Psychosocial Correlates of Length of Stay of Institutionalized Patients with Mental Illness / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the correlated factors that may influence the length of stay in mental health related facilities. METHODS: We chose 2253 patients with mental illness using a stratified multi-stage cluster sampling from 48 psychiatric hospitals, twelve psychiatric clinics, five psychiatric welfare facilities, and five mental rehabilitation facilities. The investigation involved psychiatrists, psychology practitioners, and social workers, and lasted from August 1, 2008 to November 15, 2008. Assessment and investigation of diverse factors was performed using one-way analysis of variance in order to examine their influence on length of stay. RESULTS: Factors showing significant correlation with length of stay included the types of mental health related facilities, age, marital status, socioeconomic status, type of medical security, familial support, type of admission, diagnosis, age of onset of the illness, number of admissions, severity of psychiatric symptoms, daily living and social function, GAF score, prominent thought/perception disability, memory/orientation disturbance, odd behavior/prominent regression, personal hygiene, communication/personal relationship, management of money, and public transportation/facility utilization. CONCLUSION: Findings of this study suggest that the type of mental health related facilities and the type of medical security are the most significant factors showing correlation with length of stay.

Comparison between Users of Community Mental Health Services and Psychiatric Patients in Mental Health Related Facilities in Korea / 대한정신분열병학회지

OBJECTIVES: This study was conducted to compare the characteristics of psychiatric inpatients in mental health related facilities and community mental health services-utilizing patients by diverse factors in Korea. METHODS: Questionnaires were sent via mail to 140 standard mental health centers from October to December of 2008. 64 facilities responded and data of 461 mentally disabled who are registered at and utilize the services of these mental health centers were analyzed. T-test and cross-analysis were performed to determine the differences in the averages of the variables and the discrepancy in ratios, respectively. RESULTS: Differences between long-term psychiatric inpatients and community mental health services-utilizing patients were seen in characteristics such as gender, age, type of medical coverage, family support systems, diagnosis, age of onset, duration of hospitalization, community-dwelling period, and clinical symptoms and functions. It was significantly short in length of stay in facilities in users of community mental health services with comparison to institutionalized patients. CONCLUSION: The results of this study suggest that invigoration of community mental health services is an alternative that can help deter long-term hospitalization.

Medical Care Utilization Status and Associated Factors with Extended Hospitalization of Psychiatric Patients in Korea / 예방의학회지

OBJECTIVES: This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. METHODS: Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. RESULTS: The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. CONCLUSIONS: The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

Verification of Skin Dose in Tomotherapy Using the Developed Phantom for Image Based Radiation Treatment System / 의학물리

Radiation treatment for skin cancer has recently increased in tomotherapy. It was reported that required dose could be delivered with homogeneous dose distribution to the target without field matching using electron and photon beam. Therapeutic beam of tomotherapy, however, has several different physical characteristic and irradiation of helical beam is involved in the mechanically dynamic factors. Thus verification of skin dose is requisite using independent tools with additional verification method. Modified phantom for dose measurement was developed and skin dose verification was performed using inserted thermoluminescent dosimeters (TLDs) and GafChromic EBT films. As the homogeneous dose was delivered to the region including surface and 6 mm depth, measured dose using films showed about average 2% lower dose than calculated one in treatment planning system. Region indicating about 14% higher and lower absorbed dose was verified on measured dose distribution. Uniformity of dose distribution on films decreased as compared with that of calculated results. Dose variation affected by inhomogeneous material, Teflon, little showed. In regard to the measured dose and its distribution in tomotherapy, verification of skin dose through measurement is required before the radiation treatment for the target located at the curved surface or superficial depth.

Comparison of Major Procedures of Korean Mental Health Law with Other Developed Countries / 신경정신의학

OBJECTIVES : The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since the Mental Health Act was legislated in 1995, four amendments have been made according to the issues that arose from public concerns. However, there are still many debates about the human rights protection of the mentally ill. This study aimed to provide information regarding major aspects of the Mental Health Act by comparing them among several developed countries. METHODS : Current Mental Health Acts of the state of Michigan in the United States, Scotland in England, the state of Victoria in Australia, and Japan were reviewed. Issues regarding the Korean Mental Health Act were collected from seminar materials, news media contents, and mental health professionals. RESULTS : The definition of subjects in Korean Mental Health Act was more inclusive than other countries and was derived from a medical classification of mental illness. Family members or guardians were granted important responsibilities for deciding the involuntary admission of mentally ill patients in Korea and Japan. In Western countries, Mental Health Review Tribunals or courts have the primary responsibility for important decisions about mentally ill patients. The regulation of immediate discharge after request by voluntarily admitted patients was not enacted in all countries except Korea. The mandatory procedure for involuntary admission in Western countries includes an individual case review with personal interview by a Mental Health Review Tribunal or court. CONCLUSION : The Korean Mental Health Act appears to meet the basic standards of Guidelines from international organizations. Our traditional culture and inherent health systems seem to influence the legal regulation of mental health service and might be related to the problems of human rights protection of mentally ill patients in Korea.

Development of QA Phantom Prototype for Imaged Based Radiation Treatment System / 의학물리

In this study, we developed the protopype of QA phantom for image QA including an additional component for image based radiation treatment system. The new phantom considered two main parts: Image quality and fusion accuracy. Image quality part included for daily CT number linearity and spatial resolution, and fusion accuracy part designed to simulate a simple translation-rotation setting. The CT scans of the phantom obtained from conventional CT, MVCT of Tomotherapy unit, and both image sets were satisfied the recommendation of spatial resolution. This phantom was simple and efficient for daily imaging QA, and it is important to provide a new concept of verification of image registration.

