Risk Factors for Various Cognitive Function Decline Trajectories in Adults Over 40 Years of Age: A Retrospective Cohort Study

Objective@#The aims of our study were to identify distinct trajectories of cognitive function using the group-based trajectory model. We also investigate which demographic factors act as risk factors for cognitive decline in each group. @*Methods@#The data from the Seoul National University Hospital Healthcare System Gangnam Center, from 2005 to 2019. The number of study subjects was 637. We used a group-based model to identify cognitive function trajectories. Multinomial logistic regression was employed to define risk factors for cognitive function decline. @*Results@#The cognitive function trajectories among adults over 40 years of age were heterogeneous. We identified four trajectories: high (27.3%), medium (41.0%), low (22.7%), and rapid decline (9.1%). Older age, male, low educational level, bad dietary habits, diabetes mellitus, technical worker, and lower income increased the likelihood of a cognitive function decline. @*Conclusion@#A younger age, a higher educational level, professional worker, good dietary habits, no diabetes mellitus, and no obesity improved cognitive function. A combination of these factors can improve “cognitive reserve” and delay cognitive decline. Interventions to prevent cognitive decline are needed after identification of high-risk groups for cognitive decline.

Association Between Anxiety and Depression and Gastroesophageal Reflux Disease: Results From a Large Cross-sectional Study

BACKGROUND/AIMS: The different clinical manifestations of gastroesophageal reflux disease (GERD) may be influenced by associated psychological factors. We evaluated the psychological status (anxiety and depression) according to each subtype of GERD. METHODS: Subjects who underwent esophagogastroduodenoscopy and completed a symptom questionnaire between January 2008 and December 2011 were analyzed. The subjects were classified into the following groups: erosive reflux disease (ERD), non-erosive reflux disease (NERD), asymptomatic erosive esophagitis (AEE), and controls. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively. RESULTS: We analyzed 19 099 subjects: 16 157 (84.6%), 176 (0.9%), 1398 (7.3%), and 1368 (7.2%) in the control, ERD, NERD, and AEE groups, respectively. Multiple multinomial logistic regression revealed a significant association of increased state (adjusted OR, 1.89; 95% CI, 1.53–2.33) and trait anxiety (adjusted OR, 1.78; 95% CI, 1.34–2.35) and depression (adjusted OR, 2.21; 95% CI, 1.75–2.80) with NERD. ERD group showed a significant association only with state anxiety (adjusted OR, 2.20; 95% CI, 1.27–3.81) and depression (adjusted OR, 2.23; 95% CI, 1.18–4.22). The AEE group, however, did not show any significant association with psychological factors. CONCLUSION: This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.

Gender Difference in Associations between Serum Cholesterol Levels and Depression Symptoms in Healthy General Population / 정신신체의학

OBJECTIVES: The purpose of this study was to determine the association between serum lipid profiles and depression according to gender difference. METHODS: This retrospective cohort study included 27,452 subjects(15044 men and 12408 women) who underwent health examination. The duration was from January 2013 to December 2013. We estimate the correlation between serum lipid profile and Beck Depression Inventory(BDI) scores. We compare the effect size using beta coefficient. RESULTS: In men, serum Triglyceride level was correlated positively with BDI scores(r=0.020, p<0.01). Serum LDL-C and HDL-C were negatively correlated with BDI scores(r=-0.015, p<0.01 ; r=-0.016, p<0.05). In women, Triglyceride level was also correlated positively with BDI scores(r=0.020, p<0.01), Serum HDL-C were negatively correlated with BDI scores(r=-0.019, p<0.01). There was no statistical significance between Serum LDL-C and Beck Depression Inventory(BDI) score. CONCLUSIONS: Both men and women had more depressive symptoms when they had low serum HDL-C level or high serum Triglyceride level. The depression symptoms were more severe when serum LDL-C level was low only in men.

