A Study on the Relationship between Sleep Quality and Cognitive Function in Community Elderly / 수면정신생리

Objectives@#Sleep disturbance in the elderly is associated with cognitive decline. Sleep quality is known to deteriorate with age, and prospective studies seldom have examined the relationship between sleep quality and cognitive function. This study investigates the relationship between early sleep quality and cognitive function based on six-year follow-up data of community individuals older than 60 years. @*Methods@#The participants included 622 community elderly people older than 60 years from Jinju-Si. The final analysis comprised 322 elderly people. Pittsburgh sleep quality index (PSQI) and the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) were used to assess early sleep quality and cognitive function after six years. Multiple linear regression analysis was performed to investigate the association between early sleep quality and cognitive function in the elderly. @*Results@#Early sleep quality (PSQI) was significantly associated with the results of the digit span test, clock drawing test (clox 1), and word recall test after six years. Sleep quality (PSQI) decreased significantly after six years, and lower quality of sleep (PSQI) score was associated with higher digit span test score (β = -0.167, p = 0.026) and higher clock drawing test score (β = -0.157, p = 0.031). Lower quality of sleep (PSQI) score was associated with higher word recall test (β = -0.140, p = 0.039). @*Conclusion@#The digit span test, word recall test, and clock drawing task (CLOX 1) shown to be significantly associated to sleep quality can be performed fast and easily in clinical practice. It is important to assess early cognitive function in the elderly with poor sleep quality, and further studies could suggest that these tests may be useful screening tests for early dementia in elderly with poor sleep quality.

Mediating Effect of Depressive Symptoms on the Relationship between Adult Attention Deficit Hyperactivity Disorder and Quality of Life

OBJECTIVE: The aim of this study was to investigate whether depressive symptoms affect the relationship between adult attention deficit hyperactivity disorder (ADHD) and the quality of life (QOL) in Korean soldiers. METHODS: We evaluated past and present symptoms of adult ADHD (the Korean Adult Attention-Deficit/Hyperactivity Disorder Scale and the Wender Utah Rating Scale), depression (the Center for Epidemiological Studies Depression Scale) and QOL (the Korean version of the SmithKline Beecham 'Quality of Life' scale) in 131 soldiers during mental health screenings performed by a local mental health center. A structured equation model using AMOS 19.0 was used to evaluate the mediating effect of depression. RESULTS: In our first model (without depressive symptoms), adult ADHD significantly affected QOL (standardized regression weight=-0.51, p<0.01). After depressive symptoms were added to this model, the direct effect of adult ADHD on QOL was not significant (standardized regression weight=0.10, p=0.43). Regarding the indirect effect, adult ADHD significantly affected depression (standardized regression weight=0.78, p<0.01), and depression also affected QOL (standardized regression weight=-0.79, p<0.01). CONCLUSION: Through structural equation modeling, the complete mediation model for the influence of depressive symptoms on ADHD and QOL was confirmed. These findings indicated that it might be important to consider comorbidities, such as depression, when adult ADHD is being evaluated.

Circadian Preference and Defense in Medical Students : Greater Consumption and Lesser Sublimation Predicting Eveningness / 수면정신생리

OBJECTIVES: Previous studies have reported an association between circadian preference and personality. Defense mechanism is unconscious ego process which deals with an individual's anxiety and is closely associated with one's personality. Our aim is to investigate the association between defense mechanism and circadian preference in medical students. METHODS: One hundred forty eight medical students (70 males, 78 females), aged 22 to 30, answered the Beck Depression Inventory-II, Morningness-eveningness Questionnaire, and Korean version of Defense Style Questinnaire. RESULTS: Consumption (beta=-0.262, p=0.001) and being a male (beta=0.175, p=0.031) were significant positive predictors of eveningness, while sublimation (beta=0.185, p=0.023) was a significant negative predictor of eveningness. CONCLUSION: Our study showed a relationship between specific defense mechanisms (i.e., consumption and sublimation) and eveningness in medical students, but it did not address whether the relationship is a causal one.

