• Korean Journal of Biological Psychiatry
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• v.12 no.2
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• pp.181-188
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• 2005

Objectives:Hwa-byung has been studied clinically for several years and introduced as Korean Culture- Bound Syndrome. However, the definition and the diagnostic method are not yet clarified, and there has not been any sufficient comparative study on this disease entity. This study was conducted to determine the clinical symptoms and the profile of the neurocognitive functions in Hwa-byung(HB) and Major Depressive Disorder(MDD), and We wish to identify any critical factors that differentiate the disorders. Methods:A total of 102 participants were examined, including 34 participants with MDD, 34 with HB, and 34 healthy controls. The MDD and HB patients were recruited from among inpatients and outpatients at the National Medical Center for the period from May to December of 2004. As a major diagnostic tool of MDD, diagnostic reference of DSM-IV-TR was used and as HB's diagnostic tool, We used computerized neurocognitive function test. Psychiatric symptomatology was evaluated by the Beck Depression Inventory(BDI), and Symptom Checkist-90-Revision(SCL-90-R). Oneway ANOVA, Scheffe post-hoc test and Chi-Squre Tests were used for statistical analysis. Results:The participants in three groups did not differ in terms of age, sex, and education. Assessment of BDI indicated that the MDD group had significantly higher total score than the HB group. MDD and HB groups showed significantly higher total scores on the SCL-90-R in comparison to the controls. The MDD group was found to have significantly more symptoms of depression than the HB group, based on the depression subscale of the SCL-90-R. The computerized neurocognitive function test suggest several results 1) Within the memory domain, it was found that one of the two memory tests in MDD and HB groups were significantly impaired in comparison to the control group. 2) Within the attention domain, it was found that only the MDD group was significantly impaired in comparison to the control group. 3) Within the higher cortical function domain, it was found that significant impairment exist in MDD group and HB group compared to the control group; the severity of impairment was found to be more profound in the MDD group than in the HB group. Conclusion:These results suggest that both HB group and MDD group have significantly decreased neurocognitive function than the control group, and neurocognitive function of the HB group is better than that of the MDD group.

• Korean Journal of Biological Psychiatry
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• v.2 no.1
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• pp.131-139
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• 1995

Clozapine, on atypical antipsychotic drug, has been estimated to be a major improvement in the treatment-refractory schizophrenic patients. We evaluated the clozapine efficacy in the treatment of schizophrenic patients who are refractory to classic neuroleptics. The patients were assigned in a prospective, open, comparative trial for 12 weeks. Following an dose titration, 33 inpatients with treatment-refractory schizophrenia diagnosed according to DSM-III-R were given a clozapine(N=17, approximate 300-600mg/day) or haloperidol(N=16, approximate 20-30 mg/day) for 12 weeks. The clinical state was assessed before treatment, and 1st, 4th, 8th and 12th week during treatment using Brief Psychiatric Rating Scale(BPRS) and Positive and Negative Syndrome Scale(PANSS). Assessment of side effects were mode weekly using Simpson-Angus Scale for Extrapyramidal Side Effects and Adverse Events-Somatic Symptoms. Clozapine produces significant improvement than haloperidol on the BPRS and PANSS scores. 77% (13/17) of the clozapine-treated patients were categorized as responders, who showed at least 20% decrease in total BPRS scores, compared with 31% (5/16) of haloperidol-treated patients. Extrapyramidal side effects occurred in only one patient in clozapine group, but nine patients in haloperidol group. Salivation, sleepiness, constipation and hypotension were most frequent adverse effects observed in clozapine group. There was no significant changes in total WBC and neutrophil during clozapine treatment. These findings suggest that clozapine is on effective antipsychotic drug for the Korean treatment-refractory schizophrenic patients, who are nonresponsive to or unable to tolerate classcal antipsychotic drugs due to extrapyramidal side effects.

• Korean Journal of Psychosomatic Medicine
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• v.11 no.1
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• pp.36-43
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• 2003

Objectives: The purpose of this study was to evaluate the difference of cognitve function among patients with posttraumatic stress disorder according to severity of symptoms. Methods: The subjects were 90 psychiatric inpatients and outpatients with posttraumatic stress disorer(by DSM-IV criteria) after traffic accident. The severity of symptoms was assessed by MMPI subscales; depression, psychasthenia, schizophrenia. The impairment of cognitive function was assessed by Korean Wechsler Intelligence Scale(K-WAIS). Based on scores of the MMPI subscales, the patients were divided into high group(above 70 percentile) and low group(below 30 percentile). We estimated the difference of the K-WAIS score and subtest score in the low group and high group of the MMPI subscales by indedpendent t-test. Results: The scores of high group is significantly higher in the subtests of information, vocabulary, similarity, picture completion, and picture arrangement than the low group for psychasthenia subscale of MMPI. And the score of high group is significantly higher in full scale I.Q., verbal I.Q., performance I.Q., verbal subscales except digit span and simiarity, and performance subscales than low group for schiozphrenia subscale of MMPI. Conclusion: It was found cognitive function was more impaired in the group of PTSD with severe symptom compared to the group of PTSD with mild symptoms. We suggest that psychiatrist should consider various cognitive approaches as well as pharmacotherapy in the management of PTSD.

• Korean Journal of Psychosomatic Medicine
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• v.22 no.2
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• pp.87-92
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• 2014

Objectives : Delirium of hospitalized patients is common and it is significantly associated with increased mortality rate. Misdiagnosis rates of delirium are reported in a range of 36.7 to 63% in clinical setting. We aimed to identify the clinical features and symptomatic characteristics associated with misdiagnosis of delirium. Methods : Subjects were 256 inpatients who were referred for psychiatric consultation and diagnosed with delirium by a psychiatrist at a university hospital between January 1 and June 30, 2012. Clinical data were obtained with retrospective chart review. Patients were divided into misdiagnosed group and correct diagnosed group, after reviewing the reason which were described in the consultation request form. Results : Sixty nine(27%) subjects of the 256 patients were referred for other reasons(mood, substance, anxiety, dementia etc.) than "delirium/confusion" by clinician(misdiagnosed group). In misdiagnosed group, use of antipsychotics was more common. There were no differences between the two groups in age, gender, and department of referring clinician. Fluctuation score of DRS-R-98 was higher in the correct diagnosed group. Conclusions : In this study, the risk of misdiagnosis was higher when the patients have taken antipsychotics or less symptom fluctuation. Careful clinical attention is needed for diagnosis for delirium in these patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.237-246
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• 1998

Objectives and Methods：This study investigated clinical characteristics, treatment modality, outcome of 57 children and adolescent inpatients(male 53, female 4) who were diagnosed as pervasive developmental disorder(PDD) by DSM-Ⅳ criteria recent five years. Results：1) The mean age at admission was $96{\pm}28.2$ months, and the mean age at which they first visited treatment facility was $52{\pm}26.6$ months. The mean hospitalization period was $43.7{\pm}31.3$ days. 2) Diagnosis：Twenty-seven(47.4%) of subjects met DSM-Ⅳ criteria for PDD NOS. Fifteen (26.3%) met for autistic disorder, nine(15.8%) met for Asperger's syndrome, and two(3.5%) met for childhood disintegrative disorder. 3) Comorbid diagnosis：The most common comorbid dignosis was attention deficit hyperactivity disorder(23.8%). 4) IQ test：IQ test for twenty-eight subjects was possible. The Average of the subjects was $70{\pm}27.5$. Fifteen(53.6%) of the subjects were approximate or under 70. 5) Neurology Abnormality：EEG findings of eleven(21.2%) subjects were abnormal, brain CT or MRI findings of eight subjects(21.6%) were abnormal. 6) Family Hx：Depressive disorder were found in Eight mothers(14%). Familial loading was found in twenty families(35.1%), and familial loading of PDD was found in three(5.3%). Conclusion：The most important thing for the management of PDD is early detection and early treatment. To do so, multidisciplinary team approach should be emphasized.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.227-236
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• 1998

Objectives：Conduct disorder is one of the most frequent diagnosis in outpatient and inpatient mental health facilities for children and adolescents. This study investigated the clinical characteristics of children and adolescents with conduct disorder. Methods：The study employed a retrospective review of 45 inpatients diagnosed with conduct disorder by DSM-IV criteria at SNUH Child Psychiatric Unit from 1993, March to 1998, September. Results：The results were as follows：1) The sex ratio was 2：1, male dominant. Mean age on admission was $12.8{\pm}2.4$ years old(male：$12.2{\pm}2.3$, female：$14.1{\pm}2.1$). The mean age of male subjects was significantly lower than that of female subjects(p<.05). 2) We classified all subjects according to child- or adolescent-onset type by DSM-Ⅳ. Childhoodonset type was 42.2%, and adolescent-onset, 57.8%. The onset of male subjects were significantly earlier than that of female subjects(p<.05). 3) The most common complaint was 'serious violation of rules'(77.8%) by DSM-Ⅳ dimensions, while the most common single symtom was 'run away from home overnight at least twice while living in parental or parental surrogate home'(48.9%). 4) The comorbid psychopathology of the subjects were frequently described as follows, in order of frequency：substance use(42.2%), ADHD(35.6%), depression(20.0%), tic disorder(11.1%), bipolar disorder(4.4%). 5) On MMPI, both Pd and Ma subscales got the highest scores. The mean of total IQ by KEDIWISC was $100.0{\pm}15.1$. Female subjects' IQ was higher than that of male subjects. 6) Regarding the number of visits to the OPD after discharge, many subjects(33.3%) had visited OPD fewer than four times. Conclusions：In this study, the male to female ratio of adolescent type showed a decreasing trend. An interesting finding was the fact that socio-economic circumstances, as well as the level of education among patients, were higher than those of previous studies. The subjects' problem were also principally self contered and posed no threat to others.

• Korean Journal of Psychosomatic Medicine
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• v.10 no.2
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• pp.154-165
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• 2002

Objectives : The purpose of this study was to identify characteristics of depression in cancer patients treated with chemotherapy. Methods : Subjects were 37 cancer inpatients of oncology in Yeungnam university hospital. BDI and ZDS were done and HDS was performed through semistructured interview. Results: 1) There were no significant differences of depression scale score according to sex, education, religion, marital status. 2) The mean scores of BDI, ZDS and HDS in 37 cancer patients were 18.27${\pm}$7.73, 36.51${\pm}$10.82, 15.14${\pm}$6.60, respectively. 3) HDS, ZDS scores were significantly higher in other cancer group receiving high dose chemotherapy. 4) Item score for depressed mood, diurnal variation(p<0.001), dissatisfaction(p<0.01), physical anxiety, decreased libido, sleep disturbance(p<0.05) were significantly higher in other cancer group than others. 5) Eight patients were diagnosed as having major depressive disorder, 11 as adjustment disorder, and 18 patients had no axis I diagnosis. 6) In major depressive disorder group, the score of the depressed mood item in ZDS was high (p<0.05). HDS item score for depressed mood, work difficulty, anxiey(p<0.001), psychomotor retardation(p<0.01) were significantly higher in major depressive disorder group. 7) In patients with adjustment disorder, ZDS item score of constipation(p<0.001), fatigue, anorexia (p<0.01), emptiness, sleep disturbance, dissatisfaction, weight loss(p<0.01) were high. HDS item score of hypochondriasis(p<0.01), agitation(p<0.01), fatigue, decreased libido(p<0.05) were significantly higher in adjustment disorder group. Conclusion : Some psychiatric disorders, such as adjustment disorder and major depressive disorder were common in the cancer patients in chemotherapy. Psychiatric intervention will increase compliance of cancer treatment and improve the quality of life. This study suggests that it would be important to consider the nature of somatic symptoms in diagnosing depression in cancer patients.

• Journal of Yeungnam Medical Science
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• v.1 no.1
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• pp.67-87
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• 1984

The earliest memories and dreams have been investigated in many aspects; biological, psychological, statistical, and psychotherapeutic, in psychiatric field. The approach methods to these psychic contents are innumerable according to the schools, the collector's attitudes to these materials, the collecting methods and the variable factors of the reporter. In this study the author attempted to compare the distribution of the aggression and dependency themes in these psychic contents among groups of different sexes and clinical diagnoses. In this purpose the author devised new scales, the Aggression and the Dependency Scales for the earliest memories and dreams which are composed of 12-theme classes, according to 3 aspects of the ego attitudes and 4 degrees of the intensity of drives. The scales were tested on a series of the earliest memories and dreams from 100 male medical students by two raters. The interrater reliabilities, measured by kappa method, were all significant at better than the .001 level. The author collected the reports of the earliest memories and dreams from 293 schizophrenics (161 males and 132 females) and 301 neurotics (164 males and 137 females) who were either outpatients or inpatients of 5 general hospitals and 2 private neurospychiatric clinics and from 310 controls (169 males and 141 females) who were either students, housewives or employees in Taegu area during the periods from March to August, 1980 and from April to August, 1983. The author compared the contents of the earliest memories and dreams from these 3 clinical groups on the newly devised scales and the results could be summarized as follows: In general, the contents of the earliest memories showed more differences among diagnostically different groups, while the contents of dreams showed more differences among sexually different groups. The dependency themes were more frequent than the aggression thems in all groups. The aggression themes were more frequent in dreams than in the earliest memories. Of the earliest memory themes, the distribution of the aggression themes was different among clinical groups, i.e., most frequent in schizophrenics, next in neurotics, and least in controls. The distribution of the dependency themes was in reverse order. Attitudes of being attacked were more frequent in schizophrenics. Observing attitudes of dependency need were more frequent in neurotics while gratifying attitudes were more frequent in controls. Highest degrees of aggression and delpendency were more frequent in neurotics. In the distribution of the dream themes, there were some differences among male and female schizophrenics. Aggression themes, especially active and the highest degree of aggression, were more frequent in male sclizophrenics, while dependency themes, especially frustrated themes, were more frequent in female schizophrenics. Among 3 clinical groups, observing attitudes of dependency need were more frequent in female groups, while gratifying attitudes were more frequent in male groups.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.11 no.2
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• pp.209-220
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• 2000

The purpose of this study is to find out the characteristics of depressive episode about major depression and bipolar disorder in child and adolescent. The subjects of this study were 34 major depression patients and 17 bipolar disorder patients hospitalized at child and adolescent psychiatry in OO university children's hospital from 1st March 1993 to 31st October 1999. The method of this study is to review socio-demographic characteristics, diagnostic classification, chief problems and symptoms at admission, frequency of symptoms, maternal pregnancy problem history, childhood developmental history, coexisting psychiatric disorders, family psychopathology and family history and therapeutic response through their chart. 1) The ratio of male was higher than that of female in major depressive disorder while they are similar in manic episode, bipolar disorder. 2) Average onset age of bipolar disorder was 14 years 1 month and it was 12 years 8 months in the case of major depression As a result, average onset age of major depression is lower than that of bipolar disorder. 3) The patients complained of vegetative symptoms than somatic symptoms in both bipolar disorder and depressive disorder. Also, the cases of major depression developed more suicide idea symptom while the case of bipolar disorder developed more aggressive symptoms. In the respect of psychotic symptoms, delusion was more frequently shown in major depression, but halucination was more often shown in bipolar disorder. 4) Anxiety disorder coexisted most frequently in two groups. And there coexisted symptoms such as somartoform disorder, mental retardation and personality disorder in both cases. 5) The influence of family loading was remarkable in both cases. Above all, the development of major depression had to do with child abuse history and inappropriate care of family. It is apparent that there are distinctive differences between major depression and bipolar disorder in child and adolescent through the study, just as in adult cases. Therefore the differences of clinical characteristics between two disorders is founded in coexisting disorders and clinical symptoms including onset age, somatic symptoms and vegetative symptoms.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.56-67
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• 1996

Objectives : This study was designed to find clinical factors that could be differentiated by the lateralization of lesion and also find clinical factors to predict the lateralization of lesion. Methods : The subjects were 65 cooperative inpatients and outpatients with non-traumatic subcortical cerebrovascular disease without neurologic and psychiatric history from January 1995 to September 1995 ; 48 patients in Kyung Hee University, Oriental Medicine Hospital, 35 patients in Anam Hospital, Korea University were examined as subjects, but authors excluded 20 patients whose data were incomplete or who had uncertain lesions on brain CT or MRI. The 65 patients were divided into three groups-group with left hemispheric lesion, group with right hemispheric lesion, group with both hemispheric lesion-according to the finding of brain imaging study. Their cognitive functions were evaluated by the Benton Neuropsychological Assessment(BNA), their subjective neurobehavioral symptoms by Symptom Check List-90-R(SCL-90-R), their objective neurobehavioral symptoms by Neurobehavioral Rating Scale, and their daily living functions by Geriatric Evaluation by Relative's Rating Instrument(GERRl) and Instrumental Activities of Daily Living Scale(IADLs). Results : The results were as follows : 1) The results of cognitive function test indicated that the group with right hemispheric lesion showed low functions in Tactile Form Perception(left), the group with left hemispheric lesion showed low functions in Finger localization(right), the group with right hemispheric lesion showed low functions in Finger Localization(left). 2) Though, there were little significant differences in subjective neurobehavioral symptoms, the group with right hemispheric lesion showed higher scores in all symptoms except hostility. 3) Though, there were little significant differences in objective neurobehavioral symptoms, the group with both hemispheric lesion showed higher scores in cognition, guilty/disinhibition, the group with left hemispheric lesion showed higher scores in lability of mood, the group with right hemispheric lesion showed highest scores in psychotism, neurotism, agitation-hostility and decreased motivation/emotional withdrawal. 4) There were little significant differences among three groups in Daily Living Functions, but the group with right hemispheric lesion showed the lowest functions in Instrumental Activities of Daily Living. 5) As a result of discriminant analysis on each factor's contribution to the prediction of lesion, Finger Localization(left), Phoneme Discrimination and Tactile Form Perception(right) showed that they had the potentiality to predict lesion. Conclusion : The results suggest that there are little significant differences among the groups of three non-traumatic subcortical cerebrovascular disease in cognitive functions, but the group with right hemispheric lesion showed more serious and various changes in subjective and objective neurobehavioral symptoms, and showed low functions in Instrumental Activities of Daily Living. This results suggest the possibility that the decline of the daily living function in the group with right hemispheric lesion were due to various symptoms, not due to cognitive dysfunction. The confirmation of the possibility should be worked out through the follow-up study of some groups containing cortical lesion. Apart from these findings, Finger Localization, Tactile Form Perception(right) and Phoneme Discrimination suggest that they can be used as clinically valuable cognitive parameters that predict the lateralization of lesion in non-traumatic cerebrovascular disease.