Clinical neuropsychological tests were developed originally for the diagnosis of neurological and neuro-surgical diseases. Recently, these tests are being introduced to psychiatric patients. Authors had the experience to use these tests in pychiatric outpatient clinic. Results were as follows. There was a significantly increase in language and attentional function in residual schizophrenia compared to normal control. In chronic neurosis, as visuospatial function was reduced, language and attentional functions were enhanced. With these results, authors suggest that application of neuropsychological tests in psychiatric patients may be very helpful in classifying the subgroups of disease, in selecting the modality of treatment, and in expecting prognosis.
Pak, Doohyun;Hwang, Mingyu;Lee, Minji;Woo, Sung-Il;Hahn, Sang-Woo;Lee, Yeon Jung;Hwang, Jaeuk
Korean Journal of Biological Psychiatry
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v.27
no.1
/
pp.18-26
/
2020
Objectives The aim was to find effective vectorization and classification models to predict a psychiatric diagnosis from text-based medical records. Methods Electronic medical records (n = 494) of present illness were collected retrospectively in inpatient admission notes with three diagnoses of major depressive disorder, type 1 bipolar disorder, and schizophrenia. Data were split into 400 training data and 94 independent validation data. Data were vectorized by two different models such as term frequency-inverse document frequency (TF-IDF) and Doc2vec. Machine learning models for classification including stochastic gradient descent, logistic regression, support vector classification, and deep learning (DL) were applied to predict three psychiatric diagnoses. Five-fold cross-validation was used to find an effective model. Metrics such as accuracy, precision, recall, and F1-score were measured for comparison between the models. Results Five-fold cross-validation in training data showed DL model with Doc2vec was the most effective model to predict the diagnosis (accuracy = 0.87, F1-score = 0.87). However, these metrics have been reduced in independent test data set with final working DL models (accuracy = 0.79, F1-score = 0.79), while the model of logistic regression and support vector machine with Doc2vec showed slightly better performance (accuracy = 0.80, F1-score = 0.80) than the DL models with Doc2vec and others with TF-IDF. Conclusions The current results suggest that the vectorization may have more impact on the performance of classification than the machine learning model. However, data set had a number of limitations including small sample size, imbalance among the category, and its generalizability. With this regard, the need for research with multi-sites and large samples is suggested to improve the machine learning models.
Journal of the Korean Academy of Child and Adolescent Psychiatry
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v.30
no.3
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pp.127-131
/
2019
Many neurologic disorders manifest as psychiatric symptoms. Anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis is an autoimmune disease of the brain characterized by numerous neurological and psychiatric features. Despite being rare, its prevalence is rapidly increasing and early management is critical in ensuring successful and sustainable recovery. Therefore, the illness should be considered as a differential diagnosis when clinically assessing patients. This report presents a case of a female child who was hospitalized for acute psychiatric manifestations, which was later confirmed as anti-NMDA receptor encephalitis. She recovered relatively successfully after combined neurological and psychiatric treatment. This report provides information on the clinical course of early onset anti-NMDA receptor encephalitis, including treatment strategy and prognosis.
Purpose: The purpose of this study was to investigate the importance of initial screening tests for depression and anxiety disorders in children with headache. In addition, this study evaluated whether the Children's Depression Inventory (CDI) and Revised Children's Manifest Anxiety Scale (RCMAS) are suitable for screening symptoms of depression and anxiety. Methods: A retrospective chart review was conducted of 720 children aged 7-17 years who had visited a pediatric neurology clinic for headaches and were referred to a pediatric psychiatric clinic for psychiatric symptoms from January 2010 to December 2011. All patients completed the CDI and RCMAS. Among them, charts of patients with clinically significant total scores (cutoff>15) for psychiatric symptoms, as defined by the CDI and RCMAS scoring scales, were reviewed. Results: Nineteen patients had headaches and clinically significant total scores for psychiatric symptoms. The mean age at headache diagnosis was 11.7 years, and 57% were male. Mean duration of headache was 11.5 months. Two point eight percent of the patients were diagnosed with psychiatric disorders including major depression (1.7%), generalized anxiety disorder (1.1%), and bipolar disorder (0.1%). Four patients (0.6%) were diagnosed with attention deficit/hyperactivity disorder (ADHD). Total mean CDI and RCMAS scores of patients referred to the psychiatric clinic were 18.8 and 22.2, respectively. There was no correlation between CDI or RCMAS total scores and headache frequency, duration, or severity. Conclusion: We recommend that all patients with headache should be screened for depression and anxiety by CDI and RCMAS scores.
