A Survey on Petition and Process for the Extension of Hospitalization in Mental Hospital / 신경정신의학

OBJECTIVES: The authors performed this survey to find out current status of petition and process for the extension of hospitalization of patients who were hospitalized more than 6 months. METHODS: Authors designed a questionnaire named 'Questionnaire for Survey of Current Status and Process of Petition for Extension of Hospitalization of Psychiatric Patients' and distributed it to 242 psychiatric facilities with closed wards for psychiatric patients. The psychiatric facilities includes 4 categories;psychiatric department of university hospital, psychiatric department of general hospital, psychiatric hospital and small sized private clinic. The period of survey was from Jan. 1 to Dec. 31 of 2002. RESULTS: Among 84 psychiatric facilities responded, 2,615 petitions for extension of hospitalization were submifted to the Local Mental Health Tribunal, and the dissent rate was 4.1%. The most of petitions were from psychiatric hospitals (2,265). The psychiatric departments of general hospitals favored the discharge-readmission method rather than applying extension by due process of the Mental Health Act when further admission was needed after 6 months hospitalization (280 vs. 106). The main reason for the petitions for extension of hospitalization was "no improvement" (72.7%) than "dangerousness to self or others" (14.7%). Against doctor's recommendation for discharge agter improvement, many patients couldn't be discharged becanse of guardians' refusal or cut off from caregiver or guardian. In cluded were these patients applied petitions for extension of hospitalization. CONCLUSION: This study suggests that hospitalization of some patients are extended improperly in view of the spirif of the Mental Health Act. The authors proposea new system of ambulatory treatment, reinforcement of psychiatric rehabilitation, legal control of the neglected patient by guardians.

Effects of Newer Antipsychotic Drugs on Apomorphine-Induced Climbing Behavior in Mice / 대한정신약물학회지

OBJECTIVE: Chlorpromazine equivalence was used to chart relative potencies of typical antipsychotic agents and it has been known to be in a linear relationship with dopamine D2 receptor affinity. After the introduction of these newer antipsychotic drugs, the role of other neurotransmitter systems than dopamine has been emphasized, and it is difficult to attribute the diverse effect of these drugs to common mechanism. Recently, several equivalent dose guidelines have been published for newer antipsychotic drugs. In this study, antagonism of apomorphine-induced climbing behavior was used to investigate the relationship between the clinically determined equivalent doses and behavioral effects measured by animal model of several newer antipsychotic drugs. METHOD: Several newer anti-psychotic drugs were administered 20 min before apomorphine injection. After apomorphine injection, climbing behavior was assessed for up to 20 min by visual inspection. The doses that had inhibited 50% of the control group behavior was defined to be Half-Effective Doses (HED) and calculated from the regression line. The relationship between the HED and clinical Minimum Effective Doses (MED) published elsewhere was investigated using linear regression analysis. RESULT: All the antipsychotic drugs antagonized the apomorphine-induced climbing behavior in a dose-dependent manner. Statistically significant correlation between HED and MED was found (Spearman's rho=0.96, p<0.001), and statistically significant linear relationship was also found (F=76.2, df=1, 4, p=0.001; r2=0.950). CONCLUSION: Antipsychotics inhibit apomorphine-induced climbing behavior by D2 antagonism. Therefore, the result suggests that the common mechanism underlying the therapeutic effects of newer antipsychotics might be related with dopamine D2 antagonism. However, the equivalent doses used in this study focused mainly on psychotic and behavioral symptoms, so that they are not qualified to embrace multi-dimensional therapeutic effects of newer antipsychotics. Investigation of the relationship between the equivalent doses focused on each symptom domain and the effects on diverse neurotransmitter system would broaden our knowledge of mechanism of action of newer antipsychotics.

