Variables Influencing Drug Adherence in Patients with Alzheimer's Disease

OBJECTIVES: Many patients with Alzheimer's disease have difficulty in taking their medicine by themselves and their poor drug adherence possibly results in aggravating various symptoms. The aim of this study was to assess the variables influencing drug adherence of Alzheimer's disease patients. METHODS: In a four-week period, 33 outpatients over 65 years old diagnosed with Alzheimer's disease were monitored. Drug adherences were assessed by the Medication Event Monitoring System (MEMS), the pill count, the clinician rating scale, and self-report. Agreements among adherence measures and the relationships between MEMS adherence and other clinical factors were assessed. RESULTS: The adherence rates for the MEMS, the pill count, the clinician rating scale and, self-report were 51.5%, 82.8%, 82.8%, and 87.9%. The Kappa coefficients were 0.382 (pill count vs. MEMS, clinician rating scale vs. MEMS) and 0.256 (self-report vs. MEMS). Males showed better adherence than females but the other clinical variables did not show significant differences between adherence group and non-adherence group. CONCLUSION: These findings suggest that clinicians should be concerned when assessing drug adherence in patients with Alzheimer's disease only by subjective reporting and pill counting since these methods may make patient's adherence underestimate. Clinicians should also take in mind that caregivers play an important role in improving adherence.

Adherence with Electronic Monitoring and Symptoms in Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE: The primary aim of this study was to compare electronic monitoring with other measures of adherence to Osmotic-controlled Release Oral delivery System methylphenidate in children with attention-deficit hyperactivity disorder (ADHD). The secondary aim was to analyze the relationships between adherence and clinical factors, including ADHD symptoms. METHODS: Thirty-nine children diagnosed with ADHD were monitored for adherence to medication over the course of eight weeks. Medication adherence was assessed using the Medication Event Monitoring System (MEMS), which is a bottle cap with a microprocessor that records all instances and times that the bottle is opened; patient self-report; clinician rating; and pill count. Information, including demographic and clinical characteristics, symptom rating scale, and psychological test results, were also collected. The relationships between adherence and clinical factors, including ADHD rating scores of baseline and of the changes, were assessed. RESULTS: The rate of non-adherence measured by the MEMS was found to be 46.2%, which was considerably higher than those of the patient self-report (17.9%), clinician rating (31.7%), and pill count (12.8%) of non-adherence. The rate of adherence measured by the MEMS was not significantly associated with baseline symptom severity or symptom changes over the eight weeks, although non-adherent group showed more severe baseline symptoms and inferior improvement. CONCLUSION: Adherence as measured by the MEMS showed a discrepancy with other measures of adherence in patients with ADHD. The symptom severity and level of improvement were not related to adherence with MEMS. Further studies are needed to evaluate the variables that may impact medication adherence in children with ADHD.

The Reliability and Validity Studies of the Korean Version of the Perceived Stress Scale / 정신신체의학

OBJECTIVES: Perceived stress scale is a self-report inventory to estimate the degree of individual perceived stress in daily life. The aim of this study was to introduce this scale and test the reliability and validity of the Korean version of PSS. METHODS: The total of 154 female hospital workers were included in this study. The survey questionnaires were conducted for demographic information. All participants were required to complete PSS, Hamilton Anxiety scale and Beck Depression Inventory. Reliability and validity studies were conducted and internal consistency was examined. RESULTS: The mean score of the PSS reported in this sample was 20.69+/-4.56. The overall Cronbach's alpha was 0.819, and the test-retest reliability coefficient was 0.66. PSS had a significant positive correlation with the HAM-A(r=0.49, p<0.01), and the BDI(r=0.55, p<0.01). Factor analysis yielded 2 factors with eigenvalues of 3.924 and 2.608, accounting for 65 percent of variance. Factor 1 represented "stress" and factor 2 represented "control of stress". CONCLUSIONS: This study indicates that the PSS is appropriate for estimating the perceived stress levels. These results support the use of PSS in large sections of the population in Korea.

Standardization of the Korean Version of the Posttraumatic Embitterment Disorder Self-Rating Scale

OBJECTIVE: Embitterment is a persistent feeling of being let down or insulted, feeling like a "loser", or feeling revengeful but helpless. In South Korea, social injustice experienced during rapid industrial development and protracted unemployment during the Asian economic crisis may lead to strong feelings of embitterment. North Korean defectors and victims of industrial disasters may also experience humiliation and feelings of injustice. Posttraumatic Embitterment Disorder (PTED) is a recent conceptualization of a new psychiatric disorder. This study tested the reliability and validation of the Korean version of the PTED Scale. METHODS: Subjects aged 18 years or older were recruited from a psychiatric outpatient clinic. All subjects were diagnosed with a depressive disorder. Subjects completed the Korean version of the PTED Scale, the Patient Health Questionnaire (PHQ-9) and the Patient Health Questionnaire (PHQ-15) at baseline and two weeks later. RESULTS: Approximately 15.4% of subjects could be categorized as having PTED. The test-retest reliability of the PTED Scale was good (r=0.76) and the internal consistency was very high (Cronbach's alpha=0.962). Positive correlations were found between the PTED Scale, the PHQ-9 and the PHQ-15, indicating substantial convergent validity of the PTED Scale. CONCLUSION: The Korean version of the PTED Scale is a reliable and valid measurement of embitterment in Korean adults as an emotional reaction to a negative life event.

Heart Rate Variability and Parenting Stress Index in Children with Attention-Deficit/Hyperactivity Disorder / 정신신체의학

OBJECTIVE: The aim of this study was to evaluate the relationship between sustained attention deficits in Attention-Deficit/Hyperactivity Disorder(ADHD) children and short-term Heart Rate Variability(HRV) parameters. In addition, we evaluate the relationship between The ADHD rating scale(ARS), the computerized ADHD diagnostic system(ADS) and Parenting stress index-short form(PSI-SF). METHODS: This study was performed in the department of children and Adolescent psychiatry, Korea university Guro hospital from august 2008 to January 2009. We evaluated HRV parameters by short-term recordings of 5 minutes. K-ARS and ADS are used for screening and identifying ADHD children. Intelligence was measured using Korean educational Developmental Institute-wechsler Intelligence Scale for Children. The caregivers Complete Parenting Stress Index scale for evaluation parent stress. RESULTS: The low frequency(LF) was significantly correlated with response variability of ADS. However, the other variables of ARS and ADS were not significantly correlated with LF. Hyperactivity subscale of ARS was significantly correlated with parental distress subscale and difficult child subscale of PSI-SF and inattention subscale of ARS was also significantly correlated with dysfunctional interaction and difficult child subscale of PSI-SF. CONCLUSION: The LF, 0.10-Hz component of HRV is known to measure effort allocation. This study shows that the LF component of HRV is significantly correlated with the response variability of ADS. This means that more severe symptoms of ADHD were correlated with the increase in the LF that means decreased effort allocation. These results also support the clinical usability of HRV in the assessment of ADHD. Furthermore, PSI-SF is correlated with hyperactivity and inattention variables of ARS.

Effects of Long-Term Combination Treatment with Valproate and Atypical Antipsychotics on Bone Mineral Density and Bone Metabolism in Premenopausal Patients with Bipolar Disorder: A Preliminary Study

OBJECTIVE: We investigated bone mineral density (BMD) and bone metabolism in female bipolar patients who were undergoing long-term treatment with valproate combined with a low-dose atypical antipsychotic. METHODS: Nineteen premenopausal women with bipolar disorder who were treated with valproate combined with atypical antipsycho-tics for at least 2 years were evaluated. The BMD was measured at lumbar spine and femur sites using dual-energy X-ray absorptiometry (DE-XA). The biochemical markers of bone turnover and circulating levels of gonadal hormones were assessed. Subjects with abnormal DEXA scans were compared to those with normal scans. RESULTS: Nine (47%) of nineteen subjects showed osteopenia or osteoporosis. The T-score for subjects with abnormal DEXA scans was -1.988. Decreased BMD was more prominent in the proximal femur than in the lumbar spine. Subjects with abnormal DEXA scans had high phosphorus and low testosterone levels relative to subjects with normal scans (p=0.008 and p=0.028, respectively). There was a significant negative correlation between phosphorus, osteocalcin, and femur neck BMD (p<0.05). However, multivariate analysis did not show a significant association between femur and lumbar BMD and biochemical markers of bone turnover. CONCLUSION: Long-term treatment with valproate combined with low-dose atypical antipsychotics may adversely affect BMD in premenopausal women with bipolar disorder. A prospective, controlled-study with a larger population is warranted, and assessment of BMD and bone metabolism should be taken into consideration in long-term therapy with valproate and atypical antipsychotics.

