Relationship between Insomnia and Depression in Type 2 Diabetics / 정신신체의학

OBJECTIVES: Many of the patients with type 2 diabetes are associated with sleep problems, and the rate of insomnia is known to be higher in the general population. The aims of this study were to know the frequency and clnical characteristics of insomnia, and related variables to insomnia in patients diagnosed with type 2 diabetes. METHODS: For 99 patients from 18 to 80 years of age (65 males and 34 females) with type 2 diabetes, interviews were performed. Total sleep time and sleep latency was evaluated. Insomnia was evaluated using the Korean Version of the Insomnia Severity Index (ISI-K). Severity of depressive symptoms were evaluted using the Korean version of the Hamilton Depression Scale (K-HDRM). According to the cutoff score of 15.5 on the ISI-K, subjects were divided into the group of type 2 diabetics with insomnia (N=34) and those without insomnia (N=65) at first, and then statistically analyzed. RESULTS: TInsomnia could be found in 34.34% of type 2 diabetics. Type 2 diabetics with insomnia had significantly more single or divorced (respectively 11.8%, p<0.05), higher total scores of the K-HDRS (11.76±5.52, p<0.001), shorter total sleep time (5.35±2.00 hours, p<0.001), and longer sleep latency (50.29±33.80 minutes, p<0.001). The all item scores of the ISI-K in type 2 diabetics with insomnia were significantly higher than those in type 2 diabetics without insomnia, that is, total (18.38±2.69), A1 (Initial insomnia) (2.97±0.76), A2 (Middle insomnia) (3.06±0.69), A3 (Terminal insomnia) (2.76±0.61), B (Satisfaction) (3.18±0.72), C (Interference) (2.09±0.97), D (Noticeability) (2.12±1.09) and E (Distress) (2.21±0.81) (respectively p<0.001). Variables associated with insomnia in type 2 diabetics were as following. Age had significant negative correlation with A3 items of the ISI-K (β=−0.241, p<0.05). Total scores of the K-HDRS had significant positive correlation, while total sleep time had significant negative correlation with all items of the ISI-K (respectively p<0.05). Sleep latency had significant positive correlation with total,, A1, B and E item scores of the ISI-K (respectively p<0.05). CONCLUSIONS: Insomnia was found in about 1/3 of type 2 diabetics. According to the presence of insomnia, clinical characteristics including sleep quality as well as quantity seemed to be different. Because depression seemed to be correlated with insomnia, clinicians should pay attention to early detection and intervention of depression among type 2 diabetics

Factors Influencing on the Cognitive Function in Type 2 Diabetics / 정신신체의학

OBJECTIVES: The aims of this study were to know the frequency and the nature of cognitive dysfunction in type 2 diabetics, and to reveal influencing variables on it. METHODS: From eighty type 2 diabetics (42 males and 38 females), demographic and clinical data were obtained by structured interviews. Cognitive functions were measured using the MMSE-K (Korean Version of the Mini-Mental State Examination) and the Korean Version of the Montreal Cognitive Assessment (MoCA-K) tests. Severity of depression was evaluated by the Korean Version of the Hamilton Depression Rating Scale (K-HDRS). RESULTS: 1) Among eighty type 2 diabetics, 13.75% were below 24 on the MMSE-K, while 38.8% were below 22 on the MoCA-K. 2) The total scores and subtest scores of the MoCA-K including visuospatial/executive, attention, language, delayed recall and orientation were significantly lower in type 2 diabetics with cognitive dysfunction (N=31) than those without cognitive dysfunction (N=49) (p < 0.001, respectively). 3) There were significant difference between type 2 diabetics with and those without cognitive dysfunction in age, education, economic status, body mass index, duration of diabetes, total scores of the K-HDRS, the MMSE-K and the MoCA-K (p < 0.05, respectively). 4) The total scores of the MoCA-K had significant correlation with age, education, body mass index, family history of diabetes, duration of diabetes, total scores of the K-HDRS (p < 0.05, respectively). 5) The risks of cognitive dysfunction in type 2 diabetics were significantly influenced by sex, education, fasting plasma glucose and depression. CONCLUSIONS: The cognitive dysfunction in type 2 diabetics seemed to be related to multiple factors. Therefore, more comprehensive biopsychosocial approaches needed for diagnosis and management of type 2 diabetes.

