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Clinical Subtypes of Delirium (섬망의 임상적 아형)

  • Seo, Jeong-Seok;Moon, Seok-Woo;Kim, Tae-Ho;Nam, Beom-Woo
    • 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.

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The effect of agarwood inhalation using an electric incense burner on stress and brain waves (전기향로를 이용한 침향 흡입이 스트레스와 뇌파에 미치는 영향)

  • Park, Hyun-Duck;Weon, Hee Wook
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.22 no.3
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    • pp.536-545
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    • 2021
  • This study was conducted to investigate the effect of agarwood (Thymelaeaceae) inhalation using an electric incense burner on stress and brain waves. Sixteen participants were included in the study during the period from September 2019 to April 2020. Participant recruitment was undertaken by the 'H' center. This paper focused on stress reduction and compared the differences in stress and brain waves before and after agarwood inhalation using an electric incense burner. Electroencephalography was measured by a 19 Channel, Brainmaster Discovery, and analyzed using a NeuroGuide, LORETA (Brain Mapping). The analysis of technical statistics was carried out using SPSS/WIN 21.0 and the Wilcoxon signed-rank test. The study observed that the stress response index was reduced by a significance level of 0.01 in patients with anxiety, depression, and somatization disorders after agarwood inhalation. Secondly, alpha waves were increased by a significance level of 0.05, in 18 out of 19 regions measured, except FP 1. The difference after agarwood inhalation was the most significant in the region that affects emotion. Thirdly, a LORETA analysis found that alpha waves were increased in the brain region (BA 40) predominantly responsible for memory and emotion. This result clarifies that agarwood inhalation using an electric incense burner reduced stress and had a positive effect on brain waves and hence, has potential as an alternative therapy.

The Effect of Korean version of Mindfulness-Based Stress Reduction Program on Chronic Pain of Workers. (한국형 마음 챙김 명상에 기반한 스트레스 감소 프로그램이 만성통증에 미치는 효과)

  • Susie Kim ;Sang-sub Ahn
    • Korean Journal of Culture and Social Issue
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    • v.15 no.3
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    • pp.359-375
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    • 2009
  • This study developed a program that integrated MBSR-K and progressive muscular relaxation for the health and well-being of patients with chronic pain, and proved its effectiveness by studying 40 chronic pain patients. This program used nature of mind, body scanning meditation, breath meditation, mindfulness meditation, Hatha yoga and progressive muscular relaxation to ease chronic pain. Whenever negative feelings and emotions such as fear, anxiety, and pain occurred, the program focused on those emotions and observed the outcome. This program, which was based on the results of the preceding studies, was composed of eight courses. Major findings of the study are as follows: First, the meditation group that was composed of patients with chronic pain had significant decrease of physical symptoms compared to the control group. Second, to confirm the outstanding features of the participating patients with chronic pain that brought change in the effect of the program, characteristics of clients were analysed. Third, the program factor that influenced the effectiveness of the treatment process was evident when the training was performed twice a week rather than having once a week of training and second week for homework.

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THE CHARACTERISTICS OF CHILD AND ADOLESCENT INPATIENTS WITH SEVERE OBSESSIVE-COMPULSIVE DISORDER (심각한 소아 ${\cdot}$ 청소년 강박장애로 입원한 환아들의 특징)

  • Hwang, Jun-Won;You, So-Young;Chang, Jun-Hwan;Shin, Min-Sup;Cho, Soo-Churl;Hong, Kang-E;Kim, Boong-Nyun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.15 no.2
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    • pp.143-151
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    • 2004
  • Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.

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From Trauma To growth: Posttraumatic Growth Clock (외상 후 병리에서 성장으로: 외상 후 성장 시계)

