Reminiscence of the Early Period of the Foundation of Korean Association for Geriatric Psychiatry

As a founding president of the Korean Association for Geriatric Psychiatry, I would like to look back on not only the quickening period of the association that was thirteen years ago but also on its early works and activities. This association was founded in 1994 in order to improve mental health of the aged in Korea and to help them live with dreams and ambitions. Starting with forty two members, the association has developed as one of the biggest associations, where approximately four hundred out of 2,221 psychiatrists in Korea are enrolled as regular members. In addition, it has made an eye-opening progress in terms of education, research and treatment. I hope that with the advent of an aged society, our association will play an influential role in helping the aged live creatively with hope and dignity by carrying out a psychogeriatric subspecialist system and by paying endless attention to their mental health.

Reminiscence of the Early Period of the Foundation of Korean Association for Geriatric Psychiatry

As a founding president of the Korean Association for Geriatric Psychiatry, I would like to look back on not only the quickening period of the association that was thirteen years ago but also on its early works and activities. This association was founded in 1994 in order to improve mental health of the aged in Korea and to help them live with dreams and ambitions. Starting with forty two members, the association has developed as one of the biggest associations, where approximately four hundred out of 2,221 psychiatrists in Korea are enrolled as regular members. In addition, it has made an eye-opening progress in terms of education, research and treatment. I hope that with the advent of an aged society, our association will play an influential role in helping the aged live creatively with hope and dignity by carrying out a psychogeriatric subspecialist system and by paying endless attention to their mental health.

Neurocognitive Functioning in Treatment:resistant Schizophrenics / 신경정신의학

Neurocognitive research focusing on cognitive deficits in schizophrenia resulted in several important yet potentially contradictory findings. Studies have shown that chronic patients have a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal brain-damaged patients. Some reports have suggested that there is a focal pattern of deficit, such as left hemisphere dysfunction, frontal lobe impairment, or the dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate neurocognitive functions in treatment-resistant schizophrenic patients. The subjects are 33 treatment-resistant schizophrenics. And their neurocognitive functions are compared with those of 37 treatment-reactive schizophrenic patients and 35 normal control subjects. Patients with a history of neurological disease, alcohol dependence, substance abuse and mental retardation are excluded. The diagnosis of specific subtypes are made after a review of all available information including medical records, historical data from informants, and by the confirmation of 2 board-certified psychiatrists. To control potential neurocognitive effects of medications, all patients had drug-free period of 1 week. The following tests are administered to each subjects; Mini Mental State Examination-Korean(MMSE- K), Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGI), Positive and Negative Syndrome Scale(PANSS), and Neurological Rating Scale for Extrapyramidal Symptoms(EPS scale). And they are assessed with a part of Vienna Test System which is computerized neurocognitive function tests which evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. The results indicated that treatment-resistant schizophrenic patients have deficits in eductive ability, visuoperceptual analysis, sustained attention, information-processing, reaction time and motor coordination. The study provides useful information about neurocognitive functions of carefully diagnosed subgroups of chronic schizophrenic pateints, especially treatment-resistant patients.

Neo-Elderly:The Way to Get Older Well

In this review article, the author tried to discuss how to become old in way of being respectable and dignified aged man in 'Neo-Elderly Model' in 21st century. Accordingly family principle of traditional Korean society, a senior of goodness, and filial duty thought as being Korean faith were explained. As one sees dishonor of leadership, a true picture of elderly and respectable aged person is needed. For problem areas, future plan for elderly welfare, support, and mandatory retirement age in Korea is suggested. As mean age of population is extended and elderly with specialty is growing, activity and life style of elderly need to be changed. Finally, for 'Neo-Elderly Model', harmony between old and young can be considered, and author suggested 10 life style for Neo-elderly.

