Bipolar disorder is one of the most distinct syndromes in psychiatry. Bipolar I disorder affects approximately 1 percent of the population worldwide. About 50 percent of patients with bipolar illness have a family history of the disorder. Studies of twins suggest that the concordance rate of bipolar illness is between 40 percent and 80 percent in monozygotic twins. Although researchers have proposed myriad subtypes of depression, there are two major subtypes of disorder according to DSM-IV-TR: bipolar I and bipolar II. Bipolar I disorder is diagnosed on the basis of a single lifetime manic or mixed episode. Indeed, in one follow-up survey of tertiary care patients, depressive symptoms were more than three times as frequent as manic symptoms. Antidepressant monotherapy in an undiagnosed bipolar disorder patient can have devastating effects. So, clinical evaluation of a patient presenting with depression should always include the assessment for bipolar disorder. In addition to major episodes, it is important to pay attention to the course of subsyndromal and prodromal symptoms. Treatment options for bipolar disorder have rapidly expanded over the last decade. The literature supports the efficacy of a list of agents for the management of bipolar disorder, including lithium, valproate, lamotrigine, and carbamazepine, as well as the atypical antipsychotics olnazapine, risperidone, quetiapine, ziprasidone, and aripiprazole.
Antipsychotic Agents ; Aripiprazole ; Bipolar Disorder* ; Carbamazepine ; Depression ; Follow-Up Studies ; Humans ; Lithium ; Quetiapine Fumarate ; Prodromal Symptoms ; Risperidone ; Tertiary Healthcare ; Twins, Monozygotic ; Valproic Acid

Vascular dementia is a very frequent form of dementia. Debates over classification and diagnostic criteria, and controversy over identifiable treatment targets will continue until distinct pathophysiological mechanism of vascular dementia is found. Clinical diagnostic criteria are sufficiently strong to be useful for clinical trials, but need further refinement. Cognitive changes in vascular dementia are more variable than other disorders, and are dependent on the vascular pathology. Accurate diagnosis of vascular dementia is known to need the presence of reliable cerebrovascular disease on brain imaging. Although it seems obvious that cerebrovascular disease causes pathological damage and impaired cognition, it is very difficult to find the accurate contribution of cerebrovascular pathology to cognitive decline. Most studies have shown a small but significant benefit of cholinesterase inhibitors on cognition, the significance of this effect has been slight and benefits on global functioning, activities of daily living, and behaviour have not been consistently reported. Management of vascular dementia should focus on identifying and managing vascular risk factors.
Activities of Daily Living ; Cerebrovascular Disorders ; Cholinesterase Inhibitors ; Classification ; Cognition ; Dementia ; Dementia, Vascular* ; Diagnosis ; Neuroimaging ; Pathology ; Risk Factors

OBJECTIVE: This study was aimed to investigate the effectiveness of cognitive training to Instrumental Activities of Daily Living (IADL) in community-dwelling elderly. METHODS: The participant were 786 elders who were aged over 59 years visiting local rest area from February 2015 to November 2015. The demographic data was collected. IADL were evaluated by Seoul-Instrumental Activities of Daily Living (S-IADL). Cognitive functions were evaluated by Korean Version of Mini Mental Status Examination for Dementia Screening (MMSE-DS). Before and after cognitive training, we analysed these data. RESULTS: In all 15 items of S-IADL, 4 items (using the telephone, grooming, managing belongings, talking recent events) were specially improved (p<0.05). CONCLUSION: After cognitive training, indoor activities of S-IADL were improved but some items, especially outside activities were not improved for community dwelling elderly. In future, other programs to increase outside activities or social activities should be included in cognitive training programs for community dwelling elderly.
Activities of Daily Living* ; Aged* ; Animals ; Cognition ; Dementia ; Education ; Grooming ; Humans ; Independent Living ; Mass Screening ; Telephone

OBJECTIVES: This study was aimed to investigate the efficacy of cognitive training in community-dwelling elderly, and to support mental health care system for the elderly. METHODS: We investigated 1,994 and aged over 65 years elderly visiting senior center from April 2014 to July 2014. Their demographic data was investigated. Cognitive functions were evaluated by Korean Version of Mini Mental Status Examination for Dementia Screening (MMSE-DS) and Global Deterioration Scale. Quality of life was evaluated by Korean Quality of Life-Alzheimer's Disease (KQoL-AD) and depression by Short Korean Form of Geriatric Depression Scale. Before and after cognitive training, we analysed these data. RESULTS: MMSE-DS, KQoL-AD were significantly higher in score after the cogintive training than before of that (p<0.001). SGDS-K were significantly lower in score after the cognitive training than before of that (p<0.001). CONCLUSION: Cognitive training resulted in improvement in cognitive functions, quality of life and depression for communitydwelling elderly. These results suggest that future mental health care policy has to consider the importance of community-dwelling elderly.
Aged* ; Dementia ; Depression ; Humans ; Mass Screening ; Mental Health ; Quality of Life ; Senior Centers

OBJECTIVE: This study aims to investigate the efficacy of 48-sessioned cognitive stimulation programs (CSP) in solitary elderlies with mild cognitive impairment (MCI) and dementia. METHODS: Among 194 subjects, 125 were CSP participants and 69 were controls. Korean version of Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Global Deterioration Scale, Seoul-Instrumental Activities of Daily Living (S-IADL) and Korean version of Geriatric Depression Scale-Short Form, Korean Quality of Life-Alzheimer's Disease (KQoL-AD) were assessed. Outcomes were measured at baseline and after 48th session. we analyzed these collected data. RESULTS: In CSP group, MMSE-DS (p<0.001), KQoL-AD (p=0.021) were significantly improved compared with their baseline. MMSE-DS was significantly improved in CSP group compared with controls, but KQoL-AD was not (p=0.078). Relative risk (RR) of MCI and dementia in CSP group was 0.491 [95% confidential interval (CI)=0.380-0.633] and that of activities of daily living (ADL) impairment (S-IADL>8) was 0.873 (95% CI=0.773-0.985). CONCLUSION: CSP improved cognition and quality of life in solitary elderly individuals with MCI or dementia. Also, CSP reduced relative risk of MCI and dementia by 50.8% and ADL impairment by 12.7%. Although we expect CSP might be helpful to prevent cognitive problems of them, appropriate public mental health programs are still needed for their emotional wellbeing.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Cognition ; Dementia* ; Depression ; Humans ; Mass Screening ; Mental Health ; Mild Cognitive Impairment* ; Quality of Life

