OBJECTIVES: Patients with poor insight are commonly observed among schizophrenics and they show poor drug compliance and prognosis. This study aimed at examining the characteristics of psychopathology in patients with schizophrenia who have no insight. Understanding the features of inner psychopathology in schizophrenic patients with poor insight, we assumed, could lead to insight-promoting clues. METHODS: The subjects consisted of 69 patients with schizophrenia diagnosed by DSM-IV criteria. For identifying insight level in the patients, Scale to Assess Unawareness of Mental Disorder(SUMD) was applied. After subjects were divided into two groups depending upon insight level, psychopathological differences were evaluated by Kyung Hee-Frankfruter Beschwerde Fragebogen(K-FBF), which was known as one of the subjective psychological tests for the schizophrenics. RESULTS: There was no significant differences in demographic variables, duration of illness, and dose of medication between two groups. However, significantly high rate of involuntary admission and tendency of high frequency of admission were revealed in schizophrenic patients with poor insight. And, also poor insight group showed significantly high scores in the factors of sensorimotor disorder(subscales of psychomotor disorder, perceptual disorder and blocking symptoms included) and in language-cognitive disorder factor(subscales of language disorder and cognitive floating included) compared with patients who have insight. CONCLUSION: We was assumed that lack of insight in schizophrenics could include one of the symptoms based on neuropsychological or neurobiological abnormalities in brain. Moreover, it was revealed that patients with poor insight evaluated themselves as having more serious psychopathologies than patients who had insight. It has been already known that schizophrenic patients who lack in insight are reluctant to taking psychiatric care and lack in awareness of their illness. However, this study suggests that their inner psychopathology associated with insight can be understood with the use of subjective psychological test, i.e. K-FBF. For understanding the schizophrenic patients who lack in insight, not only checking the insight but also applying the subjective test such as K-FBF seems to be helpful.
Brain ; Compliance ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Language Disorders ; Perceptual Disorders ; Prognosis ; Psychological Tests ; Psychopathology* ; Schizophrenia

OBJECT: Although there is extensive research. on treatment of acute unipolar depression, few studies examined the treatment of acute bipolar depression. This preliminary study was designed to suggest clinical guideline for treatment of bipolar depression through comparing the pharmacological treatment of bipolar depression with that of unipolar depression. METHOD: We studied 19 patients with bipolar depression and 38 patients with unipolar depression, who were admitted to Kyung Hee University Medical Crater from January 1990 to December 1997. The pattern of treatment and the response to treatment of bipolar depression were investigated compared with unipolar depression. RESULTS: The percentage of prescription in bipolar depression was as follows in order : combination of mood stabilizer and an antidepressant 52.6%, mood stabilizers 15.8%, ECT 15.8%, TCAs 5.3%, SSRIs 5.3%, RIMA 5.3%. In unipolar depression : TCAs 47.4%, SSRIs 28.9%, combination of mood stabilizer and an antidepressant 10.5%, others 13.2%. There was no significant difference in response to treatment in bipolar depression and unipolar depression. CONCLUSIONS: These results suggest a mood stabilizer and an antidepressant together or a mood stabilizer alone would be first line in bipolar depression. Among the antidepressants, bupropion, RIMA and SSRls is more recommended in that order rather than TCAs in consideration of the risk of switching into mania.
Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Depressive Disorder ; Drug Therapy* ; Humans ; Prescriptions

Authors experienced aspiration pneumonia during clozapine therapy in a 31 year-old woman patient with treatment-resistant schizophrenia. Development of aspiration pneumonia appeared to be related with side effects of clozapine including sedation, sialorrhea, and esophageal dysfunction. Each side effect seems to be mild, however it can cause fatal problems such as aspiration pneumonia if they appear simultaneously.
Adult ; Clozapine* ; Female ; Humans ; Pneumonia, Aspiration* ; Schizophrenia ; Sialorrhea

Leflunomide is a new disease modifying anti rheumatic drug (DMARD) for the treatment of active rheumatoid arthritis. Its mechanism of action differs from other DMARDs in that it inhibits the de novo pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase and therefore prevents the proliferation of activated lymphocytes. As it has been prescribed worldwide, there is a great deal of much concerns regarding its potential adverse effects. Because leflunomide has an active metabolite with a long elimination half life of approximately 2 weeks, serious adverse reactions may occur even after the leflunomide treatment has been stopped. The profile of serious reactions includes liver dysfunction, hematological disorders, severe skin reactions and respiratory dysfunction. Respiratory dysfunctions with leflunomide therapy are very rare and its incidence is lower than that of methotrexate therapy. However, there are reports in Japan showing that 5 patients died of interstitial pneumonitis and another 11 patients developed serious lung complications associated with leflunomide. This suggests the possibility of fatal respiratory toxicity of leflunomide. There are no reports of interstitial pneumonitis associated with leflunomide in Korea. We report a case of a 62-year old woman who developed interstitial pneumonitis, which might have been induced by leflunomide during the treatment of rheumatoid arthritis.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Female ; Half-Life ; Humans ; Incidence ; Japan ; Korea ; Liver Diseases ; Lung ; Lung Diseases, Interstitial* ; Lymphocytes ; Methotrexate ; Middle Aged ; Oxidoreductases ; Skin

