Alteration of Brain-Derived Neurotrophic Factor Levels in Panic Disorder / 신경정신의학

OBJECTIVES: Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in neurogenesis and synaptic plasticity, has been implicated in the pathophysiology of several neuropsychiatric disorders. However, there have been no consistent findings regarding BDNF levels in panic disorder. In this study, we investigated plasma BDNF levels in panic disorder, and evaluated whether there is an association between plasma BDNF levels and severity of symptoms of panic disorder. METHODS: Plasma BDNF levels were measured in 110 panic disorder patients and 110 normal control subjects using the enzyme-linked immunosorbent assay. The severity of symptoms of panic disorder was determined using the Panic Disorder Severity Scale, Acute Panic Inventory, Agoraphobic Cognition Questionnaire, and Hamilton Anxiety Rating Scale. RESULTS: The mean plasma BDNF levels of patients with panic disorder were significantly lower compared with those of control subjects (192.50 pg/mL vs. 693.75 pg/mL). No significant association was observed between plasma BDNF levels and the severity of symptoms of panic disorder. CONCLUSION: These results suggest that BDNF may play a potential role in the pathophysiology of panic disorder.

Effects of Antidepressant Treatment on Sexual Arousal in Depressed Women: A Preliminary fMRI Study

OBJECTIVE: There was a recent study to explore the cerebral regions associated with sexual arousal in depressed women using functional magnetic resonance imaging (fMRI). The purpose of this neuroimaging study was to investigate the effects of antidepressant treatment on sexual arousal in depressed women. METHODS: Seven depressed women with sexual arousal dysfunction (mean age: 41.7+/-13.8, mean scores of the Beck Depression Inventory (BDI) and the 17-item Hamilton Rating Scale for Depression (HAMD-17): 35.6+/-7.1 and 34.9+/-3.1, respectively) and nine healthy women (mean age: 40.3+/-11.6) underwent fMRI before and after antidepressant treatment. The fMRI paradigm contrasted a 1 minute rest period viewing non-erotic film with 4 minutes of sexual stimulation viewing an erotic video film. Data were analyzed by SPM 2. The relative number of pixels activated in each period was used as an index of activation. All depressed women were treated with mirtazapine (mean dosage: 37.5 mg/day) for 8 to 10 weeks. RESULTS: Levels of brain activity during sexual arousal in depressed women significantly increased with antidepressant treatment (p<0.05) in the regions of the hypothalamus (3.0% to 11.2%), septal area (8.6% to 27.8%) and parahippocampal gyrus (5.8% to 14.6%). Self-reported sexual arousal during visual sexual stimulation also significantly increased post-treatment, and severity of depressive symptoms improved, as measured by the BDI and HAMD-17 (p<0.05). CONCLUSION: These results show that sexual arousal dysfunction of depressed women may improve after treatment of depression, and that this improvement is associated with increased activation of the hypothalamus, septal area, and parahippocampal gyrus during sexual arousal.

The Stress Coping Strategies and Psychological Characteristics in Patients with Somatization Disorder / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the stress coping strategies and psychological characteristics, such as combined psychopathology and tendency of symptom interpretation, in patients with somatization disorder. METHODS: Thirty patients meeting the criteria of DSM-IV somatization disorder were compared with thirty controls. We evaluated the subjects using Symptom Checklist-90-Revised (SCL-90-R), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and The Ways of Stress Coping Questionnaire (SCQ). Independent t-test and Pearson correlation analysis were used. RESULTS: From the results of SCL-90-R subscales, the scores of somatization, obsession-compulsion, depression, anxiety, and psychoticism were significantly higher in patients with somatization disorder than normal controls. Somatization disorder patients had greater amplification of physical sensation in SSAS and significantly higher score in physical interpretation of SIQ compared with psychological or environmental interpretation. In the SCQ of somatization disorder patients, we observed generally lower levels of total coping scores than the control group and significant positive correlation between passive coping style of SCQ and psychological interpretation of SIQ. CONCLUSION: These results show that patients with somatization disorder have various psychopathology, greater amplification of physical sensation, physical interpretation tendency of symptoms, and insufficient copying strategy.

