An Anxiety, Depressed Mood, and Insomnia in Newly Diagnosed Women Breast Cancer Patients and Thyroid Cancer Patients

OBJECTIVES: In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. METHODS: The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. RESULTS: Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). CONCLUSIONS: A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.

A Study on the Factors Affecting Self-Concept of Children and Adolescents with Epilepsy

OBJECTIVES: The purpose of this study was to investigate the impact of clinical and psychological factors on the self-concept of children and adolescents with epilepsy. METHODS: Children and adolescents with epilepsy (n=60; age range=9–17 years) completed questionnaires about their epilepsy-related variables, self-concept, depressive symptoms, anxiety, family functions, and behavioral problems. The T-test and one-way analysis of variance were used to examine the variables affecting the total self-concept scores. To determine the independent variables by adjusting the significant variables, a stepwise regression analysis was performed. RESULTS: In the correlational analysis, age, depressive symptoms, anxiety, social problems, attention problems, and internalizing problems had significantly negative correlations with self-concept. On the other hand, IQ and family functions showed positive correlations with self-concept. Age (β=−0.177, p=0.015), depressive symptoms (β=−0.487, p<0.001), anxiety (β=−0.298, p=0.008), and attention problems (β= −0.138, p=0.048) were analyzed as independent factors to assess their impact on self-concept, and were found to account for 78.3% of the variance in self-concept by stepwise regression analysis. CONCLUSION: Parents and clinicians should pay attention to improving the self-concept of children and adolescents with epilepsy, especially if they have problems with depression, anxiety, or attention.

A Study on the Comparison of Behavioral Problems in Community-dwelling Children and Adolescents with Newly Diagnosed ADHD and Children and Adolescent with Epilepsy

PURPOSE: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood illness, which frequently presents with various comorbid emotional, social, and behavioral problems. Yet, children with epilepsy also experience significant behavioral problems. In this study, we compared behavioral problems of 124 children and adolescents with newly diagnosed ADHD and 40 youths with epilepsy, aged 6~17 years. METHODS: Among 1,576 urban community children and adolescents, the ADHD rating scale, the Comprehensive Attention Test, and a psychiatric interview were used to diagnose ADHD. In addition, we used the mother's rating on the Korean Child Behavior Checklist (K-CBCL) to assess the presence of behavioral problems. RESULTS: Compared to the epilepsy group, the ADHD group had lower IQ scores (100.29±13.47 vs. 108.61±15.04, p=0.007). In addition, the ADHD group had higher total K-CBCL scores (66.44±10.32 vs. 50.68±8.97, p<0.001) as well as higher scores on all eight subscales of the K-CBCL than the epilepsy group. Sixty-five participants (52.4%) in the ADHD group showed significant behavioral problems (t score ≥64) compared to 7.5% of epilepsy group. After controlling for IQ, using an analysis of covariance, the ADHD group showed significantly higher total scores on the K-CBCL and all its subscales (p<0.001) than the epilepsy group, except on the somatic complaints subscale (p=0.275). CONCLUSION: Children with newly diagnosed ADHD suffer from various behavioral problems; therefore, the early assessment of and interventions for comorbid behavioral problems should be conducted for optimal management of childhood ADHD.

A Study on Sociodemographic and Psychological Factors Affecting the Quality of Life in Urban-Dwelling Single Mothers / 신경정신의학

OBJECTIVES: The aim of this study was to examine socio-demographic and psychological variables and the correlation of their factors with quality of life (QOL) in urban-dwelling single mothers. METHODS: Participants were 195 single mothers living in an urban community in South Korea. Participants completed self-report questionnaires examining socio-demographic characteristics and including the following self-rating scales : the global assessment of recent stress, the center for epidemiologic studies depression scale, the scale for suicidal ideation, the Korean version of the alcohol use disorder identification test, and the World Health Organization QOL assessment instrument. RESULTS: Regarding socio-demographic variables, high educational level (p=0.009), high monthly income (p<0.001), living in own house (p<0.001), and divorced or separated on economic grounds (p<0.001) showed significantly high QOL in single mothers. Age (r=0.208, p=0.004) showed significant positive correlation with QOL ; stress (r=-0.254, p<0.001), depressive symptoms (r=-0.314, p<0.001), suicidal ideation (r=-0.217, p<0.001), and alcohol-related problems (r=-0.363, p<0.001) showed significant negative correlation with QOL. In multiple regression analysis, alcohol-related problems, financial cause of single motherhood, depressive symptoms, and income explained 37.7% of variance in total QOL. CONCLUSION: Interventions to promote QOL of single mothers should reduce the social burden and psychological problems on single mothers. Specifically, interventions providing psychological support should target new single mothers in order to reduce distress in single-mother families.

