The authors described a case of male schizophrenia who developed myoclonic jerk repeatedly and one episode of convulsive seizure during the treatment of clozapine. According to literatures and reported cases, myoclonic jerks induced in a small amount of clozapine may precede and predict the development of a convulsive seizure. Therefore clinicians have to pay attention to the development of a myoclonic jerk during the administration of clozapine. They may decrease the dosage of clozapine step by step at first in the convulsive state, and observe EEG changes of patients frequently.
Clozapine* ; Electroencephalography ; Humans ; Male ; Myoclonus ; Schizophrenia ; Seizures*

Dementia is the clinical syndrome characterized by acquired losses of cogn-itive and emotional abilities severe enough to interfere with daily functioning and the quality of life. In Korea, the majority of patients with symptoms of dementia are initially evaluated by a general practitioner, and many do not receive a follow-up assessment by a specialist. Accordingly, general practitioners play a vital role in identifying patients with possible dementia and under-taking additional diagnostic procedures. It is important that tests to confirm the presence of dementia be performed uniformly, irrespective of the specialty of the examining physician. This article will discuss the several issues in the evaluation of dementia which may be raised freq-uently by general practitioners. The infrastructure for dementia assessment team, the evaluation of patients with mild memory complaints, the assessment of cognitive and functional disability, and screening examination to detect the reversibility of dementic symptoms will be reviewed.
Dementia* ; Follow-Up Studies ; General Practitioners ; Humans ; Korea ; Mass Screening ; Memory ; Quality of Life ; Specialization

Dementia is the clinical syndrome characterized by acquired losses of cognitive abilities severe enough to interfere with daily functioning and the quality of life. More than 50 illnesses, some nonprogressive, can cause dementia. The etiologies of dementia may be grouped as follows:neurodegenerative illnesses, vascular causes, space occupying lesions, traumatic causes, toxic causes, infectious diseases, and metabolic imbalances. Because all types of dementia are treatable, at least with psychosocial interventions, accurate diagnosis is essential to determine the appropriate treatment and to provide information about prognosis, possible genetic risks, and health care planning to the patient and family. This article will review several etiological illnesses of dementia which may be faced frequently by general psychiatrists.
Communicable Diseases ; Delivery of Health Care ; Dementia* ; Diagnosis ; Humans ; Prognosis ; Psychiatry ; Quality of Life

The requirements for fellowship program in geriatric psychiatry in Korea has been proposed. Geriatric psychiatry is that area of psychiatry which focuses on prevention, diagnosis, evaluation and treatment of mental disorders and disturbances seen in old adult patients. An educational program in geriatric psychiatry must be organized to provide professional knowledge and well-supervised clinical experience. Educational goals, institutional organization, faculty and staff, facilities and clinical setting, and educational programs were covered in this article. The program requirements in Korea should be modified based on the environment and readiness with respect to the facilities and human resources. The fellowship period may be for one or two years, depending on the needs of the trainee. The one year program emphasizes clinical training while the two year option combines clinical and research training. The program has both didactic and experimental components. The didactic curriculum addresses normal and pathological aspects of aging, as well as current concepts for the assessment and treatment of elderly patients using the biopsychosocial model. The experimental component provides clinical and research experience in geriatric psychiatry.
Adult ; Aged ; Aging ; Curriculum ; Diagnosis ; Education* ; Fellowships and Scholarships ; Geriatric Psychiatry* ; Humans ; Korea ; Mental Disorders

Dementia is a multi-dimensional disorder associated with cognitive symptoms, functional impairment, and behavioral and psychological symptoms such as agitation, depression and psychosis. Behavioral and psychological symptoms of dementia (BPSD) are an integral part of the disease process and present severe problems to patients, their families and caregivers, and society at large. BPSD are treatable and are more amenable to therapy than other symptoms or syndromes of dementia. Thus, the recognition and appropriate management of BPSD are important factors in improving our care of dementia patients and their caregivers. Psychotic symptoms presented as delusions, misidentifications, and hallucinations are most prevalent BPSD in Alzheimer's disease and related dementia. The author has reviewed the clinical feature, etiology, and pharmacological and non-phrmacological management of psychotic symptoms of BPSD.
Alzheimer Disease ; Caregivers ; Delusions ; Dementia ; Depression ; Dihydroergotamine ; Hallucinations ; Humans ; Neurobehavioral Manifestations ; Psychotic Disorders

The requirements for fellowship program in geriatric psychiatry in Korea has been proposed. Geriatric psychiatry is that area of psychiatry which focuses on prevention, diagnosis, evaluation and treatment of mental disorders and disturbances seen in old adult patients. An educational program in geriatric psychiatry must be organized to provide professional knowledge and well-supervised clinical experience. Educational goals, institutional organization, faculty and staff, facilities and clinical setting, and educational programs were covered in this article. The program requirements in Korea should be modified based on the environment and readiness with respect to the facilities and human resources. The fellowship period may be for one or two years, depending on the needs of the trainee. The one year program emphasizes clinical training while the two year option combines clinical and research training. The program has both didactic and experimental components. The didactic curriculum addresses normal and pathological aspects of aging, as well as current concepts for the assessment and treatment of elderly patients using the biopsychosocial model. The experimental component provides clinical and research experience in geriatric psychiatry.
Adult ; Aged ; Aging ; Curriculum ; Diagnosis ; Education* ; Fellowships and Scholarships ; Geriatric Psychiatry* ; Humans ; Korea ; Mental Disorders

