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The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) with other recently published guidelines for treating bipolar disorder. We reviewed a total of six recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2022 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy in a same degree for mania. However, the KMAP-BP 2022 recommended MS + AAP combination therapy for psychotic mania, mixed mania and psychotic depression as treatment of choice. Aripiprazole, quetiapine and olanzapine were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Some guideline suggested olanzapine is a second-line options during maintenance treatment, related to concern about long-term tolerability. Most guidelines advocated newer AAPs (asenapine, cariprazine, long-acting injectable risperidone, and aripiprazole once monthly) as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. KMAP-BP 2022 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2022, predominantly in the treatment of psychotic mania, mixed mania and psychotic depression.
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Objective@#The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). @*Methods@#A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. @*Results@#The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p ＜ 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). @*Conclusion@#The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.
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Objectives@#The pharmacotherapy of bipolar disorder is complex. A treatment guideline or algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was revised through expert consensus on pharmacotherapy for bipolar disorder. @*Methods@#We revised the KMAP-BP 2018 questionnaire and conducted a survey of expert clinicians. Out of ninety-three members of the review committee, eighty-seven completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing. Here, we report the results from KMAP-BP 2022. @*Results@#The preferred first-step strategies for acute euphoric mania are a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. For psychotic mania, an MS and AAP combination, and AAP monotherapy are preferred. For hypomania, MS monotherapy and AAP monotherapy are preferred. The first-step strategies for mild to moderate bipolar depression are MS monotherapy, lamotrigine (LMT) monotherapy, AAP monotherapy, an MS+AAP combination, and an AAP+LMT combination. For non-psychotic severe depression, the MS+AAP combination, the AAP+LMT combination, and the MS+LMT combination are preferred. For psychotic severe depression, MS+AAP and AAP+LMT are preferred. @*Conclusion@#We obtained expert consensus and developed KMAP-BP 2022. Compared with KMAP-BP 2018, we can figure out clinicians’ preferences and decisions in real clinical situations more clearly. The preference for AAP increased, and that of MS and an antidepressant decreased. We hope KMAP-BP 2022 is helpful for clinicians who treat patients with bipolar disorder.
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Objectives@#The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for bipolar disorders, we updated KMAP-BP to provide more timely information for clinicians. @*Methods@#We conducted a survey using a questionnaire on treatments formanic/hypomanic episodes. Eighty-seven members among ninety-three members of the review committee (93.5%) completed the survey. Each treatment strategy or treatment option for manic/hypomanic episodes was evaluated with an overall score of 9, and the resulting 95% confidence interval treatment options were categorized into three recommendation levels (primary, secondary, and tertiary). The executive committee analyzed the results and discussed the final production of an algorithm by considering the scientific evidence. @*Results@#The combination of a mood stabilizer and an atypical antipsychotic, monotherapy with a mood stabilizer, or monotherapy with an atypical antipsychotic were recommended as the firstline pharmacotherapeutic strategy for the initial treatment of mania without psychotic features. The mood stabilizer and atypical antipsychotic combination was the treatment of choice, and atypical antipsychotic monotherapy was the first-line treatment for mania with psychotic features. When initial treatment fails, a combination of mood stabilizer+atypical antipsychotic and switching to another first-line agent is recommended. For hypomania, monotherapy with either mood stabilizer or atypical antipsychotic is the recommended first-line treatment, but the mood stabilizer+atypical antipsychotic combination is recommended as well. @*Conclusion@#It is notable that there were changes in the preferences for the use of individual atypical antipsychotics, and the preference for the use of mood stabilizer increased for treatment-resistant mania.
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Objectives@#After the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, its fifth revision was completed in 2022 to reflect the recent rapid developments and research into bipolar disorder and its psychopharmacology. @*Methods@#According to the methodology for previous versions, the depressive episode section of KMAP-BP 2022 was revised based on a survey consisting of 11 questions. Among ninetythree experts, eighty-seven members of the review committee (93.5%) completed the survey.The executive committee analyzed the results and discussed the final production of an algorithm by considering the scientific evidence. @*Results@#Overall, the results from this study showed little change in comparison with previous versions of KMAP-BP. However, there have been significant changes in recommendations over the span of about 20 years. The preferences for lamotrigine and atypical antipsychotics, especially aripiprazole, quetiapine, and olanzapine, have shown a tendency to continuously increase, but the preferences for risperidone and ziprasidone have not increased, but have decreased. Moreover, the preference for typical antipsychotics has significantly decreased. Additionally, concerns over the use of antidepressants in bipolar depression have been raised, and their use is not recommended in KMAP-BP 2022 as a first-line treatment. @*Conclusion@#Pharmacotherapy for acute depressive episodes with various clinical progressions and various subtypes still shows diversity, compared to pharmacotherapy for mania. We look forward to the development of bipolar depressive, episode-specific therapeutic drugs in the future, and hope the fifth update of KMAP-BP will be a complementary option for clinicians and their patients with bipolar disorder.
