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.

Association of Helicobacter pylori with gastritis and peptic ulcer diseases

The occurrence of Helicobacter pylori(H.pylori) and its relationship with gastric mucosa were studied by light and electron microscopy and culture of biopsy specimens from gastric mucosa of 160 patients with upper gastrointestinal symptoms. H. pylori were present in 96.6% of patients with active chronic gastritis, 100% of patients with duodenal ulcer and 76.9% of patients with gastric ulcer, while present in only 6.3% of individuals with histologically normal gastric mucosa. The bacteria colonized the antral mucosa more frequently than the body or than the duodenal cap mucosa. The bacteria were rarely seen in the intestinalized epithelium per se, but there was no significant difference in prevalence of H. pylori between gastritis with intestinal metaplasia and gastritis without intestinal metaplasia. H. pylori could be seen in close association with the surface of gastric epithelial cells below the mucus layer without evidence of intracellular parasitism, All of the strains tested were susceptible to penicillin, erythromycin, and most of them susceptible to tinidazole and bismuth salts. It is concluded that H. pylori are highly associated with gastritis and peptic ulcer diseases and its prevalence rates in patients with those diseases is higher than in developed countries. This strong association of H. pylori infection with gastritis and peptic ulcer diseases suggest a possible etiologic role for the bacterium in those diseases.

A Study of Clinical Correlations between Skin Test, Radioallergosorbent Test and Bronchial Provocation Test in House Dust Asthmatics

We evaluated the correlations between the allergy skin test for house dust radioallergosorbent test (RAST) and the bronchial provocation test for revealing the sensitivity of the skin test and RAST, and for aiding in the search for the causative allergen in house dust asthmatics. There was an overall 72.5% agreement between the prick test and RAST, a 73.8% agreement between the prick test and house dust bronchoprovocation test (HD-BPT), and a 71.3% agreement between HD-BPT and RAST. A positive RAST was found with a positive HD-BPT in 71.2% of cases, and if RAST was negative, HD-BPT was negative in 46.9% of cases. 69.6% of the positive cases on prick test (more than 21 mm of erythema) were positive with RAST. All of the cases with a negative skin reaction to the prick test were negative to RAST. A positive skin test was found with a positive HD-BPT in 77.1% of cases, and if the prick test was negative, the HD-BPT was negative in 50.0% of cases. 87.5% of cases with a RAST positive exhibited a positive result with HD-BPT. A significant correlation was found between the results of prick tests and those of RASTs in the early response group of HD-BPT, but not in the late and dual response groups. There were significant correlations between total serum IgE and the results of HD-BPT, and total serum IgE value and the results of RAST. The greater the size of the prick test, the greater the likelihood of a positive HD-BPT. All 5 cases with an end point of intradermal skin test of a 5 degrees -5(-l) X 10(-2) dilution of house dust noted a negative HD-BPT. There was no significant correlation between total serum IgE and total eosinophil count. There was no significant correlation between wheal and erythema size of prick test and PC20 of methacholine.

Evaluation of Right Ventricular Function with Quantitative Radionuclide Ventriculography in Chronic Obstructive Lung Diseases

A reproducible noninvasive technique for measuring right ventricular ejection fraction (RVEF) was developed using first pass quantitative radionuclide angiocardiography. Tests were carried out in the right anterior oblique position with a computerized multicrystal scintillation camera with high count rate capabilities. RVEF was calculated on beat to beat basis from the high frequency components of the background-corrected right ventricular time-activity curve. The following results were obtained; 1) In 10 normal adults, RVEF averaged 50.9+/-8.2. In 20 patients with chronic obstructive lung diseases (COPD), RVEF was 37.9+/-6.1% and significantly lower than that of normal persons(P<0.005). 2) There was meaningful correlation between RVEF and forced expiratory volume (FEVI) in patients with COPD (r=0.51). And there was significant difference of RVEF between 13 patients with FEVI less than IL/min (6 patients with right ventricular failure, 7 patients with patients without that) and 7 patients with FEVI IL/min or more (35.7+/-6.0%, 42.1+/-3.2% respectively. P<0.005). 3) All 6 patients with clinical manifestation of right heart failure had abnormal RVEF and had FEVI less than IL/min, which was significantly lower than that of 14 patients without clinical manifestation of right heart failure (33.6+/-4.8%, 39.8+/-5.6%, respectively. P<0.005). 4) In 14 patients without clinical manifestation of right heart failure, 11 patients among whom 7 patients had FEVI less than IL/min, had abnormal RVEF.

