The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

OBJECTIVE: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. METHODS: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). RESULTS: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. CONCLUSION: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

A Measurement of the Frontal Sinus Ostium Using the Sagittal Images of Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic management of frontal sinus disease remains a difficult task. In order to minimize the risk of intracranial complication, easily identifiable landmarks and measurements should be required. This study aims to identify standard distances from the columella to the anterior and posterior borders of the frontal sinus ostium in Korean men and women. SUBJECTS AND METHOD: We obtained the sagittal images taken from 30 men and 30 women. Measurements from the columella to the nasofrontal beak (NFB) and anterior skull base (ASB) were made. Also, the angle between the lines of the columella to the ASB and hard palate was measured. RESULTS: The mean distance from the columella to the NFB was 55.3+/-3.9 mm in men and 52.1+/-4.7 mm in women (p0.05). CONCLUSION: This study suggests sinus surgeons to stay a distance from the columella of less than 57.6 mm in men and 54.3 mm in women to minimize skull base injury.

A Measurement of the Frontal Sinus Depth of Korean Adults Using The Axial Images of Computed Tomography

BACKGROUND AND OBJECTIVES: Frontal sinus trephination requires understanding of frontal sinus anatomy. This study aims to identify frontal sinus depth (FSD) and bone thickness of its anterior table (FBT) using the axial images of paranasal computed tomography (CT) scans. SUBJECTS AND METHODS: We obtained the axial images taken from 30 men and 30 women. FSD and FBT were estimated at points 5, 10, and 15 mm from the midline (the straight line passing through the crista galli) on each side using the axial CT images. RESULTS: The mean male FSDs at 5, 10, and 15 mm from midline were 11.08+/-1.92, 11.38+/-2.08, and 11.49+/-2.27 mm, respectively; mean female FSDs were 8.23+/-1.38, 8.47+/-1.65, and 8.87+/-1.76 mm, respectively. Men had significantly larger FSDs than women did at all measurement points (p 0.05). CONCLUSION: These data provide the information about the frontal sinus in Korean adults.

Congenital Intratympanic Membrane Cholesteatoma: Report of Three Cases and Review of the Literature / 대한이비인후과학회지

Congenital intratympanic membrane cholesteatomas (ITMCs) are very rare. We present 3 cases of congenital ITMCs. In the first case, there was a small keratin pearl in the center of the tympanic membrane. In the other cases, cholesteatomas were found in the periphery. In all cases, cholesteatomas were confined to the space between the outer epithelial layer and the middle fibrous layer. The pathogenesis of this rare disease and the natural history are not well known. In some reported cases, it grows and invades into the middle ear. However, in the present study, the lateral growing of the ITMC was observed in one of the three cases. Furthermore, it naturally grew outward and finally moved to the external auditory canal. Careful periodic observation should be considered for alternative treatments. We present three different cases of ITMC with a review of the literature.

Five Years Follow-Up of Posttraumatic and Postviral Olfactory Disorders and Analysis of Quality of Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Posttraumatic olfactory disorder is an olfactory loss following head trauma and postviral olfactory disorder is an olfactory loss following an upper respiratory infection, with symptoms often being demonstrating less interest in eating and exhibiting emotional impairment. As there is a lack of research regarding the long-term recovery rate of olfactory disorders, this study aims to determine that of both olfactory disorders and describe the quality of life (QOL) in the patients. SUBJECTS AND METHOD: Olfactory recovery was investigated in the first and recent visits (minimal 5 years follow-up) of 18 posttraumatic olfactory disorder patients and 14 postviral olfactory disorder patients. A total of 32 patients completed 6 items of QOL questionnaire ranging from 0 to 10. RESULTS: Five (27%) of the 18 posttraumatic olfactory disorder patients showed olfactory improvement. Nine (64%) of 14 postviral olfactory disorder patients showed olfactory improvement. The mean overall rating of QOL was increased according to the severity of olfactory impairment (p<0.001). CONCLUSION: The long-term follow-up may be important to assess the olfactory disorder patients. The quality of life such as eating habits, depressive mood, and safety issues may be altered in the olfactory disorder patients.