Objectives : The evaluation of disability after trauma in psychiatry is relatively subjective compared with other departments. A consensus among evaluators could improve reliability of evaluations. We compared disability rate of common psychiatric disorders without definite brain injury depending on their diagnosis from experienced evaluators in Korea. Methods : A written questionnaire was mailed to each evaluator and the reply was analyzed. The questions included disability rate ranges of postconcussional syndrome, PTSD and depression. Other questions related with admission for evaluation, expected duration of treatment, life expectancy and need of supporting person were also asked. Results : Range of disability rate were from $8.6{\pm}4.5%$ to $26.6{\pm}12.8%$ in postconcussional syndrome, from $10.4{\pm}6.8%$ to $36.4{\pm}13.8%$ in PTSD and from $10.0{\pm}4.6%$ to $30.6{\pm}10.3%$ in depressive disorder. There were lots of diversity in expected duration of treatment with psychiatric disability. Decline of life expectancy and need of supporting person were considered at least 50% of disability. Conclusion : There is much diversity in evaluation of psychiatric disabilities with disability rate and expected duration of treatments even among experienced evaluators. A common consensus among experts may increase reliability of psychiatric evaluations after trauma.
Objectives : It is reported that panic disorder is frequently comorbid with other psychiatric illnesses. The aim of this study was to investigate differences of psychiatric comorbidity according to age of onset of panic disorder. Methods : Three hundred-two patients participated in the study. All the patients were evaluated by clinical instruments for the assessment the presence of other comorbid psychiatric disorders and various clinical features; Korean version of Mini International Neuropsychiatric Interview, Self-report questionnaires(Beck Anxiety Inventory, Beck Depression Inventory, Anxiety Sensitivity Index and State-Trait Anxiety Inventory) and clinical rating scale (Hamilton Anxiety Scale, Hamilton Depression Scale and Global Assessment of Functional score). Chi-square test was used to determine the difference between early onset and late onset panic disorder. Results : Forty percent of panic patients were found to have at least one comorbid psychiatric diagnosis. There were no differences among the groups divided by number of comorbidity in sex, agoraphobia comorbidity, duration of panic disorder, except onset age of panic disorder. Early onset group had more comorbidy with social phobia, agoraphobia, PTSD. We also found that Early onset panic disorder patients were more likely to experience derealization, nausea, parethesia than late onset panic disorder patients. Conclusion : The results of our study are in keeping with previous data from other parts of the world. Our finding suggest that earier onset of panic disorder related to more psychiatric comorbidity.
Depression is a frequently developed psychiatric symptom after stroke. Poststroke depression(PSD) causes not only psychological distress related to depression but also other disturbances in many areas such as cognitive function, activities of daily living and quality of life. Therefore, a comprehensive understanding of accurate detection and appropriate treatment of depression is mandatory in patients with stroke. This review focused on the current knowledge of PSD.
Objectives To examine direct causes of attempted suicides, methods adopted to commit suicide, and psychiatric diagnoses among suicide attempters in South Korea. Methods A total of 1359 suicide attempters who had visited emergency department of 17 medical centers due to suicide attempt from May 2013 to Nov 2013 were interviewed using semi-structured questionnaires. Results Psychiatric symptoms were the most common cause of suicide attempts (62.2%), followed by interpersonal relationships (24.4%). Women attempted suicide more often for interpersonal reasons, whereas men were more likely to do so for financial and job-related reasons. Half of participants (55.8%) attempted suicide by drug intoxication, which was more prevalent among females and those who had previous history of psychiatric disease or previous suicide attempt. Men were more likely to use more lethal methods such as pesticide poisoning and gas inhalation than women. Pesticide poisoning was also prevalent among the elderly group and the rural population. Near ninety-five percent (94.5%) of participants received a psychiatric diagnosis : the most frequent diagnosis was depressive disorder. Conclusions This is the first nationwide study of cases of attempted suicide. When stratified by age groups, gender, urbanicity, living alone or not, presence of physical illness, previous psychiatric history, and previous suicide attempt, there were significant differences with respect to causes, methods of attempted suicides and psychiatric diagnoses of suicide attempters.
