Independent predictors of depressive symptoms and social isolation on 2-year all-cause mortality among the Korean elderly in a population-based cohort study: gender differences / 한국역학회지

OBJECTIVES@#This study examined whether depressive symptoms and social isolation were independent predictors of 2-year all-cause mortality among the elderly using data from a population-based cohort study. @*METHODS@#In total, 1,033 participants (320 men and 713 women) older than 60 years of age participated in this study. Depressive symptoms, social isolation status, and socio-demographic and health-related covariates were assessed at baseline. The primary outcome measure was 2-year all-cause mortality. Data were collected through in-person interviews by trained interviewers. The GENMOD procedure was used to calculate relative risks (RRs). @*RESULTS@#Of the 1,033 participants, 102 (40 men and 62 women) died within the follow-up period of 2 years. During the 2-year follow-up period, 17.8% of depressed men and 12.3% of depressed women died, and 29.8% of socially isolated men and 14.9% of socially isolated women died. Social isolation was an independent predictor of mortality in elderly men (adjusted relative risk [aRR], 4.6, 95% confidence interval [CI], 2.0 to 10.2), while depressive symptoms were an independent predictor of mortality in elderly women (aRR, 2.0; 95% CI, 1.2 to 3.6) when controlling for potential confounding factors. However, the depressive symptoms detected using the geriatric depression scale were not associated with mortality in men, and social isolation was not associated with mortality in women. @*CONCLUSIONS@#The effects of depressive symptoms and social isolation on 2-year all-cause mortality within an elderly population differed according to gender. Gender-specific community-based interventions must be developed to potentially reduce 2-year all-cause mortality among the elderly.

The Diagnostic Rate and Drug Use Trend of Attention DeficitHyperactivity Disorder Among Children and Adults in Korea Using the National Health Insurance Database / 신경정신의학

Objectives@#Attention deficit/hyperactivity disorder (ADHD) is a condition characterized by inattention or hyperactivity and impulsivity that hinders function and development. The purpose of this study was twofold, that is, to check the diagnostic rate of ADHD, which is first diagnosed in adulthood as well as in childhood, and to compare drugs prescribed to children and adult patients. @*Methods@#This study utilized Health Insurance Review & Assessment Service data from 1 January 2009 to 31 December 2018. Only first entered International Classification of Diseases diagnostic codes were collected. We set the first year as a clearance period, checked changes in drug prescriptions over the years, and investigated differences found between pediatric and adult patients. @*Results@#The overall diagnostic rate of ADHD decreased from 71.9 to 69.7 per 100000 people between 2009 and 2012. This reducing trend was noticeable from 2012 and decreased to 43.7 by 2015, and then rose again to 65.4 in 2018. Extended-release formulation of the methylphenidate (ER-MPH) was found to be the most frequently used first drug. @*Conclusion@#Overall diagnostic rate decreased from 2009 to 2018, and the incidence of adult ADHD showed a steady increase. For children, ER-MPH was the most prescribed drug at all ages, while osmotic-release oral system formulation of the methylphenidate was most prescribed for adults.

Clinical Characteristics in Panic Disorder Patients in Emergency Department / 정신신체의학

Objectives@#：This study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack. @*Methods@#：A retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher’s exact test was used. Collected data was analyzed using R 4.03. @*Results@#：Cardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (χ2 =4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (χ2 =8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%. @*Conclusions@#：The most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.

Prevalence and Risk Factors of Postpartum Depression in Provincial Area / 우울ㆍ조울병

Background@#Studies on prevalence and social variables affecting postpartum depression appear to be inconsistent. This study aimed to examine the prevalence of postpartum depression, as well as the correlation between education, offspring, age, and risk of the postpartum depression. @*Methods@#This study included 144 mothers living in Chungju who appeared to experience postpartum depression based on a score of >10 marks on the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Correlation and logistic regression analyses were used to calculate correlation coefficients and odds ratios (OR) for postpartum depression based on the education level of mothers and number of offspring. @*Results@#Prevalence of postpartum depression was found to be 29.17%. Age was not significantly correlated with EPDS score. EPDS scores tended to decrease with the increase in the number of education years (OR, 0.66); however, EPDS scores tended to increase with the increase in the number of offspring increased (OR, 1.65). @*Conclusion@#The result of this study demonstrates that education acts as a protective factor and number of offspring acts as a risk factor for postpartum depression. It also suggests that proper intervention in the mothers’ educational level and number of offspring is necessary.

Prevalence of Depressive Disorder among the Elderly Attending Community Health Center in a Small City / 신경정신의학

OBJECTIVES: This study was conducted in order to collect data regarding depressive disorder of elderly people at a community health center. METHODS: A total of 109 elderly people participated in this study. Trained examiners evaluated the general characteristics and symptoms of the subjects. Then the doctors conducted interviews with the elderly subjects in person and diagnosed depressive disorder according to the standard of Diagnostic and Statistical Manual of Mental Disorders-IV-TR. RESULTS: The prevalence of depressive disorder was 19.3%, major depressive disorder 10.1%, dysthymic disorder 1.8%, and others 7.3%. According to results of logistic regression analysis, in terms of demographic variables, the odds ratio of elementary school dropout compared with elementary school graduates was 3.60, after adjusting for age and sex. Thus, we found that elementary school dropout was associated with an increased risk of prevalence of depression. CONCLUSION: This is the first study of prevalence of depressive disorder in a primary health care center in Korea. Results of this study confirm that the prevalence of depressive disorder is two times higher among adults in the Chungju community. In addition, the level of education was also highly related. Examiners detected a possible relationship between sex and residence. The results will be helpful in conduct of future studies at the health care center.