Behavioral Variant Frontotemporal Dementia Phenocopy Syndrome / 정신신체의학

OBJECTIVES: The aim of this study was to draw attention toward so called ‘behavioral variant frontotemporal dementia(bvFTD) phenocopy syndrome’, which is difficult to discriminate with the primary psychiatric disorders, showing poor response to conventional therapeutic drugs, leading to higher risk to misdiagnoses and legal problems. Furthermore, the author insisted that our interest and study on them must be continued. METHODS: English articles published during 2000 thru 2016 had been searched by internet with the combination of words such as ‘frontotemporal’, ‘phenocopy’ and ‘behavioral’, and reviewed. Besides, two clinical vignettes were described. RESULTS: Precise diagnosis is important because patients' behavioral symptoms can influence on their families and community. However, disease-modifying treatment for bvFTD are not developed until now, and recent therapeutic drugs are only good for specific symptoms, while deterioration progresses in spite of proper psychiatric management. The possible bvFTD patients are not progressed into probable bvFTD clinically, showing no decline of cogntive and social function, no decrease of activity function, longer survival time, and normal neuroimaging for several years. CONCLUSIONS: Rather than expected, there are much more patients having clinical symptoms, course and diagnostic findings including neuroimaging, which are atypical to classical frontotemporal dementia and primary psychiatric disorders. If our knowledge and discriminating ability is improved, discovery rate of that cases will be increased. However, the identity of these atypical features are not clarified until now, it must be further actively investigated.

Association of Cognitive Dysfunction with Thyroid Autoantibody / 정신신체의학

OBJECTIVES: The aims of this study were to know the frequency of cognitive dysfunction among patients with autoimmune thyroid disorders, and to reveal influencing factors on it, especially to clarify association with autoimmune thyroid antibodies. METHODS: From sixty-five female patients with autoimmune thyroid disorders, demographic data were obtained by structured interview. Their cognitive funtions were measured using the MMSE-K and the MoCA-K tests. Depression was evaluated by the K-HDRS. RESULTS: 1) Among patients with autoimmune thyroid disorders, 7.69% of them were below 24 on the MMSE-K, while 10.77% were below 22 on the MoCA-K. The frequency of cognitive deficit was not significantly different according to having positivity to antimicrosomal antibodies or not. 2) The antimicrosomal antibody-positive patients had significantly higher antithyroglobulin antibody titers, antimicrosomal antibody titers, and TSH concentration, while had significantly lower free T4 levels(p<0.05, respectively). 3) The total scores of the MMSE-K and the MoCA-K had significant correlation with age, marital status, antithyroglobulin antibody titers and K-HDRS(p<0.05, respectively). 4) The regression analysis revealed that variables such as age, education, autoimmune thyroid antibodies, thyroid function and depression did not influence on cognitive function of patients with autoimmune thyroid disorders. CONCLUSIONS: Our results could not support that cognitive function of patients with autoimmune thyroid disorders had correlation with autoimmune thyroid antibodies.

Cognitive Function of Thyroid Papillary Carcinoma Patients Before Radioiodine Therapy / 정신신체의학

OBJECTIVES: The aims of this study were to know the prevalence of cognitive disorders in patients with thyroid cancer, and identify related variables to them. METHODS: Subjects were consisted of fourty-two patients with thyroid cancer, who were admitted for radioiodine ablative therapy at 6-12 months after total thyroidectomy. The data were obtained from interviews about history and assessments of depression and cognitive function(Korean Version of the Montreal Cognitive Assessment, MoCA-K). RESULTS: 1) Among subjects, those with below 22 of total score of the MoCA-K were twenty-one(50.0%). 2) Upon age, education, Pre-radioiodine therapy thyroid stimulating hormone(TSH), there were statistically significant difference between subgroup with above 23 of the total MoCA-K score and those below 22. 3) The total scores of the MoCA-K in subjects had significant correlation with age, education, comorbidity, Pre-radioiodine therapy TSH, total score of the HDRS-17. CONCLUSIONS: Cognitive disorders were more prevalent among patients with thyroid cancer before radioiodine therapy. Therefore, further study should be needed to clarify the mechanism for the cognitive disorders in thyroid cancer. Furthermore, physicians should pay attention to the cognitive function and prepare preventative measures for cognitive disorder during management of thyroid cancer.

