• Korean Journal of Psychosomatic Medicine
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• v.12 no.2
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• pp.165-173
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• 2004

Objectives: Diabetes mellitus is a heterogeneous, chronic, progressive disease characterized by hyperglycemia and abnormality in protein, carbohydrate, fat metabolism. Recent studies have reorted two times prevalence of depression in individuals with diabetes compared to individuals without diabetics. This study was designed to investigate glycemic controls, anxiety, alexithymia, stress responses between depressed diabetic patients and non-depressed diabetic patients. Methods The subjects were 60 diabetic patients(mean age : $50.3{\pm}9.7$ years, 31 men and 29 women) who were confirmed to have diabetes depending on the laboratory findings as welt as clinical symptoms at the St. Vincent Hospital Diabetes Clinic, from Mar. 2004 to Sep. 2004. Laboratory test including, blood chemistry. glycated hemoglobin, urinalysis for proteinuria and Korean version of Beck Depression Inventory(BDI), State and Trait Anxiety Inventory(STAI), Toronto Alexithymia Scale(TAS) and Stress Response Inventory(SRI) were used for assessment. Based on BDI scores, all diabetics were divided into 13 depressed-diabetics group(above 20 point) and 47 non-depressed group(below 20 point). We compared demographic data. glycemic controls, STAI, TAS and SRI scores between two groups by independent t-test. Results : 1) Depressed diabetic groups were 13(mean age : $55.4{\pm}7.2$ years, 7 men and 6 women) and non depressed groups were 47(mean age $48.9{\pm}9.8$ years, 24 men and 23 women). In depressed diabetics, compared with non-depressed group, manifested aged(p=0.031), but other demographic data showed no difference between two groups. 2) No significant differences were noted in FBS, PP2h, Hb A1C, total cholesterol, HDL-cholesterol, SGOT/SGPT, BUN levels between depressed and non-depressed groups. But, blood creatine levels of depressed group were significantly increased than non-depressed group(p=0.026). 3) No significant differences were found in the score of STAI, STAI-S, STAI-T, TAS between depressed and non-depressed groups. 4) The SRI scores of depressed groups were significantly higher than non-depressed groups$(59.7{\pm}24.9\;vs.\;31.5{\pm}22.0)(p=0.000)$. Conclusion : The above results suggest that depressed diabetic patients are have more stress responses and higher blood creatine levels. However, there were no differences in laboratory data related to glycemic controls, and anxiety. alexithymia levels between two groups. We suggest that physicians should consider integrated approaches for psychiatric problems in the management of diabetes.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.219-230
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• 2005

Objectives : This study was designed to compare the demographic data, clinical characteristics, developmental delay, and psychological tests between childhood-onset and adolescent-onset schizophrenic in-patients. Methods Medical records of the 17 childhood-onset (very early onset) Schizophrenia and 16 adolescent-onset (early onset) Schizophrenia in-patients were reviewed. Sex, age, psychiatric past history, prodromal symptoms and period, subtype, co-morbid disease, developmental delay, prescribed drug and dosage, treatment response, intelligence quotient (IQ), and Rorschach test were evaluated. Results : The mean admission age of childhood-onset (very early onset) group and adolescent-onset (early onset) group were 12.69$({\pm}2.34)$ and 15.13$({\pm}1.04)$ years. The mean onset age of childhood-onset(very early onset) group and adolescent-onset (early onset) group were 10.79$({\pm}1.95)$ and 14.46$({\pm}0.82)$ years. The mean prodromal period of childhood-onset (very early onset) group and adolescent-onset (early onset) group were 15.94$({\pm}12.33)$ and 8.06$({\pm}6.10)$ month. The time to remission period of childhood-onset (very early onset) group and adolescent-onset (early onset) group were 50.58$({\pm}24.67)$ and 30.06$({\pm}18.04)$ days. Longer time to remission period in childhood-osnet (very early onset) group was associated with earlier age of onset. The mean of total IQ, performance IQ, verbal IQ were at an average level. Discussion : Childhood-onset (very early onset) group and adolescent-onset (early onset) group Schizophrenia had different clinical and psychological features including prodromal period, and IQ subtests.