A Study on Polypharmacy in the Elderly Psychiatric Outpatients with Persistent Treatments for 3 years

OBJECTIVES: The objective of this study was to investigate the prescription trends for the elderly psychiatric outpatients at a university hospital. METHODS: We performed a retrospective study based on medical records. Data on 146 elderly patients (65 years and older) diagnosed with psychiatric disorders according to ICD-10 from January 2005 to March 2008 were collected. Analyses were performed regarding demographic characteristics, prevalence of polypharmacy, and the doses and types of drugs prescribed. RESULTS: In 146 subjects, the mean age was 76.14+/-5.21. More than five types of drugs were prescribed to 49.5% of the patients in 2008. The percentage of stable users (those without changes in the category of polypharmacy for 3 years) was 69.8%. Each patient received an average of 4.20+/-1.50 kinds of drugs in 2005 and 4.02+/-1.77 in 2008. The average dose of drugs was 6.1+/-3.50 in 2005 and 6.49+/-4.09 in 2008, and the difference was not statistically significant. The average number of types of psychiatric drugs prescribed to the patients decreased from 2.37+/-0.86 in 2005 to 2.17+/-0.87 in 2008 (p<0.05). CONCLUSION: Although practice of polypharmacy showed a slow increase over the 3 years from 2005 to 2008, almost half of the elderly patients we studied received multiple drugs. Since polypharmacy can increase drug-drug interactions and adverse effects in the elderly, appropriate drug monitoring and careful prescription are necessary.

A Study on Polypharmacy in the Elderly Psychiatric Outpatients with Persistent Treatments for 3 years

OBJECTIVES: The objective of this study was to investigate the prescription trends for the elderly psychiatric outpatients at a university hospital. METHODS: We performed a retrospective study based on medical records. Data on 146 elderly patients (65 years and older) diagnosed with psychiatric disorders according to ICD-10 from January 2005 to March 2008 were collected. Analyses were performed regarding demographic characteristics, prevalence of polypharmacy, and the doses and types of drugs prescribed. RESULTS: In 146 subjects, the mean age was 76.14+/-5.21. More than five types of drugs were prescribed to 49.5% of the patients in 2008. The percentage of stable users (those without changes in the category of polypharmacy for 3 years) was 69.8%. Each patient received an average of 4.20+/-1.50 kinds of drugs in 2005 and 4.02+/-1.77 in 2008. The average dose of drugs was 6.1+/-3.50 in 2005 and 6.49+/-4.09 in 2008, and the difference was not statistically significant. The average number of types of psychiatric drugs prescribed to the patients decreased from 2.37+/-0.86 in 2005 to 2.17+/-0.87 in 2008 (p<0.05). CONCLUSION: Although practice of polypharmacy showed a slow increase over the 3 years from 2005 to 2008, almost half of the elderly patients we studied received multiple drugs. Since polypharmacy can increase drug-drug interactions and adverse effects in the elderly, appropriate drug monitoring and careful prescription are necessary.

Current Pharmacotherapy of Depression

Currently, pharmacotherapy is the primary treatment modality for depression. Various classes of antidepressants have been developed and are widely used at present. Although the antidepressant effects of these drugs are thought to be similar, there are numerous differences between drugs in pharmacologic characteristics, side effects, and tolerabilities. Furthermore, 40~50% of patients may not respond sufficiently to the first-line antidepressants they take. As the response rates are substantially insufficient, and the side effects are not uncommon, the optimal treatment of antidepressants is somewhat difficult. Therefore, the clinicians treating depression should understand the characteristics of various antidepressants and also the optimal treatment strategy. In this review, we introduce various antidepressants and optimal treatment strategies for the treatment of depression.

Association Study Between Dopamine Transporter Gene 40 bp VNTR and Antipsychotics-Induced Restless Legs Syndrome / 수면정신생리

OBJECTIVES: The pathophysiology of restless legs syndrome (RLS) is not obvious, but many promising theories involve dopaminergic deficiency and genetic causes. The RLS is presumed to occur more frequently among schizophrenic patients who take antipsychotics, most of which blocks the dopamine receptors. This study aimed to investigate whether dopamine transporter gene (DAT1) 40 base pair (bp) variable number of tandem repeat (VNTR) polymorphism is associated with the antipsychotic-induced RLS in schizophrenia. METHODS: We determined the diagnosis of RLS among the 190 Korean schizophrenic patients by the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Genotyping was performed for the 40bp VNTR in DAT1 gene using polymerase chain reaction. RESULTS: We separated the schizophrenic patients into 44 patients with RLS and 146 patients without RLS. The genotype and allele frequencies did not differ significantly between two groups. CONCLUSIONS: These results suggest that DAT1 gene 40bp VNTR is not associated with the antipsychotic-induced RLS in schizophrenia. To confirm these results, larger-scale association study is needed in the future.