Dermatophagoides Farinae, an Important Allergenic Substance in Buckwheat-Husk Pillows

Inhalation of buckwheat flour as well as ingestion of buckwheat foods induces bronchial asthma. The buckwheat flour attached to the husks used as bed pillow filling can provoke bronchial asthma in patients sensitized to buckwheat. In Korea one third of the pillows contain buckwheat husk (BH). Recently the authors examined three asthmatics who presented symptoms when exposed to house dust extract and BH-pillow extract. They had no history of asthma attack following ingestion of buckwheat foods. The possibility of mites or mite like substances in the BH-pillow extract was evaluated. There was a good correlation of skin test results between Dermatophagoides farinae (D. farinae) and BH-pillow extract. The concentrated extract of BH-pillow displayed inhibition of D. farinae radioallergosorbent test (RAST) and a dose dependent pattern RAST inhibition. The lyophilized extract of BH-clean did not show any constant feature in D. farinae RAST inhibition test. Furthermore, mites of Dematophagoides species were discovered in the contents of BH-pillows. Ten of 40 cases who tested positive to the skin test for the extract of BH-pillow manifested weakly positive to buckwheat RAST. None of them presented a previous history of buckwheat food allergy. Also we evaluated the possibility of cross-allergenicity between buckwheat and its husk. Using these results the authors concluded that there were some amounts of allergenic substance from house dust mites in the contents of BH-pillows and that the dust from these could provoke or aggravate the symptoms of asthmatics who were sensitive to house dust mites.

A Study of Allergy Skin Tests with Korean Pollen Extracts

In Korea, there are two descrite pollen seasons: a tree pollen season and a weed pollen season. In order to investigate the incidence of sensitization to the major pollens and to evaluate is clinical significance in respriatory allergic disease, skin prick tests were performed using 7 species of Korean pollen extracts (K-P extracts) and specific IgE was measured by the Phadebas radioallergosorbent test (RAST) in patients with positive skin prick tests. Of the 317 patients with respiratory allergic diseases 73 patients (23.0%) were skin prick test positive to one or more K-P extracts and the positive reactions to individual pollens were as follows: 14.2% (45/317) positive to sagebrush 10.4% to ragweed, 5.0% to grass, 4.1% to oak, 3.8% to alder, 1.9% to poplar; and 0% to pine. The 30-39yr old group manifested the highest skin test positivity 36.7%. There was no difference in the skin reactivity according to the patient's sex and the kinds of allergic disease. Also there was no relationship between birth season and skin test positivity. The agreement between the results of the skin prick test with K-P and commercially prepared Bencard's pollen extracts (B-P extracts) was good. There were good correlations between the strongly positive skin prick test and a posivite RAST and also between a netative skin prick test and a negative RAST. From this study, it can be concluded that overall sensitization rate of respiratory allergy patients to K-P exstracts was 23.0%, and that weed pollens such as sagebrush and ragweed were major pollens.

Survey of the Airborne Pollens in Seoul, Korea

A daily count of air borne pollen was done within the city limits of Seoul, Korea for a period of two years (1984-1985) using Durham's Gravity Sampling Device. Two major pollen seasons, March through May, and the month of September, were easily distinguishable. The concentration of the different types of pollen as well as all of the pollens combined varied similarly both years to a significant degree. The pollen types found in the greatest numbers were Alnus (March), Populus (April), Quercus (April-May), Pinus(May), grasses (September), and weeds (September). The main weed pollens detected in September, sagebrush, ragweed and Japanese hop would also be considered to be important allergenic pollens of respiratory allergy in Korea. The results of the survey are discussed in the light of especially relevant published literature.

Acute Renal Failure due to Potassium Bromate Poisoning

Poisoning due to potassium bromate, cold wave neutralizer for permanent waving solution in hair styling, is rarely encountered and only few cases are as a cause of acute renal failure reported in medical literature. Recently, we saw a 18 year-old-female patient, hair stylist, who was admitted to Severance Hospital due to acute renal failure after accidental ingestion of potassium bromate. This is the first known case of acute renal failure due to potassium bromate poisoning in Korea.