Associations between Vasomotor Symptoms and Depression, Stress and Quality of Life in Midlife Women / 정신신체의학

OBJECTIVES: The aim of this study was to evaluate the associations between vasomotor symptoms and factors such as sociodemographics, health behaviors, medical condition, depression, stress, anxiety, attitude toward menopause, and quality of life. METHODS: We conducted a cross-sectional study in peri- and post-menopausal women enrolled by the Korean Association of Health Promotion. Subjects submitted self-report questionnaires about vasomotor symptoms and other clinical symptoms. Associations between vasomotor symptoms and clinical variables were analyzed using stepwise multiple regression analyses. RESULTS: 1951 women completed self-report questionnaires and 1022 women were enrolled in the study. The prevalence of vasomotor symptoms in peri- and post-menopausal women was 63.9%. Variables showing significant differences between subjects with vasomotor symptoms and subjects without them were score of Beck Depression Inventory, Brief Encounter Psychosocial Instrument-Korean Version, proportions of clinically significant depression(Beck Depression Inventory≥16), Menopausal rating scale, attitude towards menopause, the 4 subscales of World Health Organization Quality of Life-BREF(Physical health, psychological, social relationships, environment), and a History of Premenstrual syndrome/Premenstrual dysphoric disorder. Stepwise multiple regression analyses indicated that Beck Depression Inventory, Brief Encounter Psychosocial Instrument-Korean Version, Menopausal Rating Scale, and the Psychological subscale of World Health Organization Quality of Life -BREF show associations with vasomotor symptoms. CONCLUSIONS: Menopausal vasomotor symptoms are associated with various psychological factors, especially with depression. Midlife women suffering vasomotor symptoms should therefore be screened for depression. Future prospective studies where clinical subjects are diagnosed using structured interviews, focusing on the causal relationship between depression and vasomotor symptoms are necessary.

Development of the Korean version of Postconcussional Syndrome Questionnaire / 정신신체의학

OBJECTIVES: The purpose of this study was to evaluate reliability and validity of the Korean version of the Postconcussional Syndrome Questionnaire(KPCSQ) which was originally developed in 1992 by Lees-Haley. METHODS: Patients with traumatic brain injury were recruited from April 2009 to December 2011 from the Korean University Ansan Hospital. We selected patients that met the ICD-10 diagnostic criteria of postconcussional syndrome and organic mental disorder including organic mood disorder, organic emotionally labile disorder, organic anxiety disorder and organic personality disorder. The KPCSQ, Trait and State Anxiety Inventory(STAI-I, II), and Center for Epidemiologic Studies Depression Scale(CESD) were administered to all subjects. Factor analysis of the items were performed and test-retest correlation were evaluated. Internal consistency of the KPCSQ and its subscales was assessed with Cronbach's alpha. External validity of the KPCSQ were examined by correlation coefficient with the STAI-I, II, and CESD. RESULTS: The Cronbach's alpha coefficient of the total PCSQ was 0.956. The test-retest reliability coefficient was 0.845. The PCSQ showed significant correlation with STAI-I, II and CESD. The factor analysis of the PCSQ yielded 4 factors model. Factor 1 represented 'affective and cognitive symptoms', factor 2 represented 'somatic symptoms', factor 3 represented 'infrequent symptoms' and factor 4 represented 'exaggeration or inattentive response'. There was no significant difference between the PCS group and the organic mental disorder group in the score on each measure. The scores on KPCSQ and its subscales in the subjects that had scored 5 or more in 'exaggeration or inattentive response' are significantly higher than those in the subjects had scored 4 in 'exaggeration or inattentive response'. CONCLUSIONS: This study suggests that the Korean version of PCSQ is a valid and reliable tool for assessing psychiatric symptomatology of patients with traumatic brain injury. Further investigations with greater numbers of subjects are necessary to assess the clinical usefulness of the KPCSQ.

