OBJECTIVE: Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide. METHODS: We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients' severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed. RESULTS: Many factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation. CONCLUSION: Psychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.
Axis, Cervical Vertebra ; Emergency Service, Hospital ; Female ; Humans ; Mental Competency ; Risk Assessment* ; Risk Factors* ; Social Isolation ; Suicide* ; Suicide, Attempted

Many studies have reported spontaneous spinal epidural hematoma (SSEH). Although most cases are idiopathic, several are associated with thrombolytic therapy or anticoagulants. We report a case of SSEH coincident with acute myocardial infarction (AMI), which caused serious neurological deficits. A 56 year old man presented with chest pain accompanied with back and neck pain, which was regarded as an atypical symptom of AMI. He was treated with nitroglycerin, aspirin, low molecular weight heparin, and clopidogrel. A spinal magnetic resonance image taken after paraplegia developed 3 days after the initial symptoms revealed an epidural hematoma at the cervical and thoracolumbar spine. Despite emergent decompressive surgery, paraplegia has not improved 7 months after surgery. A SSEH should be considered when patients complain of abrupt, strong, and non-traumatic back and neck pain, particularly if they have no spinal pain history.
Anticoagulants ; Aspirin ; Chest Pain ; Hematoma ; Hematoma, Epidural, Spinal ; Heparin, Low-Molecular-Weight ; Humans ; Magnetic Resonance Spectroscopy ; Myocardial Infarction ; Neck Pain ; Nitroglycerin ; Paraplegia ; Spine ; Thrombolytic Therapy ; Ticlopidine

Overactive bladder (OAB) is defined as urgency, usually with frequency and nocturia, and with or without urge incontinence. Duloxetine, an antidepressant that inhibits reuptake of serotonin and norepinephrine, is indicated for the treatment of stress urinary incontinence in Europe. In this paper, we present a case of a 17-year-old female patient with OAB and depressive symptoms who was successfully treated with duloxetine. This case suggests duloxetine can be an option for patient with OAB, and it also highlights the need for further studies of duloxetine's use in the treatment of OAB.
Adolescent* ; Depression ; Europe ; Female* ; Humans ; Nocturia ; Norepinephrine ; Serotonin ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urinary Incontinence, Urge ; Duloxetine Hydrochloride

The present study aimed to examine the psychometric properties of the Korean version of Stanford Acute Stress Reaction Questionnaire (SASRQ). A Korean version of the SASRQ was produced through forward translation, reconciliation, and back translation. A total of 100 healthy, non-clinical participants were selected through screening and clinical interview, and they each were given a set of questionnaires including SASRQ. Psychometric properties of SASRQ were then examined through statistical analyses. Full-scale and subscales of SASRQ yielded excellent internal consistency (Cronbach's alpha=0.98 and 0.78-0.95, respectively). Test-retest reliability at 2-week intervals was satisfactory, with coefficient r ranging between 0.47 and 0.71. Convergent validity was also demonstrated by strong correlations between SASRQ and other trauma-related questionnaires. Correlation with Social Desirability Scale, however, was not found to be significant; thus evidenced divergent validity. The Korean version of SASRQ appears to be a reliable and valid measurement tool for assessing symptoms of acute stress disorder. Including clinical samples for comparison with controls would be necessary in future studies.
Adult ; Disability Evaluation ; Female ; Humans ; Male ; Psychometrics/*statistics & numerical data ; Questionnaires ; Reproducibility of Results ; Republic of Korea ; Stress Disorders, Post-Traumatic/*diagnosis ; Stress Disorders, Traumatic, Acute/*diagnosis