Functional MR Imaging of Psychogenic Amnesia: A Case Report

We present here a case in which functional MR imaging (fMRI) was done for a patient who developed retrograde psychogenic amnesia for a four year period of her life history after a severe stressful event. We performed the fMRI study for a face recognition task using stimulation with three kinds of face photographs: recognizable familiar faces, unrecognizable friends' faces due to the psychogenic amnesia, and unfamiliar control faces. Different activation patterns between the recognizable faces and unrecognizable faces were found in the limbic area, and especially in the amygdala and hippocampus.

Comparison of Sleep Disturbance in Patients Treated with Hemodialysis, Peritoneal Dialysis and Renal Transplantation / 대한신장학회잡지

BACKGROUND: We investigated a group of patients with chronic renal failure to evaluate the prevalence and the risk factor related to sleep disturbance. We also studied to explore relationship between sleep disturbance and renal replacement therapy of chronic renal failure such as hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (RT). METHODS: The patients with 43 HD patients, 52 PD patients, and 32 RT patients completed a self- administered questionnaire package, which included Weekly Sleep Questionnaire (WSQ) and Beck's Depression Inventory (BDI). RESULTS: About 75% of chronic renal failure patients have sleep disturbance. There was difference of morning dissatisfaction feeling item score between HD and RT (pRT) groups and of daytime sedation item score among PD, HD and RT (pRT, PDRT) groups. The BDI (beta= 0.546) and the serum creatinine (beta=0.221) were significantly positive correlated with WSQ total score, but other factors (modalities of renal replacement therapy, duration of illness, duration of dialysis, Bood urea nitrogen, hematocrit, Body mass index) were not correlated with WSQ total score. CONCLUSION: Sleep disturbance is common in chronic renal failure patients. There was significant difference of daytime sleep disturbance among renal replacement therapy groups. It was caused by difference of emotional state and physical states.

Factors Affecting Stigma of Schizophrenic Patient / 신경정신의학

OBJECTIVES: Stigma of schizophrenic patient has a negative effect on the social adaptation of patients to return to society after proper treatment. This study showed the factors affecting the stigma recognized by schizophrenic patient and utilized them as the basic materials to overcome such stigma effectively. SUBJECTS AND METHOD: Total number of subjects were 318, including 278 patients who receive treatment of schizophrenia in NaJu National Hospital and 40 patients of Chonam University Hospital. The evaluation instrument of the stigma refers to 'Wording of Items in the Stigma Scale' developed by Bruce Link, translated into Korean and revised into 20 items after getting through preliminary study. It was consisted of three subscales including secret, prejudice and devaluation. Authors examined the subjects' demographical characteristics, clinical variables and degree of depression through Beck Depression Inventory. Observed were the correlation between these factors and the degree of stigma to understand the factors affecting the degree of stigma. RESULTS: This study showed that there was a significant differences in the degree of stigma according to occupation, degree of family support felt by patients, frequency of family visits and level of depression. In the degree of stigma according to occupation, students, farmers and the unemployee showed relatively higher stigma than professional technicians, especially in devaluation scale. The degree of family support felt by patients and frequency of family visits were reversely correlated with the degree of stigma. The level of depression was correlated with the degree of stigma. There is no significant difference in the degree of the whole stigma, but there is a significant difference in subscales according to the experiences of participation in disease education and treatment in hospitals. Patients who received no psychoeducation showed high scores in secret scale and patients of NaJu National Hospital had higher prejudice than patients of Chonam University Hospital. Such factors as sex, age, education, marital status, religion, residence, family economic status, frequency of hospitalization, experience of open ward, recent regular treatment and duration of illness did not show significant correlations with the degree of stigma. CONCLUSIONS: It is found that family support, regular occupation and frequent patient visits can be factors decreasing the stigma. Psychoeducation about mental illness is related to the reducing the tendency to hide the disease. In addition, coping with derpession can be helpful to reduce the stigma of patients and effective social adaptation.

