As Alzheimer's disease is the most common cause of dementia in older people, many efforts for accurate and reliable clinical diagnoses have been made all over the world. Generally diagnostic process of Alzheimer's disease is constituted with two steps : 1) to determine whether a patient is actually demented, 2) to determine whether the dementia actually caused by Alzheimer's disease. Newly developed diagnostic criteria, such as diagnostic criteria of the National Institute on Aging-Alzheimer's Association improve their specificity to diagnose Alzheimer's disease. We need Korean specific guideline for diagnosing Alzheimer's disease compatible in Korean clinical situation.
Alzheimer Disease ; Dementia ; Humans ; Sensitivity and Specificity

OBJECTIVES: The present study is to investigate inflammatory markers and associated clinical factors between treatment resistant schizophrenia and non-treatment resistant schizophrenia.METHODS: Of the 116 schizophrenia subjects who were hospitalized for ac ute symptomatic treatment, 19 patients (16%) were treated with clozapine as a treatment resistant schizophrenia(TRS) and 97 patients(84%) were treated with other atypical antipsychotics as a non-treatment resistant schizophrenia(Non-TRS). Various inflammatory markers including C-reactive protein(CRP) and clinical factors were retrospectively evaluated with electrical medical records.RESULTS: There were significant differences between two groups in disease duration(p =0.015), number of admission (p =0.003), Clinical Global Impression(p <0.001) but other demographic and clinical variables including previous antipsychotics use did not show significant differences. In terms of hematologic profiles, TRS group demonstrated higher CRP level(p =0.006), lower neutrophil count(p =0.012), and lower hemoglobin level(p =0.003) compared with non-TRS group. Body mass index was significantly correlated with CRP(r=0.318, p =0.001).CONCLUSION: The elevated level of serum CRP in TRS suggests that treatment resistance in schizophrenia may be associated with inflammatory response. However, retrospective study design and small number of subjects could limit this interpretation.
Antipsychotic Agents ; Body Mass Index ; C-Reactive Protein ; Clozapine ; Humans ; Medical Records ; Neutrophils ; Retrospective Studies ; Schizophrenia

OBJECTIVES: The purpose of this study was to evaluate gender differences with respect to the internalization or externalization of symptoms according to the amount of time spent engaged in extracurricular education. METHODS: The study included a community sample of 755 boys and girls (mean age, 6.6 years), collected from five elementary schools in Gunpo, South Korea. Primary caregivers completed a questionnaire which included information on demographics, the amounts of time children spent in extracurricular education and with other activities, and an adapted form of the Behavior Assessment System for Children (BASC-2). Gender differences regarding externalizing and internalizing behavior problems were examined according to extracurricular education. RESULTS: With respect to the boys, there was a difference in the frequency of those who had externalizing behavior problems according to their time spent in extracurricular education. In contrast, the girls exhibited no difference. With respect to those children who spent a lot of time engaged in extracurricular education, there was a gender-specific difference only with respect to externalizing behavior problems. CONCLUSION: A gender-specific difference exists only in terms of externalizing behavior problems according to time spent engaged in extracurricular education.
Caregivers ; Child ; Demography ; Humans ; Republic of Korea ; Surveys and Questionnaires

Early life stress (ELS) may induce long-lasting psychological complications in adulthood. The protective role of resilience against the development of psychopathology is also important. The purpose of this study was to investigate the relationships among ELS, resilience, depression, anxiety, and aggression in young adults. Four hundred sixty-one army inductees gave written informed consent and participated in this study. We assessed psychopathology using the Korea Military Personality Test, ELS using the Childhood Abuse Experience Scale, and resilience with the resilience scale. Analyses of variance, correlation analyses, and hierarchical multiple linear regression analyses were conducted for statistical analyses. The regression model explained 35.8%, 41.0%, and 23.3% of the total variance in the depression, anxiety, and aggression indices, respectively. We can find that even though ELS experience is positively associated with depression, anxiety, and aggression, resilience may have significant attenuating effect against the ELS effect on severity of these psychopathologies. Emotion regulation showed the most beneficial effect among resilience factors on reducing severity of psychopathologies. To improve mental health for young adults, ELS assessment and resilience enhancement program should be considered.
Adaptation, Psychological ; Adolescent ; Age Distribution ; Aggression/*psychology ; Anxiety/epidemiology/psychology ; Comorbidity ; Humans ; Male ; Military Personnel/*psychology/*statistics & numerical data ; Prevalence ; Republic of Korea/epidemiology ; *Resilience, Psychological ; Risk Factors ; Stress, Psychological/*epidemiology/*psychology ; Young Adult