The Usefulness as a Specific Marker of Blood and Nasal Lavage Fluid YKL-40 in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chitin is a recognition element for tissue infiltration by innate cells implicated in allergy and asthma. Chitinases are characterized by the ability to cleave chitin. YKL-40, the chitinase-like protein, was increased during Th2-type inflammation in an exaggerated manner in tissues of patients with asthma. However, the relationship of YKL-40 level to allergic rhinitis has not been evaluated. Hence, we evaluated the relationship between the YKL-40 level in the blood and nasal lavage fluid and allergic inflammation in nasal cavity. We also evaluated the nature of association between several important factors (eosinophil count and total IgE) in the blood and nasal lavage fluid of allergic rhinitis patients. SUBJECTS AND METHOD: The concentrations of the YKL-40 levels in the blood and nasal lavage fluid were compared between allergic rhinitis patients and healthy controls. We evaluated the YKL-40 levels in the blood and nasal lavage fluid and also evaluated symptom severity, eosinophil count, and total IgE. RESULTS: The blood YKL-40 level was not significantly increased in allergic rhinitis (49 pg/mL) than in control (44 pg/mL)(p>0.05). The YKL-40 levels in the nasal lavage fluid was not significantly increased in allergic rhinitis (1568 pg/mL) than in control (1248 pg/mL)(p>0.05). The YKL-40 levels in blood and nasal lavage fluid were not associated with important factors such as symptom severity, eosinophil count, and total IgE in allergic rhinitis patients. CONCLUSION: There is no association between the YKL-40 level in the blood and nasal lavage fluid, allergic inflammation in nasal cavity.

Prevalence of Late Effects by Designed Health Promotion Program in Long-term Survivors of Childhood Cancer / 임상소아혈액종양

BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP). METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence. RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire. CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.

Extramedullary Plasmacytoma of the Lacrimal Sac and Duct Invading the Inferior Meatus : An Extremely Rare Occurrence

Extramedullary plasmacytoma (EMP) is a rare malignant plasma cell tumor. EMPs originate outside the bone marrow, particularly in the head and neck region, and can be associated with multiple myelomas. Radiotherapy is considered the treatment of choice, since surgery is limited to biopsy and excision of the residual tumor tissue. The authors report a case of a patient presenting with a history of chronic epiphora and a palpable mass in the medial canthal area, who was found to have an EMP of the lacrimal sac and duct invading the inferior meatus.

Prevalence of Late Effects by Designed Health Promotion Program in Long-term Survivors of Childhood Cancer / 임상소아혈액종양

BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP).METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence.RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire.CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.

A Case of Septochoanal Polyp

Septochoanal polyp is a rare entity in the nasal septum. This type of polyp can extend into the choana to cause nasal obstruction and snoring, similar to the symptoms of an antrochoanal polyp. Septochoanal polyps may therefore be confused with antrochoanal polyps because of their similar appearances. The authors report a case of a seven-year-old boy who was diagnosed with a septochoanal polyp. The patient was successfully treated via an endoscopic surgical approach.

Association between Obsessive-Compulsive Disorder and Dopamine Receptor D4 Gene / 대한정신약물학회지

OBJECTIVE: The definite causes of obsessive-compulsive disorder (OCD) are still unknown. Evidences from familial, twin and segregation studies support the role of a genetic component in the etiology of OCD. There are growing evidences that OCD has specific neurochemical and neuroanatomical basis. It has been shown that serotonergic neurons play the predominant pathophysiological role in OCD. Recently, it has also been proposed that neurotransmitters other than serotonin play a role in the pathophysiology of OCD, and a series of studies have provided evidence that dopamine is involved in some OCD patients. Therefore, the aims of this study were to investigate the association between dopamine receptor D4 (DRD4) and OCD. METHODS: One hundred and fifteen OCD patients and 160 normal controls participated in this study. Genomic DNA was extracted from their blood. The genotypes and allele frequencies of the DRD4 polymorphism between OCD group and control group were compared. OCD patients were classified into early onset group (age of onset or =17) according to their onset age and the genotype and allele frequency were compared between two groups. Using principal component analysis, we had already derived 4 factors from 13 main contents of YBOCS checklist in the previous study and in this study, we investigated the association between these three factors and DRD4 genotypes. RESULTS: In this case-control study, we could find that the L-genotype frequencies of DRD4 were significantly higher in OCD than in normal control groups (chi2 test, p=0.04). There were no difference in genotype frequencies between early onset OCD group and late onset OCD group. In OCD group, patients with L-genotype had higher scores for the religious/somatic factor than the other groups (t test, p=0.009). CONCLUSIONS: The L-genotype of DRD4 may have negative effects on the development of OCD and religious/somatic factor of the obsessive-compulsive symptoms.