Kim, Yong Ku;Lee, Heon Jeong;Kim, Ji Yeon;Choi, So Hyun;Lee, Min Soo
Korean Journal of Biological Psychiatry
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v.6
no.2
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pp.227-234
/
1999
An association of low total cholesterol in blood with psychiatric diseases and suicidal behavior has been suggested. As part of an attempt to further explore this relationship, we examine first, whether serum cholesterol levels in psychiatric patients with suicidal attempt would be lower than in non-suicidal psychiatric inpatients or normal controls, second, whether such significant difference of cholesterol levels would be present when the diagnostic groups are analyzed separately, third, whether low cholesterol level would be associated with a history of serious suicidal attempts, and finally, whether low cholesterol level in suicide attempters is a state or a trait marker. We determined the serum cholesterol levels in 231 patients admitted to an emergency room following an suicidal attempt, in the same numbers of age-, sex- and diagnosis- matched non-suicidal psychiatric controls, and in the same numbers of age-, sex matched normal controls. The seriousness of an attempt was divided into 5 grades according to the degree of the resulting medical injury. Total cholesterol levels in suicide attempters were significantly lower compared with both psychiatric and normal controls, when sex, age, and nutritional status (i.e., body mass index) were controlled for. This significant relationship was observed in major depressive disorders and personality disorders, but not in schizophrenia and bipolar type I disorders. The severity of suicide by a lowering of blood cholesterol was related to the magnitude of the cholesterol reduction. After treatment of their psychiatric ailments, the cholesterol levels in suicide attempters were significantly increased. This result suggests that low cholesterol level in psychiatric patients might be a potential biological marker of suicide risk. It is hypothesized that low cholesterol levels is associated with the suicide by modifying the serotonin metabolism, the production of interleukin-2 and melatonin metabolism in psychiatric patients.
Reports about the prevalence of premenstrual symptoms state that occurs in 20 to 100% of most reproductive-age women. There is a close association between premenstrual syndrome and affective disorders as well as same some other psychiatric disorders. Late luteal phase dysphoric disorder (LLPDD) is a premenstrual condition defined in DSM-III-R by severe mood changes and other symptoms that repeatedly occur only in the luteal phase of the menstrual cycle. However, DSM-III-R does not specify how to compute the change from the follicular to the luteal phase or how to determine when the amount of change is great enough to warrant the diagnosis nor how to determine occupational or social functional impairment. This study was conducted to evaluate the nature, severity and magnitude of premenstrual syndrome in women with current psychiatric disorders by using prospective Daily Rating Form(DRF), and to measure symptom changes according to three scoring methods for diagnosing LLPDD. Our study obtains the data about premenstrual changes estimated by DRF from 22 women with psychiatric disorders who had met criteria for major depressive syndrome on the Premenstrual Assessment Form (PAF). The data was scored by each three methods and was determined to meet criteria A for LLPDD. The results are as follows: 1) the subjects, when scored according to the percent change method, effect size method and absolute severity method, met the DSM-III-R criteria A for LLPDD in 36.4% (8 subjects), 14% (3 subjects) and 4.5% (1 subject) of the cases respectively. 2) The items of irritability, anger and impatience were occurred most frequently on the DRF, when it was scored according to the three scoring methods. And the item of breast pain was next frequent according to the effect size method and the percent change method but according to the absolute severity method. 3) The PAF item of impaired social functioning was reported by 16 (73%) of the subjects. 4) 4 (18%) of the subjects met criteria A for LLPDD and reported impaired social functioning. The prevalency of LLPDD according to each method varied. The percent change method yielded the greatest (36.4%), and the absolute seventy method yielded the laest (4.5%), The effect size method yielded an intermediate frequency (14%). Therefore, for maximizing the diagnostic accuracy of LLPDD, a diagnostic procedure including a measure of change (e.q., effect size method, percent change method) as well as confirmed diagnosis by DRF, will be needed. Also, an accurate tool to evaluate impaired social functioning will be required.
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