Reversed Hand Movement during Sleep in Patients with Obstructive Sleep Apnea

OBJECTIVE: Previous findings suggest that hand movement laterality is reversed during sleep. The present study aimed to verify this phenomenon and evaluate whether the extent of reversal is correlated with the severity of sleep apnea. METHODS: A total of 184 participants (mean age: 44.5±13.0 years; 81.5% males) wore actigraphs on both hands during sleep, and nocturnal polysomnography was simultaneously performed. RESULTS: Actigraphic indices of hand movement were significantly higher for the left hand than those for the right hand (p < 0.001), including total activity score, mean activity score, mean score in active periods and fragmentation index. Additionally, calculated differences between the fragmentation index for the left versus right hands were significantly correlated with the apnea-hypopnea index (AHI, r=0.149, p=0.032). The AHI was not significantly correlated with differences in hand movement between both hands movement assessed by total activity score (r=0.004, p=0.957), mean activity score (r=0.011, p=0.876), mean score in active periods (r=-0.080, p=0.255). CONCLUSION: More severe symptoms of obstructive sleep apnea was associated with larger degree of hand movement reversal at night. This result support the theory that homeostatic deactivation occurs in the dominant hemisphere during sleep.

Change of Heart Rate Variability in Depressive Disorder after Physical or Psychological Stress / 수면정신생리

OBJECTIVES: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress states in depressive disorder patients. METHODS: HRV was measured at resting, upright, and psychological stress states in 62 depressive disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity, respectively. Differences between HRV indices and VAS score were evaluated using paired t-tests. Gender difference analysis was conducted with ANCOVA. RESULTS: SDNN (standard deviation of normal to normal intervals), LF/HF (low frequency/high frequency), and VLF (very low frequency) were significantly increased, while NN50 and pNN50 were significantly decreased in the upright position compared to resting state. SDNN, RMSSD (root mean square of the differences of successive normal to normal intervals), and VLF were significantly increased, while pNN50 was significantly decreased in the psychological stress state compared to resting state. SDNN, NN50, and pNN50 were significantly lower in an upright position compared to a state of psychological stress, and LF, HF, and LF/HF showed no significant differences CONCLUSION: The LF/HF ratio was significantly increased after physical stress in depressive disorder. However, the LF/HF ratio was not significantly increased after psychological stress, and the change in LF/HF ratio after physical stress and psychological stress did not significantly differ from each other. Significant increase in SDNN, NN50, and pNN50 in an upright posture compared to psychological stress suggests that depressive patients react more sensitively to physical stress than psychological stress.

Neuropsychiatric Symptoms and Increased Risks of Progression from Amnestic Mild Cognitive Impairment to Alzheimer's Dementia

OBJECTIVES: Neuropsychiatric symptoms (NPS) are common in dementia and in mild cognitive impairment (MCI). They might be a predictor of progression to dementia. This study aimed to investigate the effects of NPS on the natural course in MCI. METHODS: 306 community-dwelling Korean elderly with MCI from local dementia center were assessed for NPS using Neuropsychiatric Inventory (NPI). Subjects were assessed again after more than a year from baseline. 52 subjects (17.0%) were progressed to dementia. We compared baseline NPI scores between stable and deteriorated groups. RESULTS: Subjects progressing to dementia had a significantly higher prevalence of NPS (45.3% vs. 65.4%) than subjects who remained stable. Delusion (2.8% vs. 9.6%), agitation/aggression (14.6% vs. 26.9%), depression (21.7% vs. 40.4%) and disinhibition (4.3% vs. 19.2%) were more common in deteriorated group. After adjustment for other variables, on logistic regression analysis, only disinhibition at baseline was shown to be a risk factor for progression to dementia (OR=4.88, 95% CI=1.37-17.36, p=0.01, R²=302). CONCLUSION: These findings suggest that NPS in MCI may be a predictor of progression to dementia. NPS may be a useful item including delusion, agitation/aggression, depression, and disinhibition. To study course and nature of NPS may lead to better understanding of Alzheimer's disease.