The Survey of the Concept about Using Herb-Medication & the Effect on Treatment-Seeking Behavior in Psychiatric and Non-Psychiatric Patients / 신경정신의학

OBJECTIVES: The anthors examined health-seeking behavior about using herbal medicine in psyciatric and other clinical patients. The effect, side effect and motives in selecting herbal medicine were examined also. This study aimed at presenting treatment guide for psychiatric patients hereafter. METHOD: Subjects were consisted of 277 patients who were 93 medical, 81 surgical, and 102 psyhiatric patients. We made a questionnaire checking circumstances on taking herbal medicine. The investigating psychiatrist conducted person to person semi-structured interview using this questionnaire. RESULTS: Psychiatric patients preferred herbal medicine to western medicine, as other clinical patients did. In their health seeking behavior, classical illness model of oriental herbal medicine occupied a central position. In addition, psychiatric patients not only regarded herbal medicine as a more symtom-specific therapeutic medication, but also accepted side effects of herbal medicine uncritically than other clinical patients. CONCLUSIONS: As it is known that many psychiatric patients take both oriental and western medical treatment, we should not have exclusive attitude to emphasize one side between oriental and western medicine. Rather, we should deepen our understandings about oriental herbal medicine.

The Association between Polymorphism of the Dopamine D3 Receptors and Concentrations of Plasma Homovanillic and 5-hydroxyindoleacetic Acid, and Therapeutic Response of chronic Schizophrenic Patients

OBJECTIVES: Schizophrenia manifests a variety of interindividual differences in therapeutic response to antipsychotics. This might be attributable to dopamine and serotonin receptors that a important target for various antipsychotics, and the D3 receptor(DRD3) alleles they carry. The purpose of our study was to investigate whether the plasma levels of homovanillic acid(HVA) and 5-hydroxyindoleacetic acid(HIAA), and the polymorphism of DRD3 can be held as a predictor of treatment response ni chronic schizophrenic patients. METHODS: Therapeutic response for 16 korean schizophrenia patient treated during 48 weeks were assessed by PANSS used as the clinical symptom rating scales. The levels of concentration of HVA and 5-HIAA were examined by HPLC at baseline and at 48 weeks. We classified the polymorphism of DRD3 receptor using amplifying by polymerase chain reaction(PCR). RESULTS: Neither concentrations of HVA and 5-HIAA nor genotype of dopamine 3 receptor were not significantly associated with the therapeutic response. But, the patients who has A1 alleles of DRD3 gene showed poor therapeutic responses. CONCLUSION: A1 allele of DRD3 gene is associated with poor prognosis of chronic schizophrenia.

Epidemiological Study of Geriatric Depression in a Korea Urban Area

OBJECTIVE: Depression in the elderly is a major health concern that can be life threatening if not recognized and treated. Despite considerable interest, there in no consensus regarding the prevalence of depression in later life. This study was aimed to investigate the prevalence of major depressive disorder in the population over age 65 years and provide fundamental data for community mental health programs. METHOD: 500 elderly people aged over 65 years and oner in Kwachon were interviewed according to DSM-IV and examined Geriatric Depression Scale(GDS), Korea Depression Scale(KDS), MMSE-K, Korea-Dementia Rating Scale(K-DRS), etc. by trained researchers. RESULTS: Of the sample, prevalence of mild, moderate and severe depressive symptoms are 18.8%, 7.4%, and 17.8%, respectively. Prevalence of major depressive disorder is found to be 7.8%. There is no significant differences between depressive & non-depressive groups in the sociodemographic variables such as sex, age, education, family type, etc. Major depressive disorder is associated with physical illness, stressful life events, and cognitive dysfunction. CONCLUSION: The results showed similar prevalence rates to other epidemiological studies. Depressed group showed more psychological distress, stressful life events and cognitive dysfunctions than non-depressed group. Accurate and early diagnosis and adequate treatment favor a good prognosis.

Impairment of Self-Maintenance Skills and Instrumental Activities of Daily Life in Geriatric Depression