Movement Disorders that Psychiatrists Should Know / 정신신체의학

The movement disorders in psychiatry have been neglected, though it is an important psychiatric dimension to exert unfavorable influence on patients'quality of life. The etiologies of movement disorders in psychiatry can be classified as primary neurological disorders, psychiatric comorbidities of neurological disorders, manifestations of primary psychiatric disorders, drug-induced movement disorders and psychogenic movement disorders. For the rapid and proper treatment for movement symptoms and signs easily observed from psychiatric patients, psychiatrists' ability toward precise disgnosis and differential diagnosis of movement disorders should be preceded.

Characteristics of Psychiatric Consultation between Presenile and Senile Inpatients / 정신신체의학

OBJECTIVES: The aim of this study was to know differences of characteristics between presenile and senile patients who were consulted to the department of psychiatry during medical-surgical admission. METHODS: The demographic and clinical data obtained from the medical records of psychiatric consultation in the presenile inpatients with age 50 to 64 years(N=162) and those of the senile inpatients with age over 65 years(N=171) were reviewed and compared. RESULTS: 1) The most common chief complaints for psychiatric consultation in presenile patients were somatic symptoms, anxiety and sleep disturbance in order, while cognitive decline, clouded consciousness and depressed mood were most common in senile patients with statistical significance. 2) The most frequent psychiatric diagnoses after consultation in presenile patients were delirium, mood disorder and substance use disorder in order, while delirium, mood disorder and major neurocognitive disorder were most frequent in senile patients with statistical significance. 3) There were no significant difference in numbers of physical illnesses, while numbers of therapeutic drugs for them were more in senile patients. CONCLUSIONS: Our study found significant differences between presenile and senile patients on psychiatric symptoms and diagnoses in geropsychiatric consultation. Therefore, more subdivided age-specific approach seems to be needed for the geropsychiatric consultation activities.

Longevity and Dementia Prevention / 신경정신의학

OBJECTIVES: The aim of this study was to understand pharmacological and non-pharmacological methods of dementia prevention. METHODS: An internet searchof literature published from 2006 thru 2008 was done using combinations of the words'dementia' and'prevention'. These publications were subsequently reviewed. RESULTS: 1) Reduction of risk factors: control of vascular risk factors (hypertension, diabetes mellitus, obesity, hypercholesterolemia, smoking, hyperhomocysteinemia, and platelet aggregation) and medical risk factors (head trauma, depression, herpes simplex, hyperthyroidism, and alcohol problems). 2) Pharmacological trial: NSAIDs, selective COX-2 inhibitors, estrogen replacement therapy, and antioxidants. 3) Healthy diet and nutrition: macronutrients (polyunsaturated fatty acid such as omega-3, alpha-linolenic acid, docosahexaenoic acid) and micronutrients (vitamins such as vitamin A, vitamin B1, 3, 6, 9, 12, vitamin C, vitamin D, vitamin E, vitamin K; minerals such as iron, iodine, magnesium, zinc, manganese, copper, cobalt, selenium; trace elements; and non-essential micronutrients such as polyphenols). 4) Regular excercise and activities: physical activities including aerobics, flexibility, and strength exerrcises; Recreational activities including participation in religious or social activities, healthy sex life with partner, and stimulating cognitive activities. CONCLUSION: The final goal of dementia treatment is primary prevention. However, there is no proven method to achieve this. Therefore, secondary prevention or preventative maintenance through risk reduction and introduction of a healthy lifestyle in an attempt to postpone the onset of disease is a realistic goal.