Correlational Analysis of Supine Position Time and Sleep-related Variables in Obstructive Sleep Apnea Syndrome / 수면정신생리

OBJECTIVES: A supine sleep position increases sleep apneas compared to non-supine positions in obstructive sleep apnea syndrome (OSAS). However, supine position time (SPT) is not highly associated with apnea-hypopnea index (AHI) in OSAS. We evaluated the correlation among sleep-related variables and SPT in OSAS. METHODS: A total of 365 men with OSAS were enrolled in this study. We analyzed how SPT was correlated with demographic data, sleep structure-related variables, OSAS-related variables and heart rate variability (HRV). Multiple linear regression analysis was conducted to investigate the factors that affected SPT. RESULTS: SPT had the most significant correlation with total sleep time (TST ; r = 0.443, p < 0.001), followed by sleep efficiency (SE ; r = 0.300, p < 0.001). Snoring time (r = 0.238, p < 0.001), time at < 90% SpO2 (r = 0.188, p < 0.001), apnea-hypopnea index (AHI ; r = 0.180, p = 0.001) and oxygen desaturation index (ODI ; r = 0.149, p = 0.004) were significantly correlated with SPT. Multiple regression analysis revealed that TST (t = 7.781, p < 0.001), snoring time (t = 3.794, p < 0.001), AHI (t = 3.768, p < 0.001) and NN50 count (t = 1.993, p = 0.047) were associated with SPT. CONCLUSION: SPT was more highly associated with sleep structure-related parameters than OSAS-related variables. SPT was correlated with TST, SE, AHI, snoring time and NN50 count. This suggests that SPT is likely to be determined by sleep structure, HRV and the severity of OSAS.

Characteristics of Patients with Dementia and the Demands of Caregivers: Inpatients of Public Long-term Care Hospital versus Outpatients of General Hospitals

OBJECTIVE: The aim of this study is to clarify the characteristics of patients with dementia using long-term care hospitals and the demands of their caregivers. It will provide a perspective for establishing the specialized dementia hospital and appropriate dementia services in the future. METHODS: The survey was performed to the caregivers of the dementia inpatients of 71 public long-term care hospitals and outpatients from local hospitals. We distributed the questionnaires to 3,600 caregivers. Of these, 1,572 returned and then included in the analysis. RESULTS: High number of both inpatients (85.7%) and outpatients (61.5%) were diagnosed with dementia in psychiatric or neurologic department. Time laps from onset of symptoms thought as dementia to actual diagnosis was about a year. Caregivers of dementia inpatients wanted mostly dementia related welfare and care products (85.5%), physical and exercise program (84.0%), specialized dementia ward (83.1%), behavioral management (82.1%), and cognitive rehabilitation (80.5%). CONCLUSION: It is important to provide adequate management to both the patients with dementia and the caregivers. Thus, specialized institutional arrangements and medical service improvement supported by government is needed to reduce the psychological and financial burden of caregivers. We hope these results will be used to establish the principals and standards of specialized dementia hospital.

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.

The Change of Heart Rate Variability in Anxiety Disorder after Given Physical or Psychological Stress / 수면정신생리

OBJECTIVES: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress in anxiety disorder patients. METHODS: HRV was measured at resting, upright, and psychological stress states in 60 anxiety disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity. Differences between HRV indices were evaluated using paired t-tests. Gender difference analysis was accomplished with ANCOVA. RESULTS: SDNN (Standard deviation of normal RR intervals) and low frequency/high frequency (LF/HF) were significantly increased, while NN50, pNN50, and normalized HF (nHF) were significantly decreased in the upright position compared to resting state (p < 0.01). SDNN, root mean square of the differences of successive normal to normal intervals, and LF/HF were significantly increased, while nHF was significantly decreased in the psychological stress state compared to resting state (p < 0.01). SDNN, NN50, pNN50 were significantly lower in upright position compared to psychological stress and nVLF, nLF, nHF, and LF/HF showed no significant differences between them. CONCLUSION: The LF/HF ratio was significantly increased after both physical and psychological stress in anxiety disorder, but did not show a significant difference between these two stresses. Significant differences of SDNN, NN50, and pNN50 without any differences of nVLF, nLF, nHF, and LF/HF between two stresses might suggest that frequency domain analysis is more specific than time domain analysis.