Fatigue and Its Association with Socio-Demographic and Clinical Variables in a Working Population / 정신신체의학

OBJECTIVES: We aimed to explore the relationship among fatigue and perceived stress, depressive mood in the working population. We also examined associations with demographic and life style factors and investigated the effect of individual coping skills on these associations. METHODS: Fatigue Severity Scale(FSS), Perceived Stress Scale(PSS), Brief Encounter Psychosocial Instrument - Korean version(BEPSI-K), Beck Depression Inventory(BDI), Stress Coping Skill Questionnaire were administered to 621 civil servants. All of above and other demographic factors are self-administered questionnaire survey and this study is cross sectional. RESULTS: Mean FSS score was 3.04 which was lower than 3.22, the severity cut off score. FSS, PSS, BEPSI-K, BDI were all higher in female. Subjects with active coping skills showed relatively low fatigue, perceived stress, depressive mood than those with passive coping skills. Logistic regression analyses indicated that the PSS, BDI, BEPSI-K in working population increase the risk of fatigue and regular exercise lowers the risk. CONCLUSIONS: Adults who were afflicted by stress, experienced depressive mood or were physically inactive were at much higher risk of feeling fatigue. Since no other large data sets are available for fatigue, the results from this study could serve a very useful purpose, to furnish a basis for comparison with future research results based on more complete data.

Psychosocial Characteristics and Factors Associated with Referral to Psychiatric Care in the Suicide Attempters Visiting Emergency Center / 정신신체의학

OBJECTIVES: The purpose of this study was to examine the characteristics and the psychosocial factors associated to the referral to psychiatric care in the suicide attempters visiting emergency center. METHODS: We conducted a systematic chart review of 377 suicidal attempters visiting emergency center of the Korea University Ansan Hospital between January 2008 and December 2011. We gathered a data contain 20 items including psychosocial characteristics and factors related to suicide and factors related to psychiatric treatment. Multivariate logistic regression models were fitted to data to estimate the unique effects of sex, drunken status, companion, suicidal methods, place of suicide and current use of psychiatric medication on the referral to psychiatric care. RESULTS: The female gender(OR=1.63, 95% CI=0.99-2.69), suicidal attempts at home(OR=3.40, 95% I=1.21-9.56) and drunken state at visit(OR=2.34, 95% CI=1.10-5.01) are the factors that predict the risk of the non-referral of the patients to psychiatric intervention. Place of suicidal attempt was the most important factor do play a role in determining whether referral to psychiatric care will take place or not. Current use of psychiatric medication showed a trend toward significance(p=0.08, OR=1.67, 95% CI=0.95-2.95). CONCLUSIONS: These results suggest that when deciding whether to adapt or to refuse the referral to psychiatric care, the factors such as suicidal intent, lethality of suicide methods, familiar factors and alcohol may contribute onto the referral to psychiatric care. Additional research is required to investigate an association of these factors with referral to psychiatric care.

Frequency, Clinical Characteristics and Correlates of Premenstrual Syndrome in High School Students / 정신신체의학

OBJECTIVES: To investigate the frequency and clinical characteristics of premenstrual syndrome(PMS)/premenstrual dysphoric disorder(PMDD) in high school students, and determine the correlates of PMS/PMDD in association with comorbid depression and anxiety. METHODS: A total of 1688 students were recruited from 5 high schools in Seoul, Korea. Subjects completed the questionnaire composed of scales to measure premenstrual symptoms, depression, and anxiety, as well as sociodemographic and reproductive variables. Subjects were categorized into 3 groups by using the Premenstrual Symptom Screening Tool(PSST) to determine the frequency and clinical characteristics of PMS/PMDD. Multivariate logistic regression was used to identify the correlates of PMS/PMDD. RESULTS: The frequency of moderate to severe PMS and PMDD was 20.1% and 6.4%, respectively. Irritability (78.8%), fatigue(76.4%), and emotional sensitivity(69.8%) were common premenstrual symptoms, and functional impairment in academic performance(67.1%) was dominant. Dysmenorrhea[odd ratio(OR)=3.68, 95% confidence interval(CI) 2.45-5.55], family history of PMS(OR=1.91, 95% CI 1.35-2.71), and use of oral contraceptive (OR=1.85, 95% CI 1.16-2.94) were associated with the increased risk of PMS/PMDD after adjustment for depression and anxiety. Negative attitude to menses(OR=15.60, 95% CI 3.61-67.42) was associated with the increased risk of PMS/PMDD, particularly in subjects without depression and anxiety. CONCLUSIONS: PMS was common, as the frequency of PMS more than moderate severity including PMDD exceeded 25%, and disrupted daily functioning in adolescents. PMS is associated with various sociodemographic and menstrual characteristics, and these associations are affected by comorbid depression and anxiety.