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Objectives@#Treatment guidelines or an algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) was revised again through a consensus of expert opinion. The diagnosis and treatment of mixed features are not simple, and there are many things to discuss. We describe the preferences and recommendations from KMAP-BP 2022 for the treatment of mood episodes with mixed features. @*Methods@#We revised the KMAP-BP 2018 questionnaire and conducted the survey with expert clinicians. Out of ninety-three members of the review committee, eighty-seven completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing. @*Results@#In first-step strategies for mixed features with more manic symptoms, a combination of a mood stabilizer and an atypical antipsychotic is the treatment of choice. Mood stabilizer monotherapy and atypical antipsychotic monotherapy are preferred strategies. For mixed features with more depressive symptoms, a combination of mood stabilizer and atypical antipsychotic, a combination of atypical antipsychotic and lamotrigine (LMT), atypical antipsychotic monotherapy, a combination of mood stabilizer and LMT, and mood stabilizer monotherapy are preferred. For mixed features with similar manic symptoms and depressive symptoms, a combination of mood stabilizer and atypical antipsychotic, atypical antipsychotic monotherapy, and mood stabilizer monotherapy are preferred. @*Conclusion@#For mixed features, a combination of mood stabilizer and atypical antipsychotic is generally preferred, and LMT is preferred for depressive symptoms. Compared with KMAP-BP 2018, more diverse strategies and drugs are being attempted for the treatment of mixed features.
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Objective@#This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. @*Methods@#This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. @*Results@#We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (＞ 18 years) during this period. Among adult and children/adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53− 78.91) had at least one psychiatric comorbidity, respectively. @*Conclusion@#Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.
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Background@#Grit is a psychological factor that is defined as “perseverance and passion for the long term.” A growing interest exists in this factor because it aids in overcoming difficult tasks related to the psychological well-being of psychiatry residents to prevent burnout; however, it is still under-recognized in the Korean clinical practices. This study therefore examined the relationship between grit and the psychological well-being of psychiatry residents. @*Methods@#In all, 77 psychiatry residents completed the study survey, and all met our study’s participation criteria. To assess these residents’ grit, burnout, and psychological well-being, the Original Grit Scale, Maslach Burnout Inventory, and Psychological Well-being Scale were employed. For the statistical comparison, t-test, ANOVA, and Pearson correlation analysis were used. @*Results@#A significant relationship prevailed between grit and psychological well-being. The grit scores had positive and negative correlations with psychological well-being (p<0.01) and burnout (p<0.01), respectively. Thus, psychiatry residents with higher grit scores were more likely to experience less burnout and have higher psychological well-being scores. @*Conclusion@#A significant relationship existed between grit, psychological well-being, and burnout. Grit assessment thus aided in identifying psychiatry residents who were at a greater risk of quitting their training program due to poor psychological well-being or emotional exhaustion.
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OBJECTIVE: This study aimed to develop and validate a Structured Clinical Interview for Internet Gaming Disorder (SCI-IGD) in adolescents. METHODS: First, we generated preliminary items of the SCI-IGD based on the information from the DSM-5 literature reviews and expert consultations. Next, a total of 236 adolescents, from both community and clinical settings, were recruited to evaluate the psychometric properties of the SCI-IGD. RESULTS: First, the SCI-IGD was found to be consistent over the time period of about one month. Second, diagnostic concordances between the SCI-IGD and clinician's diagnostic impression were good to excellent. The Likelihood Ratio Positive and the Likelihood Ratio Negative estimates for the diagnosis of SCI-IGD were 10.93 and 0.35, respectively, indicating that SCI-IGD was ‘very useful test’ for identifying the presence of IGD and ‘useful test’ for identifying the absence of IGD. Third, SCI-IGD could identify disordered gamers from non-disordered gamers. CONCLUSION: The implications and limitations of the study are also discussed.