The Effect of Psychotherapy: Does It Represent Itself in Emotional Growth? / 신경정신의학

The author reviewed the relationship between psychotherapy and ego growth from psychoanalytic point of view. The effect of psychotherapy represents itself in ego growth. To illustrate this claim, the author reviewed Freud's concept on the effect of psychotherapy first and the concepts discussed in literatures after Freud. The main stance of this paper is that the effect of psychotherapy manifests itself in ego growth through therapeutic relationships. The author deduced that since the major part of the therapeutic process takes place unconsciously, one is unaware of his/her ego growth. Through psychotherapy, the immature part of the personality, which stoped growing in the course of development, starts to grow. It may be the ego growth either through gaining insight or the growth derived from the therapeutic relationship with the analyst. Mental illness can be looked upon as the loss of human nature, and the remedy lies in recovering the human nature. The lost human nature is recovered when one is in a therapeutic environment, that is very much maternal in nature. Psychotherapy may result in some changes in brain physiology or neurochemistry. It may take some time to bring about anatomical changes of the brain. If this assumption is correct that psychotherapy inflicts anatomical changes of the brain for it's positive effects, it should be accomplished through a long period of working-through of the problem. Some studies on this theme of neurophysiology and anatomical research are already in process and I hope to be able to explain the processes of psychotherapy in the near future.

The Analysis of Newspaper-Articles on Psychosis / 신경정신의학

OBJECT: Social stigma and prejudice against schizophrenia hinder the prevention of the disease, early treatment and social rehabilitation. This stigma and the negative viewpoint against schizophrenia are enhanced by the mass media. This study investigated newspaper articles on psychosis, which strongly influence the public recognition of the illness. METHOD: The newspaper articles of Dong-A Ilbo and Chosun Ilbo from March 1998 to February 2000 were reviewed through a news-searching program in Chollian. The search words, which were regarded as psychotic illness, were Schizophrenia, Psychosis, Mental illness, and Mental derangement. A total of 326 articles were classified by category and analyzed quantitatively and qualitatively. The viewpoint of articles on psychosis consisted of these: (1) negative (direct or indirect) (2) neutral or positive (3) no specific viewpoint. RESULT: Of the 326 articles, the number with a negative description was 228 (69.9%), the number with a neutral or positive description was 43 (13.2%), and the number with no specific viewpoint was 55 (16.9%). The most frequent negative theme was psychotic patients are dangerous or violent or may commit a crime (n=118). Other negative themes were these: psychotic patients are bizarre or grotesque (n=27), psychotic patients can't function in society well(n=18), psychosis is incurable and families should bear great burden(n=16), psychosis is shameful (n=13) and psychotic patients should be institutionalized(n=6). There were also prejudices against the cause of the illness(n=18), the description of psychosis in degrading terms(n=22) and the negative description of psychiatric hospitalization(n=18) with the words such as institutionalization, imprisonment and put into etc. In the articles using the terms mental derangement or psychosis compared with mental illness, schizophrenia and in the articles describing psychotic patient compared with illness itself, the frequency of negative articles was high. Within each type of article, news, politics and culture articles more frequently had a negative description, while health articles less frequently had a negative description and most frequently had a neutral or positive description. CONCLUSION: There should be a program for monitoring newspapers for appropriate in-formation on psychosis. It might reduce social stigma and consequently help rehabilitation of psychotic patients. Also there should be endeavors to monitor other mass media and to develop a public education campaign through the mass media.