Clinical Case Conference / 신경정신의학

No abstract available.

Molecular Genetic Typing of Legionella pneumophila Strains Isolated in Jejudo, Korea

Twenty two strains of Legionella species isolated from Jejudo, Korea were identified by comparing the rpoB (300 bp), dotA (360 bp), and mip (396 bp) gene sequence analysis. Furthermore, their genotypes were determined by sequence analysis of rpoB/dotA subgroup typing, pulse-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD) patterns. Of the 22 isolates, 21 strains were identified as L. pneumophila and 1 strain was close to L. erythra (>95% similarity of rpoB and mip). Most of the L. pneumophila strains (90%) belonged to P-I of rpoB/dotA subgroup typing, one strain of each P-III and P-IV. L. pneumophila isolates were further grouped into 4 and 6 different PFGE (P1 to P4) and RAPD (R1 to R6) patterns, respectively. On the basis of these genotypes, which may be useful for future epidemiological studies, existence of diverse L. pneumophilla population in Jejudo, Korea were observed.

Selective Serotonin Reuptake Inhibitors for the Treatment of Premature Ejaculation / 대한남성과학회지

Premature ejaculation (PE) affects the 20~30% men among general population regardless of their age. PE may be classified as lifelong (primary) or acquired (secondary) type. Diagnosis of PE is mainly based on subjective complaints of sexual symptoms. Recently proposed diagnostic system of PE is based on many aspects; intravaginal ejaculatory latency time (IELT), control over ejaculation, stress and interpersonal difficulty according to the PE problem. Standard treatment of lifelong PE is mainly pharmacotherapy. Among many treatment options, selective serotonin reuptake inhibitors (SSRIs) are recommended for off-label use by American Urologic Association and International Consultation on Sexual Medicine. SSRIs were reported to improve the PE symptom by lengthening IELT. However, daily intake of SSRIs often increases the possibility of adverse effects, such as nausea, diarrhea, loss of libido, and even erectile dysfunction. Recently, dapoxetine hydrochloride, newer SSRI with short half life, was tailored to target the PE. Dapoxetine was proved its efficacy on PE over placebo. Clinicians should keep in mind that the sexual dysfunction can be the primary complaints or the results of the intake of antidepressants at the same time.

Alteration of Plasma beta-Nerve Growth Factor Concentration in Depressed Patients with Suicidal Attempt

OBJECT: Nerve growth factor(NGF) is a protein involved in neuronal survival and plasticity in the central nervous system, which might play an important role in stress, depression and suicide. This study was performed to determine whether there is an alteration in plasma NGF concentrations in depressed patients with suicidal attempt. METHODS: The subjects were 32 depressed patients who attempted suicide and admitted in emergency room. Forty-four hospitalized non-suicidal depressive patients and the 30 normal controls were closely matched with the suicidal group in terms of age and sex. Individuals in all 3 groups were evaluated independently by a semistructured interview for the purpose of establishing a DSM-IV criteria diagnosis. The severity of depressive symptoms was evaluated using Hamilton depression rating scale(HDRS). The severity of the suicidal behavior was evaluated by Weisman and Worden's risk-rescue rating(RRR) system and the Lethality Suicide Attempt Rating Scale(LSARS). Plasma NGF level was measured by the enzyme linked immunosorbent assay(ELISA) method. RESULTS: There were no statistically significant differences of the plasma NGF levels among groups. LSARS and RRR did not reveal any significant correlation with beta-NGF level in suicidal depressive patients. CONCLUSION: This study do not support an association between beta-NGF and suicidal depression. However it is necessary to investigate this association through other route such as postmortem brain.