BACKGROUND: Atopy and bronchial hyperresponsiveness (BHR) which are characteristics of asthma, are strongly correlated but independently inherited traits. The relative contribution of maternal and paternal condition to the risk of offspring's condition is not certain. OBJECTIVE: The aim of this study was to evaluate maternal or paternal contribution to childhood atopy and BHR in a population-based sample of 140 Korean nuclear families. SUBJECTS AND METHODS: A total of 486 subjects (133 mothers, 132 fathers and 221 offsprings) participated in this study. All subjects provided questionnaire data and 483 subjects underwent allergy skin prick test with 13 inhalant allergens. Total serum IgE levels were determined in 444 subjects and methacholine bronchial provocation test were performed in 483 subjects. RESULTS: Serum total IgE level in the offspring was correlated with both maternal and paternal total IgE (mother: R=0.273, p<0.01; father: R=0.200, p<0.01). Bronchial hyperres ponsiveness was associated with parental atopy index (mother: R=0.175, p<0.01; father: R=0.205, p<0.01) and maternal BHR(R=0.201, p<0.01). The development of wheezing in the offspring was significantly associated with maternal BHR, but not paternal. CONCLUSION: These results suggest that maternal BHR does confer more risk than paternal BHR to risk of offspring's BHR.
Allergens ; Asthma ; Bronchial Provocation Tests ; Fathers ; Humans ; Hypersensitivity ; Immunoglobulin E ; Methacholine Chloride ; Mothers ; Nuclear Family ; Parents* ; Respiratory Sounds ; Skin ; Surveys and Questionnaires

Chemical pneumonitis is caused by the inhalation of noxious chemical substances and is a cause of occupational lung disease. Nitric acid, which is a one of the common air pollutants and a potential oxidant for refining and cleansing of metals, has a chance for occupational and environmental exposure. A 52-year-old man visited our hospital due to coughing and dyspnea after the inhalation of nitric acid fumes at his workplace. He had conditions of tachypnea (respiratory rate 26 /min) and hypoxemia (PaO2 42.6 mmHg, SaO2 80.2% in room air) in our emergency department. The chest radiographs showed diffuse interstitial infiltrates and ground glass opacity in both lungs. The patient made improvements in clinical symptoms and chest radiography after being given a supply of oxygen, antibiotics, and bronchodilator therapy without systemic glucocorticoid therapy. On his follow up visit after 4 weeks, he showed no symptoms and sequelae, and the pulmonary function test showed a normal pulmonary function.
Air Pollutants ; Anoxia ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Emergency Service, Hospital ; Environmental Exposure ; Follow-Up Studies ; Glass ; Humans ; Inhalation* ; Lung ; Lung Diseases ; Metals ; Middle Aged ; Nitric Acid* ; Oxygen ; Pneumonia* ; Radiography ; Radiography, Thoracic ; Respiratory Function Tests ; Tachypnea ; Thorax

The bronchial varices in mitral stenosis are uncommon and incidentally discovered during bronchoscopy. Although bronchial varices are primarily associated with bronchial or pulmonary disease, the bronchial vein can be dilated with increased pulmonary venous pressure secondary to mitral stenosis. The bronchial varices may present massive hemoptysis. The hemoptysis can be controlled by mitral commissurotomy or mitral valve replacement in case of mitral stenosis. We report a case of bronchial varies in a patient with severe mitral stenosis. The bronchial varices were found incidentally during bronchoscopy and they were nearly disappeared by mitral valve replacement.
Bronchoscopy ; Hemoptysis ; Humans ; Lung Diseases ; Mitral Valve ; Mitral Valve Stenosis* ; Varicose Veins* ; Veins ; Venous Pressure

