We report a case of atypical neuroleptic malignant syndrome (NMS) induced by olanzapine. It was expected that this atypical agent would not cause dystonia or NMS due to its unique mechanism of action with attenuated anti-dopamin-ergic activity and potentiated antiserotonergic activity, as well as other anti-cholinergic activity. We report the case of a 74-year-old male patient with Alzheimer's disease in whom signs and symptoms consistent with NMS developed following 2 weeks of olanzapine therapy. The patient presented with fever, changes in mental status, tremor, and rigidity. His laboratory findings were significant for increased serum creatine phosphokinase. The NMS subsided after treatment and the restart of olanzapine therapy was performed successfully. There have been few reported cases of olanzapine-induced NMS. Health care providers should be aware of the risk of olanzapine-induced NMS.
Aged ; Alzheimer Disease ; Creatine Kinase ; Dystonia ; Fever ; Health Personnel ; Humans ; Male ; Neuroleptic Malignant Syndrome ; Tremor

Infantile fibrosarcoma is a rare malignant soft tissue tumor occurring especially in newborn and young children under 2 years. We experienced three cases of infantile fibrosarcoma presenting in the neonatal period. Case 1 presented with a multiseptated cystic mass on his left thigh at birth that was diagnosed as lymphangioma. After picibanil injection, we noted the size of the mass doubled and a solid lesion was prominent in the magnetic resonance image. Case 2 was found to have a reddish mass on his lower back mimicking hemangioma. Over 2 weeks, the mass grew rapidly with internal hemorrhaging. Case 3 was noted to have an encircling mass around the splenic flexure, which developed into congenital bowel obstruction. All of the tumors were resected completely, but microscopic resection margin was not clear in two patients. The two patients received adjuvant chemotherapy and all patients are well without evidence of recurrence.
Chemotherapy, Adjuvant ; Child ; Colon, Transverse ; Fibrosarcoma ; Hemangioma ; Humans ; Infant, Newborn ; Lymphangioma ; Magnetic Resonance Spectroscopy ; Parturition ; Picibanil ; Recurrence ; Thigh

OBJECTIVES: Oriental medicine has affected the way in which Koreans seek psychiatric help and how they understand psychiatric symptoms and mental illnesses. In this study, we investigated the concept of psychosis in traditional oriental medicine and compared it with how modern western medicine understands the same concept. METHODS: We searched for descriptions of psychotic symptoms or illnesses in traditional medical documents of various periods. Four psychiatrists then analyzed the contents of these descriptions in terms of DSM-IV. RESULTS: The concept of psychosis in oriental medicine has two symptom domains: positive and negative symptoms, which are similar to the positive and negative symptoms of schizophrenia in modern psychiatry. However, there were differences in the basic concepts of disease entities and in the approaches to the illness. CONCLUSION: This descriptive study showed that, in oriental medicine, psychopathology is based on oriental philosophy, and that this creates wide differences between oriental and western medicine.
Medicine, East Asian Traditional ; Medicine, Traditional ; Philosophy ; Psychiatry ; Psychopathology ; Psychotic Disorders ; Schizophrenia

No abstract available.

Eleven cases of arthroscopic ankle arthrodesis were reviewed. Average age of patients was 59 years, 4 male and 7 female. Underlying diseases were osteoarthritis in 7 cases, rheumatoid arthritis in 3 cases and one post-traumatic arthritis. At the mean follow up of 15 months, fusion rate was 100%, mean time to complete union was 9.5 weeks. There were no complications such as nonunion, infection and skin problems. All patients stayed at the hospital just overnight after the surgery. Patients satisfaction was high and the functional clinical grade was excellent in 9 patients, good in 1 patient and fair in 1 patient. We concluded that arthroscopic technique was a simple and effective method for ankle arthrodesis in the selected patients and had significant advantages over the open technique.
Ankle* ; Arthritis ; Arthritis, Rheumatoid ; Arthrodesis* ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Osteoarthritis ; Skin

Since the first report by Berberich and Hirsch in 1923, conventional angiography had been playing essential roles in diagnosis and treatment in the field of Orthopedic Surgery. Angiography is still the most definitive method for evaluating arterial disease, and is also an invaluable aid in the diagnosis of certain abnormalities which characteristically alter the normal vascular pattern. But the clinical use of conventional angiography as a routine diagnostic study has been limited by the risk associated with arterial catheterization cost, and poor patient acceptance. With improvement of radionuclide angiography and development of the methods for the identification and amplification of signals from small quantities of intravascular administered iodinated contrast agent and their combination with image subtraction (so called digital subtraction angiography, DSA), we have partially substituted the DSA and Radionuclide angiography for conventional angiography in diagnosis and post-operative evaluation of orthopedic patients. We have analyzed and compared the 197 cases who had taken conventional angiography from August, 1981 to July, 1985, and 16 cases who had taken radionuclide angiography from January, 1983 to July, 1985, and 21 cases who had taken DSA from October, 1983 to July, 1985 in Department of Orthopedic Surgery, Seoul National University Hospital. The results were as follow: 1. Conventional angiography is the most reliable and most widely used method in diagnosis of peri pheral arterial disease and evaluating the distribution of peripheral circulation of patient who need arterial reconstruction. But the clinical use of the angiography has been limited by the risk of complications. 2. DSA is simple, relatively non-invasive and can be done in out-patient basis. DSA is particulary useful and can replace the conventional angiography in post-operative assessment of peripheral vascular reconstruction, in the assessment of blunt and penetrating peripheral arterial trauma, and in the evaluation of peripheral aneurysm and vascular malformation. 3. Radionuclide angiography is also simple, and has no morbidity and useful in the patients who may be allergic to the contrast medium. Radionuclide angiography is useful in the evaluation of obstruction of major artery, deep vein thrombosis, and in repeated post-operative evaluation of arterial reconstruction.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Catheterization ; Catheters ; Diagnosis ; Extremities ; Humans ; Methods ; Orthopedics ; Outpatients ; Radionuclide Angiography ; Seoul ; Vascular Malformations ; Venous Thrombosis