Relationship between Clothing Behavior & Depressive Mood / 신경정신의학

OBJECTIVE: The dressing is the basic human need and daily activity. Clothing have the function of self expression as well as self protection. The clothing behavior is closely related to psychic world and one's emotion. The aim of this study was to investigate the relationship between clothing behavior as daily activity and depressive mood as popular human emotion. METHOD: Outpatients with depressive disorder (N =88) were selected among those visiting Chonnam National University hospital. Those who had been diagnosed as depressive disorder and treated were selected by reviewing of medical records. Questionnaires for clothing behavior were initially selected from previous studies and finally 25 questions were chosen through preliminary study. Depressive symptom scales were rated by Beck Depressive Inventory (BDI). We compared the two groups divided by BDI score of 16 on 5 variable elements about clothing behavior and evaluated correlation between depressive mood and clothing behavior. RESULTS: The psychologic dependency and clothing satisfaction were related to depression. The psychologic dependency was defined as appropriate clothing behavior relieving depressive mood, but unsatisfying clothing makes one humble, so one's dressing is affected by one's mood. This psychologic dependency was high in depressive group and had positive correlation with severity of depressive symptoms. The clothing satisfaction defined as satisfaction about clothes, clothing selection and clothed self image was reversely related with severity of depressive symptoms. CONCLUSION: We found that depressive men had unsatisfying clothing behavior as they had diminished satisfaction about self and feelings of worthlessness. And the clothing behavior functions as reaction formation about depression to overcome inner depressive and empty state in depressive one. These results, on the relationship between clothing behavior and depressive mood provide the need and possibility about therapeutic meaning of clothing for depressive people.

Quality of Life Measure for Patients with Skin Diseases: Vitiligo and Psoriasis / 대한피부과학회지

BACKGROUND: In recent times, it has been gradually emphasized that an aspect of diseases impacting on the quality of an individuals life goes beyond physical impairments with the development of economic and medical technology. Skin diseases especially may be associated with a variety of negative psychologic effects, such as low self-esteem, feelings of inferiority because skin lesions are exposed to others and cause cosmetic problems. Many researchers have been already established various dermatology-specific questionnaires and disease-specific questionnaires in developed countries, but these are rare in Korea. OBJECTIVE: We tried to survey the social, psychological and physical aspects of patients with vitiligo and psoriasis to evaluate the impact of skin diseases on the quality of life in Korea. METHODS: We inquired after 64 patients by using a dermatology-specific questionnaires Skindex recently developed by Chren et al. It has 6I-items and eight scales including cognitive, social, depression, fear, embarrassment, anger, physieal discomfort, and physical limitatians.

Psychology of Intentive Care Unit Staffs / 대한구급학회지

No abstract available.

Infidelity: Its Psychoanalytic and Evolutionary Parspectives / 신경정신의학

Erich Fromm said, "A man is fundamentally a lonely being, and he needs love to overcome the loneliness and the sense of emptiness." Marriage offers a resting place for the lonely man or woman, and satisfies a variety of their needs. Marriage is an arrangement where two sexually mature human beings live together because they love each other. It is a loving relationship which is established between the mature man and woman, who have formed their own identities and could understand each other. Infidelity is a mental disorder, which destroys the marital relationship, as well as one's mental health. This paper investigates the causes of infidelity from the evolutionary and psychoanalytic perspectives. Evolutionary psychology explains infidelity as a natural phenominon. A man commits infidelity according to his instinct for spreading his genes as much as possible, while a woman behaves according to her gene's design to receive a more superior gene, in order to produce a more superior offspring. The psychoanalytic approach explains infidelity as a phenomenon which occurs when one's identity lacks an ability to sublimate libido:an unresolved Oedipus complex could also be the cause. The Maria-Prostitute complex and the Don Juan character are presented as examples to illustrate these theories. As for the sex addicts who often weren't loved in their infantile life, they commit infidelity compulsively by confusing the sexual act with mother-like caring. The psychology of a person who tries to enact the primal scene by engaging a sexual act with a prostitute is presented. Someone who is often affected by depression and helplessness due to harsh superego tries to heal themselves by sexual stimulation. Infidelitys's influence on the partner is exaggerated by the parther's inner coflict. In the end, methods to overcome infidelity are investigated. Human instincts are not at all moral. To realize this fact is the first step to maintain one's married life without any infidelity problems.

