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

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

Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin

The World Health Organization has included burnout in the 11th revision of the International Classification of Diseases as an occupational phenomenon that involves “factors influencing health status or contact with health services.” Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It manifests as exhaustion, depersonalization, and reduced job satisfaction. In the United States, more than 50% of physicians have reported burnout, and their suicide rate is more than twice as high as that of the general population. Burnout in physicians is linked with increased irritability, depression, and medical errors in practice, and decreased job satisfaction, work efficacy, and concentration. Most physicians have pointed to administrative burdens outside of clinical practice as the major cause of burnout. To prevent physician burnout, regular evaluations of stress and self-awareness of one's burnout status are essential. Each physician should make proactive lifestyle changes to reduce job-related stress, such as regular exercise, seeking help, ensuring enough rest, and fostering good interpersonal relationships. Awareness and prevention of burnout are important not only for physicians' mental health, but also for patients' care.
Depersonalization ; Depression ; Foster Home Care ; International Classification of Diseases ; Job Satisfaction ; Life Style ; Medical Errors ; Mental Health ; Suicide ; United States ; World Health Organization

The World Health Organization has included burnout in the 11th revision of the International Classification of Diseases as an occupational phenomenon that involves “factors influencing health status or contact with health services.” Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It manifests as exhaustion, depersonalization, and reduced job satisfaction. In the United States, more than 50% of physicians have reported burnout, and their suicide rate is more than twice as high as that of the general population. Burnout in physicians is linked with increased irritability, depression, and medical errors in practice, and decreased job satisfaction, work efficacy, and concentration. Most physicians have pointed to administrative burdens outside of clinical practice as the major cause of burnout. To prevent physician burnout, regular evaluations of stress and self-awareness of one's burnout status are essential. Each physician should make proactive lifestyle changes to reduce job-related stress, such as regular exercise, seeking help, ensuring enough rest, and fostering good interpersonal relationships. Awareness and prevention of burnout are important not only for physicians' mental health, but also for patients' care.

OBJECTIVES: Previous studies have shown the relationship between recognition of facial expressions and psychiatric symptoms. This study investigated how healthy young adults recognize neutral faces and which psychological distresses and symptoms relate to their recognition of neutral faces. METHODS: One hundred forty-three healthy volunteers participated in this study. We used neutral facial pictures, selected from the Japanese and Caucasian Facial Expressions of Emotion (JACFEE) photo set, to evaluate participants' facial expression recognition and the State-Trait Anxiety Inventory, Beck Depression Inventory, Toronto Alexithymia Scale, Conner-Davidson Resilience Scale, and Temperament and Character Inventory (TCI) to measure and examine their psychological characteristics. RESULTS: There were significant positive correlations between the recognition rate of neutral expressions as contempt and trait-anxiety level (r=0.21 ; p=0.01) and depression (r=0.20 ; p=0.02). This contempt-recognition was significantly negatively correlated with resilience score (r=-0.22 ; p=0.01) and the TCI self-directedness subscale (r=-0.29 ; p=0.00). Also, the TCI's harm avoidance subscale score was significantly positively correlated with the contempt recognition rate (r=0.21 ; p=0.01). CONCLUSION: These finding suggests recognition of neutral faces as contempt may be related to psychological distress, including trait and temperament characteristics. This negative bias toward neutral emotion (expressions) may affect interpersonal relations and social functioning in a healthy population.
Affective Symptoms ; Anxiety ; Asian Continental Ancestry Group ; Bias (Epidemiology) ; Depression ; Facial Expression ; Humans ; Interpersonal Relations ; Polymethacrylic Acids ; Temperament ; Young Adult

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

PURPOSE: To report a case of Miller Fisher syndrome in a pediatric patient with gastroenteritis associated with seroconversion of Campylobacter jejuni titer during the development of neurological symptoms and positive anti-GQ1b IgG. CASE SUMMARY: An 8-year-old male patient visited our clinic with bilateral ophthalmoplegia, diplopia, and ptosis of the right upper lid. He had experienced gastroenteritis one week previous, and antibodies to Campylobacter jejuni were detected in his plasma. Ophthalmic examination revealed a corrected visual acuity of 20/20 in both eyes. Ocular motor examination revealed limitations in all positions of gaze. Neurologic examination demonstrated areflexia and ataxia. The serologic anti-GQ1b IgG test was positive. Intravenous immunoglobulin and steroid pulse therapy were started. Extraocular movement, ptosis, and ataxia gradually improved after one month of treatment. CONCLUSIONS: We confirmed a case of Miller Fisher syndrome in a pediatric patient with bilateral ophthalmoplegia, ptosis, and a positive anti-GQ1b antibody test.
Antibodies ; Ataxia ; Campylobacter jejuni ; Child ; Diplopia ; Gastroenteritis ; Humans ; Immunoglobulin G* ; Immunoglobulins ; Male ; Miller Fisher Syndrome* ; Neurologic Examination ; Ophthalmoplegia ; Plasma ; Visual Acuity

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve