In silico screening method for non‑responders to cardiac resynchronization therapy in patients with heart failure: a pilot study

Background@#Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation. @*Methods@#Three-dimensional heart geometry was constructed from computed tomography images. The finite ele‑ ment method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechani‑ cal contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%. @*Results@#A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simu‑ lation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder.In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation. @*Conclusion@#This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.

The Korean Version of Fear of COVID-19 Scale: Psychometric Validation in the Korean Population

Objective@#Coronavirus disease 2019 (COVID-19) has psychological effects such as anxiety and depression as well as direct infection in people. The Fear of COVID-19 scale is a scale that can measure anxiety related to COVID-19 in a short time. The purpose of this study was to verify the reliability and validity the Korean version of Fear of COVID-19 scale (KF-COVID-19S). @*Methods@#The data of total 186 normal adults and 17 patients were finally used for the statistical analysis. For internal consistency, Cronbach’s α was calculated. For concurrent and discriminant validity, the correlations with the Hospital Anxiety and Depression scale (HADS), Patient Health Questionnaire-15 (PHQ-15), World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOLBREF) were analyzed. For construct validity, exploratory and confirmatory factor analysis were conducted. @*Results@#Cronbach alpha was 0.88. The two-factor model (factor 1: Physical fear, factor 2: Emotional fear) showed significantly positive correlations and appeared to be “good” fitness (CFI=0.906, IFI=0.907, NFI=0.902). @*Conclusion@#The KF-COVID-19S can be a useful scale that can measure the physical and emotional fears associated with COVID-19 in a short time. Because the psychiatric patients are a more vulnerable group to the fear, it is thought that the KF-COVID-19S will help to determine the patient’s level of anxiety and make a therapeutic plan for the underlying mental disorder.

The Korean Version of Fear of COVID-19 Scale: Psychometric Validation in the Korean Population

Objective@#Coronavirus disease 2019 (COVID-19) has psychological effects such as anxiety and depression as well as direct infection in people. The Fear of COVID-19 scale is a scale that can measure anxiety related to COVID-19 in a short time. The purpose of this study was to verify the reliability and validity the Korean version of Fear of COVID-19 scale (KF-COVID-19S). @*Methods@#The data of total 186 normal adults and 17 patients were finally used for the statistical analysis. For internal consistency, Cronbach’s α was calculated. For concurrent and discriminant validity, the correlations with the Hospital Anxiety and Depression scale (HADS), Patient Health Questionnaire-15 (PHQ-15), World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOLBREF) were analyzed. For construct validity, exploratory and confirmatory factor analysis were conducted. @*Results@#Cronbach alpha was 0.88. The two-factor model (factor 1: Physical fear, factor 2: Emotional fear) showed significantly positive correlations and appeared to be “good” fitness (CFI=0.906, IFI=0.907, NFI=0.902). @*Conclusion@#The KF-COVID-19S can be a useful scale that can measure the physical and emotional fears associated with COVID-19 in a short time. Because the psychiatric patients are a more vulnerable group to the fear, it is thought that the KF-COVID-19S will help to determine the patient’s level of anxiety and make a therapeutic plan for the underlying mental disorder.

Comparison of cobas EGFR Mutation Test v2 and PANAMutyper-R-EGFR for Detection and Semi-Quantification of Epidermal Growth Factor Receptor Mutations in Plasma and Pleural Effusion Supernatant

BACKGROUND: Plasma epidermal growth factor receptor (EGFR) mutation tests are less invasive than tissue EGFR mutation tests. We determined which of two kits is more efficient: cobas EGFR Mutation test v2 (cobasv2; Roche Molecular Systems, Pleasanton, CA, USA) or PANAMutyper-R-EGFR (Mutyper; Panagene, Daejeon, Korea). We also evaluated whether pleural effusion supernatant (PE-SUP) samples are assayable, similar to plasma samples, using these two kits. METHODS: We analyzed 156 plasma and PE-SUP samples (31 paired samples) from 116 individuals. We compared the kits in terms of accuracy, assessed genotype concordance (weighted κ with 95% confidence intervals), and calculated Spearman's rho between semi-quantitatively measured EGFR-mutant levels (SQIs) measured by each kit. We also compared sensitivity using 47 EGFR-mutant harboring samples divided into more-dilute and less-dilute samples (dilution ratio: ≥ or <1:1,000). RESULTS: cobasv2 tended to have higher accuracy than Mutyper (73% vs 69%, P=0.53), and PE-SUP samples had significantly higher accuracy than plasma samples (97% vs 55–71%) for both kits. Genotype concordance was 98% (κ=0.92, 0.88–0.96). SQIs showed strong positive correlations (P<0.0001). In less-dilute samples, accuracy and sensitivity did not differ significantly between kits. In more-dilute samples, cobasv2 tended to have higher sensitivity than Mutyper (43% vs 20%, P=0.07). CONCLUSIONS: The kits have similar performance in terms of EGFR mutation detection and semi-quantification in plasma and PE-SUP samples. cobasv2 tends to outperform Mutyper in detecting less-abundant EGFR-mutants. PE-SUP samples are assayable using either kit.