Correlation between Cognitive Functions and Psychotic Symptoms in Schizophrenic Patients

& executive function deficit could be reversible after treatment, and 3) medication might have a benefit in improving the cognitive functions in schizophrenia. Furthermore, the data supports that the better premorbid executive function was, the more favorable was the treatment response in schizophrenic patients. Finally, this study indicates that executive function might be an index of treatment improvement.

Decreased Concentration of Plasma Brain-Derived Neurotrophic Factor in Suicide Attempters

OBJECTS: Some studies have suggested that brain-derived neurotrophic factor(BDNF), one of the most important neurotrophins, is involved in pathophysiology of depression and suicide. This study was performed to determine whether there is an abnormality in plasma BDNF concentration in suicidal attempters. METHODS: The subjects were 71 suicidal attempters who visited emergency rooms in multi-medical centers. All subjects had been interviewed by using Structured Clinical Interview for DSM-IV(SCID), Hamilton Depression Rating Scale(HDRS), Young Mania Rating Scale(YMRS), and Positive And Negative Syndrome Scale(PANSS). The severity of the suicidal behavior was measured by Lethality of Suicide Attempt Rating Scale(LSARS) and Risk-Rescue Rating(RRR) system. Seventy-one age, sex, and diagnosis matched non-suicidal psychiatric patients who were consecutively admitted to a psychiatric ward during the same period recruited as psychiatric controls. They were drug-naive or drug-free at least more than 2 months. In addition, 80 healthy controls were randomly selected as normal controls. Plasma BDNF level was measured by the enzyme linked immunosorbent assay(ELISA) methods. RESULTS: In overall F-test, differences of the plasma BDNF levels among the groups were statistically significant(F=20.226, p<0.001). In the multiple comparisons(Scheffe), while mean levels of plasma BDNF between normal controls and non-suicidal psychiatric patients were similar(p=0.984), the BDNF levels of suicidal attempters were lower than those of other two groups(p<0.001). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal attempters. CONCLUSION: These results suggest that reduction of plasma BDNF level is related to suicidal behavior and BDNF level may be a biological marker of suicidal behavior.

A Study on the Reliability and Validity of the Korean Version of the Calgary Depression Scale for Schizophrenia(K-CDSS) / 신경정신의학

OBJECTIVES: This study was performed to standardize the Korean Version of Calgary Depression Scale for Schizophrenia (K-CDSS), a semi-structured interview scale to assess depression in schizophrenia patients and to determine the psychometric properties and clinical utility of the K-CDSS. METHODS: Sixty-one patients diagnosed as schizophrenia by DSM-IV criteria were recruited in this study. Then, the patients were interviewed using the Structure Clinical Interview for DSM-IV (SCID) by a trained psychologist. Subsequently, the KCDSS, Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS) and Simpson Angus Rating Scale (SAS) were administered by a psychiatrist. Lastly, the K-CDSS was re-assessed by a second independent rater without any previous information of patients to confirm the inter-rater reliability. RESULTS: The internal consistency using Cronbach's alpha was 0.852. Inter-rater reliability using Intraclass Correlation Coefficient (ICC) for single items and for sum score were 0.659-0.889 and 0.963, respectively. K-CDSS was assessed by a second Factor analysis and ROC (receiver operating characteristic) curve analysis were conducted. The factor analysis revealed a single factor that accounted for 53.7% of the total variance, suggesting that the uni-dimensional structure of the K-CDSS may be retained. In addition, K-CDSS showed a good convergent validity with very strong correlations with HDRS (r=0.75) and MADRS (r=0.81), respectively. However, K-CDSS was not correlated with PANSS-positive, PANSS-negative and SAS, demonstrating its satisfactory discriminant validity. The area under the ROC curve was 0.968 (standard error=0.036, p<.001). With a cut-off point of 8, the K-CDSS had a sensitivity 83.3%, specificity 97.9%, positive predictive value 90.9% and negative predictive value 95.8%. CONCLUSION: K-CDSS is considered as a short and valid tool to identify depressive symptoms in schizophrenia.

