Clinical Characteristics in Panic Disorder Patients in Emergency Department / 정신신체의학

Objectives@#：This study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack. @*Methods@#：A retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher’s exact test was used. Collected data was analyzed using R 4.03. @*Results@#：Cardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (χ2 =4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (χ2 =8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%. @*Conclusions@#：The most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.

Corrigendum: Competency-Based Psychiatry Residency Training Program Development in South Korea / 의학교육논단

This correction is being published to revise the authorship

Competency-Based Psychiatry Residency Training Program Development in South Korea / 의학교육논단

Psychiatry residency training in South Korea currently has many limits in developing proper competencies of residents. To address this problem, the Korean Neuropsychiatric Association has been developing a new competency-based training program since 2015, using the educational systems of advanced countries such as Canada, the United Kingdom, the United States, and Australia as references. It was found that within the referenced countries' residency training systems, objectives based on competencies are stated in detail by psychiatric topics as well as various assessment methods and feedback about the resident's competency level. In addition, we surveyed psychiatric resident training hospitals, and found that more than 80% of the respondents answered positively in reference to the new training program. This paper briefly reviews competency-based residency training systems of advanced countries and compares them to the current training program in South Korea. Many resources are needed to run a new competency-based training program, and governmental supports are essential to improve the quality of the residency training system.

The Characteristics of Bipolar Outpatients in Remission Showing False-Negatives on the Korean Version of Mood Disorder Questionnaire / 신경정신의학

OBJECTIVES: The Mood Disorder Questionnaire (MDQ) has been validated as a diagnostic screening instrument for the detection of patients with bipolar disorder, but some patients with bipolar disorder obtain false negative screens. So we investigated demographic and clinical characteristics in false-negative MDQ in bipolar patients. METHODS: The participants were 60 DSM-IV bipolar outpatients in remission. All completed the Korean version of the Mood Disorder Questionnaire (K-MDQ) and the Korean version of the Beck Cognitive Insight Scale (K-BCIS) and were assessed by a trained clinician on the Young Mania Rating Scale, the Hamilton Depression Rating Scale and the Global Assessment of Functioning scale. The patients were categorized into two groups according to their K-MDQ score excluding further two questions (MDQ > or =7 : K-MDQ-positives and MDQ <7 : K-MDQ-negatives). Differences in demographic and clinical characteristics between these two groups were analyzed. RESULTS: There were no statistically significant differences between K-MDQ-positives and K-MDQ-negatives on the demographic and clinical variables, except on the K-BCIS where K-MDQ-negatives reported significantly lower scores on the K-BCIS composite index and self-reflectiveness subscale. CONCLUSION: These results suggest that lack of insight is a confounding factor in screening for bipolar disorder using the K-MDQ.

The Study on Patient-Centeredness and Influencing Variables in Medical Students / 신경정신의학

INTRODUCTION: The practicing of patient-centered medical services means a change in the pattern of the nature of doctor-patient relationship. The doctor oriented relationship is now moving to the pattern that patients resolve problems autonomously and participate in the decision-making in medical services. Authors performed this study to investigate the patient centeredness and influencing variables in medical students. METHODS: Authors recruited 94 medical students before psychiatric clinical clerkship and all subjects were assessed by structured questionales including socio-demographic data, frequency of receiving doctor-patient relationship lectures, Minnesota multiphasic personality inventory (MMPI), Meyers-Briggs type indicator (MBTI), the authoritarian personality scale (AP), job satisfaction scale (JS), patient practitioner orientation scale (PPOS), problem-solving decision-making scale (PSDM), and Beisecker locus of authority in decision-making scale (BLAS), and the questionnaire of JS, PPOS, PSDM, and BLAS were rechecked after psychiatric clinical clerkship. RESULTS: After psychiatric clinical clerkship, the score of JS, PPOS were higher than before. The group who had a good memory for taking a doctor-patient relationship lecture showed higher scores of the BLAS and PSDM than unexposed group. The AP was related with MBTI, correlated with the subscale of MMPI, however, inversely correlated with PPOS after psychiatric clinical clerkship. CONCLUSION: The authoritarian personality trait was related not only with other personality trait including introversion and psychopathic deviation (Pd) but also with patient-centeredness. Taking a lecture in doctor-patient relationship is positively related to the patient-centeredness.