Subject(s)
Adolescent , Humans , Diagnosis , Immunoglobulin D , Internet , Psychometrics , Referral and ConsultationABSTRACT
BACKGROUND: The purpose of this study was to analyze the radiographic and functional outcomes of flexible intramedullary (IM) nailing in adolescent patients with forearm fractures at the diaphysis or at the metadiaphyseal junction (MDJ). METHODS: We retrospectively reviewed the results of 40 patients who underwent IM nailing for pediatric forearm fractures. Thirty males and 10 females were followed for an average of 16 months (range, 12 to 20 months). Their average age was 11 years (range, 10 to 16 years). The average duration from the onset of trauma to surgery was 3.8 days (range, 1 to 36 days). Fracture sites were located at the MDJ of the radius in 8 patients (MDJ group) while 32 patients had middle-third fractures (D group). We assessed the magnitude and location of the maximum radial bow and range of movements. Functional outcomes were evaluated using Daruwalla criteria. RESULTS: Open reduction was carried out in 8 cases. Union was achieved at an average of 8.3 weeks postoperatively. The results were classified as good in 38 and excellent in 2 according to Daruwalla criteria with restoration of forearm rotation. The mean angulation at the last follow-up was 1.8° on the anteroposterior radiograph and 3.3° on the lateral radiograph (MDJ group: 1.8° and 2.1°, respectively; D group: 1.9° and 2.8°, respectively). There was no significant difference in the mean angulation between the groups. The mean magnitude of maximal radial bow was 5.7% ± 1.8% (MDJ group, 5.2% ± 0.8%; D group, 5.9% ± 1.9%). The mean location of maximal radial bow was 58.0% ± 8.8% (MDJ group, 56.4% ± 8.9%; D group, 58.6% ± 8.9%). The differences in the mean magnitude and location of maximal radial bow with the normal contralateral arms (7.0% ± 1.2% and 50.9% ± 6.0%, respectively) were not significantly different between the groups. Complications included superficial infection (2), delayed union (1), and refracture (1). CONCLUSIONS: IM nail fixation provided satisfactory results and maintained adequate stability for both forearm bone fractures in adolescents, even though the fracture was located at the MDJ of the radius.
Subject(s)
Adolescent , Female , Humans , Male , Arm , Diaphyses , Follow-Up Studies , Forearm , Fracture Fixation, Intramedullary , Fractures, Bone , Radius , Retrospective StudiesABSTRACT
In the critically injuried and hemodynamically unstable patient, extended focused assessment with sonography for trauma (E-FAST) examination can be performed for a rapid assessment of peritoneal and/or pericardial fluid. We report a case of traumatic tricuspid regurgitation that was missed in the emergency department by E-FAST and identified by intraoperative transesophageal echocardiography.
Subject(s)
Humans , Echocardiography , Echocardiography, Transesophageal , Emergency Service, Hospital , Pericardial Fluid , Thoracic Injuries , Tricuspid Valve , Tricuspid Valve InsufficiencyABSTRACT
OBJECTIVES: This study was conducted to quantify the six dimensions of obstacles to disaster behavioral health (DBH), which was explored through the previous Qualitative Content Analysis of field workers' experiences after the Sewol Ferry accident and to determine the preference and significance of the details of every dimension. METHODS: Based on the six dimensions and their details, structured questionnaires were devised. The field workers as DBH service providers were requested to choose not only the most urgent item but also the reason for their choice. For the statistical analysis, the field workers were grouped by age, employment period, place of employment, occupation, mental health professional certificate, and experience and education of DBH interventions. Differences of the groups were analyzed using chi-square test. RESULTS: The questionnaires were distributed to 284 field workers for DBH, and a total of 79 usable questionnaires were collected and analyzed. Out of six dimensions, 43% of the field workers primarily suffered from difficulties in vertical relations of the administration system. Vague policy on DBH was the most challenging in difficulties in vertical relations of administration system (32.9%). The details of the other 5 dimensions were also discovered. Several significant differences were identified among groups according to the structured questionnaires. CONCLUSION: This study identifies the six dimensions and their significance as obstacles to DBH services. It may make a contribution to improving laws and systems when deciding on related policies and sorting out urgent problems.