OBJECTIVES: The purpose of this study is to evaluate the effect of geriatric depression in activities of daily living for self maintenance (ADL) and instrumental activities of daily living (IADL) under control for effect of cognitive impairment which can be originated by other reasons. METHODS: The author had interviews with 100 old peoples using various scales (KGDS, MMSE-K, Karnofsky Performance Status Scale, ADL, IADL, QOL questionnaire, HDRS). This study also attempts to compare three groups (depression group, recovered group, normal control group) in their functional status. RESULTS: 1) Self-maintenance skills are more affected by physical states than by depressive symptoms. But the effect of depression is more prominent in instrumental activities of daily living. 2) Korean Geriatric Depression Scale (KGDS) correlated well with activities of daily living for self maintenance (ADL) and instrumental activities of daily living (IADL), but Hamilton Depression Rating Scale (HDRS) did not show significant correlation. This reflects that KGDS is a more specific measure for geriatric depression patients. When the effect of physical illness state was eliminated, partial correlation between KGDS and ADL/IADL showed no significant association. This means that the patient's physical functioning status is very important in functional level of geriatric patient. 3) When the patient is recovered from geriatric depression through appropriate treatment, patient's functional level showed no significant differences with normal control. CONCLUSION: This article emphasizes the importance of appropriate treatment for geriatric depression. After the effect of cognitive function was controlled, geriatric depression itself showed significant functional impairment. This functional deficit can threaten the patient's independence and self-respect. So appropriate treatment for depression in geriatrics is indispensable for enhancing quality of life in old people.

A Study On The Stress, Copying and General well-being of Medical Students / 한국의학교육

The mental health of medical students deserves attention because the problems in students may negatively influence learning ability and create consequences for later adjustment to doctor's role. The purpose of this study is to understand the stress, copying, self-esteem and subjective general well-being of medical students and compare them with other students group (students of law, science and humanities). The results was as follows : First, medical students did not report more stress but they use less copying strategy than other students group. Second, there was no differences in stress, copying, self-esteem and general well-being between high and low academic achievement group in medical students. Futhermore, study-related stress had more close relationship with self-esteem, general well-being. Third, the preparatory course students showed lower score in general well-being, especially health, cheerful-depressive mood domain. These results imply that mental health promotion programmes focused in guiding adjustment for the preparatory course students are helpful. And psychiatric, academic counseling should be made available to them. It can lead to an improvement in our health care delivery system. The need of additional longitudinal research is discussed.

Cost Effectiveness of Clozapine and Risperidone in

OBJECTIVES: Risperidone and clozapine beling to a new generation of antipsychotics that are reportedly more effective and better tolerated than conventional neuroleptics. However, each of these agents costs far more per unit than conventional neuroletics. The purpose of our retrospective study was to ascertain the total cost and effectiveness of treatment before and after administration of risperidone and clozapine in 'revolving door' schizophrenia patients. METHOD: Data collected on revolving door schizophrenics for 2 years before clozapine and risperidone treatment and for at least 2 years after clozapine and risperidone treatment. Direct cost of inpatient and outpatient treatment was measured. Effectiveness was scaled as 'years of mild disability gained'. RESULT: Both risperidone and cloazpine result in higher costs and additional benefits to patients, for example, increased mild disability, reduced number of relapse, and reduced hospital length-of-stay. An ICER of risperidone was less than Rc and ICER of clozapine was greater than Rc. According to decision-analytic this model, risperidone had favorable cost-effectivenss ratios relative to clozapine. CONCLUSION: We have assumed that risperidone is more cost-effective than clozapine.

A Case of Risperidone-Induced Stuttering / 대한정신약물학회지

Stuttering as a side effect of antipsychotics is rare. There are only 4 reports of neuroleptic-induced stuttering. Most reports of neuroleptic-inducted stuttering involved low-potency drugs that have high intrinsic antimuscarinic activity. Risperidone is high potent drug and often referred to as 'atypical' antipsychotic agent due to fewer extrapyramidal side effects and efficacy on negative symptoms of schizophrenia. We experienced a case of risperidone-induced stuttering in a young male schizophrenic patient, and report this case.

Predicting Factors Associated with Drug Compliance in Manic Patients / 신경정신의학

OBJECTIVES: Drug compliance is the most important issue in long-term treatment outcome and prognosis of manic patients. Up to date, there has been no study about drug compliance at the point of the first manic episode and subsequent maintenance period. And also there are limited data regarding the rates of noncompliance in patients with bipolar disorder and schizoaffective disorder in Korea. So the author studied about the rate of noncompliance in manic patients and about the clinical predicting factors associated with their drug compliance. METHODS: Compliance of a patient was assessed by patient's report, family member's report, treater's estimation, investigator-administered questionnaire, record of unkept appointment and plasma concentration of mood-stabilizer. Data about patient-related, illness-related and treatment-related factors of compliance were collected by the review of medical records and interview with the patient. RESULTS: Forty patients (56.3%)were noncompliant with their pharmacologic regimen at the point of the first treatment period. Noncompliance was significantly associated with experience of childhood stressful life events(p=.035) presence of psychotic symptoms(p=.020)and treatment with combination of mood-stabilizers(p=.002) CONCLUSION: Patients who experienced serious life event in their childhood, had delusion or hallucination during the manic episode, or received the combination therapy of mood-stabilizer are prone to fail in treatment adherence.

