Surgical Decision for Elderly Spine Deformity Patient / 대한정형외과학회잡지

Globally, the elderly population is increasing rapidly, which means that the number of deformity correction operations for elderly spine deformity patient has increased. On the other hand, for aged patients with deformity correction operation, preoperative considerations to reduce the complications and predict a good clinical outcome are not completely understood. First, medical comorbidity needs to be evaluated preoperatively with the Cumulative Illness Rating Scale for Geriatrics or the Charlson Comorbidity Index scores. Medical comorbidities are associated with the postoperative complication rate. Managing these comorbidities preoperatively decreases the complications after a spine deformity correction operation. Second, bone densitometry need to be checked for osteoporosis. Many surgical techniques have been introduced to prevent the complications associated with posterior instrumentation for osteoporosis patients. The preoperative use of an osteogenesis inducing agent

Korean Medication Algorithm for Bipolar Disorder 2018 : Medical Comorbidity / 우울ㆍ조울병

OBJECTIVES: The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed in 2018, to provide newer guidelines for clinicians. In this section, we examined expert opinions to facilitate clinical decisions relative to treating bipolar disorder with medical comorbidity.METHODS: The survey was completed by the review committee, consisting of 61 experienced psychiatrists. This part of the survey constitutes treatment strategies, under major medical comorbidities. The executive committee analyzed results, and discussed the final production of algorithm.RESULTS: Aripiprazole was the first-line medication for bipolar patients with metabolic syndrome, cardiovascular, hepatic, renal, and cerebrovascular comorbidities. Ziprasidone also was recommended as the first-line medication in case of metabolic syndrome. Lithium also was regarded as the first-line medication, in case of hepatic problems. Valproate also was considered as the first-line medication, in case of cerebrovascular problems.CONCLUSION: This study provided the most recent consensus among experts, for treatment of bipolar disorder with physical problems.

Korean Medication Algorithm for Bipolar Disorder 2014: Medical Comorbidity / 대한정신약물학회지

OBJECTIVE: The third revision of Korean Medication Algorithm Project for Bipolar Disorder was performed in 2014 in order to provide more proper guideline for clinicians. In this study, we undertook a survey of expert opinion to help clinical decisions in medical comorbidities. METHODS: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 64 experienced psychiatrists. This survey was composed of 56 main questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific situations. The executive committee analyzed the results and discussed the final production of algorithm. RESULTS: In bipolar patients with cardiovascular, diabetic, or hepatic comorbidities, aripiprazole was first-line treatment strategy. In case of renal comorbidity accompanying bipolar disorder, aripiprazole, valproate, and quetiapine were preferred. Valproate was recommended as the first-line strategy in case of bipolar disorder with cerebrovascular diseases. CONCLUSION: This study provided information about the consensus among experts in regard to treatment strategies for bipolar disorder in the medically ill.

The Stress Perception, Depressive Symptoms and Medical Comorbidity in Healthcare Center / 정신신체의학

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.

Comorbidades médicas em pacientes ambulatoriais com transtorno do humor bipolar tipo I / General medical comorbidities in Brazilian outpatients with bipolar disorder type I

CONTEXTO: O transtorno do humor bipolar (THB) está associado a altas taxas de comorbidades médicas gerais (CMGs) e fatores de risco para problemas médicos, porém há escassos relatos sobre a prevalência dessas condições em brasileiros com THB. OBJETIVO: Descrever a prevalência de CMGs em uma amostra de pacientes com THB tipo I. MÉTODOS: Dados clínicos de 195 pacientes com THB tipo I foram revisados para identificação de CMGs. Pacientes com e sem CMGs foram comparados usando o teste não paramétrico Mann-Whitney e o teste qui-quadrado. RESULTADOS: Sessenta e três por cento dos pacientes relataram pelo menos uma comorbidade médica. As condições mais prevalentes foram: enxaqueca (31,8%), hipotireoidismo (24,1%), hipertensão (11,3%), traumatismo craniano (10,3%), asma (9,7%), epilepsia (8,2%), diabetes (5,1%), acidente vascular cerebral (2,1%) e hipertireoidismo (1%). Idade e duração da doença foram positivamente associadas à presença de CMGs (p < 0,001). CONCLUSÃO: Em concordância com relatos prévios, a maioria dos pacientes apresentou pelo menos uma doença médica. A principal limitação deste estudo reside no fato de o diagnóstico de CMGs ter sido baseado no autorrelato. Há escassos estudos visando à identificação de comorbidades médicas na população brasileira com THB e este estudo pode contribuir para melhor vigilância diagnóstica, avaliação, tratamento e diminuição da sobrecarga associada ao THB.

BACKGROUND: Bipolar disorder (BD) has been associated with high rates of general medical comorbidities (GMC) and medical risk factors. There have been scarce reports about this prevalence in Brazilian subjects with BD. OBJECTIVE: Describe the prevalence of GMC in a sample of BD type I patients. METHODS: Clinical records of 195 patients with BD type I were reviewed for identification of GMC. Patients with and without GMC were compared using the Mann-Whitney nonparametric test and the chi-Square test. RESULTS: Sixty-three percent of patients had at least one medical comorbidity. The most prevalent conditions were: migraine (31.8%), hypothyroidism (24.1%), hypertension (11.3%), traumatic brain injuries (10.3%), asthma (9.7%), epilepsy (8.2%), diabetes (5.1%), stroke (2.1%) and hyperthyroidism (1%). Age and duration of illness were positively associated with the presence of GMC (p < 0.001). DISCUSSION: In our study, in accordance with previous reports, the majority of patients presented at least one general medical disorder. The principal limitation of this study is the fact that diagnose of GMC was made based on self-report. There are scarce studies addressing GMC in the Brazilian population with BD and this report can contribute to improve diagnostic vigilance, assessment, treatment planning and decrease the burden associated with BD.