Patient-Centeredness Associated with Personality Traits of Medical Students / 한국의학교육

PURPOSE: The patient-centered attitude is an effort to understand patients themselves as well as their disease. The doctor-oriented approach has been shifting to one where patients and participate in the deciding of medical service. We performed this study to investigate the patient-centeredness and influencing variables associated with personality traits. METHODS: We recruited 94 medical students before their psychiatric clinical clerkship, and all subjects were assessed by a structured questionnaire including socio-demographic data, Minnesota Multiphasic Personality Inventory(MMPI), Meyers-Briggs type indicator(MBTI), the patient-practitioner Orientation Scale(PPOS), and the Authoritarian Personality scale(AP), The AP and PPOS questionnaires were repeated after the psychiatric clinical clerkship. RESULTS: After the psychiatric clinical clerkship, the AP scores were significantly lower than before, and the PPOS significantly higher than before. The change in the AP scores were related to MBTI, correlated with MMPI subscales, however, inversely correlated with the changes in PPOS after the clinical clerkship. CONCLUSION: The authoritarian personality trait was related to, not only the personality trait including MBTI and MMPI subscales, but also to patient-centeredness in medical students.

Impact of pain control with Ultracet(R) on the Quality of Life of cancer patients / 대한내과학회지

BACKGROUND: Cancer pain impacts the patient and improved pain management increases the quality of life (QOL) for the patient and entire family. One tablet of Ultracet(R) is composed of 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen. Mechanism of action of Ultracet(R) is multiple blocking to pain transmission with 3 synergistic actions. Ultracet(R) shows high performance analgesic efficacy with good tolerability and fast onset in previous studies. METHODS: From February 2003 to January 2004, we treated 97 patients who had cancer pain. Brief pain inventory, WHO QOL-BREF, and EORTC QLQ-C30 were evaluated before, and after median duration of treatment of 17.9 days with Ultracet(R). RESULTS: Among 97 patients, male was 59 (61%) and female was 38 (39%). Mean age was 60.3+/-12.0 (range: 25-81 years). Stomach cancer was in 19, lung cancer in 14, lymphoma in 11, unknown primary carcinoma in 8, colorectal cancer in 7, in order of frequency. Pre/post treatment visual analogue scale (VAS) score was 6.43/4.46 (p=0.000). Mild pain in 11 patients and pre/post treatment VAS score of 2.09/1.91 (p=0.875), moderate pain in 33 and 5.21/3.64 (p=0.000), and severe pain in 53 and 8.09/5.51 (p=0.000). Change of QOL after pain management was significant in emotion (65.9/72.1, p=0.012) in functional scales, and pain in symptom scales (62.0/50.9, p=0.000), sleep disturbance (p=0.018), and constipation (p=0.038) in symptom scales. We compared a QOL scales of 3 groups by response to Ultracet(R); improvement (67), no change (17), and aggravation (13). Global health (p=0.000). fatigue (p=0.019), and sleep disturbance (p=0.003) were statistically different among 3 groups. CONCLUSION: Ultracet(R) is effective in moderate to severe cancer pain and contribute an improvement of quality of life (QOL) of cancer patients.