Ischemic Sciatic Neuropathy in a Patient with Liposarcoma

BACKGROUND: Various etiologies are the causative agents for sciatic neuropathy. We present here a case of ischemic sciatic neuropathy in a patient with liposarcoma. CASE REPORT: A 55-year-old woman presented with severe pain and weakness of the left leg. She had a history of recurred retroperitoneal liposarcoma, and was being administered chemotherapy. Examination revealed weakness in ankle dorsiflexion, plantar flexion and hamstring. Complaints also included dysesthesia, and numbness in the sole and dorsum of the foot. Nerve conduction study showed low compound muscle action potentials and slow motor conduction velocity of left peroneal and tibial nerves, with indiscernible sensory nerve action potentials of the left superficial peroneal and sural nerves. Computed tomography angiography revealed occlusion of the left common iliac artery. Commencement of intravenous infusion of heparin resulted in skin color change and progression of the weakness. Hence, the patient underwent an emergency thrombectomy. CONCLUSIONS: Ischemia should be considered as a cause of sciatic neuropathy in cancer patients, which requires management with timely treatment.

Status Epilepticus after Catheter Drainage of Basal Ganglia Hemorrhage

No abstract available.

Cellular Neurothekeoma of the Scalp in the Elderly

Cellular neurothekeoma (CNT) is an uncommon variant of neurothekeoma that is composed of pithelioid to spindled cells with variable nuclear atypia or pleomorphism but no myxoid stroma. CNT occurs predominantly in the head and neck or upper trunk of children and young adults, with female predominance. The following case is different from typical CNTs. An 88-year-old female presented with a palpable mass on the scalp, which we excised. Histologically, the tumor was non-encapsulated and composed of spindled and epithelioid cells arranged in fascicles and nodules separated by a collagen-rich stroma. Immunohistochemical analysis showed that the epithelioid and spindle-shaped cells were focally positive for vimentin, neuron-specific enolase, smooth muscle actin, CD68, and CD10 but negative for S-100 protein, HMB-45, epithelial membrane antigen, and CD34. We report a new case of CNT that arose in the scalp of an older patient and that was associated with uncommon clinical, histological, and immunohistochemical profiles.

Cellular Neurothekeoma of the Scalp in the Elderly

Cellular neurothekeoma (CNT) is an uncommon variant of neurothekeoma that is composed of pithelioid to spindled cells with variable nuclear atypia or pleomorphism but no myxoid stroma. CNT occurs predominantly in the head and neck or upper trunk of children and young adults, with female predominance. The following case is different from typical CNTs. An 88-year-old female presented with a palpable mass on the scalp, which we excised. Histologically, the tumor was non-encapsulated and composed of spindled and epithelioid cells arranged in fascicles and nodules separated by a collagen-rich stroma. Immunohistochemical analysis showed that the epithelioid and spindle-shaped cells were focally positive for vimentin, neuron-specific enolase, smooth muscle actin, CD68, and CD10 but negative for S-100 protein, HMB-45, epithelial membrane antigen, and CD34. We report a new case of CNT that arose in the scalp of an older patient and that was associated with uncommon clinical, histological, and immunohistochemical profiles.

Successful Intra-arterial Stent Thrombectomy in Acute Infarction Caused by Spontaneous Middle Cerebral Artery Dissection

Spontaneous dissection of the middle cerebral artery could result in thromboembolic stroke caused by the intramural hematoma. Dissection should be considered as a possible etiology in a young stroke patient, but it is not straightforward in an emergency situation. Moreover, the efficacy and safety of thrombolytic treatment in the acute stage are unknown. We applied intravenous and intra-arterial stent thrombectomy with the Solitaire device successfully in a patient with acute left middle cerebral artery occlusion due to spontaneous dissection.

