• Korean Journal of Biological Psychiatry
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• v.18 no.4
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• pp.203-209
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• 2011

In medicine, general clinical practice moves in the direction of early detection and intervention for the prevention of progressive disease. In psychiatry, research in subjects with the risk syndrome for psychosis, has been conducted for the prevention of schizophrenia, known as a devastating chronic disease. The inclusion of 'attenuated psychosis syndrome', based on the results of early intervention studies, is one of the major issues in the upcoming DSM-V. Further investigations are needed to find biological markers and endophenotypes to supplement the diagnostic criteria. In the future, adoption of clinical staging is promising to overcome the shortcoming of current diagnosis of schizophrenia. In clinical practice, more concerns are needed about attenuated psychotic symptoms which might be risk signals for the transition to psychosis.

• Korean Journal of Psychosomatic Medicine
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• v.16 no.2
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• pp.69-74
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• 2008

Delirium is an organic psychiatric syndrome characterized by an acute onset, prominent disturbance of consciousness and cognitive impairment with fluctuating course. Although there is not a clear consensus concerning the optimal classification system for delirium subtypes, Lipowski(1983) firstly classified delirium by psychomotor activity, namely hyperactive, hypoactive, and mixed. According results of several following studies, prevalence of hypoactive delirium were not less than that of hyperactive delirium. But a diagnosis of hypoactive delirium often missed, which is most frequently misdiagnosed as depression and dementia. Hyperactive delirium can be caused by alcohol or benzodiazepine withdrawal, would be related with excessive dopamine and cholinergic deficiency, and is more responsive to high-potency antipsychotics therapy. Hypoactive delirium would be caused by metabolic encephalopathy, and tends to present a less responsiveness to antipsychotics and poorer overall prognosis with a prolonged duration of admission than hyperactive delirium. Delirium is not a homogenous syndrome. Because of different subtypes, it may have dissimilar underlying pathogenetic pathways. So different treatment strategies between various subtypes may be needed.