Radial Overgrowth after Surgical Treatment for Pediatric Distal Radius Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to examine the influence of radial overgrowth after surgical treatment for pediatric distal radius fractures. MATERIALS AND METHODS: Twenty-two pediatric patients under the age of 10 years who underwent surgical treatment for a distal radius fracture without physeal injury were enrolled in this study. They were divided into 2 groups according to the ulnar fracture; distal radius alone fracture in 9 patients group and radioulnar both fracture in 13 patients group. The radial length, ulnar variance, and radial inclination at the last follow-up X-ray were measured using a simple lateral radiograph. The visual analogue scale (VAS) of distal radioulnar joint pain, the Mayo wrist score, and range of motion of the wrist were assessed for the clinical results. RESULTS: At mean follow-up period of 3.7 years, radial overgrowth was 2.2 mm (p=0.01) compared with the un-injured side. There was negative ulnar variance on the injured side, an average of 0.8 mm (p=0.01). Clinically, mean VAS was 0.2, and the Mayo wrist score was 99.3. No significant difference in radial overgrowth (p=0.32), ulnar variance (p=0.99), VAS (p=0.29), and the Mayo wrist score (p=0.34) was observed between groups. CONCLUSION: Radial overgrowth and negative ulnar variance was observed after surgical treatment of pediatric distal radius fracture without physeal injury. However, the radial overgrowth does not affect clinical outcomes.

Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures

STUDY DESIGN: A retrospective study. OBJECTIVES: To investigate the potential risk factors for subsequent vertebral fractures according to the treatment of primary vertebral fractures. SUMMARY OF LITERATURE REVIEW: Many previous studies have been reported on bone mineral density, bone loss, and mechanical properties as risk factors for osteoporotic vertebral fractures. However, few studies have investigated subsequent osteoporotic vertebral fractures. MATERIALS AND METHODS: 57 patients who had undergone follow-up magnetic resonance imaging (MRI) of the spine were divided into two groups depending on the development of subsequent vertebral fractures: the fracture group with 40 cases and the non-fracture group with 17 cases. The patients' clinical and radiographic data including bone mineral density, medication for osteoporosis, body mass index, vertebroplasty of primary vertebral fractures, thoracic kyphotic angle and lumbar lordotic angle, fat infiltration of the back extensor muscle, and primary multiple fractures were examined. RESULTS: The subsequent new vertebral fractures occurred at a mean of 24 +/- 19 months after primary osteoporotic vertebral fractures. Vertebroplasty for primary fractures was associated with a higher incidence of subsequent new vertebral fractures (p=0.001). There was a significant increase in fat infiltration of the back extensor muscle after the primary vertebral fractures in the fracture group (p=0.001). A multiple logistic regression analysis showed the significance of vertebroplasty (odds' ratio: 4.623, 95% confidence interval: 1.145-18.699, p=0.031). CONCLUSIONS: These results suggest that vertebroplasty for primary vertebral fractures and increased fat infiltration of the back extensor muscle could be risk factors related to the development of subsequent osteoporotic vertebral fractures.

Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal

PURPOSE: The purpose of this study is to analyze the clinical results of fixation using Sirus(R) nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal. MATERIALS AND METHODS: From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus(R) nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared. RESULTS: The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment. CONCLUSION: Using Sirus(R) nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

The Relationship between Type D Personality and Suicidality in Low-Income, Middle-Aged Adults

OBJECTIVE: Low-income adults are considered to be a group at high risk for suicide. We sought to examine the effect of type D personality and other socio-demographic factors on suicidality in low-income, middle-aged Koreans. METHODS: In total, 306 low-income, middle-aged Koreans [age: 49.16+/-5.24 (40-59) years, 156 males, 150 females] were enrolled from the Korean National Basic Livelihood Security System. Socio-demographic data, including employment status, income, health, marital status, and educational attainment, were gathered. Beck's 19-item Scale for Suicidal Ideation (SSI) was applied to evaluate suicidality, and the DS14 was used to assess type D personality. RESULTS: Unemployment (p<0.01) and absence of spouse (p=0.03) predicted higher SSI scores independent of other socioeconomic factors. All type D personality scores [i.e., negative affectivity (NA), social inhibition (SI), and total score] predicted higher SSI scores independent of all socioeconomic factors (all, p<0.001). Subjects with type D personality had higher SSI scores (p<0.001), and the association between suicidality and socio-demographic factors (employment or physical health) could be found only in subjects without type D personality. CONCLUSION: Type D personality was a risk factor for suicide in low-income Koreans, independently from socio-economic factors. In addition, the socio-demographic factors were less prominently associated with suicidality in those with type D personality.

How Many High Risk Korean Patients with Osteopenia Could Overlook Treatment Eligibility?