Factor Analysis of the Adolescent Personality Assessment Inventory

OBJECTIVES: The purpose of this study was to examine the factor structure of the Adolescent Personality Assessment Inventory (PAI-A) in a standardized adolescent sample using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). METHODS: For this purpose, three models about factor structure of the PAI-A were explored with EFA in 490 adolescents and then were evaluated with CFA in 268 young offenders. RESULTS: The results showed that the five factor model was considered to be most appropriate for factor structures of the PAI-A in EFA. However, none of the factor models were appropriate for the factor structures of the PAI-A in CFA. CONCLUSION: These findings suggest that the "five factor model" is thought to explain the PAI-A the best, but further studies are needed.

The Effect of Group Music Therapy on the Social Function and Interpersonal Relationship in Outpatients with Schizophrenia / 신경정신의학

OBJECTIVES: The purpose of this study was to examine the effect of group music therapy on social function and interpersonal relationships in outpatients with schizophrenia. METHODS: A total of 24 outpatients with schizophrenia were randomly assigned to either an experimental group (with music therapy : 12 patients) or a control group (without music therapy : 12 patients). Patients assigned to the experimental group received 18 sessions of group music therapy at Iksan Community Mental Health Center. Twenty individuals with schizophrenia completed a battery of measures, including the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Social Skill Scale, Korean-Social Functioning Scale (SFS-K), Interpersonal Functioning Scale, and the Relationship Change Scale at baseline and end point. RESULTS: After 18 sessions of group music therapy, the experimental group showed significant improvements compared with the control group in the PANSS (positive, negative, general psychopathology), GAF, social skill, interpersonal relationship, some SFS-K domains (social withdrawal, recreation, independence performance), and some Relationship Change Scale domains (communication, confidence, affection, openness, understanding). CONCLUSION: These results suggest that group music therapy seems to be effective for treatment of psychopathology, social function, and interpersonal relationships of schizophrenic patients. However, the small sample size was a limitation of this study.

Executive Dysfunction and It's Relation to K-WAIS Scores in Mild Traumatic Brain Injury Patients with Normal Intelligence Quotient / 정신신체의학

OBJECTIVES: This study examined the selective deficits of executive function in patients with mild traumatic brain injury that in normal range of general intelligence level and aimed to analysis of the correlation between K-WAIS result and executive function. METHODS: 59 subjects were included in this study, who were diagnosed as mild traumatic brain injury(MTBI) and they have visited in neuropsychiatric department of Wonkwang University Hospital during from March, 2005 to September, 2010. For measurement of general intelligence quotient, the Korean-Wechsler Adults Intelligence Scale(K-WAIS) was administered and for measurement of executive intelligence quotient(EIQ), Executive Intelligence Test(EXIT) was administered. RESULTS: Of patients, 50.8% included at abnormal EIQ group. The patients of abnormal EIQ showed poorer full scale IQ(FIQ), performance IQ(PIQ) and in subscale that picture arrangement, digit symbol, digit span, block design, object assembly and comprehension were significantly different. In terms of relationships between K-WAIS and EIQ, FIQ and PIQ have positive correlation with EIQ. And in subscale, picture arrangement, digit symbol, digit span, block design, object assembly and comprehension show positive correlation with EIQ. CONCLUSION: This study suggest that MTBI patients with have normal range of general intelligence level may have deficit of executive function is common. The decline of FIQ, PIQ and some subscales of K-WAIS may suggest executive dysfunction in MTBI patients.

Depression and anxiety of the inpatients with schizophrenia / 신경정신의학

No abstract available.

Psychotherapy and Psychosocial Therapy for the Geriatric Mood Disorders

Among the mood disorders in the elderly aged older than 65, dysthymia, major depression, and mania constitute the prototypes and depressed mood is the most frequent symptom. The mode of psychotherapy and psychosocial therapy for geriatric depression, which are similar throughout adulhood, include brief dynamic psychotherapy, interpersonal psychotherapy, psychoanalytic psychotherapy and psychoanalysis, supportive psychotherapy, cognitive therapy, family therapy, and group therapy. Psychotherapy alone is of value primarily in dysthymia and major depression. Short-term cognitive therapy, brief dynamic psychotherapy, and interpersonal psychothearapy have been found to be effective, without medications, in high-functioning elders suffering from major depression with minimal or no cognitive impairment. Cognitive-behavioral psychotherapy may be the treatment of choice in the depressed medically ill. Whatever technique is utilized, it is important to be aware of the dynamic issues that are prevalent in geriatric depression patients, as well as the transference and countertransferenc problems that may be aroused.