Guides to the Evaluation of Neuropsychiatric Impairment / 신경정신의학

Generally, the role of doctors has been limited in prevention, diagnosis and treatment of diseases. However, the role has recently expanded in improving the quality of life and evaluating the impairments of various disease. Evaluation of impairment in the psychiatric area has much more difficulty than others. Symptoms of psychiatric disorders have subjective, diverse and changeable. Also, previous tools such as McBride Disability Evaluation, Law of Workmen's Accident Compensation Insurance and Law of National Compensation, are not accepted as universal instruments in psychiatric area because of their own limitation. Consequently, the Department of Impairment Evaluation Committee in Korean Neuropsychiatric Association has revised, evaluated and investigated previous diverse guidelines related with evaluation of psychiatric impairments to make reasonable and adaptable new guidelines which include recent medical opinions. We hope this guideline could be used pertinently in evaluation of psychiatric impairment in every situations.

Pharmacotherapy of Anxiety Disorders in Older People

Anxiety disorders are common psychiatric illnesses in the elderly. However, anxiety disorders in older people have not drawn much attention from researchers and clinicians alike, compared with late-life depression or dementia. The author searched for articles published from 1986 to 2006 using the key words including "anxiety", "elderly", "aged", and "pharmacological" therapy in the MEDLINE, PsychINFO, and KMbase in order to clarify effective pharmacological therapy in the elderly with anxiety disorders. Well designed studies for pharmacologic intervention in late-life anxiety disorders were rarely found. Nonetheless, studies on young adults demonstrated a number of pharmacological treatment options that can be applied to these patients. Pharmacologic treatments for the elderly include therapies using antideprssants, especially SSRI or SNRI, buspirone, or benzodiazepines. The latter requires special caution in the administration in the elderly because it can lead to adverse events. Therefore, well designed clinical trials are further needed to obtain optimal pharmacological intervention for the elderly with anxiety disorders.

Survey of Public Health Service Needs of Live-Alone Elders in Urban Area

BACKGROUND: The number and proportion of live-alone elders in Korea have been increasing dramatically. We tried to identify the physical health status of live-alone elders in community and their needs for public health service in order to provide basic data for effective public health service to promote health and quality of life. METHODS: The subjects for this study were 38 nurses who provide visit-nursing service to live-alone elders in Seoul and Kyunggi Province. Data were collected by semi-structured questionnaires. RESULTS: The half of live-alone elders had disease, but only half of them took appropriate treatment. Barrier to treatment were difficulty to access to medical center, immobility, lack of drive and also poor insight. CONCLUSION: To solve the problems related to the elderly living alone in community, the instillation of public health policy that encompass professional medical service and comprehensive team approach are needed.

Length of Stay of Psychiatric Patient and Its Correlate in Mental Health-related Facilities / 신경정신의학

OBJECT: This study was aimed to find the contributing factors that influence the length of stay in mental health related facilities and to present future direction for the mental health policy. METHODS: The 1,875 patients who are aged between eighteen and sixty-five are chosen by the stratified random sampling from ten psychiatric hospitals, six psychiatric nursing facilities and five homeless asylums. We investigate about length of stay of all subjects by sociodemographic characteristics, socioeconomic status, functional status, disease related characteristics and analyse contributing factors. RESULTS: From total subjects, average length of stay was 1,906 days, and facilities, where subjects are institutionalized, explains 40% of length of stay. Other related factors are female, old age, single, lack of supportive system before admission and after discharge, medical assistance type I, unavailable of public transportation and utility, long duration of illness, and psychotic disorder. CONCLUSION: For lowering the rate of long-term hospitalization, evaluation of appropriateness is needed for admission to nursing facility and homeless asylum and make up for the medical payment system and the supportive system from family and community.

