Restless legs syndrome (RLS) is a common sensorimotor disorder that is characterized by an urge to move the legs and peculiar, unpleasant sensations deep in the legs and its prevalence in the general population is between 3.2% and 15%. RLS significantly impairs patients' lives, often by severely disrupting sleep. However, both clinicians and patients under-recognize the RLS. RLS phenotypes include an idiopathic form and secondary form that is usually resulted from various causative conditions. The pathophysiology of RLS may be related with the dopaminergic system, which is closely linked to a number of psychotropic medications, including antidepressant and antipsychotics. Several antidepressants and antipsychotics have been shown to induce or exacerbate RLS. We need pay attention to the fact that commonly prescribed medications can be the cause of RLS.
Antidepressive Agents ; Antipsychotic Agents ; Humans ; Leg ; Phenotype ; Prevalence ; Restless Legs Syndrome ; Sensation

Acamprosate reduces the craving for alcohol by decreasing glutamate activity and increasing gamma-aminobutyric acid (GABA) action in patients with alcohol dependence. Acamprosate has tolerable side effects that include diarrhea, headache, dizziness and pruritus. In this study, we report acamprosate-induced extrapyramidal symptoms in an elderly patient with no history of neurologic disease. Severe extrapyramidal symptoms developed two days after the administration of acamprosate and improved over one week after the acamprosate was stopped. Extrapyramidal symptoms are commonly associated with dopamine receptor antagonists. However, there have been several reports of extrapyramidal symptoms occurring with drugs targeting other systems, including GABA, glutamate and serotonin. Acamprosate may decrease dopamine levels in the ventral tegmental area mediated by glutamatergic action and thus cause extrapyramidal symptoms. We suggest that acamprosate carries the risk of causing extrapyramidal symptoms.
Aged* ; Alcoholism* ; Diarrhea ; Dizziness ; Dopamine ; Dopamine Antagonists ; gamma-Aminobutyric Acid ; Glutamic Acid ; Headache ; Humans ; Pruritus ; Serotonin ; Ventral Tegmental Area

OBJECTIVES: Breast cancer has been the most prevalent female cancer in South Korea since 2001. Early detection of this disease is the most effective strategy for reducing mortality. The objective of this study was to identify factors which could predict advanced stage at diagnosis of breast cancer. METHODS: Participants who were initially diagnosed with breast cancer and referred to the Stress Clinic of the Breast Cancer Center at Kyungpook National University Hospital were included. Through a semi-structured interview, the authors investigated psychosocial variables such as the extent of marital and family functioning and emotional-economic family burden as well as sociodemographic and health behavior-, health characteristic- and cancer-related variables. RESULTS: Data were collected from 219 participants. One hundred and twenty(54.8%) subjects were diagnosed with advanced-stage breast cancer. Variables that were significantly different between the advanced-stage and early-stage groups included : monthly breast self examination(p<0.000), annual mammographic screening(p< 0.000), mode of tumor detection(p<0.000), nature of the first symptoms(p<0.000), time to treatment after di-agnosis(p<0.000), overloaded economic and family burden(p=0.018), marital functioning(p<0.000) and family functioning(p<0.00). Logistic regression analysis indicated that irregular annual mammography screening(OR=7.431 ; 95% CI 2.407-22.944) or a lack of screening(OR=25.299 ; 95% CI 7.855-81.482) and a dysfunctional marital relationship(OR=4.772 ; 95% CI 2.244-10.145) were significantly associated with advanced stage at diagnosis of breast cancer. CONCLUSIONS: We reconfirmed screening behavior to be a risk factor for delayed diagnosis of breast cancer. Our findings also emphasized the importance of psychosocial factors such as marital functioning in early detection of breast cancer. Psychiatric consultation in the area of martial functioning could be beneficial for increasing early detection in breast cancer.
Breast ; Breast Neoplasms* ; Delayed Diagnosis* ; Diagnosis ; Female ; Gyeongsangbuk-do ; Humans ; Korea ; Logistic Models ; Mammography ; Marriage* ; Mass Screening ; Mortality ; Psychology* ; Risk Factors ; Time-to-Treatment

We successfully treated a 47 year old male patient who developed diabetes twice and later fell in diabetic ketoacidosis and delirium during the 4 years of olanzapine therapy. For the first 3 months of olanzapine medication the patient gained 14kg and developed diabetes mellitus 3 years later in the maintenance of olanzapine. Fortunately his diabetes was improved after switching his medication to risperidone. 2 months later he remedicated olanzapine by chance and got 15 kg of weight gain. In a year he developed diabetes again and was finally transferred to emergency room due to diabetic ketoacidosis. It was thought that olanzapine played a negative role in the course of patient's diabetes, and it was switched to amisulpride. The result was that blood glucose levels began to be well controlled without any antihyperglycemic agents in 30 days after the complete withdrawal of olanzapine. During a year's follow up after discharge, the patient didn't show any aggravation of psychotic symptoms and any signs of diabetes. He kept his body weight 68 kg which was the same weight when he was discharged from the hospital. This case showed clearly how olanzapine affected the onset and the course of diabetes in a schizophrenic patient. Therefore we report this case with a few olanzapine related considerations.
Blood Glucose ; Body Weight ; Delirium ; Diabetes Mellitus ; Diabetic Ketoacidosis* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Hypoglycemic Agents ; Male ; Middle Aged ; Risperidone ; Weight Gain

Long-acting injectable (LAI) antipsychotics are useful in the treatments for schizophrenic patients with poor adherence due to their maintaining feature of therapeutic plasma level without daily administrations. However, their long-lasting property can cause complicated problems such as a long-lasting side effect. We report a patient who experienced LAI-induced extrapyramidal symptoms (EPSs) for 5 months after a single injection. During that period, every trial to ameliorate this condition turned out to be a failure. The 3-month formulation of paliperidone palmitate is now close at hand. We have to be aware of possible long-lasting adverse events and confirm the tolerability to LAI before use.
Antipsychotic Agents ; Hand ; Humans ; Paliperidone Palmitate* ; Plasma ; Schizophrenia

We report an extremely rare case of a patient with hypoxic-ischemic brain injury who recovered consciousness and motor and cognitive functions due to paradoxical response after zolpidem administration. A 32-year-old woman who had attempted suicide by hanging was admitted. The patient had stabilized in a state of drowsy mentality, quadriparesis, dysphagia, and impaired cognition. Brain magnetic resonance imaging was suggestive of hypoxic ischemic brain injury and unilateral infarction in the right posterior cerebral artery territory. Due to sleep disturbance, zolpidem was administered, and paradoxically consciousness level and function returned to near-normal during the duration of the drug-effect. In addition to previous reports, our case characteristically showed remarkable motor and cognitive function recovery, not only consciousness level. The drug-effect time was gradually decreased after 18 months and absent after 3 years. We have reviewed related literature and discussed possible neuropharmacological and neurobiological mechanism.
Adult ; Brain Injuries ; Brain ; Cognition ; Consciousness ; Deglutition Disorders ; Female ; Humans ; Hypoxia-Ischemia, Brain ; Infarction ; Infarction, Posterior Cerebral Artery ; Magnetic Resonance Imaging ; Posterior Cerebral Artery ; Quadriplegia ; Suicide, Attempted

OBJECTIVE: Neuropsychiatric manifestations like depression and cognitive dysfunction commonly occur in inflammatory bowel disease (IBD). In the context of the brain-gut axis model, colitis can lead to alteration of brain function in a bottom-up manner. Here, the changes in the response of the hypothalamic-pituitary-adrenal axis and inflammation-related markers in the brain in colitis were studied. METHODS: Dextran sodium sulfate (DSS) was used to generate a mouse model of colitis. Mice were treated with DSS for 3 or 7 days and sacrificed. We analyzed the gene expression of brain-derived neurotrophic factor (BDNF), cyclo-oxygenase 2 (COX-2), and glial fibrillary acidic protein (GFAP), and the expression of GFAP, in the hippocampus, hypothalamus, and amygdala. Additionally, the levels of C-reactive protein (CRP) and serum cortisol/corticosterone were measured. RESULTS: Alteration of inflammatory-related markers varied depending on the brain region and exposure time. In the hippocampus, COX-2 mRNA, GFAP mRNA, and GFAP expression were upregulated during exposure to DSS. However, in the hypothalamus, COX-2 mRNA was upregulated only 3 days after treatment. In the amygdala, BDNF and COX-2 mRNAs were downregulated. CRP and corticosterone expression increased with DSS treatment at day 7. CONCLUSION: IBD could lead to neuroinflammation in a bottom-up manner, and this effect varied according to brain region. Stress-related hormones and serum inflammatory markers, such as CRP, were upregulated from the third day of DSS treatment. Therefore, early and active intervention is required to prevent psychological and behavioral changes caused by IBD, and region-specific studies can help understand the precise mechanisms by which IBD affects the brain.
Amygdala ; Animals ; Brain* ; Brain-Derived Neurotrophic Factor ; C-Reactive Protein ; Colitis* ; Corticosterone ; Cyclooxygenase 2 ; Depression ; Dextrans* ; Gene Expression ; Glial Fibrillary Acidic Protein ; Hippocampus ; Hypothalamus ; Inflammation* ; Inflammatory Bowel Diseases ; Mice* ; Prostaglandin-Endoperoxide Synthases ; RNA, Messenger ; Sodium*

