Objective: Patients with dementia often require institutionalization as their disease progresses, but institutionalization may be associated with several negative outcomes including increased mortality. This study aimed to investigate factors related to institutionalization in patients with dementia in South Korea using nationwide population-based data. Methods: National Health Insurance Service and Long-Term Care Insurance (LTCI) database were used for analysis. The study population consisted of patients with dementia aged 65 years or older who qualified for LTCI institutional care benefits from 2008 to 2017. Multiple logistic regression was used to analyze factors related to institutionalization in patients with dementia. Results: We identified 141,552 patients, of which 90,110 were institutionalized and 51,442 were not. Older age, female sex, low income, non-family caregiver, less comorbidities, no disability and diagnosis of Alzheimer’s disease (AD) were related to institutionalization. Conclusion Consistent with previous studies, older age and diagnosis of AD were related to institutionalization. In addition, low income and non-family caregiver were associated with institutionalization, which may be due to insufficient home care service inSouth Korea.

Objectives: ：Delirium is a temporary brain dysfunction and systemic inflammation is important factor in its pathophysiology. Whether the neutrophil-lymphocyte ratio (NLR), one of the inflammatory markers, can be used as an inflammatory marker in delirium patients was investigated in comparison with C-reactive protein (CRP). Methods: ：We retrospectively reviewed the medical records of patients who were referred for consultation for delirium at hospital for one year. The NLR and CRP values at admission and delirium status were divided into the medical and the surgical treatment group, and the interaction between them was analyzed through repeated mea-sures ANOVA. Results: ：NLR was maintained without significant difference before and after delirium in the medical treat-ment group and the surgical treatment group, but CRP decreased in the medical treatment group and increased in the surgical treatment group during delirium, showing a significant interaction. Conclusions ：In delirium patients, the NLR remained constant, but the CRP differed according to the treatment group and the delirium state. This suggests the possibility that NLR could be used complementary to CRP as an in-flammatory marker in delirium patients.

Objectives: ：QTc prolongation due to antipsychotics is of major concern because it may lead to fatal ventricular arrhythmia such as torsade de pointes. However, few studies have been conducted on QTc prolongation due to antipsychotics, especially in South Korea. This study aimed to investigate how demographic and clinical variables affect QTc interval in patients with schizophrenia. Methods: ：By retrospectively reviewing medical records, we assessed QTc interval, demographic data and clinical features of 441 (175 males) patients with schizophrenia who admitted to the psychiatric ward of a general hospital. To explore the predictive factors for QTc interval, hierarchical regression analysis was performed with QTc interval as the dependent variable. Results: ：The mean QTc interval was 417.2±28.4 ms. In the hierarchical regression analysis, the use of shortacting antipsychotic injection was the strongest predictor of the QTc prolongation. Conclusions ：This study demonstrated that the use of short-acting antipsychotic injection may affect QTc prolongation in patients with schizophrenia. This result suggests that more attention should be paid to the use of short-acting antipsychotic injection in the treatment of schizophrenia.

Objectives: Recent studies have reported that delayed initiation of clozapine can affect clinical response in patients with treatment-resistant schizophrenia (TRS). This study aimed to explore the relationship between delayed initiation of clozapine and acute treatment response. Methods: Sixty-five inpatients with TRS who started clozapine for the first time were included through a retrospective chart review. Acute treatment response was defined as a 30% reduction in the Positive and Negative Syndrome Scale score or a Clinical Global Impression of Improvement score of 1 (very much improved) or 2 (much improved) at 4 weeks after initiating clozapine. Results: After meeting the TRS criteria, the mean delay for initiating clozapine was approximately 13.8 months. The delay was shorter in patients who showed a better response to clozapine in logistic regression analysis (p=0.037). Conclusion Our findings suggest that reducing the delay in initiating clozapine increases the effectiveness of clozapine in patients with TRS.

OBJECTIVES: Although delirium is a common complication among patients hospitalized in intensive care units(ICUs), little is known about the roles that diagnostic and therapeutic procedures play in its development. This study investigates the procedure-related risk factors of delirium in ICU patients. METHODS: All the consecutive patients admitted to the ICU between June 2016 and May 2017 were routinely evaluated for delirium by psychiatrists. In total, 1156 patients met the inclusion criteria and were retrospectively analyzed. A multiple logistic regression analysis was conducted to investigate independent risk factors of delirium development while adjusting for other characteristics. RESULTS: The age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, proportion of patients who had undergone an operation, and proportion of patients who were foley catheterized, mechanically ventilated, and physically restrained were higher in the delirium group. The multiple logistic regression analysis confirmed that the use of restraint was an independent risk factor of delirium (odds ratio : 10.006 ; 95% confidence interval : 6.120–16.360 ; p<0.001). The patient factors independently associated with delirium were an advanced age and a higher APACHE II score. The incidence of delirium was 15.3%. CONCLUSIONS: There is a high prevalence of delirium influenced by potentially harmful procedures in patients in ICU settings. The use of physical restraint had the strongest association with the development of delirium. These findings advocate the need to target procedure-related risk factors such as the use of restraints as preventive intervention measures for ICU delirium.
APACHE ; Catheters ; Critical Care ; Delirium ; Humans ; Incidence ; Intensive Care Units ; Logistic Models ; Prevalence ; Psychiatry ; Restraint, Physical ; Retrospective Studies ; Risk Factors