• Korean Journal of Biological Psychiatry
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• v.4 no.1
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• pp.84-94
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• 1997

This study was done to examine changes of plasma homovanillic acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week clozapine trial and to investigate the relationship between the plasma monoamine metabolites and treatment responses. Twenty-seven chronic schizophrenic patiens were treated for 8 weeks with clozapine. The psychopathology was assessed at baseline just clozapine trial and then every 2 weeks until the end of 8-week clozapine treatment using the Positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured also biweekly using high preformance liquid chromatography with electrochemical detection method. Plasma HVA and 5-HIAA levels were significantly decreased during a 8-week clozapine treatment, although plasma HVA/5-HIAA ratio showed no significant change. The changes of plasma HVA levels were in significant correlations with the changes of PANSS positive scores, of general psychophathology scores, and changes of total socres. The changes of plasma 5-HIAA levels were in signfificant correlations with the changes of PANSS negative scores. But the changes of plasma HVA/5-HIAA ratio had no significant correlation with any PANSS subscale score changes. 48% of the patients treated with clozapine was categorized as responders, who showed at least a 20% decrease in PANSS total socre and a CGI severity score of mildly ill or less(${\leq}3$) at the end pint of the study. The baseline plasma HVA levels and HVA/5-HIAA ratio were significantly higher in responders(N=13) than in nonresponders (N=14). But no significant difference in baseline levels of plasma 5-HIAA was found between responders and nonresponders. At the end point of the study, there was significant difference in the change of plasma HVA between responders(40.3% decrement) and nonresponders(3.1% increment). But no signficant differences in the change of plasma 5-HIAA and the change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. These results suggest that the antipsychotic effect of clozapine on positive symptoms may be associated with dopaminergic blocking activity, and that on negative symptoms may be associated with serotonergic blocking activity. The baseline plasma HVA levels and the change of HVA levels from baseline may be useful predictors of treatment response with clozapine.

• Korean Journal of Psychosomatic Medicine
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• v.31 no.1
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• pp.10-18
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• 2023

Objectives : The purpose of this study is to investigate the characteristics of patients referred for delirium and depressive disorder and to find direction of improvement of consultation-liason psychiatry in general hospital. Methods : We performed a retrospective computed chart review of the 4,966 inpatients hospitalized at Konkuk University Hospital who were referred to the Department of Psychiatry from August 1, 2005 to December 31, 2011. Results : Depressive disorder shows the order of frequency of consultation type Parallel-Complementary-Mending. Delirium shows the order of frequency of consultation type Mending-Parallel-Complementary. When comparing 'follow up consultation' and 'without follow up consultation' group within the depressive disorder, the proportion of men in the 'follow up consultation' group was higher. In the analysis of the consultation type, the 'follow up consultation' group showed the order of consultation type Parallel-Mending- Complementary, and type Parallel-Complementary-Mending in the 'without follow up consultation' group. When comparing 'follow up consultation' and 'without follow up consultation' group within the delirium, the proportion of the surgical field in the 'follow up consultation' group was higher. In the analysis of the consultation type, both group showed the order of consultation type Mending-Parallel- Complementary. Conclusions : Doctors in each department and psychiatrists should pay attention to delirium symptoms that may occur in surgical inpatients and preventive measures should be taken. Screening tests should be conducted in medical patients to properly evaluate coexisting psychiatric diseases. Risk factors of Delirium and Depressive disorder should be identified from the time of hospitalization, and actively discussing treatment plans and early interventions could improve the quality of medical services.