Do the Postmenopausal Women Differently Respond to Antidepressant Medication?: Comparison of the Effect of Mirtazapine Treatment between the Premenopausal and Postmenopausal Women with Depression / 대한정신약물학회지

PURPOSE: Female gonadal hormones are implicated in the psychopathology of the depression. Menopausal state may affect the response to antidepressant medication but treatment options for menopause have not been investigated extensively. Thus, the authors explored the differences in therapeutic response between pre- and post-menopause female patients with depression by evaluating the efficacy and tolerability of mirtazapine treatment during 4 weeks. METHODS: Seventy-five female patients with depression were included. 46 patients were assigned to postmenopause group or 29 patients to pre-menopause group. Efficacy was assessed with twelve's 7-point scales modified from subscales in HAM-D-17 and with Clinical Global Severity Scale, and tolerability was assessed from adverse events. Mirtazapine was administered at the flexible dose from 7.5 to 30 mg during 4 weeks. RESULTS: The post-menopause group showed significantly more reduction in scores on somatization scale (p=0.029) and shows a decreasing tendency in scores on anxiety/agitation scale (p=0.071). Significant differences between two groups were shown in the proportion of patients classified as responders (50% decreased from baseline) in anxiety/agitation (p=0.031) scale. Even though it is not statistically significant, the post-menopause group showed to be more the proportion of responders compared with the pre-menopause group in and somatization symptoms (p=0.084) scales. The proportion of responders (score <1 or 2) in CGI-S was not significantly different between two groups. CONCLUSION: Somatic symptoms and anxiety/agitation in postmenopause female patients with depression would be more likely susceptible to treatment with mirtazapine. Some symptoms of depressive disorder could differently respond to antidepressant medication between pre- and post-menopause patients, which implicated that optional treatment is required in female patients with depression.

The Effect of Hormone Replacement Therapy for Cognitive Function of Postmenopausal Depression

PURPOSE: We investigated the effect of menopausal duration on cognitive function using adjunctive hormone replacement therapy(HRT) in postmenopausal women with depression. METHOD: Twelve postmenopausal women with depressive disorder were enrolled. Six patients having menopausal duration of less than 3 years was assigned to the short duration group and six patients of more than 3 years to the long duration group. Each patient was treated with conjugated equine estrogen(1.25mg) plus medroxyprogesterone(5mg) for 8 weeks. Cognitive performance was measured by the Verbal Memory Test, Visual Memory Test, Trail Making Test, Digit Symbol Test, and Attention Shift Test. The Beck Depression Inventory was used for evaluation of depressed mood. The reproductive hormone levels were also measured. RESULTS: The long duration group showed the lower performance only in Trail Making Test B compared with the short duration group at baseline. After 8 weeks, the long duration group performed significantly better in the Trail Making Test B compared with the short duration group. The differences in change of depressive mood and gonadal hormone level between two groups were not significant. CONCLUSION: Menopausal duration before HRT may influence the effect of estrogen on cognition in some cognitive domains. This might be related with estrogen receptor hypersensitivity which induced by the longer estrogen deficiency.

Seasonal Variations in Mood and Behavior in Korean High School Students / 수면정신생리

OBJECTIVES: Although many reports have been written on seasonal variations in mood and behavior in foreign countries, few reports have dealt with Korean adolescents, except medical students. The goal of this study was to estimate the frequency of seasonal variations in mood and behavior among Korean high school students. METHODS: A total of 656 high school students living in southeastern Seoul participated in this study. The subjects were investigated with the Korean translated version of the Seasonal Pattern Assessment Questionnaire (SPAQ), and their responses were evaluated for seasonal patterns in mood and behavior change according to Kasper's criteria to make SAD (seasonal affective disorder) or SSAD (subclinical seasonal affective disorder) diagnosis. RESULTS: A total of 565 subjects completed the questionnaire and the responses (M: F=324: 241) were collected and used for analysis. The mean age was 16.73 (SD=0.65) years, and mean global seasonality score 5.88 (SD=4.72). Of the respondents, 413 (73.1%) reported problems related with seasonal changes. Total prevalence rates were 13.6% for SAD, 10.8% for S-SAD. The estimated frequencies were 5.1% for summer SAD, 3.2% for summer S-SAD, 0.5% for winter SAD and 1.1% for winter S-SAD. The prevalence rate of summer SAD or S-SAD was higher than winter SAD or S-SAD. CONCLUSION: The subjects showed a higher prevalence rate of summer type than winter type in SAD or S-SAD. These results were similar to those of other studies carried out in East Asian countries. However, the unpleasant feelings resulting from high temperature and humidity in summer rather than depression may have influenced the results. Therefore, it is necessary to make new SAD criteria of the SPAQ suitable for East Asian countries.