Psychotherapy and Psychosocial Therapy for the Geriatric Mood Disorders

Among the mood disorders in the elderly aged older than 65, dysthymia, major depression, and mania constitute the prototypes and depressed mood is the most frequent symptom. The mode of psychotherapy and psychosocial therapy for geriatric depression, which are similar throughout adulhood, include brief dynamic psychotherapy, interpersonal psychotherapy, psychoanalytic psychotherapy and psychoanalysis, supportive psychotherapy, cognitive therapy, family therapy, and group therapy. Psychotherapy alone is of value primarily in dysthymia and major depression. Short-term cognitive therapy, brief dynamic psychotherapy, and interpersonal psychothearapy have been found to be effective, without medications, in high-functioning elders suffering from major depression with minimal or no cognitive impairment. Cognitive-behavioral psychotherapy may be the treatment of choice in the depressed medically ill. Whatever technique is utilized, it is important to be aware of the dynamic issues that are prevalent in geriatric depression patients, as well as the transference and countertransferenc problems that may be aroused.

Perceived Stressful Life Events, Coping Style, Social Support and Depressive Symptoms of the Functional Dyspepsia Patients / 신경정신의학

OBJECTIVES: To investigate various factors that can mediate stress and response, such as coping style, social support, level of perceived stress, and psychopathology(especially anxiety and depression) of the functional dyspepsia(FD). METHODS: Thirty adults with functional dyspepsia were compared to thirty healthy adults who had visited the hepatobiliary clinic due to non-organic complaints(tiredness and fatigue) without FD, but the results of medical examination were normal. All subjects were evaluated for anxiety and depressive symptoms, perceived stress, coping style and social support. Symptom Checklist-90-Revision, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, Ways of Coping Checklist, Interpersonal Support Evaluation List, and a self-reporting questionnaire were included to measure the quantity of perceived stressful life events. RESULTS: The FD patients had significantly more symptoms of depression, more perceived stressful life events, demonstrated less problem-focused coping, and less social support than the control subjects. Depressive symptoms of the FD patients were negatively correlated with interpersonal support and were positively correlated with trait anxiety, whereas, problem-focused coping were positively correlated with interpersonal support. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. CONCLUSION: Our results suggest that FD patients need to be evaluated for psychiatric problems, and might benefit from psychiatric treatment with psychotherapeutic and psychopharmacological modalities.

Treatment of Clozapine-Induced Agranulocytosis Associated with Complications / 신경정신의학

The authors reported a case of clozapine-induced agranulocytosis that combined with serious complications in a 37-years-old male patient with chronic schizophrenia. Clozapine-induced agranulocytosis developed on Day 51 of clozapine treatment. The patient was transferred to hematologic department and then treated by massive antibiotics in aseptic room. After the injection of G-CSF, WBC count increased to the normal range. But the day after the normalization of WBC count, patient's general condition was worsened with fever and mild rigidity, and also CK, LDH, BUN/Cr, and LFT was increased. The patient's elevated laboratory findings with those of physical signs and symptoms suggested the neuroleptic malignant syndrome and acute renal failure. Eventually steroid was administered to the patient, and then patient's general condition and laboratory findings were normalized. We suggest that the identification of risk factors and careful regular blood monitoring is the best method for the prevention of clozapine-induced agranulocytosis. After the onset of clozapine-induced agranulocytosis, clozapine should be discontinued immediately and proper antibiotic therapy with administration of G-CSF should be done, as soon as possible. And we emphasize the importance of the education and the establishment of therapeutic relationship with patients and their family also.

A Case of Marchiafava-Bignami Disease with Personality Change / 대한정신약물학회지

Marchiafava-Bignami Disease is a rare disorder characterized pathologically by demyelination of the corpus callosum. This disease could be related with chronic alcoholism although a proven etiology has not been reported. Marchiafava-Bignami Disease (MBD) could cause the fatal acute phase symptoms (seizure, coma, and death), various neurological symptoms (tremor, dysarthria, gait disturbance, apraxia), and cognitive impairments (memory impairment, disorientation). It is also reported that MBD causes a dementia. Approximately 250 cases have been reported regarding the MBD since it was first reported in 1903. However, only 20 cases have revealed a favorable prognosis. We found a case of MBD with personality change and chronic alcoholism subsequent to the repeated improvement and aggravation for 4 years. This case is demonstrated a atrophy of splenium of corpus callosum by Magnetic Resonance Imaging. The case also is diagnosed the personality changes, such as emotional irritability, impulsivity, and indignation-expose due to general medical condition, as described in Diagnostic and Statistic Manual of Mental Disorder 4th edition (DSM-IV). However, in early phase this diagnosis did not revealed. The patient was improved in impulse control and behavior by treatment with the Carbamazepine. We investigate the etiology, pathogenesis, symptom &sign, and treatment regarding the MBD in neuropsychiatric aspect.