• Journal of Preventive Medicine and Public Health
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• v.23 no.3 s.31
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• pp.296-308
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• 1990

The relationship between copper and mercury contents in the scalp hair and chronic schizophrenia was investigated. The samples of scalp hair were collected from 80 male chronic schizophrenic patients at the age from 20 to 29, who were hospitalized in the National Psychiatric Hospital in Seoul. As the control group, 69 males were collected from general population. Hair samples were taken from the napes and the Minnesota Multiple Personality Inventory (MMPI) was performed also. The copper and mercury contents were determined by an atomic absorption spectrophotometer. Significantly higher T-score of MMPI was seen in patients group for Hypochondriasis Scale (Hs), Depression Scale (D), Psychopathic Deviate Scale (Pd), Paranoia Scale (Pa), Psychasthenia Scale (Pt), Schizophrenia Scale (Sc) subscales than control group, and the frequency distribution by T-score was also significantly different between the patient and the control group for above scales. The content of copper in the hair of patient group was significantly lower than the control group. In the case of mercury, the mean value of patient group was significantly higher than control group. Between the value of copper and mercury, statistically significant negative correlation (r=-0.25) was found. When grouped by the T-score of MMPI, there was no difference of copper contents between T-score subgroup at all MMPI scale. But the mercury contents showed significant difference between T-score subgroup at Pt, Sc scale. When compared between the group of above 70 T-score and the group of less than 70, the mercury contents of Pa, Pt, Sc scale of above 70 T-score group were significantly higher than the group of less than 70. In other scales, the mercury content of the above 70 group were higher than the group of less than 70 except Mf scale, although there were no statistscally significances. In D, Pa, Sc scales, as the T-score of MMPI increased, the contents of mercury also increased. When divided into the patient group and the control group, the copper contents of the patient groups were significantly lower than the control group at each T-score scale in most MMPI scales. In the case of mercury, the value of patient group were significantly higher than the control group in the less than 44 scale of D, in the $60{\sim}69$ scale of Pd, in the $45{\sim}59$ scale of Mf, in the $60{\sim}69$ scale of Ma, in the less than 44 of Si. These results suggest that the effects of the deficiency of copper or high intake of mecury on schizophrenia and personality may be of possible value. Thus further studies are necessary to determine whether schizophrenia and personality formation would be attributed to copper deficiency or mercury intake.

• Research in Community and Public Health Nursing
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• v.10 no.2
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• pp.435-454
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• 1999

The caregiving experiences of 100 family menbers of outpatients with schizophrenia and schizoaffective disorders were investigated for the presence of positive(positive family-patient relationship. patient' contribution to the family) and negative caregiving experience(objective and subjective burden) and their predictors. This study attempts to make the analysis of caregiving experience more useful by expanding the focus to incoporate these positive aspects of the experience of family caregiver. Objective burden consists of two elements: 'disruption of family life', 'care'(amount of caregiving related to activity of daily living). Subjective burden is defined as emotional reactions to the care giving and it comprised of 6 emotional subdimensions such as 'stigma', 'grief'. 'worry', 'pity', 'fear', 'despair'. Also we investigate the severity of patients' disturbing behaviors into two categories, positive and negative disturbing behaviors and patient' contribution to the family as a predictors of positive and negative caregiving experiences. This study use Pearson's correlation coefficient, Hierardhical regressions in the SAS Program. The results are as follows: 1. Respondents reported moderate level of objective burden 'disruption of family life' (mean = 2.48, range = 1-4), and 'care' (mean=2.54, range = 1-4), and slightly high level of total subjective burden(mean = 2.19, range = 1-4). Mean scores for the measure of the severity of behavioral disturbance indicated that the caregiver experienced negative disturbing behaviors around almost 'somtimes'(mean=2.28, range = 1-4), and positive disturbing behaviors 'almost not frequent'(mean=2.78. range=1-4). So they reported that they perceived patient's negative disturbing behaviors more than positive disturbing behaviors. Mean scores for the measure of the patient' contributions (mean = 1.99. range = 1-4) indicated that caregivers experienced these contributions a little. It means that there should be a positive aspect of possibilities of patient' family roles that can be developed in the daily life. Mean scores for the measure of the positive family-patient relationship indicated that caregivers experienced moderate level of positive family-patient relationship(mean=2.52, range = 1-4). 2. Hierardhical regression analysis 1) Hierardhical regression of 'disruption of family life' showed that the interaction between positive disturbing behaviors and patient' contributions (B = .20. p = .022) and caregiver's educational level(B=.06. p=.000) were 'significant and Hierardhical regression of 'care' showed that 'negative disturbing behaviors'(B= .35. p= .007). 'patient' contributions'(B= .28, p= .019). 'family income'(B=-.l1. p=.096) were significant. 2) Hierardhical regression of 'total subjective burden', 'stigma', 'grief', 'worry', 'pity'. 'fear', 'dispair' showed that 'positive disturbing behaviors'(B=.51. p=.000). 'negative disturbing behaviors' (B = .17, p = .026), 'caregiver's educational level'(B = .03. p=.036), 'family income'(B=.08. p=.041) were significant predictors of 'total subjective burden': 'positive disturbing behaviors'(B=.32. p=.066). 'negative disturbing behaviors'(B=.24, p=.096) 'durations of illness'(B= .03. p= .079) were significant predictors of 'stigma' 'negative disturbing behaviors'(B=.28. p=.005). 'patient sex'(B=-.32. p=.022). 'positive disturbing behaviors'(B=.28. p=.020), 'patient age'(B=.02. p=.010), 'caregiver age'(B=-01, p= .002) were significant predictors of 'grief' 'negative disturbing behaviors'(B= .28, p= .005). 'patient sex'(B= -.32. p=.039), 'caregiver age'(B=-.02, p= .023). 'caregiver's educational level'(B= .04, p = .044) were significant predictors of 'worry' 'patient sex'(B=-.46. p=.005). 'negative disturbing behaviors'(B= .28. p=.018), 'caregiver age'(B=-.01, p=.037) were significant predictors of 'pity' 'positive disturbing behaviors'(B=.83. p=.000). 'patient' contributions' (B = .22, p =.017). 'family income'(B=.09. p=.65) were significant predictors of 'fear' 'positive disturbing behaviors'(B=.49, p=.001). 'negative disturbing behaviors'(B= .24. p=.057) 'patient sex'(B=-.4l, p=.017), 'family income'(B=.14, p=.047) were significant predictors of 'dispair'. 3) Hierardhical regression of 'positive relationship' showed that 'patient contributions'(B=.32, p=.000). 'negative disturbing behaviors'(B= .24, p= .005), 'patient sex'(B=-.23, p=.036).

• Korean Journal of Psychosomatic Medicine
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• v.25 no.2
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• pp.145-152
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• 2017

Objectives : There has been long lasting trend of deinstitutionalization and public health centered care in management of individuals with disabling mental illness. We aimed to investigate current vocational rehabilitation state and effectiveness of system in korea. Methods : We carried basic survey via telephone and e-mail beforehand to figure out how many and which institutions are operating vocational rehabilitation programs to psychiatric patients. A questionnaire packages were sent to total of 108 institutions in Korea which were operating occupation rehabilitation program. Results : Of 108 institutions, 40.74% were returned with answers. The person in charge of vocational rehabilitation at each institution was mainly mental health social worker(48.8%), and the budget under \1,000,000 was the majority(61.5%) among surveyed institutions. The most commonly used vocational rehabilitation programs was case management(23.1%), followed by psychosocial rehabilitation program(21.2%), and on-the-job training(17.9%). The most effective program was case management(27.4%), followed by psychosocial rehabilitation program(19.8%), on-the-job training(17.9%). The main barrier of occupation rehabilitation to be conducted widely was 'worries about being excluded from beneficiary of National Basic livelihood Protection Act'. Conclusions : Our results suggest that, in spite of high demand in vocational rehabilitation programs, government financial support is still lacking.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.15 no.1
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• pp.61-74
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• 2004

Objectives：This study was performed to introduce a psychoeducational family therapy model for the families of schizophrenic patient and to investigate the effect of this model on the changes in coping style and depressive symptoms of the family members, and in perception of emotional support by families and depressive symptoms of patients. Methods：Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient at kindergarten, were evaluated for psychological assessments；Intelligence test, MSSB(MacArthur Story-Stem Battery), H-T-P test(House-Tree-Person test). And their parents completed rating scale, KPI-C(Korean Personality Inventory for Children about children’s psychological conditions). Results：With respects to the contents and emotional reactions of MSSB, 9 preschool children showed generally high levels of anxiety, depression, avoidance, aggression, probably related to the traumatic experiences. Even though children couldn't verbally report directly about their traumatic experiences, in both MSSB, structured play narrative assessment tool, and HPT, free drawing and association test, they demonstrated psychiatric problems through reenactment plays, regardless of clinical diagnoses. Conclusion：Present study allowed us the chance to see beyond the outer pathological behaviors of PTSD in preschool children, through deeper evaluations of their mental representation. These preliminary data suggest deep understanding of internal representation would be of help for thorough evaluations and treatment plan for preschool children, experiencing severe trauma.

• The Korean Society of Law and Medicine
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• v.18 no.1
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• pp.297-341
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• 2017

We searched out court rulings on medical affairs through court library search sites and specialized articles on medically relevant judgments sentenced in 2016. And we selected and analyzed the judgements of the court we considered important as follows. In relation to the medical civil judgements, (1) In the case of applying surgery for female infertility during cesarean section operation but it has not been done, we expressed the regret for the lack of judgment in the process of entering the medical contract, introducing the rights infringed and the scope of compensation, (2) We pointed out that the ruling on the medical malpractice estimation goes out of limit of negligence estimation doctrine, and that the court asked very high degree duty of the traditional Korean medicine doctors to cooperate with Western medicine doctors. (3) In the case of admitting hospital's 100% responsibility, we pointed out the court overlooked the uncertainty and good intention of the medical practice. (4) Additionally, We introduced the cases admitted the hospital's responsibility in the accident related to the psychiatric patients in closed ward. Relating to a medical criminal ruling, we analyzed the supreme court decision about whether the dentist's Botox injection on the patient's face is a medical practice within the scope of the license from the viewpoint whether it is within the possible range of the word. And, concerning decisions on healthcare administration, (1) we analyzed the case about when medical personnel operate multiple medical institutions, whether it is possible to get back medical care costs under the National Health Insurance Law, (2) We commented on the ruling regarding explanation obligation in terms of object, degree, subject of explanation as a prerequisite for permissible arbitrary uninsured benefits. Finally, we reviewed the decision of the Constitutional Court about the Article 24 of the Mental Health Law, which it had allowed for a mental patient to be hospitalized forcibly by the consent of two guardians and a diagnosis of a psychiatrist. Also we indicated the problems of the revised Mental Health Law.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.27-33
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• 1997

Retrograde myocardial protection is widely accepted in CABG operation because of the limitations of the antegrade method in the coronary arterial stenosis lesions. We analyzed 76 c ses of retrograde myocardial protection among 96 cases of CABG operation performed between April 1994 and August 1995, There were 48 males and 25 females, and the mean age was 58.2 $\pm$ 8.3 years. 53 patients (70%) were operated for unstable angina, 14 (18%) for stable angina, 6 (8%) for post-infarct angina, 1 (1%) for acute myocardial infarction, and 2()%) for failed PTCA. Preoperative coronary angiography revealed 3-vessel disease in 42 cases, 2-vessel disease in 11, 1-vessel disease in 10, and left main disease in 13 cases. We used SVG(63 cases), LIMA(69 cases), RIMA(11 cases), radial artery(6 cases), and gastroepiploic artery(1 case) for the grafts. Mean anastomosis was 3.2 $\pm$ 1.1. We protected the myocardium with antegrade induction and retrograde maintenance in all the cases except a case of retrograde induction and maintenance. During the aortic cross-clamping, blood cardioplegia was administered intermittently in 19 cases, and continuously in 57 In 39 cases, we used retrograde ardioplegia and antegrade perfusion of RCA graft simultaneously. We had no operative motality. Perioperative complications were arrhythmia in 15 cases, perioperatve myocardial infarction in 10, low cardiac output syndrome In 8, transient neurologic problem in 7, transient psychiatric problem in 6, ARF in 3, bleeding in 2, pneumonia in 2, wound infection in 1, and duodenal ulcer perforation in 1 . In this report, we experienced 76 cases of CABG operation with retrograde myocardial protection under the acceptable operative risk without operative mortality.