A 6 Months Follow-Up of Cognitive Function in Urban Community Elderly

OBJECT: The purpose of this study was to measure the natural changes of cognitive function over 6 months and to determine which cognitive tests were valuable for early detection of dementia in community dwelling elderly. METHOD: Cognitive functions were measured in 94 elderly registered at the Public Welfare Center in Gwacheon, the urban community of Kyunggido. After 6 months, same cognitive functions were re-measured in 54 elderly. The measures were Korean version of Mini-Mental State Examination (MMSE-K), Subtests of Korean Version of Memory Assesment Scales (KMAS), Verbal Fluency Test, Clock Drawing Task, Wechsler Digit Substitution Test and Wechsler Similarity Test. RESULTS: The mean age was 73.61+/-5.97 year. Most part of the tests were influenced by education, but not by age and sex. Of the MMSE-K subtests, the score of memory registration and memory recall declined after 6 months. The score of delayed recall of K-MAS declined, too. Decreased score was also observed in 'country' of the category verbal fluency test and 'n' of phonemic verbal fluency test, Wechsler digit substitution test and Wechsler similarity test. But, score decline was not statistically significant. Three persons were diagnosed as dementia after 6 months. And, they acquired low scores in above cognitive function tests in first cognitive function tests. CONCLUSION: Memory registration and memory recall of MMSE-K, delayed recall of K-MAS, verbal fluency test, Wechsler digit substitution test and Wechsler similarity test were sensitive to cognitive decline. The results suggest that these cognitive function tests could be applied to detect minimal changes of cognitive function in community dwelling elderly.

Switch to Olanzapine from Clozapine or Risperidone and 12-months Follow Up

In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effeciveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3 weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and Followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 2(70.5%). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refreactoriness and drug induced side effect.

Psychiatric Characteristics and Diagnosis of SHE in Patients with Liver Cirrhosis:Cognitive Functions and Evoked Potentials / 신경정신의학

OBJECTIVES: This study was designed to elucidate the psychiatric characteristics and nature of the neuropsychological deficits associated with subclinical hepatic encephalopathy(SHE) in patients with non-alcoholic liver cirrhosis. And also the authors prospectively studied the role of somatosensory evoked potentials(SEP) in the assessment of SHE. METHODS: Beck Depression Inventory(BDI) for measuring depression, State Trait Anxiety Inventory(STAI) for measuring anxiety, and Health-related Quality of Life Questionnaire(HQLQ) for measuring quality of life were administered the 41 non-encephalopathic liver cirrhosis patients(NELC) group and 31 carefully matched normal controls. And a prospective study to compare the performance of NELC group and normal controls on a short but comprehensive cognitive tests was conducted. After several cognitive tests, NELC group was divided into two groups, SHE group and non-SHE group by results of digit symbol substitution test(DSST) and/or trail making test(TMT) A and B. And then median nerve evoked cortical responses in 13 SHE patients group, 11 non-SHE patients group, and 8 normal controls were recorded for latencies of N13, P16, N20, P25, N30, P45, N65, and P95. And also responses for N13-N20 interpeak latency(IPL) and N20-N65 IPL were recorded. RESULTS: There were significant differences between the NELC group and normal controls on BDI, trait anxiety scales in STAI, and almost all HQLQ except for the cognitive function, social interaction and life satisfaction(p<0.05). The NELC group exhibited poor performance in DSST, TMT A and TMT B compared with normal controls(p<0.05). As 17 NELC patients had abnormal cognitive test results, 41.5% of cirrhotic patients had SHE. In SEP assessment, NELC group with SHE and without SHE had higher N20-N65 IPL and only NELC group with SHE had higher N65 latency compared with normal controls(p<0.05). CONCLUSION: This study suggests that the patients with liver cirrhosis exhibit relatively selective deficits in complex attentional and fine motor skills, with preservation of general intellectual ability, memory, language and visuospatial perception. DSST, TMT A and TMT B seem to be useful screening tests for the detection of SHE. And also it is expected that late components and N20-N65 IPLs of SEP are helpful in the assessment of SHE.