Comparison of the Quality of Life in Facial Burn Patients by Anxiety Trait / 신경정신의학

OBJECTIVES: This study was designed to evaluate the quality of life in facial burn patients and its relationship to anxiety. METHODS: The study subjects consisted of 36 patients in a burn center after a burn injury. The assessment of quality of life was performed using a clinical administered SF-36 scale. All participants were instructed to complete the State and Trait Anxiety Inventory of Spielberger, the Beck Depression Inventory. RESULTS: There was no correlation between the trait of anxiety and the degree of the burn. The patients who had a high score in the Trait Anxiety Inventory after the burn injury showed a low quality of life at the one year follow-up. But the patients who had a low score in the Trait Anxiety Inventory showed a better quality of life than patients who had a mild burn injury. CONCLUSION: The results of this study suggest that the patients who had severe facial burns with a high score in the Trait Anxiety Inventory showed the specific properties of a low quality of life. Therefore, they needed intensive care from the beginning of the burn injury. In this process, resilience plays a major role in adapting to acute stress, especially burns, and anxiety is one of the protective factors in resilience.

The Utility of Korean Version of the WHO Five Well-Being Index in Evaluating Depressive Symptoms and Quality of Life in the Aged Dwelling in Community

BACKGROUND AND OBJECTIVES: Recently the number of geriatric depressed people has been increasing tremendously. Among many factors affecting depression, quality of life seems to be closely related to depression. Thus, a screening tool for assessing both geriatric depression and quality of life is needed. The purpose of this study is to estimate the utility of the Korean version of the WHO-Five Well-Being Index (WHO-5) in evaluating geriatric depression as compared with SGDS-K (Short Geriatric Depression Scale of Korean version) that is being used widely and quality of life. METHODS: A sample of 244 subjects over 65-year old living in Yanggu and Inje area in Gangwon Province, Korea were interviewed and responded to scales, including WHO-5, SGDS-K, MMSE-KC (Mini Mental Status Examination in the Korean version of the CERAD assessment packet) and GQOL-D (Geriatric Quality of Life-Dementia). The total score of WHO-5 below 13 indicates low well-being. RESULTS: The WHO-5 inversely correlated with SGDS-K and positively with GQOL-D, but showed no significant correlation with MMSE-KC. The SGDS-K negatively correlated with WHO-5, MMSE-KC, and GQOL-D. Low well-being group (WHO-5 score<13) had lower GQOL-D score (t=1.9698, p<0.05) and higher SGDS-K score (t=1.9798, p<0.05) than high well-being group. In multiple regression analysis, WHO-5 was significantly associated with GQOL-D and SGDS-K (r2=0.29422, p=0.0000). CONCLUSION: The Korean version of WHO-5 was very useful to evaluate both depressive symptoms and quality of life in the aged dwelling in community.

The Effect of Antipsychotic Drug Treatment on Serum VEGF, sVEGFR-1, and sVEGFR-2 Level in Schizophrenia: A Preliminary Study

OBJECTIVES: Vascular endothelial growth factor(VEGF), one of potent cytokines, and its receptors were related with various biological functions and pathological conditions. The purpose of this study was to investigate the changes of serum level of free VEGF, soluble VEGFR-1, and soluble VEGFR-2 after treatment with atypical antipsychotic drug in schizophrenia. METHOD: The schizophrenic patients were diagnosed with DSM-IV and were prospectively followed up for 4 and 8 weeks. Thirteen schizophrenic patients were evaluated their clinical assessment with serum levels of free VEGF, sVEGFR-1, sVEGFR-2, and positive and negative symptom scale(PANSS) at baseline, 4 weeks, and 8 weeks after treatment with atypical antipsychotic drug. Thirteen normal control subjects were recruited and matched with the patient group by age and sex. RESULT: The serum level of free VEGF(295.2+/-43.7pg/ml)and sVEGFR-2(8259+/-336.7) at baseline(before treatment) in schizophrenic patients were not significantly different, compared with the control group(199.0+/-28.8 and 8481+/-371.9) respectively. However, the serum level of sVEGFR-1(86.2+/-10.3, p<0.05) was significantly increased in the schizophrenic patients compared with the control group(59.0+/-6.4). After treatment with antipsychotic drug, the serum levels of free VEGF at 4 weeks(338.9+/-56.5) and 8 weeks(309.5+/-58.7) were not significantly, different compared with baseline. But the serum levels of sVEGFR-1 was significantly decreased at 8 weeks(57.3+/-6.3, p<0.05) after antipsychotic drug treatment. The serum levels of sVEGFR-2 were decreased at 4 weeks(7761+/-403.0, p<0.05) and 8 weeks(7435+/-333.5, p<0.05) compared with baseline. CONCLUSION: The decreased serum level of sVEGFR-1 and sVEGFR-2 might be affected by dopaminergic system which was influenced by antipsychotic drug.