BACKGROUND/AIMS: Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea. METHODS: We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals. RESULTS: Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%–94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios. CONCLUSIONS: The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea.
Colonoscopy ; Colorectal Neoplasms ; Endoscopy ; Korea ; Quality Improvement ; Surveys and Questionnaires

OBJECTIVES: This study aimed to investigate the risk factors affecting suicidal ideation in community dwelling elderly individuals and to predict suicidal ideation through assessment tools.METHODS: We investigated 2,343 elderly individuals, aged 65 years or older, from February 2018 to December 2018. The participants were asked to complete sociodemographic questionnaires, including the Mini-Mental Status Examination for Dementia Screening(MMSE-DS), Short Geriatric Depression Scale(SGDS-K), Geriatric Anxiety Inventory(GAI), Athens Insomnia Scale(AIS), and Scales for Suicidal Ideation(SSI). We performed the Chi-squared test and logistic regression analysis for these data, to examine the relationship between suicidal ideation and the participants' risk factors. Moreover, we performed Receiver Operating Characteristics(ROC) curve analysis, to predict suicidal ideation through the assessment tools.RESULTS: The prevalence of suicidal ideation was 6.0%. Binary logistic regression revealed that cognitive impairment (OR=1.729, CI : 1.029–2.904), depression(OR=3.479, CI : 2.177–5.560), anxiety(OR=3.822, CI : 2.454–5.951), and sleeping disorders(OR=1.661, CI : 1.132–2.438) were independently associated with suicidal ideation. The cutoffs to predict suicidal ideation, obtained using ROC analysis were ≤21[area under the curve(AUC) : 0.582] for the MMSE-DS, >6(AUC : 0.822) for SGDS, >3(AUC : 0.817) for GAI, and >8(AUC : 0.718) for AIS.CONCLUSION: The incidence of suicidal ideation in the community dwelling elderly was quite high and was particularly related with depression and anxiety. These results could contribute to prevention and management of suicide among community dwelling elderly individuals.
Aged ; Anxiety ; Cognition Disorders ; Dementia ; Depression ; Humans ; Incidence ; Independent Living ; Logistic Models ; Prevalence ; Risk Assessment ; Risk Factors ; ROC Curve ; Sleep Initiation and Maintenance Disorders ; Suicidal Ideation ; Suicide ; Weights and Measures

Dementia ; Humans ; Weights and Measures

Objectives: ：The purpose of this study was to identify suicide risk factors among elderly residents in Gyeongsangbuk-do and to reveal the relationships between them. In addition, the differences in suicide risk factors were analyzed between the cognitively impaired group and the cognitively normal group. Methods: ：We investigated 20,127 elderly over 65 years of age, from January 2019 to December 2019. Participants were asked to complete a questionnaire survey. Cognitive function, depression, anxiety, sleep disturbance, and suicidal ideation data were assessed using a Korean version of the Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Short Geriatric Depression Scale for Korean version (S-GDS), Geriatric Anxiety Inventory (GAI), Athens Insomnia Scale (AIS), and Scale for Suicidal Ideation (SSI). Data were analyzed using the chi-squared test and logistic regression analysis to examine suicide risk factors and the relationships between them. Furthermore, differences in suicide risk factors according to cognitive function were examined. Results: ：Age, cognitive function, depression, anxiety, and sleep disturbance were identified as suicide risk factors among elderly residents in Gyeongsangbuk-do. Depression was the factor that increased risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, and 65-74 years of age. In addition, depression increased risk of suicide by 1.86 times in the cognitively impaired group. Conclusions ：Among elderly residents in Gyeongsangbuk-do, depression was the factor that contributed the highest risk for suicide. More active prevention and treatment measures for depressive symptoms should be implemented in the cognitively impaired group.

Objectives: The purpose of this study is to analyze the prevalence and factors of depression among the elderly population, a significant issue in Korea’s aging society. We aim to provide basic indicators for improving mental health and quality of life. Methods: From February to December 2021, a study was conducted on a population of 19,158 elderly individuals aged 65 and above residing in Gyeongsangbuk-do province. The severity of depression was evaluated using the Korean version of the Patient Health Questionnaire (PHQ)-9. In addition, demographic information was collected to analyze factors that may influence depression. Results: In the PHQ-9 screening, the average score was 3.65. The results showed that 13,705 individuals (71.5%) were in the normal group with scores ranging from 0 to 4, 3,683 individuals (19.2%) were in the mild group with scores ranging from 5 to 9, 1,575 individuals (8.2%) were in the moderate group with scores ranging from 10 to 19, and 195 individuals (1.0%) were in the severe group with scores of 20 or higher. It was found that place of residence, education level, type of housing, top two difficulties in daily life, subjective economic status, desired services, subjective mental health, past and current history of mental health treatment, and medication for physical illness had statistically significant effects on depression. Conclusions Various factors were found to have a significant impact on depression among the elderly population in Gyeongsangbuk-do. Proactive prevention and treatment tailored to the population characteristics of the region may be necessary.