  • Lee, Hong-Seock
    • Korean Journal of Cognitive Science
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    • v.27 no.4
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    • pp.501-539
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    • 2016
  • The human mind is a self-evolving system that develops along a multidimensional hierarchical pathway in response to traumatic stimulus. In absence of trauma, a mind integrated in conflict-free state is called monistic. When the monistic mind responses to a traumatic stimulus, a response polarity forms toward stimulus polarity within the mind, turning it into a bipartite structure. Dialectical interaction between the two opposites, originating from their incompatibility, creates a new third polarity in the upper dimension. Thereby, the mind turns into a trinity structure. When the interaction among the three polarities becomes optimized, the plasticity of the mind gets maximized into the "far-from-equilibrium state," and the function of three polarities is synchronized. Through this recalibration, the mind returns back to its monistic structure. If the mind with the recurred monistic structure responds to another traumatic stimulus, this cycle of hierarchical transformation repeats itself in this cyclical and fractal growth process through synchronization of basic trinity system. Applying this concept to the process of post-traumatic growth (PTG), this paper explores how the mind transforms traumatic experiences into PTG and proposes a 'PTG Clock' that shows a fundamental sequence in the development of the human mind. The PTG Clock consists of seven hierarchical phases, and each of the first six phases has two opposite sub-phases: shocked/numbed, feared/intrusive, paranoid/avoidant, obsessional/explosive, dependent/depressive, and meaningless/searching for meaning. The seventh, the synchronization phase, completes one cycle of the mind's transformation, realizing a grand trinity system, where the mind synchronizes its biological, social, and existential dimensions. At that point, the mind becomes more susceptible to not only the stimulus of its own traumatic experience but also the pain of others. Thereby, the PTG Clock sets out on a journey to another cycle of transformation in higher dimensions. The validity of this transformational process for the PTG Clock will be examined by comparing it to Horowitz's theory of stress response syndrome.

Effect of Paroxetine and Sertraline Treatment on Forced Swim Test-Induced Behavioral and Immune Changes in the Mouse (마우스 강제수영에 의한 행동 및 면역반응 변화에 대한 Paroxetine과 Sertraline의 효과)

  • Eum, Se-Yeun;Jeong, Min-Ho;Lim, Young-Jin;Kim, Bu-Kyung;Jeong, Soo-Jin;Hahn, Hong-Moo;Choe, Byeong-Moo
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.46-57
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    • 2000
  • Objectives : The purpose of the present study was to examine the effect of subacute treatment with the selective serotonin reuptake inhibitors(paroxetine and sertraline) on immobility in the forced swim test(FST) and on FST-induced changes in immune parameters of the mice. Methods : Authors applied a modified method of FST by Porsolt et al. Over 5 BALB/c mice were used for each group of experiments. To explore the changes in immune parameters by FST, authors investigated the production of anti-rat RBC antibody, concanavalin A(ConA)- or lipopolysaccharide(LPS)-stimulated splenocytes proliferation assay and cytokine gene expression. Results : Both paroxetine and sertraline decreased the duration of immobility in a dose-related manner. FST-performed mice showed a significant decrease in mitogenic responses of splenocytes and a slight increasing tendency in anti-rat RBC antibody response. All these responses were attenuated significantly by paroxetine and attenuated nearly nominal significance level by sertraline. The cytokine profiles of ConA-stimulated splenocytes from FST-performed mice showed stronger expression of IL-4 and weaker expression of IL-2 than control mice, and no changes in the expressions of IFN-$\gamma$ and lymphotoxin. IL-6 and IL-10 were not expressed in both group of mice. The pretreatment of paroxetine and sertraline attenuated the altered cytokine expressions in FST-performed mice to some extent. Some alterations of the expressions of IL-6 and IL-10 were observed in the mice which the selective serotonin reuptake inhibitors had been pretreated. Conclusion : The subacute treatment of paroxetine and sertraline attenuated the FST-induced behavioral and immune changes, and these serotonin reuptake inhibitors may exert some modulating effects on the immune system by the induction of cytokine gene expression, especially IL-6 and IL-10.

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Anti-stress effects of Herbal Acupuncture by Soyo-san on ovariectomized rats (소요산(逍遙散) 약침(藥鍼)이 난소적출 흰쥐의 항(抗)스트레스 작용(作用)에 미치는 영향(影響))

