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

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

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

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

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

BACKGROUND: Behavioral and psychological symptoms (BPSD) are common in dementia. These may be helpful for clinical differentiation between Alzheimer's disease (AD) and vascular dementia (VD). Most previous studies have reported the prevalence and severity of BPSD regardless of severity of progression. However, we evaluated the differences of BPSD by grading dementia progression and including severe cases only. METHODS: 141 dementia outpatients from clinics of Busan-Gyeongnam Dementia Association in Korea were analyzed. All patients were administered the Korean version of the Neuropsychiatric Inventory (K-NPI), the expanded version of Korean Clinical Dementia Rating Scale (CDR), and the Korean version of Mini-Mental State Examination (K-MMSE). RESULTS: There were 95 patients with AD and 46 patients with VD. AD patients revealed higher frequency of manifested BPSD symptoms and most of subscales showed higher composite scores also. But apathy was more severely and frequently manifested in VD. AD patients had more frequent night-time behavior and aberrant motor symptoms above 3 point in CDR 0.5 and VD patients had more frequent apathy symptom above 3 point in CDR 1. CONCLUSIONS: These results suggest that generally AD patients revealed more frequent and severe BPSDs than VD patients. Apathy was a more dominant symptom in VD. It seemed that some of the symptoms were valuable clues for the differential diagnosis even though a better designed study was required.
Alzheimer Disease* ; Apathy ; Behavioral Symptoms ; Dementia ; Dementia, Vascular* ; Diagnosis, Differential ; Humans ; Korea ; Outpatients ; Prevalence

Psychiatric disturbances in the elderly are complicated. Dementia and depression are serious causes of global impairment in the elderly. Aging is characterized by a progressive functional impairment of multiple organs, a reduction of homeostatic mechanisms, and a changed sensitivity or capacity of neurotransmitter receptors. Understanding the influence of age-dependent changes in the composition and function of the body on the pharmacokinetics and pharmacodynamics of drugs is important before prescribing drugs to elderly patients. However, there is little clinical pharmacological information available to guide pharmacotherapy for late-life psychiatric disorders. Treatment of dementia is based on the cognitive decline and behavioral symptoms that accompany dementia. Currently prescribed antidepressants have similar efficacies but the side effect profiles vary. Comprehension of the normal aging process and understanding the characteristics of each of the psychotropics are essential in geriatric psychopharmacology. Up to the present, most studies are confirmations or reproductions of previous results on efficacy or safety. Future directions for psychopharmacological research should include discovering newer drugs, treatment of resistance or nonresponders, and combination or adjunctive therapies. This review focused on the geriatric pharmacokinetic/pharmacodynamic changes and clinical information regarding currently prescribed psychotropic medications.
Aged ; Aging ; Antidepressive Agents ; Behavioral Symptoms ; Comprehension ; Dementia ; Depression ; Geriatric Psychiatry ; Humans ; Psychopharmacology ; Receptors, Neurotransmitter

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