The Relationship between Childhood Trauma Experience and Parent-Adolescent Reports of Problem Behavior : Comparison of Delinquent and General Adolescent

OBJECTIVES: The aim of this study was to investigate correlation of childhood trauma experience and parent-adolescents' assessment reports on problem behavior through comparison of delinquent and general adolescents. METHODS: First, delinquent adolescents and general adolescents were asked to complete the Childhood Trauma Questionnaire (CTQ). Then, 71 pairs of delinq uent adolescents and their parents and 133 pairs of general adolescents and their parents were asked to complete the Korean Youth Self-Report (K-YSR) and the Korean Child Behavior Checklist (K-CBCL). Finally, responses from 410 people were used for the analysis. RESULTS: First, childhood trauma experience score was significantly higher for delinquent adolescents, compared to general adolescents. Second, t-test showed a greater difference between K-YRS and K-CBCL for general adolescents than for delinquent adolescents. Third, in the case of delinquent adolescents, the correlation analysis of K-YSR filled out by adolescents and K-CBCL filled out by parents showed significant correlation in certain areas, including social immaturity, delinquent behaviors, internalization issues, and externalization issues. On the other hand, the correlation analysis of K-YSR and K-CBCL of general adolescents showed significant correlation in all sub-categories. Fourth, the correlation analysis of delinquent adolescents' CTQ and K-YSR showed minimal yet significant correlation in social adaptation, withdrawing, depression/anxiety, and delinquent/aggressive behaviors, however, no correlation was observed between CTQ and K-CBCL. The correlation analysis of general adolescents' CTQ and K-YSR, and CTQ and K-CBCL showed significant correlation in all sub-categories, although the degree of correlation varied. CONCLUSION: Delinquent adolescents had more childhood traumatic experiences. However, general adolescents' childhood traumatic experiences showed minimal yet significant correlation with various adaptation indicators and their parents responded in a similar way, indicating that general adolescents with childhood traumatic experiences need close care and attention even if they have not shown prominent delinquent behaviors.

The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome

OBJECTIVE: This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS). METHODS: 176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices. RESULTS: The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis. CONCLUSION: The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.

Comparison of Heart Rate Variability Indices between Obstructive Sleep Apnea Syndrome and Primary Insomnia / 수면정신생리

OBJECTIVES: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. METHODS: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=41.50+/-13.16 yrs, AHI 30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. RESULTS: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were 991.1+/-27.1 and 875.8+/-22.0 ms (p=0.016), standard deviation of NN interval (SDNN) was 85.4+/-6.6 and 112.8+/-5.4 ms (p=0.022), SDNN index was 57.5+/-5.2 and 87.6+/-4.2 (p<0.001), total power was 11,893.5+/-1,359.9 and 18,097.0+/-1,107.2 ms2 (p=0.008), very low frequency (VLF) was 7,534.8+/-1,120.1 and 11,883.8+/-912.0 ms2 (p=0.035), low frequency (LF) was 2,724.2+/-327.8 and 4,351.6+/-266.9 ms2 (p=0.003). CONCLUSIONS: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

The Correlation between Severity of Sleep Apnea, Sleep and Mood Related Scales, and Activity During Sleep in Obstructive Sleep Apnea Syndrome Patients / 수면정신생리

OBJECTIVES: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. METHODS: One hundred seventy six drug-free male patients confirmed as OSAS (average age=43+/-11 years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was 39.6+/-26.0. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. RESULTS: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05). Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. CONCLUSION: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.

