Clinical Correlates of Subtype and Severity in Patients with Delirium / 신경정신의학

OBJECTIVES: Delirium is commonly seen in clinical settings, and it can substantially influence the prognosis of patients. In this study, we investigated delirium with respect to its severity, classification and characteristics on each subtype. METHODS: Severity of delirium was examined in delirium patients, who were referred to the department of psychiatry in a general hospital for multidisciplinary treatment. After classification based on subtypes, factors influencing these aspects of delirium were examined. RESULTS: Among the 193 consultation-liaison patients referred to the department of psychiatry in a general hospital, 61 patients (31.6%) were diagnosed with delirium. Compared to patients in the non-delirium group, patients in the delirium group were older, had a shorter education period, and medical history of surgery. Among the delirium patients, the hyperactive subtype was found to be the most common (57.4%) and patients with the mixed subtype showed the highest severity score for delirium symptoms. In addition, the patient with the hypoactive subtype had a higher frequency of medical history of depression compared to those with the other subtypes. CONCLUSION: People with symptoms of hypoactive delirium can be misdiagnosed due to recurrence of depression, therefore, careful examination is required, particularly in patients with a history of depression.

Korean Addiction Treatment Guidelines (III) : Psychosocial Treatment of Alcohol Use Disorder / 신경정신의학

OBJECTIVES: The aim of this study is to develop guidelines for psychosocial treatment of alcohol use disorder. METHODS: According to the ADAPTE manual, the Korean alcohol use disorder treatment guidelines were developed by the guideline development committee. Recommendations from foreign guidelines were evaluated regarding the applicability and acceptability to domestic circumstances. In addition, a survey from experts was conducted, along with a review of Korean literature. By these means, recommendations of psychosocial treatment for alcohol use disorder were established. RESULTS: The main findings of the survey were as follows : 1) Although Group therapy was not recommended by foreign clinical guidelines, it was considered as a first-line treatment by Korean experts. 2) Among many psychosocial treatment programs, cognitive behavior therapy (CBT), coping skills training, 12-step facilitation, and Group therapy were commonly used programs in Korea. Finally, the following treatment methods were selected for recommendations : Group therapy, motivational enhancement treatment, CBT, behavioral self-management, alcoholic anonymous, 12-step facilitation, psychodynamic psychotherapy, psychoeducational intervention, continuous case management, and community residential rehabilitation program. CONCLUSION: Just as in treatment of chronic diseases such as hypertension, continuity is important for management of alcohol use disorder. Therefore, not only pharmacological treatment but also psychosocial treatment should be provided comprehensively after treatment of acute withdrawal symptoms.

Korean Addiction Treatment Guidelines Series (I) : Development of Korean Guidelines for the Treatment of Alcohol Use Disorder / 신경정신의학

OBJECTIVES: The aim of this study is to develop Treatment Guidelines for Alcohol Use Disorder-the Korean Addiction Treatment Guidelines-using the Adaptation method. METHODS AND PROCEDURES: As the Adaptation method of Guidelines, the ADAPTE Manual, which is developed by ADAPTE collaboration is applied. In Part 1 : preparatory work prior to the beginning of Adaptation is performed. In Part 2 : the core phase of the Adaptation in which we searched the guidelines and performed a systematic review of the literature. The two guidelines (of the AU and the UK) are selected by gone through the methodological quality and currency evaluation for guidelines. And, in order to choose the proper recommendations, the contents were evaluated with regard to the applicability and acceptability of guidelines to the domestic. Finally, in Part 3 : the adapted guideline is reviewed externally, with review and plan update. Therefore, in this way, the Korean Guidelines for Treatment of Alcohol Use Disorder, comprised of 55 recommendations, was developed. CONCLUSION: In this study, Korean Guidelines for Treatment of Alcohol Use Disorder were developed by application of the Adaptation method of ADAPTE. These are the first evidence-based Korean Guidelines for Treatment of Alcohol Use Disorder, which were modified and accepted in accordance with Korean circumstances within the range not damaging the validity of the treatment worth, and it is expected to contribute to improvement in quality and efficiency enhancement of Korean treatment of Alcohol Use Disorder.

Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal / 신경정신의학

OBJECTIVES: In development of Korean addiction treatment guidelines, the aim of this study was to investigate the experts' consensus regarding current pharmacological practice in treatment of alcohol withdrawal. METHODS: Using recommendations from foreign clinical guidelines, which were either lacking in evidence or could not be directly applied to Korea, the executive committee developed a questionnaire consisting of 17 questions. Using a nine-point scale, members of the Korean Addiction Psychiatry, who were experts (n=150) with sufficient experience in treatment of alcohol use disorder, were asked to evaluate the appropriateness of each item on the questionnaire. We classified the experts' opinion according to three categories, based on the lowest scores of 6.5 or greater as a first-line/preferred treatment, 3.5-6.5 as a second-line/reasonable treatment, and lower than 3.5 as a third-line/inappropriate treatment. The consensus was determined by chi-square test (p<0.05). Response rate was 70.4% (81/115). RESULTS: The results of the survey from the experts were as follows: 1) Symptom triggered therapy (STT) was the most appropriate strategy in treatment of alcohol withdrawal (95% CI 7.41-8.04). 2) Prophylactic benzodiazepine was recommended for management of expecting alcohol withdrawal in out-patient-department patients. 3) Among benzodiazepines, lorazepam was the most preferred. 4) For patients with severe withdrawal, lorazepam 7.4 mg/day (95% CI 6.48-8.25, maximum dose=20 mg) was recommended. 5) Risperidone, quetiapine, and haloperidol were the first-line drugs for patients with alcohol withdrawal and combined psychotic symptoms. 6) 127.5 mg (95% CI 111-145) for 2.8 months of prophylactic thiamine and 213.5 mg (95% CI 190-240) for 6.2 months of thiamine for Wernicke-Korsakoff's syndrome were recommended. CONCLUSION: We hope that these Korean addiction treatment guidelines, added by the Korean experts' consensus, will be helpful in promoting the efficacy of treatment for alcohol withdrawal.

The Relationship of Alcohol and Crime in Korea

No abstract available.

Treatment of Alcohol Use Disorder / 임상당뇨병

Prevention through screening and early intervention in the primary care setting are the best treatment strategies for alcohol use disorder. Alcohol use disorder is characterized by compulsive alcohol use potentially resulting in death. Recognizing alcohol use disorder as a chronic relapsing brain disorder is the starting point for treatment. Binge drinking and prolonged use of alcohol can not only result in changes to one's mood state, cognitive functions, and behavior, but also has damaging effects on the brain and other organs. In addition, prolonged alchol use can result in mental illness, physical disease, or social, financial, or legal problems. Like other chronic diseases such as diabetes or hypertension, alcohol use disorder has no cure, and is characterized by relapses requiring longitudinal long-term management strategies, of which treatment adherence and medication compliance are important components. Treatment for alcohol use disorder will be more effective when it combines biological, psychological, and social context approaches.