Changes of HRV after Antidepressant Treatment in Psychiatric Outpatients / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the change of heart rate variability after antidepressant treatment in depressed or anxious patients. We tried to find the usefulness of heart rate variability as a predictive marker of response to pharmacological treatments in the psychiatric field. METHODS: Forty-seven patients with major depression, anxiety disorder, and somatoform disorder were treated over 4 weeks with antidepressants and were then classified as responders or nonresponders according to Hamilton depression scales or CGI scores. The HRV variables were measured and compared among the responders/nonresponders and the matched normal control. RESULTS: The responders group exhibited low heart rate, low PSI, high SDNN, RMSSD, HRV index, NN50, pNN50, LNTP, LNLF, and LNHF compared with the nonresponders after 4 weeks antidepressant treatment. However, no significant difference in HRV variables was observed between the responders group after treatment and the normal control group and the response group after treatment. CONCLUSION: These results indicate that HRV variables would are normalized after successful antidepressant treatment and it that HRV has some possible uses as a predicting marker of antidepressant response.

The Effects of Antidepressant Treatment on Serum Cytokines and Nutritional Status in Hemodialysis Patients

The aim of this study was to investigate the effects of antidepressant treatment on serum cytokines and nutritional status in hemodialysis patients. Twenty-eight hemodialysis patients with a depressed mood were given 20 mg of fluoxetine for 8 weeks. The degree of depressive symptoms, the serum levels of interleukin-1beta, interleukin- 2, interleukin-6, tumor necrosis factor-alpha, c-reactive protein, and markers of nutritional status were assessed at baseline and after treatment. The outcome was assessed in terms of response to treatment (>50% reduction in the score of the Hamilton depression rating scale). Antidepressant treatment decreased the serum level of interleukin- 1 in both response and nonresponse groups, and increased the serum level of interleukin-6 only in the response group. At baseline, the level of interleukin-6 in the response group was lower than in the nonresponse group. Antidepressant treatment also increased fat distribution significantly in the response group which might have slightly improved the nutritional status. This study suggests that antidepressant treatment improve depressive symptoms and may affect immunological functions and nutritional status in chronic hemodialysis patients with depression.

The Relationship between the Serum Cytokine and Clinical Improvement in Major Depressive Disorder

OBJECT: Currently, the alteration of cytokine system has been known to play an important role in regard to depressive symptom. We focused on the relationship between immunological parameters and clinical improvement in major depressive disorder. METHOD: Data were collected on 26 patients with major depressive disorder using a 8-week prospective follow-up design. After 8-week treatment period with fluoxetine, patients were classified into a response group and a non-response group according to their psychopathological outcome as evaluated by Hamilton Depression Rating Scale. The differences of the immunological parameters between pre-treatment phase and post-treatment phase were compared among patients. The difference of those was also compared within each phase among them. The relationship between socio-demographic variables, depression, cytokine, mononuclear cells was examined by correlation analysis. Multiple regression analyses were performed to explore the predictors of clinical improvement of major depressive disorder. RESULT: Pre-treatment levels of IL-1beta in the response group were significantly higher than those in the non-response group. Pre-treatment levels of IL-1beta of all patients and in the response group were positively correlated with pre-treatment monocyte counts. Patients with subsequent remission showed significantly lower IL-6 values at baseline than those with non-response. Post-treatment values of IL-6 did not differ significantly among the patients. The correlation test showed more frequent relations among cytokines and mononuclear cells in the response group than in the non-responder group. Especially, serum level of IL-6 in pre-treatment phase was only significantly correlated with HAMD score after 8-week treatement phase, while other cytokines and mononuclear cells were not. Pretreatment level of IL-6 was of paramount importance in predicting clinical improvement of depressive symptom. CONCLUSION: The immune system of major depressive disorder patients might dichotomize the patients into subsequent responders and non-responders. Immune system might be of great influence on the clinical improvement of major depressive disorder. The mode of interaction between depression and cellular immune function and the mediators responsible for the cytokine production need to be studied further.

