Towards a better healthcare system in Korea: 5 suggestions from young doctors

Residents who are currently in the process of completing graduate medical education (GME) will eventually become independently practicing professionals; therefore, the quality of GME is of enormous importance for our society. To improve the quality of GME in Korea, we, as young doctors, suggest that the government support funding for GME; make all possible efforts to ensure reasonable and sustainable working conditions for residents; implement adequate maternity plans; prohibit all kinds of unauthorized medical practice by other healthcare providers; and prevent all kinds of workplace violence toward residents. These measures to improve the quality of GME will surely benefit patient safety and the overall quality of healthcare in the future.

Association between Quality of Life and Symptom Severity in Obsessive-Compulsive Disorder Patients Using EQ-5D

OBJECTIVES: Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, and more attention is recently paid on the quality of life (QoL) in OCD patients. The Euro-QoL-5D (EQ-5D) is a widely used self-report to calculate a single score which represents ‘health utilities’. The aim of this study was to assess the health-related QoL for patients with OCD using the EQ-5D and to examine the relationship between health-related QoL and symptom severity. METHODS: Seventy-three patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of OCD were recruited from the outpatient clinic in Seoul National University Hospital. Symptom severity was assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and QoL was assessed with the EQ-5D-5L questionnaire. Using Korean valuation study, a single score of QoL was calculated. RESULTS: Most of the OCD patients were relatively young (< 45 years) with the mean YBOCS total score of 19.33. The mean EQ-5D score was 0.71 and significantly correlated with symptom severity (r = -0.483, p < 0.001). 25% of the EQ-5D score was predicted by the YBOCS total score (b = -0.011, p < 0.001) by regression analysis. CONCLUSIONS: OCD patients suffer from lower health-related QoL and QoL significantly decreased as symptom severity increased. The results of the EQ-5D would enable further studies on QoL comparison across medical disease and mental disorders.

Wilson Disease Misdiagnosed as Bipolar Disorder / 신경정신의학

Various psychiatric symptoms, including depressive mood, cognitive dysfunction, and psychosis, have been observed in the course of Wilson disease, however both domestic and international case reports on Wilson disease presenting with typical mania before the onset of neurological or hepatic symptoms are rare. Even though the delayed diagnosis of Wilson disease can lead to irreversible impairment, including liver cirrhosis, diagnosis of Wilson disease usually takes more than two years for patients showing psychiatric symptoms as their first manifestation. Without careful observation and adequate understanding of the disease, clinicians may overlook signs and symptoms suggesting Wilson disease in patients showing typical psychiatric symptoms such as mania. In order to promote clinician's vigilance in detecting symptoms and signs of Wilson disease in patients showing symptoms of bipolar disorder, we report on a rare case of a 31-year-old male Wilson disease patient who developed symptoms of typical bipolar disorder before the onset of neurological or hepatic symptoms.