Elderly Patient Trends in a Chronic Mental Hospital and Accompanying Medical Diseases

OBJECTIVE: It investigated the tendency of the increase of elderly patients in a psychiatric hospital. In this regard, it examined whether the number of patients with outpatient consultant, discharge, medical diseases, and neurocognitive disorder increased or not. METHODS: It retrospectively reviewed inpatient medical records for the years 2008, 2011, 2014, 2017. To investigate the changes of elderly patients admitted to psychiatry, it examined the changes of patients who are older than 50 or 60 years in addition to the people who are older than 65 years. It analyzed diagnosis, discharge, medical diseases, and outpatient consultant of the three groups respectively. RESULTS: It confirmed that the number of elderly patients who are older than 50, 60, and 65 years has increased in mental hospital for 10 years. There was a significant increase in the number of neurocognitive disorder patients, the ratio of consultant outpatient, and the mean number of outpatient consultant. Diabetes increased in all three groups. Especially it has significantly increased for patients who are older than 50 and 60 years. In the case of patients discharged due to transfer, the number of patients increased in all three groups but it was statistically significant for the patients who are older than 50 years. CONCLUSION: The study shows that the number of elderly patients increased with the trend of aging society. In relation to this, the rate of outpatient consultant and discharge, including diabetic and dementia patients, also increased. Therefore, if the mental health department provides a system to manage the elderly ward or nursing ward to respond to the increase of elderly patients, or to manage the accompanying chronic diseases such as diabetes and its complications, it could solve the inconvenience of patients due to the consultation outside a hospital or discharge.

High School Students' Sugar Intake Behaviors and Consumption of Sugary Processed Food Based on the Level of Sugar-related Nutrition Knowledge in Seoul Area / 대한지역사회영양학회지

OBJECTIVES: The present study aimed to investigate high school students' sugar intake behaviors, the status of consuming sugary processed foods, the awareness of sugar, and the experience and interest in sugar-related education based on the level of sugar-related nutrition knowledge. METHODS: In this study, five high schools were selected in Seoul, Korea, and a survey was conducted in 400 students on the level of sugar-related nutrition knowledge and sugar intake status. A total of 349 questionnaires were used for the final analysis. For statistical analysis, descriptive statistics was performed; a t-test, χ2 test, and Friedman test were used for comparative analysis. RESULTS: The study results showed a positive association between the knowledge level of sugar and the appropriate sugar intake behavior and sugary food choices. The group with more nutrition knowledge on sugar was found to have good eating habits and to eat less sugary food. The main sources of sugar were beverages, confectionary, and bakery goods in the corresponding order, irrespective of the level of nutrition knowledge related to sugar. A significant difference was found in the groups' awareness of the sugar content of the drinks with 89.4% for the higher-knowledge group, and only 81.5% for the lower-knowledge group (p < 0.05). Results also showed that 43.9% of the higher-knowledge group and 36.4% of the lower knowledge group were interested in participating in education on sugar. CONCLUSIONS: This study result indicated the need to help adolescents to avoid excessive sugar intake from only certain favorite foods. Therefore, it is necessary to seek a systematic foundation for participatory education in order for them to maintain a low sugar intake in daily life and lead healthy eating habits by increasing their level of sugar-related information and knowledge.

Relationship between Metabolic Syndrome and Cognitive Functions in Patients with Chronic Schizophrenia / 정신신체의학

OBJECTIVES: The aim of this study was to investigate the relationship between metabolic syndrome and cognitive functions among chronic schizophrenia patients. METHODS: The survey participants were 105(40 metabolic syndrome and 65 non-metabolic syndrome) chronic schizophrenia patients at Yang-san Hospital. Each score of cognitive test(A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, stroop test), Positive and Negative Syndrome Scale, Hamilton rating scale for Depression were assessed. Statistical analysis of the relationship between various tests of A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet and metabolic syndrome were performed using ANCOVA and logistic regression. RESULTS: Schizophrenia patients with lower score on construction praxia were likely to be included in Metabolic syndrome group. However, there were no significant relationships in other tests between the two groups. CONCLUSION: This study found metabolic syndrome caused cognitive decline in chronic schizophrenia patients, especially Construction praxia. This study could be a basis to show metabolic syndrome has to be treated appropriately in schizophrenia patients and suggests the necessity of following longitudinal designed study.

Differentiating PTSD from Malingering:Considerations Interview Style and Typical Symptoms / 신경정신의학

It can be difficult to distinguish posttraumatic stress disorder (PTSD) from malingering because a person's responses after experiencing trauma depend on self-report, such as subjective complaints, and it is easy to find the diagnostic criteria for PTSD through the internet or other mass media. Therefore, it is important for clinicians to perceive patients' motivations and determine whether they have external incentives. We reviewed clinicians' and patients' interview styles, which can be useful for reducing malingering intent and detecting malingering patterns. To help clinicians differentiate PTSD from malingering, we also reviewed the diagnostic criteria (re-experience, avoidance and numbing, and hyperarousal) and the typical symptoms of true and malingered PTSD.