Characteristics of Cognitive Faculties in Elderly Depressive Patientscomplaining of Memory Decline and Patients with Amnestic Mild Cognitive Impairment

OBJECTIVES: Elderly depression is often misdiagnosed as a dementing illness such as Alzheimer's disease (AD). Moreover, depressive symptoms often are presented in the early phase of AD. It is difficult to distinguish the difference between mild cognitive impairment (MCI) and depression. The purpose of this study is to explore neuropsychological characteristics of patients with amnestic MCI (aMCI) and depression. We hypothesized that there would be the difference in the cognitive function of those groups and this made clearer the nature of a depression and aMCI. METHODS: A community dwelling older people aged over 60 years were enrolled for the study. We compared 24 patients with aMCI, 23 with depression complaining subjective memory decline, and 26 normal elderly. Demographic and neuropsychological data were gathered and assessed by trained psychologist. RESULTS: Patients with aMCI and depression had significant differences separately from normal controls in particular cognitive function. Patients with aMCI showed more cognitive declines in learning than normal older people. Patients with depression had less performance in attention and executive function than normal controls. CONCLUSION: To understand the clinical difference and underlying pathophysiology of aMCI and depression, the precise criteria of aMCI gathering more homogeneous group of depression in severity and onset time will be needed.

Onset of Manic Episode during Chemotherapy with 5-Fluorouracil

The authors report a case of 5-Fluorouracil (5-FU) induced manic episode in an elderly female without any previous psychiatric history. The patient presented manic symptoms after 4th cycle of 5-FU chemotherapy after surgery of rectal cancer. After cessation of chemotherapy and administration of olanzapine and divalproex sodium, symptoms were subsided within 10 days.

The Effects of Venlafaxine and Dexamethasone on the Expression of HSP70 in Rat C6 Glioma Cells

OBJECTIVE: The present study aimed to determine the intracellular action of the antidepressant, venlafaxine, in C6 glioma cells using heat shock protein 70 (HSP70) immunocytochemistry and HSP70 Western blots; HSP70 is known to be associated with stress and depression. METHODS: The extent of HSP70 expression was measured after rat C6 glioma cells were treated with 1) dexamethasone only, 2) venlafaxine only, 3) simultaneous venlafaxine and dexamethasone, or 4) dexamethasone after venlafaxine pretreatment. Dexamethasone (10 microM, 6 hours) did not affect the level of HSP70 expression relative to control. RESULTS: Short-term (1 hour) venlafaxine treatment significantly increased the level of HSP 70 expression. Simultaneous long-term (72 hours) venlafaxine and dexamethasone treatment significantly reduced the level of HSP70 expression. Dexamethasone treatment administered following long-term (24 and 72 hours) pretreatment with venlafaxine also significantly reduced the level of HSP70 expression. CONCLUSION: Short-term treatment with venlafaxine increases the expression of HSP70, but prolonged treatment with dexamethasone suppresses the venlafaxine-induced expression of HSP70. These findings suggest that HSP70 and dexamethasone play a significant role in the pathophysiology of depression.

Correlation between Heart Rate Variability and Sleep Structure in Primary Insomnia / 수면정신생리