  • Oh, Seung-hee;Park, Hyun-jung;Hahm, Dae-hyun;Shim, In-sop;Lee, Hye-jung
    • Journal of Acupuncture Research
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    • v.22 no.1
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    • pp.117-130
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    • 2005
  • Objective : Generation after generation, by Oriental medicine literatures, Soyo-san has been used as a clinical prescription that is important to climacteric syndrome, and also has been used extensively to psyco-neurotic problems, melancholia and stress symptoms. The experimental study of Soyo-san's effect has been reported, but the effect of herbal acupuncture solution by Soyo-san is not reported yet. Thus the purpose of this experiment is to test whether Herbal acupuncture of Soyo-san have anti-stress or antidepressant effects in the menopause or not. Methods : Female Sprague-Dawley(240-260g) rats were used. Temperature controlled within $20-25^{\circ}C$. Water and food not limited, and Manipulated the day and night 12 hours each. In the experiment, enforced Morris water maze after immobilization stress for 5 minutes, and operating Herbal acupuncture of Soyo-san 30 minutes before stress every day during 7 days. Flowed through by 4% paraformaldehyde and fixed brain tissue after test of 7 days. Results : 1) As a result of the acquisition test, Soyo-san group was recognized by significant difference compared to Ovx group and the retention test Soyo-san group increased significantly compared to Sham and Ovx group. 2) Soyo-san group showed that the degree of revealation of Tyrosine hydroxylase decreased comparing to Ovx group in ventral tegmental area and that of Choline acetyltransferase increased comparing to Ovx group in CAI region of Hippocampus. Conclusion : As a result of this experiment to grasp those effects on postmenopausal depression or learing disability and memory disorder, the possibility of Herbal acupunture by Soyo-san is warranted as a suitable treatment to relieve women's monopausal depression and those of stress reaction, improving tearing disability and memory disorder.

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Effects of 12 weeks of home-based exercise program in patients with ankylosing spondylitis (강직성 척추염 환자에 대한 12주간의 가정기반 운동 프로그램의 효과)

  • Cho, Kyoung-Hwan;Jeon, Yunah
    • Journal of the Korean Applied Science and Technology
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    • v.38 no.3
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    • pp.771-785
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    • 2021
  • This study was performed to provide detailed and comprehensive information on inflammation-related blood indicators, joint range of motion, pain scale, and psychological indicators by patient characteristics by performing a 12-week home-based exercise program for ankylosing spondylitis patients. For the purpose of this study, 10 patients with ankylosing spondylitis were selected by age (30s vs. 40s vs. 50s), gender (male vs. female), and duration (less than 5 years vs. 5 years or more). The home-based exercise program was a combination of aerobic exercise and Pilates-based resistance exercise, and was performed 4 times a week for 12 weeks at an intensity of 50-70% of maximal heart rate (MHR). As a result, after 12 weeks of home-based exercise intervention, the blood C-reactive protein (CRP) concentration of patients with ankylosing spondylitis decreased (-35.6%, p=.002), and the blood inflammation level was improved, and each joint (hip, lumbar, cervical) improved mobility (p<.05). In addition, the bath ankylosing spondylitis disease activity index (BASDAI) was decreased by -67% (p=.001) and the visual analogue scale (VAS) was decreased by -64.8% (p=.001), stiffness and pain has been alleviated. In particular, as the degree of depression decreased by -65.5% (p=.001) and the degree of anxiety by -55.2% (p=.003), 12 weeks of home-based exercise improved not only physical changes but also psychological factors. On the other hand, there was no difference in exercise effect according to age, gender, and disease duration in ankylosing spondylitis patients (p>.05). These results suggest that the 12-week home-based exercise applied in this study can be an effective exercise program that can be universally used for ankylosing spondylitis patients regardless of patient characteristics.

The Attitude of the Bereaved Family Attending a Bereavement Memorial Service (사별가족모임과 관련된 사별가족 태도 연구)

