• Korean Journal of Psychosomatic Medicine
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• v.28 no.2
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• pp.116-125
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• 2020

Objectives : Self-poisoning is the leading cause of visits to the emergency departments after a suicide attempts. This study is aimed to compare the patient characteristics according to the category of drugs ingested by the patients who attempted suicide. Methods : All medical charts were retrospectively reviewed from patients who visited the emergency center, at Seoul Medical Center, due to intentional self-poisoning from April of 2011 to July of 2019. We investigated the information regarding the subtype and quantity of the intoxication drug, how it was obtained, suicidal history, and psychiatric history, as well as, sociodemographic information. Variables were compared between prescription drug (PD) and non-prescription drug (NPD) poisoning groups. Results : The mean age of the NPD poisoning group was significantly lower than that of the PD poisoning group. The patient ratio of those enrolled in national health insurance and living with spouses were significantly higher in the NPD poisoning group. Compared to the NPD poisoning group, the PD poisoning group had a higher incidence of mental illnesses, underlying diseases and ratio of involuntary visit to the emergency department. Among the prescription drugs, the benzodiazepine poisoning group had a higher rate of self-prescription than the non-poisoning group, while the zolpidem poisoning group had a higher rate of the using someone else's prescription than other drugs. Each single drug poisoning group (benzodiazepine, zolpidem, and antidepressant single-agent) had a higher rate of no mental illness than each of the mixed-poisoning group. Conclusions : Guidelines for regulating non-prescription drugs are needed as a matter of suicide prevention. Also, this study suggests that clinicians need to be careful when issuing prescriptions and should suicidal risk according to patients' characteristics, duration of follow-up and type of drug packaging.

• Korean Journal of Biological Psychiatry
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• v.7 no.1
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• pp.85-98
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• 2000

Objective : There are four possible explanations for the sexual dysfunction of schizophrenics. The first is the possibility of a real structural aspect. The second possibility is that sexual function changes secondary to the illness. The third possibility is that there are medical and sociocultural barriers to sexual expression for chronic schizophrenics. The fourth possibility is that sexual dysfunction due to antipsychotic medication. However, we didn't know the precise cause of sexual dysfunction in schizophrenics. Therefore, the purpose of this study was to explore the mechanism of illness itself and antipsychotics on sexual dysfunction in male schizophrenics. Methods : The serum prolactin(PRL), testosterone(TST), and the plasma serotonin(5-HT) concentrations were measured by radioimmunoassay and high performance liquid chromatography method for 100 healthy male schizophrenics according to the DSM-IV. Concomitantly, the severity of psychotic symptoms using Clinical Global Impression(CGI), Brief Psychiatric Rating Scale(BPRS), Positive and Negative Syndrome Scale(PANSS), and the severity of side effects for antipsychotics using Extrapyramidal Side Effects Scale(EPSE), Anticholinergic Side Effects Scale(ACSE), the cognitive function using PANSS-Cognitive Function(PANSS-CF), Mini Mental State Exam-Korean(MMSE-K), and the sexual dysfunction using Sexual Functioning Questionnaire(SFQ), Questionnaire for Sexual Dysfunction in Men were assessed. The PRL, TST, and 5-HT levels of 50 healthy male controls who had no medical, neurological, and psychiatric illnesses were evaluated. The sexual function using SFQ(items FGa, FNa) were also assessed. Furthermore, the correlation with age, education, religion, economic status, age at onset, duration of illnesses, duration of admission, levels of PRL, TST, 5-HT, antipsychotic dosages, potency, benztropine, total duration of medication, EPSE, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K and sexual dysfunctions were identified in male schizophrenics. Results : 1) The frequencies of sexual dysfunctions for schizophrenics(80%) were significantly(p<0.001) higher than those for controls(42%). The sexual dysfunctions according to sexual response cycle were 'low sexual desire' 76%, 'impairment of achieving erection' 75%, 'impairment of maintaining erection' 75%, 'impairment of obtaining orgasm' 32%, 'impairment in the quality of orgasm' 61%, 'impairment in quantity of ejaculate' 44%, 'premature ejaculation' 15%, and 'delayed ejaculation' 50%. 2) The PRL, 5-HT levels of schizophrenics($28.5{\pm}20.6ng/ml$, $298.5{\pm}89.1ng/ml$) were significantly(p<0.001) higher than those of controls($10{\pm}5.6ng/ml$, $169.2{\pm}37.8ng/ml$), while the TST levels of schizophrenics($4.3{\pm}1.5ng/ml$) and controls($4.5{\pm}1.2ng/ml$) were not significantly different. The sexual dysfunctions of schizophrenics who had abnormal 5-HT levels($4.7{\pm}1.3$ scores) were significantly(p<0.05) higher than those of who had normal 5-HT levels($3.8{\pm}1.6$ scores) on item D7. 3) The sexual dysfunctions of unmarried schizophrenics were significantly(p<0.01 : p<0.05) higher than those of married schizophrenics($6.1{\pm}2.8$ scores, $4.7{\pm}1.3$ scores on item FGa : ${\beta}$=-0.211 on item FNa). The sexual dysfunctions were positively correlated with the rise of 5-HT levels(r=0.209, p<0.05 on item D4 and r=0.241, p<0.05 on item D7), the higher age at onset(r=0.275, p<0.01 on item FNa : r=-0.202, p<0.05 on item FDa), the longer duration of illnesses(r=0.237, p<0.05 on item D6), the longer duration of admission(r=0.234, p<0.05 on item D4 : r=0.328, p<0.05 on item D6), the longer total duration of medication(r=0.237, p<0.05 on item D6). However, age, education, religion, economic status, PRL, TST levels, antipsychotics dosage, potency, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K scores were not correlated with increased sexual dysfunctions. Conclusions : Male schizophrenics have significantly more sexual dysfunction to compare with controls. The higher frequencies of sexual dysfunctions were low sexual desire and erectile disorder. The unmarried, higher age at onset, and longer duration of diseases were positively correlated with increased sexual dysfunctions. Also high 5-HT levels were positively correlated with increased sexual dysfunctions. This means that studies of plasma 5-HT levels, albeit questionable indicators of central 5-HT function, offer some additional support for the association of sexual dysfunction with excess 5-HT activity as primary pathology of schizophrenia. Our findings suggest that excess 5-HT activity seems to affect the patient's sexual function.

