BACKGROUND/AIMS: Although transient changes in the electrocardiogram (ECG) of patients with stress-induced cardiomyopathy (SCMP) are common, there are little data about ECG changes in patients with SCMP and the clinical implications of these variations. METHODS: We investigated a total of 128 patients (age, 63.2 ± 15.4 years; female, 60.9%) diagnosed with SCMP. We compared the ECGs taken after SCMP diagnosis and during the recovery phase to those taken before SCMP diagnosis under baseline conditions. All patients were divided into two groups according to corrected QT (QTc) interval changes: recovered QTc group (QTc in SCMP > QTc in recovery phase, n = 77) and nonrecovered QTc group (QTc in SCMP ≤ QTc in recovery phase, n = 51). RESULTS: In comparison of baseline, SCMP, and recovery phase, we found the mean heart rate (81.5 ± 18.7, 96.8 ± 25.3, and 83.0 ± 19.4/min, respectively; p < 0.001), frequencies of ST segment elevation (0.0%, 8.6%, and 1.6%, p = 0.004), ST segment depression (0.0%, 6.3%, and 1.6%, p = 0.007), T wave inversion (4.4 %, 43.8%, and 61.7%, p < 0.001), and QTc (447.4 ± 35.3, 488.9 ± 67.1, and 468.0 ± 49.5, p < 0.001) showed significant changes. In-hospital mortality (9.1% vs. 25.5%, p = 0.012) and critical care (54.5% vs. 72.5%, p = 0.040) occurred more frequently in the nonrecovered QTc group than in recovered QTc group. CONCLUSIONS: The QTc can be prolonged in patients with SCMP. Short-term mortality was increased in patients where the QTc did not recover.
Cardiomyopathies* ; Critical Care ; Depression ; Diagnosis ; Electrocardiography ; Female ; Heart Rate ; Hospital Mortality ; Humans ; Mortality ; Takotsubo Cardiomyopathy

Bidirectional relationships exist between cancer and depression; the prevalence of depression in cancer patients is higher than in the general population, and depression predicts cancer progression and mortality. The mechanisms through which depression contributes to the progression of cancer are related with dysregulation of the hypothalamic-pituitary-adrenal axis and impairment of immune function. However, depression in cancer patients tends to be underdiagnosed and not appropriately treated. The methods of diagnosis and assessment of depression in cancer patents have been debated because physical symptoms of depression mimic both cancer symptoms per se and the side effects of cancer treatment. Many studies have shown that various psychosocial and/or pharmacological interventions are effective at improving depressive symptoms and quality of life in cancer patients. Furthermore, antidepressant treatments are effective for various physical symptoms related to cancer, such as fatigue, anorexia, pain, hot flashes, and itching. This article reviews and discusses current knowledge about depression in cancer patients.
Anorexia ; Axis, Cervical Vertebra ; Depression* ; Diagnosis ; Fatigue ; Hot Flashes ; Humans ; Mortality ; Prevalence ; Pruritus ; Quality of Life

Systemic lupus erythematosus(SLE) is a disease of unknown etiology in which multiple organs are damaged by pathogenic autoantibodies and immune complexes. Neuropsychiatric manifestations in SLE were first described by Kaposi in 1872. These are so diverse that they include psychosis, depression, stroke, seizure and cognitive dysfunction etc. These patients are frequently consulted for psychiatric evaluation. Neuropsychiatric manifestations in SLE are also among the leading causes of morbidity and mortality and associated with poor long-term outcome. So it is essential to recognize and intervene these symptoms early. But the clear diagnostic criteria for CNS involvement in SLE have not been formulated, and diversity and fluctuation of illness make it difficult to confirm it. The authors reported three cases of SLE with severe neuropsychiatric manifestations. These patients showed symptoms such as disorientation, auditory and visual hallucibation, delusion and mood instability. They became frequently impulsive and violent and had risks to injure themselves or others. Although CNS involvement in SLE is not well known, we reviewed the pathogenesis, classification, diagnosis, clinical manifestation and treatment of them.
Antigen-Antibody Complex ; Autoantibodies ; Classification ; Delusions ; Depression ; Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Mortality ; Psychotic Disorders ; Seizures ; Stroke

