Alcohol has extensive effects on sleep and daytime sleepiness. Alcohol has a sleep inducing effect and the effect of increased non-REM sleep and suppressed REM sleep during the first half portion of night sleep, but alcohol induces the effect of decreased non-REM sleep and increased light sleep and frequent awakenings and REM rebound during the second half portion of night sleep. Alcohol provokes chronobiological change such as the changes of amplitude or the phase shifts of hormones or core body temperature. The sleep disruption resulting from alcohol drinking may lead to daytime fatigue and sleepiness. The elderly are at particular in the increased risk of alcohol-related sleep disorders because they achieve higher levels of alcohol in the blood and brain than do younger adults after consuming an equivalent dose. Bedtime alcohol consumption among older adults may lead to unsteadiness if walking is attempted during the night, with increased risk of falls and injuries. Continued alcohol use for sleep induction often induces aggravation of insomnia, alcoholism or sleep related breathing disorders such as obstructive sleep apnea. Alcohol should not be used as substitution of sleep pill because of the dependence and tolerance for sleep inducing effect, and the sleep disruption produced by alcohol withdrawal.
Adult ; Aged ; Alcohol Drinking ; Alcoholism ; Body Temperature ; Brain ; Fatigue ; Humans ; Respiration ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sleep, REM ; Walking

OBJECTIVES: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. METHODS: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=41.50+/-13.16 yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=43.67+/-12.11 yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age 44.93+/-12.38 yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=45.87+/-12.44 yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. RESULTS: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were 991.1+/-27.1 and 875.8+/-22.0 ms (p=0.016), standard deviation of NN interval (SDNN) was 85.4+/-6.6 and 112.8+/-5.4 ms (p=0.022), SDNN index was 57.5+/-5.2 and 87.6+/-4.2 (p<0.001), total power was 11,893.5+/-1,359.9 and 18,097.0+/-1,107.2 ms2 (p=0.008), very low frequency (VLF) was 7,534.8+/-1,120.1 and 11,883.8+/-912.0 ms2 (p=0.035), low frequency (LF) was 2,724.2+/-327.8 and 4,351.6+/-266.9 ms2 (p=0.003). CONCLUSIONS: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.
Acceleration ; Anoxia ; Arousal ; Autonomic Nervous System ; Cardiovascular System ; Heart ; Heart Rate ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sympathetic Nervous System

OBJECTIVES: The aim of this study was to investigate correlation of childhood trauma experience and parent-adolescents' assessment reports on problem behavior through comparison of delinquent and general adolescents. METHODS: First, delinquent adolescents and general adolescents were asked to complete the Childhood Trauma Questionnaire (CTQ). Then, 71 pairs of delinq uent adolescents and their parents and 133 pairs of general adolescents and their parents were asked to complete the Korean Youth Self-Report (K-YSR) and the Korean Child Behavior Checklist (K-CBCL). Finally, responses from 410 people were used for the analysis. RESULTS: First, childhood trauma experience score was significantly higher for delinquent adolescents, compared to general adolescents. Second, t-test showed a greater difference between K-YRS and K-CBCL for general adolescents than for delinquent adolescents. Third, in the case of delinquent adolescents, the correlation analysis of K-YSR filled out by adolescents and K-CBCL filled out by parents showed significant correlation in certain areas, including social immaturity, delinquent behaviors, internalization issues, and externalization issues. On the other hand, the correlation analysis of K-YSR and K-CBCL of general adolescents showed significant correlation in all sub-categories. Fourth, the correlation analysis of delinquent adolescents' CTQ and K-YSR showed minimal yet significant correlation in social adaptation, withdrawing, depression/anxiety, and delinquent/aggressive behaviors, however, no correlation was observed between CTQ and K-CBCL. The correlation analysis of general adolescents' CTQ and K-YSR, and CTQ and K-CBCL showed significant correlation in all sub-categories, although the degree of correlation varied. CONCLUSION: Delinquent adolescents had more childhood traumatic experiences. However, general adolescents' childhood traumatic experiences showed minimal yet significant correlation with various adaptation indicators and their parents responded in a similar way, indicating that general adolescents with childhood traumatic experiences need close care and attention even if they have not shown prominent delinquent behaviors.
Adolescent ; Checklist ; Child ; Child Behavior ; Hand ; Humans ; Parents ; Surveys and Questionnaires