Changes of Smoking Urge and Endogenous Opioids, Prolactin, ACTH, Cortisol Levels in Nicotine Dependents with Naltrexone Pretreatment / 신경정신의학

OBJECTIVES: There is a controversy on the mechanism of nicotine dependence. Some suggest that the negative reinforcement such as withdrawal symptoms plays an important role, but others suggest that the positive reinforcement through the opioid-dopamine system plays an important role. Under the assumptions that the positive reinforcement and the opioid-dopamine interaction to have an important role in nicotine dependence, this study examined the effects of chronic naltrexone treatment on smoking behaviors, smoking urges to smoking cues and neuroendocrine responses to smoking. METHODS: In a randomized, placebo-control, double-blind design, voluntarily admitted regular smokers who wanted to quit smoking received naltrexone (13 persons) or placebo (12 persons) treatment for 2 weeks. Each week, naltrexone side effects, discomforts after the reduction of cigarette smoking, smoking urges to smoking cues, daily cigarette smoking amount, and expiratory carbon monooxide levels were checked. Also blood beta-endorphin, dynorphin, prolactin, ACTH, and cortisol levels were measured before and after smoking. RESULTS: Naltrexone treatment group showed significantly reduced smoking urges to smoking cues (p=0.036 at 2nd week), daily cigarette smoking amount (p=0.027 at 1st week), and expiratory CO levels (p=0.002 at 1st week, p=0.039 at 2nd week). Naltrexone treatment group also showed significantly increase cortisol level after smoking during the 1st week (p=0.048), and ACTH and prolactin level during the 2nd week (respectively p=0.010, p=0.009). But, the levels of beta-endorphin and dynorphin A were not different between the two groups. Discomfort profiles after the reduction of cigarette smoking, systolic and diastolic BP, and pulse rates were not different between the two groups. CONCLUSION: Longterm naltrexone treatment could be an effective tool used for the cessdtion of smoking. It was suggested that naltrexone blocks the positive reinforcement effects of smoking rather than the negative reinforcement effects of nicotine withdrawal.

Patient-Centeredness in Faculties, Residents and Medical Students / 신경정신의학

INTRODUCTION: The nature of doctor-patient relationship has changed. We performed this study to investigate the patient centeredness and influencing variables in medical faculties, residents and medical students. METHOD: The subjects were 56 medical students, 62 residents and 103 faculties in university and general hospitals. The sociodemographic data, frequency of receiving doctor-patient relationship lectures, the job satisfaction scale (JS), the patient practitioner orientation scale (PPOS), the authoritarian personality scale (AP) were items assessed. RESULT: The AP were inversely correlated with total scores of the PPOS in medical students, residents, and faculties. The scores of JS were correlated with total scores, and the care subscale of the PPOS in medical students. The group received doctor-patient relationship lecture showed higher scores of the PPOS than unexposed group. Female faculties showed higher scores of the care subscale of the PPOS than male counterparts. The scores of care subscale of the PPOS of the women doctors who have children were higher than those who do not have children. CONCLUSION: The authoritarian personality trait is correlated with the doctor/disease centeredness in medical students and doctors. The experience of learning about doctor-patient relationship is positively related to the patient centeredness. The job satisfaction, sex, and children bearing may be correlated with the patient centeredness under the certain circumstances.

Alexithymia in Patients with Alopecia Areata / 신경정신의학

OBJECTIVES: Alexithymia has been regarded as the general personality of psychosomatic disease, but it's controversial. The object of the study is to find out the relationship between alexithymia and alopecia areata. METHODS: Thirty one alopecia areata patients were compared to 31 normal healthy persons in alexithymic tendency using TAS-20K. Also MMPI and SCL-90-R were checked in both groups. Psychiatric diseases were ruled out. RESULTS: The scores of F, K, Hs, D, Hy, Pd, Pa, Pt and Sc of MMPI in alopecia areata patients were different from those in normal healthy persons. The scores of SOM, O-C, I-S, DEP, ANX, HOT, PHOB, PAR, PSY, GSI, PSDI, and PST of SCL-90-R in alopecia areata patients were significantly higher than those in normal healthy persons. In TAS-20K, the scores of Factor 1 and Total in alopecia areata patients were higher than those in normal healthy persons. CONCLUSION: Our results suggest that alopecia areata patients are more alexithymic than normal healthy persons.