BACKGROUND: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to exfended sarvival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management. METHOD: A total 159 patients(males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors. RESULTS: The mean cost of types of medical facilities during the last week of patients as 65332.5 won in charity hospital hospice unit, 105165.5 won in home hospice, 702083.4 won in university hospital hospice unit, and 1037358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2 +/- 3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain scor of home hospice as 1.7+/-1.7 and that of university hospital hospice as 1.2+/-1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depression's categorial scale of home hospice the score was 4.8+/-1.3, which was higher than those of free hospital hospice unit and university hospital non-hospice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities. CONCLUSION: The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.
Activities of Daily Living ; Apgar Score ; Charities ; Demography ; Depression ; Early Diagnosis ; Female ; Hospice Care ; Hospices ; Humans ; Life Expectancy ; Mortality ; Quality of Life*

Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.
Antipsychotic Agents ; Benzodiazepines ; Dehydration ; Delirium* ; Dementia ; Depression ; Diagnosis* ; Early Diagnosis ; Education ; Haloperidol ; Humans ; Mortality ; Palliative Care* ; Prevalence ; Quality of Life ; Quetiapine Fumarate ; Risperidone

Etiological classification of a syndrome is most warranted. However, it is very difficult in the case of dementia because many research activities are still being made about the cause of degenerative dementias. In the current paper, clinical aspects and pathological findings were also con-sidered in the etiological classification. Prevalence and annual incidence of dementia are 5-15% and 1.5-2.0% in the elderly over 65, respectively. Old age, female sex, genetic background, lower education, ethnicity or geographical difference, and head trauma seem to be risk factors for developing dementia. Urinary and fecal incontinece, extrapyramidal symptoms, primitive reflexes, psychotic symptoms, and cognitive decline seem to adversely affect on the mortality, while social class, age at onset, depressive symptoms, aggressive behavior, wandering, increased appetite, increased sexual behaviors, and early diagnosis do not.
Aged ; Appetite ; Classification* ; Craniocerebral Trauma ; Dementia* ; Depression ; Early Diagnosis ; Education ; Epidemiology* ; Female ; Humans ; Incidence ; Mortality ; Prevalence ; Reflex ; Risk Factors ; Sexual Behavior ; Social Class ; Wandering Behavior

PURPOSE: The present study aims to evaluate the prevalence of unmet needs among breast cancer survivors, to assess the relationships between unmet needs and depression and quality of life, and to explore the extent to which unmet needs of breast cancer patients relate to the time elapsed since surgery. MATERIALS AND METHODS: Among 1,250 eligible patients who participated in the study, 1,084 cases (86.7%) were used for analysis. Clinicopathological and social parameters were reviewed and the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy-Breast cancer instrument, and Beck Depression Inventory were administered. The frequency of unmet needs, the association between unmet needs and depression and/or quality of life (QOL) and the impact of the time elapsed since surgery on the patients' unmet needs were analyzed. RESULTS: The highest levels of unmet needs were found to be in the health system and information domain. Patients with a survival duration of less than 1 year since surgery showed significantly higher unmet needs in all need domains except the sexuality domain (p<0.001) than participants in the other groups. Patients with a survival duration of 1-3 years also experienced significantly higher psychological and information needs than long-term survivors (>5 years). In addition, unmet needs were significantly associated with depression (p<0.001) and QOL (p<0.001). CONCLUSION: The present study demonstrated that long-term breast cancer survivors had a significantly lower level of unmet needs than patients with survival duration of less than 3 years after surgery and patients with survival duration of less than 1 year since surgery suffered the greatest unmet needs. QOL might be enhanced if interventions are made for specific unmet needs of each patient group.
Adult ; Breast Neoplasms/*mortality/*psychology/surgery ; Cross-Sectional Studies ; Depression/diagnosis/mortality ; Female ; Health Services Accessibility/*statistics & numerical data ; Humans ; Middle Aged ; Needs Assessment/*statistics & numerical data ; Prevalence ; *Quality of Life ; Republic of Korea/epidemiology ; *Social Support

