In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

OBJECTIVES: We aimed to evaluate discrepancies between self-awareness of memory functions and actual memory functions in the elderly community. METHODS: A total of 369 individuals aged over 65 years from four elderly community centers completed clinical evaluation, neuropsychological batteries of the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K), the Geriatric Depression Scale (GDS), the Instrumental Activities of Daily Living (IADL), and the Hachinski Ischemic Score. RESULTS: Among the elderly particpants, 26.3% showed incorrect awareness regarding their memory function. Those with subjective memory complaints included 73.5% with no memory impairment, while those without memory complaints included 11.3% of those with amnestic mild cognitive impairment (aMCI) and 4.3% of those with Alzheimer's disease (AD). Subjective memory complaints were significantly associated with depression. Among the elderly with no memory complaints, incorrect awareness was associated with 'no previous education' (OR 3.6, 95% CI 1.3-9.8), 'age over 80' (OR 2.4, 95% CI 1.1-5.4), and 'male' (OR 2.3, 95% CI 1.0-5.2) ; however, it was not significantly associated with depression. CONCLUSION: Incorrect awareness of memory impairment is prevalent among the elderly. Further, elderly individuals of an advanced age with no education may have memory impairment without memory complaints.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Depression ; Humans ; Memory ; Mild Cognitive Impairment

OBJECTIVE: We aimed to investigate the factors associated with suicidality among the elderly, focusing pain as the potential correlate. METHODS: This study was a community-based, cross-sectional study that included 413 elderly subjects aged 60 years and over with depression. Suicidality and pain were evaluated using Suicidal Ideation Scale and Geriatric Pain Measure, respectively. Participants were classified into two groups : 1) those with mild-to-moderate pain ; 2) those with severe pain. The risk of suicidality was determined using logistic regression, adjusting for age, sex, education, literacy status, marital status, living arrangement, the type of medical insurance, employment status, and the number of chronic medical illnesses. RESULTS: Among all subjects with depression, fifty-one (12.3%) presented clinically significant levels of suicidality. Those with severe pain were more likely to have suicidal idea (adjusted odds ratio : 20.49 ; 95% confidence interval : 8.15-51.51 ; p value : < 0.001) than those with mild-to-moderate pain, after adjusting for other variables. Other sociodemographic and clinical variables were not associated with the risk of suicide after adjustment. CONCLUSION: The severity of pain was strongly and independently associated with suicidality in the elderly individuals. This study suggests that the pain management should be emphasized to lower the rate of suicide in those experiencing depression in the late-adulthood.
Aged* ; Chronic Disease ; Cross-Sectional Studies ; Depression ; Education ; Employment ; Humans ; Insurance ; Logistic Models ; Marital Status ; Odds Ratio ; Pain Management ; Residence Characteristics ; Suicidal Ideation ; Suicide

The nationwide prevalence of major depressive disorder in Korea is lower than most countries, despite the high suicide rate. To explain this unexpectedly low prevalence, we examined the functional disability and quality of life in community-dwelling subjects with significant depressive symptoms not diagnosable as depressive disorder. A total of 1,029 subjects, randomly chosen from catchment areas, were interviewed with the Center for Epidemiologic Studies Depression scale, Mini International Neuropsychiatric Interview, WHO Quality of Life scale, and the WHO Disability Assessment Schedule. Those with scores over 21 on the depression scale were interviewed by a psychiatrist for diagnostic confirmation. Among community-dwelling subjects, the 1-month prevalence of major depressive disorder was 2.2%, but the 1-month prevalence of depressive symptoms not diagnosable as depressive disorder was 14.1%. Depressive disorders were the cause of 24.7% of work loss days, while depressive symptoms not diagnosable as depressive disorder were the cause of 17.2% of work loss days. These findings support the dimensional or spectrum approach to depressive disorder in the community and might be the missing link between the apparent low prevalence of depressive disorder and high suicide rate in Korea.
Adolescent ; Adult ; Analysis of Variance ; Depression/*diagnosis/epidemiology ; Female ; Humans ; Interviews as Topic ; Male ; Mental Health ; Middle Aged ; Prevalence ; *Quality of Life ; Young Adult

With a rapidly aging society, geriatric mental health is emerging as important public health concern. Despite the short history of psychiatric epidemiology in Korea, recently, epidemiologic data regarding geriatric psychiatric problems has started to accumulate. In the current study, we reviewed epidemiological findings regarding geriatric mental health in Korea. It was found that up to 10% of the elderly suffer from dementia, and 10% to 20% from depressive disorder. Further, prevalence estimates of Alzheimer's disease ranged from 4.2% to 9.0%, and vascular dementia from 1.0% to 4.8%. Annual incidence rates for Alzheimer's were 2.7% to 3.4% whereas that for vascular dementia was found to be as low as 0.3%. The prevalence of major depressive disorder was 4.2% to 9.1%, while that of clinically significant depressive symptom was between 9.1% and 33.0%. Finally, those with alcohol use disorders were found to comprise up to 13.6% of elderly population and additionally, 22% to 58% of the elderly were found to have sleep difficulties. Thus major mental disorders are already prevalent among the Korean elderly and are likely to increase rapidly.
Aged ; Aged, 80 and over ; Alzheimer Disease/epidemiology ; Dementia/epidemiology ; Dementia, Vascular/epidemiology ; Depressive Disorder/epidemiology ; Humans ; Mental Disorders/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors

With a rapidly aging society, geriatric mental health is emerging as important public health concern. Despite the short history of psychiatric epidemiology in Korea, recently, epidemiologic data regarding geriatric psychiatric problems has started to accumulate. In the current study, we reviewed epidemiological findings regarding geriatric mental health in Korea. It was found that up to 10% of the elderly suffer from dementia, and 10% to 20% from depressive disorder. Further, prevalence estimates of Alzheimer's disease ranged from 4.2% to 9.0%, and vascular dementia from 1.0% to 4.8%. Annual incidence rates for Alzheimer's were 2.7% to 3.4% whereas that for vascular dementia was found to be as low as 0.3%. The prevalence of major depressive disorder was 4.2% to 9.1%, while that of clinically significant depressive symptom was between 9.1% and 33.0%. Finally, those with alcohol use disorders were found to comprise up to 13.6% of elderly population and additionally, 22% to 58% of the elderly were found to have sleep difficulties. Thus major mental disorders are already prevalent among the Korean elderly and are likely to increase rapidly.
Aged ; Aged, 80 and over ; Alzheimer Disease/epidemiology ; Dementia/epidemiology ; Dementia, Vascular/epidemiology ; Depressive Disorder/epidemiology ; Humans ; Mental Disorders/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia ; Dermatomyositis ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

OBJECTIVES: The high suicide rate has risen as a main concern in South Korea. Given the complexity of the mechanism resulting in complete suicide, studies targeting various populations are needed for broader understanding of its risk factors. This study aims to analyze the factors affecting the suicidal tendency in the population of the elderly living alone in Seoul depending on basic elderly-care services. METHODS: A total number of 415 people participated in the study. Home-visit interviews were administered by trained interviewers. Suicidal tendency was measured by the Korean version of mini international neuropsychiatric interview (K-MINI). Health-related quality of life was measured by a brief version of the World Health Organization Quality-of-life Scale (WHOQOL-BREF). Alcohol problem was assessed by the Korean version of the alcohol use disorders identification test (AUDIT-K). Among total subjects of 415 interviewees, the actual responses of 408 people were used for the final analysis. RESULTS: The result showed that the suicide risk was high in persons isolated from social support [odds ratio (OR) = 4.49], having depression (OR = 14.85), and having low quality of life (OR = 4.39). CONCLUSIONS: We found that social support, depression and health-related quality of life are associated with suicidal tendency in the elderly living alone on basic services. Our evidence will contribute to suicide prevention policy for the elderly living alone on care services.
Aged* ; Depression ; Humans ; Korea ; Quality of Life ; Risk Factors ; Seoul ; Suicide ; World Health Organization

Objective: Pharmacotherapy is considered as an essential element in the treatment of psychotic disorders including schizophrenia. Discontinuation of antipsychotic drugs increases medical use and economic burden. Therefore, maintenance of medication is essential to reduce the social burden caused by schizophrenia and schizophrenia similar psychosis (SSP), and hence, it is important to investigate the rate at which pharmacotherapy is maintained. Therefore, this study aimed to examine the current status of drug compliance using national health insurance data. Methods: This was a retrospective cohort study, which analyzed data from the nationwide insurance claims database. A total of 343,134 patients who were newly diagnosed with schizophrenia and SSP during 2011−2015. The adherence to antipsychotic drugs was assessed by medication possession ratio (MPR) and the risk factors of poor adherence were defined as MPR ＜ 40%. Results: The average of the MPRs was 45.8%, and the proportion of patients with less than 40% of MPR was 50.8%. It was found that female patients, the experience of “general hospital outpatient,” “psychiatric hospital admission,” “general hospital admission,” and patients receiving “health insurance” showed high risk of having statistically significant low MPR (＜ 40%). Conclusion In this study, the drug adherence of schizophrenia and SSP patients currently under treatment, as estimated by MPR, was very low. However, it was also found that the MPR was high among patients receiving medical aid, with less medical expenses. Thus, it is possible to consider an institutional mechanism in which schizophrenia and SSP patients can be treated with less economic burden.

Objective: The purpose of this study was to identify the associations of chronic physical disease between patients with severe mental illness (SMI) and the general population of South Korea. Methods: This study was conducted with National Health Insurance Corporation data from 2014 to 2019. A total of 848,058 people were diagnosed with SMI in this period, and the same number of controls were established by matching by sex and age. A descriptive analysis was conducted on the sociodemographic characteristics of patients with SMI. Conditional logistic regression analysis was performed to identify the associations between comorbid physical disease in patients with SMI and those of the general population. SAS Enterprise Guide 7.1 (SAS Inc, Cary, NC, USA) were used to perform all statistical tests. Results: The analysis revealed significant differences in medical insurance, income level, and Charlson Comorbidity Index weighted by chronic physical disease, between patients with SMI and the general population. Conditional logistic regression analysis between the two groups also revealed significant differences in eight chronic physical diseases except hypertensive disease. Conclusion This study confirmed the vulnerability of patients with SMI to chronic physical diseases and we were able to identify chronic physical disease that were highly related to patients with SMI.