Cognitive Dysfunctions and Soft Neurological Signs in Schizophrenic Patients / 신경정신의학

OBJECTIVES: Clinical studies have shown cognitive dysfunctions and soft neurological signs in schizophrenic patients and these findings have been suggested as evidence of organic bases in the pathophysiology of schizophrenia. This study was intended to investigate the characteristics of cognitive deficits and soft neurological signs in schizophrenia and, to determine whether any abnormality in these functions can be regarded as a trait marker of the illness which is independent of antipsychotic treatment and clinical improvement. We also investigated the correlation between cognitive deficits and soft neurological signs reflecting cognitive dysmetria, respectively. METHODS: Twenty schizophrenic patients were assessed for the soft neurological signs and cognitive functions before and after neuroleptic treatment. The patients had been medicated for at least 3 weeks with one of the atypical neuroleptics. Cognitive functions were evaluated by Trail making A, B, Stroop test and Word fluency test. Soft neurological signs were assessed by Cambridge Neurological Inventory(Part 2). Positive and Negative Syndrome Scale(PANSS) and Clinical Global Impression(CGI) were used to assess the clinical severity and Extrapyramidal Symtoms Rating Scale was used to estimate the extrapyramidal symptoms. Cognitive functions and soft neurological signs of twenty normal controls were assessed with the same scale. RESULTS: Before treatment, schizophrenic patients showed significant impairments on cognitive function tests(Trail Making A, B, Stroop Test) and soft neurological sign tests(8 items:Grasp reflex, Go/no-go, Finger thumb opposition, Rhythm tapping, Finger agnosia, Fist-edge-palm, Left-right orientation, Extinction). Although significant clinical improvements were observed after the treatment, there were no significant changes in cognitive functions and soft neurological signs(except for Go/no-go test and Finger agnosia). Among the soft neurological signs of the patients, abnormality in Rhythm tapping was significantly correlated with cognitive deficits. CONCLUSION: Schizophrenic patients showed characteristic cognitive deficits and soft neurological signs which were independent of medication and clinical symptoms. And these two characteristics were partly correlated with each other.

Contrasts between Remitted Schizophrenic Patients and Euthymic Bipolar Patients on Verbal Memory and Learning / 신경정신의학

OBJECTIVES: This study was to investigate the verbal memory and learning ability in remitted schizophrenic patients and euthymic bipolar patients in order to explore trait-dependent cognitive deficits of each disorder. METHODS: Verbal memory was assessed with KAVLT(the Korean version of Rey Auditory Verbal Learning Test) in outpatients with remitted schizophrenia(N=30), euthymic bipolar disorder(N=28), and normal control(N=72). KAVLT is made for assessment of immediate supraspan memory, registration, retention, retrieval, recognition, learning strategy, and interference effect. Several confounding factors including age, sex, educational level, attention span, residual psychopathology, and extrapyramidal symptoms were controlled among 3 groups. Patient groups were matched according to the age of onset, duration of illness, and frequency of hospitalization. RESULTS: 1) The performance of bipolar group generally fall between the performance of schizophrenia and normal controls, while being most impaired in retroactive interference. Schizophrenic group showed significant impairment on most variables of KAVLT in comparison with the groups of bipolar disorder and normal control. 2) Within group analysis revealed that residual negative symptoms, duration of illness, and number of admission were highly correlated with the impairment of verbal memory and learning in schizophrenics. Number of depressive episodes and age were negatively correlated with verbal memory and learning among bipolar disorder patients. CONCLUSIONS: Both remitted schizophrenia and euthymic bipolar patients showed distinctive impairment in verbal memory and learning compared with controls. These results suggest that specific impairment of verbal memory and learning in remitted state can be a trait-dependent marker in both diseases. These deficits can give clues to the understanding of the pathophysiology and searching for more appropriate therapeutic interventions of mental disorders to improve cognitive deficits in remitted patients.