STUDY DESIGN: Retrospective study. PURPOSE: To determine the prevalence of high risk patient with osteopenia requiring pharmacologic treatment and investigate the difference of 10-year fracture probability whether bone mineral density (BMD) include or not in Korean FRAX model. OVERVIEW OF LITERATURE: Many people with the fracture have osteopenia rather than osteoporosis, and BMD alone could be considered as a chance to prevent fracture. METHODS: Three hundred sixty-nine patients who was diagnosed as osteopenia were divided into two groups according to age (group 1, under 65 years; group 2, over 65 years), and 10-year fracture probabilities were calculated by FRAX algorithm with and without femur neck T-score. RESULTS: The high risk patients of the fracture who had above 3% of 10-year hip fracture probability were 15 cases in group 1 and 121 cases in group 2. In 193 patients of group 1, the mean 10-year fracture probability with BMD was significantly higher than the results without BMD (hip fracture: p=0.04, major osteoporotic fracture: p=0.01). Unlike the results of the group 1, the mean 10-year fracture probability without BMD was significantly higher than the results with BMD in 176 patients of group 2 (hip fracture: p=0.01, major osteoporotic fracture: p=0.01). CONCLUSIONS: Total of 136 cases (36.8%) as a high risk of the fracture with osteopenia could be overlooked treatment eligibility in Korean. The Korean FRAX model without BMD could be effective in predicting fracture risk especially in the individuals who were over 65 years.

The Effect of Cognitive Training in Patients with Mild Cognitive Impairment and Early Alzheimer's Disease: A Preliminary Study

BACKGROUND AND PURPOSE: The objective of this study was to determine the benefits of cognitive training in patients with amnestic mild cognitive impairment (aMCI) and those with early Alzheimer's disease (AD). METHODS: Eleven patients with aMCI and nine with early AD (stage 4 on the Global Deterioration Scale) participated in this study. Six participants with aMCI and six with AD were allocated to the cognitive training group, while five participants with aMCI and three with AD were allocated to a wait-list control group. Multicomponent cognitive training was administered in 18 weekly, individual sessions. Outcome measures were undertaken at baseline, and at 2 weeks and 3 months of follow-up. RESULTS: In the trained MCI group, there were significant improvements in the delayed-recall scores on the Seoul Verbal Learning Test at both the 2-week and 3-month follow-ups compared with baseline (baseline, 1.6+/-1.5; 2 weeks, 4.4+/-1.5, p=0.04; 3 months, 4.6+/-2.3, p=0.04). The phonemic fluency scores (1.0+/-0.8 vs. 5.0+/-1.8, p=0.07) and Korean Mini-Mental State Examination scores (18.8+/-0.5 vs. 23.8+/-2.2, p=0.07) also showed a tendency toward improvement at the 2-week follow-up compared to baseline in the trained AD group. CONCLUSIONS: This study provides evidence of the effectiveness of cognitive training in aMCI and early AD. The efficacy of cognitive training programs remains to be verified in studies with larger samples and a randomized design.

Special Issue / 신경정신의학

No abstract available.

Total Hip Arthroplasty Using Two-Incision Technique

BACKGROUND: To evaluate the effectiveness of minimally invasive surgery total hip arthroplasty (THA) using the two-incision technique as described by Mears. METHODS: From January 2003 to December 2006, sixty-four patients underwent total hip arthroplasty using the one-incision (group I) and two-incision (group II) technique by one surgeon. There were 34 hips in group I and 30 hips in group II. There was no difference in age, gender, and causes of THA between the two groups. We evaluated the operation time, bleeding amount, incision length, ambulation, hospital stay, and complications between the two groups. RESULTS: There was no difference in the bleeding amount between the two groups. Operation time was longer in the two-incision group than in the one-incision group. Operation time of the two-incision technique could be reduced after 15 cases. Patients started ambulation after surgery earlier in group II than group I, and the hospital stay was shorter in group II than in group I. There was no difference in clinical results between the two groups. There was no difference in component position of the acetabular cup and femoral stem between the two groups. Intraoperative periprosthetic fracture occurred in four cases (13.3%) in group II. CONCLUSIONS: Two-incision THA has the advantage of rapid recovery and shorter hospital stay. However, longer operation time and a high complication rate compared to one-incision are problems that need to be solved in the two-incision technique.

