Predictors of Quality of Life in Patients with Acute Coronary Syndrome / 신경정신의학

OBJECTIVES: An important therapeutic target for patients with acute coronary syndrome (ACS) is improved quality of life (QoL). This study investigated clinical factors affecting QoL in patients with ACS. METHODS: We evaluated 82 patients two weeks, and again at three months, after their ACS onset (diagnosis?), using the World Health Organization Quality of Life Instrument-Brief Form to assess QoL. For estimating their severity of depression, we used the Hamilton Depression Rating Scale. We used their Global Registry of Acute Coronary Events risk scores to measure the patients' ACS. Sociodemographic characteristics included age, gender, education, marital status, religion, current occupation, and monthly income. RESULTS: Depressive symptoms at baseline predicted higher QoL at both follow-ups. Some other factors, such as education, religion, and current occupation, were also significantly associated with QoL at three months' follow-up. CONCLUSION: Depression was the most important factor affecting QoL in patients with ACS, at both two weeks' and three months' follow-up.

Risperidone: the Korean Experience in the Treatment of Patients with Schizophrenic Disorder / 대한정신약물학회지

Since the introduction in 1996 of the novel antipsychotic risperidone in Korea, clinical experiences with this agent for the treatment of schizophrenia have been accumulated. This article attempts to review the published literature on clinical effects of risperidone in Korean patients with schizophrenic disorder. All available clinical articles by Korean authors or involving Korean patients were searched through electronic databases (KISEP and KMBASE) or manually. Retrieved articles were primarily written in Korean and were of several types (original article, case report, review and tutorial), and addressed various issues:efficacy, safety and tolerance, quality of life and subjective well-being, pharmacoeconomics, optimal dose and titration rate, etc. The main results are as follows. Many clinical trials to date have shown that risperidone is an effective antipsychotic agent in the treatment of positive and negative symptoms, with a milder side effect profile, in particular much less EPS than haloperidol. The effects were favorable even in chronic or treatment-resistent patients. It appears to have additional effects on quality of life and subjective well-being. Preliminary evidence suggested that risperidone may improve some types of cognitive function. Weight gain was a major problem although the weight increase was less severe than that seen with clozapine and olanzapine. Some experimental studies demonstrated prolactin elevation in patients treated with risperidone;however, clinical significance of hyperprolactinemia was unclear. Various specific cases of adverse events were reported during risperidone therapy, including new onset of manic symptoms, neuroleptic malignant syndrome, stuttering, premature ventricular contraction and hepatotoxicity;however, the numbers of cases were very few, the causal relationship was not clear in some cases, and there were no fatalities or life threatening events. At present the medication costs for risperidone are much greater than those for conventional drugs. However, risperidone therapy may be associated with substantial cost benefits, when total health service costs and quality of life were taken together into account. The target dose found to be effective was lower than the originally proposed target dose of 6 mg/day. A slower titration was also found to be preferable. Taken together, in spite of lacking in randomized controlled clinical trials and long term studies, Korean literature on risperidone use for schizophrenia provides valuable information to clinicans regarding the effective use of risperidone. Risperidone should be a first line drug for the treatment of Korean patients with schizophrenic disorder.

Vascular Risk Factors and Cognitive Function: Associations Modified by Level of Education in a Community Dwelling Elders with Cognitive Impairment

OBJECTIVE: Level of education has been reported to modify the associations between vascular risk factors and cognitive impairment. This study aimed to test this hypothesis in a community dwelling Korean elders with relative cognitive impairment. METHOD: The study group consisted of 341 participants with the Korean version of Mini-Mental State Examination (MMSE-K) scores of 24 or below. The cognitive impairment was categorized into mild (MMSE-K 21-24) or moderate to severe (MMSE-K <21). For each participant, diagnoses for vascular risk factors were ascertained, and resting blood pressure and non-fasting blood glucose and serum cholesterol levels were examined. RESULTS: In the total sample, after adjustment for age, past occupation, physical activities of daily living and cholesterol levels, the worse cognitive function (MMSE-K <21) was associated with raised systolic blood pressure and the diagnosis of diabetes. However, the stratified analyses according to education level revealed that these associations were only significant in those with no formal education. In addition, the higher level of non-fasting blood glucose was significantly associated with the worse cognitive function only for those with no formal education CONCLUSION: Older Koreans with low levels of education may be particularly vulnerable to cognitive impairment associated with risk factors for cerebrovascular disease. This has an important implication for public health strategies regarding the prevention of dementia.