Clinical Influence of Emotional Depression on Chronic Low Back Pain

OBJECTIVE: To compare the patients of chronic low back pain with and without emotional depression in terms of psychosomatic aspect and clinical outcome by cross-sectional and prospective study. METHOD: We evaluated 100 patients who were admitted due to chronic low back pain. The patients were classified into three groups (moderately depressed, mild depressed, non-depressed) by the score of Beck Depression Inventory (BDI). And three groups were compared by Pain Disability Index (PDI), Visual Analogue Scale (VAS), Pain Rating Score (PRS) and special diagnostic studies such as MRI and EMG. All subjects took the same conservative treatments for 4 weeks and then, they were re-evaluated by PDI, VAS and PRS. RESULTS: BDI score was positively correlated with VAS and PRS significantly. All groups were not different with respect to functional limitation (measured by PDI) and organic lesion (measured by MRI and EMG study). But, subjective pain (measured by VAS, PRS) were severe in depressed group. All groups showed improvement in PDI, VAS and PRS after 4 weeks of treatment. But, the amount of improvement was greater in non-depressed group. CONCLUSION: The clinician treating chronic low back pain should be familiar with depression and prepare for screening on that.

Effects of Ginseng Saponin on the Stress-Induced Plasma Corticosterone Levels in Mice / 신경정신의학

OBJECTIVES: The present study was designed to investigate the effect of ginseng saponin and its major active metabolite on the HPA axis under acute stress-i.c.v. injection stress, and immobilization stress, and to examine whether nitric oxide is involved in the mechanism of ginseng saponin on the HPA axis under acute stress. METHODS: In the experiment to study the effect of ginseng on HPA axis during stress, various dose of GTS were injected intracerebroventricularly(i.c.v.) or intraperitoneally(i.p.). Plasma corticosterone levels were measured 30 min after the i.c.v. injection stress. Immobilization stress was applied for 30 min and then blood was cellected for the assays of plasma corticosterone levels immediately after the completion of immobilization stress. To determine the active ginsenosides that can affect the stressinduced plasma corticosterone levels, various dose of each gisendosides(Rb1, Rb2, Rc, Re, Rf, Rg1, 20(S)-Rg3, and 20(R)-Rg3) were injected i.c.v. or i.p.. In the experiment to determine the involvement of the nitric oxide in the inhibitory effect of ginseng on the HPA, NG-Nitro-L-arginine methyl ester(L-NAME) and ginsenosides were coadministered i.c.v. or i.p., and plasma corticosterone levels were measured 30 min after stress was applied. RESULTS: First, the present study showed that ginseng total saponin, ginsenoside Rg3(S form), and ginsenoside Rc administered i.c.v. attenuated the intracerebroventricular injection stress-induced increase in plasma corticosterone levels, and these effects were removed by nitric oxide co-injection. Second, ginseng total saponin and ginsenoside Rc administered i.p. attenuated the immobilization stress-induced increase in plasma corticosterone levels, but ginsenoside Rg3(S form) did not attenuate the immobilization stress-induced increase in plasma corticosterone levels. The attenuative effects of ginseng total saponin and ginsenoside Rc in the immobilization stress-induced increase in plasma corticosterone levels were not affected by L-NAME co-injection. CONCLUSION: This study suggests that ginseng saponin attenuated stress-induced increase in plasma corticosterone levels and these effects were mediated by different mechanisms according to the components of ginseng saponin, and routes of administration.

Depression in chronic hemodialysis patients: risk factors and effects on nutritional parameters / 대한내과학회지

BACKGROUND: Depression is common in chronic renal failure patients and usually associated with poor appetite. Malnutrition with poor appetite is known to be associated with increased mortality in chronic hemodialysis (HD) patients. So we evaluated the prevalence, risk factors of depression and effects of depression to nutritional status in chronic HD patients. METHODS: Sixty two HD patients (age 48.8+/-11.1 years, diabetes 29%) were investigated. Each patients were interviewed and completed the Beck depression inventory (BDI, 21 items, 0-3 point). To exclude the possible confounding effects of illness and treatment symptoms, cognitive depression index (CDI, a cognitive subset of 15 items selected from BDI) was used as a measure of depression. KT/V and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assesment (SGA), body mass index (BMI), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were also measured. RESULTS: Corrected BDI score (CDI score multiplied by 21/15) was 24.9+/-12.7 and the prevalence of depression (corrected BDI score > or = 21) was 64.5%. DM patients had higher CDI score than non DM patient (22.9+/-7.2 vs 15.6+/-9.0). In univariate analysis, CDI score was correlated with age (r=0.39, p<0.01), serum albumin (r=-0.37, p<0.005), nPCR (r=-0.30, p<0.05), SGA (r=-0.42, p<0.05), BMI (r=-0.28, p<0.05), TSF (r=-0.41, p<0.05) and MAMC (r=-0.50, p<0.01). In multivariate analysis, CDI score was the strongest correlate of nPCR, SGA, BMI, TSF and MAMC. But KT/V, hematocrit, erythropoietin usage, plasma bicarbonate, serum parathyroid hormone, c-reactive protein concentration and HD duration had no relationship with CDI score. CONCLUSION: The prevalence of depression in chronic HD patients was high. Diabetes and old agewere important risk factors for depression. It was also concluded that severity of depression was correlated with markers of malnutrition and depression could be a independent risk factor of malnutrition in chronic HD patients.