OBJECTIVES: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. METHODS: One hundred seventy six drug-free male patients confirmed as OSAS (average age=43+/-11 years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was 39.6+/-26.0. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. RESULTS: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05). Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. CONCLUSION: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.
Actigraphy ; Anxiety ; Depression ; Humans ; Male ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Weights and Measures ; Wrist

OBJECTIVES: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress in anxiety disorder patients. METHODS: HRV was measured at resting, upright, and psychological stress states in 60 anxiety disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity. Differences between HRV indices were evaluated using paired t-tests. Gender difference analysis was accomplished with ANCOVA. RESULTS: SDNN (Standard deviation of normal RR intervals) and low frequency/high frequency (LF/HF) were significantly increased, while NN50, pNN50, and normalized HF (nHF) were significantly decreased in the upright position compared to resting state (p < 0.01). SDNN, root mean square of the differences of successive normal to normal intervals, and LF/HF were significantly increased, while nHF was significantly decreased in the psychological stress state compared to resting state (p < 0.01). SDNN, NN50, pNN50 were significantly lower in upright position compared to psychological stress and nVLF, nLF, nHF, and LF/HF showed no significant differences between them. CONCLUSION: The LF/HF ratio was significantly increased after both physical and psychological stress in anxiety disorder, but did not show a significant difference between these two stresses. Significant differences of SDNN, NN50, and pNN50 without any differences of nVLF, nLF, nHF, and LF/HF between two stresses might suggest that frequency domain analysis is more specific than time domain analysis.
Anxiety ; Anxiety Disorders* ; Autonomic Nervous System ; Depression ; Equipment and Supplies ; Heart Rate* ; Humans ; Stress, Psychological*

The authors reviewed the histories of the use of the term empathy, the different meanings of empathy, the origins of empathetic abilities, the referents for empathy, the paradoxical attitude of empathy, the therapeutic effect of empathy and the inadequate uses of empathy by referring to the recent psychoanalytic articles. We wanted to provide the psychoanalytic understanding of empathy for analytic psychotherapists. The important points for the psychoanalytic understandings of empathy were as follows:First, empathy is not a goal, but a method in the therapeutic process. Second, the empathetic attitude can be started at the beginning of treatment, yet it takes time for empathy to function in the treatment. Third, when providing empathy, a therapist needs both a subjective sense of sympathy for a patient and objective observation of the interaction between them during the treatment sessions. Fourth, a therapist needs to decrease his/her own narcissistic and omnipotent aspects and to use structured receptivity when providing empathy. Fifth, the process of empathy can be thought to be the result of the interaction between the patient and the therapist. Sixth, it may be more useful for a therapist to understand a patient through empathy rather than to provide a cure for a patient through empathy.
Empathy ; Humans ; Psychoanalysis

OVJECTIVES: As the attention devoted to children's mental health increases, medical costs and burdens mount as well. In the present study, we evaluated the association between socioeconomic status (SES) and major child psychiatric symptoms. METHODS: The subjects of this study were children of recruited from a mental health screening program in the Seoul Sungbuk mental health center over the course of 3 months. To establish the SES of each child, we collected data about each child's medical insurance, years of parental education, household income, family structure and housing. 149 children& parents completed questionnaires including the Childhood Depression Inventory (CDI) and the Korean Attention Deficit Hyperactivity Disorder Rating Scale (K-ARS). RESULTS: The mean K-ARS-P score was 12.1+/-11.1 and the suspected prevalence of ADHD was 20.8% (n=31). The mean CDI score was 12.9+/-7.9, and the prevalence of suspected depression was 16.8% (25). Depressive symptoms and ADHD symptoms were both more severe than those observed in a previous epidemiologic study in Korea. Depressive symptoms were more closely associated with family SES status. CONCLUSION: SES status is one of the most important risk factors in the development of major child psychiatric symptoms. In our study we found that depressive symptoms in particular were most tightly associated with psychosocial factors. Evaluation of the risk factors, early screening and intervention for low SES children would be valuable mental health management tactics to implement in a community mental health system.
Attention Deficit Disorder with Hyperactivity ; Child ; Depression ; Epidemiologic Studies ; Family Characteristics ; Housing ; Humans ; Insurance ; Korea ; Mass Screening ; Mental Health ; Parents ; Prevalence ; Risk Factors ; Social Class ; Surveys and Questionnaires

