Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

The Female Sexual Dysfunction in Overactive Bladder Patients / 대한비뇨기과학회지

Purpose: Female sexual dysfunction is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, resulting in personal distress that impacts on the quality of life and interpersonal relationships. It is a compilation of problems that has both biological and psychosocial components and is multifactorial in its etiology. In this study, the female sexual dysfunction in overactive bladder (OAB) patients was evaluated. Materials and Methods: The subjects included 63 female who visited our health care center for health medical examinations without voiding symptoms (control group) and 37 female patients with OAB. All patients were asked to complete the Brief index of sexual functioning for women (BISF-W), which had been translated into Korean. The Beck depression inventory (BDI) and State-Trait anxiety inventory (STAI) were also used to assess the relationship between the sexual dysfunction and anxiety or depression. The results were analyzed statistically by ANCOVA using age as a covariant. Results: The mean ages in the OAB and control groups were 35.47+/-6.76 and 42.70+/-9.68 years, respectively. The mean scores of desire in the OAB and control groups were 3.92+/-3.09 and 8.92+/-4.99, for arousal were 6.78+/-3.85 and 11.06+/-5.60, frequency of sexual activity 3.92+/-5.24 and 8.53+/-4.52, receptivity/initiation 10.08+/-3.71 and 11.47+/-4.91, orgasm 13.19+/-6.97 and 19.72+/-7.36, relationship satisfaction 7.12+/-1.68 and 7.11+/-1.88 and physical problems affecting sexual function 12.14+/-6.17, 11.83+/-5.05, respectively. The OAB group shows decreased sexual desire, arousal, frequency of sexual activity and orgasm compared to the control group (p<0.05). However, there were no differences in anxiety or depression between the two groups and there was no sexual dysfunction due to anxiety or depression in either group. Conclusions: Female sexual dysfunction was more common in OAB patients than the controls. OAB is one of the important factor affecting female sexual dysfunction. Consideration should be given with regard to female sexual dysfunction in patients with OAB.

Clinical Analysis of Female Sexual Assault Victims / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate female victims of sexual assault and assess the similarities and differences between them. METHODS: Case files and photographs of 59 women examined at Holy Family hospital for sexual assault during Jan 1, 1991 to Dec 31 2001 were reviewed. RESULTS: The mean age of the patients was 17.12 (+/-11.50). 45 (76.3%) of assailants were strangers to the victims. 35 (59.3%) had genital injuries and 8 (13.6%) needed surgical treatments. No victim was pregnant and 17 (28.8%) was reported to police. CONCLUSION: Sympathetic concern in the treatment of women who come forward to report the experience of sexual assaults will result in more reporting of rape. The victims need to be educated at home, at school, and by their primary care providers to avoid situations in which they could make themselves vulnerable to sexual assault, and they should be taught the importance of immediately reporting their assault and seeking medical care.

A Preliminary Study on the Standardization of the Korean Versions of Wahler Physical Symptom Inventory / 신경정신의학

OBJECTIVES: The purposes of this study were to develop the Korean version of Wahler Physical Symptom Inventory (WPSI), to examine the reliability and validity of it, and to investigate usefulness for diagnosing somatization. METHODS: The normal group was composed of 242 persons consist of middle and high school students, university students, and adults living in Seoul, Puchon, and Suwon. The two clinical groups consisted of 33 persons with somatic symptoms and 38 diabetic patients. RESULTS: Internal consistency (Cronbach alpha=.91) was very high. Test-retest reliability was calculated from 46 university group, and it's correlations was also high (.87). And the total score of K-WPSI was significantly and positively correlated with subscales of SCL-90-R. There was significant difference between the normal, psychiatry group, and diabetic group of K-WPSI (F=15.48, p<.001). Especially, K-WPSI was very useful to differentiate between the somatization group and diabetic group. CONCLUSION: K-WPSI was found to be a reliable and valid instrument for diagnosing somatization, and for differentiating somatization and diabetic groups. K-WPSI is a brief and economical questionnaire, which may curtail medical expenses of patients. It is also expectated that K-WPSI can be used for identifying somatization and providing information which may contribute to ascertain diagnosis. The limitation of this study is the small normative data, and not distinguishing sex differences. This limitation should be supplemented by future studies.