Molecular Genetic Study for FMR-1 Gene in Autistic Children / 신경정신의학

OBJECTIVES: To elucidate an association of the fragile X syndrome with autism, Southern blot analysis was performed in 66 autistic children aged from 2 years to 11 years. METHODS: Subjects were 66 autistic children with of autistic disorder diagnosed by DSM-IV criteria and Childhood Autism Rating Scale-Korean version. Genomic DNA was extracted from peripheral blood and DNA was used to detect a FMR (Fragile Mental Retardation)-1 gene. Xho/PstI probes and two restriction enzymes (EcoRI, EagI)were used for Southern blot analysis. RESULTS: There were one boy with a methylated mosaic pattern and 3 boys and 2 girls with an unmethylated premutation band. But there was no full mutation pattern. CONCLUSION: Although the possibility of the relationship between autistic disorder and FMR-1 gene has been suggested, the results from this study do not provide any definite association of FMR-1 gene with autism in autistic children.

Epidemiological Study of Dementia in a Korea Urban Area

OBJECTIVE: Dementia is major neuropsychiatic disorder in the elderly. This study was aimed to investigate the prevalence of dementia and provide fundamental data for community mental health programs. METHOD: 500 elderly people aged 65 years and over in Kwachon were interviewed according to DSM-IV and examined MMSE-K, Korea-Dementia Rating Scale (K-DRS), Clinical Dementia Rating (CDR), Modified Hatchinski Ischemic Scale (MHIS) by trained research assistants. RESULTS: Prevalence of dementia is 10.6% (Alzheimer type 8.0%;vascular type 2.6%). Old age, lower education, cardiovascular disease, head trauma and heavy smoking seem to be risk factors for developing dementia but sex difference is non significant. CONCLUSION: The results showed similar prevalence rates compared to other epidemiological studies. Demented group showed more cognitive disturbances than non-demented one. For patients of dementia, appropriate treatment and management by family members, other caregivers and mental health professionals are needed.

The Effect of Estrogen on Cognitive Functions in Female Schizophrenics: A Preliminary Study / 신경정신의학

OBJECTIVES: There have been many investigations into the evaluation and treatment of cognitive deficits in schizophrenia, because cognitive deficits do not respond well to antipsychotics and may be a very important prognostic factor for social and occupational outcomes. And it has been known that estrogen improves cognitive functions, as proved in animal studies and studies in postmenopausal women and dementia patients. And estrogen has been unvestigated as an etiologic factor of the neuroendocrine abnormalities of schizophrenia. This preliminary study was aimed to investigate the effect of estrogen on cognitive functions of female schizophrenics, as one of the estrogen projects on our institute. METHODS: The subjects consisted of 30 females with schizophrenia. During the study, all subjects maintained the same dosage of antipsychotics as before the study. Fifteen subjects were given estrogen (EG), and the other fifteen subjects were not(CG). Trail Making Test A and B, Digit Symbol Substitution Test, Finger Tapping Test, Visual continuous Performance Test, Spatial Memory Test, and Wisconsin Card Sorting Test were taken every four weeks from the baseline to the 12th week. RESULTS: At Baseline, there were no significant differences of ages, duration of illness, antipsychotic dose, ammenorrhea, PANSS, types of schizophrenia, MADRS and CGI, and cognitive function tests between EG and CG. There were no significant improvements of Trial Making Test A & B, Finger Tapping Test, and Visual continuous Performance Test in both groups. But there were significant improvements of Digit Symbol Substitution Test, Spatial Memory Test, and Wisconsin Card Sorting Test (total errors and completed categories) in EG, but not in CG. CONCLUSION: The authors found that estrogen improved some cognitive functions, such as memory and executive function in EG. But it could not be clearly defined whether those changes are due to the direct effect of estrogen on the cognitive functions, or the improvement of psychotic symptoms, or the generalized enhancing effect of cognitive functions.