BACKGROUND: Because of the widespread use and availability of agricultural insecticides, acute organophosphate poisoning as a suicide or an accident is becoming the most common type of poisoning and serious problem in Korea. The mortality of organophosphate poisoning varied from 10 to 86 percent. The cause of death was thought to be a combination of excessive bronchial secretion, bronchospasm, respiratory muscle paralysis and depression of respiratory center, summarily respiratory failure. We evaluated the respiratory complications in patients with acute organophosphate intoxication to determine the predisposing factors to respiratory failure and to reduce the incidence of respiratory failure or mortality. METHOD: We conducted a retrospective study of 111 patients with the discharge diagnosis of organophosphate poisoning who were hospitalized at Yenugnam University Hospital during the 5 years. The diagnosis of organophosphate poisoning has based on the followings (1) a history of exposure to an organophosphate compounds. (2) the characteristic clinical signs and symptoms. (3)decrease in the cholinesterase activity in the serum. RESULTS: The results were as follows 1) Respiratory failure developed in 31(28%) of 111 patients with acute organophosphate poisoning. All cases of respiratory failure developed within 96 hours after poisoning and within 24 hours in 23 patients. 2) The 80 patients who did not develop respiratory failure survived. In 31 patients with respiratory failure, 15(44%) patients were dead. 3) The patients with respiratory failure had more severe poisoning, that is, the lower level of serum cholinesterase activity on arrival, the higher mean dosage of atropine administered within first 24 hours. 4) In 16 patients with pneumonia, 14 patients developed respiratory failure. In 5 patients with cardiovascular collapse, 2 patients developed respiratory failure. 5) There was no correlation to between age, sex, the use of pralidoxime and respiratory failure. 6) The serum cholinesterase level in survivors at time of respiratory failure and weaning was 66.05+/-85.48U/L, 441+/-167.49U/L, respectively. CONCLUSION: All the respiratory failure complications of acute organophosphate poisoning occurred during the first 96 hours after exposure. The severity of poisoning and pneumonia were the predisposing factors to respiratory failure. Aggressive treatment and prevention of the above factors will reduce the incidence of respiratory failure.
Atropine ; Bronchial Spasm ; Causality ; Cause of Death ; Cholinesterases ; Depression ; Diagnosis ; Humans ; Incidence ; Insecticides ; Korea ; Mortality ; Organophosphate Poisoning ; Pneumonia ; Poisoning ; Respiratory Center ; Respiratory Insufficiency* ; Respiratory Paralysis ; Retrospective Studies ; Suicide ; Survivors ; Weaning

It is important to assess psychological distress after a diagnosis for cancer survivors, a population with a high risk for psychological distress. The aim of this study is to assess psychological distress among cancer survivors and to clarify the associated factors. In this cross-sectional analysis, data were obtained from standardized questionnaires administered to 1,163 cancer survivors and 49,243 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Survey (2007-2012). We identified the adjusted rates for psychological distress and assessed factors associated with this kind of distress using multivariate logistic regression. Cancer survivors tended to have a higher adjusted rate of psychological distress than the general population. The current depressive symptom rate for cancer survivors was 16.69%, and the adjusted rate for history of depression in cancer survivors was 15.61%. The adjusted rate for higher level of stress was 25.51% in cancer survivors. Among the cancer survivors, younger subjects, female subjects, and those with limited social support were more prone to psychological distress. In addition, current smokers or risky drinkers, those with chronic diseases, and those with a poor self-perception of their health status were also identified as a high-risk group for psychological distress. As the number of cancer survivors has increased, the importance of assessing psychological distress after a cancer diagnosis should be emphasized among all cancer survivors. Further, psychological supportive care interventions for cancer survivors are needed to improve the survival rate and improve their quality of life.
Aged ; Cross-Sectional Studies ; Depression/etiology ; Female ; Health Status ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms/*diagnosis/mortality ; Nutrition Surveys ; Quality of Life ; Social Support ; Socioeconomic Factors ; *Stress, Psychological ; Surveys and Questionnaires ; Survivors/*psychology

Chronic obstructive pulmonary disease (COPD) should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease, such as cigarette smoking, biomass exposure, and occupational dust. Spirometry is required to make the diagnosis, and a post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio < 0.7 confirms the presence of persistent airflow limitation. The goal of COPD assessment is to determine the severity of the disease, including the severity of airflow limitation, the impact of the disease on the patient's health status, the risk of future events (such as exacerbations, hospital admission, or death), and comorbidities in order to guide therapy. Concomitant chronic diseases occur frequently in COPD patients, including cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, anxiety, and lung cancer. These comorbidities should be actively surveilled and treated appropriately when present, as they can independently influence mortality and hospitalization. Above all, further efforts are required to increase the diagnosis rate of COPD in Korea.
Anxiety ; Biomass ; Cardiovascular Diseases ; Chronic Disease ; Comorbidity ; Cough ; Depression ; Diagnosis ; Dust ; Dyspnea ; Forced Expiratory Volume ; Hospitalization ; Humans ; Korea ; Lung Neoplasms ; Mortality ; Muscle, Skeletal ; Osteoporosis ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Risk Factors ; Smoking ; Spirometry ; Sputum ; Vital Capacity