Influences of Perceived Stress, Dysfunctional Attitude, Self-Efficacy, Social Support and Coping Style on Maladaptation in the Adolescents with Substance Abuse / 신경정신의학

OBJECTIVES: This study was intended to investigate the influences of the perceived stress, dysfunctional attitude, self-efficacy, social support and coping style on maladaptation in the adolescents with substance abuse. Specifically, two models, vulnerability-stress model and social learning model of substance abuse in adolescents were compared for the power to predict substance abusing behaviors and depression. METHODS: To investigate these objects, the semi-structured interview schedule, and scales for the perceived stress, dysfunctional attitude, self-efficacy, social support, coping style, expectation of substance effect, quantity of substance abuse, problems-related substance abuse and BDI were used. One hundred and fifty eight adolescents with substance abuse were asked to reply to them. The data were analyzed by correlation and multiple regression analysis. RESULTS: The results were as follows 1) Among each variables of the adolescents with substance abuse, quantity of substance abuse had significantly high correlation with problems-related substance abuse, quantity of using of substance by friends, perceived stress, avoidant coping, positive expectancy, negative expectancy, self-efficacy. Problems-related substance abuse had significant high positive correlation with perceived stress, positive expectancy, negative expectancy and self-efficacy. Interaction effect of perceived stress, coping style and social support were statistically significant. Main effects of effect of substance abuse were significant. 2) (1) Vulnerability-stress model predicted 16.6% of variances on problems-related substance abuse and social learning model, 18.4%. (2) Vulnerability-stress model predicted 16.9% of variances on quantity of substance abuse and social learning model, 30.5%. 3) Vulnerability-stress model predicted 18.8% of variances on depression and social learning model, 4.7%. CONCLUSIONS: The result of this study indicated that vulnerability-stress model was superior in predicting depression and social learning model was superior in predicting quantity of substance abuse. Two models were equal in problems-related substance abuse.

Visual Hallucinations in Schizophrenic Patients / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate actual visual hallucinations as perceived by 40 schizophrenic patients and, subsequently, to explore their psychopathology in order to assist clinicians in more effectively evaluating and treating the visual hallucination. METHODS: With the authors guidance, the content and meaning of pictures drawn, according to their perceptions, by 40 schizophrenic patients were evaluated in conjuction with an examination of the patient's emotional reaction and associated behavior. The results from the visual hallucination group were analyzed and then compared with non-visual hallucinatory control group using the Brief Psychiatric Rating Scale(BPRS) On this basis, the authors investigated the correlations between patients' strength of confidence non-visual hallucination, frequency of visual hallucination, mean duration of an episode and the score of BPRS, and the correlation between meaning of visual hallucination and the tripe of patient's delusion. finally the authors attempted to derive correlation among the items of BPRS. RESULTS: 1) The content of visual hallucination was mostly non-human and mythologically exhibiting anthropomorphic qualities while its meaning was frequently persecutory. In addition, the visual hallucinations experienced by the subjects were most often close to or within the patients' ordinary visual range with mean duration of halluinatory episodes ranging from 1 to 5 minutes. The most frequent reaction of patients is a negative emotional response and the most frequent overt behavior was either verbal or restricted physical activity. 2) There was a positive correlation between the meaning of the visual hallucination and the type of patients' delusion. 3) The group having visual hallucinations had more frequent anxiety, hallucinatory behavior and unusual thought content compared to the non-visual hallucination group. 4) There were positive correlations between patients' strength of confidence in visual hallucination and halluculatory behavior and among anxiety, tension, motor retardation and mean duration of episodes of visual hallucination. 5) There were positive correlations between hallucinatory behavior and anxiety, hallucinatory behavior and mannerism and posturing, hallucinatory behavior and excitement, and hallucinatory behavior and motor retardation. Also, there were positive correlations between motor retardation and tension, blunted affect and tension, and between emotional withdrawal and tension among each item of BPRS in the visual hallucination group. CONCLUSION: In this study of visual hallucinations in schizophrenics, the authors concluded that it is helpful for clinicians to evaluate how schizophrenic patients experience their visual hallucination.