A Concept of the Foundation of Korean Hospital for the Elderly who have Neuropsychiatric Disorders

The population of the elderly and neuropsychiatric elderly patients increases radically, but realistic management in the welfare and medical dimensions are not adequate. Especially, the treatment and care for the neuropsychiatric geriatric patients have not been achieved properly for the lack of good medical facilities and heavy economic burden. Therefore, this paper will propose a model of specialized neuropsychiatric geriatric hospital suited to our reality for the welfare of the elderly themselves and their families. For this, we investigated the needs of medical consumers through surveys. Our subjects are 41 families of neuropsychiatric elderly patients in admission and 51 caregivers. In these surveys, patrons expect the establishment of specialized geriatric hospital proper to the characteristics of neuropsychiatric elderly patients. In addition, they hope patients adminssion fee to be reduced as difficulty and specialty of neuropsychiatric geriatric patient treatment are actively applied to the medical insurance fee and national support system. According to our examination of the caregeivers for the neuropsychiatric elderly patients, caregivers didn't receive systematized training, but only brief care-giving education. Their status is also unstable and their pay is low. These issues are very important for the quality of care-giving work. Therefore, specialized neuropsychiatric geriatric hospitals should be established properly to our social reality and request, and national and social supports for the training and education of medical staffs and quite necessary.

A Study of Validity of Collateral Source Version of Korean Form of Geriatric Depression Scale(CS-KGDS)

In order to examine elderly depression in the elderly that too weakened cognitively, and physically to check depressive symptoms reliably, the authors deviced collateral source version of elderly depression scale and tested it's validity. Sixty elderly depression patients and forty-eight old person in normal group completed the KGDS (Korean Form of Geriatric Depression Scale), and their collateral source (CS) completed a CS version of the KGDS (CS-KGDS). The differences of CS-KGDS means was signified at alpha=.001 level (patients group mean=18.33 (4.71), control group mean=7.60 (5.25), t=11.18). The values of Cronbach's alpha and Split-half reliability were .88 and .81 respectively, and correlational coefficent with KGDS was .68. On factor analysis, 5 factors were extracted. They were labeled 'Physical weakening and decreased vitality' (factor 1), 'Emotional discomfort' (factor 2), 'Negative thinking and Unhappiness feeling' (factor 3), 'Cognitive dysfunction' (factor 4), 'Decreased social interest and activity' (factor 5), which congruous with internal structure of KGDS. The result of discrimination analysis showed 87.09% of hit ratio, and suggested the score of 13 as optimal cut-off score. This cut-off score was identical to that of KGDS. Conclusively, CS-KGDS could be a useful tool for evaluaion of elderly depression instead of KGDS in such case that KGDS can not be administered reliably.

Relationship between Serum Cholesterol Level and Suicide Severity in Suicide Attempters Admitted to an Emergency Room / 신경정신의학

OBJECTIVES: Epidemiological and clinical studies have suggested that low cholesterol levels or clinical trals to reduce cholesterol concentrations may be associated with suicide, violent behavior or depression. The aim of the present study was to determined i) whether suicidal psychiatric patients is characterized by decreased serum cholesterol concentration ; ii) whether significant difference of cholesterol levels might be present according to the psychiatric diagnosis, and iii) whether significant association between suicide severity and cholesterol levels might be present. METHOD: The subjects were 102 psychiatric patients who were admitted to emergency ward following an attempted suicide during the period from January 1994 to July 1997 and 102 age, and sex matched psychiatric controls who were consecutively admitted to a psychiatric ward during the same period, and 102 age, sex matched healthy normal controls. The suicide attempters were divided into 5 grades according to the suicide severity. Serum cholesterol concentrations were measured by a enzymatic method. RESULTS: The serum cholesterol level in suicidal attempters were found to be significantly lower compared with both psychiatric and normal controls. This significant relationship between suicidal attempt and low cholesterol level was observed only in depressive patients, but not in schizophrenics or personality disorder patients. Low cholesterol was significantly associated with the severity of the suicide. CONCLUSIONS: These results support the previous finding that low cholesterol level might be associated with an increased risk of suicide. The fact that the significant relationship was observed only in depressive disorder, but not in schizophrenia or personality disorder raises the possibility that the association between low serum cholesterol and suicidal behavior may have relevance to biological mechanisms in depression. It is hypothesized that low cholesterol levels would be associated with depression by modifying the serotonin, the production of interleukin 2 and melatonin metabolism.