OBJECTIVES: Apathy Evaluation Scale (AES) is one of the most frequently used scales to evaluate apathy. The purpose of this study was to evaluate the reliability and validity of the Korean version of the AES (K-AES) and to apply the K-AES in examining the characteristics of apathy in the Korean patients with schizophrenia. METHODS: 129 healthy people and 29 patients with schizophrenia have been evaluated using the K-AES, Physical Anhedonia Scale (PAS), Social Anhedonia Scale (SAS), and the Beck's Depression Inventory (BDI). Split-half reliability and internal consistency were evaluated and factor analysis and correlation analysis was conducted. Between-group comparison was conducted using independent sample t-tests. RESULTS: K-AES showed good reliability and validity. Factor analysis confirmed 3 factors, which represented interest and drive, initiative, self-awareness and self-assessment. Patients with schizophrenia showed significantly higher K-AES and BDI scores than the healthy group. K-AES scores in patients with schizophrenia were significantly correlated with the PAS score, but did not correlate with SAS and BDI scores. CONCLUSION: This study demonstrates the reliability and validity of the K-AES. Our findings also suggest that the K-AES may be a reliable instrument in assessing apathy as a negative symptom in patients with schizophrenia.
Anhedonia ; Apathy* ; Depression ; Factor Analysis, Statistical ; Humans ; Reproducibility of Results* ; Schizophrenia* ; Self-Assessment ; Weights and Measures

Alzheimer's disease (AD) is associated with cognitive and functional impairment as well as neuropsychiatric complications, including psychotic symptoms such as delusions and hallucinations. Recent studies strongly suggest that delusions should be separated from hallucinations. While AD with delusions is a phenotypically distinct from AD without delusions, subtypes of delusions may also define further distinct clinical entities. There has been also considerable debate as to whether delusions in patients with AD differ etiologically, phenomenologically, and therapeutically from delusions in other primary psychiatric illnesses. In other words, whether they are caused by changes to key areas of the brain that have been linked to the presence of delusions. This has led to speculation that these symptoms may respond better to certain drugs such as cholinesterase inhibitors. Integrating the epidemiology, clinical phenomenology, neuropathological and genetic literature for delusions in AD allows us to speculate on pathophysiology and is essential to making progress in the area of delusions in AD.
Alzheimer Disease* ; Brain ; Cholinesterase Inhibitors ; Delusions* ; Epidemiology ; Hallucinations ; Humans

Wandering is acknowledged as one of the most complex, challenging, and potentially dangerous dementia-related behaviors, and can result in elopement, injury, and even death. For the healthy people, walking is a common and a pleasurable leisure activity. However, wandering in dementia may be an exhausting behavior for caregivers and raise safety concerns. The term 'wandering' covers different types of behavior, including aimless movement without a discernible purpose. Although with respect to the etiology of wandering, biological, psychosocial and person-environment interaction has been suggested, the etiology of wandering is poorly understood. Although it is possible that management of coexistent psychopathology would help to ameliorate this problematic behavior, evidence on the effectiveness of pharmacological and non-pharmacological interventions is limited.
Caregivers ; Dementia* ; Humans ; Leisure Activities ; Psychopathology ; Walking

The nature of late-onset psychosis in the absence of a dementia or secondary to organic dysfunctions in the fifth decade of life and beyond is contentious and unresolved. Different terminologies, diagnostic criteria and age cut-offs have been applied to late-onset psychosis, which have stymied clinicians and researchers. No official diagnostic designation for patients with late-onset psychosis is included in the current psychiatric diagnostic system (Diagnostic and Statistical Manual of Mental Disorders-V, International Classification of Diseases-10). The validity of this diagnostic exclusion has been questioned. Despite these problems, a relatively consistent clinical picture has reported. However, many questions remain regarding the underlying etiology, pathophysiological mechanisms, treatment and prognosis. Whether late-onset psychosis is distinct from schizophrenia and whether it might be a harbinger of dementia are unclear. Recent studies have suggested an underlying biological pathophysiology of late-onset psychosis.
Classification ; Dementia ; Humans ; Prognosis ; Psychotic Disorders* ; Schizophrenia