Opinion of Experts about Psychiatric Evaluation after Trauma in Korea

OBJECTIVES: The evaluation of disability after trauma in psychiatry is relatively subjective compared with other departments. A consensus among evaluators could improve reliability of evaluations. We compared disability rate of common psychiatric disorders without definite brain injury depending on their diagnosis from experienced evaluators in Korea. METHODS: A written questionnaire was mailed to each evaluator and the reply was analyzed. The questions included disability rate ranges of postconcussional syndrome, PTSD and depression. Other questions related with admission for evaluation, expected duration of treatment, life expectancy and need of supporting person were also asked. RESULTS: Range of disability rate were from 8.6+/-4.5% to 26.6+/-12.8% in postconcussional syndrome, from 10.4+/-6.8% to 36.4+/-13.8% in PTSD and from 10.0+/-4.6% to 30.6+/-10.3% in depressive disorder. There were lots of diversity in expected duration of treatment with psychiatric disability. Decline of life expectancy and need of supporting person were considered at least 50% of disability. CONCLUSION: There is much diversity in evaluation of psychiatric disabilities with disability rate and expected duration of treatments even among experienced evaluators. A common consensus among experts may increase reliability of psychiatric evaluations after trauma.

The Effectiveness of 6-Month Treatment with Venlafaxine Extended Release in Generalized Anxiety Disorder: Prospective, Multi-Center, Open-Labeled Trial / 대한정신약물학회지

OBJECTIVE: We aimed to examine the efficacy and the safety of venlafaxine extended release (venlafaxine-XR), and its effect on the quality of life in patients with generalized anxiety disorder. METHODS: Fifty three patients who had generalized anxiety disorder were recruited for this study. They showed scores of 18 or higher on the Hamilton Rating Scale for Anxiety (HAMA) and did not have major depression. They were scheduled to be examined 5 times (at baseline, 4, 8, 16 and 24 weeks) and took venlafaxine-XR for 24 weeks with a flexible dosing schedule. The primary efficacy variables were the response and remission rates (response: more than 50% reduction from baseline in HAMA total score ; remission: HAMA total score< or =7). Other variables were the Hamilton Ratng Scale for Depression, Beck Anxiety Inventory, Sheehan Disabilities Scale (SDS), and World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQOL-BREF). Also, the evaluation on adverse effects was performed. RESULTS: The number of patients who completed 24 weeks of treatment was 32 (60.4%). Twenty one patients who were dropped out included 8 patients with intolerable adverse effects and 7 patients with unsatisfactory treatment response. Response/remission rates were 43.4/32.1% in the last-observation-carried-forward methods and 71.9/53.1% in the observed case data. Treatment with venlafaxine-XR improved anxiety and depressive symptoms during 24 weeks on all efficacy measures. By a completed patient analysis, venlafaxine-XR also significantly improved the disability scores on SDS and the quality of life scores on WHOQOL-BREF. In this study, nausea, palpitation, and severe tremor were common reasons of venlafaxine-XR discontinuation in GAD patients, but any serious adverse effect did not occur. CONCLUSION: Treatment with venlafaxine-XR was effective and well-tolerated for the patients with GAD, and also improved quality of life in the GAD patients.

An Association Study of the Brain-Derived Neurotrophic Factor Genes Polymorphisms and Personality Traits

BACKGROUND: Brain-derived neurotrophic factor(BDNF) genes are thought to be important factors in some personality traits. The goal of this study was to determine the role of these genes in personality traits. METHOD: The participants included 170 healthy adults with no history of psychiatric disorders and other physical illnesses for the last 6 months. All participants were tested by the Temperament and Character Inventory (TCI). BDNF Val64Met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with ANOVA. RESULT: There was a significant correlation between BDNF Val64Met and Persistence(PS)(p=0.036) in female subjects, but none with the other TCI dimensions. A post-hoc comparison revealed significant a difference between Val/Val and Met/Met (p=0.031). CONCLUSION: Our study suggests that the BDNF Val64Met gene polymorphism is associated with persistence in Korean female subjects, but the small number of subjects limits generalization of our results. Further studies with a larger number of homogenous subjects are needed to confirm whether the BDNF gene is related to personality traits.