• Research in Community and Public Health Nursing
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• v.7 no.2
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• pp.183-202
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• 1996

This study was designed out to develop a home health care service for nurses working in community care services. This study investigates actual conditions at welfare institutions related to health needs the demands of clients, and the state of home health care services we hope that this study will improve upon the current service system. In Korea home health care services are still developing and only new becoming a part of the health care supply system. The data was collected by recording the client home nursing assessments modified to the situation of UTMB home health agency. In this study 107 clients were selected for home care who needed care for physical and mental deficits. The study lasted from March to November of 1995 at one of the welfare service institutions in Chunchon city. The results show that those who most frequently needed care services were over 50 years old with a health deficit of 80.3%, followed by sex as women who needed care at 59.8%. 50.5% of the clients had very little education. 99.1% of the clients live with their family, and a medical diagnostic analysis reveals that 73.9% of the 5 year period of illnesses were the following : 38.8% - muscular -skeleton system disorder, 24.4% - hypertension and stroke, 25.7% sole disease of arthritis. For behavioral conditions 43.3% of the patients were without care services, 56.6% of the patients were taking treatment that 73.5% of those were taking medication. The most main complaint of patients were 22.4% of pain in the extremities, next were 16.8% of a limitation of body activities, 15.0% was lumbo-sacralgia. According to the investigator who was a senior student nurse, the following suggestions were made: 32.7% for curative medical services, 29.9% for physical exercise, 19.6% for emotional support. Consultation nursing services consisted of 67.2% for physical therapy, 11.2% for the maintaining healing, 9.4% for counseling. The patients at home, required assistance most frequently for muscular-skeleton problems under the category of physical systems (33.3%). But, on the other hand, 49.5% of the patients required care givers at home, 28.2% had a knowledge deficit, 21.0% had malnutrition, 18.4% had bad impaired communication. The character of health problems were devided into chronic disease(67.0%), accidents(I3.1%), and general disease(15.9%). 86% of the disabled client had an impairment of the physical system. Eating (86.9%) , Toileting(77.6%), and personal care showed much the same of ADL condition, the level and range of achievement of mobility, the most frequently self performed was 81.3% only in a room size area, and 40.2% were completely dependent when going out. Although there were a large number of home care services in th community at these welfare institutions, many clients needed a variety of curative services. As policy changes have gathered momentum, responsibility for the development of a more suitable program was demanded by the clients from the community.

• Clinical and Experimental Pediatrics
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• v.53 no.5
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• pp.648-652
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• 2010

Purpose: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. Methods: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea. Results: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were $S$ $intermedius$ (n=3), $S$ $aureus$ (n=3), $S$ $pneumoniae$ (n=1), Group B streptococcus (n=2), $E.$ $coli$ (n=1), $P.$ $aeruginosa$ (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. Conclusion: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.

