Needs Assessment of the Chronic Mentally Ill with Low Income Living in the Community / 신경정신의학

OBJECTIVES: The purposes of the study were to assess the unmet needs of the chronic mental ill in low income class living in community and to provide basic data for developing services and programs in community mental health. METHODS: Face to face interviews were done for the subjects (n=320) who were diagnosed as schizophrenia, major depressive disorder, and bipolar I disorder. The Korean version of Camberwell Assessment of Need Short Appraisal Scale (CANSAS) was used as the assessment tool of the needs. Frequencies and rates of met needs and unmet needs of each 22 items of CANSAS were estimated. We classified 22 items into six need areas by operational definition, and then estimated mean percentages of unmet needs and met needs for each 6 need areas. We also classified subjects into 2 groups by the presence of psychiatric care needs, and then estimated mean percentage of unmet needs for other 5 need areas according to psychiatric care needs. RESULTS: Among the respondents, 77.7% of them had no spouses, and 66.4% had the education of six years and over. Of the respondents, 53.8% were males, 46.2% females. And 74.3% used medical aid in social security. Most respondents did not have present occupations and persons who were living with their parents were 48.3% and persons living alone reached 8%. The diagnosis of schizophrenia was 60.9%, major depressive disorder 15.2%, respectively. Most respondents (73.6%) had been admitted to the hospitals, but they hardly used rehabilitation services or programs during the daytimes. In estimating the unmet needs for each 22 items of CANAS, the need of company of others was the highest and that of welfare benefit and daytime activity were next. Information for treatment, intimate relationship, psychological distress, money, and psychotic symptoms follow the order. The mean percentages of unmet needs for each 6 needs area were 29.5% for income needs, 26.9% for social relation needs, 17.0% for physical care needs, 14.2% for psychiatric care needs, 11.6% for daily living skill needs, and 9.6% for residency needs. We classified subjects into 2 groups by the presence of psychiatric care needs: 49% of the subjects had no psychiatric care needs and 51% had psychiatric care needs. The group that had psychiatric care needs also had higher mean percentage of unmet need in 5 other needs areas than group that had no psychiatric care needs. And these results showed statistically significant except residency needs area. CONCLUSION: When preparing services or programs in community mental health, occupational rehabilitation and social support should be included as basic services. Other services such as physical treatment, psychiatric treatment, social skill training, and residency could be considered as optional.

An Association Study between Alcohol Dependence and Candidate Genes / 신경정신의학

OBJECTIVES: This study was to explore the association between alcohol dependence and five candidate genes related to the metabolism of alcohol and the enzymes of the suspected sites in CNS. METHODS: The genotype and allele frequencies of five candidate genes in 128 male hospitalized patients who met DSM-IV criteria for alcohol dependence were compared with 128 age-matched healthy male control subjects using polymerase chain reaction and restriction fragment length polymorphism. A logistic regression analysis was applied in order to exclude the reciprocal interactions among five candidate genes. RESULTS: The NN genotype frequency of the ALDH2 gene was significantly higher in alcoholic patients than in control subjects(chi-square test, p<0.001). No difference in frequency was found in the other four genes. In a logistic regression analysis, the odds ratio for alcohol dependence in the NN genotype of the ALDH2 gene and AG or GG genotypes of the N glycosylation site on the ASA gene were 130.312(95% confidence interval, 17.22-986.43) and 2.344(95% confidence interval, 1.128-4.871), respectively. CONCLUSION: The result reiterates the association of the ALDH2 gene polyporphism and the alcohol dependence. Logistic regression analysis additionally suggested that the N-glycosylation site on the ASA gene was associated with alcohol dependence.

Polymorphism of Tryptophan Hydroxylase Gene in Alcohol Dependent Patients / 신경정신의학

OBJECTIVES: This study was performed to explore the association of tryptophan hydroxylase(TPH) gene with diagnosis of alcohol dependence and/or clinical characteristics such as age of onset, family history, and severity of symptoms in Korean alcoholics. METHODS: The genotype and allele frequencies of TPH in 100 male hospitalized patients who met DSM-IV criteria for alcohol dependence were investigated using polymerase chain reaction and restriction fragment length polymorphism and were compared with 100 agematched healthy male control subjects. And the associations between gene polymorphisms and clinical characteristics in alcoholic patients were explored. RESULTS: The distributions of TPH genotype and allele in alcohol dependent patients were not different from control subjects. However, the frequencies of TPH genotype in early-onset alcoholic patients, which were 0.57, 0.39, and 0.04(AA, AC and CC, respectively), were significantly different from those of late-onset alcoholics(0.34, 0.45, and 0.21, respectively). "A" allele was found more frequent in early-onset alcoholics. CONCLUSION: The result suggests that TPH gene polymorphism is associated with early-onset alcoholic patients possibly related with inherited abnormalities of serotonin system.

The Psychological Attributes of Aesthetic Plastic Surgery Patients and Effects of Aesthetic Plastic Surgery / 신경정신의학

OBJECTIVES: Along with the fact that people change their attitude on aesthetic surgery, many people become to have positive viewpoint on aesthetic surgery. However, according to the recent study result, it showed that aesthetic surgery patients tend to have psychopathology. To investigate effects of aesthetic surgery and tendency of aesthetic surgery patients which is presumed to be changed, various psychological evaluations were performed in the sample who had undergone aesthetic surgery. Also psychiatric and psychological attributes of aesthetic plastic surgery patients were compared with those of reconstructive surgery group and those of normal controls. METHOD: 50 of reconstructive surgery group and 50 of normal control group were selected from Dept. of Plastic Surgery of Chungbuk National University Hospital and two private plastic surgery clinics in Cheong-ju. To find out each group's psychological attributes, pre- and post-operative psychological conditions were evaluated by administering basic survey, body image scale, ego identity scale, and SCL-90-R. RESULT: 1) Patients in the group of reconstructive surgery received more stress than those in the group of aesthetic surgery and normal controls. 2) There were no significant differences in the scores of body image scale, ego identity scale and SCL-90-R between reconstructive surgery group and normal control group. 3) After aesthetic surgery, aesthetic surgery group showed improvement in almost every item in SCL-90-R, such as somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, paranoid ideation, GSI, PSDI and PST sub-scales. 4) The factors which affected on the satisfaction after surgery among group of aesthetic surgery were self-acceptance, uniqueness in self-identity scale and obsessive-compulsive, somatization in SCL-90-R. When self-acceptance was low and self-uniqueness was high, satisfaction was high. And the more patients complained about physical symptom, satisfaction was low. 5) The factors which influenced on the opinion of re-operation among group of aesthetic surgery were stability in self-identity scale, obsessive-compulsive and somatization in SCL-90-R, and physical health in body image scale. When stability was low, complaints about physical symptoms were high, viewpoint on one's health was negative and the chance of re-operation was high. 6) In group of aesthetic surgery, the higher the expectation was before surgery, the lower the satisfaction was after surgery. CONCLUSION: As described in above study result, patients who planned to have aesthetic surgery were not different from common people in terms of psychopathology. And it was also found that aesthetic surgery could improve patients' mental health. If simply administrable evaluation method to measure complaints about physical symptoms, viewpoint on one's health, stability and obsessive-compulsive is invented in the near future, it will be possible to screen patients who are likely to have low satisfaction after surgery and high tendency to have re-operation.