Delayed carbon monoxide (CO) encephalopathy patients can show cognitive impairment, aphasia, affective and personality changes and behavioral symptoms. The prognosis of them is sometimes poor or irreversible. We present a case of 61-year-old woman who visited us at 56 days after CO intoxication and showed moderate to severe cognitive impairment and behavioral problems. We prescribed the donepezil (5 mg/d), memantine (5 mg/d), choline alfoscerate (800 mg/d) and ziprasidone (20 mg/d), based on previous case reports and performed the cognitive rehabilitation. After 30 days treatment in hospital, she showed dramatic improvement in cognitive functions and behavioral problems. This case suggests that adequate pharmacological and cognitive treatment could improve the moderate to severe symptoms of delayed CO encephalopathy even about 2 months later after CO intoxication.
Aphasia ; Behavioral Symptoms ; Brain Diseases* ; Carbon Monoxide* ; Carbon* ; Cognition ; Cognition Disorders ; Female ; Glycerylphosphorylcholine ; Humans ; Memantine ; Middle Aged ; Problem Behavior ; Prognosis ; Rehabilitation

OBJECTIVE: Anxiety is prevalent in patients with mild cognitive impairment (MCI) and are considered to be a risk factor for conversion to dementia. The purpose of this study was to evaluate whether Anxiety symptoms in MCI promote disease progression in a manner related to amyloid status, and to determine the relationship between anxiety symptoms and longitudinal cerebral structural changes. METHODS: Baseline data for 230 patients with amyloid-positive MCI (52 with anxiety and 178 without) from the Alzheimer's Disease Neuroimaging Initiative study were analyzed. All participants underwent comprehensive cognitive testing, volumetric MRI, and [18F]AV45 positron emission tomography amyloid imaging. Anxiety symptoms were measured using the Neuropsychiatric Inventory Questionnaire. A voxel-based morphometric analysis using volumetric brain MRI data was used to compare longitudinal structural changes related to anxiety symptoms. RESULTS: The conversion rate to dementia was different between patients with and without anxiety in amyloid-positive MCI (37.7% vs. 16.1%, respectively ; p=0.001). Anxiety in amyloid-positive MCI was associated with longitudinal cortical atrophy in the left superior temporal gyrus, left Heschl's gyrus, left parahippocampal gyrus, left anterior cingulum, bilateral anterior cingulum and right superior orbital gyrus. CONCLUSION: Our study indicates that the presence of anxiety in patients with amyloid-positive MCI is associated with higher conversion to dementia and longitudinal cortical atrophy.
Alzheimer Disease ; Amyloid ; Anxiety* ; Atrophy ; Brain ; Dementia* ; Disease Progression ; Humans ; Magnetic Resonance Imaging ; Mild Cognitive Impairment* ; Neuroimaging ; Parahippocampal Gyrus ; Positron-Emission Tomography ; Prefrontal Cortex ; Risk Factors ; Temporal Lobe

OBJECTIVES: Nocturnal sleep disruption has been considered as a risk factor for cognitive impairment in the elderly. And the frontal lobe dysfunction was suggested to predict the progression to dementia. We aimed to illustrate the relationship of nocturnal sleep with frontal lobe function in mild cognitive impairment (MCI) patients. METHODS: Thirty MCI patients and 30 age- and sex-matched normal control (NC) subjects were selected. Frontal lobe function tests including Stroop Test, Similarity Test, Digit Span Test (DST), and Benton Visual Retention Test (BVRT) were administrated. Nocturnal polysomnography was done for each subject. RESULTS: There was no significant difference in the sleep parameters and diagnostic distributions of sleep disorders between the MCI and NC groups. In MCI patients, the mean hypopnea index (HI) of the ApoE4 positive group was higher than that of ApoE4 negative group. In the NC group, the wake time after sleep onset (WASO) was negatively correlated with the DST score (r=-0.545). In the MCI group, WASO tended to be negatively correlated with the Similarity Test score (r=-0.376, p=0.053), and slow wave sleep amount (SWS) was negatively correlated with the error score of BVRT (r=-0.489). CONCLUSION: Although there was no difference in the sleep quality and frequency of SAS between the MCI and NC groups, the severity of SDB was higher in MCI patients with ApoE4 compared to those without ApoE4. In the MCI group, the difficulty in maintaining sleep was associated with decreased executive function, and the decreased SWS was associated with impaired working memory. The relationship of nocturnal sleep with the frontal lobe function in MCI patients appears to be different from that of normal elderly subjects.
Aged ; Apolipoprotein E4 ; Dementia ; Executive Function ; Frontal Lobe ; Humans ; Memory, Short-Term ; Mild Cognitive Impairment ; Phenothiazines ; Polysomnography ; Retention (Psychology) ; Risk Factors ; Sleep Wake Disorders ; Stroop Test