The Changes of Cytokine Production during the Hangover State Induced by Experimental Alcohol Consumption / 신경정신의학

OBJECT: A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur 8-16hr after alcohol drinking. We evaluated the effects of experimentally induced alcohol hangover on immune functions by the measurement of cytokine production. METHODS: A total of 13 normal adults males participated in this study. They did not have any previous histories of psychiatric or medical disorder. We defined the experimentally induced hangover condition by 13 hours after drinking high doses of alcohol(1.5g/kg of body weight). Venous blood was taken before the alcohol drinking & during the experimental hangover conditions. Monocyte was separated and stimulated with phytohemagglutinin. Cytokine production was measured by ELISA for IL-1beta, IL-2, IL-4, IL-6, IL-10, IL-12, INF-gamma, TNF-alpha. RESULTS: The production of cytokines IL-10, IL-12 and INF-gamma were increased during hangover conditions. CONCLUSIONS: There is an changes in the production of cytokines IL-10, IL-12 and INF-gamma during hangover conditions. Thus, our results supported the hypothesis that acute alcohol treatment might affect Th1/Th2 immune balance by altering monocyte production of IL-12 and IL-10. These results suggested that elevated monocyte-derived IL-10 can contribute to the cellular immune abnormalities during hangover conditions.

A Naturalistic Study of Risperidone Treatment in Affiliated University Hospitals: Focus on Clinical Characteristics / 신경정신의학

OBJECTIVE: This retrospective naturalistic study was designed to compare the clinical characteristics including psychopathology of two groups of patients, long-term maintenance group and short-term drop-out group, who were taking risperidone. METHOD: Datas were collected for 210 schizophrenic patients with complete medical records among 580 patients who were enrolled with risperidone administration from January 1996 to December 1996 in 8 affiliated hospital of the Catholic University. The short-term drop-out patients group were assigned to whom treatment period was less than 6 month, and the long-term maintained patients group, treatment period was more than 2 years. We assessed demographics, psychopathology, and other variables related with medication based on past medical records. RESULTS: Among subjects of 210, short-term drop-out patients group were 67(31.9%) and long-term maintained patients group were 143(68.1%). Demographics and psychopathology were not significantly different between two groups. The starting and maximal dosage of risperidone was not significantly different between two groups but the maintenance dosage of risperidone was lower in long-term medicated patients group than short-term drop-out patients group(t=3.698, p<0.05). Additionally, the result of this study showed differences in experiences of past antipsychotic use as following. The number of no previous use of antipsychotic was 39(58.2%), the number of high potency antipsychotic use was 27(40.3%), and the number of low potency antipsychotic use was 1(1.5%) in short-term drop-out group. The number of no previous use of antipsychotic was 58(40.6%), the number of high potency antipsychotic use was 77(53.8%), the number of low potency antipsychotic use was 8(5.6%) in long-term maintained group(X 2=6.559, df=2, p<0.05). CONCLUSION: According to these results, administration of low therapeutic dosage should be recommended for long-term maintenance as if possible. Multi-center based retrospective naturalistic study like this would be useful for getting informations about efficacy and some other aspects of antipsychotic administration in practical field.

The Change of Cytokines by Risperidone in Patients with Schizophrenia / 신경정신의학

OBJECT: This study was carried out to evaluate immunologic difference between baseline and after 4 weeks drug treatment with atypical antipsychotics (rispreidone) by measurement of serum concentration of 6 cytokines. METHODS: The subjets were composed of 25 patients who are admitted at Dajeon St's Marys hospital of psychiatry department and diagnosed as schizophrenia by DSM-IV diagnositc criteria. We measured serum IL-1beta, IL-2, IL-6, IL-12, INF-gamma, TNF-alpha concenatrations by quantitative ELISA method using ELISA kit (Endogen Inc., Woburn, MA, USA).The two psyciatrists performed PANSS examination between baseline and after 4 weeks risperidone treatments. RESULTS: The serum level of IL-12 was increased significantly after medication of 4 weeks and the serum concentration of IFN-gamma showed the tendency of decreasement but not significant. The serum level of the other cytokines showed no significant change. CONCLUSIONS: We spectulate that the increasement of IL-12 may contribute to role of activation of immune response by treatment of antipsychotic medication (risperidone). This study is first trial of IL-12 study in neuropsychiatric field and IL-12 which play important role of immune response becomes interesting subjects in immune research.