OBJECTIVE: Despite numerous atypical antipsychotics (AAP) available, many patients with schizophrenia still experience lack of efficacy and persistent side-effects. Switching from one AAP to another with a different side-effect profile has become a common clinical strategy. We aimed to investigate effect of switching to amisulpride in patients who showed suboptimal effect and/or tolerability to current antipsychotics treatment. METHODS: This was a 6-week, prospective, multicenter, open-label, flexible-dose study in patients with schizophrenia. Switching to amisulpride was achieved using cross-titration within 7 days (day 1: 300 mg on day 1 then flexibly dosed 400–800 mg/day). The primary end-point measure was proportion of patients achieving improvement in clinical benefit at week 6 based on Clinical Global Impressions-Clinical Benefit (CGI-CB). Secondary endpoints included change in scores in CGI-CB, CGI-Severity (CGI-S), Subjective Satisfaction Scores (SSS), Brief Psychiatric Rating Scale (BPRS), and Simpson and Angus Rating Scale. RESULTS: Among 37 patients switched to amisulpride, 76% completed study and 56.8% had clinical benefit measure by CGI-CB. CGI-CB and CGI-S scores showed significant improvement at week 6 compared to baseline (mean changes of CGI-CB and CGI-S scores: −1.7+1.0, p<0.0001 and −0.6±0.0, p=0.001, respectively). SSS scores also improved significantly (mean change: 2.1±2.6, p<0.0001). Mean weight of patients significantly lowered compared to baseline (mean change: −1.2±2.0, p<0.0001). CONCLUSION: Patients with schizophrenia who showed suboptimal efficacy or tolerability with their current antipsychotics and thereby switched to amisulpride resulted in clinical benefit in terms of both improved efficacy and tolerability. The small sample size limits generalizability of the study results.
Antipsychotic Agents* ; Brief Psychiatric Rating Scale ; Humans ; Prospective Studies ; Sample Size ; Schizophrenia

OBJECTIVES: The aim of this study was to investigate the effect of resilience on depression and life satisfaction in patients with end-stage renal disease (ESRD) on Hemodialysis. METHODS: Fifty ESRD patients, aged 18 or older, on hemodialysis visiting the hemodialysis room at Catholic University of Korea, Uijeongbu St. Mary's Hospital were included in this study. All patients were divided into two groups based on a Mini International Neuropsychiatric Interview : ESRD patients with major depressive disorder (MDD), and ESRD patients without MDD. The 17-item Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale were used for assessment of the severity of depression symptoms. The Conner-Davidson Resilience Scale (CD-RISC) and Index of Well-being were used for measurement of resilience and life satisfaction, respectively. RESULTS: Sixteen (32%) patients were included in the MDD group, and 34 (68%) patients were included in the non-MDD group. The MDD group had significantly lower CD-RISC (p<0.005) and Index of well-being scores (p<0.005). The CD-RISC score showed a significant negative correlation with HAM-D-17 (r=-0.36, p<0.05) score and a positive correlation with Index of well-being score (r=0.37, p<0.01). Multiple regression analysis showed a significant relation of CD-RISC score with HAM-D-17 (beta=-0.36, p<0.05) and well-being score (beta=-0.56, p<0.005). CONCLUSION: Results of this study suggest that ESRD patients with higher resilience might be less depressed and have higher life satisfaction. Therefore, identification of clinical approaches that could increase resilience of ESRD patients might be important to prevention of depression and enhancement of life quality in ESRD patients on hemodialysis.
Aged ; Depression ; Depressive Disorder, Major ; Humans ; Kidney Failure, Chronic ; Korea ; Quality of Life ; Renal Dialysis

Nicotinamide at millimolar concentrations affects cell survival in various conditions, and is being utilized therapeutically in many human diseases. However, the effect of an acute treatment of nicotinamide at such high dose on gene expression and cellular metabolism has rarely been determined previously. In this study, we found that levels of O-N-acetylglucosamin(O- GlcNAc)ylated proteins including Sp1 acutely decreased upon treatment of 10 mM nicotinamide. Concomitantly, Sp1 protein level decreased rapidly through accelerated proteasome-mediated proteolysis. Cotreatment of glucosamine or 2-deoxyglucose, which inhibits protein deGlcNAcylation, effectively blocked the decrease induced by nicotinamide. Interestingly, the decline in the levels of Sp1 and protein O- GlcNAcylation was only transient lasting for two days post treatment, and this pattern matched closely the rapid fluctuation of the cellular [NAD(+)]. Our results suggest a possible link between cellular nicotinamide metabolism and protein O-GlcNAcylation, and an existence of cellular [NAD(+)] homeostasis.
Acetylglucosamine/*metabolism ; Blotting, Western ; Dose-Response Relationship, Drug ; Down-Regulation/*drug effects ; Humans ; Hydrolysis ; Niacinamide/*pharmacology ; Reverse Transcriptase Polymerase Chain Reaction ; Sp1 Transcription Factor/metabolism