The Preliminary Study of the Effects of Antidepressant Treatment on the Depressive Symptoms and the Nutritional Indexes in the Patients with Chronic Rena Failure on Maintenance Hemodialysis / 신경정신의학

OBJECTIVES: Depression is a common affective problem in patients with chronic medical illness. It has been well known that depression gives negative influence to medical outcome in patients with chronic renal failure (CRF). The purpose of this study is to reveal the effects of antidepressant treatment on depressive symptoms and nutritional indexes. We hope that this study could be a help to make a new model in the treatment of patients with CRF. METHODS: For this study, 30 depressive patients with CRF on maintenance hemodialysis were included. As affective variables, Hamilton Depression Rating Scale (HDS) and Zung's Self-Rating Depression Scale (SDS) were used. Medical outcomes were assessed with the following nutritional parameters: Kt/V, normalized protein catabolic rate (nPCR), serum albumin concentration, BUN, intracelluar fluid(ICF), extracellular fluid (ECF), lean body mass, fat mass, percent body fat, waisthip ratio (WHR), and body mass index(BMI). Paroxetine, one of the SSRI classes, was administered as antidepressant for 8 weeks. For statistical analysis paired t-test was used for each variables. RESULTS: The prevalences of depression were 75% from HDS and 80% from SDS (N=40). The mean+/-SD of HDS and SDS score were 12.35+/-7.45 and 59.43+/-11.89 respectively. HDS score significantly decreased (p< 05) after antidepressant treatment for 8 weeks. There was a significant increase (<.05) in such nutritional parameters as nPCR, serum albumin concentration, BUN, ICF, ECF, and WHR. CONCLUSION: Both nutritional indexes and depressive symptoms improved after 8 weeks of antidepressant treatment. We suggest that improvement of depressive symptoms should contribute to improved nutritional indexes. Long-term follow up and placebo-controlled double blind study are firmly required to confirm the results of this study.

The Relationship between Therapeutic Compliance and Emotional Variables in the Patients on Maintenance Hemodialysis / 신경정신의학

OBJECTIVES: The purposes of this study were to evaluate the relationship between therapeutic compliance and emotional variables in the patients on maintenance hemodialysis and to make a help in planning the treatment in order to promote the therapeutic outcomes. METHODS: Subjects consisted of 43 end-stage renal disease patients who had been treated with hemodialysis for more than one year. Hostility was measured with Cook-Medly Hostility Scale and depressive symptom, with beck Depression Inventory(BDI) and anxiety, with Self-rating Anxiety Scale of Zung(SAS). Serum potassium(K), and phosphorus(P) level, and interdialytic weight gain(IWG) were selected as compliance indices, for they were said to reflect the effect of diet, medication and salts restriction, respectively. RESULTS: (1) While the patients on hemodialysis got the scores within the normal range in their anxiety and hostility scale, they showed higher score of BDI than normal person, which was wtatistically significant. (2) Considering the relationship between therapeutic compliance and emotional variables, diet compliance was significantly associated with the emotional variables such as depression and anxiety. The relationship would be drawn with the equation listed below; Compliance Value=4.656 x (Depression) + 2.592 x (Anxiety)-0.13 x (Depression)x(Anxiety)-9.742 (3) When the patients were given a series of supportive psychotherapy for about 1 month, they showed the decrease in the scores of anxiety and depression scales, and the elevation in compliance value. However, there was no room for saving that the compliance ratio was improved, because of the limitation in the research methodology. CONCLUSION: Therapeutic compliance depended on between depression and anxiety among the emotional variables, the supportive psychotherapy was useful method to improved the therapeutic compliance.

Efficacy and Safety Profile of Risperidone in Schizophrenia: Open Multicenter Clinical Trial / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

A study on the behavioral trend and personality of the alcoholics' wives / 신경정신의학

No abstract available.

A preliminary study on the psychosomatic aspects of temporomandibular disorder / 신경정신의학

No abstract available.