OBJECTIVES: It is well established that primary insomnia affects the activity of autonomic nervous system. We tried to know how the activity of autonomic nervous system during night sleep changes by analyzing correlation between heart rate variability (HRV) index and the variables related with sleep structure in primary insomnia. METHODS: Thirty three subjects (mean age:36.2+/-14.2 years, male:female=15:18) who were diagnosed with primary insomnia were selected for the study. Nocturnal polysomnography (NPSG) was carried out on each subject and correlation was analyzed between high frequency/low frequency ratio (LF/HF ratio), one of HRV indices and the variables related with sleep structure which were calculated from NPSG. RESULTS: When age and sex were controlled, LF/HF ratio showed negative correlations with slow wave sleep and stage 2 sleep, respectively (r(p)=-0.43, p=0.01;r(p)=-0.37, p=0.04). On the other hands LF/HF ratio showed a positive correlation with arousal index (r(p)=0.65, p<0.001). The activity of autonomic nervous system responded differentially depending on the change of sleep structure in primary insomnia. Especially the increase of arousal index and the decrease of slow wave sleep and stage 2 sleep which are the components of non-REM sleep provoked hyperactivity of sympathetic nervous system. CONCLUSION: This study suggests that the typical change of sleep structure in primary insomnia can negatively impact on cardiovascular system.

Psychoanalytic Understanding of Empathy / 신경정신의학

The authors reviewed the histories of the use of the term empathy, the different meanings of empathy, the origins of empathetic abilities, the referents for empathy, the paradoxical attitude of empathy, the therapeutic effect of empathy and the inadequate uses of empathy by referring to the recent psychoanalytic articles. We wanted to provide the psychoanalytic understanding of empathy for analytic psychotherapists. The important points for the psychoanalytic understandings of empathy were as follows:First, empathy is not a goal, but a method in the therapeutic process. Second, the empathetic attitude can be started at the beginning of treatment, yet it takes time for empathy to function in the treatment. Third, when providing empathy, a therapist needs both a subjective sense of sympathy for a patient and objective observation of the interaction between them during the treatment sessions. Fourth, a therapist needs to decrease his/her own narcissistic and omnipotent aspects and to use structured receptivity when providing empathy. Fifth, the process of empathy can be thought to be the result of the interaction between the patient and the therapist. Sixth, it may be more useful for a therapist to understand a patient through empathy rather than to provide a cure for a patient through empathy.

Association of Psychosocial Factors in Developing Childhood Depression and ADHD in a Community Low Income Family Children

OVJECTIVES: As the attention devoted to children's mental health increases, medical costs and burdens mount as well. In the present study, we evaluated the association between socioeconomic status (SES) and major child psychiatric symptoms. METHODS: The subjects of this study were children of recruited from a mental health screening program in the Seoul Sungbuk mental health center over the course of 3 months. To establish the SES of each child, we collected data about each child's medical insurance, years of parental education, household income, family structure and housing. 149 children& parents completed questionnaires including the Childhood Depression Inventory (CDI) and the Korean Attention Deficit Hyperactivity Disorder Rating Scale (K-ARS). RESULTS: The mean K-ARS-P score was 12.1+/-11.1 and the suspected prevalence of ADHD was 20.8% (n=31). The mean CDI score was 12.9+/-7.9, and the prevalence of suspected depression was 16.8% (25). Depressive symptoms and ADHD symptoms were both more severe than those observed in a previous epidemiologic study in Korea. Depressive symptoms were more closely associated with family SES status. CONCLUSION: SES status is one of the most important risk factors in the development of major child psychiatric symptoms. In our study we found that depressive symptoms in particular were most tightly associated with psychosocial factors. Evaluation of the risk factors, early screening and intervention for low SES children would be valuable mental health management tactics to implement in a community mental health system.