OBJECTIVES: The purpose of this study is to evaluate the effects of attachment security, social support and health-related burden in the prediction of psychological distress and the mediation effects of social support and health-related burden in relationship between attachment security and psychological distress. METHODS: Finally, 161 patients were included for the analysis. Chi-square test and independent samples t-test were used for comparing differences between depressive/anxious group and non-depressive/non-anxious group. For evaluating the relationship among attachment security, social support, psychological distress and health-related burden, structural equation modeling analysis were performed. RESULTS: 40.7% and 32.0% of the patients have significant depressive symptoms and anxiety symptoms, respectively. In the analysis for testing the differences between groups who have psychological distress and who have not, there were no significant differences of sociodemographic factors and medical characteristics between groups, except for association between depressive symptoms and type of surgery (p = 0.01). Contrary to sociodemographic and medical characteristics, there were significant differences of health-related burden and two coping resources (attachment security and social support) between groups (all p < 0.01), except for the support from medical team in between anxious group and non-anxious group (p = 0.20). In the structural equation model analysis (Model fit : chi-square/df ratio = 0.8, root mean square error of approximation = 0.000, comparative fit index = 1.000, non-normed fit index =0.991), attachment security and social support emerged as an important predictor of psychopathology. CONCLUSIONS: Attachment security and social support are important factors affecting the psychological distress. We suggest that individual attachment style and the social support state must be considered to approach the newly diagnosed breast cancer patients with psychological distress.
Anxiety ; Breast Neoplasms* ; Depression ; Humans ; Negotiating ; Psychopathology ; Social Security

Background: Human immunodeficiency virus (HIV) disclosure provides personal support to people living with HIV/acquired immunodeficiency syndrome (PLWH). In addition, it has important implications for disease prevention and treatment. Research on disclosure has been conducted worldwide; however, data from South Korea are insufficient. The purpose of this study was to examine whether certain demographic, medical, and psychosocial factors act as predictors of HIV serostatus non-disclosure among PLWH in South Korea. Methods: Participants consisted of 147 PLWH who visited the outpatient infection clinic between June 2020 and January 2021. Demographics, medical factors, HIV-related stigma, and depressive and anxiety symptoms were measured. Results: The overall disclosure rate among participants was 61.2%. Logistic regression analysis showed that lower depression (odds ratio [OR], 0.918; P = 0.021) and higher disclosure concerns (OR, 1.133; P = 0.004) were significant predictors of non-disclosure. Further, married state was a major predictor of non-disclosure when single referred (OR, 3.002; P = 0.024); however, divorce, separation, and widowed status had no significant consequences. Conclusion In South Korea, the rate of HIV disclosure is lower than in other countries.The higher disclosure concerns, lower depression and married state were suggested to be important predictors of HIV non-disclosure. High level of perceived stigma and experienced discrimination of PLWH may have affected the results. The social atmosphere linking sexual promiscuity and disease may also have influenced these results. Nationwide efforts should continue to reduce the overall stigma and create a social environment where PLWH can feel safe to disclose their disease conditions.

Objective: The introduction of psychotherapy in palliative and end-of-life care settings has become increasingly common and is effective in decreasing many psychological problems. This review reports the characteristics and effectiveness of individual psychotherapeutic interventions for patients receiving palliative and end-of-life care. In addition, the review reports the effectiveness of psychotherapies considering the expected life expectancy. Methods: The PubMed, Google Scholar, and Cochrane Library databases were searched for English-language articles published between January 2000 to May 2023. Results: Twenty-six studies were included and classified into a total of nine types of psychotherapies, namely, dignity therapy (DT), life review therapy, narrative therapy, managing cancer and living meaningfully (CALM), individual meaning-centered psychotherapy, meaning and purpose therapy, meaning-making therapy, meaning-of-life therapy, and cognitive therapy. Conclusion Most of the psychotherapies provided to patients receiving palliative and end-of-life care showed effectiveness in the reduction of negative emotions and positive factors related to end-of-life issues. Most studies targeted patients with advanced cancer; however, studies on DT did not limit the target group to patients with cancer. Considering the expected life expectancy, CALM was found to be suitable for patients receiving early palliative care.