The Effects of Achievement Self Discrepancy and Evaluative Threat Stress on Performance Anxiety / 신경정신의학

OBJECTIVES: The purpose of this study to examine if the levels of anxiety(emotional, cognitive, and behavioral measures) during performance are influenced by interaction of both achievement related self discrepancy(=psychological vulnerability variable) and evaluative threat stress(=stressor) based on vulnerabilitystress model in order to identify the mechanism of development of performance anxiety and furthermore to suggest psychological intervention strategies to reduce and prevent it effectively. METHOD: High and low self discrepancy subjects consisted of students from the upper(n=40) and lower 15%(n=40) on achievement related self discrepancy scale, respectively. They were randomly assigned to either evaluative threat condition or neutral condition, and then all subjects took intellective task(verbal reasoning test and digit symbol test). RESULTS: The results were as follows; 1) High self discrepancy subjects under evaluative threat reported significantly higher level of state anxiety during performance than low self discrepancy subjects under any condition and also experienced higher degreee of state anxiety with marginal significance than high self discrepancy subjects under neutral condition, whereas there were no significant effects on the anxiety level of group variable under neutral condition or of stress variable in low self discrepancy subjects. 2) High self discrepancy subjects reported more cognitive interference during performance than low self discrepancy subjects regardless of the level of stress. 3) High self discrepancy subjects performed marginally significantly more poorly in digit symbol test than low self discrepancy subjects regardless of the level of stress, whereas there were no significant effects on verbal reasoning test. CONCLUSION: The hypothesis that performance anxiety could be affected by achievement related self discrepancy and stress, and specially by interaction between self discrepancy and stress was relatively strongly supported by the results on emotional measure of performance anxiety. In addition, this hypothesis received partial support by the results on cognitive and behavioral measures. We might conclude that it is important to consider achievement-related self discrepancy and evaluative threat stress together to understand the mechanism of development of performance anxiety and to reduce or prevent this anxiety effectively.

Doctor-Patient Relationship in the Movies

No abstract available.

Two Successful Cases of PJ Rigid Gas Permealble Contact Lens after Myopic Excimer Laser Photorefractive Keratectomy

To improve visual acuity of patients with myopic regression and corneal haze after myopic excimer laser photorefractive keratectomy(PRK), rigid gas permeable(RGP) lens have been recommended. however, spherical RGP lenses cause problems in some cases. We experienced two patients who had some problems with a spherical RGP lens after PRK, but recovered with PJ lens(Park and Joo type RGP lsens) with two base curves of optical zone depending on native patient's keratometric readings. We examined weekly and a corneal topography monthly. Some problems like superficial punctate erosion and corneal molding by spherical RGP lens were disappeared and central corneas regained their original figures and became to be spherical with the more desirable curvature 3 months after PJ lens fitting. Additionally, there was no complication. With these results, we suggest that PJ lens, newly designed RGP lens, can be a choice of RGP lens to improve a corrected visual acuity without complication in case of the patients performed myopic refractive surgery like PRK.

A Preliminary Study on Korean version of the SmithKline Beecham Quality of Life Scale(KvSBQOL) / 신경정신의학

