Recognition of Musical Nuance in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Emotion perception deficit has long been suggested to be one of the core features of schizophrenia. Although there have been several studies examining responses to facial expressions, few studies addressed music emotion recognition. The aim of this study was to examine the difference in emotion recognition in music between normal subjects and patients with schizophrenia. METHODS: Twenty pieces of music were presented to 43 patients with chronic schizophrenia and 82 healthy controls. The set of music consisted of ten pieces of sad music and ten pieces of cheerful music. The subjects were asked to answer whether each piece of music was sad or cheerful. RESULTS: The correct response rate of music emotion recognition was lower in patients with schizophrenia compared with that in healthy controls (76.67+/-19.03% vs. 93.54+/-8.18%, p<0.001). When subgroup analyses was done by type of music ('sad' or 'cheerful'), patients showed a significantly lower correct response rate in recognizing both sad and cheerful emotion in music than healthy controls (sad emotion : 65.12+/-31.15% vs. 91.95+/-15.27%, cheerful emotion : 88.0+/-16.83% vs. 95.12+/-8.64%). The significant correlations between the clinical symptom severity of schizophrenia and music emotion recognition were not found to be. CONCLUSION: The results suggest that patients with schizophrenia might have difficulties in recognizing musical nuances.

Relationship among Plasma Homocysteine, Folate, Vitamin B12 and Nutrient Intake and Neurocognitive Function in the Elderly

This study examined the relationship among plasma homocysteine, folate, and vitamin B12 levels and neurocognitive function in 118 community-dwelling elderly subjects (mean age, 75.1 +/- 6.7 years). The Mini-Mental State Examination (MMSE-KC) was used to screen and assess neurocognitive function in the participants. Dietary intake data including the use of dietary supplements were obtained using the 24-hour recall method by well-trained interviewers. Plasma folate and vitamin B12 concentrations were analyzed by radioimmunoassay, and homocysteine was assessed by a high performance liquid chromatography-fluorescence method. The proportions of participants with suboptimal levels of plasma folate ( 15 micromol/L) were 16.1%, 5.9%, and 21.2%, respectively. A multiple regression analysis showed that plasma homocysteine was negatively associated with plasma folate and vitamin B12 levels. The MMSE-KC test scores were significantly associated with plasma homocysteine and folate, but not with vitamin B12, after adjusting for age, gender, body mass index, living with spouse, education, current smoking, energy intake, and chronic diseases such as hypertension, diabetes, thyroid disease, dyslipidemia, stroke, and cardiovascular disease. A general linear model adjusted for covariates revealed that MMSE-KC test scores increased from the lowest to the highest quartiles of vitamin B1, vitamin B2, vitamin B6, vitamin B12, and vitamin C intake (p for trend = 0.012, 0.039, 0.014, 0.046, 0.026, respectively). These results indicate that the problem of folate inadequacy and hyperhomocysteinemia are highly prevalent among community-dwelling elderly people and that dietary intake of the B vitamins and vitamin C is positively associated with cognitive function scores.

Development of Guideline for Psychiatric Medical Record and Quality Improvement Following Its Application / 신경정신의학

OBJECTIVES: Medical records are used to store and communicate information about patient treatment. Nowadays, the problem oriented medical record (POMR) is the most frequently used method for medical records. The POMR has the advantage of evaluating the course of treatment; however, it is also criticized for focusing on just symptoms and signs. We propose new guidelines for psychiatric medical records based on a modified POMR. METHODS: We organized a research team of psychiatrists and psychiatric residents and, held weekly research meetings from March 2005 until May 2006. Under close psychiatric chart review, we found several problems with the POMR system, and based on these findings, we discussed various ways of modifying it. RESULTS: We propose the following AMC psychiatric medical record guidelines: 1) Problem lists should be classified into seven categories: psychiatric symptoms, function, risk, environment, special treatment, drug side effects, and medical problems. Additionally, treatment course should be described accordingly. 2) Spontaneous reports by patients should be classified as subjective information, and any contents explored by the clinician, as objective information. Brief scales should be included for the quantitative description of symptoms. 3) Assessment should include symptom severity, treatment response, compliance, and suicidal or violent risk at evaluation point. 4) Specific management strategies such as rationale for dosage adjustment, detailed psychotherapeutic intervention, and psychoeducation should be described in the plan. CONCLUSION: This is one of a few studies proposing guidelines for psychiatric medical records. The application of these will improve the quality of medical records and it is hoped that such guidelines will be used broadly.