We report the case of a 78-year-old female patient with dementia with Lewy bodies accompanying severe psychotic and parkinso-nian symptoms. The patient's symptoms did not improved with various antipsychotics, and cardiac and pulmonary side effects pre-vented adequate doses of the drugs from being administered. As an alternative approach, we performed electroconvulsive therapy, which can be conducted relatively safely in elderly patients with underlying medical conditions. The patient received 10 sessions of electroconvulsive therapy across a 4-week period. Remarkable improvements in psychotic and parkinsonian symptoms proven with validated scales were observed following the repeating electroconvulsive therapy sessions. This is the first case report describing the use of electroconvulsive therapy in a patient with dementia with Lewy bodies in Korea. This case report may help to establish new guidelines for the treatment of patients with dementia with Lewy bodies, which is still considered a difficult disease to treat.

We report the case of a 54-year-old female who was diagnosed with clinical dementia and recovered to normal cognition in only 11 days through appropriate intervention. The patient was on a complicated regimen of psychiatric medications for underlying depression and panic disorder. The patient noted increased deterioration in executive function gradual memory impairment starting in early 2020.As a result of the neuroimaging, prominent neurodegeneration and in vivo brain pathology were not observed. During outpatient clinic follow-up, severe obstructive sleep apnea (OSA) was confirmed. Based on the diagnostic results, a clinical impression was made for reversible dementia due to psychiatric drugs and OSA. During hospitalization for 10 days, the patient’s regimen of psychiatric medications with anticholinergic effects was changed, and long-acting benzodiazepines were reduced. The patient also underwent continuous positive airway pressure titration to ameliorate OSA. The patient reported subjective cognitive improvement and a comprehensive neuropsychiatric test performed at discharge later showed a normal range in all cognitive domains, and the patient's activity of daily living evaluated at the outpatient clinic after discharge had recovered.

OBJECTIVES: This study was conducted to examine the factors affecting suicide decision and to understand in detail their psychological and behavioral changes with high lethality suicide attempters who were supposed to be similar to suicide completers. METHODS: Twenty patients who visited Kangwon National University Hospital or Chuncheon National Hospital participated in this study. After applying suicide lethality with Risk-Rescue Rating Scale, high lethality attempters were screened. Each subject participated in an in-depth interview with a semi-structured interview schedule. RESULTS: The participants had high mean Risk-Rescue Rating Score (45.0+/-8.7), indicating that the study was conducted with the most lethal suicide attempters. Most attempters had chosen their methods of suicide impulsively without consideration for lethality, and most attempters reported that they chose suicide methods from recall of reports by mass media ; 70% of attempters had more than one previous suicide attempt and their suicide methods have been changed to increase the suicide success rate. Most common accompanying emotions before suicide attempts were hopelessness, helplessness, worthlessness, and loneliness. Most important precipitating factors of suicide were economic difficulties. CONCLUSION: These characteristics regarding suicide attempts led us to a detailed understanding. These results are expected to provide valuable information for development of evidence based suicide prevention policies and strategies.
Appointments and Schedules ; Gangwon-do ; Humans ; Loneliness ; Mass Media ; Precipitating Factors ; Retrospective Studies* ; Suicide*

