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

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

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

Depression is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of depressed patients with Alzheimer's disease (AD). The consecutive patients with AD who have significant depression were assigned to an 8-week open-label, prospective study. Patients received mirtazapine 15-45 mg/day. The changes in Hamilton Depression Rating Scale (HAM-D) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirty-two out of 38 (84.2%) patients completed the study. There was a significant reduction in HAM-D and CGI-S between the pre- and post-treatment with mirtazapine (p<0.01). There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of depressed patients with AD.
Alzheimer Disease ; Behavioral Symptoms ; Dementia ; Depression ; Humans ; Mianserin ; Pilot Projects ; Prospective Studies

BACKGROUND AND PURPOSE: It has been shown that sleep problems in Alzheimer's disease (AD) are associated with cognitive impairment and behavioral problems. In fact, most of studies have founded that daytime sleepiness is significantly correlated with cognitive decline in AD. However, a few studies have also shown that nighttime sleep problems are associated with cognitive function and behavioral symptoms in AD. Accordingly, the aim of this study was to evaluate the effects of nighttime sleep on cognition and behavioral and psychological symptoms of dementia (BPSD) in AD. METHODS: The study population comprised 117 subjects: 63 AD patients and 54 age- and sex-matched non-demented elderly subjects. Detailed cognitive functions and behavioral symptoms were measured using the Seoul Neuropsychological Screening Battery (SNSB) and the Korean version of the Neuropsychiatric Inventory (NPI-K). Sleep characteristics were evaluated using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K). The correlations between PSQI-K and SNSB scores and between PSQI-K and NPI-K scores were analyzed. RESULTS: In AD patients, sleep latency was found to be negatively correlated with praxis (p=0.041), Rey-Osterrieth Complex Figure Test (RCFT) immediate recall (p=0.041), and RCFT recognition (p=0.008) after controlling for age and education, while sleep duration and sleep efficiency were positively correlated with praxis (p=0.034 and p=0.025, respectively). Although no significant correlation was found between PSQI-K and NPI-K scores, sleep disturbance and total PSQI-K scores were found to be significantly associated with apathy/indifference in AD. CONCLUSIONS: Sleep problems such as prolonged sleep duration, sleep latency, and poor sleep efficiency in AD patients were correlated with cognitive dysfunction, and especially frontal executive and visuospatial functions, and BPSD. These findings suggest that treatment of nighttime sleep problems might improve cognition and behavioral symptoms in AD patients.
Aged ; Alzheimer Disease* ; Behavioral Symptoms ; Cognition ; Dementia ; Education ; Humans ; Mass Screening ; Memory, Short-Term ; Seoul

PURPOSE: Behavioral symptoms in dementia (BSD) are one of the most disturbing behaviors to caregivers and a major reason for nursing home placement. Behavioral symptoms are often treated with psychotropic drugs (PD), however, the effect of such drugs for the frail elderly dementia patient is not certain because of their critical adverse effects. Theoretical model applicable to nursing practice for BSD in nursing homes, which is essential in guiding and evaluating such interventions, is absent. This article presents the process of developing a theoretical model of BSD in nursing homes. METHOD: Using Walker and Avants' theory synthesis method, three behavior models and two system models were incorporated into the proposed model to provide the theoretical and analytical explanation of the relationships between PD usage, its determinants, and BSD. RESULTS: Resident variables and nursing home variables related to the two focal concepts (i.e., PD usage and BSD) were identified. Resident variables include demographical characteristics such as age and gender, and dementia-compromised functions such as cognitive and functional impairment. Nursing home variables include facility characteristics such as ownership type and size, and physical and psychosocial environment. CONCLUSION: The proposed model suggests that fulfillment of resident unmet needs through improvement of physical and psychosocial environment may produce better health outcomes of nursing home residents with BSD. Assessment and intervening environmental triggers of such behaviors are also suggested to be prior to the PD usage.
Aged ; Behavioral Symptoms* ; Caregivers ; Dementia* ; Frail Elderly ; Humans ; Models, Theoretical ; Nursing Homes* ; Nursing* ; Ownership ; Psychotropic Drugs