A View of Korean Psychiatrists about Electroconvulsive Therapy / 신경정신의학

OBJECTIVES: Electroconvulsive therapy (ECT) is the important treatment method which has a good effect on refractory depression, schizophrenia at acute stage, patients with suicidal ideation. Although ECT results in better effects and less adverse effects in acute stage of illnesses as compared with pharmacotherapy, clinical implications are decreasing. Thus, authors surveyed a view of Korean psychiatrists about ECT to find whether there are prejudices and/or misconceptions for ECT. METHODS: Authors made survey questionaire for the attitudes of ECT, based on the APA task force 14, a clinical study in Korea, Hermann et al's report, and questioned Korean psychiatrists on their opinions for ECT through the internet E-mail, who are the members of Korean Neuropsychiatric Association (KNPA) serving in hospitals with psychiatric inpatient units. RESULTS: 122 psychiatrists answered to survey questionnaire. 89.4% have positive attitude about ECT. They thought that ECT has relatively safe and potent therapeutic effects, and less adverse effects. The rate of psychiatrists who have been no experience to perform ECT was 13.9% (n=16). Interestingly all of them had been trained serve in university hospitals now. The rate of psychiatrists who had experienced practicing ECT past but, not experienced within 2 years recently was 48.7% (n=56). While psychiatrists who have been no experience of ECT were more worried about adverse effects, doctors who experienced practicing ECT thought preferably the aspect of safety and potent effects of ECT. Psychiatrists who prefer psychotherapy were more likely to concern about adverse effect of ECT, but there were no differences in other aspects when compared with others. Most psychiatrists participated in this survey had positive attitudes about application of ECT to geriatric patients, but negative at child&adolescent patients. CONCLUSION: Authors recognized that many Korean psychiatrists agreed with performing ECT, and expected good results, but in reality, it is difficult to expect for them to perform ECT. Several factors may be associated for that: the changes in trend of psychiatric treatment, production of novel psychotropic drugs, researches trends which pharmacotherapy is prevailing in the fields of psychiatry, and problems of education, that is, lack of standard educational curriculums and systemic training course at residency for ECT.

Aspiration Pneumonia during Clozapine Therapy / 대한정신약물학회지

Authors experienced aspiration pneumonia during clozapine therapy in a 31 year-old woman patient with treatment-resistant schizophrenia. Development of aspiration pneumonia appeared to be related with side effects of clozapine including sedation, sialorrhea, and esophageal dysfunction. Each side effect seems to be mild, however it can cause fatal problems such as aspiration pneumonia if they appear simultaneously.

Stress Among Chinese, Korean-Chinese and Korean High School Students: A Transcultural Study / 신경정신의학

About 40% of patients suffering from postencephalitic or idiopathic parkinsonism experience distressing and ill-defined sensations. Antipsychotic-induced acute extrapyramidal syndromes (EFSs) share phenomenological, pharmacological, and biochemical characteristics with these parkinsonisms. Thus, it is conceivable that antipsychotic-induced acute EPSs may also be associated with primary sensory symptoms. The aim of this study was to test this hypothesis, first by examining the frequency and risk factors of primary sensory symptoms and then by contrasting the clinical characteristics in patients with or without antipsychotic-induced acute EFSs and in patients who did or did not report sensory symptoms. The study group comprised 107 patients who receiving antipsychotics. The authors used DSM-IV criteria and Yale Extrapyamidal Symptom Scale for acute EFSs and modified McGill Pain Questionnaire for sensory symptoms. The results were as follows: 1) Twenty-one(19.6%) of 107 patients receiving antipsychotics reported sensory symptoms. Among these 21 patients, 12(57.1%) reported paresthesia, 6(28.6%) reported pain, 3(14.3%) reported both. 2) fifteen(34%) of the 44 patients with antipsychotic-induced EFSs reported sensory symptoms, while only 6(9.5%) of the 63 patients without EFSs reported sensory symptoms(p<0.01). The severity of sensory symptoms was significantly correlated with the EPSs rating score(p=0.001). 3) In the patients with sensory symptoms, the women significantly outnumbered the men(p<0.05). Any risk factor of sensory symptoms, however, couldn't be found in age, diagnosis, and drug. The subjective response including sensory symptoms were associated with drug response, drug compliance, quality of life and prognosis. It is suggested that further systematic investigation and interest about sensory symptoms and subjective response of the acute EPSs should be needed.