Social Behavioral Problems and the Health-Related Quality of Life in Children and Adolescents with Epilepsy

OBJECTIVE: The purpose of this study was to investigate the impact of specific behavioral problems on the health-related quality of life (HRQOL) in children and adolescents with epilepsy. METHODS: Children and adolescents with epilepsy (n=92; age range=6–17 years) and their mothers completed questionnaires about behavioral problems, HRQOL, socio-demographics, and epilepsy-related variables. To determine significant predictor variables of the HRQOL, the stepwise regression analyses and partial correlations were performed to adjust for other behavioral problems and covariates. RESULTS: The analyses revealed that an increase in social behavioral problems and delinquent behavior was associated with a decrease in the HRQOL. Lower levels of maternal education and the number of antiepileptic drugs were also associated with a decline in the HRQOL; the HRQOL and social behavioral problems remained significantly correlated after adjusting for maternal education level, number of antiepileptic drugs, and non-social behavioral problems. CONCLUSION: Parents and practitioners should provide intervention if behavioral problems, particularly social behavioral problems, are observed in children or adolescents with epilepsy.

A Study on the Anxiety of the Chronic Viral Hepatitis Patients Receiving Pegylated Interferon Therapy / 신경정신의학

OBJECTIVES: The aim of this study was to clarify anxiety symptoms associated with the pegylated interferon (PEG-IFN) treatment and to determine which factors are associated with these anxiety symptoms. METHODS: The subjects were 30 patients with hepatitis B and C viral infections who were waiting to receive PEG-IFN treatment. For assessment of depressive and anxiety symptoms, the Beck Depression Inventory and the State-Trait Anxiety Inventory were used. Patients were examined before treatment and then prospectively during the 2 weeks, 4 weeks and 1 years of therapy. We analyzed the changes in anxiety and depression symptoms, and applied multiple regression analysis to identify factors that significantly affect the anxiety symptoms. RESULTS: Compared to pre-treatment baseline, anxiety symptoms increased 2 weeks after treatment, and gradually decreased 4 weeks, and 1 year after treatment. And, we analyzed the sub-factors of depressive symptoms that affect the anxiety symptoms. After 2 weeks of treatment, cognitive-affective factors and hypochondriasis factors of depressive symptoms had an effect on anxiety symptoms. Furthermore after 4 weeks of treatment, the cognitive-affective factors had an effect on anxiety symptoms. CONCLUSION: In this study, we found a significant increase in anxiety symptoms after PEG-IFN treatment, and cognitive-affective depressive factors significantly affect anxiety symptoms.

Role of Sleep Center for Integrative Approach to Sleep Disorders / 이화의대지

The prevalence of sleep disorder is about 30% of the population. Common sleep disorders are insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder and parasomnia. These sleep disorders lead various medical and mental complications. However, most sleep disorders are underdiagnosed and not treated appropriately. Sleep medicine is important for treating these sleep disorders and maintaining general healthy conditions. Specialized and comprehensive treatments for sleep disorder are important in sleep medicine.

Current Clinical Practice of Insomnia / 이화의대지

Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.

Association between Obesity Indices and MMSE-K in Elderly / 신경정신의학

OBJECTIVES: The aim of this study was to investigate associations between obesity indices and cognitive functions using data from individuals older than 65 years in South Korea. METHODS: A total of 151 Koreans older than 65 years participated in this study voluntarily. Obesity was determined using body mass index (BMI) and waist-hip ratio (WHR). Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination (MMSE-K). The participants were divided into four groups according to BMI : underweight (BMI or =25.0), and two groups according to WHR : normal (WHR or =0.8). Baseline characteristics were compared among different BMI or WHR subgroups. RESULTS: Older age and smoking habits showed an association with poor cognitive function. Among different BMI groups, the overweight group had the highest scores of MMSE-K ; the item scores for time and place orientation (4.48+/-0.770 and 4.80+/-0.500) and attention/calculation (4.00+/-1.258) as well as total score (25.88+/-2.877). Overweight in BMI showed an association with better cognitive function (OR(adjusted )=0.098, 95% confidence interval=0.017-0.577). CONCLUSION: In this study, the overweight group measured by BMI showed better cognitive function than other groups. Overweight in elderly might be acceptable in order to maintain cognitive performance. Further investigation regarding the underlying mechanism explaining the relationship between cognitive function and body weight will be needed.

Psychopharmacologic Strategies for Women to Plan Pregnancy / 대한정신약물학회지

Clinicians are faced with major challenges when treating women with psychiatric disorders who are contemplating pregnancy or are pregnant. Recent data suggest that pregnancy has no protective effect on the course of psychiatric disorders and that discontinuation of psychotropic drugs is associated with a significant risk of relapse. This article reviews the major clinical dilemmas in managing women with psychiatric disorders who plan to conceive. Before pregnancy, clinical considerations for the interventions such as family planning, parental education and supporting, and antenatal care are important to reduce the risk of pregnancy complications. To treatment decision, clinicians should discuss with the woman the absolute and relative risks associated with not treated mental disorder and psychotropic drugs. Non-pharmacological treatment should be considered also. Treatment strategies, for each of the women with psychiatric disorders who plan to conceive are discussed.