Clinical Analysis of Abdominal Actinomycosis: 8 Cases

PURPOSE: Actinomycosis is still a relatively rare infection, characterized by multiple abscesses, draining sinuses and the appearance of sulfur granules, which are valuable in aiding the diagnosing the discharge of involved tissues. In most instances, the onset of an abdominal disease is preceded by inflammatory or a traumatic incident resulting in the perforation of the mucosa of the gastrointestinal tract. Intensive and prolonged antimicrobial therapy, and wide surgical excision of involved tissues are the two general principles of therapy. METHODS: We experienced 8 cases of abdominal actinomycosis after a laparotomy between March 1997 and February 2002. RESULTS: The results were as follows: 1) There was a 1: 1 male to female ratio of abdominal actinomycosis, and a mean age of 47 years. 2) The clinical features were different for each involved organ, -but, most of the clinical symptoms were nonspecific to suspect actinomycosis. 3) The frequently involved organs were mainly located lower abdomen, such as the appendix and cecum, sigmoid colon and small bowel. 4) In 60% of the patients, the predisposing factors were identifiable, these being: a previous abdominal operation, IUD and abdominal injury. 5) The preoperative diagnoses included: acute appendicitis, and periappendiceal and intra-abdominal abscesses. The pre-exploratory diagnoses were made by ultrasound and abdominal CT. 6) Explorations were performed in all patients, depending on their diagnosis, to afford the proper surgical treatment and correct diagnosis. After the operation, all the patients were treated with oral antibiotics for long period. CONCLUSION: The authors conclude that pre-exploratory cytological or culture studies, with careful history taking, for low abdominal tumors or abscesses may increase the rate of correct diagnosis, as could proper explorations.

Quality of Life in Patients with Panic Disorder / 신경정신의학

OBJECTIVES: Panic disorder is a chronic condition that may carry significant negative impact on the quality of life in patients. However, the association between quality of life in panic patients and their clinical characteristics has not been investigated. Aim of this study is to compare quality of life in panic patients and healthy controls by using WHO Quality of Life(QOL) Scale that evaluates the domains of physical health, psychological health, social relationship and environment. Additionally, relationship between clinical factors in patients with panic disorders and their quality of life were explored. METHOD: 64 patients with panic disorder and 27 healthy controls were recruited in this study and WHO QOL Scales were completed. Total scores and scores of domains of WHO QOL Scale in two groups were compared. Correlation analysis and multiple regression analysis were performed to examine the relationship between quality of life and the clinical characteristics in patients with panic disorder. RESULTS: Total scores and scores of all domains except environmental domain of WHO QOL scale in patients with panic disorder were decreased compared to those in healthy controls. Clinical characteristics including the severity of agoraphobia and depression, number of symptoms during panic attacks and the frequency of panic attacks showed significant correlation with quality of life in general and most of subscales of QOL. Multiple regression revealed that the severity of depression, the number of symptoms during panic attacks and the severity of agoraphobia in the presence of accompanied persons were factors directly affecting the quality of life in the patients with panic disorder. CONCLUSION: Quality of life in patients with panic disorder was poorer than that of healthy controls. The severity of depression, the number of symptoms during panic attacks and the severity of agoraphobia in the presence of accompany were related to the quality of life in the patients with panic disorder.

Neuropsychological Functioning and Dimensions of Symptoms in Schizophrenia / 대한정신약물학회지

OBJECTIVES: On the basis of the relationship between positron emission tomography and symptom profiles in schizophrenia by Liddle et al, the authors attempted to investigate the related brain regions associated with clinical symptoms by studying the correlations between the performance of neuro-psychological tests likely to reflect functioning of dorsolateral preftontal, orbitofiontal or cingulate, parietal, and temporal cortices and 3 dimensions (psychotic or reality distortion, negative, and disorganization) of symptoms. METHODS: 41 subjects with a confirmed diagnosis of schizophrenia were scored for each of the three dimensions by Positive and Negative Syndrome Scale. Subjects performed 12 neuropsychological tests designed to measure impairment in specific areas of the brain. RESULTS: According to partial co-rrelations to remove possible confounding variables, the neuropsychological correlates of psychotic(reality distortion) and disorganization dimensions were some tests considered to be related to dorsolateral prefrontal and parietal lobes, and cingulate and dorsolateral preliontal cortices, respectively. CONCLUSION: The results support a part of hypotheses, a specific relation between disorganization and cingulate cortex. In addition our results suggest the possibile relations between a psychotic dimension and functions of dorsolateral prefrontal and parietal lobes, and between a disorganization one and functions of cingulate and dorsolateral prefrontal cortices. The authors believe that our study supports different neural circuits associated with each of dimensions of symptoms, particularly psychotic and disorganization, in schizophrenia.