  • Jung, In-Soon;Shim, Byoung-Yong;Kim, Young-Seon;Lee, Ok-Kyung;Han, Sun-Ae;Shin, Ju-Hyun;Lee, Jong-Ku;Hwang, Su-Hyun;Ok, Jong-Sun;Kim, Hoon-Kyo
    • Journal of Hospice and Palliative Care
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    • v.8 no.2
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    • pp.143-151
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    • 2005
  • Purpose: Bereavement Memorial Service has been held every year by the hospice team at St. Vincent's Hospital for the purpose of supporting the bereaved family who feel grief and mourning. The purpose of this study is to find out the attitude of the bereaved attending at bereavement memorial service (BMS) and to find out the areas needing improvements to set up better memorial service. Methods: Hospice team sent invitation card to 180 families of patients who admitted and passed away at hospice ward Nov., 2003${\sim}$Oct., 2004. Among them 22 families attended the BMS meeting, which was held on 26th Nov., 2004. The researcher collected data from 22 families with 'Questionnaire' survey. Except identifying data and 2 dichotomy questions, we used open-ended questionnaire. 1 researcher conducted a telephone interview survey in 18 families who couldn't attend at BMS meeting. Results: The median age was 56 (range $16{\sim}19$) and there were 37 females and 3 males. They were patient's wife (22), mother (4), husband (5), daughter (4), mother-in-law (1), siblings (1), brothers wife (1). Duration after bereavement, $1{\sim}3$ months (17) was the highest frequency. 36 families agreed 'the dead experienced the death with dignity'. The reason of agreement to the death with dignity was 'the patient died in preparation' (16). 'the patient died in well-being condition spiritually' (9), 'the patient died in comfort physically (7). 4. persons thought the dead died with indignity. The bereaved defined 'the death with dignity' as follows: 'acceptance of death & death in spiritual well-being' (9), 'death in physical comfort condition' (7), 'the death in psycho-social well-being' (3), non-respondents (10). Most families (21) were still in difficulty to overcome bereavement grief. The answer regarding the method to overcome the difficulty was 'with spiritual sublimation' (13), 'with devotion of oneself in daily life' (10), 'with devotion to mourning as it is' (3). With regard to their attitude to invitation, 'having joy and thanks from hospice team' (21), 'grief' (4), 'suffering' (4). Toward the existence of hesitation about attendance at BMS meeting, the result as follows. Nonexistence of hesitation respondent (34), existence respondent (6), the reason for hesitation was various; 'the meeting reminds me of the suffering times', 'the meeting makes me to recall, and it will be likely to cry', and so on. The needs and feelings to memorial service meeting were various; 'it was meaningful time', 'it was good to recall about the dead', 'more meeting annually' and so on. In respect of the most difficulty after bereavement, in attendant family, 'depression' (10) was the highest frequency, whereas, in non-attendant family, the most difficult thing was 'financial problem/role difficulty (6). Conclusion: This study shows the rate of attendance was high in bereaved whose bereavement duration $1{\sim}3$ month. Most of bereaved were still suffering from bereavement grief within 1 year. Although most families didn't hesitate and felt positive mood to invitation, the rate of attendance was low. Comparing with two groups between attendant family and non-attendant, the latter felt more difficulty in 'financial problem/role difficulty, on the other hand, the former felt difficulty in 'depression'. Hereafter, the additional study about the factor relating to these attitude and needs of the bereaved relating to memorial service will be necessary.

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Personal Growth through Spousal Bereavement in Later Life (노년기 배우자 사별 후 적응과정에서의 개인적 성장)

  • Chang, Sujie
    • Korean Journal of Social Welfare
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    • v.65 no.4
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    • pp.165-193
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    • 2013
  • This study purposes to explore the growing process through spousal bereavement in later life, and to develop the theory. A qualitative research was conducted, and the participants were 17 seniors. The analysis according to Strauss and Corbin's grounded theory(1998), resulted in 143 concepts, 43 subcategories, and 19 categories. Range analysis according to paradigm showed that the causal conditions were 'marital relationships', 'independent/dependent tendencies', and 'emotional readiness for the death of a spouse', and the phenomena were 'depression', 'hopelessness', 'daily stress', 'psychological intimidation', 'regret', and 'sense of being freed'. The contextual conditions that affect these phenomena were 'desire for intimate personal relationships' and 'desire to maintain independence'; the action/interaction strategies to manage the phenomena were 'facing reality' and 'efforts for construction of the new life'; and the mediating conditions that promote or suppress these action/interaction strategies were 'social support' and 'spirituality'. The results were 'reconstruction of the meaning in life', 'increase in self-esteem', 'reinforcement of social network' and 'embrace and acceptance'. Furthermore, when personal growth after bereavement of a spouse was analyzed focusing on changes over time, the growth process consisted of three steps: 'sadness and despair', 'embracing and moving forward', and 'personal growth'. The pattern analyses were performed to typify recurring relations by category, and 5 types were derived. The results of our study show that personal growth after spousal loss is an integrative process in life after crisis, and can be conceptualized as the process of overcoming the despair that immediately follows the death of a spouse, seeking a new life by actively taking control, and discovering a strengthened self.

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