• Korean Journal of Psychosomatic Medicine
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• v.30 no.2
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• pp.66-72
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• 2022

Clozapine is accepted as the "gold standard" antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.

• Anxiety and mood
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• v.16 no.2
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• pp.83-90
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• 2020

Objective : Heart rate variability (HRV) is known to reflect autonomic nervous system activity. Individuals with posttraumatic stress disorder (PTSD) are reported to have lower HRVs. We attempted to find HRV indices with head up tilt position that reflect the symptoms well in order to evaluate PTSD symptoms. Methods : Sixty-seven patients with PTSD and 72 patients without PTSD were assessed using the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory, the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index. HRV was measured in the head-up tilt position. We collected data regarding heart rate (HR), standard deviation of the NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), log low-frequency (LNLF) and log high-frequency (LNHF). Results : The value of LNHF was different according to presence or absence of PTSD after head-up tilt position. In the findings of the association between PTSD symptoms and HRV indices as based on head-up tilt, LNHF had a significant correlation with the total score of PCL-5. Conclusion : The reduction of the high-frequency component of HRVs in the PTSD group might reflect more PTSD symptoms.

• Korean Journal of Social Welfare Studies
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• v.47 no.3
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• pp.187-221
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• 2016

This study examines determining factors of effectiveness and satisfaction of Veteran Medical Service Delivery System. Especially, the association between the relevant variables of the effectiveness of the Veteran Medical Service Delivery System and the variables of the satisfaction from the perspective of beneficiaries was studied. Multi-level analysis was utilized to separate results of the evaluation of effectiveness in organizational-level and the evaluation of satisfaction in individual-level. This study tests key posited hypothesis by using survey data collected from 5 medical center of country(Seoul, Busan, Daejeon, Daegu, Gwangju). In terms of the result of the hypothesis testing on the effectiveness variable, integrity(${\beta}=.156$), accountability(${\beta}=.376$, financial sufficiency(${\beta}=.109$), and adequacy (${\beta}=.367$) are the determinants among various factors in evaluating veteran medical service delivery system, statistically reflecting the perception of directors of the veteran medical service delivery facilities on effectiveness. In other word, professionalism variable(${\beta}=0.99$) and effectiveness variable(${\beta}=-1.09$) are statistically reflecting the perception of directors of the beneficiaries satisfaction with employee. The findings suggests that the theoretical and practical implications will improve Effectiveness and Satisfaction of Veteran Medical Service Delivery System.

• Sleep Medicine and Psychophysiology
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• v.29 no.2
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• pp.35-39
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• 2022

REM sleep behavior disorder is parasomnia characterized by unpleasant dreams and dream-enactment behaviors associated with excessive electromyography activity in REM sleep. This may appear idiopathic or secondary to other neurological or medical conditions. REM sleep behavior disorder, which appears to be idiopathic, most often implies the possibility of later neurodegenerative diseases due to synucleinopathy, so accurate diagnosis is important in predicting prognosis. For the diagnosis of REM sleep behavioral disorder, REM sleep without atonia, which appears in the polysomnography, is essential. Obstructive sleep apnea, trauma-related sleep disorders, and vigorous periodic leg movements during sleep are known as diseases that show dream enactment behavior in elderly patients. Considering that it may be accompanied by other sleep disorders that can mimic REM sleep behavioral disorders, it is important to differentiate sleep

• Korea Journal of Hospital Management
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• v.26 no.2
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• pp.1-16
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• 2021

This study aims to examine the effect of integrated health and welfare(IHW) services on medical use and medical expenses in Korean Veteran Hospitals. Data on the volume of medical use and medical expenses were collected from two patient groups of 5 Veterans' Hospitals: the beneficiary group who has received IHW services and the non-beneficiary group who has not. Each group was composed of 265 patients respectively. The results of the study revealed that the volume of home nursing services, home rehabilitation services, ambulatory services have increased significantly, whereas the average length of stay, number of using emergency services, and average medical expenses have decreased after receiving integrated health services in the beneficiary group. In contrast, the non-beneficiary group showed much more increase both in the volume of inpatient and outpatient services, as well as the average medical expenses, compared to those of the beneficiary group. This results imply that the provision of IHW services have positive impacts on the enhancing the effectiveness of the medical resources utilization for the veteran patients.

• The Journal of Korean Academy of Prosthodontics
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• v.54 no.2
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• pp.160-166
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• 2016

Although physiologic abrasion in normal range need not to be corrected, when hard tissue of teeth are worn abnormally fast, it can cause severe damage and destroy esthetics and, functional structure of occlusion consequently. To establish a correct occlusal plane and space for the patient with worn dentition, it is necessary to increase vertical dimension. However, actual occlusal vertical dimension remains unhanged with compensation for the increase of alveolar bone height equivalent to the decrease of teeth length. A 74-year-old male presented with worn dentition and fractured tooth. Based on the assessment of OVD including clinical findings, full-mouth rehabilitation without increase of OVD was planned. This case presents that a satisfactory clinical result was achieved by restoring the worn dentition without changing occlusal vertical dimension.