Alcohol Urge and Plasma beta-endorphin Change after Alcohol Challenge in Naltrexone Pretreated Social Drinker / 신경정신의학

OBJECTIVES: The present study was performed to evaluate whether naltrexone treatment are effectively lowering the urge of alcohol drinking, and to investigate the its mechanism of action. METHODS: 15 healthy male social drinkers were voluntarily participated. The experimental method was double-blind placebo-controlled cross over design. Subjects ingested a naltrexone (50mg)/day or placebo for 1 week. Plasma beta-endorphin, plasma ACTH and serum cortisol levels were measured before, at 20 minutes and at 60 minutes after alcohol exposure. Subjects completed self-report questionnaires such as the visual analog scales of drink urge and the alcohol sensation scales at regular intervals. RESULTS: 1) During naltrexone pretreatment period, subjects reported more headache, dizziness, nervousness, fatigue, day somnolence, nausea, and decreased appetite than placebo pretreatment period. But serum GOT/GPT levels were not significantly different between two pretreatment periods. 2) In case of naltrexone pretreatment, subjects reported significantly less urge to alcohol drink on the self-reporting urge scales, especially at post-drinking 20 minutes and 60 minutes than placebo pretreatment. 3) After alcohol challenge, subjects reported significantly more dizziness on the alcohol sensation scales in case of naltrexone pretreatment, and reported less mood elevation trend though it was not statistically significant. Other scores were not significantly different between two pretreatments. 4) Plasma beta-endorphin levels were significantly different when treated with naltrexone. In case of naltrexone-pretreatment, the increasing degree of plasma beta-endorphin during 20 minutes after alcohol challenge was significantly higher than placebo pretreatment. 5) Basal plasma ACTH level and basal serum cortisol level were not significantly different between two pretreatments. After alcohol challenge, only the decreasing degree of plasma ACTH levels during 20 minutes was significantly lowered in the naltrexone pretreatment than placebo pretreatment. CONCLUSIONS: Naltrexone reduced urge to alcohol drinking in social drinker. The action mechanism of naltrexone may be partially blocking opioid positive reward system and partially alcohol mimicking its property.

Plasma Beta-Endorphin, Adrenocorticotropic Hormone and Cortisol Change in Alcohol Abstinent Patients / 신경정신의학

OBJECTIVES: The present study was performed to evaluate the change in releasing action of hypothalamus-pituitary-adrenal axis after alcohol abstinence in patients with alcohol dependence, and to identify the etiologic mechanism of alcohol dependence indirectly. METHODS: Plasma beta-endorphin, cortisol and ACTH level was measured in 14 alcohol dependent patients and in 14 healthy persons after 7 days and 28 days of alcohol abstinence at 08: 00h and 12: 00h, twice a day. RESULTS: 1) There was no significant difference in plasma beta-endorphin, cortisol and ACTH level measured at 08: 00h and 12: 00h between patients and control group after 7days of alcohol withdrawal. 2) Plasma beta-endorphin level measured at 08: 00h in patients was significantly elevated comparing with control group after 28days of alcohol withdrawal. But, there was no significant difference in plasma beta-endorphin level measured at 12: 00h and in plasma cortisol and ACTH level measured at both 08: 00h and 12: 00h between two groups after 28days of alcohol withdrawal. 3) In the patient group, there was no significant difference between patients after 7days and 28 days of alcohol withdrawal in plasma beta-endorphin, cortisol and ACTH level measured at 08: 00h and ACTH level measured at 12: 00h. But, beta-endorphin and cortisol level measured at 12: 00h were significantly lowered in patients after 28days of alcohol withdrawal than after 7days of withdrawal. 4) In decreasing rate of beta-endorphin production from 08: 00h to 12: 00h, there was significant difference between patients and controlled group after 28days of alcohol withdrawal. CONCLUSION: In alcohol dependent patients, lower level of beta-endorphin and increased reducing rate in diurnal variation of beta-endorphin after alcohol withdrawal are evident, which in turn may elevate craving for alcohol intake, and there findings support the opioid compensation theory in the development of alcohol dependence.