• Korean Journal of Biological Psychiatry
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• v.4 no.2
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• pp.198-210
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• 1997

To examine the double-faced thymoleptic(antidepressant and antimanic) effects of risperidone in mood disorders, this article reviews the psychotropic-induced mania, thymoleptic effects of antipsychotics, therapeutic effects of risperidone and risperidone(RIS)-induced mania(RIM) in mood disorders, risk factors of RIM, possible neurochemical mechanism of these thymoleptic effects, pathophysiological and clinical significance of thymoleptic effects, and suggestive clinical guideline of RIS in mood disorders. RIS appeared effective for bipolar disorder at a lower dose than that recommended for schizophrenia, especially in the cases of maintenance of mood stabilizers, and gradual titration from low doses. Manic induction/exacerbation can occur by chance during RIS treatment in mood disorders, schizoaffective disorders, and schizophrenias. The possible risk factors for RIM are refractory mood disorder, especially in bipolar I disorder with poor initial response ; refractory schizoaffective disorders, especially in bipolar type with poor initial response ; refractory chronic schizophrenias, especially with initial responses ; psychotic features ; higher initial doses ; rapid titration ; combined therapy with antidepressants in refractory depression ; and RIS monotherapy in mania/hypomania. RIS is a drug that preferentially block 5-HT2 receptors. The effects of low dose are due mainly to the blockade of 5-HT2 receptors. There are more gradual increase in D2 blockade with increasing dose and this D2 blocking properties become apparent at higher doses. This may be related to a modulation of dopaminergic transmission by 5-HT2 antagonism at lower doses with the direct action of RIS on DA receptors coming into play at higher dose. The serotonergic antagonistic effect may be important for its effects on depressive symptoms. This, together with adequate blo-ckade of D2 receptors, may not necessarily lead to destabilization of mood disorder, but rather to more therapeutic effects. Therefore, this dose-receptor affinity relationship with both antidepressant and antimanic effects according to treatment duration can explain a continuum of antidepressant effect, antimanic effect, behavioral stimulation, and manic/hypomanic induction/exacerbation. It was the recognition of a useful psychiatric side effects by a thoughtful observer with fertile minds that led to their ultimate utilization as psychotropic drugs, i.e., phenothiazine, MAOI, TCA, and lithium. And, in vivo pharmacological challenge by novel psychotropics, as a neurochemical probe, with more specific actions is a useful tool to select pharmacologically homogeneous subgroup of the same phenotypical(clinical) condition, to further study the unknown underlying pathogenesis of various mental illnesses. Finally, RIS may be a useful alternative or adjunctive drug for patients with mood disorders without psychotic features or refractory to treatment with standard antipsychotic drugs. The more conservative doses(tirated slowly from 1-3 mg/d) of RIS, and maintenance of mood stabilizer in the cases with risk factors of RIM are recommended in mood disorder.

• Journal of Korean Academy of Nursing
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• v.26 no.3
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• pp.709-729
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• 1996

This study was done to analyze the trends of research on coping in Korea, to suggest future direction, for research on coping, and ultimately to contribute to an increase in explanation of adaptation. This article reviewed 79 nursing research papers on coping done since 1978 by examining them according to the period of publication or presentation, research design, type of subjects, measurement instruments, research for a degree or not, range of reliability, and association of coping and related variables. The results are as follows : The number of studies on coping increased rapidly from the mid-1980's and decreased slowly from the mid-1990's. The maority of the studies were surveys, comparative studies, or correlational studies. The subects of the 46 studies were healthy people, while those in the remaining studies were patients with a variety of illnesses. Thirth-eight studies on coping were done for master's thesis, three for dissertion, and 38 were not degrees. The Bell and Jalowiec coping scales have not been used since the early 1990's. In contrast, Lazarus and Folkman's W.C.C.L. has been used increasingly since that time. The reliabilities of the coping scale were reported in 37 cases and the Cronbach's alpha coefficients were .71 to .86. All subjects reported using more problem-oriented coping than emotion-oriented coping in short-term or emotion-oriented coping and healthy groups did more long-term coping. It was difficult to describe consistently the relationship between stress and coping according to the type of coping scale or research subjects, but generally moderate relationships were found. This was due to instrumental problems and no consideration of situational context. The subject group who used more short-term coping and less long-term coping reported poorer mental status, and higher scores in burnout and state anxiey than others. That is, the relationship between stress and adaptation increased the power of explanation with intervening the mediating effect of coping. The association of locus of control, mastery, social support, and self-concept with coping showed positive relationships : those of uncertainty and severity in illness with coping showed negativerelationships ; those of state anxiety and depression with short-term coping were positive, and those of self-esteem with long-term coping or problem-oriented coping were negative. There were significant differences in the scores of types of coping according to religion, level of education, and socio-economic status. That is, Presbyterians and Catholics, those with higher education levels and higher socio-economic status used more long-term or problem-oriented coping. On the basis of the above findings the following recommendations are made : 1. There is a need to test the mediating effect of coping variable in order to clarify the concept. 2. Longitudinal studies are needed to determine the patterns of change in coping strategies when stressful events are encountered. 3. It's necessary to develop a reliable and variable measurement tool for coping. 4. There is a need to identify subscales of coping to increase explanation of variance 5. It's necessary to consider personal, situational, and antecedent variables : the characteristics of subject populations, the natures of illness and treatment situations. 6. The power of explanation of studies designed to identify the stress-adaptation process should be increased using the combination model of process-oriented coping and cognitive-structural model.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.2
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• pp.112-118
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• 2018