Effects of Integrated Psychological Therapy for Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study, as a preliminary one attempting to develop the Korean version of Integrated Therapy for the rehabilitation of schizophrenic patients, was designed to investigate the results of Integrated Psychological Therapy(IPT) and review the problems during the program application. METHODS: Cognitive Differentiation Scale, Problem-Solving Scale, and PANSS(Positive And Negative Syndrome Scale) were administered to schizophrenic inpatients before and after IPT incorporating cognitive differentiation, social perception, verbal communication, social skill and interpersonal problem-solving skill subprograms. The therapy groups were offered activities three times per week during the 12-week program. The control groups were attention-placebo groups for control ling factors such as group interaction and social attention, and were offered psychoeducation. RESULTS: The 12-week IPT groups, compared with the control groups, demonstrated significant improvements in the general psychopathology and the total symptoms of PANSS, but did not in cognitive functions and problem-solving skill. Significant improvements in cognitive functions were found only after cognitive differentiation subprogram and social skill subprogram had limited effects on social skills. But within 12-week IPT groups significant improvements in the positive symptoms, negative symptoms and general psychopathology were found. CONCLUSION: These findings support some effectiveness of IPT, but do not address the unique contribution by cognitive components. Applied to schizophrenic patients in this country, this modality had the problems such as differences in sociocultural and lingual background, duration of treatment, homogeneity in the level of the functioning among group members, management of emotions in activities, and the therapists' skill in the training of cognitive components. So the modification of this modality will be required.

Ethnographic Study on Concept of Alcoholism in Korea(II): Focus Group Study / 신경정신의학

The purpose of this study is to establish the Korean concept of the terms related to the use of alcohol and to use those terms in order to replace the terminologies which are inadequate within the Korean culture in diagnosing alcohol abuse. To achieve our intent, the Focus Group Study ethnographic research method was used in this study. The results are as follows: 1) Alcohol is generally perceived as a food rather than a substance in Korea. Alcohol-related behaviors are judged to be problematic according to the problems f311owing the drinking behavior rather than the drinking behavior itself. 2) Repetitive drinking in spite of interpersonal problems was found to be a significant diagnostic guideline of alcoholism in Korea. This finding befits the concept of diagnostic criteria of DSM-III-R and ICD-10. 3) It would be to be appropriate to add some of the typical symptoms rather than change the whole diagnostic concept of ICD or DSM to establish the medical concept of withdrawl phenomenon. 4) Alcohol abuse and alcohol dependence are two separate disease entities. Thus, education of the concepts would allow Koreans to distinguish and to use these two terms. 5) The concepts of acute intoxication, abuse, harmful use and dependence in ICD and DSM should be used after an appropriate revision.

Relationship between Symptom Profiles and a Part of Neuropsychological Test in Patients with Schizophrenia / 대한정신약물학회지

The Psychopathology of schizophrenia is composed of many heterogeneous symptom complex, and multifaceted approaches have been done on this subject. It is so simplified a method that the complex symptoms of schizophrenia are classified into only positive and negative symptoms. Preceded studies of other researchers said cognitive deficit of the schizophrenics played important roles in the symptom formation. The purpose of this study is the evaluation of the relationship between the symptoms of schizophrenia and the memory function and low level of cognitive function. In this study, 30 subacute and chronic schizophrenic patients were included. PANSS(Positive and Negative Symptom Scale) was applied to evaluate the clinical symptoms in each subject. The memory function and low level cognitive function were evaluated using WMS-R(Wechsler Memory Scale-revised version) and Decision-reaction timer. The results showed negative correlations between cognitive factor of PANSS(5 factor model) and delayed recall of WMS-R. These results suggest the possibility that symptom evaluation using PANSS can be a preliminary estimation of cognitive function in schizophrenia.