Clinical Manifestations of Depressive Symptoms in Korean Elderly

OBJECTIVE: To analyze characteristics of depressive symptom manifestation in Korean elderly by use of the Psychogeriatric Assessment Scale-Korean Version (PAS-K). METHOD: In the two epidemiological studies conducted in Yoncheon and Ulsan separately, PAS-K (Psychogeriatric Assessment Scale-Korean Version) was used as a common screening tool for depression in aged persons (65+). We analyzed the symptom characteristics in total subjects (n=1.641) by factor analysis and compared depressive symptomatology between male and female, urban and rural, educated and uneducated persons. Chi-square method was used to evaluated the differences in positive response rates of each depressive symptoms, and also item response theory was used to compare depressive symptomatology between male and female subject groups. RESULTS: Two factor structure that comprises 'combined emotional, cognitive and somatic factor' and 'sleep factor' was found in female, rural and uneducated groups. While, three factor structure composed of 'emotional factor', 'combined cognitive and somatic factor' and 'sleep factor' was found in male, urban and educated groups. Women endorsed significantly more depressive symptoms than men. Depressive mood, fatigue, restlessness, thoughts mixed up and suicide idea were more prevalent in female group. However, women reported their symptoms, especially emotional symptoms like depressive mood, restlessness, suicide idea, in less severe state of depression than men. In the evaluation of each item characteristics, most items were relevant in their item characteristics for the assessment of depressive symptoms in Korean elderly. However, 'hypnoticsalcohol use' item had very low correlation coefficient with total symptom score and it was less discriminative than other symptom items. CONCLUSION: Symptom characteristics of depression in Korean aged persons were different between groups according to sex, urbanicity and education level. An influence of Confucian culture on different symptom expression between male and female groups should be considered.

The Palliative Radiation Therapy in Malignant Extra-Hepatic Biliary Obstruction / 대한방사선종양학회지

PURPOSE: To evaluate the effectiveness of external radiation therapy and the prognostic factors, we retrospectively analyzed therapeutic results of malignant extrahepatic biliary obstruction (EHBO). METHODS AND MATERIALS: We analyzed the results of the external radiation therapy in 59 patients of inoperable malignant EHBO who had been treated with more than 10 Gy of external radiation therapy from April 1984 to December 1996. There were 21 stomach cancer (35.6%), 12 pancreas cancer (20.3%), 15 extrahepatic biliary cancer (18.6%) and 11 another cancer (18.6%). Their pathologies were confirmed in 31 patients (52.5%). They divided into 27 adenocarcinoma and 4 nonadenocarcinoma. Their chief complaints were jaundice in 47 patients (79.7%) and abdominal pain in 15 patients (49.2%). Twelve patients had slightly increased bilirubin level in liver function test without jaundice. We treated twenty four patients (40.6%) with percutaneous transhepatic biliary drainage (PTBD) and 32 patients (54%) with systemic chemotherapy (CT). We performed external radiation therapy (ERT) upto 10.8~55.8 Gy (median 37.8 Gy) with palliative aim. RESULTS: Overall median survival duration was 7.80+/-1.15 months. The response rates of jaundice were 81.8% in PTBD group and 66.7% in non-PTBD group without statistical significance. The improving rate of jaundice was not significantly different in decreased ratio of total bilirubin level. But abdominal pain was more decreased in CT group than non-CT group (P70), total radiation dose more than 35 Gy and good response of pain after therapy. There were increased in bacterial cholagitis in PTBD group and gastrointestinal complications in CT group. CONCLUSION: External radiotheapy could improve jaundice and abdominal pain in malignant EHBO patients. Overall survival duration was prolonged in patients with higher performance status and patients who had been treated with more than 35 Gy of total radiation dose. In the future, we expect not only better palliative role but also the prolongation of survival of using the ERT combined with other treatment method. But to achieve certain conclusion, we need futher study consisted with many kinds of treatment methods including new technologies in RT.

The Effect of External Radiation Therapy for Intracranial Arteriovenous Malformation: Conventional Radiation Therapy vs Stereotactic Radiosurgery / 대한치료방사선과학회지

From February 1987 through July 1990, the seventeen cases of inoperabelintracranial arteriovenous malformation (AVM) were treated using 6 MV linear accelerator at the Division of Therapeutic Radiology, Kang Nam St. Mary's Hospital. Of seventeen cases, fourteen were male and three were female. Ages ranged from 10 to 51 years (median age of 26 years). The main symptoms were headache, epilepsy and hemiparesis in decreasing order of frequency. The middle cerebral artery is the most common origin of the feeding vessel (41.2%). Four were treated by conventionally fractionated radiation therapy (CRT), thirteen were treated by stereotactic radiosurgery (RS). Duration of follow-up study, two of four CRT group showed minimal response. Of thirteen cases of RS group, two (15.4%) showed complete response, five (38%) partial response, two (15.4%) minimal response and four (30.7%) no response by the same assessment. There was no statistical significance in terms of follow-up period (p=0.22), size of lesion (p=0.82) and treated dose (p=0.65). Further accumulation of experience s recommended with proper case selection and sufficient follow-up period.