Effect of Symptoms of Adult Attention Deficit Hyperactivity Disorder on Symptoms of Post Traumatic Stress Disorder in Korean Conscripts

OBJECTIVE: This study is conducted to investigate the effect of symptoms of Attention Deficit and Hyperactivity Disorder (ADHD) on symptoms of Posttraumatic Stress Disorder (PTSD) among 224 conscripts during 5 weeks of military basic training. METHODS: Total number of subject is 224 conscripts. We evaluated past and present symptoms of ADHD with Korean-Wender Utah rating scale (K-WURS) and Korean adult attention -deficit/hyperactivity disorder scale (K-AADHDS) and stress and symptoms of PTSD with Brief Encounter Psychosocial Instrument-K (BEPSI-K), the Korean version of the Impact of Event Scale-Revised (IES-R-K) on 1 week and 5 weeks later of basic military training. Pearson correlation analysis and multivariate logistic regression analysis were performed to evaluate risk factors of PTSD using SPSS program and Path analysis also was used to find relationship between past and present ADHD and PTSD simultaneously using AMOS program. RESULTS: Present symptoms of ADHD (OR=1.145, CI=1.054-1.245, p=0.001) and Past symptoms of ADHD (OR=1.049, CI=1.005-1.095, p=0.028) were significant risk factor of PTSD symptoms on 1st week of basic military training. The symptoms of PTSD on fist week was also significant risk factor of PTSD after 5weeks of basic military training (OR=1.073, CI=1.020-1.129, p=0.006). Using path analysis, we could found confirm these relations between past and present ADHD symptoms and symptoms of PTSD. CONCLUSION: The result suggests that past and present symptoms of ADHD are the risk factor of symptoms of PTSD on first week. And the symptoms of PTSD on first week are also risk factor of PTSD symptoms on last weeks in Korean conscripts. The symptoms of ADHD might make an important role in vulnerability of the symptoms of PTSD in Korean conscripts.

Clinical Characteristics Associated with Quality of Sleep in Old Stroke Patients : Preliminary Study

OBJECTIVES: Although sleep problem is a common complaint in stroke survivors, there is paucity of studies on quality of sleep in old patients with stroke. The purpose of this study was to investigate the clinical characteristics associated with quality of sleep in old patients with stroke. METHODS: A comprehensive clinical and psychiatric assessments was performed in 30 patients who were admitted in rehabilitation department. Quality of sleep was evaluated with the Pittsburgh sleep quality index (PSQI). Other rating scales such as Modified Barthel Index, Korean mini mental state examination, Hamilton rating scale for anxiety, and Hamilton rating scale for depression were also performed to evaluate the clinical characteristics. RESULTS: Thirteen patients (43%) were 'poor sleeper' defined as a global PSQI score >5. In the partial correlation test, poor sleeper group were significantly associated with anxiety (r=0.69, p<0.01) and depression (r=0.76, p<0.01). In the multivariate logistic regression analysis, depression symptoms (OR=1.51, p=0.01) were only significant predictor of 'poor sleep' compared with other factors including age, sex, stroke type, stoke location, stroke site, past medical history, anxiety, and cognitive function. CONCLUSION: The results may suggest that it is important to assess depression when old patients with stroke show decreased quality of sleep. Further following studies will be needed for finding relation with other clinical factors.