Suicide in the Korean Elderly

OBJECTIVES: The suicide rate has been increasing among the aged Koreans since 1990. However, there is few study on the epidemiology, causes, and strategies to help them. METHODS: The data were collected by the internet search for the journals and documents of studies on the suicide among aged Koreans from 1995 thru 2006. RESULTS: 1) The suicide rate (36.1 per 100,000) in the Korean elderly with age over 65 has been increasing over 50% since 1998, which estimated as 19.9 times of that in the general population. 2) The biopsychosocial factors possibly related to the elderly suicide in Korea are age, depression, bereavement, physical illness, elder abuse, poor economy and social support system. The poor economy, elder abuse and depression seemed to be the most influential. 3) The rate of the elderly suicide in Korea can be reduced with the active prevention by early detection and intervention of risk factors. CONCLUSION: The strategy including reduction of risk factors, regional welfare services and policy seems to be needed for the prevention of elderly suicide in Korea.

Predictors of Quality of Life in Patients with Dementia of the Alzheimer's Type

OBJECTIVES: The aim of this study was to analyze factors affecting quality of life (QOL) among Korean dementia patients. METHODS: The subjects were consisted with 54 patients with dementia of the Alzheimer's type and 54 normal aged controls with age over 60. The QOLs were assessed with the Korean Version of the Quality of Life in Alzheimer's Disease: Patient and Caregiver Report (KQOL-AD). For analyzing factors affecting QOL in dementia, the clinical data were obtained by structured interview and medical records, serum homocysteine levels were measured, and the severity of dementia (Mini-Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional activities (Activities of Daily Living, Instrumental Activities of Daily Living) and depression (Geriatric Depression Scale) were evaluated using various rating scales. RESULTS: 1) The mean (+/-S.D.) score of KQOL-AD in patients with dementia of the Alzheimer's type (24.30+/-5.06) was significantly (p<0.005) lower than those in normal aged controls (26.56+/-3.25). 2) The factors influencing on KQOL-AD in patients with dementia of the Alzheimer's type were age (p<0.01), cognitive function (p<0.01), severity of dementia (p<0.01), activities of daily living (p<0.01), depression (p<0.01) and serum homocysteine levels (p<0.05). CONCLUSION: In conclusion, multiple factors including problems originated from dementia itself as well as causes fundamentally related with pathophysiology of dementia might influence on the quality of life in patients with the Alzheimer's dementia.

Predictors of Quality of Life in Patients with Dementia of the Alzheimer's Type

OBJECTIVES: The aim of this study was to analyze factors affecting quality of life (QOL) among Korean dementia patients. METHODS: The subjects were consisted with 54 patients with dementia of the Alzheimer's type and 54 normal aged controls with age over 60. The QOLs were assessed with the Korean Version of the Quality of Life in Alzheimer's Disease: Patient and Caregiver Report (KQOL-AD). For analyzing factors affecting QOL in dementia, the clinical data were obtained by structured interview and medical records, serum homocysteine levels were measured, and the severity of dementia (Mini-Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional activities (Activities of Daily Living, Instrumental Activities of Daily Living) and depression (Geriatric Depression Scale) were evaluated using various rating scales. RESULTS: 1) The mean (+/-S.D.) score of KQOL-AD in patients with dementia of the Alzheimer's type (24.30+/-5.06) was significantly (p<0.005) lower than those in normal aged controls (26.56+/-3.25). 2) The factors influencing on KQOL-AD in patients with dementia of the Alzheimer's type were age (p<0.01), cognitive function (p<0.01), severity of dementia (p<0.01), activities of daily living (p<0.01), depression (p<0.01) and serum homocysteine levels (p<0.05). CONCLUSION: In conclusion, multiple factors including problems originated from dementia itself as well as causes fundamentally related with pathophysiology of dementia might influence on the quality of life in patients with the Alzheimer's dementia.