Pathological Laughing and Crying: Pathophysiology and Treatment / 정신신체의학

Pathological laughing and crying(PLC) is a condition that is characterized by episodic, brief, contextually inappropriate, uncontrollable outbursts of laughing and/or crying. It can be observed in patients with various neurological disorders. PLC often causes distress in interpersonal functioning and activities for patients and their families. PLC can be recognized easily with proper understanding of the condition and its nature. Also it generally shows good response to various pharmacological treatments. This review aims to encourage the diagnosis and treatment of PLC by providing definition and clinical presentation of PLC, analysis of its pathophysiology and various current treatment options.

The Changes of Blood Glucose Control and Lipid Profiles after Short-Term Smoking Cessation in Healthy Males

OBJECTIVE: Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. METHODS: Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the beta-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). RESULTS: The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA beta-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). CONCLUSION: During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.

Neuropsychiatric Aspects of Traumatic Brain Injury: Symptoms and Pharmacotherapy / 대한정신약물학회지

Traumatic brain injury (TBI) is well recognized as a disability category with high incidence and prevalence as well as considerable impact on survivors and their families. Neuropsychiatric symptoms such as cognitive deficit, psychosis, depression, mania, anxiety are common after TBI. Treatment of the neuropsychiatric symptoms associated with TBI should result in decreased handicap, improved quality of life, and decreased societal impact. This article discusses the clinical approach to treating patients with neuropsychiatric complications following TBI.

An Association Between Apolipoprotein E epsilon4 and Cognitive Function in Community-Dwelling Elders with Questionable Dementia

OBJECTIVES: It was the aim of the present paper to examine the impact of the apolipoprotein E(APOE) epsilon4 on cognitive performance in community-dwelling elderly samples with'questionable dementia'. METHODS: Total 295 samples who were diagnosed with'questionable dementia'in the recent year and completed the Korean version of the Consortium Establish a Registry for Alzheimer's Disease(CERAD-K) neuropsychological assessment protocol, were recruited. The CDR test established score of 0.5. Genomic DNA was extracted from the venous blood and APOE genotyping was done in this group. Their cognitive performance was compared by the occurrence of the APOE epsilon4 allele. RESULTS: The impact of epsilon4 allele was significant in the Word List Recall Test(WLRT, F=4.511, df=1, p=0.035). The'young-old' group aged 75 years and under had a significantly lower performance on the Word List Recall Test(WLRT, F=5.090, df=1, p=0.015), but the'old-old'group over 75 years of age had not significantly different performance on the all the item of tests in epsilon4+ allele group. CONCLUSION: The conclusion to be drawn here is that community-dwelling elderly samples with epsilon4 allele in 'questionable dementia' had a significantly lower performance on the Word List Recall Test in the CERAD-K neuropsychological test batteries and the effect was prominent in the 'young-old' age group.

A Case of Catatonic Schizophrenia Associated With Proximal Interphalangeal Joint Flexion Contracture in Non-Dominant Hand / 신경정신의학

OBJECTIVES: Psychogenic contractures in the hand are a rare topic in the medical literature and psychoflexed hand is rarely mentioned even in orthopedic textbooks. By reporting a case with classic catatonic features of the catatonic type of schizophrenia associated with proximal interphalangeal joint flexion contracture in non-dominant hand, the existence of this rare and almost unknown entity is emphasized and the diagnostic and therapeutic importance facing the clinicians dealing with psychological related symptomatology is suggested. CASE: A 54-year-old, single, right-handed woman who lived alone presented to emergency department in catatonic stupor state, severe dehydration due to refusal of oral intake for about 15 days. She had received a diagnosis of schizophrenia, catatonic type at age 33 and had been hospitalized with catatonic motor and behavioral symptoms for a long time. She was hospitalized in medical intensive care unit and abnormal results of laboratory studies at admission including hypernatremia due to severe dehydration, prerenal azotemia, and hemoconcentration was corrected. Catatonia was confirmed by CRS Catatonia Rating Scale (CRS). Her catatonic and other psychotic symptoms began to resolve with treatment, but the patient was found to have had the psychogenic hand deformity characteristics of proximal interphalangeal joint flexion contractures of left 2nd, 3rd, 4th, 5th finger which started about 20 years ago. She allowed us to try to have a appropriate diagnostic evaluation but as she had experienced a full resolution of catatonic and other psychotic symptoms, she began to resist all the orthopedic treatments. She was discharged by caregiver's request because of economic problems. CONCLUSION: This case highlights the importance of having specific and systemized medical workups for catatonia of schizophrenia in order to prevent the sequelae of severe psychopatholgy such as flextion contractures and other potential complications.