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder showing many neuropsychological deficits. Many environmental risk factors have been thought to increase the risk for the disorder. We examined blood iron levels in children with ADHD and a control group to find an association between iron deficit and diagnosis, neuropsychological characteristics and clinical features. METHODS: An ADHD group (n=50) and control group (n=45) of children 6-12 years of age were recruited. Both groups were diagnosed by semi-structured interview, and they were evaluated using the Korean version of the ADHD Rating Scale (K-ARS), Korean version of IOWA Conner's Rating Scale (K-IOWA), intelligence quotient (IQ), and neurocognitive function tests (continuous performance test, children's color trails test, Stroop color-word test). Iron levels in blood were determined using the inductively coupled plasma mass spectrometry instrument. Independent t-test and correlation were used to determine the relation of blood iron levels with symptom ratings and neurocognitive function. Logistic regression was performed to determine the diagnostic value of blood iron levels. RESULTS: Blood iron levels were significantly lower in ADHD than in control and showed negative correlation with K-ARS and K-IOWA scores. Blood iron levels showed positive association with IQ and Stroop color-word test results and negative association with results of continuous performance testing. Low blood iron levels predicted the diagnosis of ADHD. CONCLUSION: Lower levels of blood iron were associated with ADHD symptom severity, IQ, and frontal lobe-mediated neurocognitive function. As blood iron levels may influence ADHD, measurement of iron levels in blood may be useful for evaluation of symptoms and neurocognitive function in ADHD.
Child* ; Diagnosis ; Humans ; Intelligence ; Iowa ; Iron* ; Logistic Models ; Mass Spectrometry ; Plasma ; Risk Factors

Objective: Neuropsychiatric symptoms are common among patients with major neurocognitive disorder. Antipsychotic medica-tions have been widely used to manage behavioral and psychological symptoms of dementia (BPSD), however efficacy and safety of these agents are conflicting. In this study, we tried to overview the association of antipsychotic medication use and neuropsychi-atric symptoms with cognitive decline in patients with Alzheimer’s disease. Methods: We reviewed the medical charts of patients who were diagnosed as major neurocognitive disorder due to Alzheimer’s disease from November 2014 to October 2015. We reviewed whether the subjects had used antipsychotics, and whether patients had neuropsychiatric symptoms. We used linear mixed models to examine the statistical difference between each group. Results: Total of 106 subjects were included in the study. There was no statistically significant difference in cognitive function decline (Korean Version of Mini-Mental State Examination score change) between subjects with or without BPSD (p=0.62), and between subjects with or without antipsychotic medication (p=0.09). Conclusion There was no evidence that antipsychotic medication and BPSD are associated with more cognitive decline. Findings imply that neuropsychiatric symptoms and cognitive impairment come from different etiologic causes, which highlights the heterogeneity of the disorder. Clinician should decide whether to use antipsychotic medication while carefully considering the effect and side effects of antipsychotic medication throughout the treatment period.

Objective: This study aimed (1) to identify distinct subgroups of psychiatric patients referred for a mental health certificate for military service suitability and (2) to determine whether there is a difference in clinical features such as treatment responsiveness and prognosis among certain subgroups. Methods: We conducted latent profile analysis (LPA) using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical profiles of the participants. Linear mixed model analysis was performed to examine changes in the severity of clinical symptoms and functional level according to the treatment period of the latent classes derived from the LPA. Results: The results indicated that the best-fitting model was a three-class model, comprising Class 1 (mild maladjustment), Class 2 (neurotic depression and anxiety), and Class 3 (highly vulnerable and hypervigilant). We demonstrated that the three subgroups displayed different characteristics in treatment responsiveness and clinical course based on their Clinical Global Impression-Severity and Global Assessment of Functioning scores over a treatment period of 6 months. While subjects in Classes 1 and 2 significantly improved over 6 months, those in Class 3 showed little or no improvement in our clinical parameters. Conclusion This study has yielded data with clinical implications for treatment planning and interventions for each subgroup classified that were based on MMPI-2 clinical profiles of military recruits who might be maladjusted to serve.