• Korean Journal of Psychosomatic Medicine
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• v.31 no.2
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• pp.155-164
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• 2023

Objectives : The aim of this study was to identify the factors affecting ideas of persecution in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods : We retrospectively reviewed 116 patients who underwent CAPS and MMPI 2 between May 2013 and April 2020 at Veteran Health Service Medical Center. Based on the CAPS score, the patients were divided into the PTSD group (n=63, age: 58.16±17.84) and the trauma exposed without PTSD group (n=53, age: 67.34±12.05). After checking the correlation between Ideas of persecution, CAPS, and MMPI-2 scales, linear regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results : The PTSD group showed significant differences in Schizophrenia, Ideas of persecution, Dysfunctional negative emotions, Aberrant Experiences, Psychoticism, Negative Emotionality/Neuroticism, Anxiety, Depression, and Anger scales compared to the trauma-exposed without PTSD group. When analyzing the correlation between Idea of persecution, CAPS and MMPI-2 scales, there was a strong association with most of the scales in MMPI-2 and Idea of persecution except Disconstraint. Multiple linear regression analysis performed in PTSD group identified that risk factors for Idea of persecution were Dysfunctional negative emotions and Anger scale. Conclusions : The PTSD group had increased idea of persecution compared to the trauma exposed without PTSD group. Dysfunctional negative emotions and anger may be risk factors for idea of persecution in trauma exposed population.

• The Journal of Korean Academy of Prosthodontics
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• v.55 no.2
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• pp.171-179
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• 2017

Severely worn dentition is frequently multifactorial. It is crucial that the etiology of excessive wear be determined, but accurately diagnosing the factors responsible for tooth wear is often confusing. Before initiating the treatment of these cases, meticulous examination and determining vertical dimension are essential. A 69-year-old male patient had the chief complaint that he has worn dentition and functional and esthetic discomfort. Based on model analysis and diagnostic wax up, new vertical dimension had been determined. Provisional restorations were cemented and after 5 months permanent prostheses were fabricated. This case reports a satisfactory functional and esthetic clinical outcome achieved by restoring the vertical dimension.

• Korean Journal of Psychosomatic Medicine
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• v.31 no.2
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• pp.63-71
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• 2023

Urinary incontinence (UI), affecting 3%-11% of males and 25%-45% of females globally, is expected to rise with an aging population. It significantly impacts mental health, causing depression, stress, and reduced quality of life. UI can exacerbate psychiatric conditions, affecting treatment compliance and effectiveness. It is categorized into transient and chronic types. Transient UI, often reversible, is caused by factors summarized in the acronym DIAPPERS: Delirium, Infection, Atrophic urethritis/vaginitis, Psychological disorders, Pharmaceuticals, Excess urine output, Restricted mobility, Stool impaction. Chronic UI includes stress, urge, mixed, overflow, functional, and persistent incontinence. Drug-induced UI, a transient form, is frequently seen in psychiatric treatment. Antipsychotics, antidepressants, and other psychiatric medications can cause UI through various mechanisms like affecting bladder muscle tone, altering nerve reflexes, and inducing other conditions like diabetes or epilepsy. Specific drugs like lithium and valproic acid have also been linked to UI, though mechanisms are not always clear. Managing UI in psychiatric patients requires careful monitoring of urinary symptoms and judicious medication management. If a drug is identified as the cause, options include discontinuing, reducing, or adjusting the dosage. In cases where medication continuation is necessary, additional treatments like desmopressin, oxybutynin, trihexyphenidyl, or amitriptyline may be considered.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.1
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• pp.26-33
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• 2020

Purpose: Agent Orange (AO) is a herbicide and defoliant used by the United States and its military allies during the Vietnam War. Pneumonia is a common cause of death among Vietnam veterans in our hospital. There have been no previous studies researching any association between AO exposure and the prognosis for pneumonia. The primary objective of this study was to investigate associations between AO exposure and 30-day mortality due to pneumonia. The secondary objective was to examine the clinical factors associated with therapeutic outcomes in veterans with pneumonia, and to assess the prevalence of combined diseases in AO-exposed veterans. Methods: This study retrospectively included veteran patients diagnosed with pneumonia in the emergency department and hospitalized between February 2014 and March 2018. The enrolled patients were grouped according to their defoliant exposure history, and the clinical information of defoliant-exposed and non-defoliant-exposed groups were compared. Patients were divided according to 30-day mortality, and significant factors influencing mortality were evaluated by using univariate analysis and multivariate analysis. The final multivariate model revealed the effect of AO exposure on therapeutic outcomes of pneumonia. Results: A total of 1006 patients were analyzed. Of these, 276 patients had a history of AO exposure, whereas 730 patients had not been exposed. Factors positively associated with 30-day mortality were malignancy, respiratory rate, blood urea nitrogen, and albumin which was negatively associated with mortality. Conclusion: Exposure to defoliant is not associated with 30-day mortality in patients with pneumonia. However, veterans with defoliant exposure are associated with a high prevalence of diabetes mellitus, hypertension, cerebrovascular accident, malignancy, and chronic kidney disease.