OBJECTIVES: The SmithKline Beecham' Quality of Life's scale(SBQOL) by Dunbar et at. was developed in an attempt to produce a valid scale which would be justice to the complexity of human experience which constitutes perceived Quality of life. This study was attempted to verify the reliability and validity of the Korean version of SBQOL(KvSBQOL). METHODS: KvSBQOL was administered to 377 university students. Subjects were asked to rate the same 23 items in the aspect of three states, i.e., 'self now'-as they felt at present: 'ideal self-how they would feel as their ideal person: 'sick self-how they would feel as a person who is sick or unwell. The distribution and the differences of KvSBQOL for three mental sets, as well as the split-half reliability, test-retest reliability, and internal consistency for the self now were assessed. For the evaluation of concurrent validity, the Stress Questionnaire(SQ) and Eysenck's Personality Questionnaire(EPQ) were employed as the external criterion. Construct validity was assessed by examining the relationship between the inter-element differences and the scores of other scales: Somatization(SOM) of SCL-90-R(Symptom Checklist-90-Revision), Beck Depression Inventory(BDI), Stait-Trait Anxiety Inventory(STAI) and Internal-External Control Scale(I-E Scale). And then, common factor analyses with varimax rotation and multiple regression analyses were carried out. RESULTS: The element score of self-now was normally distributed, that of ideal self was significantly negatively skewed, and that of sick self was significantly positively skewed. The significant inter-element differences(ideal self/self now, ideal self/sick self, self now/sick self) were found. The split-half reliability(.83), test-retest reliability(.84), and internal consistency(Cronbach alpha, .898) were found to be high. The inter-element distance(ideal self and self now) of the KvSBQOL score was positively correlated with the SQ score and neuroticism score of EPQ, while negatively correlated with extroversion score of EPQ. The inter-element distance showed significant correlations with SOM of SCL-90-R, BDI, STAI, 1-E Scale scores. Factor analysis of 23 items resulted in a five factor solution accounting for 34.24% of total explained variance. The five factors were interpreted as competence, psychological well-being, stability, physical well-being, and activity. The severity of somatization, depression, anxiety and external control contributed to five factors of KvSBQOL. CONCLUSIONS: These findings confirmed the high reliability and validity of KvSBQOL and suggest the possibility that KvSBQOL could be a useful measure of QOL in patients with psychiatric disorders.

The Oedipus Complex in Traditional Korean Society: Oedipal and Preoedipal Themes / 신경정신의학

OBJECTIVES: Freud said that the Oedipus complex is universal. Some psychiatrists in Korea have tried to discover the presence of an Oedipus complex in their traditional society. They have identified evidence of sons' wish to kill the Oedipal Father and their desire for incest with mother. Therefore, the author not only puts forth a variety of evidence for the Oedipus complex, but also lays an emphasis on other aspects of the principle(Oedipal theme, preoedipal theme, etc.) by investigating new information in Korean society. METHODS: The authors looked into myths, shaman's folksongs, legends, butcher's folktales, folk drama, filial piety, and traditional family structures. The authors reestimated them from a calssical psychoanalytic point of view. RESULTS: The authors found castration anxiety, the desire for incest, identification with parents, and the dissolution of the Oedipus complex as the Oedipal theme. And the authors discovered dyadic realtionship, 'anal phallus', negative Oedipus complex, and the desire of being in fusion with primary object as the preoedipal theme. CONCLUSIONS: The authors found many themes and factors connected to Oedipus complex influencing our culture and life. Therefore, the authors believe that there is an Oedipus complex in traditional Korean society.

The Relation of Mood Disorder to Season of Birth / 신경정신의학

To examine the relation of mood disorder to season of birth, we analyzed the data of 156 male and female mood disorder patients who were admitted to or visited NaJu National Mental Hospital from March 1997 to June 1997. The results of this study were as follows: 1) There was a significant difference of birth season distribution in patients with mood disorder compared with that of geneal population. We suggest that birth seasonal factors have influence on onset of mood disorder. 2) High onset rate in spring was noted in patients with mood disorders. Winter-born patients had a significantly low onset rate in autumn, and autumn-born patients had a significantly low onset rate in winter. The results suggest that seasonal factors affecting onset of schizophrenia are associated with onset of mood disorder. Further studies should follow to find out concrete and objective relation of mood disorder to season of birth.

Comparison of ego defense mechanisms in the patients with schizophrenic disorders, mood disorders, and neurotic disorders / 신경정신의학

No abstract available.