Objective: The aim of this study was to investigate the association between the use of statins and the occurrence of delirium in a large cohort of patients in the intensive care unit (ICU), considering disease severity and statin properties. Methods: We obtained clinical and demographical information from 3,604 patients admitted to the ICU from January 2013 to April 2020. This included information on daily statin use and delirium state, as assessed by the Confusion Assessment Method for ICU. We used inverse probability of treatment weighting and categorized the patients into four groups based on the Acute Physiology and Chronic Health Evaluation II score (group 1: 0−10 - mild; group 2: 11−20 -mild to moderate; group 3: 21−30 - moderate to severe; group 4: ＞ 30 - severe). We analyzed the association between the use of statin and the occurrence of delirium in each group, while taking into account the properties of statins. Results: Comparisons between statin and non-statin patient groups revealed that only in group 2, patients who were administered statin showed significantly higher occurrence of delirium (p = 0.004, odds ratio [OR] = 1.58) compared to the patients who did not receive statin. Regardless of whether statins were lipophilic (p = 0.036, OR = 1.47) or hydrophilic (p = 0.032, OR = 1.84), the occurrence of delirium was higher only in patients from group 2. Conclusion The use of statins may be associated with the increases in the risk of delirium occurrence in patients with mild to moderate disease severity, irrespective of statin properties.

Background: Depression is a global mental health concern that negatively affects individuals’ health and increases medical costs. This study aimed to assess whether early depression management is cost-beneficial and effective from the perspective of quality indicators. Methods: Data of patients newly diagnosed with depressive disorder between 2012 and 2014 as well as follow-up data until 2020 were extracted from the National Health Insurance Service database. Hospitalization, emergency room visits, and annual medical expenses were set as dependent variables to estimate the effect of depression and information on medical expenditures. Six quality indicators developed by the Health Insurance Review and Assessment Service comprised independent variables. Results: In total, 465,766 patients were included in this study. Patients who met the quality indicators were more likely to be hospitalized with a psychiatric diagnosis. Furthermore, patients who met the quality indicator of revisiting within 3 weeks of their first visit had greater psychiatric and overall expenses during the early treatment phase; however, the overall expenses gradually decreased over time. Conclusion High-quality initial treatment for depression can be cost-effective in the long term; however, further studies are needed to discern its immediate clinical effects.

Purpose: Repeated transcranial direct current stimulation (tDCS) is expected to have the potential to improve cognitive function in patients with mild cognitive impairment (MCI). We aimed to evaluate the efficacy and safety of at-home tDCS for elderly patients with MCI. Materials and Methods: Patients aged 60–80 years, who maintained normal daily living but reported objective memory impairments, were enrolled. Active or sham stimulations were applied to the dorsal frontal cortex (left: anode; right: cathode) at home for 2 weeks. Changes in cognitive function were assessed using visual recognition tasks and the Mini-Mental State Exam (MMSE), and safety and efficacy were assessed using self-reports and a remote monitoring application. Results: Of the 19 participants enrolled, 12 participants were included in the efficacy analysis. Response times and MMSE scores significantly improved after active stimulation compared to the sham stimulation; however, there were no significant differences in the proportion of correct responses. The mean compliance of the efficacy group was 97.5%±4.1%. Three participants experienced burns, but no permanent sequelae remained. Conclusion This preliminary result suggests that home-based tDCS may be a promising treatment option for MCI patients; however, it requires more attention and technological development to address safety concerns.

OBJECTIVES: In this preliminary study, we investigated the clinical characteristics of patients who were first diagnosed with psychotic disorder and explored the impact of the adherence to antipsychotics on long-term medical use. METHODS: All national health insurance claims related to psychotic disorders including gender, age, income, and drug compliance, from January 1, 2008 to December 31, 2015, were examined. With trend test using Medication Possession Ratio (MPR), we compared the medical use between the compliant group (MRP≥0.8) and the comparative non-compliant group (0.2≤MPR<0.8). RESULTS: Among 28,095 participants in total, 16,239 patients (57.8%) were diagnosed as schizophrenia; the 30s were the most common (n=7,151, 25.5%). Drug compliance was generally low regardless of the diagnosis and was the lowest among 20s with the 40–60% range of income. The compliant group showed lower psychiatric and medical use than the comparative group in the following years (p<0.0001). CONCLUSION: These findings suggest that patients in the 20s and 30s with the 40–60% range of income, who are diagnosed with schizophrenia at the first psychiatric visit, may need more clinical and political attention. The results also emphasize the importance of initial drug adherence to antipsychotics in reducing long-term psychiatric costs.
Antipsychotic Agents ; Compliance ; Diagnosis ; Humans ; National Health Programs ; Psychotic Disorders ; Schizophrenia

OBJECTIVES: normal circadian rhythm of autonomic nervous system function stands for the daily change of sympathetic and parasympathetic modulation, which can be measured by heart rate variability (HRV). Generally, patients in the intensive care unit (ICU) are prone to sleep-wake cycle dysregulation, therefore, it may have an influence on the circadian rhythm of autonomic nervous system. This study was designed to interpret possible dysregulation of autonomic nervous system in ICU patients by using HRV. METHODS: HRV was assessed every 3 hours in 21 ICU patients during a 7-minute period. The statistical differences of HRV features between the morning (AM 6 : 00–PM 12 : 00), and the afternoon (PM 12 : 00–PM 18 : 00) periods were evaluated in time domain and frequency domain. RESULTS: Patients showed significantly increased normalized power of low frequencey (nLF), absolute power of low frequencey (LF)/absolute power of high frequencey (HF) in the afternoon period as compared to the morning period. However, normalized power of high frequency (nHF) was significantly decreased in the afternoon period. There was no statistically significant difference between the morning period and the afternoon period in the time domain analysis. CONCLUSIONS: The increased sympathetic tone in the afternoon period supports possible dysregulation in the circadian rhythm of autonomic nervous system in ICU patients. Future studies can help to interpret the association between autonomic dysregulation and negative outcomes of ICU patients.
Autonomic Nervous System* ; Circadian Rhythm* ; Critical Care* ; Heart Rate* ; Heart* ; Humans ; Intensive Care Units*