Association between Helicobacter pylori Seropositivity and the Coronary Artery Calcium Score in a Screening Population

BACKGROUND/AIMS: Helicobacter pylori causes numerous extragastric manifestations, including coronary heart disease. The coronary artery calcification (CAC) score, measured using computed tomography (CT) has been used as a screening test for coronary atherosclerosis. This study investigated the association between H. pylori seropositivity and CAC scores in a screening population. METHODS: Patients who underwent a health checkup between October 2003 and July 2007 and who did not have a history of ischemic heart disease were enrolled in the study. Subjects were screened with a multidetector CT scan to determine the CAC score and for anti-H. pylori antibody immunoglobulin G; traditional risks for coronary heart disease were evaluated using a structured questionnaire, anthropometric measurements, and laboratory tests. RESULTS: Of the 2,029 subjects enrolled (1,295 males), 1,214 (59.8%) subjects were H. pylori positive and 815 were H. pylori negative. There were no significant differences in the baseline characteristics of the seropositive and seronegative patients. When the CAC presence or absence scores were considered, multivariate analysis revealed that H. pylori seropositivity was statistically associated with the presence of CAC and that this association was stronger in the mild CAC score category. CONCLUSIONS: H. pylori seropositive patients are at a higher risk for coronary atherosclerosis regardless of traditional cardiovascular risk factors. This association is particularly applicable for early coronary atherosclerosis.

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteic Fractures in the Elderly / 대한정형외과학회잡지

PURPOSE: To evaluate the positive effects and problems through clinical and radiological results of cementless bipolar hemiarthroplasty for intertrochanteric fractures above type A2 in the elderly. MATERIALS AND METHODS: From December 2006 to June 2009, 54 bipolar hemiarthroplasties were performed in 54 patients in our hospital. The mean age was 78.8 (67-93) years. Of these cases, 13 were male and 41 were female. The fractures were of type A2.1 in 17 cases, type A2.2 in 23 cases and type A2.3 in 14 cases. There was no walking limitation in 45 patients, but 4 of the remaining 9 patients had walking limitations and used walking aids at their residence. A posterolateral approach as well as cementless femoral stems was used in all the patients. Clinical results were evaluated according to operation time, amount of bleeding, time to resume walking, duration of hospital stay, recovery of walking ability, and complications. Prostheses loss was evaluated on the follow-up radiographs. RESULTS: Twenty-two of 39 patients who had medical co-morbidity had more than two medical co-morbidities. Operations were performed at a mean time of 5.5 days after the fracture. The mean operation time was 95 minutes. The average total amount of bleeding was of 715 cc. Patients began walking at an average of 5.9 days after operation and the average duration of hospital stay was 19.2 days. Sixteen patients (29.6%) died at an average period of 1.6 years after their operation. At the time of discharge, 32 patients (59%) had recovered walking ability, but at the last follow-up compared to the pre-injury status, the recovery rate of walking had decreased to 46% (25 patients). Complications included a deep infection in one case, dislocation in 2 cases and hematoma in 2 cases. The cause of revision was deep infection. There were no revisions due to prosthesis loosening. CONCLUSION: Cementless bipolar hemiarthroplasty for intertrochanteric fractures in the elderly had some problems due to the prolonged operation time and increased amount of bleeding, but it also had advantages including the early return to walking after the operation and decreased hospital stay. It is one of the treatment options for the elderly with unstable intertrochanteric fractures.

Psychophysiological Characteristics of Chronic Pain Patients Measured by Biofeedback System / 수면정신생리

OBJECTIVES: Chronic pain is one of the most common experiences of humans and a typical psychophysiological disorder. The aim of this study was to measure the psychophysiological responses in chronic pain patients using a biofeedback system, and to compare them with the results from normal healthy subjects. METHODS: Forty two patients with chronic pain (17 males and 25 females, average age 44.67+/-11.10 years) and 42 normal healthy controls (17 males and 25 females, average age 45.17+/-10.46 years) participated in this study. Electromyography (EMG), skin conductance (SC), and skin temperature (ST) were recorded using biofeedback system during the 3 phases (baseline, stress, and recovery) of stress reactivity test, and average values of them were calculated. Difference of values between two groups in each corresponding phase was analyzed with independent t-test, and change of values across phases of stress reactivity test was analyzed with paired t-test (all two-tailed, p<0.05). RESULTS: Compared to normal controls, chronic pain patients had higher value of EMG (baseline : 8.10+/-5.97 micronV vs 4.72+/-1.52 micronV, t=-3.56, p<0.01 ; stress : 11.25+/-6.89 micronV vs 8.49+/-4.78 micronV, t=-2.13, p<0.05 ; recovery : 7.12+/-3.77 micronV vs 4.78+/-1.59 micronV, t= -3.70, p<0.01) and SC (baseline : 1.06+/-1.0 micronS vs 0.42+/-0.29 micronS, t=-4.0. p<0.01 ; stress : 1.87+/-2.05 micronS vs 1.03+/-0.86 micronS, t=-2.47, p<0.05 ; recovery : 1.74+/-1.77 micronS vs 0.64+/-0.59 micronS, t=-3.8, p<0.01) in all the 3 phases. But, skin temperature comparison did not reveal significant differences in all the 3 phases between two groups. CONCLUSION: Psychophysiological responses of chronic pain patients in stress reactivity test were different from those of normal healthy controls. These results suggest that sympathetic nervous system is more activated in chronic pain patients.