The authors reviewed the meanings of a psychoanalytic setting, which is composed of a patient's free association and an analyst's analytic neutrality. In particular, this was done by discussing the definitions of a psychoanalytic setting, the functions of free association, and the development of the meanings of analytic neutrality over time. The purpose this wasto provide an understanding of a psychoanalytic setting for psychoanalytic therapists. To fully understanda psychoanalytic setting, the several points must be considered. Firstly, a patient's introspection about his/her inner world in the presence of an analyst in a psychoanalytic setting facilitates the development of the psychoanalytic process. Secondly, both a patient's reflective functioning of his/her mental process and a patient's relational experiences of transference feelings toward their analyst is important for analytic treatment. Thirdly, a patient's progress withfree association during treatment sessions indicates spontaneity, a motivation to be cured from a patient's standpoint. Fourthly, a patient and an analyst become aware of the meaning of a patient's materials from free association through the process of Ed-highlight: Unclear. I'm not sure what you mean by this word. Are you referring to the patient's thoughts or feelings? free association itself. Fifth, the main aim of analytic neutrality is to understand the patient's psychic reality, and it is important to understand this reality through interaction between a patient and an analyst
Free Association ; Humans ; Motivation ; Psychoanalysis

OBJECTIVES: It is well established that primary insomnia affects the activity of autonomic nervous system. We tried to know how the activity of autonomic nervous system during night sleep changes by analyzing correlation between heart rate variability (HRV) index and the variables related with sleep structure in primary insomnia. METHODS: Thirty three subjects (mean age:36.2+/-14.2 years, male:female=15:18) who were diagnosed with primary insomnia were selected for the study. Nocturnal polysomnography (NPSG) was carried out on each subject and correlation was analyzed between high frequency/low frequency ratio (LF/HF ratio), one of HRV indices and the variables related with sleep structure which were calculated from NPSG. RESULTS: When age and sex were controlled, LF/HF ratio showed negative correlations with slow wave sleep and stage 2 sleep, respectively (r(p)=-0.43, p=0.01;r(p)=-0.37, p=0.04). On the other hands LF/HF ratio showed a positive correlation with arousal index (r(p)=0.65, p<0.001). The activity of autonomic nervous system responded differentially depending on the change of sleep structure in primary insomnia. Especially the increase of arousal index and the decrease of slow wave sleep and stage 2 sleep which are the components of non-REM sleep provoked hyperactivity of sympathetic nervous system. CONCLUSION: This study suggests that the typical change of sleep structure in primary insomnia can negatively impact on cardiovascular system.
Arousal ; Autonomic Nervous System ; Cardiovascular System ; Hand ; Heart ; Heart Rate ; Polysomnography ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: Elderly depression is often misdiagnosed as a dementing illness such as Alzheimer's disease (AD). Moreover, depressive symptoms often are presented in the early phase of AD. It is difficult to distinguish the difference between mild cognitive impairment (MCI) and depression. The purpose of this study is to explore neuropsychological characteristics of patients with amnestic MCI (aMCI) and depression. We hypothesized that there would be the difference in the cognitive function of those groups and this made clearer the nature of a depression and aMCI. METHODS: A community dwelling older people aged over 60 years were enrolled for the study. We compared 24 patients with aMCI, 23 with depression complaining subjective memory decline, and 26 normal elderly. Demographic and neuropsychological data were gathered and assessed by trained psychologist. RESULTS: Patients with aMCI and depression had significant differences separately from normal controls in particular cognitive function. Patients with aMCI showed more cognitive declines in learning than normal older people. Patients with depression had less performance in attention and executive function than normal controls. CONCLUSION: To understand the clinical difference and underlying pathophysiology of aMCI and depression, the precise criteria of aMCI gathering more homogeneous group of depression in severity and onset time will be needed.
Aged ; Alzheimer Disease ; Depression ; Executive Function ; Humans ; Learning ; Memory ; Mild Cognitive Impairment