use, Young's Internet Addiction Scale and Korean Contracted Version of Cloninger's Tridimensional Personality Questionnaire (TPQ). RESULTS: There were statistically significant differences in age, marital status, occupation, psychiatric history, smoking history, alcohol history and onset age of internet use among non-addiction, overuse and addiction groups by Young's scale. Of the TPQ items harm avoidance (HA) scores were significantly higher in addiction and overuse groups than non-addiction group. Reward dependence (RD) scores were significantly lower in addiction group than non-addiction group. Novelty seeking (NS) scores were significantly higher in addiction group than non-addiction group. CONCLUSION: This study suggests a significant difference of novelty seeking in temperament characteristics between adults and adolescents with internet addiction. Further studies are expected for profound understanding of internet addiction.

The Reliability and Validity of the Korean Translation of the Gambling Symptom Assessment Scale(KG-SAS) / 신경정신의학

OBJECTIVES: The purpose of this study was to test the reliability and validity of the Korean translation of Gambling Symptom Rating Scale (KG-SAS). METHODS: Using self-report sampling, we eventually included 231 subjects and analysed 70 subjects. These subjects were tested for KG-SAS and the Korean version of Barratt Impulsiveness Scale (BIS). RESULTS: In the reliability test, Cronbach's alpha coefficient was .913 which provided the evidence for the internal consistency. Content validity was assessed with factor analysis and two factors were extracted. Compared with the original scale, both scales embody the same theoretical conceptualization. To assess the validity of the KG-SAS, correlation coefficient was calculated between the KG-SAS and the Korean version of BIS. We got the result that there was a correlation between the KG-SAS and the Korean version of BIS (p<0.01). CONCLUSION: The results of the present study support that the KG-SAS is a reliable and valid scale for evaluating pathological gambling symptom assessment. Based on the results, this study suggests that KG-SAS would be a promising measurement to treat and study pathological gambling.

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.