Disruptive behavioral disorders [oppositional defiant disorder (ODD) and conduct disorder (CD)] are common comorbid disorders in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). ODD/CD may be comorbid up to 60% of children and adolescents with ADHD. Comorbid ODD and CD symptoms can have a significant impact on the course and prognosis of patients with ADHD. Stimulant medications have shown effectiveness in treating both core ADHD symptoms and oppositional symptoms. Assessment and management of comorbid disruptive behavioral symptoms is an essential part in evaluation and treatment of ADHD patients. Further research is needed to investigate the efficacy and safety of various behavioral and medication regimens for ADHD, comorbid ODD and CD and to examine the relationships between ADHD, comorbid ODD and CD.
Adolescent ; Behavioral Symptoms ; Child ; Conduct Disorder ; Humans ; Prognosis

Disruptive behavioral disorders [oppositional defiant disorder (ODD) and conduct disorder (CD)] are common comorbid disorders in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). ODD/CD may be comorbid up to 60% of children and adolescents with ADHD. Comorbid ODD and CD symptoms can have a significant impact on the course and prognosis of patients with ADHD. Stimulant medications have shown effectiveness in treating both core ADHD symptoms and oppositional symptoms. Assessment and management of comorbid disruptive behavioral symptoms is an essential part in evaluation and treatment of ADHD patients. Further research is needed to investigate the efficacy and safety of various behavioral and medication regimens for ADHD, comorbid ODD and CD and to examine the relationships between ADHD, comorbid ODD and CD.
Adolescent ; Behavioral Symptoms ; Child ; Conduct Disorder ; Humans ; Prognosis

Alzheimer's disease (AD) is the most typical progressive and irreversible dementia characterized by loss of intellectual capacity in many domains, altered behavior, inability to care for oneself, and ultimately neurologic abnormalities. In the treatment of AD, the focus is limited to relief of cognitive and behavioral symptoms. But the choice of adequate treatment according to severity level is difficult task for maintaining patient's quality of life. We experienced a case of typical presenile Alzheimer's disease who progressed severe dementia while being treated with cognitive enhancers and psychosocial intervention for three years. In review of this case, we conclude that early detection and active treatment of presenile dementia is most important factor for delaying of progress and decreasing of family burden.
Alzheimer Disease ; Behavioral Symptoms ; Dementia* ; Humans ; Nootropic Agents ; Quality of Life

OBJECTIVE: We investigated caregivers' attitudes toward dementia, which may play a key role in the timely treatment and optimal care of people with dementia (PWD), and patient and caregiver factors potentially associated with these attitudes. METHODS: As a part of the Nationwide Survey on Dementia Care in Korea, we evaluated the attitudes of 731 community-dwelling caregivers of PWD with the Dementia Attitude Scale (DAS). Using stepwise multiple regression analysis, we investigated the sociodemographic factors of the caregivers, the clinicodemographic factors of the PWD, and the situational factors of caregiving that may influence caregivers' attitudes. RESULTS: The mean score on the DAS total was 80.65+/-16.0 (maximum : 140). The mean score on the DAS Knowledge subscale, which reflects awareness of dementia, was 42.86+/-9.6 (maximum : 70), and that on the DAS Comfort subscale, which reflects emotional and behavioral attitudes toward dementia, was 37.79+/-10.3 (maximum : 70). Non-spouse caregiver, living in a rural area, completion of a formal care education program (caregiver factors) and female patient, high educational level, high clinical dementia rating and mild behavioral symptoms (patient factors) were associated with a high DAS total score. CONCLUSION: We found much room for improvement in caregivers' attitudes towards PWD in Korea, indicating a need for strategies to improve these attitudes, targeting the at-risk group.
Behavioral Symptoms ; Caregivers* ; Dementia* ; Education ; Female ; Humans ; Korea

This paper reviewed the studies on hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, I have proposed a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from those of the depressive disorders, which have been postulated to be similar to HB. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. I propose that the new anger disorder to be included in the new international classification system as a member of the larger family of mood disorders. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder.
Anger* ; Behavioral Symptoms ; Classification ; Depressive Disorder ; Humans ; Mood Disorders ; Psychiatry

OBJECTIVES: The purpose of this study is to examine the efficacy and side effects of quetiapine and haloperidol for the treatment of symptoms of delirium. METHODS: One hundred and seven patients with delirium were recruited and randomly assigned to receive a flexible-dose regimen of quetiapine or haloperidol over 7days and seventy-seven patients completed the study(quetiapine group N=40, haloperidol group N=37). The severity of delirium was assessed by using Memorial Delirium Assessment Scale(MDAS) scores, the psychiatric and behavioral symptoms were assessed by Neurobehavioral Rating Scale(NRS) scores, and the cognitive status was measured by Mini-mental state examination Korean version(MMSE-K) scores. The side effects were measured by Drug Induced Extrapyramidal Symptoms Scale(DIEPSS) scores. RESULTS: MDAS scores significantly improved in both treatment groups. NRS scores also significantly improved in both treatment group, but the group-by-time effect approached significance, likely caused by the greater decrease in scores of the quetiapine group. MMSE-K scores significantly improved only in the quetiapine group. Side effects associated with treatment were not significant in either treatment groups. CONCLUSION: This study suggests that quetiapine is as efficacious as haloperidol in the treatment of delirium. In particular, quetiapine seems to improve psychiatric and behavioral problems of delirium and was more effective than haloperidol in cognitive improvement.
Behavioral Symptoms ; Delirium ; Dibenzothiazepines ; Haloperidol ; Humans ; Prospective Studies ; Quetiapine Fumarate