Serotonin Transporter Gene Polymorphism and Major Depression / 신경정신의학

OBJECTIVE: Serotonin transporter(5-hydroxytryptamine transporter, 5-HTT) plays a critical role in the termination of serotonergic neurotransmission into the presynaptic neuron and represents an initial site of uptake inhibiting antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors. We investigated the possible association between the 5-HTT gene and major depression, and examined whether there are genotypic characteristics in 5-HTT gene that result in treatment nonresponsiveness to uptake inhibiting antidepressants. METHODS: 5-HTT gene polymorphisms are analyzed with the primers flanking the second intron and regulatory region from genomic DNA. We genotyped 142 patients with major depression and dysthymia, and 252 age and sex matched normal subjects. All individuals were Korean. RESULTS: We found no significant differences in the allele frequency(2 nd intron, p=0.941 : promoter, p=0.122) between patients and controls. However, in association studies between antidepressant responsiveness in depressive patients and allele frequencies of 5-HTT gene polymorphism in intron2 and promoter regions, there was shown significant differences in both(p<0.0001, p=0.0028, respectively by Fisher exact test). CONCLUSIONS: These results suggest that there is no major effect of 5-HTT gene polymorphisms on the susceptibility to major depressions, while antidepressant nonresponding is related with genotypic alteration in 5-HTT gene.

Women's Job Stress, Coping Resources and Mental Health: In the Sample of Female Office Workers in a General Hospital / 신경정신의학

OBJECTIVES: The Purpose of this study is to identify the relationships among women's job stress, coping resources, and mental health based on stress-coping model. METHODS: Forty-three female clerks working in general hospital participated in this study and filled out the Korean version of job stress inventory (K-OSI) and Minnesota Multiphasic Personality Inventory (MMPI). To explore the relationships between job stress and mental health, a series of correlational analysis and multiple regression analysis was conducted. Also, ANOVAs were conducted to identify buffering effects of coping resources in job stress experience. RESULTS: The perceived job stress level was positively correlated with psychosomatic complaints. In addition, the psychosomatic complaints of the women were negatively correlated with their own coping resources. Among the various stress factors of the job life, specifically role insufficiency and role ambiguity has the negative effects on women's metal health. However working women's experience of depressive and anxiety symptoms was not significantly related to the job stress but to the socialsupports. Also, stress-coping model and buffering effects of coping resources were identified in this study. CONCLUSIONS: Despite the job stress of women has negative effects on their mental health, these effects could be buffered by appropriate coping resources such as social support and self-care. In severe job stress situations, it would be better to cope with difficulties reasonably than to avoid them passively.

Three Cases of Frontotemporal Dementia / 신경정신의학

Frontotemporal dementia is a common cause of dementia and distinguished from Alzheimer's disease. Because its clinical symptoms are characterized by slow progressive social breakdown and change of personality before cognitive impairments become prominent, it may be diagosed as other psychiatric disease. We have presented three cases of frontotemporal dementia. They had typical clinical histories and symptoms which deserve to be considered frontotemporal dementia. They showed appropriate findings of frontotemporal dementia in the neuropsychological tests and brain imaging study with brain magnetic resonance imaging and 18F-FDG positron emission tomography. Their clinical histories and findings are thought to be helpful for clinician to give attention to and diagnose frontotemporal dementia.

The Effect of Risperidone on Attention and Information-Processing in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: The aim of this study is to evaluate the effect of risperidone on attention and information-processing in schizophrenic patients after 8 weeks of treatment and to determine whether any improvement on cognitive function relates to improvement in psychopathology. METHODS: The subjects were 29 schizophrenic inpatients with active psychotic symptoms and the controls were 25 normal volunteers. Pre- and post-treatment clinical symptoms were assessed by Positive and Negative Syndrome Scale, Clinical Global Impression and Extrapyramidal Symptom Rating Scale. Vigilance, continuous atttention, the speed of information-processing and fine motor coordinations were assessed by standardized computerized neurocognitive function tests. RESULTS: At baseline, patients showed significantly poor vigilance and continuous attention than normal controls and these functions were not improved after treatment. The positive and negative symptoms and the general psychopathology were significantly improved. The only item of cognitive tasks signi-fica-ntly improved after treatment was decision time to complex audio-visual stimuli in information-processing task. This improvement was not related to the improvements in psychopathology. The level of extrapyramidal symptoms was not related with any of the cognitive fucntion tests items. CONCLUSIONS: Treatment with risperidone appeared to exert a favorable effect on the speed of information-processing and this appeared to be due to a direct pharmacodynamic characteristics of the drug.