Lamotrigine Augmentation in Patients with Treatment-Resistant Major Depressive Disorder: A Naturalistic Study / 대한정신약물학회지

OBJECTIVE: Lamotrigine's possible efficacy in the treatment of depressive disorders has been suggested. This naturalistic study investigated clinical response to lamotrigine augmentation in patients with treatment-resistant depression. Characteristics of the lamotrigine-responders were also explored. METHODS: Clinical data from 40 lamotrigine- treated patients with treatment-resistant unipolar depression were analyzed. The subjects were diagnosed with DSM-IV major depressive disorder and resistant to at least 2 antidepressants. Efficacy of lamotrigine treatment was measured by the changes in mean scores of the Clinical Global Impression Severity subscale (CGI-S), which were extracted from the prospective mood chart and structured interviews. Response was defined as a decrease of at least 2 or more from baseline on the CGI-S. Untoward effects associated with lamotrigine treatment were also assessed through medical records. RESULTS: Significant reduction in the CGI-S mean score was observed from baseline through 8 week lamotrigine augmentation in 40 patients with treatment-resistant unipolar depression (t=5.7, df=39, p<.01), and the magnitude of treatment effect was large (r(effect size)=0.68). Drop-outs were mainly attributable to lamotrigine-associated rash (N=5). Greater rate of improvement was associated with responder group (N=14) compared to non-responder group (N=17) from week 3 onward. CONCLUSION: The results of current study lend support to the potential benefit of lamotrigine augmentation in a subpopulation of patients with treatmentresistant unipolar depression. Continuation of lamotrigine add-on for more than 3 weeks may be needed to assess clinical outcome. Lamotrigine augmentation was generally well-tolerated. Large scale, double-blind studies are necessary to confirm its use as an augmentation agent.

The Development of Behavioral Modification Program on Weight Reduction in Overweight Patients taking Atypical Antipsychotics: Preliminary Study

OBJECTS: SThe authors developed a behavioral modification program for overweight outpatients with schizophrenia and bipolar disorder who had been treated with atypical antipsychotics, and evaluated the applicability of this program to outpatients. METHODS: Two men and nine women who had been treated with atypical antipsychotics and who had gained at least 5 percent of their pre-treatment body weight for 10 weeks, attended a behavioral modification program. The patients' weight, body mass index and the diet-activity scale were assessed and were compared with those of a matched comparison group who did not attend the behavioral modification program. RESULTS: The body weight of patients who attended the behavioral modification program reduced with statistical significance. The treatment group showed significant improvement in diet-related items but not in activity-related items of the diet-activity scale. CONCLUSIONS: This study suggested the applicability of a behavioral modification program on weight reduction to overweight patients taking atypical antipsychotics for the first time in Korea. Additional large scale studies are needed to validate the effectiveness of this program.

Trends in Pharmacotherapy of the Hospitalized Patients with Bipolar Disorder: A Twele-year Naturalistic Study / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to examine the pharmacological treatment patterns in inpatients with bipolar disorder at a university hospital, and to establish appropriate clinical practice guideline in light of recent advances of pharmacotherapy of bipolar disorder. METHODS: A total of 454 first-admission cases with a diagnosis of bipolar disorder or schizoaffective disorder from 1990 to 2001 were analyzed with regard to the clinical characteristics and the use of mood stabilizers, antidepressants and antipsychotics. RESULTS: In manic, hypomanic, and mixed episodes, there has been a substantial increase in the use of valproate while the use of lithium has decreased. Antipsychotic drugs were prescribed as combination regimen in over 80% of total cases. In 44.6% of bipolar depression cases, mood stabilizers were not prescribed. In 70.7% of bipolar depression cases not receiving mood stabilizers, antidepressant monotherapy was utilized. The use of SSRIs and RIMA has increased, while a decrease was observed for TCA. There has been a tendency of the increased use of atypical antipsychotics. In particular, clozapine monotherapy has increased in mood stabilizer resistant cases. CONCLUSIONS: The results of the present study suggest that the prescription patterns have changed in general agreement with recent advances of pharmacotherapy of bipolar disorder during the past twelve years. However, there was clear tendency to use antipsychotics rather than other mood stabilizers as the combination regimen. Moreover, accurate diagnosis and careful reconsideration for pharmacological treatment strategies are required in bipolar depression, mixed states, and rapid cycling.