Objectives : Delirium is one of the most common mental illnesses that can affect cognitive function. Melatonin has been shown to be effective in the treatment of insomnia, and recent studies have shown a protective effect to prevent delirium. This study was conducted to investigate the efficacy of melatonin in delirium patients. Methods : All patients were referred to psychiatric department for insomnia and symptoms of delirium, and were diagnosed delirium by the DSM-5 diagnostic criteria. We compared base line severity of delirium with K-DRS-R-98-R (Korean version of Delirium Rating Scale revised 98) and after taking 2mg of melatonin, retrospectively. The side effects were also identified by referring to the medical records. Results : A total 21 patients had taken melatonin for insomnia and delirious symptoms. The K-DRS-R-98 scores were decreased from $15.24{\pm}2.64$ before treatment to $6.57{\pm}5.42$ after treatment. And CGI-S scores were also decreased from $4.14{\pm}0.48$ before treatment to $2.81{\pm}0.93$ after treatment (p<0.05). Conclusions : This study illustrates the possibility of melatonin as an effective treatment option for delirious symptoms such as disorientation, motor agitation, lability of affect and hallucinations as well as insomnia, with less concerns of drug side effect. Further study with a larger sample and prospective design will be required to confirm these results.

• 한국노년학
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• v.28 no.4
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• pp.1179-1200
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• 2008

Knowledge about somatization (somatic manifestation of psychological distress symptoms) among immigrant populations is limited. While several studies have recognized somatization as a culturally distinctive expression of depression amongst older Korean immigrant population, somatization has not been incorporated into the comprehensive empirical model for depression of this population. In order to improve our general understanding of the phenomenon, the objective of this study is to empirically investigate principal contributing factors of somatization as well as inter-relationships among them. Data were collected from a cross-sectional community survey of 234 older Korean immigrants ($$age{\geq_-}55$$) in the New York metropolitan area. The statistical methodology employed a robust hierarchical regression procedure that iteratively downweights outliers. The results indicated that living arrangement, greater numbers of physical illnesses, and depression were significant explanatory factors of somatization. Furthermore, physical illness had a significant joint effect with perception of health on somatization, which confirms that positive perception of health exerts a moderating effect on the relationship between physical illness and somatization. The knowledge obtained from this study will contribute toward extending our knowledge on somatization and implementing more culturally sensitive mental health services for this population.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.1
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• pp.8-16
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• 2021

Purpose: This study was conducted to analyze the social factors influencing the 'authenticity of suicidal ideation' based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion: The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

• Journal of Ginseng Research
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• v.46 no.1
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• pp.62-70
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• 2022

Background: Maternal Toxoplasma gondii (T. gondii) infection during pregnancy has been associated with various mental illnesses in the offspring. Ginsenoside Rh2 (GRh2) is a major bioactive compound obtained from ginseng that has an anti-T. gondii effect and attenuates microglial activation through toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling pathway. GRh2 also alleviated tumor-associated or lipopolysaccharide-induced depression. However, the effects and potential mechanisms of GRh2 on depression-like behavior in mouse offspring caused by maternal T. gondii infection during pregnancy have not been investigated. Methods: We examined GRh2 effects on the depression-like behavior in mouse offspring, caused by maternal T. gondii infection during pregnancy, by measuring depression-like behaviors and assaying parameters at the neuronal and molecular level. Results: We showed that GRh2 significantly improved behavioral measures: sucrose consumption, forced swim time and tail suspended immobility time of their offspring. These corresponded with increased tissue concentrations of 5-hydroxytryptamine and dopamine, and attenuated indoleamine 2,3-dioxygenase or enhanced tyrosine hydroxylase expression in the prefrontal cortex. GRh2 ameliorated neuronal damage in the prefrontal cortex. Molecular docking results revealed that GRh2 binds strongly to both TLR4 and high mobility group box 1 (HMGB1). Conclusion: This study demonstrated that GRh2 ameliorated the depression-like behavior in mouse offspring of maternal T. gondii infection during pregnancy by attenuating the excessive activation of microglia and neuroinflammation through the HMGB1/TLR4/NF-κB signaling pathway. It suggests that GRh2 could be considered a potential therapy in preventing and treating psychiatric disorders in the offspring mice of mothers with prenatal exposure to T. gondii infection.