OBJECTIVES: The purpose of this study was to examine the determinants of care burden of caregivers in patients with dementia. METHODS: 128 dementia patients and patients' caregivers participated in this study. Care burden using the BI ; cognition using the K-MMSE ; dementia severity using the CDR ; activities of daily living using the S-ADL and the S-IADL ; behaviour problems using NPI were measured. RESULTS: The results showed that care burden was related significantly with the K-MMSE, the CDR, the S-ADL, the SIADL and the NPI total score. Of the behavior problems, agitation/aggression, anxiety, disinhibition, irritability, and aberrant behavior correlated positively with care burden of caregivers. Regression analysis indicated that agitation/aggression, anxiety, the CDR contributed to care burden. CONCLUSION: Agitation/aggression, anxiety and dementia severity contributed to care burden of caregivers. The identified determinants of care burden and the stress of caregivers suggest areas of therapeutic intervention to reduce caregiver's burden so that the institutionalization can be delayed.
Activities of Daily Living ; Anxiety ; Caregivers* ; Cognition ; Dementia* ; Humans ; Institutionalization

OBJECTIVES: Seoul-Activities of Daily Living(S-ADL) was developed to assess elderly person's basic activities of daily living. This study aims to develop standardized ADL assessment scale and confirm the reliability and validity of the S-ADL. METHODS: It was participated in 336 controls and 145 patients diagnosed Alzheimer's disease. RESULTS: In controls, it was statistically significant to age, but not sex, education, region and presence of spouse. Also, reliability and validity were statistically significant. Principal axis factoring analysis revealed three factors that accounted for 66.67% of the total variance(1.self-care/hygiene, 2.ambulation, 3.toileting). According to each CDR stage, there were significant difference, except for CDR 0.5 and CDR 1 suggesting early dementia. Particularly, it was remarkable for functional impairment in CDR 2 and CDR 3 suggesting moderate to severe dementia. The order of the loss of function was (1) self-care/hygiene, (2) toileting, and (3) ambulation. CONCLUSIONS: Our study showed that the S-ADL could be a very reliable and valid tool for the assessment of functional disabilities of Korean dementia patients. Particularly, S-ADL would be useful in assessing daily function of moderate to severe AD.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Axis, Cervical Vertebra ; Dementia ; Education ; Humans ; Reproducibility of Results* ; Spouses ; Walking

OBJECTIVE: The Positive and Negative Affect Schedule (PANAS) was developed as a measure of positive affect (PA) and negative affect (NA). The aim here is to examine the factor structure and concurrent validity of the Korean version of the Positive and Negative Affect Schedule (K-PANAS) in a clinical sample in Korea. METHODS: K-PANAS was administered to a clinical sample in Korea. Internal consistency, test-retest reliability, and confirmatory factor analysis (CFA) were undertaken to examine the factorial structure and reliability of the K-PANAS. RESULTS: The reliability of K-PANAS is satisfactory. CFA showed that several of the models commonly used in Western populations provided an insufficient fit. The modified model provided a more adequate fit to the data. CONCLUSION: The authors demonstrate that the K-PANAS has adequate psychometric properties, and that findings obtained in the West using PANAS were partially replicated.
Appointments and Schedules ; Korea ; Psychometrics

OBJECTIVE: Serotonin transporter(5-hydroxytryptamine transporter, 5-HTT) plays a critical role in the termination of serotonergic neurotransmission into the presynaptic neuron and represents an initial site of uptake inhibiting antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors. We investigated the possible association between the 5-HTT gene and major depression, and examined whether there are genotypic characteristics in 5-HTT gene that result in treatment nonresponsiveness to uptake inhibiting antidepressants. METHODS: 5-HTT gene polymorphisms are analyzed with the primers flanking the second intron and regulatory region from genomic DNA. We genotyped 142 patients with major depression and dysthymia, and 252 age and sex matched normal subjects. All individuals were Korean. RESULTS: We found no significant differences in the allele frequency(2 nd intron, p=0.941 : promoter, p=0.122) between patients and controls. However, in association studies between antidepressant responsiveness in depressive patients and allele frequencies of 5-HTT gene polymorphism in intron2 and promoter regions, there was shown significant differences in both(p<0.0001, p=0.0028, respectively by Fisher exact test). CONCLUSIONS: These results suggest that there is no major effect of 5-HTT gene polymorphisms on the susceptibility to major depressions, while antidepressant nonresponding is related with genotypic alteration in 5-HTT gene.
Alleles ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Depression* ; DNA ; Gene Frequency ; Humans ; Introns ; Neurons ; Promoter Regions, Genetic ; Regulatory Sequences, Nucleic Acid ; Serotonin Plasma Membrane Transport Proteins* ; Serotonin Uptake Inhibitors ; Serotonin* ; Synaptic Transmission