Plasma Total Homocysteine Levels are not Associated with Medial Temporal Lobe Atrophy, but with White Matter Changes in Alzheimer's Disease

BACKGROUND AND PURPOSE: Elevated plasma total homocysteine (tHcy) levels are reported to be associated with an increased risk of Alzheimer's disease (AD). However, the mechanism by which homocysteine contributes to the pathogenesis of AD is as yet unknown. The aim of this study was to elucidate the relationship between white matter changes (WMC) and medial temporal lobe atrophy (MTA) on brain magnetic resonance imaging (MRI), and plasma levels of tHcy in AD patients. METHODS: Seventy-two patients with a clinical diagnosis of probable AD were recruited to the study. Plasma tHcy levels, vascular risk factors, and WMC and MTA on brain MRI were evaluated in all patients. The AD patients were classified into two groups: those with no or minimal WMC (69.2+/-8.8 years, mean+/-SD, n=36) and those with moderate-to-severe WMC (74.6+/-4.6 years, n=36) on brain MRI. RESULTS: In a univariate logistic regression analysis, the risk of moderate-to-severe WMC in AD was significantly associated with increasing age, female gender, lower education level, hypertension, high plasma tHcy levels, and lower Mini-Mental State Examination (MMSE) score. Multivariate logistic regression analysis revealed only high plasma tHcy as the independent and significant risk factor for moderate-to-severe WMC [odds ratio (OR; adjusted for age, gender, education level, MMSE score, and hypertension comparing the top tertile - tHcy levels > or =12.9 micromol/L - with the bottom tertile - tHcy levels < or =9.4 micromol/L)=7.35; 95% confidence interval, confidence interval=1.36-39.84; p=0.02], and age as a borderline significant risk factor (OR=1.08, 95% CI=0.99-1.19, p=0.09) in AD patients. Plasma tHcy levels were not correlated significantly with either right or left MTA. CONCLUSIONS: Our results suggest that the vascular pathway mediates the association between elevated plasma tHcy levels and AD.

Distribution of Coronary Artery Calcification in an Asymptomatic Korean Population: Association with Risk Factors of Cardiovascular Disease and Metabolic Syndrome

BACKGROUND AND OBJECTIVES: Coronary artery calcification (CAC) has been used as surrogate marker for coronary atherosclerosis. We developed a set of age-and gender-stratified CAC distribution and risk factors for CAC in a population of asymptomatic Korean subjects. SUBJECTS AND METHODS: Between 2003 and 2007, 3,961 asymptomatic subjects without a history of ischemic heart disease (male 64%, mean age 56+/-10 years) were screened for CAC by the use of multi-detector computed tomography. RESULTS: The total CAC score was assigned to a percentile according to age and gender. The prevalence of CAC and mean CAC score increased with age [p or =90 cm in males; > or =80 cm in females) was 1.445 (95% CI 1.222-1.709). CONCLUSION: This study reports the distribution of CAC score by age and gender. It will serve as a reference standard for the clinical interpretation of CAC results in the asymptomatic Korean population.