OBJECTIVES: Patient insight is a very important factor in the management of schizophrenia. Manic symptoms can occasionally be identified by the patient, even in cases of schizophrenia. The aim of this study is to examine the relationship among patient insight, the psychotic and manic symptoms, and the demographic clinical variables.METHODS: Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities were evaluated according to the Korean version of the Scale to assess Unawareness of Mental Disorder (SUMD-K), the Korean version of Mood Disorder Questionnaire (K-MDQ), and the Brief Psychiatric Rating Scale (BPRS).RESULTS: The mean number of previous admissions was 3.85. The mean CGI-S score was 3.8 and a significant negative correlation (r=0.26) was shown with “awareness of mental disorder”. Thirty-five percent of subjects were K-MDQ positive (cutoff point=7 or more). Among the SUMD-K, “awareness of effect of medication” showed a significant negative correlation (r=−0.33) with the total K-MDQ score, but not with the total BPRS score. The negative correlation was more obvious in participants with negative K-MDQ (total K-MDQ score 6 or less, r=−0.31).CONCLUSION: A possible relationship was observed between these manic symptoms and patient insight. Identification of manic symptoms in schizophrenia would be considerable in a clinical setting.
Brief Psychiatric Rating Scale ; Female ; Humans ; Mental Disorders ; Mental Health ; Mood Disorders ; Schizophrenia

PURPOSE: The aim of this study is to examine the risk factors of cognitive impairment in elderly hip fracture patients with no underlying neurologic disease, and to determine its effect on functional recovery postoperatively. MATERIALS AND METHODS: From August 2012 to August 2013, 39 patients older than 65 years of age, who underwent hip fracture surgery and were followed-up for a minimum of 1 year at Hallym University Sacred Heart Hospital, were enrolled. All patients were assessed using Korean version of Mini-Mental State Examination (MMSE-K) after admission. All patients were divided into cognitive normal group (MMSE-K> or =24) and cognitive impairment group (MMSE-K<24). WOMAC (Western Ontario and McMaster University) score and Harris hip score were used for assessment of functional recovery at 6-month follow-up. RESULTS: Sixteen patients (41.0%) were classified as the cognitive impairment group. The number of underlying diseases was the only statistically different factor between the two groups. In the evaluation of functional outcome, the functional decline was less in the cognitive normal group. Risk factors for cognitive impairment in elderly hip fracture patients were old age, high body mass index, and the number of underlying diseases, particularly an endocrinologic disease like diabetes. CONCLUSION: Cognitive impairment in elderly patients may have a negative effect on functional recovery after hip fracture surgery. Therefore, we recommend routine evaluation of cognitive function in elderly hip fracture patients even with no underlying neurologic disease.
Aged ; Body Mass Index ; Follow-Up Studies ; Heart ; Hip Fractures ; Hip* ; Humans ; Ontario ; Risk Factors*

OBJECTIVE: It is not easy to diagnose bipolar disorders accurately in the clinical setting. Although Korean version of the Mood Disorder Questionnaire (K-MDQ) is easily administered, it still has weakness regarding case finding. In this study, we suggest a new weighted version of the K-MDQ to increase its screening power. METHODS: Ninety-five patients with bipolar disorders and 346 controls (patients with schizophrenia, patients with depressive disorders, patients with anxiety disorders, and subjects without any psychiatric disease) were enrolled in this study. The subjects received brief information on the K-MDQ, and then independently completed the questionnaire. RESULTS: Using odds ratios, we constructed a new weighted K-MDQ (W-K-MDQ). Item 1 (feel so good or hyper) was weighted 7 times and item 4 (less sleep) 3.5 times. Item 7 (easily distracted) and item 11 (more interested in sex) were excluded. Part 2 (simultaneity) and 3 (functional impairment) were also excluded as in the original K-MDQ. The sensitivity of the W-K-MDQ with a cutoff value of 10 was enhanced to 0.789. The area under the receiver operating characteristic curve was increased to 0.837. CONCLUSION: We suggested a new formula for K-MDQ using 11 of its items. The W-K-MDQ can be easily applied with good sensitivity to screen for bipolar disorders in clinical settings in Korea. Further evaluations with larger samples are needed to establish the usefulness of the W-K-MDQ.
Anxiety Disorders ; Bipolar Disorder ; Depressive Disorder ; Diagnosis, Differential ; Humans ; Korea ; Mass Screening* ; Mood Disorders* ; Odds Ratio ; ROC Curve ; Schizophrenia