PURPOSE: External beam radiotherapy (EBRT) is a useful option to treat head and neck skin cancer patients who are not indicated for surgery. In this study, we evaluated the treatment outcomes of EBRT in an Asian population.MATERIALS AND METHODS: The records from 19 head and neck skin cancer patients (10 with squamous cell carcinoma and 9 with basal cell carcinoma) who were treated with definitive or adjuvant EBRT from 2009 to 2017 were retrospectively reviewed. The radiotherapy doses administered ranged from 50 to 66 Gy (median, 55 Gy) with 2.0–2.75 Gy per daily fraction (median, 2.5 Gy). The T stage at presentation was as follows: Tis (1 patient), T1 (11 patients), T2 (6 patients), and T3 (1 patient). None had regional lymph node disease or distant metastasis at presentation. The local failure-free survival (LFFS) rates, toxicity, and cosmetic results were analyzed.RESULTS: The median age was 75.5 years (range, 52.6 to 92.5 years). The median follow-up duration from the completion of radiotherapy was 44.9 months (range, 5.8 to 82.6 months). One local failure occurred in a patient with a 2.1-cm posterior neck squamous cell carcinoma at 32.5 months after radiotherapy (1/19, 5.3%). The 3-year LFFS rate was 91.7%. No patients died from skin cancer during follow-up, and no grade 3 complications occurred. The cosmetic outcomes were excellent for 16 (84.2%) and good for 3 (15.8%) of the 19 patients.CONCLUSION: EBRT offers good local control and cosmetic outcomes in patients with head and neck skin cancer, with no grade 3 complications.
Asian Continental Ancestry Group ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Head ; Humans ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Skin Neoplasms ; Skin ; Treatment Outcome

Purpose: The purpose of this study was to evaluate the effect of attachments and palatal coverage on stress distribution in maxillary implant overdenture using finite element analysis. Materials and Methods: Four maxillary overdenture 3-D models with four implants placed in the anterior region were fabricated with computer-aided design. 1) Ball-F: Non-splinted ball attachment and full palatal coverage, 2) Ball-P: Non-splinted ball attachment and U-shaped partial palatal coverage, 3) Bar-F: Splinted milled bar attachment and full palatal coverage, 4) Bar-P: Splinted milled bar attachment and U-shaped partial palatal coverage. Stress distribution analysis was performed with ANSYS workbench 14. 100 N vertical load was applied at the right first molar unilaterally and maximum stress was calculated at the implant, peri-implant bone and mucosa. Results: The use of the ball attachment showed lower maximum stress on implant and peri-implant bone than the use of the milled bar attachment. But it showed contrary tendency in the mucosa. Regardless of attachment, full palatal coverage showed lower maximum stress on implant, peri-implant bone and mucosa. Conclusion Within the limitation of this study, ball attachment improved stress distribution on implant and periimplant bone rather than milled bar attachment in maxillary implant overdenture. Also, full palatal coverage is more favorable in stress distribution.

OBJECTIVE: The present study aimed to investigate predictors for planned suicide attempters. METHODS: This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared. RESULTS: Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs. CONCLUSION: The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.
Depression ; Depressive Disorder, Major ; Divorce ; Emergency Service, Hospital ; Hope ; Humans ; Impulsive Behavior ; Mass Screening ; Psychopathology ; Risk Factors* ; Substance-Related Disorders ; Suicidal Ideation ; Suicide* ; Suicide, Attempted ; Widowhood