Psychoanalytic Situation : Free Association and Analytic Neutrality / 신경정신의학

The authors reviewed the meanings of a psychoanalytic setting, which is composed of a patient's free association and an analyst's analytic neutrality. In particular, this was done by discussing the definitions of a psychoanalytic setting, the functions of free association, and the development of the meanings of analytic neutrality over time. The purpose this wasto provide an understanding of a psychoanalytic setting for psychoanalytic therapists. To fully understanda psychoanalytic setting, the several points must be considered. Firstly, a patient's introspection about his/her inner world in the presence of an analyst in a psychoanalytic setting facilitates the development of the psychoanalytic process. Secondly, both a patient's reflective functioning of his/her mental process and a patient's relational experiences of transference feelings toward their analyst is important for analytic treatment. Thirdly, a patient's progress withfree association during treatment sessions indicates spontaneity, a motivation to be cured from a patient's standpoint. Fourthly, a patient and an analyst become aware of the meaning of a patient's materials from free association through the process of Ed-highlight: Unclear. I'm not sure what you mean by this word. Are you referring to the patient's thoughts or feelings? free association itself. Fifth, the main aim of analytic neutrality is to understand the patient's psychic reality, and it is important to understand this reality through interaction between a patient and an analyst

Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

The risk of cardiovascular disease is known to be increased in obstructive sleep apnea syndrome (OSAS). Its mechanism can be explained by the observation that the sympathetic tone increases due to repetitive apneas accompanied by hypoxias and arousals during sleep. Heart rate variability (HRV) representing cardiac autonomic function is mediated by respiratory sinus arrhythmia, baroreflexrelated fluctuation, and thermoregulation-related fluctuation. We evaluated the heart rate variability of OSAS patients during night to assess their relationship with the severity of the symptoms. We studied overnight polysomnographies of 59 male untreated OSAS patients with moderate to severe symptoms (mean age 45.4+/- 11.7 yr, apnea-hypopnea index [AHI]=43.2+/-23.4 events per hour, and AHI >15). Moderate (mean age 47.1+/-9.4 yr, AHI=15-30, n=22) and severe (mean age 44.5 +/-12.9 yr, AHI >30, n=37) OSAS patients were compared for the indices derived from time and frequency domain analysis of HRV, AHI, oxygen desaturation event index (ODI), arousal index (ArI), and sleep parameters. As a result, the severe OSAS group showed higher mean powers of total frequency (TF) (p=0.012), very low frequency (VLF) (p= 0.038), and low frequency (LF) (p=0.002) than the moderate OSAS group. The LF/HF ratio (p=0.005) was higher in the severe group compared to that of the moderate group. On the time domain analysis, the HRV triangular index (p=0.026) of severe OSAS group was significantly higher. AHI was correlated best with the LF/HF ratio (r(p)=0.610, p<0.001) of all the HRV indices. According to the results, the frequency domain indices tended to reveal the difference between the groups better than time domain indices. Especially the LF/HF ratio was thought to be the most useful parameter to estimate the degree of AHI in OSAS patients.

Comparison of Sleep Indices between Both Wrist Actigraphies and Nocturnal Polysomnography / 수면정신생리

The present study compared the actigraphic indices between both wrist actigraphies (WATGs), and the sleep estimates between each WATG and nocturnal polysomnography (NPSG) to assess their differences and consistencies. We studied 22 right-handed subjects (mean age 43.9+/-13.3 years, M:F=14:8) with untreated primary sleep disorders (primary insomnia=8, simple snorer=2, obstructive sleep apnea=12) undergone by overnight both WATGs and NPSG, simultaneously. Comparison and correlation were analyzed between right and left wrist actigraphic data. In the sleep estimates of both WATGs and NPSG, each WATG was compared and correlated with NPSG in sleep period time (SPT), total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake time (WT). Sleep indices between both WATGs showed significant positive correlations with no correlations in SL and fragmentation index (FI). There were no differences in sleep indices between both WATGs. SPTs of both WATGs, SL of left WATG, and TST of right WATG showed positively significant correlations, and SE of right WATG did negatively significant correlation in sleep indices between each WATG and NPSG. As each WATG was compared to PSG, SPTs of both WATGs and WT of right WATG were decreased, and TST and SE of right WATG and SL of left WATG were increased. Inconsistent SL and FI between both WATGs indicate that the activities between both WATGs can differentially happen during wake or arousal. Inconsistent sleep estimates between each WATG and NPSG may indicate the limited usefulness in measuring and analyzing one-night sleep by using WATG.