A Standardization Study (I)of the Korean Version of Occupational Stress Inventory(K-OSI) Reliability and Validity Study / 신경정신의학

OBJECTIVES: The present study explored the reliability and the validity of our newly constructed job stress scale, the Korean version of the Occupational Stress Inventory (K-OSI) METHODS: Through preliminary item-analysis, we constructed 140 items of the Korean version of Occupational Stress Inventory (K-OSI) K-OSI consists of three subscales measuring three sections, 'ORQ'(Occupational Role Questionnaire) 'PSQ'(Personal Strain Questionnaire) and 'PRQ'(Personal Resource Questionnaire) respectively. The normative group consisted of 805 adult workers who represented six major job classes in Korea. RESULTS: The internal consistency coefficients of 'ORQ', 'PSQ', and 'PRQ' ranged from .89 to .92, and of those 14 subscales ranged from .70 to .88. The test-retest reliability coefficients of 8 week duration ranged from .62 to . 79, and bilingual's consistency coefficient ranged from .82 to . 96. The validity of the K-OSI was investigated by factor-analysis, yielding 3 factors of overall job stress and its responses, personal stress coping, psychological, physical, and behavioral responses of job stress. CONCLUSION: The present results indicate that the K-OSI is a reliable and valid measure of job stress.

Development of Korean Auditory Verbal Learning Test / 신경정신의학

OBJECTIVES: The present study was designed to develop KAVLT (Korean Auditory Verbal Learning Test)and to examine its reliability and validity. The KAVLT is a modified Korean version of RAVLT (Rey Auditory Verbal Learning Test) The KAVLT assesses immediate supraspan memory, registration, retention, retrieval, recognition, learning strategy, and interference effect. METHODS: Final version of KAVLT was developed through preliminary trials. The KAVLT was administered to 75 normal healthy adults and 30 organic brain syndrome patients. Twenty-five normal controls were retested 3 weeks after the first trial to examine the test-retest reliability. The scores of basic and combined indices of KAVLT were compared between normal controls and patients. Factor analysis was done to investigate the construct validity. RESULTS: Significant correlations were found between the test-retest scores of most of the basic indices. Discriminant validity which differentiates organic brain syndrome patients from normal controls was excellent. In order to accomplish the structure analysis of the KAVLT, different sets of scores were submitted to factor analysis procedure. Factor analysis of KAVLT basic indices revealed 2 factors, 'aquisition' and 'retention'. In the factor analysis of KAVLT's basic and combined indices, 4 factors emerged: 'general learning', 'retroactive interference', 'proactive interference', and 'primacy/recency effect'. CONCLUSION: The newly developed KAVLT was found to be a reliable and valid tool for evaluating multifactorial assesment of verbal memory and learning in Korean subjects.

A Standardization Study II on Korean Version of Occupational Stress Inventory (K-OSI): Demographic Variables and Norm / 신경정신의학

OBJECTIVES: This study examined the effects of demographic variables on the job stress experience and established the norms of the Korean version of Occupational Stress Inventory. METHODS: The normative group consisted of 805 adult workers who represent seven major job class in Korea. K-OSI were administered to normative group and data were analyzed by subjects' demographic variables. RESULTS: To explore the effects of demographic variables on K-OSI, we considered several factors such as age, sex, duration of employment, job class, job position and so on. The results were as follows: 1) We found significant sex difference in K-OSI. Compared with men, women showed higher scores in Role Insufficiency, Role Ambiguity, Social Support, Vocational Strain Scales and men showed higher scores in Role Overload, Responsibility Scales. 2) Generally, a person who was older, earned higher salary, more duration of employment experienced job stress and had more coping resources. 3) In general, white-collar workers, job classes and job position had little effects on job stress. But other workers such as security guards, military officers were different from general white-collar workers in K-OSI. CONCLUSION: Because men and women showed significant difference in K-OSI, we constructed norms according to sex. K-OSI would be an useful instrument to identify one's job stress experience and to develop intervention plan.

Public knowledge and attitudes toward depressive illness / 신경정신의학

No abstract available.