Comparative Analysis of Emotional Symptoms in Elderly Koreans with Hwa-Byung and Depression

OBJECTIVE: This study compared the symptomatic emotional traits of elderly South Korean patients with hwa-byung and those with depression. METHODS: We enrolled 58 patients with hwa-byung, 180 patients with depression, and 181 healthy control subjects. All participants completed the Hwa-byung Scale, Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS), State Trait Anger Expression Inventory (STAXI), Reaction Inventory (RI), and Aggression Questionnaire (AQ). Chi-square tests and a one-way analysis of variance with Games-Howell post-hoc tests were used to compare demographic variables and scores. RESULTS: A binary logistic regression analysis was used to examine risk factors for hwa-byung. Scores in the hwa-byung group were higher than those in the depression group for the HDRS; BDI; GDS; trait anger STAXI subscale (trait anger temperament and trait anger reaction); state anger and anger expression STAXI subscales (anger-in, anger-out, and anger control); physical and verbal aggression as well as anger and hostility AQ subscales; and disturbance, embarrassing circumstances, personal disrespect, and unpleasant encounters RI subscales. A binary logistic regression analysis demonstrated that the state anger STAXI subscale, verbal aggression and anger AQ subscales, and unpleasant encounters RI subscale were significantly associated with hwa-byung. CONCLUSION: Elderly patients with hwa-byung had more severe anger traits and states as well as higher depression severity compared to those diagnosed with clinical depression. Excessive anger and anger reactivity to unpleasant factors may be risk factors for hwa-byung, whereas the appropriate expression (rather than suppression) of anger may decrease the risk of hwa-byung.

Early Assessment of Delirium in Elderly Patients after Hip Surgery

OBJECTIVE: This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. METHODS: This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98) was used to assess prodromal symptoms daily before the onset of delirium. RESULTS: Almost 28% (n=18) of the 65 patients developed delirium after surgery. Delirium in elderly patients after hip surgery was observed more often in older patients and those with acute admission, hip fracture, higher APACHE III score, lower MMSE score, and higher CRP levels within early days after the operation. Sleep-wake cycle disturbances, thought process abnormalities, orientation, and long-term memory in symptom items of K-DRS-98 were showed significant difference on 4 days before delirium, lability of affect on 3 days before, perceptual disturbances and hallucination, and visuo-spatial ability on 2 days before, and delusion, motor agitation, and short-term memory on the day before the occurrence of delirium. CRP levels within 24 hours and 72 hours after hospitalization were significantly higher in the delirium group. CONCLUSION: Medical professionals must pay attention to behavioral, cognitive changes and risk factors in elderly patients undergoing hip surgery and to the prodromal phase of delirium. K-DRS-98 may help in identifying the prodromal symptoms of delirium in elderly patients after hip surgery.

Anger in Elderly Patients with Depressive Disorders

OBJECTIVE: This study was conducted to investigate anger in elderly patients with depressive disorders. METHODS: The subjects included 216 elderly patients with depression and 198 controls. All subjects were assessed by the State and Trait Anger Inventory (STAXI), Aggression Questionnaire (AQ), Reaction Inventory (RI). RESULTS: Elderly patients with depressive disorder showed lower levels of trait anger and anger expression on the STAXI, lower levels of verbal aggression and hostility on the AQ, and lower levels of anger reaction to the unpredictable disruption and disturbances factor, the embarrassing circumstances factor, and the personal disrespect factor on the RI than the controls. In the depression group, the severity of their depression was positively correlated with the trait anger, state anger, anger expression (except 'anger control') scores on the STAXI; the physical aggression, anger, and hostility scores on the AQ; and the anger reaction to unpredictable disruption and disturbances factor, the embarrassing circumstances factor, and the personal disrespect factor scores on the RI. However, the severity of depression negatively correlated with only anger control on the STAXI. In the linear logistic regression analysis, as there were higher levels of state anger seen in the STAXI, anger on the AQ, anger reaction to unpleasant factors on the RI, and therefore the likelihood of depression would be higher. CONCLUSION: Elderly depressive patients are less likely to have anger traits and to express anger than normal elderly. However, in elderly depressive patients, the higher they have severity of depressive symptoms, the higher they reported anger experience and anger expression.