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Humans , Disasters , Education , Employment , Health Personnel , Health Services , Jurisprudence , Korea , Mental Health , OccupationsABSTRACT
PURPOSE: To investigate the quantification of metamorphopsia with a novel method that uses Monpack One (Metrovision, Perenchies, France) and to compare the relationship between metamorphopsia score and spectral-domain optical coherence tomography (SD-OCT) findings in patients with epiretinal membrane (ERM). METHODS: This study included 37 eyes of 35 patients with idiopathic ERM. We examined the patients using SD-OCT and quantified the degree of metamorphopsia using the Monpack One. On the topographic map of the Early Treatment Diabetic Retinopathy (ETDRS) grid, central retinal thickness at the fovea (1 mm), and parafovea (3 mm) was measured with the SD-OCT software. The correlation between these factors was analyzed. We repeated the metamorphopsia test twice in 22 eyes of 11 healthy subjects in order to calculate intraclass correlation coefficients (ICCs) and evaluate the reproducibility and reliability of the new metamorphopsia test. RESULTS: On the ETDRS grid, the retinal thickness (µm) of the central, superior, inferior, nasal, and temporal subfields was 495 ± 102, 428 ± 98, 454 ± 78, 434 ± 83, and 463 ± 95, respectively. The mean total metamorphopsia score was 24.8 ± 13.9, while those for the superior, inferior, nasal, and temporal subfields were 14.7 ± 9.1, 15.1 ± 8.6, 15.9 ± 8.9, and 14.6 ± 8.6, respectively. Linear regression analysis revealed that total metamorphopsia score was significantly related to central retinal thickness (p = 0.01). Moreover, each subfield of parafoveal retinal thickness positively correlated with metamorphopsia subfield score (p 0.9) in all subfields. CONCLUSIONS: The degree of metamorphopsia in ERM could be quantified objectively on each subfield using the Monpack One metamorphopsia test. The degree of metamorphopsia significantly correlated with retinal thickness measurements based on SD-OCT.
Subject(s)
Humans , Diabetic Retinopathy , Epiretinal Membrane , Linear Models , Retinaldehyde , Tomography, Optical Coherence , Vision DisordersABSTRACT
PURPOSE: To investigate the quantification of metamorphopsia with a novel method that uses Monpack One (Metrovision, Perenchies, France) and to compare the relationship between metamorphopsia score and spectral-domain optical coherence tomography (SD-OCT) findings in patients with epiretinal membrane (ERM). METHODS: This study included 37 eyes of 35 patients with idiopathic ERM. We examined the patients using SD-OCT and quantified the degree of metamorphopsia using the Monpack One. On the topographic map of the Early Treatment Diabetic Retinopathy (ETDRS) grid, central retinal thickness at the fovea (1 mm), and parafovea (3 mm) was measured with the SD-OCT software. The correlation between these factors was analyzed. We repeated the metamorphopsia test twice in 22 eyes of 11 healthy subjects in order to calculate intraclass correlation coefficients (ICCs) and evaluate the reproducibility and reliability of the new metamorphopsia test. RESULTS: On the ETDRS grid, the retinal thickness (µm) of the central, superior, inferior, nasal, and temporal subfields was 495 ± 102, 428 ± 98, 454 ± 78, 434 ± 83, and 463 ± 95, respectively. The mean total metamorphopsia score was 24.8 ± 13.9, while those for the superior, inferior, nasal, and temporal subfields were 14.7 ± 9.1, 15.1 ± 8.6, 15.9 ± 8.9, and 14.6 ± 8.6, respectively. Linear regression analysis revealed that total metamorphopsia score was significantly related to central retinal thickness (p = 0.01). Moreover, each subfield of parafoveal retinal thickness positively correlated with metamorphopsia subfield score (p 0.9) in all subfields. CONCLUSIONS: The degree of metamorphopsia in ERM could be quantified objectively on each subfield using the Monpack One metamorphopsia test. The degree of metamorphopsia significantly correlated with retinal thickness measurements based on SD-OCT.
Subject(s)
Humans , Diabetic Retinopathy , Epiretinal Membrane , Linear Models , Retinaldehyde , Tomography, Optical Coherence , Vision DisordersABSTRACT
BACKGROUND: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo™ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. METHODS: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. RESULTS: The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%. CONCLUSIONS: Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.
Subject(s)
Humans , Arterial Pressure , Blood Pressure , Cardiac Output , Catheters , Hemodynamics , Pulmonary ArteryABSTRACT
Guyon's canal syndrome is a compression neuropathy of the ulnar nerve entrapment at the wrist. Compression of the ulnar nerve at the wrist by a ganglion, lipomas, diseases of the ulnar artery, fractures of the hamate and trauma is a common etiological factor. We report on a rare case of ulnar neuropathy caused by a schwannoma at the level of Guyon's canal.
Subject(s)
Ganglion Cysts , Lipoma , Neurilemmoma , Ulnar Artery , Ulnar Nerve , Ulnar Nerve Compression Syndromes , Ulnar Neuropathies , WristABSTRACT
BACKGROUND: Critical illness that requires major surgery is often associated with non-thyroidal illness syndrome (NTIS). The characteristic feature of NTIS is low serum triiodothyronine (T3) levels, and in severe illness, the levels of serum thyroxine (T4) are also low in the absence of a rise in thyroid stimulating hormone (TSH). However, little is known about the changes in thyroid hormones during and after liver transplantation (LT). This study was conducted in order to evaluate the intra- or postoperative changes in thyroid hormones. METHODS: Twenty-two patients who underwent LT were enrolled. Serum levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), free T3 (FT3) and free T4 (FT4) were measured immediately after the induction of anesthesia (T1), at the end of the anhepatic period (T2), at the end of the surgical procedure (T3), and at 24 hours (T4) and 120 hours postoperatively (T5). RESULTS: The mean levels of T3, T4, FT3, FT4 and TSH were significantly decreased throughout the study when compared with the T1 value. The mean levels of T3, T4 FT3 and TSH were below the normal range from T2, T4 and T5. CONCLUSIONS: We suggest that LT may induce NTIS by at least postoperative day 5. In the future, longer follow-up studies, and the effects of thyroid hormones on the prognosis and determination of the advantages and disadvantages of T3 replacement therapy to these patients will be required.
Subject(s)
Humans , Anesthesia , Critical Illness , Euthyroid Sick Syndromes , Liver Transplantation , Prognosis , Reference Values , Thyroid Hormones , Thyrotropin , Thyroxine , TriiodothyronineABSTRACT
BACKGROUND: Locking of metacarpophalangeal joint (MPJ) of the index finger occurs when volar radial osteophytes of the metacarpal head catch the accessory collateral ligament. We devised a ligament-preserving approach to quickly restore the MPJ motion while protecting the radial collateral ligament. METHODS: We retrospectively reviewed the results of nine patients treated for a locked MPJ of the index finger. In three patients, closed reduction was successful. In six cases, volar radial osteophytes were excised from the metacarpal head using a ligament-preserving technique through a longitudinal incision on the radial side. We analyzed osteophyte shape and height as demonstrated by X-ray and computed tomography (CT). Function was evaluated by examining the range of motion, recurrence, Disabilities of the Arm, Shoulder and Hand (DASH) score, and MPJ stability based on the key pinch strength. One male and eight female patients were followed for an average of 33 months (range, 12 to 65 months); the average age of patients was 41 years (range, 34 to 47 years). The average duration of locking of the MPJ was 23 days (range, 1 to 53 days). RESULTS: The sharp type of osteophytes was identified in six patients and the blunt type of osteophytes was indentified in three patients. The average height of radial osteophytes on the index finger metacarpal was 4.6 +/- 0.4 mm in the axial CT image. At the final follow-up, the average extension limitation decreased from 26degrees (range, 10degrees to 45degrees) to 0degrees, and further flexion increased from 83degrees (range, 80degrees to 90degrees) to 86degrees. There was no recurrent locking after surgery. The DASH score improved from 24.3 to 7.2. Key pinch strength improved from 67.3% to 90.4%. CONCLUSIONS: We obtained satisfactory outcomes in irreducible locking of the MPJ of the index finger by excising volar radial osteophytes of the metacarpal head using a ligament-preserving approach.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Collateral Ligaments/surgery , Fingers/physiopathology , Metacarpophalangeal Joint/physiopathology , Osteophyte/complications , Range of Motion, Articular , Retrospective StudiesABSTRACT
OBJECTIVES: We aimed to determine whether the adult attachment styles of pregnant women could predict development of postpartum depression. METHODS: Korean version of Revised Adult Attachment Scale, State Trait Anxiety Inventory-State/Trait (STAI-S/T), and Center for Epidemiologic Studies-Depression Scale (CES-D) were administered at baseline. Edinburgh Postnatal Depression Scale (EPDS), Parenthood Stress Questionnaire (PSQ), STAI-S, and CES-D were assessed at week 2 and 6 postpartum. Participants were categorized into the secure-mom (SM ; n=48) or insecure-mom (IM ; n=9) group. RESULTS: While STAI-S scores in SM showed a continuous decrease during the entire observation period, STAI-S scores in IM decreased during the first two weeks but increased during the next four weeks. While SM showed decreased CES-D scores from week 2 to 6, IM showed increased CES-D scores from week 2 to 6. Although SM showed decreased EPDS scores from week 2 to 6, IM showed increased EPDS scores from week 2 to 6. In SM, the change in EDPS score from week 2 to week 6 showed positive correlation with PSQ-ability and PSQ-social subscale scores. CONCLUSION: Assessing the maternal adult attachment style before giving birth appears to be helpful for screening the high-risk group who are vulnerable to development of postpartum depression.