Therapeutic Effects of Psychosocial Programs in the Day Care Service on Cognitive Impairment and Depressive Symptoms in the Elderly Patients / 신경정신의학

Cognitive impairment and depression are the most common symptoms affecting the elderly on physical and mental states. Studies have shown that these symptoms in mild cases are improved by psychosocial intervention, emphasizing the importance of therapeutic intervention provided in the community. The purpose of this study was to investigate whether the psychosocial program at a geriatric day care service has any therapeutic effect on the cognitive function and depressive symptoms in the elderly and whether such effect can be maintained. The experimental group was composed of 37 elderly patients attending the day care service at the mental health center located in Kwangju county, Kyonggi province. The control group was composed of 22 elderly patients who either refused intervention or who dropped out of the program. Cognitive function was assessed with the Korean version of the Mini-Mental State Exam(MMSE-K) and depressive symptoms were assessed with the Short-form Geriatric Depression Scale(SGDS) The experimental group and the control group were compared on the score of on each test, which was administered before and after the program and 10 weeks after discontinuation of program. In the experimental group, the scores acquired immediately after the program and at 10 weeks of follow-up were also compared. The results showed that psychosocial intervention at a geriatric day care service was significantly associated with the change in SGDS scores dependent on time but not significantly associated with the change in MMSE-K scores. In the experimental group whose follow-up assessment was possible, it was further shown that 43% of patients had increased SGDS scores 10 weeks after the program ended, indicating that depressive symptoms had worsened. This study suggests that psychosocial therapeutic intervention in the geriatric day care service improve depressive symptoms but not cognitive functions in the elderly. In addition, for a considerable percentage of subjects in the experimental group, the improvements in depressive symptoms were not sustained after the intervention was withdrawn. These findings proposes a need of strengthening therapeutic intervention to maintain such effect.

Effects of the Speed of Crystalloid Preload in Preventing of Hypotension during Spinal Anesthesia for Caesarean Section / 대한마취과학회지

Hypotension during spinal anesthesia for cesaresn section remains as a common and serious complication despite the use of uterine displacement and volume preloading. This study was designed to compare the efficacy of the speed of crystalloid preload for reduc- ing the incidence of hypotension during spinal anesthesia for elective cesarean section. Twenty ASA I parturients were randomly allocated to receive 20ml/kg of crystalloid over either 20min (group 1) or 10min(group 2) before spinal anesthesia. Both groups showed a significant increase in central venous pressure during and immediately after preload, but there was no significant difference between the groups. Six patients in group 1 developed hypotension(a decrease in systolic pressure below 100mmHg and a fall of 20% from baseline values) and so did seven patients in group 2. We concluded that rapid crystalloid preloading did not reduce the incidence of hypotension during cesarean section under spinal anesthesia and its effectiveness in questionable.