A Preliminary Study on Standardization of Korean Form of Geriatric Depression Scale(KGDS) / 신경정신의학

The purpose of this study was to construct Korean Geriatric Depression Scale(KGDS) items and test the reliability and validity of KGDS. Total 151 items from GDS, BDI, SDS, MMPI-D, and K-CES-D were administered to 81 depressed elderly and 75 elderly control groups. Sixty-four preliminary items which have discrimination power between depression and control groups were selected. Then by correlational analysis considering adjusted item-total correlation, 40 items were finally chosen to construct KGDS. The values of Cronbach's alpha and split-half reliability were 0.88 and 0.79, respectively. The differences of means was signified at alpha=.001 level(patients group mean=23.40+/-8.13, control group mean=12.50+/-8.82, t=9.76). The result of factor analysis showed that KGDS had six factors. They were labeled negative thinking and unhappiness feeling(factor 1), emotional discomfort(factor 2), cognitive dysfunction(factor 3), decreased vitality(factor 4), physical weakening and inclosed somatic concern(factor 5), social withdrawal and loss of interest(factor 6), which represent depressive features of the elderly in thought, emotional, cognitive, physical, and social aspects. The total percentage of variance of the 6 factors was 51.2%. The result of discrimination analysis showed that hit ratio of KGDS was 76.7%, and the score of 16 was suggested as the optimal cut-off score. Additionally, by using percentile score distribution of control(normal) group, it is suggested that the score of 16-22 represents borderline or mild depression, the score of 23-25 are moderate depression, and greater than the score of 26 severe depression. Conclusively, KGDS not only improves diagnostic discrimination power 10% more than other depression scales including GDS, but also show sufficient reliability and validity, thus can be used for evaluaion of elderly depression. Finally, some issues relevant to sample selection and the necessity of concising content and items of KGDS are discussed.

An Assiociation Study of Interleukin-2 Receptor beta-Chain Gene Polymorphism on Chromosome 22 in Korean Schizophrenic Patients / 신경정신의학

BACKGROUND: While a significant genetic predisposition to schizophrenia has been proposed, the mode of inheritance or nature of etiological factors is unknown. Previous reports of a genome-wide survey for schizophrenia susceptibility genes have indicated a possible region of linkage on chromosome 22. In order to test the possibility that the interleukin-2 recepto beta chain(IL-2R beta ) gene on chromosome 22 is of etiological importance in schizophrenia, a case-control association study was conducted. METHODS: Subjects were ninety-three schizophrenic patients with a diagnosis of schizophrenia by DSM- III -R criteria and ninety-seven normal controls. Schizophrenic patients were divided by clinical phenotypes such as DSM- III -R diagnostic subtypes, positive and negative symptoms, and family history so as to increase the homogeneity of schizophrenics. Genomic DNA was extracted from whole blood lymphocytes according to standard procedures. The DNA was used to study a dinucleotide repeat in the IL-2R beta gene. To reveal the dinucleotide polymorphism, genomic DNA of subjects was amplified by polymerase chain reactions(PCR). RESULTS: At the IL-2R beta gene locus, all the previously reported alleles (eight different alleles) of a dinucleotide polymorphism were identified. There was no significant difference between number of heterozygosity in schizophrenic patients and in normal controls. There was no significant difference in the distribution of frequencies of alleles between schizophrenics and normal controls. In addition, there was no significant difrfrence in the allele frequencies among subtypes of schizophrenic patients according to DSM- III -R diagnostic subtypes, positive and negative symptoms, and family history. CONCLUSIONS: The present study did not detect a difference in frequencies of alleles of a dinucleotide polymorphism at the IL-2R beta gene locus between schizophrenic patients and normal controls. These results do not support an evidence that IL-2R beta gene plays, a major role in the etiology of schizophrenia.