Objective: As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos. Methods: Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila. Results: The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation. Conclusion A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.
Rehabilitation ; Rehabilitation of Speech and Language Disorders ; Neurobehavioral Manifestations ; Cognitive Behavioral Therapy ; Behavioral Symptoms ; Communication Disorders ; Insurance, Major Medical

OBJECTIVES: The aim of this study was to draw attention toward so called ‘behavioral variant frontotemporal dementia(bvFTD) phenocopy syndrome’, which is difficult to discriminate with the primary psychiatric disorders, showing poor response to conventional therapeutic drugs, leading to higher risk to misdiagnoses and legal problems. Furthermore, the author insisted that our interest and study on them must be continued. METHODS: English articles published during 2000 thru 2016 had been searched by internet with the combination of words such as ‘frontotemporal’, ‘phenocopy’ and ‘behavioral’, and reviewed. Besides, two clinical vignettes were described. RESULTS: Precise diagnosis is important because patients' behavioral symptoms can influence on their families and community. However, disease-modifying treatment for bvFTD are not developed until now, and recent therapeutic drugs are only good for specific symptoms, while deterioration progresses in spite of proper psychiatric management. The possible bvFTD patients are not progressed into probable bvFTD clinically, showing no decline of cogntive and social function, no decrease of activity function, longer survival time, and normal neuroimaging for several years. CONCLUSIONS: Rather than expected, there are much more patients having clinical symptoms, course and diagnostic findings including neuroimaging, which are atypical to classical frontotemporal dementia and primary psychiatric disorders. If our knowledge and discriminating ability is improved, discovery rate of that cases will be increased. However, the identity of these atypical features are not clarified until now, it must be further actively investigated.
Behavioral Symptoms ; Cognition ; Diagnosis ; Diagnostic Errors ; Frontotemporal Dementia* ; Humans ; Internet ; Neuroimaging

OBJECTIVES: The purpose of this study was to compare the efficacy of galantamine treatment, especially attention ability between patients with pure Alzheimer's disease (AD) and Mixed dementia (MD) during a 24-week trial. METHODS: A total of 40 patients were recruited for this 24-week study. The effect of galantamine on attention was measured using Seoul Computerized NeuroCognitive Function Test (SCNT) and frontal functions test of Seoul Neuropsychological Screening Battery (SNSB). Patients'activities of daily living using the Seoul-Activities of Daily Living (S-ADL) and the Seoul-Instrumental Activities of Daily Living (S-IADL) ; behavioral symptoms using the Korean version Neuropsychiatric Inventory (K-NPI) were measured at baseline and 24-week. RESULTS: 17 pure AD patients and 23 MD patients were analyzed in this study. Attention as measured by SCNT was not significantly different from baseline after 24 weeks of treatment in both groups. There was no significant difference between two groups in mean change from baseline in the SCNT, S-ADL, S-IADL and K-NPI scores at 24-week. CONCLUSION: Galantamine showed a therapeutic effect on cognition, activities of daily living, neuropsychiatric symptoms in pure AD and MD. Furthermore, Galantamine may specifically help to maintain attention and it may have positive effects on other cognitive and functional abilities.
Activities of Daily Living ; Alzheimer Disease ; Attention ; Behavioral Symptoms ; Cognition ; Dementia ; Galantamine ; Humans ; Mass Screening

OBJECTIVES: Coexistence of depression is one of the important behavioral symptoms in patients with dementia of Alzheimer type. The study on the relationship between depression and cognitive abilities and/or functional abilities emerges as very important one. The aim of this study was to investigate whether depression is related to the impairment of daily activities and to certain areas of cognitive function in mild to moderate dementia of Alzheimer type. METHODS: In this study, 48 patients with dementia of Alzheimer type among elderly community-residents in Kwangju, Kyunggi province, aged 65 and older, were finally included. We examined their demographics and administered Korean Version of the Mini-Mental State Examination(MMSE-K), Korean Version of the Neurobehavioral Cognitive Status Examination(Korean version of NCSE), Korean Form of Geriatric Depression Scale(KGDS), Activities of Daily Living(ADL), and Instrumental Activities of Daily Living(IADL) to the subjects. We classified the subjects into two groups, dementia with and without depression on the basis of KGDS scores. The two groups were compared using X2 test and independent ttest. RESULTS: The results show that the two groups did not differ in sex, age, education, and scores of MMSE-K. The depressed dementia group showed significantly poorer performance in bathing, one item of ADL, than the nondepressed dementia group. The depressed dementia group showed significantly more impairment in total scores of IADL and each score of three items(shopping, housework, handling finances) than the non-depressed dementia group. However, the two groups showed no significant differences in five major cognitive ability areas of Korean version of NCSE. CONCLUSION: These results suggest that depression in patients with dementia of Alzheimer type is highly related to the functional impairments, instrumental activities of daily living and part of activities of daily living, beyond the effects of cognitive impairments.
Activities of Daily Living* ; Aged ; Baths ; Behavioral Symptoms ; Dementia ; Demography ; Depression* ; Education ; Gwangju ; Gyeonggi-do ; Housekeeping ; Humans