Influences of Stress, Anxiety, Depression, and Personality Trait on Nausea, Vomiting, and Retching of Breast Cancer Patients Receiving Chemotherapy / 신경정신의학

OBJECTIVES: The aim of this study was to identify influences of stress, anxiety, depression, and personality trait on nausea, vomiting, and retching of breast cancer patients perceiving chemotherapy. METHODS: Breast cancer patients who were admitted to Ewha Womans University Cancer Center for women to receive chemotherapy participated in the study. In addition to sociodemographic and clinical factors, self-reported questionnaires, including Type D personality Scale 14, Hospital Anxiety and Depression Scale, and Global Assessment of Recent Stress scale were used to evaluate psychological factors of the subjects. For examination of anticipatory and post chemotherapy nausea, vomiting, and retching, the subjects filled out the Rhodes Index of Nausea, Vomiting, and Retching and Visual Analogue Scale. RESULTS: No significant influence of type D personality, anxiety, or depression on nausea, vomiting, and retching was observed. If the patient experienced more severe stress, higher scores for anticipatory and post chemotherapy nausea, vomiting, and retching were recorded. The tendency was retained after adjusting for the cycle number of chemotherapy, the emetic risk of the chemotherapy regimen, type D personality, anxiety, and depression. Specifically, financial problems, unusual happenings, ordinary daily stress, and general stress were significantly related to nausea, vomiting, and retching. CONCLUSION: Assessment of life stress, especially for financial problems, unusual happenings, and ordinary daily stress of patients receiving cancer chemotherapy can be used as an effective way to reduce the risk of nausea, vomiting, and retching related during chemotherapy.

Social Factors of Depressive Symptoms in an Urban Community Population / 신경정신의학

OBJECTIVES: This study aimed to examine the prevalence of depressive symptoms and the correlates of social factors and life stress in an urban population. METHODS: 932 residents of Yangcheongu, Seoul were selected using multi-phasic cluster sampling method to represent each district. Trained interviewers visited each separate household individually and collected self-reported questionnaires, which represent socio-demographic characteristics of community residents. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depressive symptoms (CES-D score over 21). Global Assessment of Recent stress (GARS) was used to evaluate life stress level. RESULTS: The prevalence of depressive symptoms in men was 11.8%, while in women it was 14.1%. Depressive symptoms were higher in divorced or separated persons, those with lower family incomes, high self-assessed level of stress scores, and frequent alcohol drinking patterns. In a multivariate logistic regression analysis, high level of stress scores was independently associated with depressive symptoms. Sudden changes in relationship, sickness/injury and ordinary daily stress subscales were significantly associated with depressive symptoms when other subscales were controlled. CONCLUSION: Compared with point prevalence of depressive disorder, the prevalence of depressive symptoms in an urban population is relatively higher. The assessment of life stress level, especially for sudden changes in relationship, sickness/injury or ordinary daily stress, can be used as an effective screening tool for detection and prevention of depressive disorder.

A Study on Correlation between Anxiety Symptoms and Suicidal Ideation

OBJECTIVE: In South Korea, the number of deaths from suicide has increased in the last two decades, and suicide has become both a social and political problem. In this study, after controlling the variables influencing suicidal ideation, it was expected that it would be determined if anxiety symptoms are independently related to suicidal ideation. METHODS: Data were obtained from 327 psychiatric outpatients accomplished a self-reported questionnaire that included sociodemographic characteristics and clinical variables as well as self-rating scales for measuring the severity of one's anxiety, depression, and suicidal ideation. Logistic-regression analyses were used to determine the correlation between anxiety symptoms and significant suicidal ideation, adjusting for covariates. RESULTS: The patients with significant suicidal ideation were shown to be less educated, unemployed, never married, divorced, or separated by death, or living alone, and were shown to have a lower income, a drinking habit, a higher number of past suicide attempts, and more family members who committed suicide, than the patients without significant suicidal ideation. After adjusting the covariates influencing significant suicidal ideation, anxiety symptoms were associated with significant suicidal ideation. However, after adjusting for depressive symptoms, only the trait anxiety was associated with significant suicidal ideation. CONCLUSION: These findings suggest that anxiety symptoms are an independent risk factor for suicidal ideation. Clinicians may thus use anxiety symptoms for the screening examination when evaluating suicidal ideation and risk, and will have to actively evaluate and treat the anxiety symptoms of patients with suicidal tendencies.

A biologic study on toothash - plaster of paris mixture with absorbable collagen membrane in the treatment of peri-implant defects

A Gartner duct cyst of the vagina causing dysuria and dyschezia in a Yorkshire Terrier

A 5 year-old, intact female Yorkshire terrier was referred for dysuria and dyschezia. The radiographic and ultrasound examination showed a round shaped mass caudal to the urinary bladder that contained anechoic fluid within the thin walls. During surgery, the cyst was noted to be attached to the outer wall of the vagina, not connected to the vaginal lumen. Cystic fluid was removed and the cystic wall was resected. Then the remaining cystic wall was omentalized to prevent a recurrence. Histological examination confirmed that the cyst was of Wolffian duct origin. In this case, a large Gartner duct cyst causing urological problems was diagnosed and removed by surgical resection.

Comparison of new bone forming activity after osteotomy using Er:YAG laser and conventional bur in rabbit mandible