Features of Gastric Neoplasm Detected during the Screening Examination

BACKGROUND/AIMS: Gastric cancer is the leading malignancy in Korea and early detection through the health screening seems to be important. The aims of this study were to investigate the features of gastric neoplasms detected during screening, and to figure out the risk factors of these lesions. METHODS: From October 2003 to September 2005, subjects who visited Seoul National University Hospital Healthcare System Gangnam Center for health check-up were included in the study. The program included a questionnaire and tests including anti-Helicobacter pylori (H. pylori) antibody, esophagogastroduodenoscopy or double contrast upper gastrointestinal study. To figure out the risk factors, an age and gender-matched, four-fold sized control group was selected from the subjects. RESULTS: Of 25, 432 subjects, 122 cases of gastric neoplasms were detected including 61 adenocarcinoma (45 early gastric cancers), 53 adenoma, 7 mucosa-associated lymphoid tissue lymphoma, and one metastatic cancer. There was no significant statistical difference in basal characteristics of the subjects between gastric adenocarcinoma and adenoma. When comparing with the control group those without gastric neoplasms, smoking history, family history of stomach cancer, and H. pylori seropositivity were found to be significant risk factors for gastric neoplasms. Metabolic syndrome was more prevalent in adenoma than in the control (p<0.05). CONCLUSIONS: The health screening may be beneficial in early detection of gastric cancer. In addition, metabolic syndrome might be related with gastric adenoma.

Neurofeedback Treatment of Panic Disorder

BACKGROUND: It is reported that many types of psychiatric disorders, including anxiety disorder, are related with abnormal brain wave activity, and neurofeedback is associated with clinical improvement in generalized anxiety, OCD, phobic disorder, and PTSD. But in panic disorder, previous studies with neurofeedback are very lacking. Therefore, in this study, the author applied neurofeedback to patients with panic disorder, refractory to cognitive-behavioral therapy and medication. METHODS: From March 2 to May 15 in 2005, six patients with a panic disorder had received 20 sessions of neurofeedback training. The author evaluated the treatment effect by using the alteration of K-APPQ score, the frequency of panic attack, medication and individual handicap. RESULTS: All 6 patients completed 20 sessions of neurofeedback training. At the end, the score of total APPQ, agoraphobia, and interoceptive fear was decreased (P= 0.028) and the frequency of panic attack, medication, and individual handicap was also decreased. CONCLUSION: Neurofeedback training was successful in reducing panic symptom severity, frequency and individual handicap. A controlled study on a larger population is strongly recommended.

Patients' Attitudes toward Proactive Screening for Sexual Dysfunction

BACKGROUND: Although proactive screening for sexual dysfunction in primary care has been emphasized as an important part of comprehensive care, doctors seldom ask their patients about their sexual function. Worry about patients' responses was reckoned as a major barrier, but few studies have dealt with how patients feel and what they want. This study was aimed to describe and analyze the attitudes of patients toward proactive screening for sexual dysfunction. METHODS: A set of self-administered questionnaire was given to every patients who visited a family medicine clinic in a university hospital for 2 weeks from March 16, 2005. RESULTS: A total of 185 patients were analyzed. Among them, 72.4% were willing to consult their physician when they were in trouble with their sexual function, and 84.3% said proactive screening for sexual dysfunction was necessary. Many patients did not care about 'when to be asked' and wanted to be asked in face-to-face interview rather than by a questionnaire. Sentence emphasizing that every patient is given the same question was most preferred. CONCLUSION: Patients' attitude toward proactive screening for sexual dysfunction in primary care was generally positive. Patients preferred to be asked "I ask every patient about his sexual problem. If you're OK, I ask you about your sexual problem." regardless of timing, during the interview.

Clinical Characteristics of Obsessive-Compulsive Disorder: Inpatient Record Study / 신경정신의학

This study examined the clinical features of patients with obsessive-compulsive disorders who had been admitted to the Department of psychiatry, Seoul National Univ. Hospital from 1980 to 1995, using retrospective investigation of medical records. The subjects were 26 patients(male 22, female 4) who were compatible with the criteria of OCD by DSM-III-R. The results were as follows: 1) The most common obsessive thinking was pathologic doubt, followed by contamination, need for symmetry, somatic and sexual obsession, religious and aggressive obsession in descending order. Twenty three percent of patients had multiple obsessions. 2) The most common compulsive ritual was checking, followed by washing, need to ask and confess, symmetry and precision, counting in descending order. Thrity nine percents of patients had multiple rituals. 3) Depression, schizophrenia, Tourette's syndrome and tic disorder were the co-existing disorder with obsessive compulsive disorder. Cormorbid personality disorders in OCD were obsessive personality disorder, borderline personality disorder, schizotypal personality disorder and passive-aggressive personality disorder. 4) The course in OCD with co-existing disorder was worse than that in pure OCD. 5) The verbal IQ was significantly higher than the performance IQ checked by KWIS in obsessive compulsive disorder.