Korean Elderly Long-term Care Insurance System and Long-term Care Hospital

Korea is becoming aging society and the number of the aged who need long-term care service is increasing. Korean Elderly Long-Term Care Insurance System will be newly adopted soon and to make the system work successfully, comprehensive evaluation and management by professionals with have knowledge of geriatrics is necessary. In addition, long-term care hospitals should play their role between medical services and nursing care facilities as central organizations and form mutual system. The new insurance system only focuses on nursing care without regards of above facts. Other problems of it will be discussed in this study.

Association Study of -2548A/G Polymorphism of Leptin Gene with Antipsychotics-Induced Weight Gain / 대한정신약물학회지

OBJECTIVES: Leptin, the product of ob gene, is secreted by adipocytes and signals the size of peripheral fat stores to the brain. Several evidences indicate that a polymorphism in the promoter region (-2548A/G) of leptin gene is associated with antipsychotics-induced weight gain. This study aims at investigating the association between the -2548A/G polymorphism of leptin gene and antipsychotics-induced weight gain in Korean schizophrenia patients. METHODS: Seventy one patients with schizophrenia were recruited. All of the subjects were antipsychotics-naive or free of antipsychotic drugs for the previous 3 months. Genotyping was done for the -2548A/G polymorphism of leptin gene. Body mass index (BMI) was measured at baseline, after 4 weeks and after 8 weeks of antipsychotic drug treatment. The subjects were grouped on the basis of the presence or absence of the G allele (AA vs. AG/GG) and two-sided t tests for independent samples was used to analyze the relationship between two genotype groups and BMI change. And a chi-square analysis was conducted to test the association between the allele type and BMI change. RESULTS: We could not find any association between the -2548A/G polymorphism of leptin gene and antipsychotics-induced weight gain. CONCLUSION: Our data do not support the involvement of the -2548A/G polymorphism of leptin gene in antipsychotics-induced weight gain in the acute treatment phase.

Polymorphisms and Serotonin Dopamine Antagonist-Induced Weight Gain in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: Several lines of pharmacological evidences including the data of animal studies indicate that serotonin 2C receptor (5HT2C) is involved in the pharmacodynamic process of serotonin dopamine antagonists (SDA)-induced weight gain. Controversial data have been reported on the association between the polymorphisms of 5HT2C receptor gene and antipsychotics-induced weight gain. This study aims at investigating the association between the polymorphisms of 5HT2C receptor gene and SDA-induced weight gain in korean schizophrenic patients. METHODS: Seventy-seven schizophrenia patients in their first episode or patients who did not take any antipsychotics for the previous two months were recruited. All the patients were administered with one of the SDAs (risperidone, olanzapine, quetiapine, clozapine) for 8weeks. Body mass index (BMI) were measured weekly during the 8weeks. The subjects were genotyped for the -759 C/T and -697 G/C polymorphism of the 5HT2C receptor gene. RESULTS: The degree of linkage disequilibrium between the two polymorphic loci genotyped are almost 100%. Significant association was not observed between polymorphisms of the 5HT2C receptor gene (-759 C/T and -697 G/C) and SDA-induced weight gain after 8 weeks of treatment. CONCLUSION: Our data do not support the involvement of the polymorphisms of 5HT2C receptor gene (-759 C/T and -697 G/C) in SDA- induced weight gain. Further studies with sufficient sample size are warranted to follow up on the trend of high weight gain in the male patients having -759 T (-697 C) allele.

Factors Related to Weight Gain in Patients with Schizophrenia Treated with Serotonin-Dopamine Antagonists / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate demographic, clinical, behavioral and metabolic-endocrine factors related to weight gain in patients with schizophrenia treated with serotonin-dopamine antagonists(SDA). METHODS: Forty-two in-patients with DSM-IV schizophrenia were recruited from Samsung Seoul Hospital and St. Andrew Neuropsychiatric Hospital. The subjects were first-episode patients or patients who did not take any antipsychotics for the previous two months. All the patients were administered with one of the SDAs for 8 weeks. Body weights and body mass index (BMI) were measured weekly during the treatment period. The mean levels of daytime activities were evaluated at baseline and 4 weeks and 8 weeks after the treatment. To assess the clinical response to the medication, the Krawiecka Rating Scale (KRS) and Clinical Global Impression (CGI) were applied before and after the treatment. Fasting blood levels of glucose, cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL), and serum level of prolactin were measured before and after the treatment. RESULTS: The body weight and BMI were significantly increased through the treatment periods. There were significant increases in the blood levels of cholesterol, TG and prolactin after 8 weeks. KRS total score showed significant decrease and the mean level of daytime activities showed significant increase by the treatment. Significant negative correlations were observed between the weight gain indices and the baseline BMI. The level of clinical improvement was significantly correlated with the degree of weight gain. Gender, age, smoking, daily dosages of antipsychotics, level of daytime activity and changes in appetite did not show any association with the weight gain indices. Neither the baseline biochemical variables nor their changes after the treatment were significantly correlated with the indices of weight gain. CONCLUSION: This result implies that low baseline BMI could be a risk factor of weight gain in short-term treatment of schizophrenia with SDAs. And it is also suggested that the effects of SDAs on weight gain and the clinical improvement might be developed through the same pharmacodynamic pathway.