BACKGROUND: Wheezing is an important clue in the diagnosis of asthma. Previously, a Korean National asthma survey used a written questionnaire, containing the question, "Have you ever experienced a breathing sound-like 'sack-sack' or a flute sound (the Korean description for wheezing) during the last 12 months?" The response to this question showed a large discrepancy between the prevalence of wheezing and physician diagnosed asthma. This might have resulted partly from a misunderstanding of the question, due to an inadequate description for wheezing. This study was aimed at finding how well the layman understands the term "wheezing" when described as a breathing sound-like 'sack-sack', a whistle or a flute. SUBJECTS AND METHOD: Sixty subjects, without experience of wheezing(group I), and 45 subjects, with chronic cough alleging wheezing(groupII), were recruited from the Hallym University's Sacred Heart Hospital, in Anyang, Korea. Four different breathing sounds; vesicular, wheezing, tracheobronchial and crackle, were played for the subjects, without any experience with wheezing, and they were asked "which sound is most like that you would imagine when asked about a breathing sound-like 'sack-sack', a whistle or a flute?" This was followed by replaying the true wheezing sound, and then a global assessment was requested for the concordance between the real wheezing sound and the imagined wheezing sound. The wheezing sound was played for those subjects alleging wheezing, and they were asked, "have you really experienced that sound". RESULTS: Only 46.7% of group I answered correctly, with 13.3% choosing the vesicular sound, 16.7% the tracheobronchial sound, 5.0% the crackle and 18.3% failed to answer. The concordance between their imagined wheezing and the real sound was 69.3+/- 22.4%(mean+/-S.D.). 77.8% of groupII recognized the correct sound as the one they had experienced. CONCLUSIONS: Language is not sufficient to the layman for describing natural sounds, such as wheezing.
Asthma ; Cough ; Diagnosis ; Gyeonggi-do ; Heart ; Korea ; Prevalence ; Surveys and Questionnaires ; Respiration* ; Respiratory Sounds* ; Singing*

Pulmonary gangrene is a rare and severe complication of bacterial pneumonia, where a pulmonary segment or lobe is sloughed due to parenchymal devitalization of the parenchyma, with secondary anaerobic infection and necrosis caused by pulmonary vascular thrombosis. Prior to the antibiotic era, massive pulmonary gangrene was potentially fatal. Herein, a case of pulmonary gangrene in a 67-year-old man is reported. He complained of fever, chills, dyspnea and purulent sputum of 5 days duration. The plain chest radiograph showed well-marginated right upper lobe consolidation, with bulging minor fissure, suggestive of a Klebsiella infection. A contrast CT scan demonstrated consolidation of the right upper lobe, with a central necrotizing portion. Klebsiella species was confirmed from both sputum and blood cultures. After appropriate antibiotics, the chest X-ray and CT scan 3 weeks later showed a large cavity with an air-fluid level, sloughing-off and extrusion of necrotic lung tissue, suggestive of pulmonary gangrene. Seven months later, the right gangrenous lung showed severe volume loss on a chest radiograph. The management of pulmonary gangrene has been somewhat controversial. Herein, it was managed without surgical drainage or resection. If the antibiotic therapy had failed, then a surgical approach would have been considered.
Aged ; Anti-Bacterial Agents ; Chills ; Drainage ; Dyspnea ; Fever ; Gangrene* ; Humans ; Klebsiella Infections ; Klebsiella* ; Lung ; Necrosis ; Pneumonia* ; Pneumonia, Bacterial ; Radiography, Thoracic ; Sputum ; Thorax ; Thrombosis ; Tomography, X-Ray Computed

BACKGROUND: The prevalence of asthma has been increasing due to changes in lifestyles. OBJECTIVE: The aim of this study was to evaluate the prevalence of asthma and atopy for an interval of three years in children living in rural areas of Cheju island. METHODS: A total of 1,055 and 755 subjects aged 7-15 years in South Cheju County were enrolled for an interval of three years, respectively. They responded to the modified ISAAC questionnaire, and underwent allergy skin prick test with locally common aeroallergens and methacholine bronchial provocation test. Children who had asthma symptom as reported on the questionnaire and bronchial hyperresponsiveness to methacholine were diagnosed as current asthma. Atopy was defined as the positive skin responses to one or more aeroallergens. RESULTS: The prevalence of current asthma had increased from 4.4% to 7.0% during the three years, especially among children aged 13 to 15 years (3.9% vs. 7.6%), although the asthma prevalence was similar between the two intervals among children aged 7 to 12 years (5.2% vs. 6.8%). The atopy rate had significantly increased from 37.7% to 45.9% during the three years. As for common sensitizing aeroallergens, sensitization rate to citrus red mite had significantly increased among both the young and the old age groups. The sensitization rates to house dust mites, such as D. pteronyssinus and D. farinae, had increased among the old age groups, but not among the young age groups, although the sensitization rates to cockroach and Japanese cedar pollen were similar among both the young and old age groups at the two intervals. CONCLUSION: The prevalence of current asthma and atopy had increased among children living in rural areas of Cheju island during the three year interval. The sensitization to house dust mite and citrus red mite had increased during the three years, and may play an important role in the increased prevalence of current asthma.
Asthma* ; Bronchial Provocation Tests ; Child* ; Citrus ; Cockroaches ; Cryptomeria ; Epidemiology ; Humans ; Hypersensitivity ; Jeju-do* ; Life Style ; Methacholine Chloride ; Mites ; Pollen ; Prevalence* ; Pyroglyphidae ; Skin ; Surveys and Questionnaires