Relation of Serum Homocysteine Level to Oxidative Stress in Patients with Alzheimer's Dementia / 신경정신의학

OBJECTIVES: The goal of this study was to find an association between elevated blood homocysteine level in Korean patients with dementia of the Alzheimer's type (DAT), to analyze affecting factors, and to identify the role of oxidative stress which was known to be an underlying mechanism of hyperhomocysteinemia in DAT. METHODS: The subjected were consisted of 54 patients with dementia of the Alzheimer's type and 54 normal controls with age over 60. The clinical data was obtained by structured interview and medical records. Serum homocysteine, plasma total antioxidant capacity (TAC) and serum apolipoprotein E (apo E) levels were measured, and the cognitive function (Mini-Mental State Examination, MMSE), severity of dementia (Clinical Dementia Rating, CDR/Global Deterioration Scale, GDS), activities of daily living (Activities of Daily Living, ADL/Instrumental Activities of Daily Living, IADL) and severity of depression (Geriatric Depression Scale) were also evaluated using various rating scales. RESULTS: 1) The mean (+/-S.D.) serum homocysteine level in patients with dementia of the Alzheimer's type (21.69+/-8.24 micromol/L) was significantly (p<0.05) higher than the mean (+/-S.D.) serum homocysteine level in the control group (16.60+/-4.85 micromol/L) 2) The mean age and IADL scores of DAT patients with elevated serum homocysteine level were significantly higher than those of DAT patients with normal serum homocysteine level (p<0.05). However, there were no difference between groups in the MMSE, GDS, CDR, ADL, Geriatric Depression Scale, plasma TAC and serum apo E level. 3) The serum homocysteine level in patients with Alzheimer's dementia had no correlation with age, cognitive function, severity of dementia, activities of daily living, severity of depresseion nor plasma TAC and serum apo E level. CONCLUSION: This study does not support the association between elevated serum homocysteine level and oxidative stress.

The People of KAGP : Officers and Directors

No abstract available.

Troubles during Dementia Management : Geropsychiatric Restraints

OBJECTIVES: The use of physical restraints for the geropsychiatric patients has been underreported to decrease in recent years. The aims of this study were to investigate frequency of restraints, to identify predictors and reasons for restraint use with geropsychiatric patients, to evaluate restraint related risks, and to suggest care alternatives used in restraint reduction. METHODS: English literatures published during 1990 thru 2005 were searched using internet and were reviewed. RESULTS: 1) Prevalence of restraint use in nursing homes was 25-85%. Incidence rate of restraints in geriatric ward of psychiatric hospital was 27.1%, which was 10.6 times more for the dementia patients. 2) Predictors of restraint use with geropsychiatric patients were older age, cognitive impairment, disruptive behaviors, impaired mobility and history of falls. Two variables most likely to affect fall and safety risk were cognitive function and ambulatory status. 3) Restrained patients were significantly more demented, show more safety judgement problems, and have a much higher overall risk for injury. 4) Five care alternatives to replace restraints are environmental care alternatives, alterations in nursing care, activities, physiological alternatives, and psychosocial alternatives. CONCLUSION: Physical restraints cannot just be removed. Care alternatives should be implemented to protect patient's safety. This is the beginning for the provision of safe care in a dignified and less restrictive environment that will promote or maintain patient's abilities.

Attitudes toward Disclosing Dementia Diagnosis in Korean Elderly and Family with Dementia Patients

OBJECTIVES: The aims of this study were to know whether Korean healthy elderly and family with dementia patients were wishing to disclose the diagnosis of dementia, to identify reasons of their wishing and unwishing to disclose, and to analyze influencing factors on the disclosing of dementia. METHODS: We obtained data from 78 healthy elderly with age over 60 and 73 family with dementia patients by interviewing with questionnaire about attitudes toward disclosing dementia. RESULTS: 1) 51.3% of healthy elderly and 58.9% of family with dementia patients were wishing to disclose dementia. Other relatives whom they wanted to tell were spouse or adult children. Most family with dementia patients wanted to have predictive tests in preparation for their future. 2) The main reasons for wishing to disclose were to make advance planning in healthy elderly, and to be careful and cooperate well to treat if they aware their illness in family with dementia patients (p<0.005, respectively). The main reasons for unwishing to disclose were whether they might be frightened or upset in healthy elderly (p<0.025), and to worry about being depressed in family with dementia patients (p<0.005). The main reasons why family wanted to be told were family's right to know and to explore treatment options. 3) The influencing factors on disclosing dementia seemed to be sex (p<0.01) and marital status (p<0.005) in healthy elderly, and education (p<0.005), marital status (p<0.005), religion (p<0.025) and socioeconomic status (p<0.01). CONCLUSION: The attitude toward disclosing diagnosis of dementia in Korean healthy elderly and family with dementia patients seemed to be more active. Therefore, doctors should prepare in mental attitude and knowledge to satisfy their need by active provision of information and education.

Psychosocial Factors Associated with Suicidal Idea among Korean Elderly

OBJECTIVES: The aim of this study was to analyze psychosocial factors associated with suicidal idea among Korean elderly. METHODS: The sociodemographic data and psychopathology were evaluated by questionnaire and psychiatric interview in community-dwelling elderly with age over 60 (N=100) and adults with age 30-49 (N=60). Suicidal idea was assessed by 9th item of Beck Depression Inventory (BDI). To analyze factors associated with suicidal idea in Korean elderly, we assessed family function (Family Adaptation Partnership Growth Affection Resolve, APGAR), alcohol problem (Cut Annoyed Guilty Eye-Opener, CAGE), depressive symptoms (HAM-D, BDI), cognitive function (CDR, MMSE-K, GDS), and functional activities (ADL, I-ADL). RESULTS: 1) The frequency of suicidal idea of the elderly with age over 60 (20.0%) was significantly higher than that of adult with age 30-49 (6.7%)(p<0.05). 2) The factors associated with suicidal idea were major depressive disorder (OR=42.17, 95% C.I. : 2.62-679.03), physical illness (OR=27.01, 95% C.I. : 1.18-616.50), depressive symptoms (OR=12.18, 95% C.I. : 2.91-49.98), poor economic status (OR=7.18, 95% C.I. : 1.05-48.86). 3) The means of variables in the elderly with suicidal idea were ADL 6.4+/-1.1, HAM-D 17.8+/-7.7, BDI 30.0+/-9.5, APGAR 4.8+/-2.6, which were significantly higher than those of the elderly without suicidal idea (p<0.05, respectively). 4) The HAM-D score in the Korean elderly had statistically significant correlation with APGAR (gamma=0.376, p<0.01), BDI (gamma=0.808, p<0.01), ADL (gamma=0.316, p<0.01), GDS (gamma=0.282, p<0.01), CDR (gamma=0.258, p<0.01) and education level (gamma=-0.208, p<0.05). The BDI score had statistically significant correlation with APGAR (gamma=0.341, p<0.01), HAM-D (gamma=0.808, p<0.01), GDS (gamma=0.340, p<0.01), CDR (gamma=0.301, p<0.01), ADL (gamma=0.325, p<0.05) and I-ADL (gamma=0.206, p<0.05). CONCLUSION: These results suggested early detection, psychogeriatric intervention of the elderly with high risk factors and active treatment of medical illness could reduce suicidal idea among them.

Every Facet of the 2004 IPA Asia Pacific Regional Meeting in Seoul

No abstract available.

Factors Related to the Morale of Korean Elders

OBJECTIVES: The aims of this study were to assess the morale of Korean elders, to analyze the affecting factors, and to look for the ways to raise their morale. METHODS: The structured interviews and measurements of depression (Four-Item Geriatric Depression Scale and Vulnerability Factors), cognitive function (Short Portable Mental Status Questionnaire) and morale(Measurement of Morale in the Elderly Scale, MMES) were taken for the 50 Korean elders (28 females and 22 males) with age over 65 who were visiting Jong Myo during January to February in 2004. RESULTS: 1) In Korean elders, the mean scores of total MMES were 100.82+/-12.36. According to the items, mean scores of Satisfaction were 43.52+/-5.14, Equanimity 36.80+/-7.53, Will-to-live 20.00+/-4.43. 2) The total MMES scores were significantly affected by variables such as income (p<0.05), economy (p<0.005), elder abuse (p<0.01) and depression (p<0.001). While other variables including age, residence, education, number of children, sex, religion, spouse, job, illness and cognitive function were not related. CONCLUSION: To encourage morale in the Korean elders, economic support by welfarism, socio-legal prevention of elder abuse, and active involvement of geropsychiatrists into the early detection and treatment of depression must be needed.

Mild Cognitive Impairment - Aging to Alzheimer's Disease -

No abstract available.

Guidelines on Depression in Older People - Practising the Evidence -

No abstract available.