The Validity of the Assessment Tools for the Korean Long-Term Care System

OBJECTIVES: For the further development of the Korean Long-Term Care System, we analyzed the validity of the assessment tools of cognitive impairment and behavioral problems for the Korean Long-Term Care System. METHODS: We investigated 326 elderly people who were residing in Onyang 4-dong and Dogo-myun, Asan-si, Chungcheongnamdo. Our research team visited their residence and performed the assessment tools for the Korean Long-Term Care System and Korean version of the Mini-Mental State Examination (MMSE-K), Neuropsychiatric Inventory-Questionnaire (NPI-Q) and Seoul-Instrumental Activities of Daily Living (S-IADL). RESULTS: The correlation between the cognitive function tests and MMSE-K (r=0.579, p<0.001) and that between the behavioral problem tests and NPI-Q (r=0.688, p<0.001) were not as good as we expected. Moreover, if the items of the behavioral problem tests were decreased to 10 items as the government wanted, we got much lower correlation coefficiency. The cognitive function tests could not detect early cognitive deterioration in dementia. CONCLUSION: The assessment tools of cognitive impairment and behavioral problems for the Korean Long-Term Care System need modifications to promote validity.

An Association Study of the 5-HTTLPR and COMT Genes Polymorphisms and Personality Traits

BACKGROUND: Serotonin transporter gene-linked polymorphism region(5-HTTLPR) and catechol-O-methyltransferase(COMT) genes are thought to be important factors in some personality traits and the etiology of anxiety disorder. The goal of this study was to determine the role of these genes in personality traits. METHOD: The participants included 116 healthy adults with no history of psychiatric disorders and other physical illness for the last 6 months. All participants were tested by Temperament and Character Inventory(TCI). The 5-HTTLPR, COMT val158met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with t-test and ANOVA. RESULT: There were possible relationships of the 5-HTTLPR with self-transcendence(P=0.050) and COMT val158met polymorphism with cooperativeness(P=0.053). CONCLUSION: We found associations between 5-HTTLPR, COMT polymorphisms and the some TCI character dimensions. Further studies of polymorphisms of other genes and their interactions may clarify the complex relationship between personality and genes.

Clinical Features of Elderly Patients Referred to Neuropsychiatric Department

OBJECTIVE: As the geriatric admission and geropsychiatric consultation increase, more study was needed about geropsychiatric consultation. This comparative study investigates the character of geropsychiatric consultation in general hospital. METHOD: We compared 22 young patients (25(age<45) with 55 elderly patients ((65) who are consulted to neuropsychiatry department for the first time for 3 months (2004. 1. 1-2004. 3. 31) in Kang-Dong Sacred Heart Hospital, Hallym University. Data on patterns of consultation, demography, psychiatric and physical illness were collected and analyzed. RESULT: 1) The rate of psychiatric consultations for elderly patients was 6.2%, and this rate was much higher than 1.9% of young patients. 2) There were no significant difference in referral department between the elderly group and the control group, and internal medicine was the most common referral department in both groups. 3) The main reasons of consultations were alcohol related problems and psychiatric follow up in order in control group, but sleep disturbance and disorientation in order in elderly group. 4) In elderly group, the most frequent psychiatric diagnoses made by consultants were organic brain disorder such as dementia and delirium, but in control group, they were functional psychiatric disorder such as alcohol related disorder and psychosis. 5) Psychotropic drug and follow-up consultation were two most frequent recommendations from consultants in both group. But recommendations for psychotherapy and psychosocial management were rare in both groups. 6) There were significant difference only in psychiatric transfer among compliance for psychiatric consultation between the elderly group and the control group. Compliance for recommendations were low in both groups. 7) In both group, only one follow up consultation was done. And OPD follow up after discharge was rare in both groups. CONCLUSION: Elderly patients need more psychiatric consultations than younger patients and has different characteristics in pattern of consultations. Further studies are warranted on geropsychiatric consultation in Korea.