A Review on School System Failure ('School Collapse') in Korea and Its Psychiatric Implication in School Non-Attenders / 신경정신의학

OBJECTIVES: This review strives to look through the reality of school situation in Korea which gives the most severe burden of conflict to adolescents nowadays, for the purpose of better understanding of them. METHODS: Followings comprised of the summary of the materials from the published articles and books, and from mass media regarding 'school collapse' phenomenon in Korea, and also include materials regarding school non-attenders. And discussion was done with developmental and psychiatric perspectives on the phenomenon along with on school non-attenders. CONCLUSION: School non-attenders nowadays with the issue of 'school collapse' have different characteristics from the dropouts reported in many previous studies. Psychiatrists need to accommodate their previous view on adolescents as the way of adolescents' coping has rapidly changed. It is noted that there are few researches regarding school non-attenders, as well as regarding school factors associated with non-attending in Korea. This review was done to call for future studies focused on the interdependent relationship between school processes and the individual characteristics of non-attenders, so that enable us to capture the complexity of how adolescents make their decision of hangingin or droppingout of school.

Results of 1998 Korean Depression Screening Day and Sociodemographic Characteristics of Participants / 신경정신의학

OBJECTIVES: This study was performed to analyze the sociodemographic characteristics of participants in '1998 Korean Depression Screening Day' and to evaluate the results of the screening test. METHODS: By using the survey results of 619 volunteers from 8 hospitals, the authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and the psychiatric treatment history of respondents. The assessment measure was the Zung Self-Rating Depression Scale. RESULTS: The mean depression score of all participants was 57.5+/-13.8 and it came under mild depression. Of all participants, 69.5% (N=430)had at least mild depressive symptoms, 43.1% (N=267)had at least moderate symptoms, and 18.4% (N=114)had severe symptoms. Never have 56.8% of respondents in the severely depressed range and 63.9% of those in the moderately depressed range had psychiatric treatment. The results suggest that the age group of 29-year-old or younger (relative to 60-year-old or older group)and full-time employment status (relative to unemployment)are protective factors of depression. CONCLUSIONS: By '1998 Korean Depression Screening Day', many depressed patients were detected and their depressive symptoms had statistically significant relationships with some sociodemographic characteristics. The results suggest that the education and screening test programs for depressive illness facilitated by Depression Screening Day are useful to the patients regardless of being under current treatment or not.

Altered Auditory Event Related Potentials Following Administration of Methylphenidate in Children with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTS: Event related potential(ERF) has been recently applied to examine the neurophysiological disturbance in attention deficit hyperactivity disorder(ADHD), particularly with regard to N100 and P300 which are known as one of ERP components closely linked with cognitive function. On the basis of these aspects, this study was designed to evaluate electrophysiologic characteristics and its availability for diagnosis and treatment of ADHD children by comparison of ERP between normal controls and ADHD children before and after methylphenidate (MFD) administration. METHODS: We examined the topographic auditory ERF and T.O.V.A.(Test of variables of attention), a standardized computerized visual continuous performance test following administration of stimulant drug, MPD 10mg in 13 ADHD children and compared these results with those of 11 normal controls. RESULTS: The results were as follows: 1) Thought the difference was not spastically significant(P=0.0548), N100 latencies seemed to be longer in ADHD children than in normal controls. N100 amplitudes also seemed to be larger in ADHD children than in normal controls(P=0.0629). 2) The F300 latencies significantly shortened after MFD administration when compared with those before MPD administration in ADHD group(P<0.01). 3) ADHD group performed significantly less well than normal controls in T.O.V.A.(P<0.05). And T.O.V.A. scores significantly improved after MFD administration in ADHD group(P<0.01). 4) The N100 and P300 latencies and the T.O.V.A. scores were significantly correlated before MPD administration in ADHD group(P<0.05). 5) The F300 latencies before MFD administration were significantly correlated with the amplitudes of changes of T.O.V.A. scores after MFD administration(P<0.05). CONCLUSION: It seems that prolonged N100 latency of ADHD children can be regarded as a relatively enduring trait marker and that F300 latency may reflect attentional response ability along with therapeutic effect by stimulant.