Understanding of Antipsychotics in Elderly Patients with Dementia

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.

Attunement Disorder : A Disorder of Brain Connectivity

OBJECTIVES: We reviewed cellular and synaptic dysconnectivity, disturbances in micro- and macro- circuitries, and neurodevelopmentally-derived disruptions of neural connectivity in the pathogenesis of schizophrenia. METHOD: We reviewed the selected articles about disturbances in neural circuits which had been proposed as a pathogenetic mechanism of schizophrenia. RESULTS: The literature review reveals that schizophrenia may be a disease related to disturbance in neurodevelopmental mechanism, shown as 'a misconnection syndrome of neural circuit or neural network'. In descriptive psychopathological view, definition of a disorder of brain connectivity has limitation to explain other aspects of schizophrenia including deterministic strictness in thought process. CONCLUSION: Schizophrenia is considered as a disorder of brain connectivity as well as a neurodevelopmental disorder related with genetic and environmental factors. We could make a suggestion that "JoHyeonByung (attunement disorder)" denotes the disturbances of psychic fine-tuning which correspond to the neural correlates of brain dysconnectivity metaphorically.

The Effects of Emotionally Focused Therapy(EFT) for Couples : Pilot Study / 신경정신의학

OBJECTIVES: This study investigated the effects of Emotionally Focused Therapy (EFT) on distressed married couples. METHODS: We conducted 5 to 19 EFT sessions once a week with 10 couples from Yongin Mental Hospital who were experiencing marital conflict. We assessed participants before and after EFT, using the Beck Depression Inventory (BDI), Symptom Checklist 90-R (SCL-90R), and Korean Marital Satisfaction Inventory (K-MSI). The EFT consisted of 3 stages comprising 9 steps. Every couple followed this EFT structure. RESULTS: After completing the EFT sessions, the inventories showed the couples experiencing significant improvements in various psychological symptoms and marital satisfactions. CONCLUSION: These results indicate that EFT could be applied to distressed couples in a clinical setting and could effectively reduce psychological symptoms and improve marital satisfaction. Further study of the generalizability of these results and of the process variables are needed.

Effects of Psychodrama on the Elderly Patients with Dementia

OBJECTIVES: This study was to evaluate the cognitive and noncognitive effects of Psychodrama on elderly dementia patients. METHODS: The psychodrama treatment group was composed of 16 elderly dementia patients and control group was matched the psychodrama group. The psychodrama group received 8 session of psychodrama therapy every week. Cognitive function and non-cognitive function of two groups were evaluated by MMSE-KC, K-BNT, Geriatric Depression Scale, Barthel Activities of Daily Living, Self-Esteem Scale before and after Psychodrama. RESULTS: Improvement of Self esteem was observed in psychodrama group. Worsening of depression was observed in control group, but psychodrama group was not observed. CONCLUSION: Psychodrama with elderly dementia can be useful to enhance Self esteem and to prevent worsening of depression

Effects of Psychodrama on the Elderly Patients with Dementia

OBJECTIVES: This study was to evaluate the cognitive and noncognitive effects of Psychodrama on elderly dementia patients. METHODS: The psychodrama treatment group was composed of 16 elderly dementia patients and control group was matched the psychodrama group. The psychodrama group received 8 session of psychodrama therapy every week. Cognitive function and non-cognitive function of two groups were evaluated by MMSE-KC, K-BNT, Geriatric Depression Scale, Barthel Activities of Daily Living, Self-Esteem Scale before and after Psychodrama. RESULTS: Improvement of Self esteem was observed in psychodrama group. Worsening of depression was observed in control group, but psychodrama group was not observed. CONCLUSION: Psychodrama with elderly dementia can be useful to enhance Self esteem and to prevent worsening of depression