OBJECTIVES: This study was conducted to investigate knowledge, attitude, and experience regarding suicidal behavior among mental health workers in Gangwon province of Korea to use as a basis for development of suicide prevention and education programs. METHODS: Questionnaires consisted of 31 questions including general knowledge regarding suicide statistics and suicide related legislation, attitude toward suicide, awareness of suicide, and individual experiences of suicidal behaviors. Chi-square and binary logistic regression analyses were used to determine differences and association among attitude toward suicide, individual experience of suicide, and sociodemographic characteristics. RESULTS: Taboo attitude toward suicide showed association with age and male. Males thought that social responsibility for suicide is necessary. Religiously non-affiliated group and people who had previous suicidal ideation and attempts showed a more permissive attitude toward suicide. CONCLUSION: The findings of this study suggest that demographic characteristics and previous individual experience of suicidal behaviors might influence attitude toward suicide. These personal characteristics should be considered in development of suicide prevention programs for mental health workers.
Education ; Gangwon-do ; Humans ; Korea* ; Logistic Models ; Male ; Mental Health* ; Social Responsibility ; Suicidal Ideation ; Suicide ; Taboo

OBJECTIVES: This study was conducted to investigate knowledge, attitude, and experience regarding suicidal behavior among mental health workers in Gangwon province of Korea to use as a basis for development of suicide prevention and education programs. METHODS: Questionnaires consisted of 31 questions including general knowledge regarding suicide statistics and suicide related legislation, attitude toward suicide, awareness of suicide, and individual experiences of suicidal behaviors. Chi-square and binary logistic regression analyses were used to determine differences and association among attitude toward suicide, individual experience of suicide, and sociodemographic characteristics. RESULTS: Taboo attitude toward suicide showed association with age and male. Males thought that social responsibility for suicide is necessary. Religiously non-affiliated group and people who had previous suicidal ideation and attempts showed a more permissive attitude toward suicide. CONCLUSION: The findings of this study suggest that demographic characteristics and previous individual experience of suicidal behaviors might influence attitude toward suicide. These personal characteristics should be considered in development of suicide prevention programs for mental health workers.
Education ; Gangwon-do ; Humans ; Korea* ; Logistic Models ; Male ; Mental Health* ; Social Responsibility ; Suicidal Ideation ; Suicide ; Taboo

OBJECTIVES: We compared the parameters of the sleep-wake rhythm in mild cognitive impairment (MCI) patients to those of normal elderly subjects, to illustrate how the characteristics of circadian rhythm relate to a specific neurocognitive function. METHODS: We selected 12 MCI patients and 12 age- and sex-matched normal control (NC) subjects and administered the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Neuropsychological battery and Stroop Color-Word Test (SCWT) to each subject. We measured each subject's sleep-wake rhythm by applying actigraphy for 96 hours. The sleep-wake rhythm was examined by cosinor analysis. RESULTS: There was no significant difference in the amplitude or acrophase of the sleep-wake rhythms between the NC and MCI groups. In the combined group, amplitude was positively correlated with Constructional Praxis scores (r=0.434, p<0.05), and acrophases tended to be positively correlated with Word List Memory scores (r=0.370, p=0.07). CONCLUSION: There was no difference between MCI patients' sleep-wake rhythm's amplitude and acrophase and those of NC subjects. Furthermore, decreased amplitude was associated with impaired visuospatial function in the combined group. It will be necessary to confirm this result in an expanded MCI group in a future study.
Actigraphy ; Aged ; Alzheimer Disease ; Circadian Rhythm ; Humans ; Memory ; Mild Cognitive Impairment ; Polymethacrylic Acids

Phendimetrazine is a medication currently being used to help patients with weight loss. It shares a chemical structure with amphetamines. As such, it shares some of the same toxicities, which can include psychosis. Two cases present good examples of phendimetrazine-induced psychotic disorder. A 30-year old female was admitted to emergency room with visual hallucination, auditory hallucination and aberrant behavior. Another 38-year old housewife was accompanied by her family to evaluate mood swing, auditory hallucination and behavioral change to psychiatric clinic. After evaluation in psychiatric ward, they were confirmed to have causal relation with prescription diet pills. These case reports demonstrate the potential dangers of amphetamine based diet pills. There have been several cases of cardiomyopathies and pulmonary hypertension related to phendimetrazine, but psychosis is something that is rarely recognized in an outpatient setting. Two cases showed the importance of obtaining a careful medication history in all patients and specially recognizing diet pills with an amphetamine base causing psychosis.
Amphetamine ; Amphetamines ; Cardiomyopathies ; Diet ; Emergencies ; Female ; Hallucinations ; Humans ; Hypertension, Pulmonary ; Morpholines ; Outpatients ; Prescriptions ; Psychotic Disorders ; Weight Loss