Manic Patient with Meningioma Treated with Low dose Risperidone and Valproic Acid

We describe the case of a 73 year-old female patient, YSG, who initially presented with a manic episode without any previous psychiatric history and was later diagnosed as having a meningioma in the left frontal lobe. YSG's symptoms were characterized by hyperactivity, insomnia, aggressive behavior with an auditory hallucination. She showed no abnormal signs on a complete neurologic examination. A gadolinium-enhanced MRI study showed a huge, extra-axial mass with homogenous enhancement in the left high convexity of the frontal lobe. Her manic symptoms subsided after administration of risperidone 1mg and valproic acid 500mg daily, for three weeks without surgical resection of the tumor. These findings suggest that YSG's mania might have resulted from the left-sided frontal tumor, and that her symptoms were treated rapidly by small doses of risperidone combined with valproic acid. Medical staff who care for manic patients should be aware of this possibility of a organic lesion without evidence of neurologic disease.

The Resolution of Amenorrhea in Female Patients Taking Risperidone

OBJECTIVE: To find out the optimal assessment that can relieve amenorrhea associated with risperidone. METHODS: Sixteen female outpatients who have taken risperidone for more than 3 months reported voluntarily amenorrhea during Nov 2001 to May 2002. Since the reports of the amenorrhea, the resolution of amenorrhea has been prospectively followed during the next six months. The dosage of risperidone was reduced or discontinued in nine of sixteen patients, while risperidone was switched to olanzapine or quetiapine in other 7 patients according to the clinician's decision. RESULTS: Fourteen of 16 patients showed higher levels of prolactin than normal level. Five patients of the risperidone-reduction group recovered from the amenorrhea while all subjects of the drug-switch group recovered. The resolved patients of the former group recovered from amenorrhea in the dosage below 3mg per day of risperidone. Two patients of the risperidone-reduction group were dropped out during the reduction. CONCLUSION: These findings suggest that risperidone-induced amenorrhea may be alleviated by reducing dosage to less 3mg per day(including discontinuation) or by switching to other antipsychotic drugs. Whether we would choose which method depends on patient's clinical status, diagnosis, and dose of medication and so on.

Sexual function and psychological characteristics of penile paraffinoma / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To identify the sexual, emotional and psychological status of men who augmented their penis with mineral oil injection for their small penis.</p><p><b>METHODS</b>Men who had penile paraffin were asked to answer the semi-structured questionnaire. The questionnaire was designed to assess the motivation, method of penile injection, changes in erectile function and satisfaction after penile injection. SCL (Symptom checklist)-90-R, STAI (State and Trait Anxiety Inventory) and Zung SDS (Self-rating depression scale) were also included in the questionnaire for psychological evaluation.</p><p><b>RESULTS</b>A total of 357 men completed the questionnaire. The first-ranked motivation of the injection was recommendation by their acquaintances (48.9 %). The majority of the respondents had the procedure by non-medical person (78.0 %). Before injection, 17.2 % had a sense of inferiority in their penis and 32 % worried about their weak erectile function. After injection, 33.0 % have found relief from their sense of inferiority and 17.8 % wish to feel improvement in their erectile function. Most of the respondents (91 %) were not satisfied with their penis and 74 % of them replied that they want to remove the injected material. Only 15.6 % did not experience side effects. Most of the subjects have suffered from various side effects such as inflammation, skin necrosis, pain, etc. No evidence of psychiatric pathology was found in psychological evaluation.</p><p><b>CONCLUSION</b>The motivations of mineral oil injection were recommendation by their acquaintances or desire to be more mannish. Most of them had suffered from various side effects and only a small number of them felt improvement in their sense of inferiority, in their penis and erectile function. Increased public awareness is needed for the prevention of this physically and psychologically debilitating problem.</p>

Self-concept, Anxiety, Depression Scales and Behavior Estimation in Primary Nocturnal Enuresis / 대한비뇨기과학회지

Purpose: Nocturnal enuresis has been regarded as one of the most prevalent problems of childhood. Nocturnal enuresis may lead to a distressing and perplexing problem for children, resulting in social withdrawal, guilty feelings, and a sense of loneliness. In this study, we investigated changes in self-awareness, anxiety, depression, and behavior estimation before and after treatment in children with primary nocturnal enuresis. MATERIALS AND METHODS: Psychologic inventories were evaluated in 48 primary nocturnal enuretic patients who had been successfully treated for their nocturnal enuresis from April 2001 to March 2002. Before and after treatment, self-administered questionnaires, such as Kovac's Children's Depression Inventory, Piers-Harris Children Self-Concept scale, and State-Trait Anxiety Inventory for Children, were evaluated by the enuretics. Their parents were also evaluated by the Child Behavior Check list. RESULTS: In Kovac's Children's Depression Inventory and Piers-Harris Children Self-Concept scale, there were no signs of psychologic abnormality before and after treatment of nocturnal enuresis in terms of self-awareness and depression. Compared with the pre-treatment scores, there was significant improvement in trait anxiety after treatment of nocturnal enuresis (p<0.05). In the Child Behavior Check list, the parents thought that enuresis did not lead to abnormal behavior in their children. CONCLUSIONS: These results suggest no serious psychopathologic abnormalities before and after treatment of primary nocturnal enuresis. The enuretic patients may suffer from trait anxiety. Consequently, the successful treatment of nocturnal enuresis may alleviate a child's anxiety and prevent secondary psychopathologic abnormalities.

Pharmacogenomics of Antidepressants / 대한정신약물학회지

In an approach known as pharmacogenomics, many psychopharmacologists hope to match depressive patients to specific drugs based on the patients' genetic profiles. Many researchers and pharmaceutical companies are investing their efforts and vast amount of money in the pharmacogenomic aspects of many diseases. The numbers of pharmacogenomic reports are relatively small in the field of antidepressants because, in part, depressive disorders are multifactorial diseases with diversity of pathophysiology. In this review, the usefulness of therapeutic drug monitoring, phenotyping and genotyping of drug metabolizing enzymes before administration of antidepressants to depressive patients was discussed. Pharmacodynamic aspects of antidepressants, focused on the results of former studies about the relationship of the polymorphisms of the several genes (serotonin transporter genes, serotonin receptors, etc) and drug response, were also discussed.

Changes of Psychopathology and Extrapyramidal Symptoms When Co-administering Fluoxetine and Haloperidol

OBJECTIVES: The authors have intended to know the drug interaction of fluoxetine and haloperidol when coadministering two drugs to the chronic schizophrenics by assessing the changes of positive, negative symptoms and extrapyramidal symptoms. METHOD: We selected 38 patients, the chronic schizophrenics with no physical problems. they are randomly assigned to placebo group and drug group. And then, placebo or fluoxetine 20mg were administered to the subjects of each group during 8 week period. We have assessed their psychopathology and extrapyramidal symptoms using positive and Negative Syndrome Scale(PANSS), Clinical Global Impression(CGI), Simpson-Angus Scale at o, 2, 4, 6, 8 week during the period. RESULTS: 38 patients have completed the study during 8 week. 1) PANSS, CGI : no significant difference between groups and no significant change according to the times. 2) Simpson-Angus Scale : no significant changes. CONCLUSION: When co-administering fluoxetine and haloperidol, there were no significant changes of psychopathology and extrapyramidal symptoms. There results suggest that it is safe to coadminister fluoxetine to schizophrenic with haloperidol treatment.

A Case of Stevens-Johnson Syndrome in a Hypoxic Brain Injury Patient Treated with Carbamazepine / 신경정신의학

Although carbamazepine is being widely used in treatment of a variety of psychiatric disorders, it has some serious potential risks, including Stevens-johnson syndrome. Authors experienced in consultation a case of Stevens-johnson syndrome due to usage of carbamazepine. The patient was treated with carbamazepine to control for aggressive behavior after a hypoxic brain damage. Authors report a case of Stevens-johnson syndrome due to carbamazepine and also reviews related articles.

Psychiatric Symptoms in Survivors of the Sampoong Accident / 신경정신의학

In order to evaluate psychiatric symptoms in survivors of the Sampoong accident, we interviewed 624 survivors of the accident. The most common complaint of the subjects was sleep disturbance(54.2%). And then, headache(31.8%), irritability and anger(23.3%), intense distress over reminders(24.2%) followed. Common somatic complaints were headache, chest discomfort, extremity pain, backache, and gastrointestinal discomfort. This study revealed that most of the subjects had various psychiatric symptoms after the Sampoong accident.