Comparison of MMSE Profiles Between Dementia, Psychotic Disorders, and Mood Disorders

Objective@#Cognitive impairment has been an area of interest for psychiatrists. Not only do patients with dementia exhibit symptoms associated with cognitive impairment, but those with some mental disorders such as psychotic and mood disorders as well. However, differences in cognitive impairment between these disorders remain unclear. In this study, we used the Korean Mini-Mental State Examination (K-MMSE), a tool that can be easily administered to patients, to compare cognitive impairment profiles among patients with dementia, psychotic disorders, and mood disorders. @*Methods@#We collected demographic and clinical characteristics of 59 patients who were over 50 years old. Cognitive func-tion was assessed using the K-MMSE. Patients were divided into three groups based on International Classification of Diseases 10th revision diagnosis codes: 1) F00-F01 Dementia, 2) F20-F29 Psychotic disorders, and 3) F30-F39 Mood disorders. We compared K-MMSE subscale scores between the three groups using one-way analysis of variance. @*Results@#The three groups did not differ in demographic data. The dementia group showed the lowest scores in orientation to time (standard deviation [SD]=1.45, F=3.233, p<0.05) and place (SD=1.25, F=3.388, p<0.05), as well as registration (SD=1.00, F=4.425, p<0.05) and recall (SD=0.91, F=3.364, p<0.05) of memory compared to the groups with psychotic and mood disorders. The psychotic disorder group showed significant impairment in language (SD=1.34, F=3.348, p<0.05) compared to the other groups. No significant differences were observed in calculation and drawing. @*Conclusion@#This study suggests that certain K-MMSE subscale scores could indicate an illness that causes cognitive impairment, especially in dementia, psychotic disorders, and mood disorders. By using K-MMSE profiles, we could provide better in-terventions for patients with cognitive impairment.

Development of Mental Healthcare Model in Seoul

Objective@#To develop an integrated and comprehensive community-based mental healthcare model, opinions were collected on various issues from practitioners in mental health service institutions currently offering mental healthcare services in Seoul through a focus group interview, qualitative research method, and Delphi survey. @*Methods@#The focus group interview was conducted with six practitioners from mental health welfare centers and six hospital-based psychiatrists. A questionnaire of opinions on the mental healthcare model was filled by these practitioners and psychiatrists. A Delphi survey was additionally conducted with a panel of 20 experts from a community mental health welfare center and hospital-based psychiatrists. @*Results@#The focus group interview results showed the need for integrated community-based mental healthcare service and the need to establish a system for managing mental and physical health in an integrated manner. Based on the survey results, the current status of community-based mental healthcare services was investigated, and the direction of the revised model was established. The Delphi survey was then conducted to refine the revised model. @*Conclusion@#The present study presents the Seoul-type community-based mental healthcare model with integrated services between a psychiatric hospital with a mental health welfare center as well as combined mental and physical health services. This is ultimately expected to help people with mental illnesses live healthy lives by meeting their needs as community members.

A Comparative Study of the Effective Infusion Method of Propofol for Patients That Prefer to be Sedated under Brachial Plexus Block / 대한마취과학회지

BACKGROUND: Patients who are scheduled for upper extremity surgery under brachial plexus block (BPB) prefer to have no memory of the surgical procedure and some form of sedation is therefore necessary. Because of this we have tried to find an adequate infusion method for propofol that would supply better sedation and less complications. METHODS: We divided 60 patients who were scheduled for upper extremity surgery under BPB into four groups according to loading dose and following continuous infusion rate of propofol (Group 1: 0.2 mg/kg, 8 microgram/kg/min, group 2: 0.4 mg/kg, 16 microgram/kg/min, group 3: 0.6 mg/kg, 33 microgram/kg/min, group 4: 0.8 mg/kg, 50 microgram/kg/min.). We evaluated the degree of sedation, amnesia, recovery, changes of blood pressure, heart rate, and respiratory effect of each group. RESULTS: According to the sedation score, groups 3 and 4 were sedated better than groups 1, 2 (P< 0.05). But the mean arterial pressure (MAP), heart rate and respiration were more depressed and recovery time prolonged in the higher dosage groups (P< 0.05). Three patients among group 4 developed severe respiratory depression, at which time infusion of propofol was stopped. CONCLUSIONS: The ideal infusion method of propofol for effective sedation was 0.4 0.8 mg/kg of loading dosage, followed by 16 50 microgram/kg/min of continuous infusion dosage. But the more dosages of propofol that were administered, the more complications appeared, so we must use care in administering propofol as a sedation adjuvant to BPB.

The Effect of Bupivacaine on Blood Coagulation In Vitro under Thromboelastography / 대한마취과학회지

BACKGROUND: Deep vein thrombosis (DVT) is a common complication following major surgical procedure. In regional anesthesia with local anesthetics, deep vein thrombosis is less frequent than in general anesthesia. Several studies have advocated that local anesthetics alter the function of platelets, the stability of vascular endothelium, and the hemodynamics of the blood flow in the epidural anesthetic region. We investigate the effect of the local anesthetic bupivacaine on blood coagulation in vitro under thromboelastography (TEG). METHODS: 16 Healthy volunteers who had no history of coagulation defect and anticoagulant use were evaluated. The patients were divided into 4 groups and each group was treated with bupivacaine in the following concentrations; the lower clinical level (1 microgram/ml, B1 group), the higher clinical level (2 microgram/ml, B2 group), the systemic toxicity level (4 microgram/ml, B3 group), and a control group which was treated with normal saline. We compared the TEG parameters of each group, reaction time (R), coagulation time (K), alpha angle (alpha), maximal amplitude(MA) and fibrinolysis index (lysis 60), respectively. RESULTS: As compared with the control group, there were no significant differences in the other 3 groups, especially in maximal amplitude. CONCLUSIONS: In the clinical concentration, bupivacaine had no effect on blood coagulation under TEG. Thus in the clinical concentration of bupivacaine, DVT is more influenced by several physiologic changes which are induced by epidural anesthesia, include stability of vascular endothelium, increased blood flow, and decreased catecholamine release rather than by the effect of bupivacaine on blood per se.